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The real reason American health care is so expensive - YouTube
Channel: Vox
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I cannot tell you how obsessed I am with this chart.
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It shows exactly what is wrong with America's
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conversation about health care.
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On one level, you've seen this chart before.
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It shows health care spending as a share
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of the economy of a bunch of countries.
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There's Germany and France and Japan and Canada
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and oh! There's America.
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But now I want to add something you haven't
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seen to this chart.
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This is how much of that spending in each country
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is private and how much is public.
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Here's what's amazing:
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America's government spending on health care
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on programs like Medicaid and Medicare and the VA -
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our versions of socialized medicine.
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It's about the same size as these other countries.
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These countries where the government runs
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the whole health care system!
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And then there's our private spending.
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It's the private insurance system that makes
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health care in America so expensive.
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Conventional wisdom says that the government is
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more expensive than the private sector.
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"It can't say no. It's corrupt, it's inefficient, it's slow."
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"If you want something done right
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you give it to the private sector."
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That is what we hear in America all the time.
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And yet here we are with the biggest
private sector spending the most.
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If you look at the data on physician visits
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and hospital discharges, you can get rid of one theory.
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Americans don't consume more health care
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than people in these other countries.
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We don't go to the doctor more than the Germans
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or the Japanese. In fact we go to the doctor less.
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The difference between us and them
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is that we pay more.
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Every time we go to the doctor for everything
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from an angioplasty to a hip replacement
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from a c-section
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to a pain reliever.
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In America, the price for the same procedure
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at the same hospital, it varies enormously
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depending on who is footing the bill.
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The price for someone with public insurance
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like Medicare or Medicaid is often the lowest price.
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These groups he covers so many people
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that the government can demand lower
prices from hospitals and doctors
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and they get those lower prices.
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If the doctors and hospitals say 'No'
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they lose a ton of business.
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They lose all those people on Medicare
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all those people on Medicaid.
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But there are hundreds of private insurance companies
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And they each cover far fewer people than
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a Medicare or a Medicaid.
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And each one has to negotiate prices
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and hospitals and doctors are on their own.
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And if you're uninsured, you have even less leverage.
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Nobody is negotiating on your behalf.
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So you end up paying the highest price.
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One study found that most hospitals charge uninsured
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patients four times
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as much as Medicare patients for an ER visit.
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Other countries, they don't have this problem.
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Instead of every private insurance company
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negotiating with every healthcare provider.
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There's just this big list.
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The country, the central government, they go
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and they say, "If you want to sell to us, to all
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of our people, then here's what you can charge
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for a checkup. Here is what you can charge for an MRI
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or a prescription for Lipitor.
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And so then whether that bill goes to the
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heavily regulated private insurance
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companies in Germany or directly to the government
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like in the UK.
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Each country is telling the doctor or hospital
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or drug company how much that bill will be.
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And because the government controls access
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to all of the customers. It's an offer that hospitals
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and doctors and pharmaceutical companies
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typically can't refuse.
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"I'm going to make him an offer he can't refuse."
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In America the idea is that you'll be a consumer.
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That you'll do what you do when you go to
Best Buy and buy a television.
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But that just doesn't work in healthcare.
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It doesn't work in healthcare because
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you often come and get health care when you're
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unconscious, in an ambulance,
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when you're scared,
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when it's for your spouse or your child
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It is a time when you have the least bargaining power.
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You are not usually capable of saying, 'No.'
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You're not knowledgeable enough to do it,
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you're not comfortable doing it,
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or you're not conscious enough to do it.
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That's why in other countries the government is a
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person who can say 'No' for you.
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You can say, 'No, that's too expensive
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you're going to have to lower your price'
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because they do have that power.
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Anchor: A new push for single-payer health care
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right here in the US.
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Demonstrator: What do we want?
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Crowd: Single-payer!
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Demonstrator: When do we want it?
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Crowd: Now!
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Anchor: California and others are saying maybe
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we should adopt the European model.
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Klein: If we decided to create a single-payer system
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with one of these huge price lists in the US
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There would be nothing to stop
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lobbying from hospitals from doctors from
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drug companies. And those prices would get influenced.
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So we could end up with a single-payer system
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that is expensive. Even as expensive as
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our current system.
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It all depends on how much you negotiate down
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the prices and now in America
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these groups have so much power
because they are so rich.
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That it's really hard to get them to bring down the prices.
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This is the irony of American healthcare:
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It's so expensive that it's become
hard to make it cheaper.
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All that money they make, that becomes political power.
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And years and years and years of overpaying -
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those are huge industries now.
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And they have a lot of influence in Congress.
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Under a single-payer system
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if we did drive prices down, doctors and hospitals
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they would be paid less than they are right now.
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That might mean some of them close
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or some go out of business or some move.
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It would be really painful. One person's waste
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is another person's essential service or local hospital
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or their income. But then single-payer
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it's not an all-or-nothing choice.
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For instance, there's a really interesting section
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of Bernie Sanders Medicare-for-all bill.
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Where he lays out this interim plan.
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It's a plan he wants while he's setting up
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his new single-payer system.
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And in that plan, he expands Medicare
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to cover vision and dental.
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And he opens it to nearly everyone.
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Not just people 65 and older.
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All kids go on Medicare automatically
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and most adults can buy in.
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That plan, on its own, it wouldn't get American
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health care spending far down overnight.
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But it would at least begin to recognize
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what we already know
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and what most other countries already do:
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That health care is one of those things the government
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can do cheaper and better than the private sector.
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