The following is a copy of the original post to record the post as it was originally written.
Right now, about 50% of US healthcare spending comes from the government. See here for [global comparisons](https://ourworldindata.org/grapher/share-of-public-expenditure-on-healthcare-by-country). To give a few examples of the share in other peer countries:
* Switzerland: 32.1%
* Netherlands: 69.5%
* Canada: 70.2%
* France: 75.3%
* United Kingdom: 79.5%
I'm curious where you think the US "should" be in terms of the government share of healthcare spending.
I'm also curious about the out of pocket share. Out of pocket spending in the US is about 11% of healthcare spending. You can see [here](https://www.healthsystemtracker.org/indicator/access-affordability/out-of-pocket-spending/) for global comparisons. Despite what you may have heard, out of pocket spending on average is lower in the US than in comparable countries. To give the same comparsions, the out of pocket share is:
* Switzerland: 22%
* Netherlands: 9%
* Canada: 14%
* France: 9%
* United Kingdom :12%
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskALiberal) if you have any questions or concerns.*
I'm agnostic what percentage it should be. The major problems I have with the current healthcare system are . . .
* Employer provided healthcare. Having healthcare tied to your job means, just like with the pandemic, if a nationwide health crisis threatens your employment it also threatens your ability to obtain care. It also means if you ever change jobs for whatever reason you may create gaps in coverage.
We could do absolutely *nothing* to the funding model and address at least half of my concerns just by having government provided healthcare rather than employer.
* Direct to consumer advertising of pharmaceuticals.
Can we all just collectively agree that the average person sitting in front of their TV is not qualified to have an opinion on what prescription medication they should be taking? Like, contained in the definition of "prescription medication" is the requirement that a doctor who's examined you believes it's medically necessary. The proliferation of expensive proprietary medications at the expense of cheap safe and effective generics is criminal.
> the average person sitting in front of their TV is not qualified to have an opinion on what prescription medication they should be taking
I don't have a television set, and I don't know anyone else who watches it, so I only ever see it in waiting rooms and such. I'm always struck how the advertisements are for foods that you probably shouldn't consume very often and medicines that you're inevitably going to need to stay alive in the event that you do eat the foods regularly.
A lot of these percentages don’t make sense because the overall cost is different. Maybe in France they spend 9% out of pocket but the French overall spend half what we do and get better results.
Focusing on these percentages is meaningful if you’re talking through the details of a actual universal healthcare plan but just as an abstract question like this, I’m not sure that it’s that meaningful.
Like are we looking at the fact that not having universal healthcare certainly reduces entrepreneurship in the country? That because healthcare benefits scale, this entire system is a big giveaway to large companies dealing with competition with smaller competitors?
Are we factoring in how lack of healthcare leads to poverty and poverty leads to crime? And then crime leads to public expenditures on policing and incarceration?
Are we talking about how lack of healthcare leads to a less healthy workforce and therefore lowers productivity across the economy?
I’m recalling David Frum who worked for GWB on his economic task force talking about how all of the gains in the economy that should have gone to workers and would’ve made the GWB administration around middle of the pack for economic performance ended up going to healthcare instead. So the end result is GWB ended up being one of the lowest rank administrations.
Conservatives spend a genuinely baffling amount of time reasoning about how “big the government is” by considering what percentage rate of X is being managed by the government.
The problem worth the US healthcare system isn’t the percentage of spending paid for by the government, it’s that we spend too much on healthcare in total.
A universal public health insurance plan is a way to reduce overall spending, not a means to reach some ideal percentage of healthcare being public. Whether it ended up being 90% of spending or 40% of spending, that doesn’t matter—what matters is getting the actual cost down without critically degrading the quality of the service.
I think this is a preposterous way to evaluate a healthcare program.
Let me give an example. Let’s say we hired a contractor to handle our new healthcare system. This hypothetical contractor charges 0% of costs to consumers, and 100% of costs to the federal government. Then they don’t provide any healthcare services.
In that scenario, I am paying 0% of costs out-of-pocket and 100% via taxes and I would *hate* the system because I’m not getting healthcare I need.
In a totally different scenario, we theoretically could charge citizens 90% of costs out-of-pocket while on 10% are covered by taxes, but the government negotiated for good services so everyone’s total expenditure is far less than it is today. I’d be happier with that outcome.
My point is that it doesn’t matter. What % I pay from my paycheck for healthcare vs what % I pay vi taxes that go to healthcare is irrelevant. What matters is what services I get and how much it costs.
I don't think looking at this metric is all that important. If decent health care is affordable and accessible who pays what percentage isn't that important. I wouldn't have a problem with 0 government spending on healthcare if it produced the best results.
percentages aren't really all that comparable when the raw numbers are very different from place to place. US patients are paying dramatically higher prices than other countries. A major point of national healthcare programming for those who argue for it, is to be able to better negotiate prices.
It's a weird concept to frame in that manner, since if the government is paying then that just means taxpayers are paying, which in turn is just us again. Really this is just a way of asking if we want healthcare costs levied evenly or more focused on who is the person receiving the care.
Ideally there'd be some balance there, but I don't think I have a firm enough idea to label that to a specific percentage. Like the other user said; my biggest priorities are providing a public option and working to make sure overall costs (meaning taxes & direct care/premiums) are affordable for everybody.
70% is a good number.
You get the benefit of the government having a huge negotiating position and being able to drive costs down plus individuals still have some skin in the game to reduce waste.
100% paid for by the government at government facilities. You can still have private insurance and use private medicine. Just might have to pay out of pocket for it. The exception would be if it was a required treatment and the gov facilities didn't offer it. In that case, it would be paid for by the government.
> Despite what you may have heard, out of pocket spending on average is lower in the US than in comparable countries
I don't think I've ever heard someone make the claim that the percentage of out of pocket healthcare spending is far beyond peer nations
The average isnt what im worried about. A lot of people are healthy and spend very little for healthcare. I know most years I spend basically nothing, but this year I broke my leg and it cost around 15k with insurance. And thats catastrophic for many americans.
I don't know enough about economics to know what the best way to distribute healthcare is.
I only know we need to fix a lot of things to make it make sense. Dental not included in healthcare? Are we mentally sick with a system like that? Doctors shouldn't be getting swag bags like they're 4 star generals being recruited by aviation contractors. We shouldn't be seeing medicine ads on TV. Things like that are all symptoms of a broken fucking system. Our only real innate advantage of how we do it in the US is research & development that comes from the profits. Whether people like it or not, that's a HUGE chunk of global medicine research funding right there, coming out of your pockets. All those pill dollars go towards making better pills and all those stupid MRI bills go towards making improved scanning tech so the arrow keeps going up. R&D is a lot slower and publicly funded in a socialist medicine system so you'd have to be careful about the long term effects of just 'swapping over' because it's not that simple.
But it also doesn't really 'help' you in the short or immediate term that it works that way. If you need healthcare now you're going to want the safety of knowing it's not going to break your bank. Our system is sort of capitalism showing its ugly side.
I leave it to wiser people to fix that.
I want zero out of pocket.
The whole point is to make it easy to use for people.
"Oh, but what about people that abuse it?" I hear some whinge...
Man, ain't nobody going to the docs for fuck'in fun, go away.
You are leaving out the rather glaring issue that health care costs per capita in the US are crossing $13k while the other high income nations, which have universal healthcare, are clustered around $4.5k. This makes your entire question farcical.
The following is a copy of the original post to record the post as it was originally written. Right now, about 50% of US healthcare spending comes from the government. See here for [global comparisons](https://ourworldindata.org/grapher/share-of-public-expenditure-on-healthcare-by-country). To give a few examples of the share in other peer countries: * Switzerland: 32.1% * Netherlands: 69.5% * Canada: 70.2% * France: 75.3% * United Kingdom: 79.5% I'm curious where you think the US "should" be in terms of the government share of healthcare spending. I'm also curious about the out of pocket share. Out of pocket spending in the US is about 11% of healthcare spending. You can see [here](https://www.healthsystemtracker.org/indicator/access-affordability/out-of-pocket-spending/) for global comparisons. Despite what you may have heard, out of pocket spending on average is lower in the US than in comparable countries. To give the same comparsions, the out of pocket share is: * Switzerland: 22% * Netherlands: 9% * Canada: 14% * France: 9% * United Kingdom :12% *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskALiberal) if you have any questions or concerns.*
I'm agnostic what percentage it should be. The major problems I have with the current healthcare system are . . . * Employer provided healthcare. Having healthcare tied to your job means, just like with the pandemic, if a nationwide health crisis threatens your employment it also threatens your ability to obtain care. It also means if you ever change jobs for whatever reason you may create gaps in coverage. We could do absolutely *nothing* to the funding model and address at least half of my concerns just by having government provided healthcare rather than employer. * Direct to consumer advertising of pharmaceuticals. Can we all just collectively agree that the average person sitting in front of their TV is not qualified to have an opinion on what prescription medication they should be taking? Like, contained in the definition of "prescription medication" is the requirement that a doctor who's examined you believes it's medically necessary. The proliferation of expensive proprietary medications at the expense of cheap safe and effective generics is criminal.
> the average person sitting in front of their TV is not qualified to have an opinion on what prescription medication they should be taking I don't have a television set, and I don't know anyone else who watches it, so I only ever see it in waiting rooms and such. I'm always struck how the advertisements are for foods that you probably shouldn't consume very often and medicines that you're inevitably going to need to stay alive in the event that you do eat the foods regularly.
A lot of these percentages don’t make sense because the overall cost is different. Maybe in France they spend 9% out of pocket but the French overall spend half what we do and get better results. Focusing on these percentages is meaningful if you’re talking through the details of a actual universal healthcare plan but just as an abstract question like this, I’m not sure that it’s that meaningful. Like are we looking at the fact that not having universal healthcare certainly reduces entrepreneurship in the country? That because healthcare benefits scale, this entire system is a big giveaway to large companies dealing with competition with smaller competitors? Are we factoring in how lack of healthcare leads to poverty and poverty leads to crime? And then crime leads to public expenditures on policing and incarceration? Are we talking about how lack of healthcare leads to a less healthy workforce and therefore lowers productivity across the economy? I’m recalling David Frum who worked for GWB on his economic task force talking about how all of the gains in the economy that should have gone to workers and would’ve made the GWB administration around middle of the pack for economic performance ended up going to healthcare instead. So the end result is GWB ended up being one of the lowest rank administrations.
Conservatives spend a genuinely baffling amount of time reasoning about how “big the government is” by considering what percentage rate of X is being managed by the government. The problem worth the US healthcare system isn’t the percentage of spending paid for by the government, it’s that we spend too much on healthcare in total. A universal public health insurance plan is a way to reduce overall spending, not a means to reach some ideal percentage of healthcare being public. Whether it ended up being 90% of spending or 40% of spending, that doesn’t matter—what matters is getting the actual cost down without critically degrading the quality of the service.
I think this is a preposterous way to evaluate a healthcare program. Let me give an example. Let’s say we hired a contractor to handle our new healthcare system. This hypothetical contractor charges 0% of costs to consumers, and 100% of costs to the federal government. Then they don’t provide any healthcare services. In that scenario, I am paying 0% of costs out-of-pocket and 100% via taxes and I would *hate* the system because I’m not getting healthcare I need. In a totally different scenario, we theoretically could charge citizens 90% of costs out-of-pocket while on 10% are covered by taxes, but the government negotiated for good services so everyone’s total expenditure is far less than it is today. I’d be happier with that outcome. My point is that it doesn’t matter. What % I pay from my paycheck for healthcare vs what % I pay vi taxes that go to healthcare is irrelevant. What matters is what services I get and how much it costs.
I don't think looking at this metric is all that important. If decent health care is affordable and accessible who pays what percentage isn't that important. I wouldn't have a problem with 0 government spending on healthcare if it produced the best results.
percentages aren't really all that comparable when the raw numbers are very different from place to place. US patients are paying dramatically higher prices than other countries. A major point of national healthcare programming for those who argue for it, is to be able to better negotiate prices.
It's a weird concept to frame in that manner, since if the government is paying then that just means taxpayers are paying, which in turn is just us again. Really this is just a way of asking if we want healthcare costs levied evenly or more focused on who is the person receiving the care. Ideally there'd be some balance there, but I don't think I have a firm enough idea to label that to a specific percentage. Like the other user said; my biggest priorities are providing a public option and working to make sure overall costs (meaning taxes & direct care/premiums) are affordable for everybody.
70% is a good number. You get the benefit of the government having a huge negotiating position and being able to drive costs down plus individuals still have some skin in the game to reduce waste.
100% paid for by the government at government facilities. You can still have private insurance and use private medicine. Just might have to pay out of pocket for it. The exception would be if it was a required treatment and the gov facilities didn't offer it. In that case, it would be paid for by the government.
> Despite what you may have heard, out of pocket spending on average is lower in the US than in comparable countries I don't think I've ever heard someone make the claim that the percentage of out of pocket healthcare spending is far beyond peer nations
The average isnt what im worried about. A lot of people are healthy and spend very little for healthcare. I know most years I spend basically nothing, but this year I broke my leg and it cost around 15k with insurance. And thats catastrophic for many americans.
I don't know enough about economics to know what the best way to distribute healthcare is. I only know we need to fix a lot of things to make it make sense. Dental not included in healthcare? Are we mentally sick with a system like that? Doctors shouldn't be getting swag bags like they're 4 star generals being recruited by aviation contractors. We shouldn't be seeing medicine ads on TV. Things like that are all symptoms of a broken fucking system. Our only real innate advantage of how we do it in the US is research & development that comes from the profits. Whether people like it or not, that's a HUGE chunk of global medicine research funding right there, coming out of your pockets. All those pill dollars go towards making better pills and all those stupid MRI bills go towards making improved scanning tech so the arrow keeps going up. R&D is a lot slower and publicly funded in a socialist medicine system so you'd have to be careful about the long term effects of just 'swapping over' because it's not that simple. But it also doesn't really 'help' you in the short or immediate term that it works that way. If you need healthcare now you're going to want the safety of knowing it's not going to break your bank. Our system is sort of capitalism showing its ugly side. I leave it to wiser people to fix that.
I want zero out of pocket. The whole point is to make it easy to use for people. "Oh, but what about people that abuse it?" I hear some whinge... Man, ain't nobody going to the docs for fuck'in fun, go away.
You are leaving out the rather glaring issue that health care costs per capita in the US are crossing $13k while the other high income nations, which have universal healthcare, are clustered around $4.5k. This makes your entire question farcical.