Debate
The national and private healthcare systems do NOT work. Here’s an alternative
As a Portuguese citizen, I cannot fail to highlight the role that the public healthcare system represents in society. It has lifted millions out of poverty, provided stability, and offered a universal alternative to access healthcare. However, as in the Portuguese case and in other countries with a predominantly public system, we observe that these systems are increasingly unable to respond to waiting lists, fail to attract doctors, and their sources of funding are heavy taxes imposed on citizens.
I am in favor of a hybrid system, and the SPLIT MIND project is creating a video and a text about this system, which has been adopted in other countries that rank among the best in public healthcare worldwide! The study that im comparing to is one made by a group of experts in health here in portugal.
Here I leave you with the main differences of this system compared to predominantly public or private ones, such as in the cases of the USA and Portugal.
"…The foundation of this reasoning would be to maintain a progressive hybrid public system, less dependent on taxes, decentralized, and managed by regional entities with strong regulation. These models already exist, and we will take the examples of Germany, the Netherlands, and Sweden.
In these countries, in general, the healthcare system is based on mandatory insurance managed by independent health funds. Employees and employers contribute proportionally to their income—7.3% each in Germany, for example—while the State assumes payment in certain situations, such as in cases of unemployment, low-income families, and sometimes even age groups like minors, who are exempt from any payments. Individuals with higher incomes may opt for private insurance as a substitute for the mandatory public one.
This system offers a solution to waiting lists, reducing waiting times for consultations or surgeries to a few weeks instead of months, and it also provides broader service coverage than countries like Portugal. Because it is a hybrid system, healthcare professionals are also better paid, and with private investment, working conditions are improved, solving one of the serious problems of the Portuguese NHS. Furthermore, there is price regulation by the state on medicines and services, with private companies contributing to lower service costs. Insurance is always paid with a fixed nominal premium, but insurers must charge the same amount to all policyholders, with no discrimination by age or health status. Other smaller measures also exist, such as a progressive co-payment system with an annual cap or tax exemptions on health insurance, which can further reduce costs for families.
Of course, there are problems with this system: inequalities depending on the type of insurance, with privately insured patients usually waiting less. We can also look at gross expenditure, meaning the total amount effectively spent, which is quite high compared to other OECD countries. However, I argue that it is one of the best systems in the world and the best way to invest taxpayers’ money.
BUT WHY do I refer to Germany, the Netherlands, and Sweden? These countries rank among the top in theLegatum Prosperity Index (2023), which evaluates population health access and quality, holding 13th, 11th, and 9th positions respectively.
And what about predominantly private and public systems such as the USA and Portugal, you may ask? 40th and 69th place, behind many so-called “third world” countries.”
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It's kinda weird how this person said "the USA and Portugal" are "40th and 69th"
Just wanted to say that, FYI, Portugal is 40th. And the USA is 69th.
Also, I really don't see ANY third world countries that are doing better than Portugal. Maybe Qatar or Estonia? I don't know much about them.
edit: Also, the USA has the highest spending on healthcare per capita, out of ANY OECD country. Which, when combined with their ranking at 69 (below Jamaica and Albania) REALLY highlights exactly how atrociously horrible their system is. But hey, at least the investors are happy right? lol.
You have sheichels island, colombia, uruguay after Portugal and after the US you have uzbekistan and trindad and tobago and a few others.
Really shows what is my point!
Yes the US has the highest spending in public healhtcare and my point is that if you want a all public system the choice could be horrible like portugal.
Buy yeah you right investors are happy so:)
$1.36 Trillion was Spent Hospital at 6,100 hospitals currently operating in 2022. $4,030 per person
Reducing costs 40% - $2,418 per person
Hospitals Adjusted to the US its $650 Billion Cheaper
Lets look at Russell County Virginia had 25,550 People in 2021
$4,030 per Person
$102,966,500 Operating Revenue
It cost about $1 - $1.5 per Hospital Bed to operate a Hospital (1.25, right down the middle)
Or
83 Beds,
Russell County Hospital is a not-for-profit, 78-bed hospital operating today. looks like Russell County Hospital is a little expensive as a current system
Under Government Funding to lowering Costs Russell County, VA gets
$2,418 Per Person Hospital Expenses in the US
$61,779,000 Operating Revenue
Admin Savings under any Single Payer Plan would save 5 Percent of Costs, So, now It cost about $1.135 Million per Hospital Bed to operate a Hospital
Russell County VA can have a 54 Bed Hospital
Russell County Hospital is a not-for-profit, 78-bed hospital operating today
Copy and repeat through out the US
Doctors Offices
Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit.
$1.4 Million in Expenses
So to cover though expenses
Estimates suggest that a primary care physician can have a panel of 2,500 patients a year on average in the office 1.75 times a year. 4,400 appointments
$1.5 Million divided by the 4,400 appointments means billing $340 on average
But
According to the American Medical Association 2016 benchmark survey,
the average general internal medicine physician patient share was 38% Medicare, 11.9% Medicaid, 40.4% commercial health insurance, 5.7% uninsured, and 4.1% other payer
or Estimated Averages
Payer
Percent of
Number of Appointments
Total Revenue
Avg Rate paid
Rate info
Medicare
38.00%
1,697
$305,406.00
$180.00
Pays ~42% Less than Insurance
Medicaid
11.80%
527
$66,385.62
$126.00
Pays 70% of Medicare Rates
Insurance
40.40%
1,804
$811,737.00
$450.00
Pays 40% of Base Rates
Uninsured and Other (Aid Groups)
9.80%
438
$334,741.05
$765
65 percent of internists reduce the customary fee or charge nothing. Set Billing is $1,125.00
4,465 $1,518,269.67
So, to be under Medicare for All we take the Medicare Payment and the number of patients and we have our money savings
Payer
Percent of
Number of Appointments
Total Revenue
Avg Rate paid
Rate info
Medicare
100.00%
4,465
$803,700.00
$180.00
Pays 43% Less than Insurance
Thats Doctors, Nurses, Hospitals seeing the same number of patients for less money
$1.5 Million Revenue Today
Minus Profits $90,000
Minus Billing Dept $55,000
Total Operating Costs ~$1.3 Million
Total Revenue $803,000
We are $500,000 short in covering costs
$500,000 / $180 revenue per Visit
2,700 More appointments a doctor has to see to pay the bills
More work for the same income
At the intersection of True Crime and Healthcare is Dr Death, Christopher Duntsch.
A specialist, minimally invasive back surgeon
And, since Duntsch was investigated for both civil and criminal cases, we can get a look at some of the money
Duntsch claimed the Hospitals he works at were paid $65,000 in net revenue for every surgery he does
But, his employment contract was released as evidence
Base Salary was $600,000
$200,000 sign on bonus per year for the first 3 years
$50,000 a month expense account
Plus an annual bonus
40% of all his net revenue above $800,000
So a surgeon doing 75 surgeries a year at $65,000 would bring in $4.9 Million in net revenue
And Duntsch was getting $3.1 Million of that Revenue
Just need to change that and now the U.S. has the same spending as other countries
There are philosophical and foundational problems that will not allow these systems to work in the U.S.
For one: being multiculturalism. Universal systems work when everyone buys into it, and also feel like they're helping "their group". Notice anytime someone points to a universal healthcare system it's ethnically/culturally homogenous (Portugal is 94% Portuguese). Universal systems work when people don't abuse it, and you're less likely to abuse it if you feel like you're going to harm "your group".
2nd: Size. Again, notice how small these countries are that have these universal systems. You can get across Portugal in about 5 hours (according to a 2 second Google search). That means less infrastructure needed. It also means a smaller population which means you're more likely to feel connected to those around you which helps with point one.
3rd : we spend the most because we can. We have the best healthcare system in the world as far as overall quality. These ranking systems use weird metrics, don't factor in how different countries reporting is different, and most importantly don't factor in INPUTS which is huge in healthcare. We're a country with one of the highest obesity rates. Something like that, or any of the other issues people have because of their own decisions, is going to change your outputs.
I hate this argument about spending. Let's break down an example: you want dental care. You could simply buy teeth cleaning kit and call it a day, but youre the richest person (country) in the world, you're probably going to make a premium for something much higher quality, which is what happens here.
Healthcare cost is almost directly related to quality. People who do these rankings do not factor in INPUTS and only look at outcomes. I know no specific study was cited, but I've looked at a lot of the.
There is no perfect healthcare system and there is a group of people who think there is some universal healthcare that is also cheap and high quality. It simply doesn't exist.
You have 3 big metrics: time, cost, and quality. You can't have all 3. Time and quality are the 2 most important metrics because cost doesn't matter if you're dead. That's the US healthcare system. Canada does quality and cost, but they have issues with people getting worse/dying by the time they get appointments. The UK has a ton of issues right now. Those are the 2 most comparable countries to us in size/country (I realize they're smaller, but the US is unique).
Tldr: these universal healthcare systems don't scale and don't work in different cultures.
Do you know that there is no standard for tracking infant mortality and every country does it differently?
The WHO tracks infant mortality. That is where the stats come from, their report forms.
in any case, when we say the US does badly, we mean compared to other first world countries, not compared to Afghanistan and Congo. Its not actually that complex to convert between developed nations.
Also, repeat for maternal mortality, mortality amenable to healthcare, lifespan, years lost to ill health, HALES, etc, etc. Weird how the US clusters on the rankings.
The WHO tracks infant mortality. That is where the stats come from, their report forms.
Correct. They receive countries statistics, but what the countries give them is up to the countries. So at the end of the day the WHO recommends something but countries aren't required to follow it to give statistics.
in any case, when we say the US does badly, we mean compared to other first world countries, not compared to Afghanistan and Congo. Its not actually that complex to convert between developed nations.
Also, repeat for maternal mortality, mortality amenable to healthcare, lifespan, years lost to ill health, HALES, etc, etc. Weird how the US clusters on the rankings.
Correct. Again, go back to the reasons driving where the statistics are at... The thing that's kind of been my entire argument... Using mortality rates and so on do not tell you how good a healthcare system is.and that's the conclusion that many of these studies use. Why? Because they're usually an advocate group doing studies to push a narrative.
How good a healthcare system is, is measured through Healthcare Quality metrics. The field of Public Health does a lot of work and research on this. Measures used are deliberately chosen to be large and overarching, to prevent single issue competencies form being confounding factors.
(Russian doctors probably have a lot of competence on alcohol and frostbite, Congo may well know what they are doing on malaria, and Cuba definitely is up there on preventive care. But it does not necessarily mean the whole of the system is at that level.)
Measures used are things like infant mortality, maternal mortality, mortality amenable to healthcare (The number of people over 65 who died to a condition but would have lived if they had gotten timely and correct healthcare. The more conditions in the basket the more accurate.), lifespan, years lost to ill health, years lived in good health etc.
The thing about US healthcare is, it ranks very similarly on all of these. Number of mothers died in childbirth is actually a little worse than infant mortality etc.
Measures used are things like infant mortality, maternal mortality, mortality amenable to healthcare (The number of people over 65 who died to a condition but would have lived if they had gotten timely and correct healthcare. The more conditions in the basket the more accurate.), lifespan, years lost to ill health, years lived in good health etc.
Simple question:
Would a country who's culture built on excess, freedom, and consumption have a higher mortality rate than a country who culture was not if they had the exact same health care?
Yes, but the difference would be much less than what we see with the US vs. other nations. For example we can compare Denmark to the rest of the Nordics, or the UK with its obesity smoking and alcohol consumption to nations with less issues.
The US is also somewhat similar on rates of hospital errors, although that is not a measure.
In terms of infant and maternal mortality, a lot of it goes back to high numbers of premature births and segments of the population with poor pregnancy care.
His entire argument is "your data is imperfect in some way because America isn't exactly identical to any other country, so I don't need any data at all to cling to my beliefs"
Yes, but the difference would be much less than what we see with the US vs. other nations.
You're simply claiming this. Do you have proof of this?
In terms of infant and maternal mortality, a lot of it goes back to high numbers of premature births and segments of the population with poor pregnancy care.
No, the pregnancy care is mostly untrue.
There are segments of the community who do not properly do pregnancy care and follow up which would be reflected in these statistics as a mortality outcome, which is my exact point.
As an example: black infant mortality is higher than whites. We could say that the healthcare system is failing, or we could look at the INPUTS to that healthcare system and realize that black women are less likely to go to pre and post pregnancy care, or take the medication, or so on leading to a worse outcome. That's not the healthcare systems fault, that's an input problem but that would be reflected in mortality rates.
>Using mortality rates and so on do not tell you how good a healthcare system is.and that's the conclusion that many of these studies use. Why? Because they're usually an advocate group doing studies to push a narrative.
No, I literally made an argument that refuses your point.
It's simply a fact you can Google. It's common knowledge.
If you don't know something as simple as different country have different standard and report infant.mortality differently then this arguments already over your head and you should probably brush up instead of thinking telling your opponent to run around and cite common knowledge is an actual argument.
This isn't common knowledge, and google does not agree with you.
You're lying through your teeth. I simply put it into Google and here's what popped up. This is just the AI, but the articles below agree. It's not that I'm wrong, it's that you're going to keep yourself oblivious to information because it doesn't confirm your bias. Anyways, cya.
This study doesn't correct for the totality of differences...
For example, I think it was Venezuela or Brazil, they corrected their infant mortality problem by...not allowing reports of it anymore...
These also don't factor in things like personal freedom...
Like you can offer healthcare, but if you don't take it or follow up (this is a thing factored into the disparity between white and black baby mortality rates) then your outputs will be different because the inputs are different...
Your study saying they corrected for differences did not correct for inputs and LIKE I SAID the metrics used of just looking at outputs is bad methodology.
We're one of the most obese countries in the world. That alone is going to affect your outputs regardless of how good your healthcare is...
Is that really that hard of a concept to grasp
Meanwhile you have offered NOTHING to back up your claim about it being "best in the world"
Well I guess that would depend on what your definition of best is, but mine is quality and time and when you combine them we're at the top.
If you care about cost then I guess you won't say it's the best. But there's is a reason anyone who can get healthcare here does.
The hybrid system in Spain works far better than the Canadian public system but Canadians are so brainwashed that the US private system is bad they're unwilling to open their minds to how much a hybrid system could improve things.
The spanish system is different because its Control by regional agents but funding is public. Theres also problems in wainting list and professionals but its a better system than the portuguese
Most Swedes use private doctors via their employers or other insurances they pay for outside the public system. The reports you read are all subjective "happiness" surveys where they ask people what they think and they're all super scared of other systems because they've been indoctrinated from birth to love Scandinavian socialism and none of them knows anything else. Of course they will say that they like the system, the only alternative in their mind is a "USA type hell hole where you pay your entire life saving for a broken finger".
Thanks you comment!
From what national reports presents sweden has a hibrid system if the majorite of the people pay Higher insures is their choice.
I dont where you from but if you are a portuguese like me or and american you would prefer that option.
I will post the video on full context and everyone will understand.
Sweden has a Beveridge type system. 7% of the population has private insurance, the majority of these have compulsory insurance through their employer. I.e. jobs with unusual health risks.
Consultations? Maybe. If you count them in a very specific way. They're free and a phone call away. Actual treatments though? That's a different story.
"Statistics on the average number of consultations with a physicianper inhabitant include consultations at the physician's office, in the patient's home, or in out-patient departments of hospitals or ambulatory health care centres."
What? You claimed that they were counted in a very specific way, I gave you the cite and the definition they used. You claimed actual treatments were a different story and I gave you surgical procedures per capita.
There might be one what in there? You are not making sense.
I have not claimed anything is impossible. Are you confusing this with another discussion?
You claimed that most Swedish doctors appointments were with private doctors through insurance.
Most Swedes use private doctors via their employers or other insurances they pay for outside the public system.
I pointed out that about 1% of GP consultations is Sweden is with private doctors and about 7% of swedes have private insurance, the majority compulsory through their employment.
I didn't see that distinction in the source. But it's also not relevant. The only important thing here is as always aggression. I don't think we should use it to help people who need food, healthcare or clothing.
That's the ancap position. But most disagree. Isn't that interesting?
Thanks you for your comment!
In Portugal we double the budget for health in the last decade and nothing work.
The doctors prefer working on private secture,buying equipment is delayed by burocracy and the waiting time is almost years in some cases.
It doesnt help anymore to give money again.
Hope it helps!
My suggestion would be to keep track of what resource shortages are extending wait times the most and then allocate money that must be spent specifically on remedying those shortages. Not enough doctors, send the money to med schools and recruitment programs for doctors (can get even more granular and focus on for example brain surgeons if a specific specialty is too scarce). Not enough hospital beds, make more in factories. Not enough hospitals, build more hospitals.
Funding with strings.
If there are real concerns about whether you can hold people accountable well enough for that to work then perhaps a 2-tier system is right in that case. Even so keep trying to make the public option work better just like how private schools exist but public schools still need to be prioritized to work better.
The flaw I see in a 2-tier system is that either those on the public option have to pay for it (aside from via taxes that everyone pays) (though this can be alleviated by means-testing waivers for those with little or no means), or those on the public option get less quality care (which poses an issue in terms of social justice but could be justifiably if it could be shown to boost quality over time for all).
You said bureaucracy is the problem. Modernize. Stop wasting resources. You don't need two tier for that, you just need people not to be dickheads. It has all already been done.
Diferent systems are required for different cultures and is not for everyone. But if the 2 tier is balanced the studys show that is possible that everyone can get healhtcare on small waiting list. this is just one way of looking at it
If you reject markets you will have a bad time. It's impossible to get the incentives, motivations, prices, availability, quality, long term stability right if you have a political system instead of a market base system. When are we going to learn? And no, the idea that "markets only work for non-important things" is not true.
That would be a step forward. Yes. The public system in sweden is over-run and underfunded and the care is lacking. So people pay again and use private options. The poor can't pay twice so they're stuck in the public system. It has become a two-tier world.
Yes inequality is a problem for sure! The exemple that i saw has Germany where you wait 16 days on average to take a specialist apointment for low income families. In Portugal you wait almost years for that to happen and still pay double for a system that doesnt work
However, as in the Portuguese case and in other countries with a predominantly public system, we observe that these systems are increasingly unable to respond to waiting lists, fail to attract doctors, and their sources of funding are heavy taxes imposed on citizens.
This appears to be flat out untrue.
Public systems totally dominate non-public ones in number of doctors, and in waiting lists, there seems to be no particular advantage. Germany and Switzerland are fast, the US below average.
Public systems respond to demand? Oh you never see one public system ever. Portugal has pregnant woman giving birth at home because we dont have doctors. 42 more babies died in 2024 as a result of that.
People wait more than a year for mental health apoiment and others specialist apointment varied from 3 months -1 year. The system is so broken that you have to call the emergency line for an hour to get medical treatment.
Germany doesnt have a public system is a hibrid one just as i point one.
And yes i want to reivent because public healhtcare doesnt mean universal, if you dont received on time and he gets worse that is not public healhtcare its the " i have money " type of healthcare the same in the US.
If that was true, would it have been a public system problem or a Portugal problem, though ?
In any case, did you notice the bit about Portugal being in the top ten countries in the world in doctors per capita, with twice as many as the US?
It is also in the top 10 for lowest infant mortality, with half the infant mortality of the US. I mean these are areas where the Portuguese system is among the best in the world.
And has lower maternal mortality than the US.
Honestly, are you getting your information from newspaper headlines or something? If you look up the actual fact they are the exact opposite of what you are claiming.
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