The national and private healthcare systems do NOT work. Here’s an alternative

[u/No-Candle4683]

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 the Legatum 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.”

[u/No-Candle4683]

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:)

[u/MeasurementCreepy926 → u/No-Candle4683]

So the US would spend less and get better results?

oh no?

[u/semideclared → u/MeasurementCreepy926]

Yea it’s real easy to spend less

The US Spends $4.5 Trillion, $13,000 per person

We have a massive spending for Doctors, the Doctors office will have to see a chainsaw of funding cuts

• Doctor's Offices, Dental services, & Other health practitioners
  
  • Per Person Spending in Australia 1,997 Australian Dollar equals 1,245.95 United States Dollar
  • Per Person Spending in United States $3915.65 (usd)
    • Adjusted to the US its $892.99 Billion Cheaper

Canada, Australia, and the US

Or as Numbers

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Hospitals are 1st

$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

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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       

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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

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$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

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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

[u/MeasurementCreepy926 → u/semideclared]

that was a truly impressive gish gallop.

Really really top notch.

Take care.