The real reason American health care is so expensive

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