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.

100 thoughts on “The real reason American health care is so expensive

  1. The US system is built on greed and poilitical movement is only measured on how much it benefits THEMSELVES financially, as in theay don't want to pay money through tax instead of credit card (which would make the total amount of costs much less because they don't wan't to pay anything at all..
    Hence, if they can't have it their way, they cry socialist.

  2. Have you seen the way the VA operates? It’s a joke. I plan on going into the Medical Field. If we start utilizing singe-payer healthcare, I’m dipping. There is no point in studying for that long and passing many test to get paid way less.

  3. Mass shootings, Obesity, STDS, fast food addiction, low i.qs, massive divorce rate, overreachimgmilitary and police United States should turn it diwn a bit and fix its own problems

  4. This video is so left-wing, that all the time U.S. appeared on the screen…it was on the left.

    Freud would be glad!

  5. Does anyone know the source of the survey he mentions at 2:19? I'm doing a research project on this topic and was hoping to use a data set to reference?

  6. It’s not american tho,it’s UNITED STATES,american includes
    Canadians
    And latinos🤷🏻‍♂️🤷🏻‍♂️🤷🏻‍♂️
    America it’s a continent not a country👍🏼

  7. Good video, thank you. I have a couple of honest questions to ask. Before I get to them, I agree that the power of lobbying groups is absolutely detrimental to individual people and their freedom in the US. Elections in the US is an opiate to the masses to convince Americans that they matter. Until either lobbying rules change, and/or the number of "representatives" is increased such that the number of people they represent is small enough to actually make a difference, the status quo is where it's at. That said, remember that lobbying only works if there is the flip side to the relationship. Politicians and bureaucrats have to be party to the lobby game for it to work.

    On to my questions (with some commentary). First, I grew up in Canada, and used the health care system in three provinces: Ontario, Manitoba and Alberta. When statistics are used such as were in this video, I never see the qualitative comparisons between countries. At least between Canada and the US, the delivery of health care is not apples to apples. Hip replacement was an example used in the video. When I worked at a college in Manitoba, there were three employees who needed hip replacement surgery. Each had been trying different options before surgery, in order to avoid surgery. Once the doctor finally concluded that surgery was the only way, it was at least 6 months on the waiting list to get in. Health care delivery costs less when the single-payer system dictates a price that is too low, it's not worth it for people to get in on the delivery side, and you have massive backlogs.

    Second question: Do you think that part of the higher cost for services and drugs is because that most of the R&D is done by US companies in the US? Put a different way, do you think that higher costs in the US subsidize health care in the rest of the world? Growing up in Canada, there is not much evidence of a strong entrepreneurial spirit. There aren't many industry-changing innovations that come from Canada. From a health care standpoint, most of what is offered in Canada came via the US. I don't know if or how much this is true for other countries that are compared with the US. My assumption is that maybe Japan and Germany on the hardware side. If that equation changes, costs might fall in the US, but will that cause costs to rise in other countries? If so, do we care?

    One of the most eye-opening parts of the video was the comment that at the time of needing the expensive services, patients are not in a position to negotiate costs. That said, if I go to the ER, with a gaping wound or some internal pain, there is no way for someone to give you an idea of how much it costs until they run some tests. For me the biggest disappointment of the ACA law was that it didn't divorce health insurance from employment.

  8. Universal greed is the total problem. The tragic American paranoia over social programs kills them. Americans are far too selfish to think of a social program. They can't understand the concept of I am healthy but will pay a small amount because they have been taught to be selfish. If you pay a tiny amount now all those small payments add up and if you become in need then you can be helped. American society is built on greed and that is their flaw.

  9. There will be a tipping point when all those guns are turned inwards..the second amendment was made for that..the right to fight against domestic government .

  10. "It is so expensive, it is hard to make it cheaper." Great point about majority of people using healthcare when they are uncomfortable.

  11. Sry guys, but where exactly is "Protugal" ? 😉
    I think you messed that up in the first graphic…. but still a nice vid like always!

  12. The main issue is the medical and pharmaceutical business is run for profit. It shouldn’t be. Any and all profits should only be rounded back into better practices and medication as a perpetual cycle of bettering human health.

  13. Do American doctors swear by the "Hippocratic Oath"? If they do, isn't it then logical to conclude that one becomes a doctor to help all people in healing and prolonged life….rather than becoming a doctor only to profit exuberantly? If they don't follow this oath, then people and mostly american people should realized that any version of US healthcare is only a business whose main point is to make money and nothing else.

  14. It's expensive cause there's very little free market competition, it's a cartel – too much regulations, IP laws… favoring some others over the rest

  15. Health care in America. Sure we've got thousands of hospitals
    An army of doctors and surgeons.
    Legions of assistants and nurses.
    Just no health care. We had one
    President that tried to fix this mess. And now, God help us.

  16. So glib, so simple. GIve it to the government and let them manage it. They've done such an outstanding job on the war on poverty, education, and yes, even Medicare, which is perpetually on the verge of being broke (Part A) and requires ever-escalating taxes to stay afloat. The problem isn't just private insurance–it's third party payment of any sort. The more insulated patients are from cost, the more prices will rise, AND the higher the demand for treatment. If you don't care because you don't pay, well….up the prices go. And pretending that slashing payment won't affect access is naive. When Canada and the UK run out of money for healthcare in any given fiscal year, which they frequently do, they stop doing high-end elective surgeries. So forget about getting your mobility restored because your hip is in constant pain and you can't work. You can just deal with it until the budget resets. Also keep in mind that the US subsidizes foreign healthcare systems by selling American-designed medical devices and pharmaceuticals to them at a fraction of what they sell them for in the U.S. So, yeah, our drugs are more expensive because Europe's drugs are so much less expensive. Same with medical devices. If all rates were Medicare rates, you'd see an instant closing of of hospitals and physicians retiring. Maybe we need that type of disruption….inefficient doctors and hospitals should go out of business. But let's start with the problem: third-party payers. I hate 4-minute videos that explain away complex topics like healthcare spending. You have the right idea, but these cursory treatments do more harm than good because they paper over the consequences.

  17. I live in India.
    We get appointments, checkups and even medicine free of cost.
    You can walk in and out treated free for small ails like fever and stuff.

    If you’re rich, you can go to a private hospital but, the doctors in government hospitals are better.

  18. Unmentioned 800 lb hippo in the room. The reason why America does not have an advanced single payer or advanced multi-payer health care system like the Germans or the Swiss is because a large number of the white population does not want to pay for healthcare that will benefit people of color. Ditto for higher education, nutrition (Food Stamps), housing (section 8), etc. All the before mentioned preserve and enhance life and a large segment of the white collective does not favor that especially in times when the white population is in demographic decline (fewer births and greater deaths). Is what it is but with the law of karma you not only reap what you sow, you reap greater than what you sow and later than what your sow. Rip up the social safety net and it won't be there for you when you need it. Everyone is a death, divorce, illness, injury and layoff away from poverty (and ill health). Don't wish ill on anyone but this element made its bed and has to sleep in it. A good series on healthcare on YouTube is Healthcare Triage. Gets into health issues and compares the American healthcare (sick care) system with a handful of other nations (Germany, France, UK, Taiwan, Canada). Recommend.

  19. Hey, anyone remember the time BEFORE the government got involved with healthcare and doctors where plenty, and had to compete? You know, that same point where even the poorest man could afford any treatment? No? Oh well, not like you care about healthcare… Oh wait.

  20. The greatest advance in health care will happen when most people go into Prevention.  
    In China 1/3 of the people use liquid colloidal minerals to prevent disease, 
    eat mainly vegetables to prevent cancer, 
    use Quigong exercises to prevent many diseases, like arthritis, etc.

    Ask not what the government can do for you. – JFK.

    Please join the Friday Students Strike for the climate Emergency.
    SF City Hall noon.
    Youtube: paul8kangas

  21. I live in Australia. Earlier this year I got so depressed I stopped eating and had to be hospitalised. If that had I bankrupted my family that would have broke me. Vote for Andrew yang America.

  22. This is really something else. I hate how the health care system is. I am about to pull my hair out dealing with insurance companies!! The government owns everything, and we get nothing. Health insurance bills raise to the top. I hate it

  23. How the heck can hospitals just decide to charge someone a different price?? Whether you have insurance or not the cost of preforming a procedure should be the same. It’s not like the actual cost of putting on cast changes based on who it is.

  24. Because big pharmaceutical mafia and doctors unions … they are highly paid average $250,000 , no other civilized nation would let them get away with that money, nowhere in this world and shortly capitalism greedy transformed the rights of a person into a profitable scam business where insurance in top of doctors ridiculous salaries , not to mention people are loosing trust in doctors those days. It’s a mafia that won’t allow easily doctors from other parts of the world integrate and be accepted in to USA or into the union gang. Because of medical school profits .. everything is linked and one purpose to get rich and keep the status. This industry that should help people transformed into a mafia. For USA this cause it’s lost.. people are too into anti depressive and drugs and they are not capable of a social revolution. Good luck.

  25. The idea that the free market aspect of American healthcare is what drives costs could not possibly be farther from the truth. The aspect that drives up costs in every industry is the government because it removes competitive pricing. When a good or service exists in the private sector, companies are able to compete against each other which inherently increases quality and reduces costs. This is the same reason why college costs skyrocketed after the introduction of guaranteed government-backed student loans. When companies are given direct deals with the government , costs always go up and will continue to go up indefinitely. A great example would be the fact that the average public school runs on three times the cost per student as a comparable private school. Nationalizing healthcare might be a quick way to reduce the costs to the consumer, but would undoubtedly cause costs to increase to even more. The sad part is that publications like Vox and politicians like Bernie Sanders are completely aware of this, but fight to nationalize industries like healthcare simply because of the profits nationalization would provide corporations.

  26. The real culprit here is everyone "negotiating" prices. Why don't the government just require hospitals to post their prices REGARDLESS of insurance? Not even a universal medicare will make it cheaper if prices remain not transparent.

    Also, it should be mandated to healthcare professionals to consider the patients ability to pay especially when telling them they "need" that surgery but in reality, it is more of an elective!

    US healthcare practitioners are so cookie cutter, there is so much waste.

  27. It is expensive, at least partly, because of liberal mandates that require treatment of illegal aliens and those costs get passed on to others.

  28. I am not an expert, but after studying about the American healthcare from this video, I can not say anything because at the beginning I said "I am not an expert"

  29. "Conventional wisdom says 'the government is more expensive than the private sector'"? When you hear a "truth" a thousand times but you never see the proof it is not "conventional wisdom" it is ideology.

  30. What he doesn’t tell you is that if your “uninsured” means discounts at hospitals if you are willing to make the payment plans and it’s very much cheaper than anything else .80k for full dental implants. 5 dollar prescriptions, universal also means the government and the hospitals can decide whether your worth the time and money to
    Treat

  31. In 2017 I was rush to the ER because I couldn't walk straight and I kept falling. Luckily it was only bad vertigo. But at the time they thought it was a brain tumor and gave me an MRI…. I'm still paying payments on it…

  32. In Sweden where I am from we only pay at most 20 dollars when visiting like the GP but we don't pay for surgeries or treatments because here when you reach a certain amount of money you get covered by a highcost protection that pays your expenses for you and you don't have to worry about if you are gonna be able to pay for the treatment once it is done and you are let go from the hospital. I wonder how american hospitals even can have the heart to send you a bill on hundreds and thousands of dollars just because you were unfortunate to get sick at the wrong time and maybe can't afford to pay those expenses

  33. My sister had two surgeries brain and back, four specialists in the room each monitoring her extremities….price $0. Fyi Canada.

  34. Guess what? Insurance companies are for-profit, meaning that they need to consistently meet quarterly financial goals so that their shareholders get the main benefit. In other words, this is a corporatist/capitalist mentality that Americans LOVE. Yes, while it is true that we do consume goods and services on our own free will, healthcare issues are sometimes beyond our control and we don't have the free will to CHOOSE to consume goods and services.

  35. I commend you on the solid effort… But you cannot sum up such a complex issue in five minutes. I'm not saying your presentation isn't factual, it is. I'm saying this is just a slice of a very large pie. But to call american healthcare a free market is reckless use of vocabulary, it is the most regulated market in the country.

  36. Firstly, it's worth pointing out that nobody is saying get rid of private healthcare. There's a booming private healthcare sector in the UK and it works for them because it costs more and people who have it end up in NHS hospitals in an emergency because as you pointed out, they're not conscious enough to make that call or because transferring them immediately risks further injury.

    In any case, a lot of the private treatment happens in NHS hospitals.

    Secondly, as far as I understand, your state healthcare is costing you 300+ billion a year which means you wouldn't even have to raise taxes to switch to an NHS since that's enough to give every american citizen a 1 billion dollar lifetime healthcare budget.

    In any case, the system you have now means you're paying for healthcare twice. Once in taxes and again to private companies.

  37. What the Frick that last part about government making it cheaper is totally wrong this is why I am conservative because the private sector always works when government isn’t involved with all them regulations.

  38. The cost of giving birth to my son is $13K in 2013. Luckily, we had employer's insurance, we paid $2500 a year for insurance and we paid around $1500 on the hospital bill. If I'm getting sick, I go to see the doctor to ask for a prescription, I'll get charged $110. Our employers paid a lot on our insurance I wonder if they give us that money and we pay for our own without insurance that would be beneficial to us rather than wasting a big chunk of money on insurance every year.

  39. It's because healthcare is the only industry where you show up not knowing what you need, what to expect, and you get a bill weeks later and are on the hook to pay for it not knowing if it's legitimate. Hospitals should be required to have itemized bills for services before you even check out. And if they don't have time to categorize all the proper costs, the facility should eat the charge. That's how all other industries function, and it's how health should too.

  40. I hate the idea of "price fixing" but I literally see no other way. I went to the ER (because it was the only place open) to get two bags of saline. My bill would have been $12k without insurance. Even after insurance, I had to pay $2500 out of pocket… for some saltwater.

  41. The American healthcare system is not a free market, case and point no hospitals publish their prices publicly. It's a crony market controlled by insurance companies and the hospitals allowed by the US government. IMO to fix the system we need to:
    1. Have emergency care paid by the government, examples would be a car accident or a sudden heart attack. Basically it's a life or death situation and you have to get to a hospital ASAP.
    2. Force all hospitals to publish their prices for procedures publicly also make balance billing ILLEGAL, if someone is working in a hospital they should be FORCED to take the insurance the hospital they are working in accepts
    3. Get insurance completely out of the drug market, drugs are expensive because insurance will pay whatever the drug companies want and like hospitals drug manufacturers should be FORCED to publicly display prices for drugs.

  42. In finland health care is free/really cheap, people literally go to see a doctor because of a headache, because its free

  43. Imagine saying that the US operates under the free market.

    With a public hospital, you're obviously going to pay less, since it's already been mostly paid by your taxes, and everyone else's (whether they went to it or not). However, with private companies, not only do you have to pay the company itself and the employees, but the government forces many costs into it through a multitude of taxes (including indirect ones like the taxes they have to pay when importing goods from other countries), patents, regulations either on the staff, the architecture of the hospital itself, or in the maintaining of it.

  44. I remember seeing the commercial years ago about how the Government should stay out of Hospitals.
    In some ways it made sense because when you give too much power to the Government it leads to Tyranny that's what happened in Rome.
    And that's why Europe has many Dictators.

  45. Health Care is too expensive, I have about maybe $500+ in medical bills (my health is poor so yeah). Also getting sued by a hospital, it's not fair that other countries ambulances are free…

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