I’m no lover of the US healthcare system - other countries get better outcomes for less than is spent by the US government - and basically all their costs are borne by the government, unlike in the US.

But: you have to be careful with large numbers. There are 0.3 billion people in the USA. United Healthcare says they cover 51 million. That $20 billion is $392 per insured person - a lot, sure, but hardly a large fraction of what they each pay.

Compared with other countries, the inefficiency of for-profit healthcare is a far worse problem than the amount of profit they make.

I agree with the gist of your comment overall. The system needs massive overhaul, which will take a lot of political will.

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ch4s3 4 days ago | parent | next [-]

> and basically all their costs are borne by the government

The costs are born by people paying 20-25% VAT. The government just collects and disperses those funds. This may be more efficient, but the cost is born by everyone in society.

> Compared with other countries, the inefficiency of for-profit healthcare

The US health system(s) are a patchwork of non for profit entities, for profits, government programs, and employer sponsored arrangements. It's definitively not a single system and not wholly for profit. No one would ever intentionally design a something this we, it's accidental, it evolved over time.

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jrmg 4 days ago | parent | next [-]

> The costs are born by people paying 20-25% VAT. The government just collects and disperses those funds. This may be more efficient, but the cost is born by everyone in society.

Well, yes, all costs ‘borne by the government’ are in fact borne by people paying taxes - or government borrowing.

[You could follow the chain even further and say that, of course, the cost of those taxes, borne by people, is people’s income, borne by their employers (or investments) but that obviously gets pointless and ludicrous pretty fast because the chain never ends…]

Anyway, that’s not my point - the point is that the US government, in per capita terms, spends more (public money collected in taxes or borrowing) on healthcare than governments of countries where (almost) all healthcare spending comes from the government (public money collected in taxes or borrowing). Private spending is in addition to this.

Again, spending by the US government is more than spending by other countries governments, even though the US supposedly has a private insurance based system (that also costs a huge amount in addition to government spending!)

I looked up a source…

https://www.pbs.org/newshour/health/health-costs-how-the-us-...

…and it turns out I’m slightly wrong - US government healthcare spending per capita is beaten by the governments of Norway, Luxembourg, and perhaps the Netherlands. But even they spend vastly less than the US if private spending is also considered.

The US system is unarguably hugely more expensive - less efficient - than the systems of the entire rest of the developed world, for worse health outcomes.

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ImPostingOnHN 4 days ago | parent | prev [-]

Does VAT really go entirely to healthcare?

If not, we'd have to compare with the total taxloads borne by citizens of compared countries

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ch4s3 4 days ago | parent [-]

It varies country by country and funds are essentially fungible. France for example nominally has special payroll taxes that go towards healthcare. Some OECD nations have mandatory insurance schemes where you pay some premium monthly. It really varies a lot. It is however true that VAT is pretty much universal to OECD nations with single payer systems and make up a significant chunk of government tax receipts. Its essentially impossible to dodge.

But when comparing most incomes levels, Americans pay much lower taxes than OECD counterparts.

	▲	ImPostingOnHN 4 days ago \| parent [-]
		What I'm saying is that the better comparison metric would be (total tax load + total direct healthcare spending) per capita

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Taikonerd 4 days ago | parent | prev | next [-]

> Compared with other countries, the inefficiency of for-profit healthcare is a far worse problem than the amount of profit they make.

Yes! That's a really pithy way of saying it.

The big insurers spent a lot of money internally on handling claims, administrative overhead, etc. That's because of the whole model of insurance, where each individual claim has to be reviewed.

Some health systems are experimenting with simpler models, like capitation: "the insurer will pay the hospital $X per covered patient, and the hospital will handle all of that patient's health needs." That model would get us out of claims hell.

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4 days ago | parent | prev [-]

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