Recently, due to the outbreak of the new crown epidemic in various countries, we have also learned about the social conditions in various fields such as medical and health in some countries through news reports. Among them, the situation in the United States has surprised many netizens. The medical level in the United States is highly developed, but there is still the problem of expensive medical care for ordinary people.
There were some people in China who did not understand the real situation before, and once imagined that most Americans enjoy better social welfare, but recent news reports are quite different from their imagination.
So why does this superpower still have these problems? We can interpret this issue from the different attitudes of former US President Barack Obama and current President Trump to health care reform.
Former US President Barack Obama signed the "Patient Protection and Affordable Care Act" in 2010, which is what we often call "Obamacare Reform." The central idea of this bill is to require every American citizen to purchase medical insurance.
In all major developed countries in the world, universal health insurance is very common, but the United States is an exception. Simply put, this is because the United States is not only expensive to see a doctor, but insurance is also not cheap, so many people choose not to buy medical insurance. And because American insurance companies sometimes sell insurance selectively in order to make money, if you are weak or have a relatively dangerous medical history, they will often not sell insurance to you.
Medical institutions in the United States are market-oriented, so Americans do not have the problem of difficulty in seeing a doctor, but there is a relatively serious problem of expensive medical treatment. Without medical insurance, how expensive is it to see a doctor in the United States? The well-known self-media person and American Jew Guo Jerry has produced a number of videos involving American medical treatment and provided a lot of data for reference. Here are some specific data provided by Guo Jerry:
If you don’t buy insurance, just simply test your blood type, which costs $87 (2017 data). With insurance, you only need to pay $4. If you don’t buy insurance, the cost of treating a fracture is about US$7,500, the average cost of a 3-day hospitalization is about US$30,000, and the treatment of cancer requires hundreds of thousands of US dollars.
Moreover, there is no need to pay for medical treatment in the United States, but after the medical treatment, the patient will receive a bill that records the amount he needs to pay. The waiting time is not short, about 1 to 2 months. If the patient refuses to pay, the hospital has the right to sue the patient, and the patient’s credit score will be reduced. So, if you don’t have insurance and you have a serious illness, what awaits you after you are discharged from the hospital is an unknown fear. You don’t know how much you have to pay. If it is a huge sum of money, it is very difficult for many low- and middle-income families, and some people may have to bankrupt their families.
Although medical insurance can largely solve the problem of expensive medical care, purchasing medical insurance itself is not cheap. Each family in the United States needs to pay about $2,000 in medical insurance for a month, and the company will pay about 70% to its employees. Patients still need to pay about 10% of the cost for each visit. However, even if Americans are seeing a doctor every day of the year, there is a maximum annual self-payment limit. The maximum amount of out-of-pocket payments will not exceed this fixed limit, and the remaining money will be paid by insurance.
Even so, in 2019, 30 million Americans did not purchase any insurance. As a result, this has formed a difficult problem in the United States: Many people do not buy insurance because they think it is expensive. But when it comes to seeing a doctor, they will pay more expensive costs. This is the data after Obama painstakingly introduced the healthcare reform policy. Therefore, Obama’s original health care reform bill required: everyone must have medical insurance, and there is a fine for not buying medical insurance, and insurance companies cannot selectively sell insurance based on the age and physical condition of the insured.
We know that Obama is a Democrat and Trump is a Republican. There is a significant difference between the Democratic Party and the Republican Party in the United States. The Democratic Party emphasizes government intervention, while the Republican Party emphasizes free market regulation. During the Great Depression, President Roosevelt introduced a New Deal of relief, rehabilitation and reform, and used state intervention to help the United States weather the economic crisis. Roosevelt, who introduced the New Deal, was a Democrat. When Obama campaigned as the Democratic presidential candidate, his main campaign platform was this healthcare reform policy. After taking office, he implemented this policy and included more than 30 million Americans in the scope of medical insurance.
However, this reform has caused a lot of controversy in the United States, and the current President Trump has always insisted on its abolition. Many people may think: Is it not a good thing that everyone has medical insurance? But in the United States, it's actually not that simple.
One controversy brought about by this bill is that the average American spend on medical insurance has soared. In 2015, the cost of healthcare in the United States was approximately US$3.2 trillion, with an average of nearly US$10,000 per person. Major expenditure items include hospital care (32%), physicians and clinical services (20%), and prescription drugs (10%). In 2016, medical costs in the United States were much higher than other OECD countries, accounting for 17.2% of GDP, while Switzerland, the second highest country, accounted for 12.4% of GDP. And what does this 5% difference in GDP ratio mean? That means $1 trillion.
这项法案引起的一个争议是美国人在医疗保险上的平均支出已经飙升。 2015年，美国的医疗保健费用约为3.2万亿美元，平均每人近10,000美元。主要支出项目包括医院护理（32％），医生和临床服务（20％）和处方药（10％）。 2016年，美国的医疗费用远高于其他经合组织国家，占GDP的17.2％，而瑞士是第二高的国家，占GDP的12.4％。 GDP比率相差5％意味着什么？这意味着1万亿美元。
Money does not appear out of thin air. Where do these extra expenditures come from? Two methods: increase revenue and reduce expenditure.
Open source means increasing taxes from high-income groups, and fines for those who refuse to buy insurance. The Republican Party strongly opposes this approach. They believe that charging high taxes on high-income groups is an unfair practice, and it will cause losses to those who create more wealth for the society. If you take their money away for use by the poor, it is a "robbing of the rich." Help the poor". Therefore, Obama's reforms have offended high-income groups.
To cut expenditure is to reduce the government's investment in medical institutions and save money. But in this way, it will cause dissatisfaction among all stakeholders, and it will also cause the price of medical insurance to rise to a certain extent.
There is another problem: there are many types of medical insurance in the United States. Elderly people over 65 years old and low-income people can obtain cheaper insurance from the government (as the US population becomes more and more aging, this also gives the government A lot of pressure). Specifically:
There is a policy called "Medicaid", which is a government insurance plan for people of all ages whose income is not enough to pay for medical expenses. Simply put, it is the medical insurance subsidy for the poor. As of 2017, it provides free medical insurance to 74 million low-income and disabled people (23% of Americans).
Another policy is called "Medicare", which mainly provides cheap medical insurance for Americans 65 and older. It also provides some young people with disabilities identified by the Social Security Administration, as well as those with end-stage renal disease and amyotrophic lateral sclerosis. Medical insurance is provided for the sick. In 2018, the policy provided 59.9 million people with medical insurance, of which 52 million were over 65 years old, and the policy covered about half of the cost.
For the poor, the government manages insurance; for the elderly, the government provides cheap insurance. But many middle-class people can only buy relatively expensive commercial insurance. Therefore, many people who are too expensive and do not buy insurance are actually young and middle-aged, and the probability of getting medical insurance is not high, or even the chance of getting sick. So they choose not to buy it because they think they don't need it.
Obama makes these people who think they don’t need medical insurance to buy medical insurance, which will naturally cause dissatisfaction. Most of these people are neither high-income earners nor destitute. Obama's health care reform has also increased the economic pressure on the middle class. For those who have no money, the government takes care of their medical insurance; for those who are rich, the government deducts money from them. What is the fairness? In this way, Obama also offended the middle class. In addition, the Republican Party also stated that forcing everyone to spend money on medical insurance is against the US Constitution.
Trump's view is that the medical insurance system should operate in accordance with the principles of a free market. Therefore, he has always been committed to overthrowing Obama's policy. But in fact, one of the reasons why medical care is so expensive in the United States is that medical care is highly market-oriented.
Most hospitals and medical insurance in the United States are privately owned. Similarly, medical devices and drugs are mostly developed by private companies. The United States has invested a lot of money in the research and development of medical devices and drugs, both from public resources and from private sources.
The high prices of patented drugs in the United States have also encouraged substantial reinvestment in this type of research and development. As a result, the price of related medical services will also increase, including the price of labor, the price of medicine, and the price of diagnosis. Moreover, if there is really free competition in the market, drug prices could have been lowered. However, many medicines have patents and are protected by law, thus gaining a monopoly position, and the prices cannot be lowered. Generally speaking, after a patent is granted, one can have up to 20 years of market exclusive rights. But even if the patent is about to expire, drugmakers will find ways to delay the listing of related generic drugs. For example, they applied for a patent for the coating of this drug and a patent for the pharmaceutical method of this drug. As a result, cheap generic drugs could not enter the market for a long time.
Moreover, the U.S. medical system has clearly underutilized preventive measures. Uninsured Americans usually choose to "carry" when they get sick, and they can't wait for treatment before going to the disease, which often costs much more than they choose to continue treatment. During treatment, there are also cases of over-utilization of medical services. There are many unnecessary treatments that increase costs.
A 2017 survey report showed that after a survey of the health care systems in 11 developed countries, it was found that in terms of access to, efficiency and fairness of medical services, the U.S. health care system is the best among these 11 developed countries. The most expensive and least efficient system.
For Americans, they are unwilling to go to the hospital because they are sick. Besides being expensive, there is another reason: Before going to the hospital, they need to call to make an appointment instead of going to the hospital to register at any time like the Chinese do. This has also caused many Americans to be reluctant to go to the doctor when they are mildly ill, because the waiting time for the doctor is often several days.
Therefore, the common people in the United States usually go to a doctor through a family doctor instead of going to a big hospital.
Family doctors in the United States do not work in hospitals, they have their own offices. In the United States, almost every family has its own family doctor (these family doctors are all qualified and their information is available online). If Americans are not serious, they will see a family doctor. If the family doctor can solve it, they can solve it directly; if it can’t be solved, the family doctor will introduce a specialist to the patient.
Of course, family doctors are not one-to-one, they will meet multiple families at the same time. In other words, this is a bit like a Chinese clinic. However, American families generally choose a fixed family doctor and do not change frequently.
Unlike going to the hospital, there is basically no need to wait too long to see a family doctor. You can usually see the doctor on the same day or the next day. Every year, Americans have a physical examination with their family doctor.
Therefore, there are huge differences between the US medical system and the way patients see a doctor. Although the United States is a highly developed country and medical technology is also world-leading, it is not as many Chinese imagined that all people have good medical benefits. On this issue, they are also constantly exploring.
All in all, every country has its own cultural, social, and ideology. There is no omnipotent system in the world, and it works in every corner. Therefore, prescribing the right medicine is a responsible attitude towards the people. However, "seeking truth from facts" and "serving the people" should be two principles that apply everywhere. Regardless of the system, these two points should always be adhered to.