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Almost 100 Million People a Year 'Forced To Choose Between Food and Healthcare' (theguardian.com) 415

Almost 100 million people are pushed into extreme poverty each year because of debts accrued through healthcare expenses. From a report: A report, published by the World Health Organization and the World Bank this week, found the poorest and most vulnerable people are routinely forced to choose between healthcare and other necessities for their household, including food and education, subsisting on $1.90 a day. Researchers found that more than 122 million people around the world are forced to live on $3.10 a day, the benchmark for "moderate poverty," due to healthcare expenditure. Since 2000, this number has increased by 1.5% a year. A total of 800 million people spend more than 10% of their household budgets on "out-of-pocket" health expenses, defined as costs not covered by insurance. Almost 180 million people spend a quarter or more, a population increasing at a rate of almost 5% per year, with women among those worst affected.
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Almost 100 Million People a Year 'Forced To Choose Between Food and Healthcare'

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  • Don't be mistaken (Score:5, Insightful)

    by damn_registrars ( 1103043 ) <damn.registrars@gmail.com> on Thursday December 14, 2017 @10:21AM (#55738203) Homepage Journal
    The reason health care is so costly in the US can be found at the top of the insurance companies. Many of the top execs of these companies - including the ones that are listed as "non-profit" or "not-for-profit" take in guaranteed annual bonuses that exceed the lifetime earnings of most Americans. The "Affordable Care Act" just gave these greedy capitalists the keys to the kingdom as well, in guaranteeing them customers for the rest of time.

    People dropping out of the insurance market and having no coverage won't solve this problem. The solution is to finally have our country behave like a modern industrialized nation and have a single-payer system. It's too bad nobody was willing to propose such a sensible thing. [berniesanders.com]
    • Re: (Score:2, Insightful)

      by Train0987 ( 1059246 )

      Single-payer would bankrupt the country. There will never be enough of anything to satisfy demand completely.

      The solution is to relax regulations, not increase them. Remove the artificial limits placed on the number of doctors by the AMA, relax the burdens on licensing, etc. Cap malpractice payouts through tort reform.

      • Re: (Score:2, Insightful)

        by Anonymous Coward

        This is so dangerously stupid.

        • Why exactly is dangerous and stupid?

          You think this idea is wrong, but I believe there to be evidence that this *could* be at least partially right on some points.

          • Why exactly is dangerous and stupid?

            I sense presence of the libertarian shibboleth that the free market will fix everything. That is what is dangerous and stupid.

            Also the reliance on shaky facts, common among libertarians. I don't want to get into a long discussion but let's just pick out one since it was mentioned:

            Cap malpractice payouts through tort reform.

            This has always been an appeal to emotion rather than reliance on actual facts and figures. My dad was a personal injury lawyer for 60 years and had gotten record-setting multimilion dollar malpractice settlements. Outrageous?

      • by mridoni ( 228377 ) on Thursday December 14, 2017 @10:39AM (#55738359)

        Single-payer would bankrupt the country. There will never be enough of anything to satisfy demand completely.

        Well, I just can't understand how most of Europe and Canada do it without actually going bankrupt.

        • Re: (Score:2, Informative)

          by Anonymous Coward
          By limiting services as much as possible.
          • by OrangeTide ( 124937 ) on Thursday December 14, 2017 @10:50AM (#55738459) Homepage Journal

            Yet everyone gets their insulin in Canada. I can't say the same for USA.

            There is limiting services through budget constraints that are applied broadly. And there is limited services by not providing any services to lower class people. Which model do you think we have in the US?

            • In the USA you just show up at ER and don't pay if you don't have a med plan and they can't turn you away.

              • by Train0987 ( 1059246 ) on Thursday December 14, 2017 @11:38AM (#55738879)

                And the rest of us absorb those costs. That's another reason why prices are out of control.

              • In the USA you just show up at ER and don't pay if you don't have a med plan and they can't turn you away.

                That is not entirely true. If you are having a medical emergency the ER cannot turn you away for lack of insurance but that doesn't mean they can't bill you for coming in - and they will. They're just limited in how far they can go with their attempts to collect on fees before they hand them over to the government.

                Furthermore as already pointed out the hospital only needs to stabilize you. If you need an organ transplant and you have no insurance, that simply won't happen. If you went in because you were suicidal you'll be kept for a couple days and then sent right back out.

              • This nonsense again (Score:5, Informative)

                by fyngyrz ( 762201 ) on Thursday December 14, 2017 @11:52AM (#55739045) Homepage Journal

                In the USA you just show up at ER and don't pay if you don't have a med plan and they can't turn you away.

                The ER has to try to stabilize you. They don't have to provide needed treatment beyond that, or drugs — and they won't. What they will do is determine what will stabilize you, do that, give you perhaps one dose of whatever prescription(s) is(are) needed which you can then go get from a pharmacy if you can pay for it, and refer you to a doctor, who you can also go to if you can pay for it, and that's the end of it.

                You have cancer? Diabetes? A hernia? You're not going to get the treatment you need for that at the ER. Period. The ER does things that are specific to the moment, like set a broken arm. Still, you get to pay for the meds, and any follow-up care.

                ER visits are not even remotely comparable to appropriate medical care for anything serious. People who claim it is have no idea what they are talking about.

              • In the USA you just show up at ER and don't pay if you don't have a med plan and they can't turn you away.

                I believe that's called the illegal alien plan. It passes the costs onto the rest of us who actually do pay.

        • Vermont tried it (Score:4, Informative)

          by Kohath ( 38547 ) on Thursday December 14, 2017 @11:13AM (#55738647)

          Well, I just can't understand how most of Europe and Canada do it without actually going bankrupt.

          By starting 50 or 75 years ago and keeping costs from rising year after year up until the present.

          Vermont tried to go single-payer a couple years ago. They couldn’t make it work [dallasnews.com] because there was no way for them to cut doctor and nurse salaries enough to make the financing work out.

          If you want to understand, start by learning from Vermont's experience.

        • Single payer would bankrupt the country if we left the system as it is today, which is ludicrous.

          Show of hands: Who here thinks charging someone $2k for 10 minutes in an MRI sounds fair ?

          How about $20k / hour for a surgery ?

          $30k for a ride on life-flight ?

          $150k for a thirty day hospital stay ?

          $200k for a round of chemo ?

          These numbers aren't made up folks. They are quite real. Can you afford it as they are today ?

          The fix is simple: As part of the plan to go single payer, you first have to regulate how muc

        • Re:Don't be mistaken (Score:5, Informative)

          by Kjella ( 173770 ) on Thursday December 14, 2017 @12:37PM (#55739493) Homepage

          Well, I just can't understand how most of Europe and Canada do it without actually going bankrupt.

          It's because US people put up a straw man and cut it down. A single payer system means it's funded almost entirely by taxes (here in Norway co-pay is ~$30/visit and capped at ~$250/year), it doesn't mean they got infinite money or resources and it doesn't mean they deliver everything the patients want or need. There's only so many hospitals, doctors and nurses as the budget permits. Treatments are granted based on medical need and ranked based on quality-adjusted years of life. Waiting lists are prioritized on urgency and impact. It's not the best care money can buy, it's trying to be the most fairly distributed level of care possible at that funding level.

          Single payer doesn't mean exclusively public employees, there are many private doctors and institutions delivering services into the public system. But apart from that there's also truly private insurance and private healthcare, if you can afford it. It's not subsidized, you don't get a tax refund and it caters to a market that won't wait and won't take anything less than excellence. LIke if a pro sports player is injured and need surgery, they often use that because in the public system they're not special and you can't pay to get to the head of the line. Same way some people bankroll certain medications we've rejected to give because of cost, typically >$100k/year. Even though they're medically proven to work and the patient will die sooner.

          So if it's not a happy wonderland, why is it working better? Because we don't have insurance people trying to save costs by denying coverage. We don't have doctors that earn more by billing more or get kickbacks from selling brand drugs. While there's an ever ongoing pressure to reduce costs, we're not looking to cherry pick profitable patients and hospitals don't get stuck with unprofitable ones. For the most part we simply have medical personnel and administrators trying to balance out the limited resources based on who needs it most. And they're actually pretty good at it, as long as they don't get other personal incentives.

          Just to take one example, there's a national standard for average ambulance response time which says it should be <12 minutes in >90% of the cases in urban areas and <25 minutes in >90% of the cases in rural areas. Poor or rich area? Easy or hard geography? Doesn't really matter. The money is distributed so it's mostly uniform no matter where you live, we're not quite hitting that metric but then we'd rather fall a little short most places rather than fail spectacularly in a few. Those are the stretch goals, on the low end you have a standard of adequate healthcare which is like a legal minimum. It's a pretty low bar though where violations are usually human error, flaws or failures in the system like say no ambulance is actually dispatched. It's not your typical triage.

      • by dcw3 ( 649211 ) on Thursday December 14, 2017 @10:57AM (#55738509) Journal

        Bullshit. Single payer removes a middleman that is of no value added, and in fact raises the total cost of healthcare.
        And, for whatever it's worth, I'm saying this as a fiscal conservative.

        • by Kohath ( 38547 )

          Single payer removes a middleman that is of no value added

          How is a government bureaucrat paying a doctor less of a middleman than an insurance company bureaucrat paying a doctor?

          • Medical insurance companies tell the hospitals what they can charge for any given procedure based on the individual plan the customer has purchased. Depending on your plan the the cost of the procedure and the copay will differ. There are only two major health care insurance providers in the US. On the west coast this is Bluecross/Blueshield for instance. Every other provider is a reseller of their products who make money by slightly changing the packages and adding things like vision and dental (also p

            • by Kohath ( 38547 )

              That's a lot of text, but it doesn't make a government payer not a middleman.

              • by Alsn ( 911813 )
                Said text also includes a suggestion at the end that in one of the cases where that government IS the middle man, costs are lower. I'm not American, so I don't really know what to compare it to, but unless that part is an outright lie, the text does indeed seem to suggest that a government payer is a *better* middleman.
        • by Shotgun ( 30919 )

          Bullshit. You've just changed the middleman to a government bureaucrat.

      • by damn_registrars ( 1103043 ) <damn.registrars@gmail.com> on Thursday December 14, 2017 @11:01AM (#55738531) Homepage Journal

        Single-payer would bankrupt the country.

        Just because the GOP says that, doesn't make it true. The rest of the industrialized world uses some form of single-payer and their nations aren't going broke. We use a market-based system with essentially no floor and we are going broke. We are the only industrialized nation where it is even possible to go bankrupt due to medical debt.

        The solution is to relax regulations, not increase them

        Single payer does relax regulations. The biggest barriers to health care right now come from the insurance industry, not the government.

        Remove the artificial limits placed on the number of doctors by the AMA

        You really need to look in to what you're saying. Several problems exist with that statement.

        First of all, we have alternative paths to practicing medicine. Ever hear of a Nurse Practitioner? They are able to practice medicine on their own now in several states. Ever hear of a Physician's Assistant? They are taking patients independently for routine cases in many states as well. Ever hear of a Doctor of Osteopathic medicine? They can also see patients on their own. We also have pharmacists who can do more patient care than before in many situations - they are doing a lot more now than just handing out prescriptions and selling Sudafed.

        Do you really want someone practicing medicine who has less qualifications than that?

        Cap malpractice payouts through tort reform.

        Malpractice payouts are a trivial expense compared to what goes to the top of the insurance industry. In fact most doctors pay vastly more in malpractice insurance than they will ever pay in malpractice settlements. The reason why so few doctors go in to Obstetrics (for example) isn't because they are actually concerned about the possibility of committing malpractice, but because the insurance industry requires them to carry absurd terms for their malpractice insurance. Sure, the lawyers are getting a big cut but it is dwarfed again by what the insurance company execs get - and the insurance execs get it regardless of their own performance while the lawyers have to prove a case in court to get the big paycheck.

        In other words the bulk of your argument reads like an ad for the insurance industry.

        • by c ( 8461 ) <beauregardcp@gmail.com> on Thursday December 14, 2017 @12:04PM (#55739163)

          Single-payer would bankrupt the country.

          Just because the GOP says that, doesn't make it true.

          If the GOP were in charge of single-payer, they'd make it true.

      • by Computershack ( 1143409 ) on Thursday December 14, 2017 @11:03AM (#55738549)

        Single-payer would bankrupt the country. There will never be enough of anything to satisfy demand completely.

        The solution is to relax regulations, not increase them. Remove the artificial limits placed on the number of doctors by the AMA, relax the burdens on licensing, etc. Cap malpractice payouts through tort reform.

        Its not bankrupted any other first world country which has universal healthcare free at the point of need. The tax burden per capita of the UK NHS is the same as the tax burden per capita in the USA for Medicare and Medicaid yet the NHS covers 100% of the population. It may not be perfect but people don't have to make the choice between getting treatment and eating.

      • Your solution is to not require medicines get vigorously tested before being prescribed?

        Or to not be able to sue the bejesus out of the surgeon who accidentally amputates the wrong leg?

        • by Shotgun ( 30919 )

          I worked for a short stint at a medical company. They developed tests for cognitive ability to be used during medical trials. I automated QA for a web interface.

          Their entire process was stilted by a need to generated literally several reams of paper in an attempt to overwhelm "investigators". I use quotes, because the FDA people would come in and make comments like a sheet of the eight page "script" was not signed, or was signed but the date was missing. I'm saying that the FDA people added actually zer

      • to the job killing regulation that is the medical license. If it's good enough for Dr Nick Riviera it's good enough for me. And let's not let anyone sue Dr Nick, heavens no. Sure, he used an artichoke heart instead of a human on, but he passed the savings on to you!

        Oh, fyi, payouts for medical malpractice, according to this [getreferralmd.com] very pro tort reform (I hate calling it that) website are only $3.6 billion. This is /., so this story didn't belong here in the first place (news for nerds) but as a nerd I trust you
        • Is the party med school.

        • by Shotgun ( 30919 )

          How many doctors get successfully sued? What happens to THAT small percentage of doctors?

          The thing your statistic misses is that only a small percentage of the doctors make up that .3%, but those doctors are totally destroyed. In response, the doctors that are NOT part of that .3% go to extraordinary lengths, unreasonably expensive lengths, to make sure they don't wind up part of that .3%.

          It's the tail wagging the dog, like how we all have to get cavity searched to ride an airplane, because of a few box k

      • Single-payer would bankrupt the country. There will never be enough of anything to satisfy demand completely.

        The solution is to relax regulations, not increase them. Remove the artificial limits placed on the number of doctors by the AMA, relax the burdens on licensing, etc. Cap malpractice payouts through tort reform.

        That depends on many factors. Are we talking about health care for US citizens or for illegals also? Are we talking about paying the highest cost in the world for the same medications or do we get prices on par with Canada? If we restrict the conversation to US citizens and we treat it as an engineering problem and intelligently attack it I'm confident it could be solved. If instead we get distracted by politics and political correctness (ie is the diversity enough, lobbyist companies get higher no bid

      • This just doesn't mesh, we currently pay more tax dollars on healthcare in the US per capita than countries which have single payer while offering inferior healthcare to most.

        How is capping malpractice payouts relaxing regulations? If you want to cut cost by removing regulations, remove the regulations that reduce competition by making the FDA approval process completely tax subsidized and provide a public option that disregards patent awarding contracts to third parties to produce a subset of the most expe
    • by kaybee ( 101750 )

      I'm not saying it isn't a problem, but if you divide out the CEO compensation by the number of insured people, you'll find it isn't going to be that significant. I'll do the math for you if you reply with the most egregious health care CEO salary you can find.

      • You get compensated for risk, responsibility, and skill. I'm generally OK with that, except that mostly we see that word 'responsibility' being seen as a perfect synonym for 'authority', which it is not.

        And the risk? Well, your risk is that your obscene (to most people) income will be temporarily interrupted until your peers install you in the next available slot... and you get a big payout to cover your expenses until that happens. And even if it all somehow goes completely to shit, you still have so mu

        • by ranton ( 36917 ) on Thursday December 14, 2017 @11:03AM (#55738555)

          It's not how much they draw compared to each person, it's how much they draw in total. It is, in fact, obscene.

          Considering this thread was started with the statement: "The reason health care is so costly in the US can be found at the top of the insurance companies.", the only thing that matters is how much they draw compared to each person. For the purposes of this discussion that is. Whether or not their pay is obscene has no bearing on whether or not it is the reason health care is so costly in the US, which is the contention which was being refuted by the post you replied to.

          Based on the figures I found here [propertycasualty360.com] the top 10 highest paid insurance CEO's made $159 million in 2014. That is about $1.30 per household. I don't think health care costs are so high just because of an extra ten cents per month we all pay extra to pay these CEO's.

          If I use Amtrust Financial Services (home of the highest paid CEO above) as a model, the entire C-level suite including the CEO made 261% of the CEO's pay. So I'll estimate that the C-level suite at the 10 companies above were paid $415 million in 2014, which is about a quarter per household per month.

          If you factor in every C-level executive in every insurance company in the US, I doubt you would come to more than a couple dollars per household per month. That is not why insurance is so expensive. I would still agree that private insurance companies are the number one reason why health care is so expensive in the US but it has far more to do with the stockholders who demand return on investment (gasp, the horror) than it does with obscene CEO pay.

      • And what justification do you have for dividing the CEO compensation by the number of insured people, rather than dividing the CEO compensation by the number of CEOs? Sure, you can make any big number small by dividing it by a big number.

        • by kaybee ( 101750 )

          Sure, take the total compensation of all CEOs of all healthcare companies, then divide by the number of insured, and the number is still small. It doesn't change anything. If you want to add it up go ahead.

          Meanwhile, Google tells me this is the highest-paid healthcare CEO, at $22 million per year:

          https://www.fiercehealthcare.c... [fiercehealthcare.com]

          Looks like they have 12 million members:

          https://www.centene.com/ [centene.com]

          So, definitely the $1.83 per year that he is taking from each member is really ruining their lives.

    • Everything in your first paragraph is true -- despite the loaded phrase "greedy capitalists". But you cannot just plop "single payer" in like a grand solution. Every other country with single payer has their own collection of horror stories of needed treatment and diagnostics being pushed out months. All these countries still have third-party health insurance available to cover things their government has deemed unnecessary or has not adequately provisioned for.
    • by pots ( 5047349 )
      The cost of health care in the US is a pretty robust problem. There's no single culprit, the executives that you talk about at insurance companies and elsewhere do take a chunk of it, but given the size of health care expenditures it's not enough to make a big difference. The insurance companies have fairly thin profit margins.

      The largest single factor (i.e.: the group with the highest profit margins) are the pharmaceutical companies. They've been given essentially free reign, with minimal limitations an
  • by OffTheLip ( 636691 ) on Thursday December 14, 2017 @10:26AM (#55738233)
    I'm surprised it's not a greater percentage than that. It is for me.
  • That's one way to cure obesity I guess.

    Or unemployment and homelessness.

  • That's barely 1% of the world population. I think that's damned impressive.

  • Give all the Stats you want. In America, one of the richest country's in the world, we simply don't give a shit about Poverty or Healthcare issues and have no interest in solving them.

    • by dcw3 ( 649211 )

      Depends.

      We have our own poor to take care of. I you can't solve that, than you have no business trying to solve it for the rest of the world. Do we really need to be sending money around the world when we have homeless on the streets of every major city? How about all of those veterans who still can't get help in spite of all the media attention that was brought to it over the last couple years?

      Many of us who do have decent healthcare are not pleased with our premiums skyrocketing. This isn't giving us

  • Plan B is jail/prison (cover more then er and free food)

  • News for Nerds? (Score:4, Insightful)

    by SpaceBoyToy ( 2633691 ) on Thursday December 14, 2017 @10:54AM (#55738489)

    First of all, I don't want to minimize the seriousness of this topic. It deserves discussion and action. I'm just not sure it belongs here, on this site.

    I have come to /. for many years to stay up to speed on the latest tech news and other interesting news that interests me. I also follow many other sites for political content. Lately, every site has seemed to wade into politics more than usual. I understand we live in a hyper partisan environment. However, we must have some safe havens from it. This site serves as that, to some extent, for me. I would hate to see it devolve into yet another political dystopia.

    This site was built for a particular niche. I don't know about the rest of you, but I would like to see it stay in the niche.

    • by davek ( 18465 )

      Mod parent up. Stories like this are why I rarely read /. anymore.

      There are plenty of sites for political flamewars. It would be nice if this site went back to being one for only tech-y political flamewars.

  • In my country (Spain) and quite a few other ones, medical expenses rarely represent an issue as far as a part of all the salaries (and contributions of companies/self-employers) is being used to pay for the public health care system. I could even stop working/contributing for some years without losing these benefits (I did over-contribute in the past); but even people with no work or illegal immigrants can enjoy it under quite a few scenarios. You only use paid/private alternatives either voluntarily or for
    • by tsqr ( 808554 )

      In my country (Spain) and quite a few other ones, medical expenses rarely represent an issue

      And yet your country with a pubic health care system, and my country (US) without one, are in the same boat with respect to "catstrophic spending" on health care. More info here. [worldbank.org] (PDF)

  • If I have to choose between living and bankrupting my family,

    I'm gonna die, and as quickly as possible.

  • So-called 'health insurance' only really benefits you if you become seriously ill or injured. Otherwise all it does is suck money out of your pocket every month and give you nothing in return. In my opinion, if the average person spent money every month on physical activities and eating healthier instead of spending that money on so-called 'health insurance', they'd find that they don't need 'health insurance'. They'd be stronger, more resistant to injury and illness, lower chance of cancers or heart diseas
    • Agree wholeheartedly. Layer a high-deductible policy on top of that (true "health insurance" for big, unexpected problems rather than the make-my-office-visits-and-pills-a-bit-cheaper system we have today), and the vast majority of people would be set.

  • You can look at the LASIK clinics for an example of a medical industry which is mostly unaffected by insurance, since it is generally considered an elective procedure. The price is mostly quoted up front, and you can shop around for a better price, or go for a more reputable doctor. From what I can tell, price is also much lower than most procedures covered by insurance. Of course, if you can't afford LASIK, then you simply don't get it done, so there is a much smaller coercive price driver.

    Actually, on sec

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