In 2015, national healthcare expenditures grew 5.8 percent to $3.2 trillion, or $9,990 per person, and accounted for 17.8 percent of Gross Domestic Product (GDP), but are we getting our money's worth? The details by type of spending or product, the major source of funds and type of sponsor can be found in the CMS.gov linked report.
According to columnist George Will, U.S. healthcare spending alone is larger than all but four of the world's largest total national economies; I'll take his word for it because the comparison number isn't important except to say, "wow" — it's fast approaching $1 out of every $5 spent on anything in our economy and that is important.
Healthcare in the U.S. became a de facto entitlement long ago. It makes no difference if you get it through your employer or from one of the countless government programs; Medicare, Medicaid, MediCal, the State Children’s Health Insurance Program (SCHtIP), TRICARE, VHA, and/or IHS — it’s almost all paid for or subsidized by the taxpayers directly or indirectly. Out-of-pocket costs, which one has to assume includes co-pays, and might also be tax deductible, were only 11 cents on the dollar; the other 89 cents came from a government program or insurance.
Those government programs alone cost more than $980 billion annually, tax expenditures for healthcare another $260 billion, and the value of the tax breaks are more than $1 trillion ($1,000 billion) over five years.
Additionally, there are the direct public costs at every level. For example, in 2015 the 1.3 million California county, city, K-12, and Special District employees who qualified for benefits received $10.7 billion in tax-free health insurance worth, on average, $8,100 each paid from public funds.
Someone without health insurance, employed or not, likely qualifies for some degree of help, subsidy or tax deduction, many qualify for several programs at the same time. Even the destitute get medical care.
All rolled together if that isn't an entitlement, I don’t know what is.
The U.S. is overflowing with medical care, maybe not where you want it and when you want it, but it’s available somewhere, always at a cost to someone. It’s a business and like any other business it tends to flock to the places and specialties where there is money to be made.
A heck of a lot of companies and people are making a living in the healthcare industry. More people are in it for the money than to be Dr. Kildare; there is no shame in that, but it’s important to remember that most products and services cost whatever the traffic will bear and there has been no traffic cop working on healthcare highway, so costs are out of control.
The Republicans believe they can get rid of the subsidies, they are only kidding themselves since everyone has them in one form or another; the Democrats believe that if they just got rid of the insurance company profits all would be well, they are as foolish as the Republicans because insurance payments are making up the difference in the cost and what the government pays which cannot sustain the system.
Both recently learned that lesson. First in California, where the Democratic-dominated legislature found itself unable to pay for the proposed $400 billion single-payer plan just to cover MediCal and some related programs, then in D.C. where the Republican-dominated House couldn't even pencil out a working alternative to the Affordable Care Act, itself nationally un-affordable in spite of its catchy title.
Both parties are afraid to take on the real problem, the cost, which means you have to take on the unions, the medical establishment from bottom to top, all their manufacturers, suppliers and service providers, and especially the entitled patients none of whom have any incentive to worry about costs. After all, they believe that it’s all OPM (Other People’s Money).
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