US spends most on health care but has worst health outcomes(wesh.com)
wesh.com
US spends most on health care but has worst health outcomes
https://www.wesh.com/article/us-health-care-worst-outcomes-high-income-countries-new-report/42745709
133 comments
Private insurance doesn't have to be bad. Netherland has private insurance, and it works fine. Admittedly we've got probably the most expensive healthcare system in Europe, but it's still about half of what the US pays. But it does need to be tightly regulated, and more importantly, the healthcare system itself needs to be regulated. There needs to be a drive to lower costs while increasing quality. And of course the insurance company needs to take care of the costs. I see far too many stories about people having to fight their own insurance company.
The real fundamental problem I think is that the US healthcare system is primarily run for profit, and not for the health of the people. Both by insurance companies (who strongly resist paying), and by hospitals and other healthcare providers (who love to spring unexpected costs on you). That's the primary difference between the US and Dutch systems.
The real fundamental problem I think is that the US healthcare system is primarily run for profit, and not for the health of the people. Both by insurance companies (who strongly resist paying), and by hospitals and other healthcare providers (who love to spring unexpected costs on you). That's the primary difference between the US and Dutch systems.
>Netherland has private insurance, and it works fine.
Fine-ish. For example some medications are not available because the insurance companies decided they would pay only for the cheapest generics and then only the lowest prices of anyone. For some reason this means that manufacturers decide to only supply to the Netherlands when they have ample supply.
Also there are the inefficiencies of the insurance companies who are for profit entities that spend large ammounts of money on their executive teams and ad campaigns to convince people to switch their policy to a difference insurer.
Fine-ish. For example some medications are not available because the insurance companies decided they would pay only for the cheapest generics and then only the lowest prices of anyone. For some reason this means that manufacturers decide to only supply to the Netherlands when they have ample supply.
Also there are the inefficiencies of the insurance companies who are for profit entities that spend large ammounts of money on their executive teams and ad campaigns to convince people to switch their policy to a difference insurer.
That's why I said fine, not great. There's tons of room for improvement, but it's not the disaster that the US health care system is.
But obviously any system that involves for-profit companies with executives and shareholders is going to siphon some money out of the system. I don't doubt socialised healthcare systems are fundamentally cheaper, and if done well, at least equal in quality. I'm just saying it's not just the privatised nature that's crippling the US system; it's certainly not helping, but it's aggravated by being a particularly poorly implemented privatised system that's entirely about profit and doesn't really care about the people it's supposed to help.
And let's not fool ourselves; there are also wrong ways to do socialised healthcare. I do think socialised is generally better, but you always have to look critically at all the parts of the system.
But obviously any system that involves for-profit companies with executives and shareholders is going to siphon some money out of the system. I don't doubt socialised healthcare systems are fundamentally cheaper, and if done well, at least equal in quality. I'm just saying it's not just the privatised nature that's crippling the US system; it's certainly not helping, but it's aggravated by being a particularly poorly implemented privatised system that's entirely about profit and doesn't really care about the people it's supposed to help.
And let's not fool ourselves; there are also wrong ways to do socialised healthcare. I do think socialised is generally better, but you always have to look critically at all the parts of the system.
It may not have to be bad but it is absolutely an unnecessary siphon of funds out of the healthcare system. Simply put every single ass in a seat at an insurance company is $N not being spent on providing actual healthcare.
Some administrators are going to be necessary to run any sort of healthcare system. Just as an example, someone has to prepare and send each doctor a W-2 every year.
Ok so are we now pretending hospital administration staff doesn't already exist? Or that the simple majority of employees in Dr's offices aren't there solely to process insurance claims? So again, for the cheap seats, insurance companies: 100% overhead, 0% healthcare provided.
Good point. Not sure what I was thinking when I wrote that. No insurance adjusters around, nobody needs to issue them paychecks.
In David Graeber's book "Bullshit jobs", there's a quote from Barack Obama saying that strongest argument against overhauling the US health system is the millions of lost jobs from the insurance and adjacent industries. So there seems to be your answer, from the horse's mouth.
The Insurance industry is a bug vampire squid sucking money out of the system, and ironicly stopping many from getting the health outcomes they need.
A small group chat I’m a part of has one person who works for an insurance company. Reading his messages about his work day is just depressing.
“Oh, yeah, if someone has that cancer and they’re under 45 it’s an auto-reject from me. Just too unlikely for them to have it” was one message that’s stuck with me. You (or your company) pays thousands of dollars a year (or more) to an insurance company to cover you for when the worst things happen—and despite you or your doctors trying to get your shit together, somebody chilling 1500 miles away skims your report and auto-declines any form of coverage just because it seems unlikely. Then it’s an uphill battle of trying to not only battle your illness and your daily life, but a company that has employees with worse judgement than an AI thrown together by some dude on Twitter in a weekend.
It’s disgusting to think about.
“Oh, yeah, if someone has that cancer and they’re under 45 it’s an auto-reject from me. Just too unlikely for them to have it” was one message that’s stuck with me. You (or your company) pays thousands of dollars a year (or more) to an insurance company to cover you for when the worst things happen—and despite you or your doctors trying to get your shit together, somebody chilling 1500 miles away skims your report and auto-declines any form of coverage just because it seems unlikely. Then it’s an uphill battle of trying to not only battle your illness and your daily life, but a company that has employees with worse judgement than an AI thrown together by some dude on Twitter in a weekend.
It’s disgusting to think about.
how.... how... can they reject anything that the hospital says?
Because they are allowed to. Having no (useful) regulation allows that and more. And no it's not abuse, it's the system working as designed. If there's a problem with it, don't take it with the people in the system, as tempting as it might be. They will be replaced by others with the same reject-happy finger. It needs a new system, heavily regulated like in Europe, and this means exactly the uphill battle you would expect.
Propublica just ran a good article on UHG's attempts to deny coverage to a university student with severe ulcerative colitis. Apparently the insurer has its own panels of MDs that it can deploy to lobby the patient's doctor into different courses of treatment. In this case, UHG staff completely fabricated statements from the patient's doctor in order to justify reducing care to an ineffective level. https://www.propublica.org/article/unitedhealth-healthcare-i...
They are not rejecting what the hospital says. I imagine pigsty’s account is missing some nuance, such as an uncommon diagnosis or prescription requiring further proof. The doctor might think (and might very well be guessing correctly), but the protocols require a certain level of evidence that was not provided.
It could also be malfeasance, but I doubt that is happening on a systemic level at the big health insurance companies. They benefit from more healthcare spending, so I do not see why they would want to tamp down on necessary expenses.
It could also be malfeasance, but I doubt that is happening on a systemic level at the big health insurance companies. They benefit from more healthcare spending, so I do not see why they would want to tamp down on necessary expenses.
They are rejecting on the presumption that the billing is erroneous. The hospital would follow up and get it approved. It’s a crude system and I’m not excusing it.
You understand that if the Insurance industry didn't exist we would just re-create it right? I mean, if you tell people they can spend any amount of money on healthcare they will bankrupt whatever pot of money is available. You're just suggesting we go from saying the Insurance industry is terrible to saying whatever Government agency is running healthcare is terrible.
Read about how doctors and patients talk about Medicaid, Medicare or Tricare. If you say they're popular I'd agree with you - but you need to see what people say when they're asked if they like their own private insurance; generally that's popular too. Most people like whatever health insurance they have most of the time because insurance only pinches in edge cases - not when I'm healthy and only in the subset of sick case called "I want a treatment that my insurance won't pay for." Those cases are always going to happen and sometimes it will be for legitimate reasons.
Read about how doctors and patients talk about Medicaid, Medicare or Tricare. If you say they're popular I'd agree with you - but you need to see what people say when they're asked if they like their own private insurance; generally that's popular too. Most people like whatever health insurance they have most of the time because insurance only pinches in edge cases - not when I'm healthy and only in the subset of sick case called "I want a treatment that my insurance won't pay for." Those cases are always going to happen and sometimes it will be for legitimate reasons.
> I'm generally a very conservative person. But even I am for government funded healthcare. Who in the hell is against it?
I'm European but there are major issues with waiting times, terribly low wages, strikes, ambulance provision, etc. in almost every country I've lived in.
Overall I think public healthcare is well worth it - in theory you can save a lot with one central purchaser, and even moreso if the government was willing to do drug discovery and production directly too.
But it is difficult to ensure future governments don't ruin it. It's kind of like why the unemployment funds and minimum wage negotiations being in the hands of trade unions instead of the government has worked out better in Sweden.
I'm European but there are major issues with waiting times, terribly low wages, strikes, ambulance provision, etc. in almost every country I've lived in.
Overall I think public healthcare is well worth it - in theory you can save a lot with one central purchaser, and even moreso if the government was willing to do drug discovery and production directly too.
But it is difficult to ensure future governments don't ruin it. It's kind of like why the unemployment funds and minimum wage negotiations being in the hands of trade unions instead of the government has worked out better in Sweden.
In US there is also major issues with waiting time. Like months for anything non-emergency. And emergency is just partially covered by an insurance anyway, so it doesn't really count. Also an Uber instead of ambulance.
Not sure about the wages and strikes though. But considering the fact that our neighbor doctor is a member of a yacht club, and the landlord who is another doctor had invested in a bunch of apartments that he lost the track of them, I guess they are fine.
Not sure about the wages and strikes though. But considering the fact that our neighbor doctor is a member of a yacht club, and the landlord who is another doctor had invested in a bunch of apartments that he lost the track of them, I guess they are fine.
The entire insurance industry, and almost all of the industries who make money from it, are against it, for one. There are many doctors and nurses who would also be incensed if you told them that they had to take less pay EVEN IF you also immediately eliminated all their education debts. Nurses in particular are heavily incentivized to work overtime because they usually work insane 12 hour shifts to begin with.
You also can't reform it if you aren't going to touch the pharmaceutical industry. There are medicines that cost $3K a month here that cost $0.50 in Africa for the same dosage. I can understand that the US is funding the military to a ridiculous degree to maintain its global hegemony... but I can't understand why voters think it's a good idea to allow pharmaceutical manufacturers to gouge the crap out of people.
Nothing about medical care is a traditional manufacturer / consumer relationship. I'd rather nationalize the pharma companies and all medical patents for medicines or devices which are sold more than a factor of 5x in the US over its lowest price.
You also can't reform it if you aren't going to touch the pharmaceutical industry. There are medicines that cost $3K a month here that cost $0.50 in Africa for the same dosage. I can understand that the US is funding the military to a ridiculous degree to maintain its global hegemony... but I can't understand why voters think it's a good idea to allow pharmaceutical manufacturers to gouge the crap out of people.
Nothing about medical care is a traditional manufacturer / consumer relationship. I'd rather nationalize the pharma companies and all medical patents for medicines or devices which are sold more than a factor of 5x in the US over its lowest price.
Is the long-run alternative that future medicines like that are available for $0.50/month worldwide or not available at all?
> many doctors and nurses who would also be incensed if you told them that they had to take less pay EVEN IF you also immediately eliminated all their education debts
If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.
> many doctors and nurses who would also be incensed if you told them that they had to take less pay EVEN IF you also immediately eliminated all their education debts
If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.
> Is the long-run alternative that future medicines like that are available for $0.50/month worldwide or not available at all?
Not if the government nationalizes the pharmaceutical industry and treats it like NASA, which it should have done a LONG time ago.
> If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.
Hospitals are overworking medical staff. The average nursing shift is 12 hours long. Most surgeons are putting in 60+ hours a week. The number of medical staff needs to increase and their work hours need to be normalized as much as possible. We've allowed medical associations to artificially gatekeep the populations of staff for no damned good reason.
Not if the government nationalizes the pharmaceutical industry and treats it like NASA, which it should have done a LONG time ago.
> If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.
Hospitals are overworking medical staff. The average nursing shift is 12 hours long. Most surgeons are putting in 60+ hours a week. The number of medical staff needs to increase and their work hours need to be normalized as much as possible. We've allowed medical associations to artificially gatekeep the populations of staff for no damned good reason.
> That we are all overweight is another.
https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...
Obesity vs overweight (the former is surely a better predictor of health outcomes anyway) aside, we’re definitely higher than comparable nations, but I wouldn’t say significantly so.
https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...
Obesity vs overweight (the former is surely a better predictor of health outcomes anyway) aside, we’re definitely higher than comparable nations, but I wouldn’t say significantly so.
Yes you are, especially when it comes to the "landwhale" category of 400+ pounds.
Even the link you provided says that the US would fit among the Arab countries, but would be a major outlier in Europe. There are people with bellies here, BMI > 30, but the "unable to walk without a motorized wheelchair" category is rare.
I live in the Czech Republic, a notorious beer-guzzling nation that was never known for being slim. But the kind of obscene, ballooning fatness that is ubiquitous in the US was never seen here until, say, 2015. Unfortunately I slowly see it slowly emerging among the youth, probably the ones who live on the fastfood diet.
(Fast food used to be relatively expensive compared to Czech salaries, so people wouldn't gorge on it everyday, but this has changed and now it one of the cheaper options out there.)
Even the link you provided says that the US would fit among the Arab countries, but would be a major outlier in Europe. There are people with bellies here, BMI > 30, but the "unable to walk without a motorized wheelchair" category is rare.
I live in the Czech Republic, a notorious beer-guzzling nation that was never known for being slim. But the kind of obscene, ballooning fatness that is ubiquitous in the US was never seen here until, say, 2015. Unfortunately I slowly see it slowly emerging among the youth, probably the ones who live on the fastfood diet.
(Fast food used to be relatively expensive compared to Czech salaries, so people wouldn't gorge on it everyday, but this has changed and now it one of the cheaper options out there.)
If you're looking at large countries (>5M) with genetically diverse populations, it's #1.
That the top 10 are all smaller countries primarily populated with those with pacific islander/Polynesian backgrounds is remarkable though. Hard to argue there's not something genetic going on there, though apparently there is a cultural preference for larger body size (equating it with material wealth) in at least some such countries. It's presumably also the reason NZ has measurably higher obesity rates than we do in AUS.
Perhaps surprisingly the US is only #20 on the list of countries sorted by average BMI, and not that much higher than NZ (or even AUS). I haven't been to the US in well over 10 years now but perhaps we're just playing catch-up here, as at the time I remember being shocked just how many people with truly massive bodies seemed to be commonplace in a way I'd never observed back home.
Having said all that, I happen to know there's a school of thought that many (if not most) of the health issues supposedly "caused" by being overweight are largely an artifact of health professionals being so focused on their patients' weight that they fail to diagnose other health issues early on, or that patients no longer feel comfortable speaking to their doctors etc. The fact that the stats on diabetes/stroke/heart failure etc. correlate so strongly with obesity across such a large range of countries, even those where apparently "fat shaming" isn't a thing, leads me to be somewhat skeptical of that POV.
Having said all that, I happen to know there's a school of thought that many (if not most) of the health issues supposedly "caused" by being overweight are largely an artifact of health professionals being so focused on their patients' weight that they fail to diagnose other health issues early on, or that patients no longer feel comfortable speaking to their doctors etc. The fact that the stats on diabetes/stroke/heart failure etc. correlate so strongly with obesity across such a large range of countries, even those where apparently "fat shaming" isn't a thing, leads me to be somewhat skeptical of that POV.
Definitely an interesting read, though I'd counter that 30% higher in the US than in the UK feels significant (36.2% versus 27.8%).
For extra context, the UK has a higher rate of obesity than any EU country. So the US is a definite outlier amongst advanced economies.
The trick is to spread consumerism ads and fastfood chains all other the world, such that this list doesn't show a big difference. If you manage to pollute everyone else fast enough, statistics can be blurred to a point where there is obviously no reason to act.
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Did that already. There's a pizza hut within line of site of the Great Pyramids at Giza.
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> Who in the hell is against it?
Roughly half the country is against it! And ironically, it's often because they want "choice" in their medical care, despite the fact that health insurance is tied to your employment and you barely have any choices under your control anyway -- you go with the clinic or hospital that takes your plan, and you go with the doctor that's available.
Roughly half the country is against it! And ironically, it's often because they want "choice" in their medical care, despite the fact that health insurance is tied to your employment and you barely have any choices under your control anyway -- you go with the clinic or hospital that takes your plan, and you go with the doctor that's available.
It's such a complete lie that our current system confers any advantages whatsoever. It's a line trotted out by insurance lobbyists, then politicians, then shitty news media, and finally by the poor brainless voters themselves.
If Americans had any international perspective at all it would be much harder to keep that fiction alive, but Americas generally are completely ignorant of how people live outside the us, and not interested in finding out.
If Americans had any international perspective at all it would be much harder to keep that fiction alive, but Americas generally are completely ignorant of how people live outside the us, and not interested in finding out.
The US has lower wait times and substantially better cancer treatment than most comparison countries, including Canada and the UK. Entire categories of specialist cancer treatment are simply not available in Canada.
No advantages whatsoever? That would be a plausible argument if Canadians didn't seek treatment in the US in record numbers, growing by over 20% a year.
No advantages whatsoever? That would be a plausible argument if Canadians didn't seek treatment in the US in record numbers, growing by over 20% a year.
From the international perspective, US is probably closer to the EU than to, say, France or Britain, (both in size and in relative decentralization), and we do not have a common healthcare system in the EU either - plus there seems to be even less support for it than in the US.
Actually, Americans are ignorant of the outside world, but not in the way that you're painting. They generally think that Europe has socialized single-payer healthcare, which is mostly not true (a few European countries, like the UK, do, but most have an insurance-based system). They also think that most of the world has access to the quality of care that people do in the US (nope). They also think doctors and nurses get paid the same outside the US (far from it.) They think that government healthcare means that there will be nobody to say no to expensive procedures (very untrue: there will always be a bureaucrat scrutinizing how much is spent on a patient).
The media promotes all of these myths, with the eventual goal of a complete government takeover of health care.
We can add one bonus myth here too: the idea that the US healthcare system leaves people to die if they have no money and no insurance. Nope! If you show up at any emergency room, they cannot refuse treatment. And of course, getting insurance for the poor or lower-middle class is easier than ever due to Obamacare.
So while it's far from a perfect system, it's a lot better than the media paints it as. And the government alternatives are not utopian. See https://www.theguardian.com/society/2022/mar/02/private-heal...
The media promotes all of these myths, with the eventual goal of a complete government takeover of health care.
We can add one bonus myth here too: the idea that the US healthcare system leaves people to die if they have no money and no insurance. Nope! If you show up at any emergency room, they cannot refuse treatment. And of course, getting insurance for the poor or lower-middle class is easier than ever due to Obamacare.
So while it's far from a perfect system, it's a lot better than the media paints it as. And the government alternatives are not utopian. See https://www.theguardian.com/society/2022/mar/02/private-heal...
I literally watched a dude die waiting to be seen in an ER in the US. They are absolutely required to treat but nobody said anything about how they prioritize patients when the ER is busy. Some more news for you, you can't waltz into the hospital with any number of chronic or life threatening conditions and expect to get effective treatment. You'll get the bare minimum required to stabilize your condition in the moment then you're out the door. Not sure what you're stanning here.
I have personally seen the opposite -- a relative came into the hospital with no healthcare (even Obamacare which he was 100% eligible for, but simply forgot to sign up for) and got the best possible healthcare. And eventually got retroactively put on Medicare, so that he didn't have to pay.
In any case, people die waiting for service with single-payer healthcare as well. Before you try to reform the system, try to understand how the system actually works rather than just repeating talking points.
In any case, people die waiting for service with single-payer healthcare as well. Before you try to reform the system, try to understand how the system actually works rather than just repeating talking points.
Your anecdote does not disprove the general case. If you walk into a hospital dead broke with no insurance with a chronic but not immediately life-threatening condition you're not getting the same level of care an individual would if they had the ability to pay for ongoing treatment. I've got a couple ER nurses I can rope into the conversation that can confirm that if you'd care to try to continue arguing the point.
As far as healthcare reform goes there's nothing particularly complicated about having a multi-billion dollar industry sieve funds that could be better spent on actual healthcare providers. There is also the minor issue of America's medical bankruptcy rates compared against literally every other industrialized nation on the planet, and the small matter of us having both the most expensive (by a wide margin) and one of the least effective healthcare systems of any 1st world country. Again, what the fuck are you stanning over there?
As far as healthcare reform goes there's nothing particularly complicated about having a multi-billion dollar industry sieve funds that could be better spent on actual healthcare providers. There is also the minor issue of America's medical bankruptcy rates compared against literally every other industrialized nation on the planet, and the small matter of us having both the most expensive (by a wide margin) and one of the least effective healthcare systems of any 1st world country. Again, what the fuck are you stanning over there?
This is an extremely popular liberal talking point. I do not believe it to be true.
The article linked below has it at 60/40. But that's just a simple yes/no survey. When you probe the 40, they are mostly for it too, just with extreme reservations. Talk to some. It's definitely not an 'I got mine, let everyone else die' as is painted.
https://thehill.com/policy/healthcare/3826215-57-percent-sup...
The article linked below has it at 60/40. But that's just a simple yes/no survey. When you probe the 40, they are mostly for it too, just with extreme reservations. Talk to some. It's definitely not an 'I got mine, let everyone else die' as is painted.
https://thehill.com/policy/healthcare/3826215-57-percent-sup...
You don't believe it to be true based on what? The fact that it's an extremely popular liberal talking point, or some actual data?
The actual data is closer to 1/3 against than 1/2. Nothing more is usually collected than that vote.
I don't believe, even given revised data above, that even 1/3 are against it. I'd estimate less than 1/5 are against it no matter what. The remainder has doubts and conditions, a given considering how awful government projects usually go. If I thought healthcare would be run like the DMV, I'd vote against it too.
I don't believe, even given revised data above, that even 1/3 are against it. I'd estimate less than 1/5 are against it no matter what. The remainder has doubts and conditions, a given considering how awful government projects usually go. If I thought healthcare would be run like the DMV, I'd vote against it too.
How awful which government projects go? Yeah the DMV is a thing, but so is NOAA and NASA.
Those are good orgs, but not really customer facing ones. Of those people interact with, I can't think of one people actually like. Social Security offices come to mind. And apparently the IRS is impossible to get ahold of, though luckily I've never need to.
I mean why would you want to?
In US there are two useless armies of administrators sucking money out of providing patient's care -- one army employed by insurance industry to deny a claim whenever they can, the other one employed by hospitals and healthcare providers to fight back. It doubles the waste and unproductive work in the best tradition of "bullshit jobs".
I'm a conservative also.
Stuff that basically everyone needs to deal with should be out of pocket with tranparent ahead-of-time pricing. Doctors and occasional specialists, non-exotic meds, normal chronic conditions, etc. State covers/helps it if you can't (means testing with sliding scale, no cliff). Paying for stuff kinda sucks, but less so than brutal waste pulled out of your paycheck or taxes.
Financially major issues could be covered by private insurance or some government plan.
Vaccines subsidized by feds.
Invincibles aren't such a huge problem that we need to twist the whole system around for people who can pay but don't.
Done.
Stuff that basically everyone needs to deal with should be out of pocket with tranparent ahead-of-time pricing. Doctors and occasional specialists, non-exotic meds, normal chronic conditions, etc. State covers/helps it if you can't (means testing with sliding scale, no cliff). Paying for stuff kinda sucks, but less so than brutal waste pulled out of your paycheck or taxes.
Financially major issues could be covered by private insurance or some government plan.
Vaccines subsidized by feds.
Invincibles aren't such a huge problem that we need to twist the whole system around for people who can pay but don't.
Done.
> but less so than brutal waste pulled out of your paycheck or taxes.
Are you suggesting that universal systems are more wasteful? Wouldn't that imply that a simple natural experiment of total healthcare spending vs average health outcomes should show a benefit to private over universal/tax funded?
Are you suggesting that universal systems are more wasteful? Wouldn't that imply that a simple natural experiment of total healthcare spending vs average health outcomes should show a benefit to private over universal/tax funded?
In the US a lot of tax dollars are wasted on healthcare. A lot more would be wasted if we tried some kind of universal health care in the US.
It seems to me that a lot of waste in this area is tax dollars paying for commercial prices. The US has some truly insane baseline costs in healthcare. Having the state pay for them, or having the state provide an insurer, only kicks the ball into someone else's court.
Figure out why a hospital can charge you $25 for an aspirin, and start there. If you just let the state pay that $25, yes your taxes are being wasted.
Figure out why a hospital can charge you $25 for an aspirin, and start there. If you just let the state pay that $25, yes your taxes are being wasted.
> But even I am for government funded healthcare. Who in the hell is against it?
It's a fallacy to claim US healthcare is not "government funded". Aside from that, Canadian wait times for surgery are substantially worse than the United States (even before they stopped necessary surgeries during lockdown). [1]
The amount of Canadians who visit the United States has increased dramatically over the last 10 years, many of which seek services which are simply not available at all in Canada -- such as specialist cancer treatment.
The NHS in the UK, commonly cited as the golden child of government-run healthcare, has the longest wait lists ever with tens of thousands waiting over a year. [2] NHS spending has increased over 6.5% yearly since 2010, with even more massive increases planned for 2024-25.
With the massive NHS spending, UK's nurses and doctors are treated like slave cattle. They earn less than 1/3rd of their US counterparts. This indicates administrative incompetence, skyrocketing middle management, waste and fraud.
[1] https://fee.org/articles/america-outperforms-canada-in-surge...
[2] https://www.bbc.com/news/health-61825071
The amount of Canadians who visit the United States has increased dramatically over the last 10 years, many of which seek services which are simply not available at all in Canada -- such as specialist cancer treatment.
The NHS in the UK, commonly cited as the golden child of government-run healthcare, has the longest wait lists ever with tens of thousands waiting over a year. [2] NHS spending has increased over 6.5% yearly since 2010, with even more massive increases planned for 2024-25.
With the massive NHS spending, UK's nurses and doctors are treated like slave cattle. They earn less than 1/3rd of their US counterparts. This indicates administrative incompetence, skyrocketing middle management, waste and fraud.
[1] https://fee.org/articles/america-outperforms-canada-in-surge...
[2] https://www.bbc.com/news/health-61825071
I find it interesting that whenever socialized healthcare in the US is mentioned, there's always someone eager to point out the failings of Canada's and the UK's systems, yet I never hear mention of any of the other socialized healthcare systems that basically every highly developed nation maintains. I truthfully don't know any statistics on this sort of thing, so I couldn't tell you how good Finland or Greece or Spain are when it comes to healthcare. You'd think there would be relevant criticism to bring up elsewhere if the whole idea is flawed at it's core - otherwise, who cares if Canada's implementation of the concept sucks? Let's learn from their mistakes and others' successes.
Lack of access to doctors is a big issue in Canada. E.g., here's a list of posts on /r/canada about family doctors in the past year: https://www.reddit.com/r/canada/search/?q=family%20doctor&t=...
Canada is almost unique among developed countries with government healthcare in that it doesn't also have a parallel private medical system for those who can afford to pay for it. So naturally rich Canadians will often pay for private healthcare in the US.
I'm originally Canadian but have lived in Australia for the past 10+ years (in Melbourne). We've never had any issues getting medical appointments with local doctors (usually "bulk billed" so we pay nothing or a very nominal amount for the appointment). But we also have private medical insurance, which is required above a certain age (30 something), that we use occasionally for specialist appointments. But even then the out-of-pocket fee is something like $70 which is fine.
Unlike Canada, AFAIK most countries in Europe (e.g., Sweden, France, Spain, Germany) have parallel private medical care, so Canada really is unusual in that respect.
Canada is almost unique among developed countries with government healthcare in that it doesn't also have a parallel private medical system for those who can afford to pay for it. So naturally rich Canadians will often pay for private healthcare in the US.
I'm originally Canadian but have lived in Australia for the past 10+ years (in Melbourne). We've never had any issues getting medical appointments with local doctors (usually "bulk billed" so we pay nothing or a very nominal amount for the appointment). But we also have private medical insurance, which is required above a certain age (30 something), that we use occasionally for specialist appointments. But even then the out-of-pocket fee is something like $70 which is fine.
Unlike Canada, AFAIK most countries in Europe (e.g., Sweden, France, Spain, Germany) have parallel private medical care, so Canada really is unusual in that respect.
The NHS in the UK is after a decade of sabotage by a Conservative government who would like nothing more than to see it scrapped and replaced with private healthcare insurance like the US has. As it stands it is a system that is being starved of resources and yet it is still outperforming the US.
Can you explain how 6.5%/year increases in budget over 12 years is "starving"? Also curious how you square "outperforming" with the worst ever waiting times for critical surgeries.
> In 2017, the UK spent £2,989 per person on healthcare, which was around the median for members of the Organisation for Economic Co-operation and Development: OECD.
> of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
> As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017.
https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Health care inflation is significantly higher than the retail price index. The population is aging - older people consume far more health resources than younger people.
> of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
> As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017.
https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Health care inflation is significantly higher than the retail price index. The population is aging - older people consume far more health resources than younger people.
I'm fairly sure that half a min of extra searching for stats would have turned up number of patients treated over that 12 year period - up 12% excluding covid, which pushed waiting lists up massively.
https://www.kingsfund.org.uk/audio-video/key-facts-figures-n...
TBH I think most of the recent spending has been in management, rather than where it actually needs to be, so that doesn't help.
As mentioned, outperforming here is a relative benchmark vs the US, as stated in the article.
https://www.kingsfund.org.uk/audio-video/key-facts-figures-n...
TBH I think most of the recent spending has been in management, rather than where it actually needs to be, so that doesn't help.
As mentioned, outperforming here is a relative benchmark vs the US, as stated in the article.
> Can you explain how 6.5%/year increases in budget
Yes! It needs more. Glad to have cleared that up.
> Also curious how you square "outperforming" ...
This is the conclusion of the study in the article you're commenting on
Yes! It needs more. Glad to have cleared that up.
> Also curious how you square "outperforming" ...
This is the conclusion of the study in the article you're commenting on
France increased healthcare spending by 0.3%/year between 2010 and 2019.
UK is outpacing France's spending increases by 2,066%. How does the UK need over 20x more spending increases than its close neighbor, exactly?
UK is outpacing France's spending increases by 2,066%. How does the UK need over 20x more spending increases than its close neighbor, exactly?
In 2017 (a year for which I have statistics) France spent 25% more per person on healthcare than the UK.
https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
The initial claim was that healthcare was being "starved", I don't think 20x more than their neighbors in spending increases is "starved".
Besides, in 2019, the difference was 4% on a per capita basis -- according to World Bank figures. [1] [2] Probably reflecting the massive difference in spending increases.
Given the NHS' planned spending increases from now until 2025, it is very likely the UK will overtake France altogether. NHS spending plans to 2025 that are already agreed outpace inflation by 6 billion pounds.
[1] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat...
[2] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat...
Besides, in 2019, the difference was 4% on a per capita basis -- according to World Bank figures. [1] [2] Probably reflecting the massive difference in spending increases.
Given the NHS' planned spending increases from now until 2025, it is very likely the UK will overtake France altogether. NHS spending plans to 2025 that are already agreed outpace inflation by 6 billion pounds.
[1] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat...
[2] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat...
Growing and aging population is the main two.
The Financial Times has published stark data showing persistent underinvestment when Conservatives are in power, compared with peer countries.
The Financial Times has published stark data showing persistent underinvestment when Conservatives are in power, compared with peer countries.
> The NHS in the UK, commonly cited as the golden child of government-run healthcare
Except for government clowns, the ones that still claim Brexit was a splendid idea, and people with vested interests absolutely nobody claims that.
At least not since 2008 and austerity when the Tories started wanton destruction of the NHS.
There's a massive drive to private healthcare for those that can afford it and the rest is welcome to eat shit.
Or to wait 25 hours for an ambulance while lying on the floor with s broken hip.[0]
[0] https://www.independent.co.uk/news/health/ambulance-wait-wal...
Except for government clowns, the ones that still claim Brexit was a splendid idea, and people with vested interests absolutely nobody claims that.
At least not since 2008 and austerity when the Tories started wanton destruction of the NHS.
There's a massive drive to private healthcare for those that can afford it and the rest is welcome to eat shit.
Or to wait 25 hours for an ambulance while lying on the floor with s broken hip.[0]
[0] https://www.independent.co.uk/news/health/ambulance-wait-wal...
I think everyone is aware of this by now - the question is, do we understand what is preventing reform? It seems that we need to move beyond the revelation that 'the system is bad' and starting doing something about it. If so, what?
The issue is the medical-industrial complex in the US, intimately tied with a huge medical insurance industry, that spends a lot of money lobbying to fight against reform. And healthcare is already a heavily regulated industry so any political barriers become even harder to overcome. I believe Obamacare was an attempt to wiggle around to a (somewhat shitty) solution.
I suspect change will only come once the existing tensions towards healthcare expenses boil to an outrage. Talk to anyone in the US though, they will complain about their healthcare!
I suspect change will only come once the existing tensions towards healthcare expenses boil to an outrage. Talk to anyone in the US though, they will complain about their healthcare!
Well, some won’t and I think that exposes another issue: the poor outcomes have a lot to do with a lot of people not getting care or waiting too long due to cost. If money is no object the US healthcare system is as good as any (I bet you would see this if you broke down by socioeconomic status).
> If money is no object the US healthcare system is as good as any
I don't think so. The medical personnel are way too stressed. You having money does not change that the people that will see you suffer in an inhuman system.
Even apart from money, how on earth is it possible that the people who should know more better than anyone else the effects of stress and lack of sleep let doctors work in far too long shifts? How does the existence of 24 hour shifts make any sense?
The system has a lot more problems than just money.
Just one example link: https://bcmj.org/articles/sleep-deprivation-among-physicians
It's not just the US: https://www.theguardian.com/society/2022/jan/17/nhs-doctors-...
Also always interesting to read: https://old.reddit.com/r/medicine/
I don't think so. The medical personnel are way too stressed. You having money does not change that the people that will see you suffer in an inhuman system.
Even apart from money, how on earth is it possible that the people who should know more better than anyone else the effects of stress and lack of sleep let doctors work in far too long shifts? How does the existence of 24 hour shifts make any sense?
The system has a lot more problems than just money.
Just one example link: https://bcmj.org/articles/sleep-deprivation-among-physicians
It's not just the US: https://www.theguardian.com/society/2022/jan/17/nhs-doctors-...
Also always interesting to read: https://old.reddit.com/r/medicine/
Well, as you say, that problem isn’t unique to the US.
Of course, though that is only the case for a very small minority of people.
There is a big overlap with those people and the people that ultimately make decisions affecting whether that system exists though.
There is a big overlap with those people and the people that ultimately make decisions affecting whether that system exists though.
As far as I can tell nobody agrees on the details of why the system is bad. I'll pick on the split between the medically assisted dying vs. preserve life at all costs camp as a simple example. Both sides could probably agree that the current situation is bad, but neither side is about to give ground on why or which direction to go next.
In my view, there are a lot of trivial and important changes that could make US healthcare cheaper, better and more available. As long as I don't specify any further details, everyone can agree with me.
In my view, there are a lot of trivial and important changes that could make US healthcare cheaper, better and more available. As long as I don't specify any further details, everyone can agree with me.
All of that surplus spending is going to someone who isn't interested in seeing their cut reduced.
So what?
Both of the countries I've lived in have carried out health-related reforms (one a really big reform — almost half of hospital beds were closed, the other a much smaller reform). The people who lost income didn't matter for the success or failure of either reform.
Both of the countries I've lived in have carried out health-related reforms (one a really big reform — almost half of hospital beds were closed, the other a much smaller reform). The people who lost income didn't matter for the success or failure of either reform.
So they can spend a lot of money to convince people that reforms are bad, they can buy influence among powerful politicians, and all the rest of the moves that make it so elite preferences do a lot to dictate policy the world over. Are we being naive here?
I think so, yes.
You're basically saying that there are lobbyists and that's an insurmountable obstacle, and throwing your hands up in the air. You're not, for example, trying to learn how the countries that executed reforms successfully did so.
EDIT: You could easily find a list online of the top ten health systems. Learning about the reforms carried out by each of those in the past 30 years requires effort, but it's really not impossible.
You're basically saying that there are lobbyists and that's an insurmountable obstacle, and throwing your hands up in the air. You're not, for example, trying to learn how the countries that executed reforms successfully did so.
EDIT: You could easily find a list online of the top ten health systems. Learning about the reforms carried out by each of those in the past 30 years requires effort, but it's really not impossible.
US health spend is bigger than the GDP of every country on that list. The biggest employer in nearly every congressional district is a healthcare system. It’s politically difficult.
You make it sound as if closing nearly half of a country's hospital beds is politically simple. Was done. Or as if nationalising most of a state's hospitals is politically simple. Was done. (In some people's opinion, not mine, but lots of people described it in those words, so it's a fair way to describe the political controversy of the reform.)
It's possible to learn how these things were done, or it's possible to just give up and say it's politically difficult.
It's possible to learn how these things were done, or it's possible to just give up and say it's politically difficult.
Since Medicare has served as a model for some countries that provided universal care, I don’t think lessons are what we need. The problem is overcoming strong, bipartisan opposition.
Maybe I missed a rhetorical question but would-be reformers of the American health system were defeated by the efforts of moneyed interests (AMA, insurers, etc) in the past. It’s not that nobody thought of it. Argue about the wisdom of it if you want, but Obamacare was structured as it was with the idea of turning the industry into allies rather than implacable opponents.
No, I think the part you miss is that some people succeeded at difficult reforms. Consider a reform where control of parts of each hospital's budget is removed from the owners/management of most hospitals. Might meet with some resistance, wouldn't you say so? You Americans seem to have this idea that your entrenched interests are somehow uniquely skilled at defending the status quo. Something like: "American hospital systems are so much better at defending their budget than that hospital system, so therefore that learning how that reform was executed would be pointless."
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Seems to me it's ideology and profit.
The US isn't the only country with a partisan, ideological driven political landscape but it is probably the loudest. Ideologues on the right are able to pander to their base by equating any healthcare reform as socialist, substandard, death panel creating and an affront to freedom. People will accept a bad deal if they think it is the right deal.
Healthcare companies benefit so much that they are one of the biggest lobbying industries in the US, spending $690 million a year on lobbying (quick Google result, so pinch of salt). The changes they want are those that will profit them more, so it benefit them to feed the ideologues.
The US isn't the only country with a partisan, ideological driven political landscape but it is probably the loudest. Ideologues on the right are able to pander to their base by equating any healthcare reform as socialist, substandard, death panel creating and an affront to freedom. People will accept a bad deal if they think it is the right deal.
Healthcare companies benefit so much that they are one of the biggest lobbying industries in the US, spending $690 million a year on lobbying (quick Google result, so pinch of salt). The changes they want are those that will profit them more, so it benefit them to feed the ideologues.
> If so, what?
Bring it into the political discourse. And vote.
Bring it into the political discourse. And vote.
"To catch up with other high-income countries, the administration and Congress would have to expand access to health care, act aggressively to control costs, and invest in health equity and social services we know can lead to a healthier population."
The U.S. has the highest rate of people with multiple chronic health conditions... and the highest obesity rate...
I think they are seriously missing something. Obesity is related in part to our built environment and car-centric lives forced on us to a large degree by our built environment. Pollution may be a root cause of multiple chronic conditions.
Just beefing up our health care system likely isn't sufficient.
The U.S. has the highest rate of people with multiple chronic health conditions... and the highest obesity rate...
I think they are seriously missing something. Obesity is related in part to our built environment and car-centric lives forced on us to a large degree by our built environment. Pollution may be a root cause of multiple chronic conditions.
Just beefing up our health care system likely isn't sufficient.
That is why the problem is intractable. The very way of life, the lot sizes houses are on, the paved earth in all 4 directions are at the root of the problem, and there is no fixing that on a US wide scale. And people like that lifestyle, they like their individual, huge cars and huge (relatively) houses and huge parking lots and huge roads and huge food and drink portions.
Trying to fight that in a democracy will take a long, long time.
Trying to fight that in a democracy will take a long, long time.
>The very way of life, the lot sizes houses are on, the paved earth in all 4 directions are at the root of the problem, and there is no fixing that on a US wide scale.
Paved earth isn't a bad thing if you're opposed to car-centric lifestyles. Dense cities (like Manhattan NYC) are nothing but pavement outside the parks, but that's what you need if you want a walkable lifestyle. Lots of earth and grass everywhere means everything is so far apart you need to drive.
Paved earth isn't a bad thing if you're opposed to car-centric lifestyles. Dense cities (like Manhattan NYC) are nothing but pavement outside the parks, but that's what you need if you want a walkable lifestyle. Lots of earth and grass everywhere means everything is so far apart you need to drive.
Yes, I meant more paved earth area per person.
That's true: a car-based society has a lot more per-capita pavement because of all the roads (and wider roads), and especially parking spaces.
I wonder if anyone has done an analysis comparing different nations and their per-capita road infrastructure maintenance costs. The US has to be the worst at this, and surely is a big drag on the economy.
I wonder if anyone has done an analysis comparing different nations and their per-capita road infrastructure maintenance costs. The US has to be the worst at this, and surely is a big drag on the economy.
> And people like that lifestyle, they like their individual, huge cars and huge (relatively) houses and huge parking lots and huge roads and huge food and drink portions.
Do they like it or have they simply never had any choice in the matter and have never experienced anything else? The extremely high housing prices in the few dense walkable places seems to imply there is more demand than supply for such developments, so at least some prefer them.
Do they like it or have they simply never had any choice in the matter and have never experienced anything else? The extremely high housing prices in the few dense walkable places seems to imply there is more demand than supply for such developments, so at least some prefer them.
Sure, some of them. But nowhere near the critical mass of voters needed to redirect entire infrastructure budgets away from prioritizing cars and large indoor spaces, to prioritizing public transit/walking/cycling and denser living. And this transition would take decades and cause a lot of pain in that time for eventual benefits the voting populace will never see, so it is a nonstarter.
Some of them, but not nearly enough as you point out, plus it's really hard politically to get people to want to change to a different lifestyle. I left the US partly because I wanted to live a walkable lifestyle and the very few places in the US that offered that were too unaffordable (and had many other problems, such as the shitty healthcare system).
Obesity is mostly about food, its quality, the amount of sugar, and how accessible/affordable healthy food is. Physical activity is a secondary culprit but nowhere near as critical as food and drinks.
The healthcare industry isn't the only one that needs a massive, aggressive check in the US.
The healthcare industry isn't the only one that needs a massive, aggressive check in the US.
It comes down to a few issues:
a) The USA pays more for drugs than the rest of the world does. b) private health insurance is really inefficient. c) The US doesn’t do public and preventative health very well. d) The US wastes money overtreating rich people and undertreating poor people more than other countries. e) The US does a bunch of expensive and more importantly counterproductive end-of-life care than other countries. f) The US pays its doctors more than other countries because the supply is artificially restricted and governments don’t push back like they do elsewhere.
a) The USA pays more for drugs than the rest of the world does. b) private health insurance is really inefficient. c) The US doesn’t do public and preventative health very well. d) The US wastes money overtreating rich people and undertreating poor people more than other countries. e) The US does a bunch of expensive and more importantly counterproductive end-of-life care than other countries. f) The US pays its doctors more than other countries because the supply is artificially restricted and governments don’t push back like they do elsewhere.
D and E are simply the result of healthcare consumers choosing to spend their money on care that wouldn't even be available under a public system. Taking that into consideration, "look how much of our GDP we spend on healthcare" is not the glaring indicator of a broken system that people make it out to be. People are allowed to spend their own money.
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Of course it does. Three reasons:
* A big chunk of the money goes to private insurance, never materializing into “health”.
* Health centers being run as a business, not a national necessity (like roads or the military)
* An obscurity in health practice pricing that would be illegal in any other activity.
* A big chunk of the money goes to private insurance, never materializing into “health”.
* Health centers being run as a business, not a national necessity (like roads or the military)
* An obscurity in health practice pricing that would be illegal in any other activity.
I would ass a fourth reason: health is a very much a public (as in collective) issue, not a sum of individual medical problems. Something that is fundamentally at odds with the dominant ethos of how to deal with problems in america in the past 50 years or so.
That is what I was trying to convey on my second point, but perhaps I didn't do a good enough job at it. Yes as a European I see it as a mere "efficiency" thing. My (admittedly, very simplistic) thinking goes like this:
> In a population of 1000 perhaps 10 will get a Really Bad Health Issue that requires Really Expensive Treatment that costs 100. So those 1000 people pool their resources up and each pays 0.1 so that if they happen to be one of the unfortunate 10 they are covered. Given that this is a shared risk for those 1000 people, the higher possible entity (the state) is put in charge.
It seems the Americans thinking starts the other way around:
> Anything public is awful and should be avoided at all costs. I'd better take my chances with a private entity (even if that means grouping with another 100 people instead of 1000, and that the private entity takes one cut, so we end up paying 2 each instead of 0.1) because the alternative is just awful.
... But then they are fine with having a very well publicly-funded military and police departments.
> In a population of 1000 perhaps 10 will get a Really Bad Health Issue that requires Really Expensive Treatment that costs 100. So those 1000 people pool their resources up and each pays 0.1 so that if they happen to be one of the unfortunate 10 they are covered. Given that this is a shared risk for those 1000 people, the higher possible entity (the state) is put in charge.
It seems the Americans thinking starts the other way around:
> Anything public is awful and should be avoided at all costs. I'd better take my chances with a private entity (even if that means grouping with another 100 people instead of 1000, and that the private entity takes one cut, so we end up paying 2 each instead of 0.1) because the alternative is just awful.
... But then they are fine with having a very well publicly-funded military and police departments.
A risk pool being split among multiple companies doesn't actually increase the average amount that each group would have to pay. For the group of 100 in your example, only one tenth of a person is going to have to get one tenth of the expensive treatment, so each one still has to pay 0.1. As long as each underwriter has a sufficiently large group to ensure that the average cost incurred by its members is sufficiently close to the population average, the relative sizes of those groups isn't going to affect their members' premiums. Insurance administration is not an economy of scale so competition in the marketplace would ensure downward pressure on prices. In contrast, a state provider would have little incentive to cost-cut or innovate since they wouldn't have to earn people's business, and any public option would necessarily be attempting to balance the interests of multiple groups (such as public sector unions/government employees, health care providers, and health care consumers) at the expense of the consumers whose interest would have been prioritized in a competitive market. Taking that into consideration, it's doubtful that the lack of shareholders in a public system would represent enough of a benefit to actually lower costs for consumers. Americans have enough experience with poorly managed government programs to intuitively understand that a socialized health care system isn't going to be an improvement over our current system.
And yes, since national defense and law enforcement are desirable services that can't be provided by a competitive market, we are fine with the government providing those specific services in a constitutionally-limited way. That preference is actually more ideologically consistent than your preference to socialize our healthcare system unless you're going to advocate for abandoning capitalism entirely.
And yes, since national defense and law enforcement are desirable services that can't be provided by a competitive market, we are fine with the government providing those specific services in a constitutionally-limited way. That preference is actually more ideologically consistent than your preference to socialize our healthcare system unless you're going to advocate for abandoning capitalism entirely.
> For the group of 100 in your example, only one tenth of a person is going to have to get one tenth of the expensive treatment, so each one still has to pay 0.1
That makes no sense. It will be one person. Not a tenth. And also if that was true the private insurance would raise their quota to 1.9. And then deny treatment to that unfortunate person anyway because it’s cheaper to pay a lawyer to litigate the expensive cases than to pay them.
Your last bit makes no sense to me at all. It is clear that health care is desirable, and can’t be provided by a competitive market. The richest country in the world can’t pull it off. You lose much more people per week to health care unavailability than to wars. From the point of view of mere efficiency of capital it makes no sense.
And are talking as if there was no proof that socialized care works in other countries. It’s right there if you’re willing to look for it.
If your state agencies are poorly managed and you go private, that is a self-perpetuating cycle. Fewer people will use them, they will get budget cuts, and get worse. The solution is to revolt, strike, demand better, and help each other, even if they are poor.
Abandoning some aspects of capitalism is completely possible and rational.
That makes no sense. It will be one person. Not a tenth. And also if that was true the private insurance would raise their quota to 1.9. And then deny treatment to that unfortunate person anyway because it’s cheaper to pay a lawyer to litigate the expensive cases than to pay them.
Your last bit makes no sense to me at all. It is clear that health care is desirable, and can’t be provided by a competitive market. The richest country in the world can’t pull it off. You lose much more people per week to health care unavailability than to wars. From the point of view of mere efficiency of capital it makes no sense.
And are talking as if there was no proof that socialized care works in other countries. It’s right there if you’re willing to look for it.
If your state agencies are poorly managed and you go private, that is a self-perpetuating cycle. Fewer people will use them, they will get budget cuts, and get worse. The solution is to revolt, strike, demand better, and help each other, even if they are poor.
Abandoning some aspects of capitalism is completely possible and rational.
It does make sense. A smaller group will have a correspondingly smaller number of people who will end up needing treatment, so the expected value for an individual's cost doesn't actually depend on the number of people in the group, just the probability that any specific person will end up requiring treatment and the cost of the treatment. Maybe you are confused because you chose a specific example wherein the expected number of treatments required is less than one? Are you thinking that because it's not possible to have only a fraction of a person require treatment that we need to round up to 1 person? That's not how probability works and if you simply extend that logic to a group of a single person then your error should become immediately apparent. While it's true that only whole numbers of people can get sick, when you take repeated samples of small groups you will find that occasionally one group member will require treatment, but much more commonly than that, zero group members will require treatment. When you weight each case by its relative probability of occurring, then you get the same expected cost per person that you calculated for the large group.
Your lack of intuition about such a simple linear relationship should be extremely concerning to you. It suggests that you are approaching the question with an emotional attachment to a particular outcome that is blinding you to the extremely simple and intuitive correct answer.
There's a lot more to unpack here, but I don't have time to address it point by point. You are making a lot of assertions that seem much more reflective of left-wing ideology than actual conditions on the ground. You suggest that consumers demanding better is a solution to public systems that don't actually meet consumers needs, but the very nature of public goods ensures that no individual consumer will ever be in a position to make a demand that administrators will have to prioritize over competing demands from producers and public employees. The nature of democracy gives outsized influence public sector unions and interest groups that can then turn around and contribute a share of those benefits back to politicians campaigns. In contrast, a competitive market affords consumers to actually make demands with some weight behind them. A producer has to take a consumers demands into account lest that consumer simply take his business to a competing producer. The weight of the empirical evidence affirming this fundamental difference between public and private systems is completely overwhelming, and your resistance to the idea that capitalism is a far better system than socialism for the vast majority of goods suggests an emotional attachment to an ideology that has very intentionally been sold to the public in such a way as to make uncritical advocacy for that ideology very self-flattering to those very advocates.
I know that I didn't really address the middle part of your argument but let me assure you that those ideas are just as contrary to reality as any of the ideas that I chose to address. I might come back to those in a future post if I find myself with both the time and the inclination to do so.
Your lack of intuition about such a simple linear relationship should be extremely concerning to you. It suggests that you are approaching the question with an emotional attachment to a particular outcome that is blinding you to the extremely simple and intuitive correct answer.
There's a lot more to unpack here, but I don't have time to address it point by point. You are making a lot of assertions that seem much more reflective of left-wing ideology than actual conditions on the ground. You suggest that consumers demanding better is a solution to public systems that don't actually meet consumers needs, but the very nature of public goods ensures that no individual consumer will ever be in a position to make a demand that administrators will have to prioritize over competing demands from producers and public employees. The nature of democracy gives outsized influence public sector unions and interest groups that can then turn around and contribute a share of those benefits back to politicians campaigns. In contrast, a competitive market affords consumers to actually make demands with some weight behind them. A producer has to take a consumers demands into account lest that consumer simply take his business to a competing producer. The weight of the empirical evidence affirming this fundamental difference between public and private systems is completely overwhelming, and your resistance to the idea that capitalism is a far better system than socialism for the vast majority of goods suggests an emotional attachment to an ideology that has very intentionally been sold to the public in such a way as to make uncritical advocacy for that ideology very self-flattering to those very advocates.
I know that I didn't really address the middle part of your argument but let me assure you that those ideas are just as contrary to reality as any of the ideas that I chose to address. I might come back to those in a future post if I find myself with both the time and the inclination to do so.
> Maybe you are confused because you chose a specific example wherein the expected number of treatments required is less than one?
In my example 10 people out of 1000 required the treatment. If it's 100 people, then 1 will need it. You must have misread.
> Your lack of intuition about such a simple linear relationship should be extremely concerning to you
That's very condescending and a bit ironic. I think you should apologize.
> much more reflective of left-wing ideology
"Left" means different things in different places. In my country, a big chunk of the people on the "right" feel the same way you feel about the army, but about healthcare. Which is that some things like life-threatening problems are too important to let personal gain interfere. More on that in a second.
> actual conditions on the ground
I am writing this from the ground. My son just got treated by our public health system twice this week - the last one today. (His pediatrician was on strike today, actually. That is a bit inconvenient for us but it is fine. It's not life or death). My sister in law got diagnosed with cancer and got treatment for it. This is reality that I am telling you is happening right now. Not a theoretical thing that I am imagining might work on a communist country. It exists, and it works.
For the life-threatening cases at least. It is not perfect - there's sometimes long waiting lists for non-life-threatening ones. That is where private health plays a role. Those who don't want to wait, or want a private room in the hospital, can pay for it.
But if you are poor and you get cancer you don't necessarily die. Your family doesn't have to beg in gofundme for your treatment, nor they are left bankrupt. Which is absolutely a reality in the US.
> The nature of democracy gives outsized influence public sector unions and interest groups that can then turn around and contribute a share of those benefits back to politicians campaigns. In contrast, a competitive market affords consumers to actually make demands with some weight behind them.
I prefer referring to people as people. Or, citizens, in the context of a country.
Perhaps that is where our difference of opinion comes from. I don't see a country as a business. So naturally its people are not "consumers". Poor people may not be able to consume much, but they are still people.
On buying public administrators: in my country, lobbying consists in "having meetings with politicians". It does not mean "giving presents" or "contributing to campaigns". That is called bribing, and is against the law. Again, not a perfect system by any means. There's plenty of corruption, as well as other problems. One of them, and one of the places where I do agree with you, is that that interest groups (especially those sponsored by the extremely wealthy) still have much more levers to pull than the average person.
Where I differ with you is in how to fix this. You propose that "people vote with their wallet". The problem with that is that the money that consumers use to vote with their wallet eventually goes into the pockets of the ones funding the interest groups that eventually make laws against them. This is a problem both in my country and in the US. It gets worse with inequality, which is getting worse everywhere, but especially in the US.
My proposed solution is simply that there's other things besides the consumer-producer relationship. This doesn't necessarily imply a communist regime or an anarchist revolution. It just means Europe, man.
In my example 10 people out of 1000 required the treatment. If it's 100 people, then 1 will need it. You must have misread.
> Your lack of intuition about such a simple linear relationship should be extremely concerning to you
That's very condescending and a bit ironic. I think you should apologize.
> much more reflective of left-wing ideology
"Left" means different things in different places. In my country, a big chunk of the people on the "right" feel the same way you feel about the army, but about healthcare. Which is that some things like life-threatening problems are too important to let personal gain interfere. More on that in a second.
> actual conditions on the ground
I am writing this from the ground. My son just got treated by our public health system twice this week - the last one today. (His pediatrician was on strike today, actually. That is a bit inconvenient for us but it is fine. It's not life or death). My sister in law got diagnosed with cancer and got treatment for it. This is reality that I am telling you is happening right now. Not a theoretical thing that I am imagining might work on a communist country. It exists, and it works.
For the life-threatening cases at least. It is not perfect - there's sometimes long waiting lists for non-life-threatening ones. That is where private health plays a role. Those who don't want to wait, or want a private room in the hospital, can pay for it.
But if you are poor and you get cancer you don't necessarily die. Your family doesn't have to beg in gofundme for your treatment, nor they are left bankrupt. Which is absolutely a reality in the US.
> The nature of democracy gives outsized influence public sector unions and interest groups that can then turn around and contribute a share of those benefits back to politicians campaigns. In contrast, a competitive market affords consumers to actually make demands with some weight behind them.
I prefer referring to people as people. Or, citizens, in the context of a country.
Perhaps that is where our difference of opinion comes from. I don't see a country as a business. So naturally its people are not "consumers". Poor people may not be able to consume much, but they are still people.
On buying public administrators: in my country, lobbying consists in "having meetings with politicians". It does not mean "giving presents" or "contributing to campaigns". That is called bribing, and is against the law. Again, not a perfect system by any means. There's plenty of corruption, as well as other problems. One of them, and one of the places where I do agree with you, is that that interest groups (especially those sponsored by the extremely wealthy) still have much more levers to pull than the average person.
Where I differ with you is in how to fix this. You propose that "people vote with their wallet". The problem with that is that the money that consumers use to vote with their wallet eventually goes into the pockets of the ones funding the interest groups that eventually make laws against them. This is a problem both in my country and in the US. It gets worse with inequality, which is getting worse everywhere, but especially in the US.
My proposed solution is simply that there's other things besides the consumer-producer relationship. This doesn't necessarily imply a communist regime or an anarchist revolution. It just means Europe, man.
Ok, I see where the problem is. The 10 people requiring the 100 treatment in your example will cost 1000. That's one dollar per person, not one tenth. For the group of 100, 1 person will require the 100 treatment and it is still 1 dollar per person. You very obviously made a mistake and I incorrectly assumed it was in your calculation of the costs for the second group. The underlying point is still the same though, and you should be concerned that such a simple relationship is not intuitive to you. I'm not going to apologize because I still feel that this is indicative of emotional reasoning on your part. If this sounds condescending then that's only because this is about as simple as math can possibly get and yet you still failed to recognize the glaring logical contradiction.
The cost of 100 is the cost of the whole treatment system. That includes doctors, nurses, medical equipment etc. For a capacity of around 10 cases.
But yeah, focus on purposely misinterpreting my arguments all you want. Have a nice day.
But yeah, focus on purposely misinterpreting my arguments all you want. Have a nice day.
If the cost is 100 for 10 cases, then it's going to be 10 for 1 case. Cost per person is still the same. You need fewer doctors, nurses, and medical devices to treat fewer people.
https://web.archive.org/web/20230206073329/https://www.wesh....
(Because the article is blocked in some regions.)
(Because the article is blocked in some regions.)
> US spends most on health care but has worst health outcomes
US does not spend on healthcare. It spends on people making profits from healthcare.
But, Europe is slowly getting there too.
US does not spend on healthcare. It spends on people making profits from healthcare.
But, Europe is slowly getting there too.
US spends most on health care but has worst health outcomes, BUT, it has the best healthcare profits!
This whole entire industry is a racketeering scheme.
The medical industry justifies their excess profits as necessary for supporting the "free market" in "generating innovation".
In reality:
1. Their "free market" is anything BUT a free market.
2. "Generating innovation" is not a substitute for generating positive health outcomes.
3. Their excess profits are primarily used for propaganda and bribery to justify their own existence and protect their racket.
Just look up the laws restricting Medicare from bargaining on medical care and prescription drugs to understand just how much of a racket this whole industry is. It is criminal in every way - aside from the written law, since the people who make the laws are co-conspirators in the scheme.
It's so much worse than the "most expensive" healthcare in the world. This nauseatingly overinflated healthcare is further subsidized by US taxpayer funds from the shit medical care and extortionate drug prices that Medicare is legally obligated to pay. It actually adds trillions to our Federal Deficit each year... so we get the worst health outcomes WHILE driving the US government into bankruptcy.
This whole system maximizes profits for a limited number of players at the expense of our doctors, our patients, the fiscal health of Medicare, and the future of our republic.
The medical industry justifies their excess profits as necessary for supporting the "free market" in "generating innovation".
In reality:
1. Their "free market" is anything BUT a free market.
2. "Generating innovation" is not a substitute for generating positive health outcomes.
3. Their excess profits are primarily used for propaganda and bribery to justify their own existence and protect their racket.
Just look up the laws restricting Medicare from bargaining on medical care and prescription drugs to understand just how much of a racket this whole industry is. It is criminal in every way - aside from the written law, since the people who make the laws are co-conspirators in the scheme.
It's so much worse than the "most expensive" healthcare in the world. This nauseatingly overinflated healthcare is further subsidized by US taxpayer funds from the shit medical care and extortionate drug prices that Medicare is legally obligated to pay. It actually adds trillions to our Federal Deficit each year... so we get the worst health outcomes WHILE driving the US government into bankruptcy.
This whole system maximizes profits for a limited number of players at the expense of our doctors, our patients, the fiscal health of Medicare, and the future of our republic.
There needs to be a big movement towards physical fitness in the US. Get people doing calisthenics at home (almost everyone can do incline pushups as a start), going to the gym, using indoor bikes, eating less, whatever it takes.
Improving the health system won't fix everything.
Improving the health system won't fix everything.
"But the harsh fact of the matter is that there is also an increasingly large number of young Americans who are neglecting their bodies—whose physical fitness is not what it should be—who are getting soft. And such softness on the part of individual citizens can help to strip and destroy the vitality of a nation. For the physical vigor of our citizens is one of America’s most precious resources. If we waste and neglect this resource, if we allow it to dwindle and grow soft then we will destroy much of our ability to meet the great and vital challenges which confront our people. We will be unable to realize our full potential as a nation." - President-elect John F. Kennedy, Dec 26. 1960
https://tomnikkola.com/soft-american/
https://tomnikkola.com/soft-american/
Why indoor bikes? Why not outdoor bikes? That will solve even more problems.
> Improving the health system won't fix everything.
Of course there's no silver bullet that will fix everything, but it's silly to think you can fix the outrageous costs of the healthcare system without fixing the healthcare system.
> Improving the health system won't fix everything.
Of course there's no silver bullet that will fix everything, but it's silly to think you can fix the outrageous costs of the healthcare system without fixing the healthcare system.
> Why indoor bikes?
Lower barrier to entry. A lot of cities have no good infrastructure for outdoor biking.
I agree that the healthcare system needs fixing as well, in addition to making the country healthier by lifestyle.
Lower barrier to entry. A lot of cities have no good infrastructure for outdoor biking.
I agree that the healthcare system needs fixing as well, in addition to making the country healthier by lifestyle.
...or we could find a real solution
Living a healthier lifestyle in order to rely less on the healthcare system should absolutely be part of a "real solution". Both for cost reasons as well as the fact that some problems caused by obesity simply can't be fixed. It also has other benefits like improving general quality of life.
This implies we should spend less?
Implies the US is doing domething different that is causing it to cost us more and get worse health outcomes. It's probably our whole health insurance system. It would probably be better and cheaper if we just had a universal healthcare system like many other countries.
>the system is bad
Doctors aren't paid when you are healthy. How would you suggest fixing such a system? Because if you figure it out, there's a whole system of auto mechanics that could probably benefit from the solution.
Doctors aren't paid when you are healthy. How would you suggest fixing such a system? Because if you figure it out, there's a whole system of auto mechanics that could probably benefit from the solution.
It is not necessary to have to propose a solution before highlighting flaws or having an opinion about some thing. This is arguing in bad faith. Besides, you only have to read any article like this to find examples of other healthcare systems that have better outcomes for less spending
Second, you've not only massively oversimplified, you have also made a false equivalence. Doctor's aren't the only ones getting paid, the CEOs take home billions, as do shareholders. If you think going to the hospital in the US is the same as taking a car to a garage in the US, then you are greatly mistaken. To equate the 2 is either unthinkingly glib or willfully disingenuous.
Second, you've not only massively oversimplified, you have also made a false equivalence. Doctor's aren't the only ones getting paid, the CEOs take home billions, as do shareholders. If you think going to the hospital in the US is the same as taking a car to a garage in the US, then you are greatly mistaken. To equate the 2 is either unthinkingly glib or willfully disingenuous.
> Doctors aren't paid when you are healthy
Isn't it worst that doctors are paid if you are not healthy? Doesn't it create an incentive for them to prevent you from being completely healthy?
Anyway, most countries in Europe pay their doctors regardless of you health status and that money comes out directly of taxpayers' pockets whom most of them are 100% happy to make it that way
Isn't it worst that doctors are paid if you are not healthy? Doesn't it create an incentive for them to prevent you from being completely healthy?
Anyway, most countries in Europe pay their doctors regardless of you health status and that money comes out directly of taxpayers' pockets whom most of them are 100% happy to make it that way
But doctors in Europe are paid a pittance in comparison.
Like less than a third or even a quarter of US wages.
That's the real issue - they will never want to take a hit to living standards. It was possible in the UK because it was directly after the war and the Blitz had killed hundreds of thousands of people, and there was a real threat of communism.
Whereas the USA is nowhere that situation today. Things are going very well for the majority of people so drastic change would be very hard.
Like less than a third or even a quarter of US wages.
That's the real issue - they will never want to take a hit to living standards. It was possible in the UK because it was directly after the war and the Blitz had killed hundreds of thousands of people, and there was a real threat of communism.
Whereas the USA is nowhere that situation today. Things are going very well for the majority of people so drastic change would be very hard.
> That's the real issue - they will never want to take a hit to living standards.
So what are they gonna do? Refuse to treat people and starve themselves to death? They'll be replaced by people willing to earn less and who probably care about the work they do rather than just caring about earning a fat paycheck - those exist, as other countries prove. Seems like a win to me.
So what are they gonna do? Refuse to treat people and starve themselves to death? They'll be replaced by people willing to earn less and who probably care about the work they do rather than just caring about earning a fat paycheck - those exist, as other countries prove. Seems like a win to me.
Yeah, go on strike, or refuse to work with the public health system, etc.
Britain had all of these issues and it cost a lot of money.
There's also other issues - like the NHS doesn't cover circumcision unless there is medical need (this is not so controversial in the UK, but would be in the USA), and it does cover gender transition surgery, etc. (despite covering no other cosmetic surgery, and nowadays not covering dentistry or opticians) - all of these issues are controversial and difficult.
Britain had all of these issues and it cost a lot of money.
There's also other issues - like the NHS doesn't cover circumcision unless there is medical need (this is not so controversial in the UK, but would be in the USA), and it does cover gender transition surgery, etc. (despite covering no other cosmetic surgery, and nowadays not covering dentistry or opticians) - all of these issues are controversial and difficult.
> But doctors in Europe are paid a pittance in comparison. Like less than a third or even a quarter of US wages.
I'm not sure that comparing absolute amounts between countries makes a lot of sense. And doctors would still likely be in top 1% to 5% also in Europe.
I'm not sure that comparing absolute amounts between countries makes a lot of sense. And doctors would still likely be in top 1% to 5% also in Europe.
> But doctors in Europe are paid a pittance in comparison.
It also doesn't cost them a million dollar to become a doctor.
And they don't have to work 80 hours a week.
Doctors in Europe are also easily in the top 5% earners.
It also doesn't cost them a million dollar to become a doctor.
And they don't have to work 80 hours a week.
Doctors in Europe are also easily in the top 5% earners.
> Doctors aren't paid when you are healthy
They are, here in my country.
I am healthy (AFAIK) my taxes are paying for doctors too.
Also, I am healthy (AFAIK) because I go to the doctor even when I am not sick to check on my health.
I already paid for it.
They are, here in my country.
I am healthy (AFAIK) my taxes are paying for doctors too.
Also, I am healthy (AFAIK) because I go to the doctor even when I am not sick to check on my health.
I already paid for it.
> Doctors aren't paid when you are healthy.
Doctors are paid to be doctors. And there is always a fraction of the population that aren't healthy. Just like you insinuate with your car mechanic analogy, it's probably a good idea to have a system that doesn't give doctors incentive to give patients more expensive treatment, and instead have incentives to reach good health outcomes.
Doctors are paid to be doctors. And there is always a fraction of the population that aren't healthy. Just like you insinuate with your car mechanic analogy, it's probably a good idea to have a system that doesn't give doctors incentive to give patients more expensive treatment, and instead have incentives to reach good health outcomes.
Oops, I meant to reply to https://news.ycombinator.com/item?id=34674371 and here I am replying to the main thread, lacking context. My mistake.
I have heard similar arguments from pseudo-medical practitioners and I am going to assume you are not trolling.
There are huge logical gaps in your statement.
1/ Being alive is a constant fight against diseases, aging and myriad other illness. 2/ In any reasonable population, there would be a percentage of people who need more medical care than others. 3/ Children and old people are more vulnerable. 4/ Given these above, the doctors cater to people who need the medical care. 5/ The world is not static. You can eat something bad and get sick. The doctors and by extent, the entire healthcare system is not a sterile environment to put people in.
Why not propose an alternate system where doctors can be proactive in asking people to take care of themselves - maybe like asking them to take a vaccine?
There are huge logical gaps in your statement.
1/ Being alive is a constant fight against diseases, aging and myriad other illness. 2/ In any reasonable population, there would be a percentage of people who need more medical care than others. 3/ Children and old people are more vulnerable. 4/ Given these above, the doctors cater to people who need the medical care. 5/ The world is not static. You can eat something bad and get sick. The doctors and by extent, the entire healthcare system is not a sterile environment to put people in.
Why not propose an alternate system where doctors can be proactive in asking people to take care of themselves - maybe like asking them to take a vaccine?
I'm generally a very conservative person. But even I am for government funded healthcare. Who in the hell is against it? I've not met a single person completely against it, mostly just people against people abusing emergency rooms.
Certain big media and politicians are against it, saying we have the best in the world and often pointing at waiting lists in other places. My last gastro had a 7 month waitlist. What in the hell am I paying a fortune for every paycheck, then?