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US spends most on health care but has worst health outcomes

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Re: US spends most on health care but has worst health outcomes

#91

Post by wizofaus »

TechnicolorByte wrote: post #33
silisili wrote: post #8

This isn't at all surprising, for multiple reasons. The entire insurance industry existing is a big one. That we are all overweight is another. 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 agains…

> 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.

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.

Re: US spends most on health care but has worst health outcomes

#92

Post by callahad »

bosie wrote: post #30
pigsty wrote: post #18

Earlier quoted context omitted.

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…

how.... how... can they reject anything that the hospital says?

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...

Re: US spends most on health care but has worst health outcomes

#93

Post by alexisread »

0xy wrote: post #39
smcl wrote: post #35

Earlier quoted context omitted.

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.

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.

Re: US spends most on health care but has worst health outcomes

#94

Post by mcv »

yourusername wrote: post #71
mcv wrote: post #28

Earlier quoted context omitted.

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…

>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…

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.

Re: US spends most on health care but has worst health outcomes

#95

Post by otikik »

HourglassFR wrote: post #55
otikik wrote: post #37

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.

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.

Re: US spends most on health care but has worst health outcomes

#96

Post by Arnt »

junofan wrote: post #75
Arnt wrote: post #17

Earlier quoted context omitted.

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'…

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.

Re: US spends most on health care but has worst health outcomes

#97

Post by peoplefromibiza »

_vbnz wrote: post #69
tehCorner wrote: post #53

Earlier quoted context omitted.

> 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

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…

> 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.

Re: US spends most on health care but has worst health outcomes

#98

Post by mapremap »

rgmerk wrote: post #89

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 cou…

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.

Re: US spends most on health care but has worst health outcomes

#99

Post by forgetfreeman »

jrockway wrote: post #68
forgetfreeman wrote: post #65

Earlier quoted context omitted.

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.

Re: US spends most on health care but has worst health outcomes

#100

Post by forgetfreeman »

silisili wrote: post #82
forgetfreeman wrote: post #72

Earlier quoted context omitted.

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.

How awful which government projects go? Yeah the DMV is a thing, but so is NOAA and NASA.
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