US health system ranks last compared with peer nations

Re: US health system ranks last compared with peer nations – report

#51

Post by daemonologist » Thu, Sep 19, 2024, 6:41 AM UTC

gertlex wrote: post #16

jimbob45 wrote: post #3

It's unfair to judge the EU piecewise but then judge the US as a whole. Either let us compare apples to apples by judging the whole EU against the US or let us judge individual European member states against individual US states.

As an American, I'm probably heavily influenced about non-state-by-state discussion in the media and thus ignorant... (and work in tech and don't directly pay for health insurance...) but I don't think I'm aware of significant state-by-state differences in healthcare. I know California generally has more regulations and has MediCal, but most insurance options I've encountered seem to be multi-state (regional, not nec…

Medi-Cal is California's implementation of Medicaid, which along with CHIP is always administered by the individual states (though the federal government tries to apply some controls via funding).

That's the only big top-down state-by-state distinction that comes to mind, but there are a lot of small details. We have some models predicting medical outcomes and financials and state is always at or near the top of the SHAPs. Sometimes bigger than age or household income. (I don't study this or anything, just an incidental observation.)

Re: US health system ranks last compared with peer nations – report

#52

Post by rscho » Thu, Sep 19, 2024, 6:42 AM UTC

arjie wrote: post #36

One thing that's surprised me about the US is the general slowness of most things. In India, you can get MRIs and CT Scans same day. Or you could the last time I was there. And it didn't cost very much in comparison. My doctors have all been good (attested to by my parents who are surgeons themselves) but the healthcare system is wonky. One thing I didn't expect is that the Indian system where you just drag your heal…

Electronic health records have dismal ergonomy, usually. They're profiled for billing performance instead of care performance.

Re: US health system ranks last compared with peer nations – report

#53

Post by vidarh » Thu, Sep 19, 2024, 6:43 AM UTC

mytailorisrich wrote: post #42

vidarh wrote: post #33

Earlier quoted context omitted.

As someone in the UK with income in the top 1%, I have never bothered with private insurance because I genuinely don't feel I need it. I occasionally pay for private GP services, and I've paid for some private services for my son, but for the most part the NHS works. It has waiting times for non-essential things, and if you don't want that, you can pay for insurance that gets you seen faster and it costs a pittance.…

As soon as you need treatment beyond standard GP/prescriptions, like checks/analyses or specialised consultation/treatment then private insurance comes very handy to get good care quickly. Waiting times are not only for non-essential things. The only thing with no waiting time is A&E if you are in immediate danger of death. The NHS is some "safety net" that does the bare minimum at this point, or no longer anything a…

I have had extensive rounds of tests for various things with the NHS over the last several years, and never had a problem sufficient to feel private insurance, even as cheap as it is in the UK, to be worth it. I don't doubt it's worth it for some, but there's a reason - and while costs will stop some, costs does not explain nearly all of it, given how cheap it is - that only about 10% of the UK population has private insurance, even with the underfunding of the NHS in recent years (e.g. 20%-30% lower healthcare spend for capita PPP adjusted than comparable economies does have an effect).

There's an inflection point, sure, where you start spending enough privately that the insurance is worth it, but so many of these things are so cheap here anyway that the gap from between where it starts to pay off until you're ill enough to get reasonably fast treatment with the NHS is quite narrow.

Sometimes people think it is wider than it really is because people want and push for treatments that are not medically indicated. E.g. patients pushing for pointless MRIs is common enough that same-day MRIs is a huge industry here even though they only make an impact on outcomes for very specific symptoms.

Re: US health system ranks last compared with peer nations – report

#54

Post by askonomm » Thu, Sep 19, 2024, 6:44 AM UTC

arjie wrote: post #36

One thing that's surprised me about the US is the general slowness of most things. In India, you can get MRIs and CT Scans same day. Or you could the last time I was there. And it didn't cost very much in comparison. My doctors have all been good (attested to by my parents who are surgeons themselves) but the healthcare system is wonky. One thing I didn't expect is that the Indian system where you just drag your heal…

In Estonia all of our records (incl. Health) are digitized and online in a central system that both doctors and you can access. It works wonders. Every doctor I go to can see my entire medical history with a press of a button, and I don't have to deal with any of that. Likewise when they prescribe new things, I can see my prescriptions right there, and so forth. We're a 100% online nation now, and clearly when done well it's remarkably good.

Re: US health system ranks last compared with peer nations – report

#55

Post by Trhoe3849 » Thu, Sep 19, 2024, 6:44 AM UTC

simonbarker87 wrote: post #38

vidarh wrote: post #25

Earlier quoted context omitted.

Not that I'm trying to make you feel worse about it: In the UK we pay less per capita in taxes toward healthcare than you do in the US (or at least did last I added up the numbers - Medicare and Medicaid alone added up to a higher per capita cost than the NHS), and if we do want private health insurance, which here is basically "queue skip insurance", it costs a fraction of in the US because they only need to provide…

> For a lot of elective procedures, the price is even low enough that it'd pay you to fly to the UK and stay in a hotel to get things done here if the recovery isn't too long. But please don’t do this. Our system is better than the US but private is now starting to struggle along with the NHS wait times as more people use their private coverage where they wouldn’t have done before.

Flying to UK for cheap healthcare is a sick joke.

There are much better countries for medical tourism: Thailand, Malaysia, Greece...

Re: US health system ranks last compared with peer nations – report

#56

Post by fire_lake » Thu, Sep 19, 2024, 6:46 AM UTC

askonomm wrote: post #54

arjie wrote: post #36

One thing that's surprised me about the US is the general slowness of most things. In India, you can get MRIs and CT Scans same day. Or you could the last time I was there. And it didn't cost very much in comparison. My doctors have all been good (attested to by my parents who are surgeons themselves) but the healthcare system is wonky. One thing I didn't expect is that the Indian system where you just drag your heal…

In Estonia all of our records (incl. Health) are digitized and online in a central system that both doctors and you can access. It works wonders. Every doctor I go to can see my entire medical history with a press of a button, and I don't have to deal with any of that. Likewise when they prescribe new things, I can see my prescriptions right there, and so forth. We're a 100% online nation now, and clearly when done w…

Does one big digital system make a cyber attack more damaging?

Re: US health system ranks last compared with peer nations – report

#57

Post by mrweasel » Thu, Sep 19, 2024, 6:48 AM UTC

cat_plus_plus wrote: post #20

Because we are paying for the rest of the world. Allow prescription drug imports from abroad. Pharma companies will be forced to charge more in the rest of the world and less in US. Allow insurance plans based on medical tourism for expensive procedures. Some countries will say no, but a lot of countries will say yes for profit. Once you have a choice of a hip replacement in Mexico or India, hospitals in these countr…

> Because we are paying for the rest of the world.

While I don't know if that covers all the expenses, I don't think people appreciate how much funding the US system is contributing to new med-tech development.

A previous client created some analytics software, they have EU regulatory approvals, but those are almost secondary, without FDA approval they would shutdown. All of their client, except for a few UK customer (who just bundle and resell in the US) all of their clients are in the US. For a lot of smaller medical companies, even in the EU, the US market is their number one source of revenue.

I might be wrong, but it's also my impression that if you do have the money, you'll get much more in-depth care and treatment in the US. And it's from this segment many companies find the funding to develop new technology that will only much much later trickle down to public healthcare systems else where in the world.

Re: US health system ranks last compared with peer nations – report

#58

Post by fire_lake » Thu, Sep 19, 2024, 6:48 AM UTC

ein0p wrote: post #8

Lately I can’t even get a doctor - both the specialist and primary care doctors are booked months in advance. And I have one of the best insurance coverages currently available. Remember how we laughed at Canadians and Brits waiting for months to see their free/cheap doctors? Well we’re at a point where we have to wait _and_ pay through the nose. And then they can’t really do anything or fuck you up even worse.

The UK isn’t functioning well at the moment. Cancer treatments keep getting delayed and people are dying as a a result, to give one example. I don’t know which countries are doing a good job on health, but it’s not the UK.

Re: US health system ranks last compared with peer nations – report

#59

Post by netsharc » Thu, Sep 19, 2024, 6:48 AM UTC

ein0p wrote: post #46

vidarh wrote: post #25

Earlier quoted context omitted.

Not that I'm trying to make you feel worse about it: In the UK we pay less per capita in taxes toward healthcare than you do in the US (or at least did last I added up the numbers - Medicare and Medicaid alone added up to a higher per capita cost than the NHS), and if we do want private health insurance, which here is basically "queue skip insurance", it costs a fraction of in the US because they only need to provide…

The US is so corrupt that I’m afraid any attempt at universal healthcare would make it even more expensive. Obamacare was basically a trillion dollar giveaway to Big Pharma and Big Healthcare. The only positive thing I can see in it for me personally is that it became possible to buy (extremely expensive) healthcare privately rather than through an employer, and you could not be denied due to pre-existing condition.…

Obama himself has said to that Obamacare (well ACA) is like (to use my own analogy) a "patch" on a a system that can't just be reimplemented (most of it due to political reasons). It's not terrific but it's what was able to be done.

Whereas e.g. single payer was an unachievable pipe dream from where they were standing in 2008/09. And he'd rather have something a bit better rather than go for the excellent system and fail and be left with the bad system.

Re: US health system ranks last compared with peer nations – report

#60

Post by gsa » Thu, Sep 19, 2024, 6:48 AM UTC

arjie wrote: post #36

One thing that's surprised me about the US is the general slowness of most things. In India, you can get MRIs and CT Scans same day. Or you could the last time I was there. And it didn't cost very much in comparison. My doctors have all been good (attested to by my parents who are surgeons themselves) but the healthcare system is wonky. One thing I didn't expect is that the Indian system where you just drag your heal…

Electronic interop, in my experience talking to my GP (not US), is tricky not because of technical challenges but very strict privacy implications.