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US health system ranks last compared with peer nations – report

theguardian.com

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

#201

Post by jq-r »

A_D_E_P_T wrote: post #184
jq-r wrote: post #169

Earlier quoted context omitted.

Well some relatively common things are easy to get in Croatia (bloodwork and meds - GPs like to prescribe those to get rid of you), more serious like exams, treatments, surgeries are absolutely terrible with waiting lists which are years long. People are dying, and/or their condition worsens before they even see a specialist. This is common knowledge for many years now. Private clinics are opening left and right with…

I've lived in the US where my health insurance had like a $6000 deductible and a $1400/month price-tag. (And, by the way, I really didn't appreciate how American doctors would gatekeep drugs, restrict their availability, and add significantly to their cost.) Here, you can walk into any private clinic in Croatia, and arrange for even a fairly complicated surgery, and it'll cost you way less than all that. Your annual…

I'm not sure if we're talking here about the same things. You may say: "oh it's easy to get meds and it's cheap to do X, medical system is great" while being a medical tourist and/or having a far above average pay, I would accept that. It's great if you have the means. Just like it's great in USA if you're rich, right? But directly comparing two completely different systems and different orders of magnitude of purchasing power and taxes doesn't really paint a good picture of how it's here.

For an average citizen the system is terrible and getting worse by the day. The examples are too numerous to mention.

I'm also not sure if you think that I'm somehow against private clinics. I'm not. They of course won't compete on medications with public services as that's pointless. What I do find apalling is that doctors are working in both public and private clinics completely legally. Moreover, that practice makes the public services worse by removing the availability of the doctors and makes taxpayers being double charged for the same service.

There would be riots with pitchforks if most needed some non-basic ("take these pills") medical help. When you're young you probably don't need much. But as you get older you actually might need some procedure or a treatment. But by that time you are actually older, sicker, and there aren't too many of you to actually riot. And many jump the lines by having friends (of friends) working in hospitals. It's bleak and grim and I don't see it getting better.

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

#202

Post by consteval »

mytailorisrich wrote: post #153
vidarh wrote: post #142

Earlier quoted context omitted.

> The NHS has much bigger problems than funding. Even the new, left-wing government has indicated that they won't increase funding without reforms. It's always very convenient to starve something of funding for years when you want to insist something needs to be reformed before you can spend as much as it costs to provide service at an adequate quality. Reform or no reform, outcomes won't improve without increasing t…

The point is that throwing ever more money at a bottomless pit isn't a solution. Hence there must be changes, not just more money. Another issue is that the NHS is a religion. It is blasphemous to suggest departing from free-of-charge delivery or private involvement (although that's already what we have). Even suggesting "reform" is badly received.

The reason is that private intervention is tricky. The US has a fully private healthcare system, and as you can see from this post, it's shit.

I'm from the US so excuse any oversimplifications, but over the past couple decades I've noticed a trend of US-ification in British politics. I would be careful with looking to greener pastures.

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

#204

Post by mytailorisrich »

consteval wrote: post #202
mytailorisrich wrote: post #153

Earlier quoted context omitted.

The point is that throwing ever more money at a bottomless pit isn't a solution. Hence there must be changes, not just more money. Another issue is that the NHS is a religion. It is blasphemous to suggest departing from free-of-charge delivery or private involvement (although that's already what we have). Even suggesting "reform" is badly received.

The reason is that private intervention is tricky. The US has a fully private healthcare system, and as you can see from this post, it's shit. I'm from the US so excuse any oversimplifications, but over the past couple decades I've noticed a trend of US-ification in British politics. I would be careful with looking to greener pastures.

The thing is that right next to the UK is France, which I know.

The French system is based on a mandatory health insurance, now with mandatory private health insurance in addition to that.

GPs and most health professionals are private practices that set up shop like a, say, lawyer would and there is big private sector involvement up to hospital level.

I think there are many similar examples throughout the world.

This is partly why I find this focus on the US system in the UK puzzling. My best guess is that it is used as a scarecrow by those opposed to any changes to the NHS.

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

#205

Post by ImJamal »

usr1106 wrote: post #200
ImJamal wrote: post #191

Earlier quoted context omitted.

The US has no common health system. There are a few systems that are common (Medicare) but that is only for the elderly. The rest of the system is all done on the state level. The rules vary amongst all the states.

> the rest of the system is all done on the state level Ok. Didn't know that. But you are talking about public services aren't you? I would assume a rather small fraction of the huge US health expenses are publicly financed. The bigger part is completely private businesses, both service production and insurances for those who have one. That's the opposite in most EU countries and UK. A large fraction is either produc…

I don't know the percentage so I don't know if it is a small fraction. The basic setup is:

Medicare - federal program for seniors

Medicaid - state program for poor people (there may be some sort of funding by the federal government, but it is run by the states)

Private insurance - this is paid by the individual and/or the company they work for

The laws/regulations regarding what is and isn't allowed with the private insurance is handled mostly by the states, not the federal government. The federal government has pushed for various rules (ACA/Obamacare) but there is a debate about the constitutionality of the federal government getting involved.

There are also specific programs within the governmental systems that focus on children (Insure Kids Now) and provide dental not just medical.

Within Medicare there are additional (supplemental) coverages that provides better benefits called Medigap.

I'm sure there are more programs than just Medicare and Medicaid, but those are the largest ones.

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

#206

Post by wkat4242 »

xtracto wrote: post #192
wkat4242 wrote: post #98

Earlier quoted context omitted.

Are there safeguards in place to prevent the wrong people looking up your data with the touch of a button though? I'm aware of Estonia's digital prowess but for me privacy is a top concern and I'm glad we're not so all-in here.

I understand where you are coming from. But for ME I have personally ever wondered why are people afraid of others knowing their medical history. This I know is a very unpopular opinion, but for my specific case, I've got plenty of medical record that may be considered "shameful"? Got several colonoscopies, endoscopies, I lost a finger, I had a LIS (anal operation) , etc, etc, etc haha. Yet, I kind of don't really ca…

In countries where healthcare can exclude preexisting conditions this can be a major problem.

And it's not just about shame. It's just about it being nobody's business. I'm not afraid of people knowing my history (though I imagine my mental health history may raise some eyebrows, I don't feel bad about it) but it's just none of anyone else's business and I would certainly be pissed if someone knew that I didn't confide in.

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

#207

Post by A_D_E_P_T »

jq-r wrote: post #201
A_D_E_P_T wrote: post #184

Earlier quoted context omitted.

I've lived in the US where my health insurance had like a $6000 deductible and a $1400/month price-tag. (And, by the way, I really didn't appreciate how American doctors would gatekeep drugs, restrict their availability, and add significantly to their cost.) Here, you can walk into any private clinic in Croatia, and arrange for even a fairly complicated surgery, and it'll cost you way less than all that. Your annual…

I'm not sure if we're talking here about the same things. You may say: "oh it's easy to get meds and it's cheap to do X, medical system is great" while being a medical tourist and/or having a far above average pay, I would accept that. It's great if you have the means. Just like it's great in USA if you're rich, right? But directly comparing two completely different systems and different orders of magnitude of purcha…

I don't think you appreciate how much worse things are in the USA, even after adjusting for income and taxes. (Effective tax rates are very similar between the two countries, besides.)

Medical care isn't perfect in Croatia -- but it's not perfect anywhere, and at least in Croatia the poor can have many of their needs met by a pharmacist, without even needing to see a doctor; they'll never need to pay >$1000/month out of pocket for garbage "insurance" with a high deductible; they have the option of public care for certain procedures and treatments, and private clinics for others.

Yeah, there may be an element of corruption to it -- perhaps if you "know a guy" you'll get your appointment more quickly -- but this is small-time corruption on a human scale. In the US the corruption takes place on far vaster and more impenetrable scales, with lobbyists, regulatory capture, and I could go on...

And, yeah, some can't afford private care, and need to rely wholly on the public system in their old age. I dare say the public system in Croatia is still a damn sight better than Canada's, or the UK's. Maybe you can tell me which country has an ideal public system? Distant Japan's, perhaps?

As for public system doctors working in private clinics -- it's like that all over the world, as far as I can tell. The medical system in Hong Kong is very highly regarded, and it produces good outcomes, and I know from personal experience that doctors there also work both systems simultaneously. Public hospital in the morning, private office in the evening -- or public hospital on Mondays and private clinics the rest of the week.

In fact, the system in Hong Kong is very much like Croatia's, but Hong Kong's private clinics are roughly 5-10x more expensive, on average, for the same procedures!

All things considered, and in light of the alternatives, Croatia's is really a better system than almost any in the world, for rich and for poor.

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

#208

Post by HDThoreaun »

xtracto wrote: post #189
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 Mexico my experience was this: * 8am arrive to the emergency room in a private hospital * 8:10am get seen by an internist doctor and after initial review, tell the doctor that I would like to get an MRI. 8.20 get a doctor prescribed mri ans take it to the radiology department 8:40 get the MRI 9:30 Get the results of the MRI, and pay for the whole thing: No more than $1500 USD. Without insurance . 10:00am take mri…

Plenty of urgent care places in the US will give you an mri if you walk in. It’s just expensive because labor here is crazy expensive compared to Mexico.

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

#209

Post by HDThoreaun »

vkazanov wrote: post #165
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 someone in the same income range, and many friends in comparable spot, I have to say that NHS is sometimes ok . Here's an NHS case. Case 1. My friend's wife had her body going numb, like, completely senseless. They didn't have a private insurance back then. It was maddening hard to get past the GP. And then there were numerous tests, and queues, and... She had a viral brain infection that was, luckily, easy to fix…

On the other hand doctors on the US prescribe far too many tests. These tests are generally set to have a 5% false positive rate so if you prescribe 14 tests you’re more likely than not to get a false positive. From talking to doctors it seems extremely common for something like that to happen and it’s always a headache when it does.

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

#210

Post by fellowniusmonk »

DavidPeiffer wrote: post #87
diogenescynic wrote: post #67

Quality of care is shit. Doctors barely care about their patients. It’s all a racket. Most areas seem to have a local monopoly that takes over the local hospitals. Obamacare has done nothing to really change anything meaningfully.

Obamacare is a mixed bag, but I don't think I'd go back to a pre-obamacare era if I had a choice. So many people stayed at jobs for longer than ideal because they had pre-existing conditions that wouldn't be covered under a new insurance plan. The consolidation of the last 20 years has been a real black mark on the system. It was supposed to improve outcomes by making all the records easily available in one system. I…

Pre ACA was absolutely insane. Literally any change would have been better. The artificially limited and abusive process of training doctors is still completely broken. The training pipeline is pure protectionism. The rise of nurse practitioners and the creep of doctor like responsibilities for nurses is a sign of the complete failure of our doctor training pipeline.

Approximately each year we have 1 doctor finishing residency for every 120 births, compare that to Portugal which has 1 new doctor for every 57 births.

Horrible individual, family and economy destroying things from pre-ACA:

1. Because I wasn't born with a perfect body I was literally forced to work for a company until ACA because I was uninsurable. I started my first successful startup immediately after ACA became law with an idea I had fully fleshed out a decade prior. It's a horrid drag on the economy to introduce infinite health (and bankruptcy) risk to any attempt to be an entrepreneur.

2. If you WERE ever eligible for private insurance and every stopped paying for it (because you had insurance through your company) you were unable to quit that job and go back to private coverage, if you tried you would be denied if you weren't in perfect health. Fully contiguous coverage would still get you fully denied for "pre-existing conditions". Coverage was not guaranteed to transfer between states.

3. My family was bankrupted and financially destroyed because my mother was diagnosed with cancer during a short interstitial period where the company my father was working for suddenly went out of business and keeping cobra would have cost 15k a month so they didn't. It was so messed up she qualified for state medicare but that meant that my families income couldn't be above ~15k, my parents only option for my dad to get a normal paying job was to divorce (which they refused to do on religious grounds), this meant that I had to enter the workforce full-time to pay for my family to have a roof and food over their heads at 15.

Even though so much of the brunt of this was put on my childhood shoulders I was able to make it out ok all things considered because I am a complete bastard of a person, my siblings who were less resilient were absolutely destroyed, we were all in the top 10% of intelligence based on standardized testing.

The pre ACA system was a kafkaesque nightmare that was completely different state to state so many people found themselves unable to move states for work because coverage and eligibility was effectively unparsable between states for the laymen.

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