The US likes to pretend free markets are our principle, but we have completely destroyed every notion of a free two-sided market on healthcare. That's the simple explanation for our outcome.
US health system ranks last compared with peer nations – report
211–220 of 239 posts
Re: US health system ranks last compared with peer nations – report
#212Earlier quoted context omitted.
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…
I'm sorry you went through that. My analysis was short largely because I was still in high school when it passed. I knew it was a nightmare prior, but didn't have any direct experiences.
The beat of the drum has long been "repeal the ACA" for a political party. It rallies people to undo a sweeping change the other party put in place, but it has never materialized. So many parts of the ACA poll very popular, a complete repeal without a really good alternative (which has also never materialized beyond "a concept of a plan") would be a surefire way to immediately lose political standing.
And perhaps most sad of all of this is ACA didn't even remove health insurance from its tie to employers. There are still massive inefficiencies for people who hit a deductible or max out pocket early in the year. They'll either need to pay through the nose for COBRA through the year end, or switch jobs and start over with the deductible and max out of pocket, which for large swaths of the population is simply not a reasonable option. Switching near the start of the plan year is optimal, but definitely less efficient overall.
In 2020 I learned health insurance premiums from your paycheck are taken pre-tax, however you cannot deduct COBRA premiums. It really rubs salt in the wound for people who have been laid off.
Re: US health system ranks last compared with peer nations – report
#213Earlier quoted context omitted.
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…
I'm sorry you went through that. My analysis was short largely because I was still in high school when it passed. I knew it was a nightmare prior, but didn't have any direct experiences. The beat of the drum has long been "repeal the ACA" for a political party. It rallies people to undo a sweeping change the other party put in place, but it has never materialized. So many parts of the ACA poll very popular, a complet…
Yes, I mean I was young and a republican at the time but even I was pissed that Joe Liberman voted single payer down.
My perspective at the time which was naive/wrong was that we should either deregulate completely (which was a foolish perspective from my youth) or switch to single payer like France's system where doctors stay independent (unlike the UK's NHS at the time) and we just shoot the health insurance industry.
It was very obvious to anyone who had regular dealings with our system that it was opaque, cruel, insane and a premium cost for an inferior experience.
Not to mention the history of insurance companies losing lawsuits because as a "cost saving tactic" they would deny claims by default so people would die before procedures were approved.
From a cost efficacy and perverse incentives perspective it was clear that things had to change but that the ACA as it was passed would be easy to pick away at and sabotage by insurance industry and health provider conglomerates, and that is exactly what has happened.
Still the protections in place are FAR better than what we had.
It was very common at the time to hear even Republicans refer to themselves as "wage slaves" because of how beholden the populace was to corporate insurance and how it effected career choices.
Re: US health system ranks last compared with peer nations – report
#214Re: US health system ranks last compared with peer nations – report
#215Re: US health system ranks last compared with peer nations – report
#216I find it hard to trust a report that puts Canada above Germany in any healthcare related ranking. In terms of access, quality, and coverage, there's absolutely no comparison.
Where did it put Canada above Germany? All it has is a list but doesn't claim it is in any order except they are all above the United States.
Re: US health system ranks last compared with peer nations – report
#217Earlier quoted context omitted.
The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills. In all cases treatment is required by law, regardless of payment.
>In all cases treatment is required by law, regardless of payment. No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for fre…
I'm not sure where this is happening, and I'm not saying you're wrong, but where I live, doctors are paid salary and they care for patients, so from my perspective what you're referring to sounds like a myth. My friends, who are doctors, operate all the time on people who have no identification and they do their absolute best. And there is no monetary incentive to do otherwise and they would quit and find a different hospital if there were. Anecdotal? Maybe. I'm open to hear from a doctor that says otherwise.
As best I can tell, the medical community and education system would reject a doctor in the US from licensure for any other attitude towards health care.
Re: US health system ranks last compared with peer nations – report
#218Earlier quoted context omitted.
The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills. In all cases treatment is required by law, regardless of payment.
> In all cases treatment is required by law, regardless of payment. Screening for and stabilization of emergency medical conditions is required at all emergency departments by law, regardless of ability to pay, but that's much more limited than "in all cases, treatment is required by law, regardless of payment", and even then, hospitals skirt the rules.
And how does this differ from care elsewhere?
To contrast, my sister lives in Europe and needs shoulder surgery and unless she pays for a private treatment (by the same doctor) she will not be treated for 12 months. Guess what I paid for. Is that any better?
Re: US health system ranks last compared with peer nations – report
#219Earlier quoted context omitted.
The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills. In all cases treatment is required by law, regardless of payment.
Not true except for immediate emergency care. Many employers do not provide coverage. They skirt the law by employing people part-time (Walmart, Amazon) or as gig workers. Even if the law reads as you claim that doesn’t mean you can get care in the US.
And that's different from other countries how? I can walk into a hospital in any country in Europe as a non-citizen and request non emergency care and receive it?
>Many employers do not provide coverage
For under 50 employees, making less than 50k, Healthcare.gov covers those cases. You can visit there now to confirm my claim.
And yes, it means you can get care in the US. I brought my Euro girlfriend here and she got care under a bullshit name. And they treated her, the same as any other patient. And she never paid anything. It was non emergency and we went to an emergency room anyway.
Do you have a counter example? If so please share.
Re: US health system ranks last compared with peer nations – report
#220Earlier quoted context omitted.
In the UK you also pay insane taxes and your _median_ citizen in the UK has far less disposable income after all expenses including healthcare, according to OECD metrics. In software engineering specifically, I'd make a third of my current income in the UK. I'd much rather make 3x as much in the US and still get free healthcare through my employer, with shorter waiting lists and better treatment outcomes than the NHS…
> They will very quickly find that the US system is far better than the NHS. We get seen more quickly, our doctors can afford to actually spend time on us, more effort goes into root-causing a problem, we have more treatment options, etc. Nothing stops you from choosing extra insurance in the UK too if you believe you need that level of cover. The only reason you're comparing it to the NHS instead of an equivalently…
In the UK, not only would I pay massive taxes for healthcare, but then I'd also have to purchase private healthcare anyways.
The US is far cheaper, even according to OECD metrics (disposable income after all expenses incl. healthcare.)