Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

U.S. health is lousy compared with peer nations, report says

latimes.com

Post reply on HN
Print view View original

81–90 of 110 posts

Re: U.S. health is lousy compared with peer nations, report says

#81

Post by jgon »

potatolicious wrote: post #51
Irregardless wrote: post #21

And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. News Flash: The U.S. isn't a welfare state. To benefit from everything this country has to offer, you need to pay for it. Yes, it would be better if that didn't apply to healthcare, but there needs to be some method of exclusion when demand is high and supply is low.…

> "And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities." Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior. As a Canadian who lives in the US it's often shocking how different the perception of the…

As a Canadian I'll chime in and say that I waited 6 months for knee surgery. In a way it sucked, but on the other hand it made sense. I waited 6 months because all I had was a meniscus tear, so I could still do many forms of exercise, drive, walk, run, and work. My chief limitation was my inability to do Judo and soccer.

So I waited for 6 months behind a number of people including those who had similar non-critical injuries but were diagnosed earlier and those who had severe knee injuries requiring reconstruction or replacement. Rationing was done on a need basis rather than my ability to pay. Some people may talk about how terrible this is, and to be honest I probably could have afforded the surgery in a "private" system. Then again, when I was much younger and needed my first knee surgery I would have been hosed in a private system. And no, I wouldn't have been covered under my parent's policy in a private system.

Furthermore, when I have required urgent care, I have received it immediately. The longest I have waited is a few hours in the emergency room. Close friends who have dealt with much more serious life-threatening diseases have started receiving treatment/surgery within a few days or even the same day.

So yes, I experienced the terrible gulag that are Canadian medical wait lists and it really wasn't that bad. The wait lists are based on triaging, rather than wealth, and having wait times based on medical decisions made by professionals rather than economic incentives seems a much more humane system to me. I understand that some will call this "unfair" but that just means our definition of fair is different.

Re: U.S. health is lousy compared with peer nations, report says

#82

Post by hollerith »

avalind wrote: post #76
tptacek wrote: post #75

Earlier quoted context omitted.

It would be shocking if the US had infant mortality rates that were apples-apples close to Sweden. Sweden has just 9 million people, and they're very homogenous. The lede on stories about US infant mortality isn't that Sweden outdoes us. It's things like "the US ranks alongside Qatar and Croatia". Those are the assertions I think we need to be more careful about.

Totally Agree with you. I would think that a big reason as to why the U.S has the rankings it has is the heterogeneity of the US population.

According to yesterday's article in the NYT, this trend of the US's not keeping up with this group of 14 wealthy countries was absent in 1950 and only really started picking up steam after 1980. Since the US population was already significantly more heterogenous in 1950, why didn't that heterogeneity show through in the life-expectancy data for 1950?

Re: U.S. health is lousy compared with peer nations, report says

#83

Post by seanx »

zanny wrote: post #39
maushu wrote: post #29

Earlier quoted context omitted.

> Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? At least we get treatment not dependent on the quantity of money we have.

I'm American, but I know a lot of people from Canada, and after many conversations, the "2 months for a specialist" is bullshit. In practice, preventative medicine and not having to fear to afford healthcare when you need it drastically reduce the demand on the most expensive and specialized doctors and practices because you deal with problems before they end up in the emergency room. I have no health insurance right…

How the hell can a doctors visit run to $800?

Re: U.S. health is lousy compared with peer nations, report says

#84

Post by potatolicious »

seanx wrote: post #83
zanny wrote: post #39

Earlier quoted context omitted.

I'm American, but I know a lot of people from Canada, and after many conversations, the "2 months for a specialist" is bullshit. In practice, preventative medicine and not having to fear to afford healthcare when you need it drastically reduce the demand on the most expensive and specialized doctors and practices because you deal with problems before they end up in the emergency room. I have no health insurance right…

How the hell can a doctors visit run to $800?

Probably on the high end of things, but it's really not that hard. Based on what I've seen from my insurance co. the base rate for my doctor is about ~$250, even for something as simple as simple consultation about the flu (i.e., no tests or other treatment/equipment).

If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.

Re: U.S. health is lousy compared with peer nations, report says

#85

Post by avalind »

hollerith wrote: post #82
avalind wrote: post #76

Earlier quoted context omitted.

Totally Agree with you. I would think that a big reason as to why the U.S has the rankings it has is the heterogeneity of the US population.

According to yesterday's article in the NYT, this trend of the US's not keeping up with this group of 14 wealthy countries was absent in 1950 and only really started picking up steam after 1980. Since the US population was already significantly more heterogenous in 1950, why didn't that heterogeneity show through in the life-expectancy data for 1950?

The difference in heterogeneity between the US and the other countries has probably increased from 1950 to today. But I also suspect that some of this difference in life-expectancy between the US and the 14 others is that it might be easier to implement preventive health care measures that reach the whole population in societies that have more comprehensive health care insurance by default.

It would be really interesting to see data comparing the healthiest people in the US and other similarly developed countries.

Re: U.S. health is lousy compared with peer nations, report says

#86

Post by w1ntermute »

tokenadult wrote: post #79
w1ntermute wrote: post #27

Earlier quoted context omitted.

Do you know if these things are demographically linked, like education is[0]? I haven't done any research, but my gut tells me they are. 0: http://super-economy.blogspot.com/2010/12/amazing-truth-abou...

You should learn not to rely on that link for your understanding of the world. It is crap.

Why do you think my worldview would be based on a single blog post?

And can you elaborate on why you think the post is wrong?

Re: U.S. health is lousy compared with peer nations, report says

#87

Post by grecy »

tptacek wrote: post #75
avalind wrote: post #74

Earlier quoted context omitted.

Yes. But I'm not sure I follow here, both Sweden and the US use the same criteria to report a live birth (All live births are reported) and seem to use the same definition of Infant mortality rate, (Death before first birthday). I fail to see how reporting differences explain the difference in infant mortality between the two countries. Of course, compared to countries that use extra conditions for live births (weigh…

It would be shocking if the US had infant mortality rates that were apples-apples close to Sweden. Sweden has just 9 million people, and they're very homogenous. The lede on stories about US infant mortality isn't that Sweden outdoes us. It's things like "the US ranks alongside Qatar and Croatia". Those are the assertions I think we need to be more careful about.

> Sweden has just 9 million people, and they're very homogenous.

The population has no impact when we're looking at per-capita statistics.

Canada and Australia have the highest immigration rates in the world, so their homogeneity is going down, yet statistics like these are not going up.

Re: U.S. health is lousy compared with peer nations, report says

#88

Post by pcurve »

tptacek wrote: post #66
pcurve wrote: post #65

Earlier quoted context omitted.

"Outcomes in the US for chronic serious illnesses are at or near the top of the rankings." This is because we have so many people with chronic serious illnesses that we know what to do with them better (at high costs). This isn't something to be proud of.

That's a pat way to dismiss any ranking of countries for health outcomes. If you want to come up with a way to produce a low rank for the US on some holistic indicator, you will not have a hard time doing it. Are we the "healthiest" country in the world? Certainly not! We don't even have mandatory military service. The issue here is that we need to be clear on what lessons we're trying to draw from the rankings. Peop…

Is it better to have a nation with 2.5% diabetic population than 6.5% population, if it meant that the nation wouldn't have the best (but still very good) diabetic treatment outcome? Is that a good trade-off? Probably.

I replied, because often apologists for American healthcare (I'm not saying you are one) neglect to mention why we have a good treatment outcome for certain conditions.

Re: U.S. health is lousy compared with peer nations, report says

#89

Post by grecy »

tptacek wrote: post #80
sjg007 wrote: post #77

Earlier quoted context omitted.

suicides, greatest country ever...

It does not help at all that we have overseas military commitments at a scale no other industrial country would match. The suicide rate for veterans is wildly higher than for civilians.

The US has a lower "active military per capita" than lots of OECD countries.

http://en.wikipedia.org/wiki/List_of_countries_by_number_of_...

Re: U.S. health is lousy compared with peer nations, report says

#90

Post by roc »

maxerickson wrote: post #37
roc wrote: post #24

Earlier quoted context omitted.

It's not a problem that can be 'hacked'. Much like hunger in the third world: it's a political problem. Practical solutions have long since been developed and proved in other places. The problems persist where they do, because there's no political will to actually implement the solutions in those places.

Most health care systems are grappling with costs and the demand for care outstripping the supply. It isn't a solved problem.

They're grappling with costs because their professional ethics require they treat people who can't pay, yet their business obligations require they don't treat those people until it's serious and likely expensive.

So because X number of people get X-Rays that will never be paid for, providers have to try to find some amount they can charge those who do pay, to cover the difference. And the trick with that, is that insurance companies know damn well what X-Rays should cost and have the bargaining power to squeeze out much of the padding in the cost of an X-Ray. [1]

Which means those costs are eating into profits in a big way and has healthcare providers struggling to make the math work out. Particularly for those that service poorer areas, where fewer well-ensured patients can offset the cost of uninsured patients.

And when you don't have a lot of slack in your budget, it's pretty difficult to add beds and professionals to increase your ability to supply healthcare.

[1] Which is another perverse incentive for the hospitals to use new machines/drugs/methods when old ones will do just fine. Firstly, they're incentivized because their profit is largely function of the percent of raw cost the insurance companies allow for profit. So an X-Ray++ brings in more profit than a bog-standard X-Ray for the same amount of professional time.

Secondly, because newer tools are by definition not yet commoditized, they can squeeze more 'buffer' into those prices, until the insurance companies can sort out what it 'should' be and more hospitals get in on tool X and begin essentially competing with one another, by accepting lower rates.

Post reply on HN