It’s really interesting how the US has managed to get a health system that’s extremely expensive, doesn’t cover everybody, is highly bureaucratic and complex, delivers below average outcomes and has overworked hospital staff. And somehow people defend this system because it works fine for the top few percent (especially the people in Congress) and people who have Medicare or VA.
Is there any country with a medical system that people don't complain about? For instance is there anyone in the world that would agree: "Gee, my healthcare is so cheap, it's surprising that it covers everything I want it to without me needing to go out of my way to justify my treatment options and I have so many medical professionals available to me at a moments notice!"
France is #1 in care according to the world health organization for 1/2 the cost per capita. It is all private, well-regulated, and provides universal coverage (your company pays your premium; if you have no employer, the govn't does).
We are #37 according to the world health organization and we cost twice as much.
I'm sure people in France complain, but they have way less of a reason to.
Some reasons for the cost savings: universal, portable medical record, insurance companies have to remit with three business days, reference pricing, one system not medicare, VA, private. Private insurance companies don't make tons of money they are so well regulated...
> France is #1 in care according to the world health organization for 1/2 the cost per capita. It is all private, well-regulated, and provides universal coverage (your company pays your premium; if you have no employer, the govn't does).
> We are #37 according to the world health organization and we cost twice as much.
Note that ranks alone are not sufficient to evaluate this comparison. If the top 40 countries for Healthcare outcomes all had near-equivalent mortality rates, e.g., it wouldn't necessarily be a problem to be #37.
That said, they don't have equivalent mortality rates, so the ranks do happen to discriminate quite a bit.
Life expectancy in the USA is lower than France primarily due to other factors like obesity, sedentary lifestyles, substance abuse, suicide, and violence. Those problems can't really be fixed through healthcare system reforms (although making our healthcare system more efficient might eventually free up some funding for other social issues).
The NHS is one of the most beloved institutions on the planet AFAICT.
Of course everyone would prefer if everything were better all the time, but complaints about the US system and clearly not on the same plane as those about UK’s.
Wow, the last few years are a shocking drop. In 2010, 70% reported "very or quite satisfied" and 18% "very or quite dissatisfied." 2010 - 2020 seemed to hover around 60-65% "very satisfied."
Unless you're reading news items about no ambulances or beds, being left on trollies in corridors, waiting lists for procedures lack of available GP appointments. Before covid not as a result.
I have experience in Germany and the US. I don’t think there is much difference in these aspects. As far as GP appointments go, here in new Mexico the wait time is measured in months and years.
IMO, the problem with healthcare is the same issue as with other labor-intensive things like childcare, education etc. It's Baumel's cost disease. Products hey cheaper due to automation and get cheaper relative to services. This makes these things get really expensive in relation. The most common intervention for this unfortunately is demand-side subsidies which of course make things worse. The other intervention is tighter controls which means more paperwork which also make things more expensive. Happens everywhere.
Of course, because comp is much higher in the US than in most countries, including most western countries, maybe worth the exclusion of tiny, unusual places like Switzerland.
I don't mean to start a flame war, but the most positive things I've heard are from Indian colleagues/friends who are used to paying cash for very affordable service back in India.
No insurance or national coverage, just low overhead and high skill.
Those colleagues were very wealthy by Indian standards to begin with and have only increased their purchasing power by being abroad. India does in fact have free care at government facilities and they are certainly not "low overhead and high skill". I'd pick rural American healthcare over rural Indian healthcare 10 times out of 10.
From my experience talking to veterans, they think the VA is bad until they experience the alternative. But medicine is just incredibly individualized, so it's natural that everyones' experience will be unique.
It doesn't work very well for people going through VA.
Source: MIL is a former nurse, former-VA claims processor. She found both the level of coverage, and the rules she had to follow to deny it, and the hoops her patients had to jump through to get treatment were utterly insane.
Everyone here likes starting wars. We're very good at starting wars. Starting wars, and support-the-troops pins are cheap. We really don't like paying for the cost of war, though. That's expensive.
>It’s really interesting how the US has managed to get a health system that’s extremely expensive, doesn’t cover everybody, is highly bureaucratic and complex, delivers below average outcomes and has overworked hospital staff.
Well, most of Europe' social welfare systems were wiped out by the end of 1945 and were then rebooted with forethought and precedent of what not to do. The US is an archaic hodgepodge of systems over a 100 years old and were created with no precedent to model from.
People defend this system because their lives and livelihood are tied to it. It is dumb, but without a thing like a world war to wipe the slate clean it is what we have to work with.
Eh, most of the current designs in the US healthcare industry has its roots with the move to employer-sponsored healthcare in the 1940s (see: 1942 Stabilization Act and it's consequences). Private health insurance was barely a thing in the 1920's and pretty much didn't exist before then.
I generally agree. As I said, it was a hodgepoge, with no one solution covering the nation. Lots of proposals for more comprehensive solutions but nothing ever with enough momentum to make it into law.
I'm mostly just speaking of calling the US system archaic compared to Europe's post-WWII, because for the most part the US system wouldn't be how it is until 1943 which most would consider post WWII.
In other words, I don't think it's the age that's the problem. It's that most European countries don't mind as much having their national government run things while the US tends to push more federalistic/distributed systems.
In fact, I doubt most people in 1942 would have even thought about the federal government's ability to regulate healthcare. Wickard v. Filburn was decided in November, which is the case that really opened the interstate commerce clause. Heart of Atlanta Motel v. US wouldn't happen until 1964, only then finally allowing federal laws to prevent restaurants from discriminating racially. If the federal government can't even set standards for restaurants it's rather hard to argue they have the ability to regulate hospitals and healthcare that happens inside a state.
Medicare wouldn't get founded until 1965, it's not a bit coincidence this happened after SC decisions widening the interstate commerce clause.
The powers of the federal government looked extremely different in 1942 than they do today.
> It’s really interesting how the US has managed to get a health system that’s extremely expensive, doesn’t cover everybody, is highly bureaucratic and complex, delivers below average outcomes and has overworked hospital staff.
The healthcare industry (it should not be an "industry") in the US is all about extracting maximum profit for the benefit of middlemen.
In a rational system, the only people who should be involved in health care are the patients and the providers (doctors, nurses, technicians, etc) who actually provide health care. Nobody else should be involved, let alone skimming profits from the care.
In the US both the providers and the patients are just an afterthought, the whole system is set up to extract maximum profit to the hospital and clinic administrators and, most and worst of all, to the insurance industry. The latter of course contributes nothing at all in therms of actual health care, it's pure profiteering.
The solutions are quite simple, but they don't maximize the share price and CxO bonuses at insurance companies so it's not possible to implement them in the US.
> In a rational system, the only people who should be involved in health care are the patients and the providers (doctors, nurses, technicians, etc) who actually provide health care. Nobody else should be involved, let alone skimming profits from the care.
While I agree with the sentiment, hospitals require management to run well. They certainly don't need the amount of overhead they have, but it can't just be doctors, nurses and patients. Maybe in very small hospitals you could actually have doctors manage schedules and things like that, but once you reach a few dozen people you'll want to have someone coordinating availability and to deal with scheduling at the very least.
I did not mean to imply there should be a place for office admins to do scheduling, facilities people to keep the building running, etc. They are needed, and should be paid a fair living wage for their work. What should be eliminated is the very highly paid class of middlemen who provide no value and just skim profits from the labor of health care providers.
Well don't leave us hanging. If the solutions are quite simple then what are they?
It's easy to say that only patients and providers should be involved with healthcare. But what do you propose to do with patients who need expensive treatments and can't afford to pay? Some level of cost and risk sharing is always going to be necessary, and that's where the complexities and politics come in.
My opinion of VA healthcare dropped a lot living next to a VA hospital. There were a lot of homeless nearby who seemed to be veterans who had come for the hospital.
I don't see how this is the hospital's fault: they can't keep patients indefinitely. Today's Washington Post has an article on the increasing number of homeless seniors https://wapo.st/3q8Gzeb which includes this passage:
"After treatment for an acute illness, hospitals often discharge homeless patients, who wind up back in shelters or even back into their sidewalk tents and makeshift lean-tos, in what health practitioners in Phoenix ruefully call “treat-and-street.” ... A pinball effect takes hold, said health-care providers, shelter operators and advocates. Homeless people bounce from homeless shelter to hospital, then to a nursing home for a short-term recuperation stay. Once that short-term stay ends, nursing homes must decide if the person is infirm enough to qualify for long-term care. If the answer is no, they must leave the nursing home, starting the cycle over again."
I would consider it VA not being an example of "it works fine" if they can sometimes get some help after waiting a long time, then get dumped out in the street to rot. Maybe the specific hospital itself isn't at fault, but the program in general is contributing to the exact issue you're quoting, which is more or less what I'm talking about.
Seems to me it is a poverty support/housing problem, not a healthcare problem (which, sure, impacts healthcare, in the same sense that poverty/housing issues impact education and pretty much every other aspect of society.)
Seems to me that the problem there is the non-healthcare part of how America provides for veterans (and citizens in general). If the same veterans with the same healthcare weren't homeless...
> The defenders of the system are entirely medical workers
No, that's not correct. Doctors and nurses largely despise the US system. They are incredibly overworked and streched too thin to provide great care (and most of them are in it at least partially because they enjoy caring for people).
The US system only benefits the middlemen who provide no healtcare value: insurance companies and hospita/clinic adminitrators.
