Argument: Healthcare is NOT a Right

[LizzyM]

It is just insulting that you make these false statements about Cuban Healthcare, especially considering you claim to be an admission faculty from an American medical school. Cuban's system may be efficient, but that is because of the horrible treatment and neglect of their citizens. Why do you "dare" to say dictatorial? That is the reality of that country which is ran by horrible dictators who don't care even the slightest about the healthcare of the citizens. The Cuban government is horrible. There is nothing good about Cuban healthcare. I personally know two American doctors who came to the US as children from Cuba, they share none of your fantasy thoughts about Cuba. They lived it, they know how horrible it is. It is awful and I think we should threaten military action if they don't change their tune, horrible horrible life for Cubans. That is the reality and it is insulting to American physicians and especially Cuban citizens that you spew this type of nonsense.

I'm sorry. Perhaps English is not your native tongue and you don't understand the nuance of what I'm saying. "dare I say, dictatorial" is in that indeed, Cuba is a dictatorship and calling the primary care system dictatorial is something of a play on words but not intended as a play on words... indeed the system of primary care works because the island is a dictatorship.

You have strong feelings but your message is a rant that cannot be taken seriously. You are basing your opinions on your political stand and not based on any evidence.

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[Panthersfan25]

I'm sorry. Perhaps English is not your native tongue and you don't understand the nuance of what I'm saying. "dare I say, dictatorial" is in that indeed, Cuba is a dictatorship and calling the primary care system dictatorial is something of a play on words but not intended as a play on words... indeed the system of primary care works because the island is a dictatorship.

You have strong feelings but your message is a rant that cannot be taken seriously. You are basing your opinions on your political stand and not based on any evidence.

Ummm, whatevs.

You can't be taken seriously, "my opinions" are the realities for Cubans that suffer under the current and previous regimes. That is a fact beyond disputing. My statements about Cuba have nothing to do with politics. It is embarrassing for you to be suggesting anything different.

 

[Panthersfan25]

That's because you're comparing all private schools against all public schools. This does not mean that all private schools are better than all public schools, it merely means that, on average, private schools are better. For example, Greenwich has an average SAT score of 1250, which would put it in the middle of the pack when compared with private schools in the state. The top private schools are far above and beyond Greenwich, however, but they have a hefty price tag associated with them. Hopkins, for example, costs $41,000 per year, almost two times as much as Greenwich's $21,667 per student per year (and far less than that is paid by each parent due to the tax burden being spread to all property owners in the town).

Yes, on average private schools are better.

On average, private schools are no where near $41,000 per year.

If we eliminate extremes on both ends, it is evident that the costs are comparable and private schools have better academic scores and success. I didn't say better outcomes, because outcomes are subjective and often vary depending on goals. Not going to college doesn't equate a bad outcome, for example.

 

[Panthersfan25]

I'd like to respond by parts. Sorry if it lengthens my post a bit



First, we were just talking about efficiency when you said

I was pointing that you're factually wrong in this assumption since most government-run universal coverage systems in developed countries have more efficient outcomes for their spending thn us.

Second, the outcomes are based on DALYs and a few other fairly standard and consistent measurements.



Efficiency doesn't translate to outcomes, outcomes translate to efficiency. And, many of the countries which have a larger mortality toll from non-communicable diseases (like hypertension, obesity, diabetes, you name it) still rank significantly more efficient in outcomes vs spending

Not to imply that Ecuador and Peru have good healthcare frameworks, but Kuwait, Saudi Arabia and the Emirates, which have the ability to fund such good healthcare, use a public system and STILL spend less than us in both absolute and per capita terms. That is, they're spending less than us per person, and despite having a larger proportion of people dying from non-communicable diseases they have better outcomes. The point I'm trying to drive here is that there's a strong element to our problem that isn't just the fact a large fraction of our population eats too many calories for their own good. Our healthcare is known for its inefficiency.



Totally, but 11% of our population has none such needs met. And this is after regulations lowered that number since 2010 (it has risen after a trough about halfway since, at about 8.6%.) This is a problem that countries which spend less per person don't struggle with, even after having a lot of fat people (the U.K. for instance, doesn't appear in these non-cummulative charts because it's placed a whole rung above the healthcare system of the U.S. and the other charted countries in terms of outcomes, AND it has 29.8% obesity rate which is only 5.20% under the U.S. according to Worldatlas (another link I cannot share until Friday). I struggle to believe a 5.20% larger obesity burden makes us spend over twice as much as them per head.




See the last two sentences above. Also, it's quite relative. We're doing a nice job compared to most of Latin America, Africa and a lot of the ME and SA (not all, obviously) depending on what measure you use, but Western European countries seem to produce a much better service to society by most measures.


But the population's behavior isn't what we want to fix with healthcare, though it would be nice to do so. There is much more than population behavior making Americans suffer, and for a population above 33 million there are many other health concerns than obesity which could be addressed with health coverage. I also think it's disingenuous to just blame fat people for national issues that affect people regardless of weight



I don't care about what you consider lesser or how you rank countries or how patriotic you are, but I'll tell you that typing DO NOT NEED TO CHANGE TO A MODEL FROM A LESSER COUNTRY makes you sound like someone appealing to emotions and not facts to make his case. If you won't resort to that, I'm sure we can have a much less polemic conversation of better quality. Thanks in advance.

Some of your points are fair and I can appreciate your perspective although I don't agree with it.

Some of the inefficiency in our country is consumer choice. Consumers have the right to schedule appointments and procedures that may not be necessary and the government doesn't ration healthcare or tell people they can't have something done. A government ran healthcare system can (and does) tell people of certain ages (or other factors) they don't qualify for various things. As we all know, much of what we do in healthcare is unnecessary or not evidence based. Our country could be super efficient, but at the same time be withholding necessary services that may increase morbidity or mortality, or decrease quality of life or other factors. You could sacrifice consumer choice and the doctor-patient decision making by utilizing algorithms to determine who qualifies and who doesn't. That is a road many (including me) don't want to go down. I'd rather error on a little more inefficiency while maintaining my healthcare decisions between me and my doctor, and not some outcome-efficiency driven scheme ran by the government.

The major point I'm trying to make is there is more to the picture than just these graphs about outcomes, efficiency, and cost.

 

[goatmed]

Some of your points are fair and I can appreciate your perspective although I don't agree with it.

Some of the inefficiency in our country is consumer choice. Consumers have the right to schedule appointments and procedures that may not be necessary and the government doesn't ration healthcare or tell people they can't have something done. A government ran healthcare system can (and does) tell people of certain ages (or other factors) they don't qualify for various things. As we all know, much of what we do in healthcare is unnecessary or not evidence based. Our country could be super efficient, but at the same time be withholding necessary services that may increase morbidity or mortality, or decrease quality of life or other factors. You could sacrifice consumer choice and the doctor-patient decision making by utilizing algorithms to determine who qualifies and who doesn't. That is a road many (including me) don't want to go down. I'd rather error on a little more inefficiency while maintaining my healthcare decisions between me and my doctor, and not some outcome-efficiency driven scheme ran by the government.

The major point I'm trying to make is there is more to the picture than just these graphs about outcomes, efficiency, and cost.

Some of the inefficiency in our country is consumer choice. Consumers have the right to schedule appointments and procedures that may not be necessary and the government doesn't ration healthcare or tell people they can't have something done.

Whatever the many sources of efficiency loss may be, the point is that it's lost in our system at a much larger rate than is lost in comparably wealthy countries which are spending half of what we spend.

A government ran healthcare system can (and does) tell people of certain ages (or other factors) they don't qualify for various things. As we all know, much of what we do in healthcare is unnecessary or not evidence based.

It's also worth mentioning, that on the rarer occasions when the rationing of supplies to give society the most for its buck denies reasonably priced treatments, most countries have private hospitals and offer optional private insurance, just as you can take your kid to private school. This rationing means millions of people whose economic counterparts cannot pay for care do get care. And, a more efficient system at a given funding level produces more services by definition. This is why, as I mentioned earlier, a 5 percent difference in the prevalence of obesity turns into a 2x cheaper care in the UK relative to us.

Our country could be super efficient, but at the same time be withholding necessary services that may increase morbidity or mortality, or decrease quality of life or other factors. I'd rather error on a little more inefficiency while maintaining my healthcare decisions between me and my doctor, and not some outcome-efficiency driven scheme ran by the government.

The major point I'm trying to make is there is more to the picture than just these graphs about outcomes, efficiency, and cost.

I don't mean for you to take this as condescending or an insult, but the fact you were telling me that the government was inefficient to convince me it's a bad idea to leave it to the government just a few hours ago, and now you're telling me inefficiency is ok seems contradictory, like a shifting of goalposts. I want you to pause and think about how the value of "efficient" got flipped there when it didn't fit with your underlying idea. I also suspect you're not quite familiar with what efficiency is.

There's a reason that all those charts use DALYs and DALE measurements in their calculation of outcomes, it's precisely morbidity and mortality that efficiency reduces by the way it's defined. I know I'm repeating myself, but I don't think you're grasping what the efficiency means.

It is about outcomes and cost, the best outcomes for a given cost are what we should strive for.

I end with a question: Do you think consumer choice is worth 33 million people having no choice but an emergency room?

 

[LizzyM]

Ummm, whatevs.

You can't be taken seriously, "my opinions" are the realities for Cubans that suffer under the current and previous regimes. That is a fact beyond disputing. My statements about Cuba have nothing to do with politics. It is embarrassing for you to be suggesting anything different.

Your statements about America being the best in the world are very jingoistic. Your opinions about outcomes not being a good measure of quality are very astounding to me given that they are reported to come from a current medical student.

 

[VA Hopeful Dr]

Your statements about America being the best in the world are very jingoistic. Your opinions about outcomes not being a good measure of quality are very astounding to me given that they are reported to come from a current medical student.

The problem is that most outcomes studied are done in poor ways that don't control for confoundering factors very well.

 

[VA Hopeful Dr]

But no extensive athletics, basically bball soccer and cheerleading

All the private schools I'm familiar with (ie. not the super ritzy ones that all the Kennedy's go to) basically have the parents subsidize the majority of athletics through various fundraisers.

It wouldn't surprise me if private schools could operate as cheaply as public schools, I've just not seen it.

 

[goatmed]

The problem is that most outcomes studied are done in poor ways that don't control for confoundering factors very well.

That may be true in some occasions. However, even assuming that the outcome metrics in question are confounded, I would find myself hard-pressed to believe disparities in patients prior to showing up at the doctor's office are so great that we have to spend over 230% more per head than the Brits, for instance. Bear in mind they're no America in terms of obesity, but are the closest it gets on that side of the pond (within 6% in obesity prevalence.) Confounding factors may explain small differences in efficiency, but we're speaking of a pretty enormous one.

 

[VA Hopeful Dr]

That may be true in some occasions. However, even assuming that the outcome metrics in question are confounded, I would find myself hard-pressed to believe disparities in patients prior to showing up at the doctor's office are so great that we have to spend over 230% more per head than the Brits, for instance. Bear in mind they're no America in terms of obesity, but are the closest it gets on that side of the pond (within 6% in obesity prevalence.) Confounding factors may explain small differences in efficiency, but we're speaking of a pretty enormous one.

Would that extra money both worth almost a 50% increase in 5-year survival in cancer patients?

The Myth of Americans' Poor Life Expectancy

 

[goatmed]

Would that extra money both worth almost a 50% increase in 5-year survival in cancer patients?

From the study cited by your link, the United States is indeed almost as good as some others and best at some, overall pretty great (pic related.)

Nonetheless, this edge vanishes more or less when you don't have insurance.

It's also worth noting that Cancer is not the only disease we want to invert on. And whatever difference cancer survival achieves is lost in the DALYs. I'm crossing my fingers that this link works:

EDIT: It didn't work. Please search "Age standardized disability-adjusted life year Global Health Observatory" or wait til (midnight?) when this account turns 10 days old and I can link put the link

This site has age-standardized disability-adjusted life years you can compare between countries.

As you can see on the map, our disability-adjusted life year rate is significantly higher than that of U.K. and its neighbors. This is only a piece of the full list, you can check it out at the link.

So, whatever we're spending it in, even if it's America's second largest killer, it's not minimizing lost time despite being twice as expensive.

Second edit: The Forbes Article also claims that when deaths from injuries are removed, the U.S. life expectancy becomes highest. I couldn't corroborate that because the link was dead, but searched something along the same lines and this turned up from the article Major Causes of Injury Death and the Life Expectancy Gap Between the United States and Other High-Income Countries, attributing 48% of that gap to major injuries, drug poisonings, firearm related injuries, and motor vehicle accidents in men and 19% in women.

 

[Panthersfan25]

Whatever the many sources of efficiency loss may be, the point is that it's lost in our system at a much larger rate than is lost in comparably wealthy countries which are spending half of what we spend.



It's also worth mentioning, that on the rarer occasions when the rationing of supplies to give society the most for its buck denies reasonably priced treatments, most countries have private hospitals and offer optional private insurance, just as you can take your kid to private school. This rationing means millions of people whose economic counterparts cannot pay for care do get care. And, a more efficient system at a given funding level produces more services by definition. This is why, as I mentioned earlier, a 5 percent difference in the prevalence of obesity turns into a 2x cheaper care in the UK relative to us.


I don't mean for you to take this as condescending or an insult, but the fact you were telling me that the government was inefficient to convince me it's a bad idea to leave it to the government just a few hours ago, and now you're telling me inefficiency is ok seems contradictory, like a shifting of goalposts. I want you to pause and think about how the value of "efficient" got flipped there when it didn't fit with your underlying idea. I also suspect you're not quite familiar with what efficiency is.

There's a reason that all those charts use DALYs and DALE measurements in their calculation of outcomes, it's precisely morbidity and mortality that efficiency reduces by the way it's defined. I know I'm repeating myself, but I don't think you're grasping what the efficiency means.

It is about outcomes and cost, the best outcomes for a given cost are what we should strive for.

I end with a question: Do you think consumer choice is worth 33 million people having no choice but an emergency room?

You are extremely close-minded and simply choose not to understand other view points. Inefficiency has more than one cause, especially in healthcare. The inefficiency secondary to consumers making their healthcare choices in conjunction with their physician is acceptable. The inefficiency of a government ran system (think medicare or VA) is unacceptable due to all of the waste, fraud and abuse; furthermore when these programs do something wrong no individual is ever held accountable. You're just so determined to prove that government running every aspect of our life is better you refuse to consider anything else that may actually be better. There is no shifting goal posts, I just have the ability to think about this outside the box, something you clearly lack. Another problem with your ignorant argument is outcomes. Not every person or culture desires the same outcomes. Having a one size fits all government single payer system that determines which outcomes we care about is terrible, especially at the level of the physician-patient level. All these ignorant charts and graphs you're fixated have blinded you to the realities of healthcare. Healthcare occurs and the micro and macro level. All you care about is the macro level. Basically, you say if we take care of most people for most big stuff, things will be better. What if you're one of those people who don't fit within the most big stuff? What if your government ran system tells you that you're too old to get a procedure or that the waiting list is 15 months? Combine this with being low income and you have people at the mercy of the government, not a place I and many others desire to be.

I'm not going to answer your consumer choice question in the misleading context you framed it. Consumer choice is totally worth it so that 330,000,000 people aren't all stuck making their healthcare decisions within the allowable framework determined by Washington DC.

 

[Panthersfan25]

Your statements about America being the best in the world are very jingoistic. Your opinions about outcomes not being a good measure of quality are very astounding to me given that they are reported to come from a current medical student.

Nice attempt at pivoting away from your ignorant statements about the superior and exception primary care provided by the Cuban government. Again, super embarrassing for you to say something so incredibly ignorant.

I'm sorry that stating the obvious, America is the best country on earth, is offensive to you. Maybe you should retreat to a safe space if that bothers you too much as you clearly feel we are not. In regards to outcomes, I was suggesting that using outcomes to compare countries was not a good idea due to differences in the patient population in addition to many other factors.

At least I got into medical school, unlike other faculty on SDN, who had to settle for other lesser positions in an attempt to compensate for the deficiencies.

 

[Panthersfan25]

Would that extra money both worth almost a 50% increase in 5-year survival in cancer patients?

The Myth of Americans' Poor Life Expectancy

According to @goatmed, we care only about outcomes related to cost. If you have cancer in an efficiency-outcome government healthcare system, you'll likely find yourself without many options because spending lots of money on cancer treatments that may or may not give you a few extra months or years to spend with your children/grandchildren isn't going to be prioritized or cared about. "Sorry, you're SOL" unless you can pay for this yourself would be a common phrase in a government ran system. By again, what does it matter? All we care about is outcomes at the macro level, forget about the doctor-patient decision making.

 

[Panthersfan25]

The problem is that most outcomes studied are done in poor ways that don't control for confoundering factors very well.

Correct, and I would like to add that many of these so called "studies" are likely designed to show a certain result. Anytime a country like Cuba reports statistics that show healthcare as good or better than first world countries, you know something is off. It doesn't take a medical school admissions committee member to figure that one out (or so one would think).

 

[Panthersfan25]

All the private schools I'm familiar with (ie. not the super ritzy ones that all the Kennedy's go to) basically have the parents subsidize the majority of athletics through various fundraisers.

It wouldn't surprise me if private schools could operate as cheaply as public schools, I've just not seen it.

Yes, the amazing thing about this argument is that people like @goatmed believe that the government can do more with $100 than the private industry. This genius (sarcasm) likes to pick out the most expensive private schools and use them for most examples when they know that most private schools don't cost anywhere near $30,000 or more. Most are under $10,000 per year for high school and most K-8 are under $5,000. Private schools can operate at the same cost or cheaper while producing much better results. Sure is strange how @goatmed doesn't seem very concerned about outcomes for this argument. This is a perfect example of private vs government. Private (consumer choice) wins.

 

[Panthersfan25]

That may be true in some occasions. However, even assuming that the outcome metrics in question are confounded, I would find myself hard-pressed to believe disparities in patients prior to showing up at the doctor's office are so great that we have to spend over 230% more per head than the Brits, for instance. Bear in mind they're no America in terms of obesity, but are the closest it gets on that side of the pond (within 6% in obesity prevalence.) Confounding factors may explain small differences in efficiency, but we're speaking of a pretty enormous one.

Obesity and all the associated co-morbidity is a big deal. You find yourself hard pressed to accept any result that doesn't fit the mold of government knows best.

 

[goatmed]

You are extremely close-minded and simply choose not to understand other view points.

I don't like this type of hostility that goes nowhere. But this feels like the pot calling the kettle black

Inefficiency has more than one cause, especially in healthcare. The inefficiency secondary to consumers making their healthcare choices in conjunction with their physician is acceptable.

May be acceptable to you. But it's neither fiscally responsible nor good at having people receive necessary care. Because of inefficiency, which, mind you, isn't just the result of consumer choice as you make it seem, tons of people end up uninsured, underinsured, or in financial ruin. To ignore those peoples' plight because of some abstract affinity to consumer choice seems like a purely ideological stance which you feel strongly about and thus refuse to accept its empirically demonstrable human cost.

The inefficiency of a government ran system (think medicare or VA) is unacceptable due to all of the waste, fraud and abuse; furthermore when these programs do something wrong no individual is ever held accountable.

This is nonsense, and universal coverage does not imply in any way a specific framework of malpractice law. It's also worth noting that the net effect of inefficiency is the same, healthcare resources wasted and people receiving substandard or no healthcare at all. The result of inefficiency matters, not the causes. You're making some odd mental gymnastics here about what sources of inefficiency matter or don't matter and completely losing sight that it has negative consequences regardless of where its coming from. Because these consequences are real regardless of the source, we want to minimize them wherever we can to reduce this cost. This is something that countries with universal coverage do much better than us on average.

You're just so determined to prove that government running every aspect of our life is better you refuse to consider anything else that may actually be better. There is no shifting goal posts, I just have the ability to think about this outside the box, something you clearly lack.

You're thinking outside of the constraints of logic, I'll hand you that

Another problem with your ignorant argument is outcomes. Not every person or culture desires the same outcomes. Having a one size fits all government single payer system that determines which outcomes we care about is terrible, especially at the level of the physician-patient level.

I think you're still unfamiliar with what is meant by "outcomes." The reason these employ measures like Disability-Adjusted Life Years is that we generally agree that people entering healthcare want 1. Not to be disabled 2. To not die prematurely. I don't think there's a lot of customers anywhere who disagree with those outcomes being good.

All these ignorant charts and graphs you're fixated have blinded you to the realities of healthcare. Healthcare occurs and the micro and macro level. All you care about is the macro level.

It's not about caring about the micro or the macro level of healthcare, it's about recognizing the macro level of healthcare is the sum of patient experiences, and when the macro level looks ugly so does the micro level. To use an analogy, there's no such thing as a dirty car that's actually clean when you look at it closely.

Basically, you say if we take care of most people for most big stuff, things will be better. What if you're one of those people who don't fit within the most big stuff? What if your government ran system tells you that you're too old to get a procedure or that the waiting list is 15 months? Combine this with being low income and you have people at the mercy of the government, not a place I and many others desire to be.

If this happens you can always go to a private hospital, you know those aren't illegal in most countries with universal coverage, right?
Also, the situation you describe is MUCH more common in the U.S., not because people have insurances that deny coverage for certain things (which does happen nonetheless) but because 11 percent of our population fell through the cracks and is in no sort of waitlist or expecting a procedure. Again, you're missing the forest for the trees.

I'm not going to answer your consumer choice question in the misleading context you framed it. Consumer choice is totally worth it so that 330,000,000 people aren't all stuck making their healthcare decisions within the allowable framework determined by Washington DC.

How was my framework misleading? Slightly over a tenth of those 330,000,000 people aren't making healthcare decisions or are making undesirable healthcare decisions because they have no coverage and no framework determined by nobody, aside from costly ER visits of course. The cost, which is human suffering, is real even if you don't care or want to pretend it's not there.

According to @goatmed, we care only about outcomes related to cost. If you have cancer in an efficiency-outcome government healthcare system, you'll likely find yourself without many options because spending lots of money on cancer treatments that may or may not give you a few extra months or years to spend with your children/grandchildren isn't going to be prioritized or cared about.

There's no such thing as an "efficiency-outcome" government healthcare system. Efficiency and outcomes are two measures (the latter dependent on the former) of healthcare system performance. And, you keep missing the forest for the trees. We have more years of healthy lives lost here than in the aforementioned counterparts, so on average there are a lot more stories of undelivered or underdelivered care on this side of the pond and on this side of the 49th parallel.

"Sorry, you're SOL" unless you can pay for this yourself would be a common phrase in a government ran system. By again, what does it matter? All we care about is outcomes at the macro level, forget about the doctor-patient decision making.

You''re giving away how little exposure you've had to national health systems, this is seldom if ever a response in a hospital of any kind. Sure, some expensive treatments are foregone for their cheaper alternatives. Now go and ask your insurance to cover any of the meds on the non-covered list, which as far as I'm aware just about every coverage plan has. And yes, you can pay for it on your own. That's no different from other countries, the only difference is, of course, that the American pills and procedures come out on a disproportionately expensive bill.

This is my last response to you in this thread. As just about everyone here has pointed out, you're very vaguely familiar at best with measurements of health performance and their significance and healthcare systems. You've taken up enough time from people here speaking in rhetoric and logical missteps so that we could all arrive to your underlying conclusion: "USA is best country in the world." I'm sorry, but bumper sticker slogans don't necessarily match the nuances and vicissitudes of the real world, and loving America doesn't mean defending present political or economic arrangements, nor has it ever been so. I hope you pause and think about these concepts and what they mean at the "macro" level you invoke and the amount of human suffering one system or another elicits.

Best of luck

 

[Panthersfan25]

I don't like this type of hostility that goes nowhere. But this feels like the pot calling the kettle black


May be acceptable to you. But it's neither fiscally responsible nor good at having people receive necessary care. Because of inefficiency, which, mind you, isn't just the result of consumer choice as you make it seem, tons of people end up uninsured, underinsured, or in financial ruin. To ignore those peoples' plight because of some abstract affinity to consumer choice seems like a purely ideological stance which you feel strongly about and thus refuse to accept its empirically demonstrable human cost.


This is nonsense, and universal coverage does not imply in any way a specific framework of malpractice law. It's also worth noting that the net effect of inefficiency is the same, healthcare resources wasted and people receiving substandard or no healthcare at all. The result of inefficiency matters, not the causes. You're making some odd mental gymnastics here about what sources of inefficiency matter or don't matter and completely losing sight that it has negative consequences regardless of where its coming from. Because these consequences are real regardless of the source, we want to minimize them wherever we can to reduce this cost. This is something that countries with universal coverage do much better than us on average.



You're thinking outside of the constraints of logic, I'll hand you that



I think you're still unfamiliar with what is meant by "outcomes." The reason these employ measures like Disability-Adjusted Life Years is that we generally agree that people entering healthcare want 1. Not to be disabled 2. To not die prematurely. I don't think there's a lot of customers anywhere who disagree with those outcomes being good.


It's not about caring about the micro or the macro level of healthcare, it's about recognizing the macro level of healthcare is the sum of patient experiences, and when the macro level looks ugly so does the micro level. To use an analogy, there's no such thing as a dirty car that's actually clean when you look at it closely.

If this happens you can always go to a private hospital, you know those aren't illegal in most countries with universal coverage, right?
Also, the situation you describe is MUCH more common in the U.S., not because people have insurances that deny coverage for certain things (which does happen nonetheless) but because 11 percent of our population fell through the cracks and is in no sort of waitlist or expecting a procedure. Again, you're missing the forest for the trees.


How was my framework misleading? Slightly over a tenth of those 330,000,000 people aren't making healthcare decisions or are making undesirable healthcare decisions because they have no coverage and no framework determined by nobody, aside from costly ER visits of course. The cost, which is human suffering, is real even if you don't care or want to pretend it's not there.





There's no such thing as an "efficiency-outcome" government healthcare system. Efficiency and outcomes are two measures (the latter dependent on the former) of healthcare system performance. And, you keep missing the forest for the trees. We have more years of healthy lives lost here than in the aforementioned counterparts, so on average there are a lot more stories of undelivered or underdelivered care on this side of the pond and on this side of the 49th parallel.


You''re giving away how little exposure you've had to national health systems, this is seldom if ever a response in a hospital of any kind. Sure, some expensive treatments are foregone for their cheaper alternatives. Now go and ask your insurance to cover any of the meds on the non-covered list, which as far as I'm aware just about every coverage plan has. And yes, you can pay for it on your own. That's no different from other countries, the only difference is, of course, that the American pills and procedures come out on a disproportionately expensive bill.

This is my last response to you in this thread. As just about everyone here has pointed out, you're very vaguely familiar at best with measurements of health performance and their significance and healthcare systems. You've taken up enough time from people here speaking in rhetoric and logical missteps so that we could all arrive to your underlying conclusion: "USA is best country in the world." I'm sorry, but bumper sticker slogans don't necessarily match the nuances and vicissitudes of the real world, and loving America doesn't mean defending present political or economic arrangements, nor has it ever been so. I hope you pause and think about these concepts and what they mean at the "macro" level you invoke and the amount of human suffering one system or another elicits.

Best of luck

It is difficult to respond to all of your inaccurate assumptions, it isn't my job to educate you. Above, I wasn't referring to malpractice. I was referring to un-elected bureaucrats screwing up our system and suffering no consequences, often these losers get transferred or promoted. VA is a great example.

Your whole argument is rhetoric leftist propaganda and intentional missteps because you have been brainwashed in American left leaning non-free speech colleges.

Speaking of the real world, people want to come to this country from all over the world, yes, America is the greatest and this is evident if you would just open your eyes. This country would be even better if so many of its own citizens didn't have an agenda to destroy things as we know them. If things are so bad, removing all the illegal immigrants would really be doing them a favor, so lets remove them and put America first.

 

[Panthersfan25]

Your statements about America being the best in the world are very jingoistic. Your opinions about outcomes not being a good measure of quality are very astounding to me given that they are reported to come from a current medical student.

Oh @LizzyM, where are you? Why the silence? Cuba is best.

U.S. slashing embassy staff in Cuba, issuing travel warning because of apparent sonic ‘attacks’

Go take yourself and family there for the great primary care. You're comments are such a slap in the face to current and former Cubans who have tolerated this evil Regime. You should be ashamed and embarrassed by your comments.

 

[Psych_hopeful]

Oh @LizzyM, where are you? Why the silence? Cuba is best.

U.S. slashing embassy staff in Cuba, issuing travel warning because of apparent sonic ‘attacks’

Go take yourself and family there for the great primary care. You're comments are such a slap in the face to current and former Cubans who have tolerated this evil Regime. You should be ashamed and embarrassed by your comments.

Can you stop with the ad hominem attacks? For real, I feel like I'm reading rantings and ravings from a lunatic. You strawman her words and then attack LizzyM's character. What type of idiot are you

 

[Panthersfan25]

Can you stop with the ad hominem attacks? For real, I feel like I'm reading rantings and ravings from a lunatic. You strawman her words and then attack LizzyM's character. What type of idiot are you

Just to recap, you accuse me of attacking while you just attacked me. LizzyM made these comments and doubled down on them while accusing me of being too stupid to understand. One must question another person's character when they stand up for the Cuban oppressive government. Things must look different from the ivory towers.

 

[Panthersfan25]

Just a refresher

Not sure about Taiwan but the Cuban system is very good at primary care. No one would go there for tertiary services but if you live there the doctor and nurse responsible for your care (and the care of your neighbors) will be all over you to be sure that you are doing what you are supposed to do.

You are naive if you think that the US health care system provides the best primary care of every nation on earth.

Almost half of all pregnancies are unintended (mistimed or unwanted).
Unintended Pregnancy in the United States

Our infant mortality is far from the lowest in the world and ditto the mortality rate of children under 5 years of age.
List of countries by infant mortality rate - Wikipedia

One in three Americans have high blood pressure and only about half have it under control.
High Blood Pressure (Hypertension) Information | cdc.gov

I could go on.

My information on Cuba is a few years old and is based on a first-person account I heard from a physician/faculty member at my institution who visited there.
This WHO report from 9 years ago is interesting, too.
WHO | Cuba’s primary health care revolution: 30 years on

 

[Psych_hopeful]

Just to recap, you accuse me of attacking while you just attacked me. LizzyM made these comments and doubled down on them while accusing me of being too stupid to understand. One must question another person's character when they stand up for the Cuban oppressive government. Things must look different from the ivory towers.

Honestly, I just read "I'm a lunatic. " from your post. She didn't once condone the government. She only said that their PRIMARY CARE was really good. I'm sorry if you can't understand that saying a country's primary care is good isn't the same as "The Cuban dictatorship is number 1".

Seriously, that's fed up to strawman her like that and then attack her character. We aren't in the Stalinist Soviet Union where you can erase history and rewrite it however you like.

 

[MOHS_01]

We aren't in the Stalinist Soviet Union where you can erase history and rewrite it however you like.

This makes me wonder how much attention you’ve paid to news cycles and history lessons.


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