US has best healthcare if you're not poor?

[shangrila]

US is definitely not a place you want to be healthcare-wise if your family is living near the poverty line, which makes our system "rank" overall very low internationally compared to Europe, Canada, Australia, Japan, and Singapore.

My question is, how would our healthcare system fare if we only compared the different countries as experienced by upper-middle class families? The people in this group usually have good health insurance that does not limit their options significantly, there is much quicker access to care as opposed to Europe and Canada, and we have a good concentration of many of the best hospitals in the world. As someone who comes from a family of professionals, I hear from my international friends who are from similar backgrounds that while their systems are overall better, the average upper-middle class family often feels more frustrated with their healthcare system back home.

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[DermViser]

How is this any different than any other area? Food, Shelter, Higher Education, etc. I 100% agree with you. Expect to get pummeled for bringing up very valid criticisms of healthcare systems in other countries.

 

[PL198]

I mean no rank is free of bias. It's still my opinion that the US has the best healthcare in the world. In my opinion, most of the health organizations that rate the quality of care in a nation highly overvalue chronic care or the prevalence of chronic disease as a factor for rating health-care system. I'm not really sure how the US even has poorly rated chronic care. The information from physicians is there, it's just that people don't actually follow that information and thus develop chronic disease. There is no health care system with better acute care in the world than the US, bar none. I tend to think that is way more indicative of the actual quality of a health-care system, rather than chronic care, in which you are only as good as the discipline level of your patients. I have no idea how patients refusing to do what their physician tells them, somehow reflects negatively on the actual quality of chronic care.

 

[DermViser]

I tend to like to look at better metrics like mortality rates from cancer survival in patients from diagnosis onwards: http://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/

 

[alpinism]

Heh won't ever see that in the New York Times.

 

[PL198]

I tend to like to look at better metrics like mortality rates from cancer survival in patients from diagnosis onwards: http://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/

Exactly. Yet somehow when doctors in America inform patients about what they have to do to fix a condition, the patient refuses to do so, that negatively effects our health-care evaluation. It's pretty funny to look at the chronic disease rates of socially strict, conservative ( reserved, not politically) societies vs those of a more "anything goes" approach and see the HUGE difference. It's just a discipline issue IMO. Education helps, but a very very small amount.

 

[Psai]

Why would you look at a silly endpoint like mortality when you can look at patient satisfaction scores? Much more important, especially if you're a hospital CEO.

 

[DermViser]

Why would you look at a silly endpoint like mortality when you can look at patient satisfaction scores? Much more important, especially if you're a hospital CEO.

You bet!

 

[BadHorse]

Why would you look at a silly endpoint like mortality when you can look at patient satisfaction scores? Much more important, especially if you're a hospital CEO.

Just to interject and play devil's advocate, this is not looking at mortality. This is looking at five-year survival for the cancers for which the US almost certainly over-screens. Five-year survival in screening is a statistic known to suffer from both lead-time and length-time bias. This just shows that the US diagnoses these cancers earlier and more often (and often subjects healthy individuals to unnecessary workups, tests and surgeries in the process), something that's often associated with worse outcomes for patients overall, and often comes with no actual mortality benefit. I take this as exceedingly poor evidence that our healthcare system is doing well.

 

[DermViser]

Just to interject and play devil's advocate, this is not looking at mortality. This is looking at five-year survival for the cancers for which the US almost certainly over-screens. Five-year survival in screening is a statistic known to suffer from both lead-time and length-time bias. This just shows that the US diagnoses these cancers earlier, something that's often associated with worse outcomes for patients and often comes with no actual mortality benefit. I take this as exceedingly poor evidence that our healthcare system is doing well.

Overscreening is irrelevant. We're talking about people with a confirmed diagnosis of cancer, period.

 

[DermViser]

Exactly. Yet somehow when doctors in America inform patients about what they have to do to fix a condition, the patient refuses to do so, that negatively effects our health-care evaluation. It's pretty funny to look at the chronic disease rates of socially strict, conservative ( reserved, not politically) societies vs those of a more "anything goes" approach and see the HUGE difference. It's just a discipline issue IMO. Education helps, but a very very small amount.

And now doctors have the luxury of being blamed for a patient not doing what he/she says and getting their pay docked for it.

 

[Kahreek]

US is definitely not a place you want to be healthcare-wise if your family is living near the poverty line, which makes our system "rank" overall very low internationally compared to Europe, Canada, Australia, Japan, and Singapore.

My question is, how would our healthcare system fare if we only compared the different countries as experienced by upper-middle class families? The people in this group usually have good health insurance that does not limit their options significantly, there is much quicker access to care as opposed to Europe and Canada, and we have a good concentration of many of the best hospitals in the world. As someone who comes from a family of professionals, I hear from my international friends who are from similar backgrounds that while their systems are overall better, the average upper-middle class family often feels more frustrated with their healthcare system back home.

I would probably agree, if you are wealthy enough (I would say more like upper mid class versus not being poor), chances are you will have better care compared to other 1st world nations. Given you spend proper amount on health coverage, which is not cheap.

 

[PL198]

And now doctors have the luxury of being blamed for a patient not doing what he/she says and getting their pay docked for it.

I just have 0 idea how patient compliance somehow determines if a health care system is effective or not. Americans are the laziest, most entitled group population the world has ever seen. We will always be terrible on the chronic diseases so long as this is true. I will never believe anyone who says that our health care system is poor because of this. The best doctor isn't going to prevent a non-compliant patient from getting ill.

 

[Kahreek]

Overscreening is irrelevant. We're talking about people with a confirmed diagnosis of cancer, period.

yeah but if you diagnose cancer early yet you cant change the natural course of disease progression (true for many carcinomas), you survival rates will be higher despite of equal treatment efficacy.

 

[Kahreek]

.

 

[EMDO2018]

Americans are so sick because of the culture. People from countries like Sweden are generally already very healthy, they bike everywhere and don't eat as much. whereas Americans sit on their ass all day, stuff their faces, and expect doctors to come up with a magic pill to make all the lard go away.

 

[Brain Bucket]

Let's not go comparing swedes to americans. it's supremely unfair.

 

[DermViser]

Let's not go comparing swedes to americans. it's supremely unfair.

Well it's just easier to blame America and say healthcare sucks just bc everything in healthcare isn't utopian to where everyone has equal access with the same benefits, etc. If you look at news stories, only the positives of European style or Canadian style healthcare is trumpeted. The downsides are all swept under the rug.

 

[Anastomoses]

Let's not go comparing swedes to americans. it's supremely unfair.

Unfair how?

 

[db1210]

No matter where you are from, just about everything is better when you are wealthy.

 

[@JackShephard]

Americans are so sick because of the culture. People from countries like Sweden are generally already very healthy, they bike everywhere and don't eat as much. whereas Americans sit on their ass all day, stuff their faces, and expect doctors to come up with a magic pill to make all the lard go away.

Exactly.

I tend to like to look at better metrics like mortality rates from cancer survival in patients from diagnosis onwards: http://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/

And after the above Swede statement, while I have no doubt that America is likely highly ranked in all of these areas - we also have more screening, cancers diagnosed and treatment options, alongside more spending than any of these other countries. We spend twice as much per person than many of these countries. Survival rates are interesting, but I'd like to see the # of cancers diagnosed per capita when looking at data like this. Furthermore, increased survival can be from lead time bias (unless someone presents data showing that it has been minimized).

Edit: The Forbes article which this was taken from states:

The Myth of Americans' Poor Life Expectancy
It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s not true.

I'm not here to support all European healthcare, but I will refute claims that are wrong. This Forbes article is wrong, America doesn't have better life expectancy.

http://gallery.mailchimp.com/de3259be81e52e95191ab7806/files/HAG2013.pdf
http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf

Where does America actually rank in life expectancy?

Apparently were below average. There are a good 25 countries better than us, including Slovenia and Denmark.

This is far more interesting because it ties the spending per capita to the life expectancy in years.

Here again is another picture of the %GDP that goes to healthcare:

Now with all that, I wouldn't try to argue our life expectancy isn't great because our medical system is poor. I think the personal responsibility of the patient plays a huge role. But to the Forbes article quoted above:

It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. ... The only problem is it’s not true.

Actually, it is true. It's 1000% true and to claim otherwise is ridiculous and just as bad as the NYT's, just in a conservative direction instead of a liberal direction.

 

[DermViser]

Unfair how?

Unfair when it comes to then extrapolating of what they do there to here.

 

[Anastomoses]

Unfair when it comes to then extrapolating of what they do there to here.

i think he was implying much more.

 

[DermViser]

Exactly.



And after the above Swede statement, while I have no doubt that America is likely highly ranked in all of these areas - we also have more screening, cancers diagnosed and treatment options, alongside more spending than any of these other countries. We spend twice as much per person than many of these countries. Survival rates are interesting, but I'd like to see the # of cancers diagnosed per capita when looking at data like this. Furthermore, increased survival can be from lead time bias (unless someone presents data showing that it has been minimized).

Edit: The Forbes article which this was taken from states:



I'm not here to support all European healthcare, but I will refute claims that are wrong. This Forbes article is wrong, America doesn't have better life expectancy.

http://gallery.mailchimp.com/de3259be81e52e95191ab7806/files/HAG2013.pdf
http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf

Where does America actually rank in life expectancy?

Apparently were below average. There are a good 25 countries better than us, including Slovenia and Denmark.

This is far more interesting because it ties the spending per capita to the life expectancy in years.

Here again is another picture of the %GDP that goes to healthcare:

Now with all that, I wouldn't try to argue our life expectancy isn't great because our medical system is poor. I think the personal responsibility of the patient plays a huge role. But to the Forbes article quoted above:



Actually, it is true. It's 1000% true and to claim otherwise is ridiculous and just as bad as the NYT's, just in a conservative direction instead of a liberal direction.

Um, no.

 

[Brain Bucket]

i think he was implying much more.

He is.

 

[DermViser]

His data is more recent (but doesn't exclude fatal injuries). Either way, the United States spends way more on health care than any other country but gets marginal returns on investment.

That's bc doctors can't control patient behavior once they leave our office/hospital.

 

[deleted500612]

Um, no.

This chart does not even make sense. You'll notice that a lot of countries on this list the average life expectancy decreases when they remove "fatal injuries" from the equation, which is impossible. Also, even if it were correct this is from the 80s-90s, which is pretty outdated.

 

[DermViser]

This chart does not even make sense. You'll notice that a lot of countries on this list the average life expectancy decreases when they remove "fatal injuries" from the equation, which is impossible. Also, even if it were correct this is from the 80s-90s, which is pretty outdated.

The point is that we went from #19 to #1 in life expectancy when you remove fatal injuries from the equation (car accidents, gun shots wounds, etc.

 

[Moose A Moose]

Well it's just easier to blame America and say healthcare sucks just bc everything in healthcare isn't utopian to where everyone has equal access with the same benefits, etc. If you look at news stories, only the positives of European style or Canadian style healthcare is trumpeted. The downsides are all swept under the rug.

Wizard. This.

 

[deleted500612]

The point is that we went from #19 to #1 in life expectancy when you remove fatal injuries from the equation (car accidents, gun shots wounds, etc.

I fail to see how you can make that point from data that is both outdated and clearly false... ie some countries life expectancies are shown to *decrease* after removing fatal injuries from the equation, which is impossible. The "data" is obviously BS.

If you look at more recent and reputable data that isnt 20 years old you will see that the average life expectancy nowadays is almost 10 years higher than what it shows in the chart you posted. Some countries have a life expectancy 5 years higher than the US right now. Sure most life expectancy data does not account for fatal injuries, but even so it would not make up a 5 year life expectancy gap.

To be fair, I think a large part of that difference comes from the obesity/junk food epidemic in the US and doesn't really have anything to do with quality or efficacy of healthcare being rendered. I'd be interested to see what the life expectancy difference is between upper-class Americans with top-level health coverage compared to lower-class Americans though.

 

[PL198]

I fail to see how you can make that point from data that is both outdated and clearly false... ie some countries life expectancies are shown to *decrease* after removing fatal injuries from the equation, which is impossible. The "data" is obviously BS.

If you look at more recent and reputable data that isnt 20 years old you will see that the average life expectancy nowadays is almost 10 years higher than what it shows in the chart you posted. Some countries have a life expectancy 5 years higher than the US right now. Sure most life expectancy data does not account for fatal injuries, but even so it would not make up a 5 year life expectancy gap.

To be fair, I think a large part of that difference comes from the obesity/junk food epidemic in the US and doesn't really have anything to do with quality or efficacy of healthcare being rendered. I'd be interested to see what the life expectancy difference is between upper-class Americans with top-level health coverage compared to lower-class Americans though.

I don't think that would tell you anything either. On average, lower-class people are certainly lazier than their upper-class counterparts, and certainly less likely to be compliant. Can't wait for someone to be like " ZOMG BUT WHAT ABOUT TRUST FUND BABIES," yet they are the overwhelming minority of upper class people. Most people that are there, got there by actively doing something, which required hard work. Really hope this doesn't turn into a " poor people are so hard working" debate, but oh well.

 

[deleted500612]

I don't think that would tell you anything either. On average, lower-class people are certainly lazier than their upper-class counterparts, and certainly less likely to be compliant. Can't wait for someone to be like " ZOMG BUT WHAT ABOUT TRUST FUND BABIES," yet they are the overwhelming minority of upper class people. Most people that are there, got there by actively doing something, which required hard work. Really hope this doesn't turn into a " poor people are so hard working" debate, but oh well.

For sure, I just mean it would be an interesting statistic to see how much of a difference there actually is in the life expectancy between the classes, and especially if the gap is larger in the privatized US system compared to other single-payer countries where the quality of healthcare between upper/lower class citizens is more homogenized.

 

[@JackShephard]

Um, no.

The United States doesn't "Move to #1" because you don't discount the life expectancy of the entire other group!

If Japan has a life expectancy of 78.7 then they keep that. Just because they have older people dying of fatal injuries doesn't mean we now ignore their TRUE life expectancy.

The argument you're making is that the United States has a high fatality rate - therefore our life expectancy is truly higher.

That's fine if you want to make this argument, but then the other countries can keep their TRUE life expectancy (i.e. they get to use the highest # of the two groups). Keeping this in mind, the United States moves from #19 to #10, because there are 9 countries that have higher life expectancy than the US no matter how you work the numbers in your favor.

Furthermore, this data is old as mentioned above. That OECD report has data up to 1999! 15 years ago.

So essentially America spends twice as much as most and has a life expectancy of somewhere between #10-19 a good fifteen years ago. The true life expectancy #'s from the last year are below average.

So, I say - "um, no"

 

[@JackShephard]

I fail to see how you can make that point from data that is both outdated and clearly false... ie some countries life expectancies are shown to *decrease* after removing fatal injuries from the equation, which is impossible. The "data" is obviously BS.

If you look at more recent and reputable data that isnt 20 years old you will see that the average life expectancy nowadays is almost 10 years higher than what it shows in the chart you posted. Some countries have a life expectancy 5 years higher than the US right now. Sure most life expectancy data does not account for fatal injuries, but even so it would not make up a 5 year life expectancy gap.

To be fair, I think a large part of that difference comes from the obesity/junk food epidemic in the US and doesn't really have anything to do with quality or efficacy of healthcare being rendered. I'd be interested to see what the life expectancy difference is between upper-class Americans with top-level health coverage compared to lower-class Americans though.

Yes, he's trying to say we are #1 if you look at it - yet as you pointed out, other countries have people living so long that they are dying of fatal injuries as old people. Even when you try to manipulate the data to make it look good for America, we're still behind Norway.

I read a few of the blogs with comments stating "We move to #1 when you adjust everything" - it's simply not true. If a 100 year old man in Japan drives off a cliff, you don't remove him from the life expectancy pool. That's what these people are trying to get you to believe.

 

[PL198]

The United States doesn't "Move to #1" because you don't discount the life expectancy of the entire other group!

If Japan has a life expectancy of 78.7 then they keep that. Just because they have older people dying of fatal injuries doesn't mean we now ignore their TRUE life expectancy.

The argument you're making is that the United States has a high mortality rate - therefore our life expectancy is truly higher.

That's fine if you want to make this argument, but then the other countries can keep their TRUE life expectancy (i.e. they get to use the highest # of the two groups). Keeping this in mind, the United States moves from #19 to #10, because there are 9 countries that have higher life expectancy than the US no matter how you work the numbers in your favor.

Furthermore, this data is old as mentioned above. That OECD report has data up to 1999! 15 years ago.

So essentially America spends twice as much as most and has a life expectancy of somewhere between #10-19 a good fifteen years ago. The true life expectancy #'s from the last year are below average.

So, I say - "um, no"

I don't really see what your point is though. I hear you that our life expectancy isn't so hot, and that we spend a lot, but neither of those reflect on our health-care system in my opinion. Both are attributable to A) lazy, noncompliant patients who end up costing the system more money when they need super expensive acute care that could have been avoided if they properly handled their chronic issues B) more bureaucratic yellow tape and Tort proceedings than anyone else.

I don't see how either of those result in our healthcare being bad. I think we have really good health care and really bad people that make it really inefficient.

 

[@JackShephard]

I don't really see what your point is though. I hear you that our life expectancy isn't so hot, and that we spend a lot, but neither of those reflect on our health-care system in my opinion. Both are attributable to A) lazy, noncompliant patients who end up costing the system more money when they need super expensive acute care that could have been avoided if they properly handled their chronic issues B) more bureaucratic yellow tape and Tort proceedings than anyone else.

I don't see how either of those result in our healthcare being bad. I think we have really good health care and really bad people that make it really inefficient.

I didn't state that it did. I was replying to the Forbes article that stated:

The Myth of Americans' Poor Life Expectancy
It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s not true.

This isn't true and that's why I refuted it. So my point is, #1 - let's not use half truths to argue our point. #2 - our system is too expensive and we can make major strides in our system if we can improve costs and efficiency. More people can get healthcare and our nation can avoid trillions in national debt. These are big ideas and concerns. But I understand most on SDN don't care too much about these factors.

I NEVER tried to associate America's life expectancy with quality of our system, so one else did. Please re-read my first post on this thread where I stated:

Now with all that, I wouldn't try to argue our life expectancy isn't great because our medical system is poor. I think the personal responsibility of the patient plays a huge role.

And as for your quote:

B) more bureaucratic yellow tape and Tort proceedings than anyone else.

These are contributors, but there is waste all across the system. Bureaucratic yellow tape and tort reform can hardly explain the differences below:

By the way, these are the negotiated prices! These are NOT billed prices or manipulated data.



Average prices

Gleevec:
New Zeland: $989
US: $6,200

Reflux drug:
Netherlands: $33
US: $215

CT scan abdomen:
Spain: $94
US: $896

MRI
Switzerland: $138
US: $1,145

Hospital costs per day:
Spain: $481
US: $4,293
US 95th percentile: $12,726

Appy:
Argentina: $1,723
US: $13,910

Child Delivery:
Argentina: $2,237
US: $10,002

C-section:
Spain: $2,844
US: $15,240

Knee Replacement:
Argentina: $6,015
US: $25,398

 

[PL198]

I didn't state that it did. I was replying to the Forbes article that stated:


This isn't true and that's why I refuted it. So my point is, #1 - let's not use half truths to argue our point. #2 - our system is too expensive and we can make major strides in our system if we can improve costs and efficiency. More people can get healthcare and our nation can avoid trillions in national debt. These are big ideas and concerns. But I understand most on SDN don't care too much about these factors.

I NEVER tried to associate America's life expectancy with quality of our system, so one else did. Please re-read my first post on this thread where I stated:

And as for your quote:



These are contributors, but there is waste all across the system. Bureaucratic yellow tape and tort reform can hardly explain the differences below:

Have you compared those prices in other nations to cash-only practices? That's what I'm more curious to see. Not to mention the fact that US trained docs are the best on average(obviously there are specific docs that are heads of their fields all over, but on the broad scale) and it's considerably easier to become a doctor in another nation after being licensed in the US than it is the other way around.

 

[Nephronlearner]

Wow, why is everyone over here so obsessed with comparing the systems?! Both the US and EU (along with some other places, obviously) are the richest parts of the world and instead of simply accepting it, people keep comparing and looking for subtle differences that can make one seem better than the other. Kinda pointless, imo.

I have written a long post about it earlier, so I won't repeat it but, as someone who lives in a country with relatively 'socialised' medicine, I have had the privilege to witness both the pros and cons of the system first hand. And with all the media coverage, it's impossible not to be aware of all the pros and cons of the US system.

First of all, all the 'data' is easily manipulated. For instance, Germany has better cancer survival for some types of cancer than the US (pancreas, oesophagus,...). Switzerland has better survival in some others, such as leukaemia. Belgium does better in lung cancer.
None of that was mentioned in the table above, making it seem as if the US has best cancer survival for every type of cancer. But even that is irrelevant because it is ridiculous to use subtle differences (usually <5%) to claim that one system is necessarily better than the other. Many other things affect cancer survival that have nothing to do with the quality of the system. Yes, a 20% difference may indicate something (UK and breast cancer for example) but saying that 1% difference proves something is just... ridiculous.

Furthermore, a lot of the posts here seem like Fox News horror stories (and horror stories are again a lousy argument simply because you can find them in ANY system). I have never seen a 'death panel' or however some people call it. In fact, I have seen 80 year olds on eye surgeries in 'socialised medicine'. As for rationing healthcare, I am sure insurance companies do not cover everything either, do they? Otherwise there would be no HMO 'horror stories'. And if the insurance (whether private or national) refuses to cover something - people can still get it if they pay out of pocket (trust me, they can get the fancy drugs here too).

Life expectancy and infant mortality are also terrible things to look at when comparing quality of care, since pretty much every decent hospital both in the US and EU can deal with pre-mature births. Also heart attack treatment is generally the same everywhere, lol.

The biggest difference between the systems is that it seems that Americans need to be more responsible not to lose health coverage, while it is not a fear over here. I have been told several times by American friends that they couldn't afford health insurance (and yet they could afford to travel to Australia for holidays). Hard to blame the system when things go wrong.
Horror stories exist in each system and they won't cease to exist regardless of possible health care reforms.

There are advantages to both systems, and only those who have experienced both (which I believe not many here have) can give an objective analysis from patient or doctor perspective. And even then, some will vote for the US system while others will vote for the NHS/German/Swiss/French system simply because - both the EU and US enjoy state of art facilities and high quality physician workforce.

Also note, it is region dependent. Someone living in rural Mississippi may not get the same quality of care as someone living in Paris, while someone living in rural Bulgaria may not get the same care as someone living in Boston.

Hope at least someone can give up the political agenda and actually seriously consider the usefulness of this discussion. Life expectancy is relatively similar afterall, so I assume we will all be fine regardless of how the health care is coordinated.

 

[@JackShephard]

Wow, why is everyone over here so obsessed with comparing the systems?! Both the US and EU (along with some other places, obviously) are the richest parts of the world and instead of simply accepting it, people keep comparing and looking for subtle differences that can make one seem better than the other. Kinda pointless, imo.

I have written a long post about it earlier, so I won't repeat it but, as someone who lives in a country with relatively 'socialised' medicine, I have had the privilege to witness both the pros and cons of the system first hand. And with all the media coverage, it's impossible not to be aware of all the pros and cons of the US system.

First of all, all the 'data' is easily manipulated. For instance, Germany has better cancer survival for some types of cancer than the US (pancreas, oesophagus,...). Switzerland has better survival in some others, such as leukaemia. Belgium does better in lung cancer.
None of that was mentioned in the table above, making it seem as if the US has best cancer survival for every type of cancer. But even that is irrelevant because it is ridiculous to use subtle differences (usually <5%) to claim that one system is necessarily better than the other. Many other things affect cancer survival that have nothing to do with the quality of the system. Yes, a 20% difference may indicate something (UK and breast cancer for example) but saying that 1% difference proves something is just... ridiculous.

Furthermore, a lot of the posts here seem like Fox News horror stories (and horror stories are again a lousy argument simply because you can find them in ANY system). I have never seen a 'death panel' or however some people call it. In fact, I have seen 80 year olds on eye surgeries in 'socialised medicine'. As for rationing healthcare, I am sure insurance companies do not cover everything either, do they? Otherwise there would be no HMO 'horror stories'. And if the insurance (whether private or national) refuses to cover something - people can still get it if they pay out of pocket (trust me, they can get the fancy drugs here too).

Life expectancy and infant mortality are also terrible things to look at when comparing quality of care, since pretty much every decent hospital both in the US and EU can deal with pre-mature births. Also heart attack treatment is generally the same everywhere, lol.

The biggest difference between the systems is that it seems that Americans need to be more responsible not to lose health coverage, while it is not a fear over here. I have been told several times by American friends that they couldn't afford health insurance (and yet they could afford to travel to Australia for holidays). Hard to blame the system when things go wrong.
Horror stories exist in each system and they won't cease to exist regardless of possible health care reforms.

There are advantages to both systems, and only those who have experienced both (which I believe not many here have) can give an objective analysis from patient or doctor perspective. And even then, some will vote for the US system while others will vote for the NHS/German/Swiss/French system simply because - both the EU and US enjoy state of art facilities and high quality physician workforce.

Also note, it is region dependent. Someone living in rural Mississippi may not get the same quality of care as someone living in Paris, while someone living in rural Bulgaria may not get the same care as someone living in Boston.

Hope at least someone can give up the political agenda and actually seriously consider the usefulness of this discussion. Life expectancy is relatively similar afterall, so I assume we will all be fine regardless of how the health care is coordinated.

Hmm. I agree with most of what you said.

I think what people like me are presenting is that our American system is expensive and doesn't necessarily yield any better results. We're not talking small differences either.

I keep hearing people say the data can be manipulated - so I've focused on completely objective data, like the below (or any and all of the charts listed on my first post #21):


Your quote:

people keep comparing and looking for subtle differences that can make one seem better than the other.

What is subtle about this:
By the way, these are the negotiated prices! These are NOT billed prices or manipulated data.

Average prices

Gleevec:
New Zeland: $989
US: $6,200

Reflux drug:
Netherlands: $33
US: $215

CT scan abdomen:
Spain: $94
US: $896

MRI
Switzerland: $138
US: $1,145

Hospital costs per day:
Spain: $481
US: $4,293
US 95th percentile: $12,726

Appy:
Argentina: $1,723
US: $13,910

Child Delivery:
Argentina: $2,237
US: $10,002

C-section:
Spain: $2,844
US: $15,240

Knee Replacement:
Argentina: $6,015
US: $25,398

I have no political agenda. I don't agree with either conservative or liberal principles 100%. For example, I think Obamacare wasn't good for America but I also support making the system more cost effective and efficient so more Americans can afford healthcare. Your example of people taking trips to Australia and while not being able to afford health insurance are very unique. Poor people don't usually go on trips to Australia (or is poor 50k per year in salary to you?).

I think if you read through my posts with a logical open mind, you'll find I've neither idealized other systems nor demonized ours. I've listed specific problems backed with objective data, like the data presented in this post and in post #21. Everything is region dependent, sure... except our GDP #'s, our per capita spending, our unit prices of all these healthcare services, and the runaway train of healthcare spending.

 

[Nephronlearner]

Hmm. I agree with most of what you said.

I think what people like me are presenting is that our American system is expensive and doesn't necessarily yield any better results. We're not talking small differences either.

I keep hearing people say the data can be manipulated - so I've focused on completely objective data, like the below (or any and all of the charts listed on my first post #21):


Your quote:

What is subtle about this:
By the way, these are the negotiated prices! These are NOT billed prices or manipulated data.

Average prices

Gleevec:
New Zeland: $989
US: $6,200

Reflux drug:
Netherlands: $33
US: $215

CT scan abdomen:
Spain: $94
US: $896

MRI
Switzerland: $138
US: $1,145

Hospital costs per day:
Spain: $481
US: $4,293
US 95th percentile: $12,726

Appy:
Argentina: $1,723
US: $13,910

Child Delivery:
Argentina: $2,237
US: $10,002

C-section:
Spain: $2,844
US: $15,240

Knee Replacement:
Argentina: $6,015
US: $25,398

I have no political agenda. I don't agree with either conservative or liberal principles 100%. For example, I think Obamacare wasn't good for America but I also support making the system more cost effective and efficient so more Americans can afford healthcare. Your example of people taking trips to Australia and while not being able to afford health insurance are very unique. Poor people don't usually go on trips to Australia.

I think if you read through my posts with a logical open mind, you'll find I've neither idealized other systems nor demonized ours. I've listed specific problems backed with objective data, like the data presented in this post and in post #21. Everything is region dependent, sure... except our GDP #'s, our per capita spending, our unit prices of all these healthcare services, and the runaway train of healthcare spending.

I wasn't referring to you in particular, I referred to the general 'atmosphere' on this thread, and also to those who seem to believe that 'governments make decisions instead of doctors' - which is beyond laughable (especially since I would bet that the government here has much less control than the insurance companies over there)

I am perfectly aware of a lot of issues American system has: lots of services are overcharged, insurance companies generate huge profits, and so on and so on.
But the point of my post was that the majority of people are doing fine in any developed country.
That being said, relatively high percentage of population without health insurance does seem to be a uniquely American problem, but then again, a lot of people COULD afford healthcare (including my relatives who live in America) but choose to spend money on other things instead. Personally, I am a liberal and I absolutely do believe that every person should get health insurance. But each system has it's problems, they are just of different nature.

In my opinion, the best way to deal with those issues would be to limit the 'power' of insurance companies (setting yearly maximums, cancelling insurance, not insuring people based on pre-existing conditions etc) - they would still generate more than enough profit. While 'government control' may seem scary at times, a little of it is often necessary to keep things in order. Just imagine letting the police force go private.

As a matter of fact, as someone who owns both state-sponsored and private insurance, I can testify that I have had some issues with private insurance myself.

 

[DermViser]

I wasn't referring to you in particular, I referred to the general 'atmosphere' on this thread, and also to those who seem to believe that 'governments make decisions instead of doctors' - which is beyond laughable (especially since I would bet that the government here has much less control than the insurance companies over there)

I am perfectly aware of a lot of issues American system has: lots of services are overcharged, insurance companies generate huge profits, and so on and so on.
But the point of my post was that the majority of people are doing fine in any developed country.
That being said, relatively high percentage of population without health insurance does seem to be a uniquely American problem, but then again, a lot of people COULD afford healthcare (including my relatives who live in America) but choose to spend money on other things instead. Personally, I am a liberal and I absolutely do believe that every person should get health insurance. But each system has it's problems, they are just of different nature.

In my opinion, the best way to deal with those issues would be to limit the 'power' of insurance companies (setting yearly maximums, cancelling insurance, not insuring people based on pre-existing conditions etc) - they would still generate more than enough profit. While 'government control' may seem scary at times, a little of it is often necessary to keep things in order. Just imagine letting the police force go private.

As a matter of fact, as someone who owns both state-sponsored and private insurance, I can testify that I have had some issues with private insurance myself.

Governments effectively ration care. If you as a doctor believe that a certain treatment is better, the govt. will say sorry we don't cover it. There is NO appeals process. Private insurance companies DO have appeals processes in which a doctor can send a letter stating why a specific treatment should be covered, etc. That's the difference.

 

[PL198]

I wasn't referring to you in particular, I referred to the general 'atmosphere' on this thread, and also to those who seem to believe that 'governments make decisions instead of doctors' - which is beyond laughable (especially since I would bet that the government here has much less control than the insurance companies over there)

I am perfectly aware of a lot of issues American system has: lots of services are overcharged, insurance companies generate huge profits, and so on and so on.
But the point of my post was that the majority of people are doing fine in any developed country.
That being said, relatively high percentage of population without health insurance does seem to be a uniquely American problem, but then again, a lot of people COULD afford healthcare (including my relatives who live in America) but choose to spend money on other things instead. Personally, I am a liberal and I absolutely do believe that every person should get health insurance. But each system has it's problems, they are just of different nature.

In my opinion, the best way to deal with those issues would be to limit the 'power' of insurance companies (setting yearly maximums, cancelling insurance, not insuring people based on pre-existing conditions etc) - they would still generate more than enough profit. While 'government control' may seem scary at times, a little of it is often necessary to keep things in order. Just imagine letting the police force go private.

As a matter of fact, as someone who owns both state-sponsored and private insurance, I can testify that I have had some issues with private insurance myself.

There is no such thing as more than enough profit.... Forcing private companies to insure people and not drop their coverage is a joke. Let's force every car dealership to keep giving people cars after they wreck them over and over, because transportation is necessary right? Oh wait, then that dealership goes out of business, because their business is to make money, not give it away. It's a business and anyone with a basic understanding of risk-assessment knows it's a joke for companies to be unable to deny people based on previous conditions or to force them to keep covering people. Business have 1 purpose- profit. If you're going to put handcuffs on them and order them around left and right, just take them over and call it what it really is. No need to do it behind a bunch of regulations and pretend you're something you arent.

 

[Nephronlearner]

Governments effectively ration care. If you as a doctor believe that a certain treatment is better, the govt. will say sorry we don't cover it. There is NO appeals process. Private insurance companies DO have appeals processes in which a doctor can send a letter stating why a specific treatment should be covered, etc. That's the difference.

Insurance companies will not cover everything either. They refuse to insure people based on pre-exisiting conditions, they cancel policies when someone gets sick, increase premiums, sometimes making it very difficult for a low middle class family to afford high quality care. It's not like they are perfect, either.

I am still not sure what you mean by governments rationing care. I have never seen or heard of a person being denied care. 'Government saying something won't be covered' - again I am not sure how that should work. Doctor's over here do not call the government to ask whether the patient gets something, lol. Anything written on the prescription (assuming it's an approved drug) is available. Same with surgeries. The big difference may be that on average, FDA approves cancer treatments (and some other expensive treatments) several years sooner than European organisations. That is probably why on average Americans live longer with cancer.
As for unapproved drugs, those are generally not the cures but rather drugs that prolong life by 3-4-5 months and cost ridiculous amounts of money that do not get the approval. Again, it varies between countries. UK seems to be very strict when it comes to that while Switzerland and Germany (and possibly France) seem to be more America-like. Interesting to note, private insurance companies provide insurance to people there - however they legally cannot do any of the things American companies tend to do. In my opinion, quite a good way to organise it.

 

[Nephronlearner]

There is no such thing as more than enough profit.... Forcing private companies to insure people and not drop their coverage is a joke. Let's force every car dealership to keep giving people cars after they wreck them over and over, because transportation is necessary right? Oh wait, then that dealership goes out of business, because their business is to make money, not give it away. It's a business and anyone with a basic understanding of risk-assessment knows it's a joke for companies to be unable to deny people based on previous conditions or to force them to keep covering people. Business have 1 purpose- profit. If you're going to put handcuffs on them and order them around left and right, just take them over and call it what it really is. No need to do it behind a bunch of regulations and pretend you're something you arent.

Some people don't think health care should be only about insurance companies generating profit and prefer not having to worry about going homeless due to healthcare costs.

I certainly do support the idea of private ownership of companies and competition and capitalism in general. However, I also think that in some aspects there must be a line that shouldn't be crossed. I wouldn't want the police force to be entirely private and turn into a pure money-generating service, I don't want fire departments do be turned into that, and I don't want hospitals turned into that.

Some people will inevitably agree, while others will disagree, but in my opinion, when it comes to healthcare, the best way to use the money is to invest it in research, providing access to care and actually delivering good care, not just letting a few folks generate billions. Fine for law firms and banks, not for medicine.

 

[PL198]

Insurance companies will not cover everything either. They refuse to insure people based on pre-exisiting conditions, they cancel policies when someone gets sick, increase premiums, sometimes making it very difficult for a low middle class family to afford high quality care. It's not like they are perfect, either.

I am still not sure what you mean by governments rationing care. I have never seen or heard of a person being denied care. 'Government saying something won't be covered' - again I am not sure how that should work. Doctor's over here do not call the government to ask whether the patient gets something, lol. Anything written on the prescription (assuming it's an approved drug) is available. Same with surgeries. The big difference may be that on average, FDA approves cancer treatments (and some other expensive treatments) several years sooner than European organisations. That is probably why on average Americans live longer with cancer.
As for unapproved drugs, those are generally not the cures but rather drugs that prolong life by 3-4-5 months and cost ridiculous amounts of money that do not get the approval. Again, it varies between countries. UK seems to be very strict when it comes to that while Switzerland and Germany (and possibly France) seem to be more America-like. Interesting to note, private insurance companies provide insurance to people there - however they legally cannot do any of the things American companies tend to do. In my opinion, quite a good way to organise it.

What about the bolded makes them imperfect? You understand the purpose of a private corporation is to make money, right? It's not to make you feel good at night or to ensure that people get the best care possible. Those might be externalities created by their actions, but they certainly aren't the purpose. By definition, adhering to this principle would make them perfect. Adhering to what you wish would make them imperfect. Have you ever heard of prior authorization? It's not like you call up Uncle Sam and are like " Yo Uncle Sam I want to prescribe X because this this and this," It's more like, a certain drug has authorization needed for it's approval.

Seriously. I don't understand how this is a shock. The point of a company is to make money. Nothing else. Literally, nothing else. I don't understand how we have people about to become physicians that don't understand this concept.

 

[PL198]

Some people don't think health care should be only about insurance companies generating profit and prefer not having to worry about going homeless due to healthcare costs.

I certainly do support the idea of private ownership of companies and competition and capitalism in general. However, I also think that in some aspects there must be a line that shouldn't be crossed. I wouldn't want the police force to be entirely private and turn into a pure money-generating service, I don't want fire departments do be turned into that, and I don't want hospitals turned into that.

Some people will inevitably agree, while others will disagree, but in my opinion, when it comes to healthcare, the best way to use the money is to invest it in research, providing access to care and actually delivering good care, not just letting a few folks generate billions. Fine for law firms and banks, not for medicine.

Yes because medicine is some magical exception to every other rule in the modern universe. It's all or nothing. You don't get to arbitrarily set policy in one industry that isn't binding in the others. If you want to do that, everyone will run from healthcare because it would be fiscally irresponsible to be involved in healthcare at that point, and then who would carry out your world-improving duties? No one. All your dreams and ambitions about "the future of medicine" just discourage people from actually getting involved.

 

[DermViser]

Insurance companies will not cover everything either. They refuse to insure people based on pre-exisiting conditions, they cancel policies when someone gets sick, increase premiums, sometimes making it very difficult for a low middle class family to afford high quality care. It's not like they are perfect, either.

I don't think you understand how insurance is supposed to work. It's not meant to pay for every health transaction you have your entire life. You can get insurance on a house that has had previous fire damage (hence insurance companies not paying for pre-existing conditions), and premiums increase bc overall care has increased. It is not the job of a private health insurance company to make it affordable for everyone.

 

[Nephronlearner]

Yes because medicine is some magical exception to every other rule in the modern universe. It's all or nothing. You don't get to arbitrarily set policy in one industry that isn't binding in the others. If you want to do that, everyone will run from healthcare because it would be fiscally irresponsible to be involved in healthcare at that point, and then who would carry out your world-improving duties? No one. All your dreams and ambitions about "the future of medicine" just discourage people from actually getting involved.

Would you really want to go to a private police station after having your house robbed? Or would you want to call the private fire department when your house is on fire and having them reject you and let your house burn in ashes on grounds that you might have had a malfunctioning oven?

The whole idea is: things that directly affect the well being of population should be regulated and not turned solely into profit-generating industries. Sure, every insurance company will make lots of profit, but cutting down that profit by a bit to prevent total chaos from happening does not seem that bad. You have the right to disagree obviously but... keep in mind what it would be like if EVERYTHING went completely private.

 

[PL198]

Would you really want to go to a private police station after having your house robbed? Or would you want to call the private fire department when your house is on fire and having them reject you and let your house burn in ashes on grounds that you might have had a malfunctioning oven?

The whole idea is: things that directly affect the well being of population should be regulated and not turned solely into profit-generating industries. Sure, every insurance company will make lots of profit, but cutting down that profit by a bit to prevent total chaos from happening does not seem that bad. You have the right to disagree obviously but... keep in mind what it would be like if EVERYTHING went completely private.

Oh so you mean if those services were private, they'd actually be able to be used by the people that pay for them, unlike now where huge majorities of their time is spent on people that don't even pay any taxes? What a tragedy that would be! Every little thing affects the well being of a population. That's the problem. You can be abstract and say the economic access to certain products has socially repercussions on a population. What is the number 1 "justification" for obesity among poor people? Lack of access to local markets. Oh, so now grocery stores are another industry that can't make a profit, right? Here's a hint: Businesses develop where the economic conditions are present for them to succeed.

 

[Nephronlearner]

I don't think you understand how insurance is supposed to work. It's not meant to pay for every health transaction you have your entire life. You can get insurance on a house that has had previous fire damage (hence insurance companies not paying for pre-existing conditions), and premiums increase bc overall care has increased. It is not the job of a private health insurance company to make it affordable for everyone.

The thing some have a problem with is that if the private insurance is the only one available, it becomes unaffordable for many. That's why a lot of people, including me, believe that some form of government regulation should be in place. Obviously, not living in the US I don't know all the details, but expanding government programmes (medicare/medicaid) to provide insurance to those who can't afford it (not those who elect not to buy it) would not be that bad of a solution. Plenty of countries do that and it seems to be working. Obviously, the issue is whether the government can be trusted to do it well, without wasting too much money on it.