8 ms·

Universal healthcare is simply more efficient. The NHS delivers the same outcomes (longevity, infant mortality, etc.) as the American health system at less than

Universal healthcare is simply more efficient. The NHS delivers the same outcomes (longevity, infant mortality, etc.) as the American health system at less than half the cost (healthcare spending / % GDP). Fully private provision of insurance for any events that follow a non-normal distribution (as most, but not all healthcare costs do) simply does not work, has never worked and will never work.

chimeracoder 10y ago
[deleted]
- TheOtherHobbes 10y ago
  The UK also has infinitely better healthcare-related bankruptcy statistics. I suspect it would be easier to improve the 5-year cancer survival rates in the UK than it would be to eliminate healthcare-related bankruptcies in the US. The NHS has also become increasingly inefficient over the last couple of decades, as managerialisation and stealth privatisation have diverted funds away from front-line patient care towards administration costs and third-party profits.
- nkrisc 10y ago
  How do those rates look when you account for income?
- stephencanon 10y ago
  > The UK also has dramatically worse 5-year cancer survival rates than the US - in some cases, almost half what the US provides[0][1]. 5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die.
  - jessaustin 10y ago
    Stipulating that five years is the wrong period to use, what would the right period be? Intuitively, there must be some period of time over which different nations could be meaningfully compared on this basic health result.
    - wutbrodo 10y ago
      > Stipulating that five years is the wrong period to use, what would the right period be? The short answer: Whenever death rates plateau for the 99th (or whatever) percentile, relative to progression of the illness. If you wait XX years until the effect of moving around the diagnosis date is largely mitigated statistically, then the error begins to fade. The long answer: This isn't quite the right question to ask at all, because it assumes away the possibility that the naive "years from diagnosis" is a flawed metric in the first place. The point of the comment you're responding to is that "n-year survival rate (from diagnosis)" as measured is a flawed statistic in general, because the baseline from which the counting starts can be different for people with the exact same outcomes. An illustrative _reductio ad absurdum_ thought experiment here is that of taking two people with the exact same cancer, detecting one earlier, and giving both exactly no treatment (or treatment on the exact same schedule). Despite having identical quality of care and outcome, the person whose cancer was detected earlier will show up as having a better 5-year survival rate, simply because we started counting earlier and her 5-year mark came earlier in the progression of the disease. This can be mitigated to an extent by controlling for stage of cancer or whatever, and that's probably a good idea, but this is necessarily brittle and hard to scale and study.
      - jessaustin 10y ago
        You've proved too much. This same argument could be used to show that we can't decide e.g. which drugs or lifestyle choices make death due to cancer more or less likely, or indeed which behaviors make death due to any long-term illness more or less likely. Congratulations I guess, but you've just put a bunch of medical researchers out of a job. They had to study a long time to do that job!
        10y ago
  - TearsInTheRain 10y ago
    I feel like it is trivial to account for this difference by using something like the stage the cancer was caught in, type/size of mass etc
    - stephencanon 10y ago
      It's extremely difficult to do this without running up against Simpson's paradox (which doesn't stop lots of people from trying, of course).
  - ptaipale 10y ago
    >5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die. This does not make sense. The earlier you detect cancer, the higher is the likelihood that treatment is effective. 5-year survival rate absolutely correlates with 10-year survival rate and 30-year survival rate. Though it is undoubtedly true that in the long term, we're all dead. That is however not a meaningful indicator of health care system effectiveness.
    - danielweber 10y ago
      If you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better. So you can't just look at cancer survival rates. I meant what I said about AND CHANGE NOTHING ELSE but experience tells me I have to repeat it. Merely detecting it earlier, BUT DOING NOTHING ABOUT IT, will improve your cancer survival stats.
      - DrScump 10y ago
        <If you detect cancer earlier AND CHANGE NOTHING ELSE...> That is a meaningless population unless you are suggesting that providers are working hard to detect cancer and then, having found cancer, choose to not treat it at all.
        danielweber 10y ago
        Ugh, no, I'm not using that as a population to compare to. Here, let me put it into a story. We're comparing the health care of two countries, A & B. The survival rates of cancer are better in country A. So researchers study what country A does to get better results. They find that it has a system of early detection followed by slathering people with chicken blood. Well, you aren't sure if the chicken blood is the right thing, but surely the early detection means people are healthier, right? No, because . . . ahem, "if you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better." In fact, country A and country B may be exactly the same when it comes to treating cancer. But because of very real statistical artifacts like https://en.wikipedia.org/wiki/Will_Rogers_phenomenon https://en.wikipedia.org/wiki/Will_Rogers_phenomenon, it leads to statistics showing the country A is better when people have the exact same outcomes. Perhaps you think that rubbing with chicken blood is an unfair comparison of the US health care system, because it uses science-y stuff. But measuring outcomes is hard. Lots of things that people naturally assume improve health outcomes (see other discussion on this page about annual checkups) don't. Some things that we assume improve health care outcomes actually worsen outcomes. Radical chemotherapy is the go-to example. And insurance companies were required to pay for it, too, following expensive court cases. (Health care costs were held nearly flat in the US under HMOs, which put a lid of costs but had no noticeable negative impact on outcomes. This pretty much broke their cost containment. They were also unpopular because they said no a lot.) So figuring out if the US has better cancer outcomes is hard, because the US really puts a big emphasis on early detection, but it might be just early detection which makes the stats look good. I'm not trying to push a narrative right here. There are a bunch of different health care systems in the world, and the one thing we know about the US system is that it costs more. This is not necessarily a bad thing, because it's possible we are getting more benefit (by pushing new treatments) but it's also something that the US has not explicitly decided to do, neither by policy nor by the invisible hand of a bunch of individual actors in the market.
- wk_end 10y ago
  You're cherry picking. You've presented one stat where the US system comes out well ahead of the UK system (which is far from the only socialized health care system). But so what? It's true that the American health care system is not literally the worst at everything. But yes, when all is said and done, if you look at the data in aggregate [0], socialized medicine provides far more bang for the buck than the American system does. [0] https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... The US usually does quite well: often times somewhat better than some countries with socialized health care, usually somewhat worse than some others; it's rare that there's a dramatic difference between it and other first world countries. But, of course, where there is a dramatic difference is in costs: the US often spends twice as much per capita [1]. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Moreover, the way those costs are distributed is socially destructive in the US in a way that they simply aren't in any other country. No one in Canada goes bankrupt due to medical bills; in the US, roughly 2 million people do a year, and another 56 million struggle to pay their bills [2]. [2] http://www.cnbc.com/id/100840148 http://www.cnbc.com/id/100840148 And again, all this is for what is, in aggregate, roughly the same quality of care.
  - CWuestefeld 10y ago
    in the US, roughly 2 million people do [bankrupt due to medical bills] a year, and another 56 million struggle to pay their bills This is misinterpreting the data. The vast majority of this is the problems caused by lost income - an inability to work while ill, not because of the medical bills themselves. EDIT: remove repeated phrase
    - wk_end 10y ago
      The press release for the original study this article is based on claims they've accounted for this: "NerdWallet Health chose to include only bankruptcy explicitly tied to medical bills, excluding indirect reasons like lost work opportunities." [0] https://www.nerdwallet.com/blog/health/managing-medical-bills/nerdwallet-health-study-estimates-56-million-americans-65-struggle-medical-bills-2013/ https://www.nerdwallet.com/blog/health/managing-medical-bill...
jomamaxx 10y ago
"Universal healthcare is simply more efficient. The NHS delivers the same outcomes (longevity, infant mortality, etc.) as the American health system at less than half the cost (healthcare spending / % GDP)" This is completely false. Both 'longevity' and 'infant mortality' are absolutely not measures if the quality of the healthcare system. I've lived in Canada, US, Germany, France. The best healthcare system is by far the US - however - it's very expensive, and it doesn't cover everyone, which are both big problems. The quality of care for those who are covered in the US is unrivalled. Of course, don't get the wrong insurance, you could be out o luck, and out on the street ...
- mac01021 10y ago
  > The quality of care for those who are covered in the US is unrivalled. I would be interested in more specifics about this. It's hard to find statistics that provide a clear comparison of quality between healthcare systems.
- larrywright 10y ago
  Whenever anyone proposes universal healthcare in the US, I tell them two stories: 1) My aunt is an oncology nurse in a major city. A high percentage of her patients are from Canada, because they can get treated here for their cancer, and are unable to get those treatments in Canada (or can't get them in a timely manner). Of course, these are only the patients who can afford to pay it out of pocket or have supplemental health insurance. 2) My dad developed a rare lung disease and was treated by the VA (which is government run healthcare for veterans of the US Armed Forces). They determined he needed a lung transplant to survive. It took them 18 months to run the tests necessary to determine if he was a candidate for a transplant, and due to the progressive nature of the disease, by the time they were done running their tests, a panel in DC determined he was no longer a viable candidate for a transplant, and sent him off to die[1]. As a last-ditch effort, he reached out to Mayo Clinic, who agreed to see him. They ran the same tests in 3 days, and determined that he was a candidate for a transplant. He got a new lung, and lived for three more years. I strongly suspect the delay in treatment cut his life short, but I'm not a doctor. I do not want universal healthcare. [1] People make fun of Sarah Palin and her "death panels", but they're a very real thing no matter what they're called.
danielweber 10y ago
The US is more expensive. But that's as far as you can say.

chimeracoder 10y ago

[deleted]

TheOtherHobbes 10y ago
The UK also has infinitely better healthcare-related bankruptcy statistics. I suspect it would be easier to improve the 5-year cancer survival rates in the UK than it would be to eliminate healthcare-related bankruptcies in the US. The NHS has also become increasingly inefficient over the last couple of decades, as managerialisation and stealth privatisation have diverted funds away from front-line patient care towards administration costs and third-party profits.
nkrisc 10y ago
How do those rates look when you account for income?
stephencanon 10y ago
> The UK also has dramatically worse 5-year cancer survival rates than the US - in some cases, almost half what the US provides[0][1]. 5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die.
- jessaustin 10y ago
  Stipulating that five years is the wrong period to use, what would the right period be? Intuitively, there must be some period of time over which different nations could be meaningfully compared on this basic health result.
  - wutbrodo 10y ago
    > Stipulating that five years is the wrong period to use, what would the right period be? The short answer: Whenever death rates plateau for the 99th (or whatever) percentile, relative to progression of the illness. If you wait XX years until the effect of moving around the diagnosis date is largely mitigated statistically, then the error begins to fade. The long answer: This isn't quite the right question to ask at all, because it assumes away the possibility that the naive "years from diagnosis" is a flawed metric in the first place. The point of the comment you're responding to is that "n-year survival rate (from diagnosis)" as measured is a flawed statistic in general, because the baseline from which the counting starts can be different for people with the exact same outcomes. An illustrative _reductio ad absurdum_ thought experiment here is that of taking two people with the exact same cancer, detecting one earlier, and giving both exactly no treatment (or treatment on the exact same schedule). Despite having identical quality of care and outcome, the person whose cancer was detected earlier will show up as having a better 5-year survival rate, simply because we started counting earlier and her 5-year mark came earlier in the progression of the disease. This can be mitigated to an extent by controlling for stage of cancer or whatever, and that's probably a good idea, but this is necessarily brittle and hard to scale and study.
    - jessaustin 10y ago
      You've proved too much. This same argument could be used to show that we can't decide e.g. which drugs or lifestyle choices make death due to cancer more or less likely, or indeed which behaviors make death due to any long-term illness more or less likely. Congratulations I guess, but you've just put a bunch of medical researchers out of a job. They had to study a long time to do that job!
      - 10y ago
- TearsInTheRain 10y ago
  I feel like it is trivial to account for this difference by using something like the stage the cancer was caught in, type/size of mass etc
  - stephencanon 10y ago
    It's extremely difficult to do this without running up against Simpson's paradox (which doesn't stop lots of people from trying, of course).
- ptaipale 10y ago
  >5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die. This does not make sense. The earlier you detect cancer, the higher is the likelihood that treatment is effective. 5-year survival rate absolutely correlates with 10-year survival rate and 30-year survival rate. Though it is undoubtedly true that in the long term, we're all dead. That is however not a meaningful indicator of health care system effectiveness.
  - danielweber 10y ago
    If you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better. So you can't just look at cancer survival rates. I meant what I said about AND CHANGE NOTHING ELSE but experience tells me I have to repeat it. Merely detecting it earlier, BUT DOING NOTHING ABOUT IT, will improve your cancer survival stats.
    - DrScump 10y ago
      <If you detect cancer earlier AND CHANGE NOTHING ELSE...> That is a meaningless population unless you are suggesting that providers are working hard to detect cancer and then, having found cancer, choose to not treat it at all.
      - danielweber 10y ago
        Ugh, no, I'm not using that as a population to compare to. Here, let me put it into a story. We're comparing the health care of two countries, A & B. The survival rates of cancer are better in country A. So researchers study what country A does to get better results. They find that it has a system of early detection followed by slathering people with chicken blood. Well, you aren't sure if the chicken blood is the right thing, but surely the early detection means people are healthier, right? No, because . . . ahem, "if you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better." In fact, country A and country B may be exactly the same when it comes to treating cancer. But because of very real statistical artifacts like https://en.wikipedia.org/wiki/Will_Rogers_phenomenon https://en.wikipedia.org/wiki/Will_Rogers_phenomenon, it leads to statistics showing the country A is better when people have the exact same outcomes. Perhaps you think that rubbing with chicken blood is an unfair comparison of the US health care system, because it uses science-y stuff. But measuring outcomes is hard. Lots of things that people naturally assume improve health outcomes (see other discussion on this page about annual checkups) don't. Some things that we assume improve health care outcomes actually worsen outcomes. Radical chemotherapy is the go-to example. And insurance companies were required to pay for it, too, following expensive court cases. (Health care costs were held nearly flat in the US under HMOs, which put a lid of costs but had no noticeable negative impact on outcomes. This pretty much broke their cost containment. They were also unpopular because they said no a lot.) So figuring out if the US has better cancer outcomes is hard, because the US really puts a big emphasis on early detection, but it might be just early detection which makes the stats look good. I'm not trying to push a narrative right here. There are a bunch of different health care systems in the world, and the one thing we know about the US system is that it costs more. This is not necessarily a bad thing, because it's possible we are getting more benefit (by pushing new treatments) but it's also something that the US has not explicitly decided to do, neither by policy nor by the invisible hand of a bunch of individual actors in the market.
wk_end 10y ago
You're cherry picking. You've presented one stat where the US system comes out well ahead of the UK system (which is far from the only socialized health care system). But so what? It's true that the American health care system is not literally the worst at everything. But yes, when all is said and done, if you look at the data in aggregate [0], socialized medicine provides far more bang for the buck than the American system does. [0] https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... The US usually does quite well: often times somewhat better than some countries with socialized health care, usually somewhat worse than some others; it's rare that there's a dramatic difference between it and other first world countries. But, of course, where there is a dramatic difference is in costs: the US often spends twice as much per capita [1]. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Moreover, the way those costs are distributed is socially destructive in the US in a way that they simply aren't in any other country. No one in Canada goes bankrupt due to medical bills; in the US, roughly 2 million people do a year, and another 56 million struggle to pay their bills [2]. [2] http://www.cnbc.com/id/100840148 http://www.cnbc.com/id/100840148 And again, all this is for what is, in aggregate, roughly the same quality of care.
- CWuestefeld 10y ago
  in the US, roughly 2 million people do [bankrupt due to medical bills] a year, and another 56 million struggle to pay their bills This is misinterpreting the data. The vast majority of this is the problems caused by lost income - an inability to work while ill, not because of the medical bills themselves. EDIT: remove repeated phrase
  - wk_end 10y ago
    The press release for the original study this article is based on claims they've accounted for this: "NerdWallet Health chose to include only bankruptcy explicitly tied to medical bills, excluding indirect reasons like lost work opportunities." [0] https://www.nerdwallet.com/blog/health/managing-medical-bills/nerdwallet-health-study-estimates-56-million-americans-65-struggle-medical-bills-2013/ https://www.nerdwallet.com/blog/health/managing-medical-bill...

jomamaxx 10y ago

"Universal healthcare is simply more efficient. The NHS delivers the same outcomes (longevity, infant mortality, etc.) as the American health system at less than half the cost (healthcare spending / % GDP)" This is completely false. Both 'longevity' and 'infant mortality' are absolutely not measures if the quality of the healthcare system. I've lived in Canada, US, Germany, France. The best healthcare system is by far the US - however - it's very expensive, and it doesn't cover everyone, which are both big problems. The quality of care for those who are covered in the US is unrivalled. Of course, don't get the wrong insurance, you could be out o luck, and out on the street ...

mac01021 10y ago
> The quality of care for those who are covered in the US is unrivalled. I would be interested in more specifics about this. It's hard to find statistics that provide a clear comparison of quality between healthcare systems.
larrywright 10y ago
Whenever anyone proposes universal healthcare in the US, I tell them two stories: 1) My aunt is an oncology nurse in a major city. A high percentage of her patients are from Canada, because they can get treated here for their cancer, and are unable to get those treatments in Canada (or can't get them in a timely manner). Of course, these are only the patients who can afford to pay it out of pocket or have supplemental health insurance. 2) My dad developed a rare lung disease and was treated by the VA (which is government run healthcare for veterans of the US Armed Forces). They determined he needed a lung transplant to survive. It took them 18 months to run the tests necessary to determine if he was a candidate for a transplant, and due to the progressive nature of the disease, by the time they were done running their tests, a panel in DC determined he was no longer a viable candidate for a transplant, and sent him off to die[1]. As a last-ditch effort, he reached out to Mayo Clinic, who agreed to see him. They ran the same tests in 3 days, and determined that he was a candidate for a transplant. He got a new lung, and lived for three more years. I strongly suspect the delay in treatment cut his life short, but I'm not a doctor. I do not want universal healthcare. [1] People make fun of Sarah Palin and her "death panels", but they're a very real thing no matter what they're called.

danielweber 10y ago

The US is more expensive. But that's as far as you can say.