12 ms·

> One solution could be to get rid of insurance scam (yes I call it a scam) and then lets hospitals/doctors compete with transparent pricing in a free market.

> One solution could be to get rid of insurance scam (yes I call it a scam) and then lets hospitals/doctors compete with transparent pricing in a free market. I don't understand the American (and it is American) obsession with having a free market in healthcare. Why do Americans not look at public provision, paid for via your tax system? Canada does it, so it demonstrably does work in North America, Europe does it, with varying degrees of efficiency, but it basically works. No-one in Europe or Canada lives "in fear having an accident or getting sick" because they know healthcare is provided by the state in the same way as education, fire services and police service are all provided as a public service, for the general good of society, via taxation. Americans are happy to send their children to school, to be able to call the fire department or the police (we'll set aside the clear problems of US policing - you generally still call the police when you see a bank robbery, so there is a degree of confidence in them still). So why is healthcare the exception? What sort of mentality says I am to blame for getting sick and told if I cannot afford medical treatment, I should not have become ill?

refurb 10y ago
Because it's worked pretty well for Medicare and Medicaid? Large portions of both were privatized through Medicare Advantage and Managed Medicaid. The gov't pays private companies a flat rate per patient who selects their plan. A majority of Medicare coverage is provided through private companies (100% for the drug benefit). Last I saw 80%+ of Medicaid patients are covered by a private plan. What are the benfits? The private companies take on the risk. If the lump sum the gov't gives them isn't enough to cover costs, tough, the company takes a loss. Gov't loves it as it makes budgeting easy. The other benefit is choice. A patient can select from a multitude of plans that benefit them the most. Want a top doctor? Pick a plan where his/her hospital is in network. Have a chronic disease where you take a lot of meds chronically? Pick a plan with better drug benefits. Medicare Part D - the drug benefit created in 2005 that is entirely private - came in dramatically under cost forecasts.
- chimeracoder 10y ago
  > Because it's worked pretty well for Medicare and Medicaid? Large portions of both were privatized through Medicare Advantage and Managed Medicaid. The gov't pays private companies a flat rate per patient who selects their plan. Yeah, Original Medicare is pretty awful - I wouldn't recommend it to anyone who's able to get a Medicare Advantage plan. It's not just the cost-of-care and the overall expense to the patient (even though Medicare Advantage tends to win out on both of those aspects as well). It's that Original Medicare is a horribly frustrating experience for the patient as well. Of course, most people (especially most people under the age of 65) don't understand the difference, and when they think about Medicare, they think of a publicly-run program, even though around 40% of the Medicare population is on a Medicare Advantage plan.
codegeek 10y ago
You have a point. But Americans generally are not convinced that a Govt. provided healthcare (paid through taxes) is the right solution. I personally don't have a problem with that as long as the main problem of "fear" is resolved. Whatever it takes. The problem is that we are not able to get out of the whole "insurance-company-being-the-middleman-in-everything" business.
thesimon 10y ago
>Why do Americans not look at public provision, paid for via your tax system? Because raising taxes is bad, obviously one day you'll be big and don't want to pay health care for all the people down there. And of course it's a slippery slope. Today it's health care, tomorrow it's minimum wage and the day after you find yourself in a Gulag /s Just look at how hard republican states tried to push against Medicaid.
- darkhorn 10y ago
  You mean that the European Union is heading to Gulags?
  - maxxxxx 10y ago
    He is being facetious.
    - pjc50 10y ago
      Yes, but some US politicians have literally tried to argue that way ("death panels " etc)
k-mcgrady 10y ago
>> "I don't understand the American (and it is American) obsession with having a free market in healthcare." I think part of it is the culture of believing you can be anything you want to be. It's the same reason the poor often vote against their interests in the US - they believe that soon they'll be rich and want low taxes and few regulations. That they are the exception.
- refurb 10y ago
  If you want those people to change how they vote you need to stop talking down to them. "Hey stupid! You're voting for people that hurt you." Or then again, maybe they just have a different opinion than you on what is important to them?
  - gonvaled 10y ago
    Surely nobody can be tricked onto supporting positions contrary to his interests. That would be impossible, since people are rational, educated and perfectly informed. There is a minority of people who are actually completely out of touch with reality, so-called demagogues and populists, and to a less extent all politians: they are completely deluded in thinking that by repeating a point a thousand times they can mislead those perfectly informed masses.
  - enraged_camel 10y ago
    If someone continuously keeps getting tricked into voting against their own self-interests, with the belief that their vote will actually benefit them, then yes, they absolutely deserve contempt. As the saying goes: "Fool me once, shame on you. Fool me twice, shame on me." A large part of the American populace has been getting fooled repeatedly for decades.
    - mindcrime 10y ago
      If someone continuously keeps getting tricked into voting against their own self-interests It has not been established that they are voting against their own self-interests. You are just assuming you know what their interests are better than they do.
rdtsc 10y ago
Reasons are historic and idelogical. A free market is considered sort of a religion here. In other words we don't usually evaluate and consider things based on their own merit (what is the best way to provide healthcare, what is the best way to fix infrastructure, like bridges, etc), but rather how will this make free market happy. We treat it as sort of a deity and if we don't abide by its likes we'll be severely punished.
- milcron 10y ago
  Reminds me of this interesting wiki article, "American Civil Religion" https://en.wikipedia.org/wiki/American_civil_religion https://en.wikipedia.org/wiki/American_civil_religion
  - rdtsc 10y ago
    Or brilliant. That explains exactly how I understand it. Didn't know the phenomena had a name associated with it.
  - maxxxxx 10y ago
    This article is great. It explains the reverence for the constitution and the founding fathers.
- _superposition_ 10y ago
  The healthcare "market" is anything but free. From insurance companies, negotiated prices, all the way down to the AMA limiting the supply of doctors and all the other things they do to keep prices high. It seems the only thing free about it is the freedom to get screwed over. So in those terms, I'm not sure what sort of diety it is that we're worshipping.
  - rdtsc 10y ago
    > The healthcare "market" is anything but free. It is "free" in the propaganda domain. That it is sold to the voters as "free, therefore efficient and better than government controlled"
hibikir 10y ago
I Lived in Spain for a couple of decades, and I much prefer their government run hospitals to the way the US works. However, I do not believe that the US could just flip a switch and go to a public hospital system, so I would be happy with a more transparent, more competitive hospital system. The question here is not what system to create in a vacuum, but the road in the middle. I live surrounded by a whole lot of ultra-expensive, luxurious hospitals, staffed by extremely well paid professionals (and not so well paid residents), which, in many cases, have six figures worth of debt for the privilege. To move to a public system, all of those things would have to change: Those luxurious, privately owned hospitals are never going to give great prices to a single payer system. The doctors are not going to be happy with lower wages. Medical schools would have to change drastically, so they can actually provide a number of doctors that resembles the rest of the western world. This level of disruption is what makes major changes like that in a system that employs so many people unpopular: It's a bit like how the US military can't take big cuts, as they are political suicide. So overall, the change would be huge, and would be hard to make slowly. Therefore, I'd much rather solve it in the US through markets. Once the system has a whole lot less rent seeking behaviors, and the incentives are better aligned, a public option would actually be easier than from the catastrophe we live on now, where prices are secret, and yet, a hospitalization will often involve 10 to 20% coinsurance.
- cylinder 10y ago
  You do a public system for all and then a private system for whomever wants to buy in. You incentivize the private option by levying a tax on those in upper incomes who do not buy private health cover. This is the Australian system and it's the most reasonable option for the US but I guess in America we can never admit to looking to other countries and have to pretend nobody else has figured out healthcare.
  - aianus 10y ago
    Wouldn't all of the best doctors only treat rich people? Why would you expect them to do the same work for less money over at the public hospital?
BurningFrog 10y ago
> Why do Americans not look at public provision, paid for via your tax system? Canada does it, so it demonstrably does work in North America, Europe does it, with varying degrees of efficiency, but it basically works. This article presents a good argument for why Single Payer won't work well in the US: https://www.bloomberg.com/view/articles/2014-04-30/single-payer-would-make-health-care-worse https://www.bloomberg.com/view/articles/2014-04-30/single-pa... > Americans are happy to send their children to school Americans are, on average not happy to send their children to public schools
- jimbokun 10y ago
  That was a great analysis from Bloomberg, thanks for the link.
  - massysett 10y ago
    Look through all her articles, she writes a lot about US healthcare policy, generally with a skeptical eye toward recent legislative efforts.
- keypusher 10y ago
  Why are the vast majority of US children enrolled in public school if their parents are so unhappy about it?
  - splintercell 10y ago
    Because they have no other option. One of the reasons why Americans are so vehemently against Universal Healthcare because once you go there, you don't easily get to come back. Once govt starts to provide a certain service, it kills the private sector market for that. Then no matter how terrible govt service is, there isn't much which can be done about it.
Kalium 10y ago
It should also be remembered that various levels of the American government have a record with public provision that is at best mixed. Walter Reed, anyone? Psychiatric institutions in the 80s and before? When you have a distressingly high chance of getting a terrible system, you wind up somewhat skeptical of people who want to tear down what's already in place and do public provisioning. Good and pure intentions are not an adequate substitute for competence.
- jimbokun 10y ago
  Of course, you cannot seriously associate "competence" with the current US free market healthcare system.
  - Kalium 10y ago
    Depends a great deal on one's definition of "competent". If you define it by outcomes for those with access to service, it does reasonably well. If you define it by access to service, it does poorly. The fear is that a system that works for some will be replaced by system that everyone can access but works for nobody.
hiram112 10y ago
The US has far more diversity than most of the Western European nations, though this is obviously changing. Socialism really doesn't work here as well when 'other' people are getting more benefits than you. I'm sure part of it xenophobic, but part of it is actually legitimate. For example, a bad accident left my credit ruined in my early 20s due to medical bills. I do remember, several times, waiting in agonizing pain in an emergency room full of people who could not even speak English. Essentially, the reason my bills were so high was because the hospital was allowed to recoup the nonpayers' bills by upping mine. It would cost the average taxpaying couple tens of thousands of dollars to have a child in the US. So we have declining birthrates amongst educated people. In contrast, undocumented (illegal, whatever) purposefully come to the US to have an anchor baby. Those playing by the rules pick up the tab. This can rub even the most socially progressives the wrong way. Same with public education, unemployment benefits, and social security. I think that you are going to see many social services cut, and move towards the US style, in places like Canada, Western Europe, and Australia as more and more immigration creates a less homogeneous population. The fact that many immigrants purposefully head to the nations like Sweden and Germany with the most generous social systems shows that the end results will not be good for the native population.
jimbokun 10y ago
I do not have an ideological bent towards having a public health care system. But what this article indirectly points out, is the sheer, utter incompetency of US health care providers. The whole justification for a private system is supposed to be greater efficiency. In many markets, for whatever reason, this seems to work. Goods became cheaper and better due to competition, the invisible hand, etc. etc. "My cousin was triaged immediately. Within two minutes a nurse checked her ankle, gave her codeine, and then sent her off to an urgent care clinic. She wasn’t even registered in the ER." "The urgent care clinic had a few people ahead of us. It took about 10 minutes to check in and then no more than 15 minutes to be seen. A lovely nurse named Leslie triaged my cousin and agreed an x-ray was in order and made the arrangements. My cousin did not need to see a doctor or a nurse practitioner to get an x-ray. I’m not sure I’ve ever seen that happen in the U.S." "The nursing triage was wonderful and actually doing nursing (I hate seeing nurses relegated to charting)." In our wonderful US free market system, we have very highly trained professionals spending staggering amounts of their time on bureaucratic paper work and busy work, while the NHS just skips straight to treating patients efficiently and professionally. With a system this bad, people at every level of the health care industry should be getting fired every day for their gross incompetency. From the insurance companies to the health care executives to the health care professionals, they simply suck at their jobs and need to be held accountable. If a public system can deliver the benefits in reality that a private system is supposed to deliver in theory, let's go with the public system. Which is very near the top of my list with annoyances with the Republican party, by the way. They are so obsessed with the theory and ideal of private market capitalism, they don't care to observe whether their theory matches up with reality.
- jrnichols 10y ago
  "My cousin did not need to see a doctor or a nurse practitioner to get an x-ray. I’m not sure I’ve ever seen that happen in the U.S." I've had a few internet discussions with this particular doctor before and what I've learned is that she's used to things in California because what she describes above is definitely something that I've seen and experienced in the US. Kid fell off bike. We went to ER. Doc & tech met us in triage. Went right back to x-ray. We were in and out of the ER with imaging taken care of in less than 90 minutes. Also, being punted to urgent care isn't always a good thing. This is how Kaiser missed a damaged disc in my lower spine. They had a habit of turfing me to urgent care and brushing it off as sciatica. It was when I moved to Texas that a Baylor ER did an MRI, revealing the true source of the problem, and was shocked that in all the years before, nobody had ever done that. Health care systems aren't identical in every state, as I've found out the hard way. "The nursing triage was wonderful and actually doing nursing" This might be another reason things are so expensive. Not every single aspect of emergency department care needs a full blown RN to take care of it. But when attempts by other levels of provider (LVN, LPN, EMT-Paramedic) are made, nursing unions come in like a hawk and lobby to crush whatever efforts are being made. It's frustrating to see happen.
caseysoftware 10y ago
> Canada does it, so it demonstrably does work in North America, Europe does it, with varying degrees of efficiency, but it basically works. Without going into the politics, size and population/density are two major differences: - Canada has about 10% of the population of the US with much of it clustered around a handful of major cities so the vast majority of citizens can be covered by having good systems in a handful of places. - Compared to Europe, the difference is even more striking. Just considering Texas: it is roughly the size of France but with half the population despite having 3 of the top 10 biggest US cities. And that's still not even 10% of the US population. Whatever approach is tried in the US needs to take these differences into account.
- raverbashing 10y ago
  There's no secret to solving this problem, and it works basically the same way everywhere Yes, in France you might be 1h/2h by car from a hospital depending on what you need You have a tiered system: 1st level is "everyday stuff", 2nd level is regional centers (so you get routine surgeries and more complex stuff), and at the 3rd level you got your excellence centers for specialized stuff (think transplants, major surgeries, etc) In the US case yes, you might want to have a 3rd level center per state (might not be exaustive)
  - apathy 10y ago
    Per state? Try per region. My department serves a tertiary referral facility and there's another one across town. Of course, "town" is 18 million people, but you get the idea. I guess I could see having one tertiary center to serve say VT and NH but if memory serves even they have one apiece.
- philwelch 10y ago
  The US "free market" health care system doesn't fix this. Outlying areas still have shitty hospitals and major cities still have world-class hospitals clustered together. If you're too sick for your local small town hospital they pop you in an ambulance and take you to the city. Texas might be "roughly the size of France" but a huge chunk of that is uninhabited desert.
jimbokun 10y ago
One more comment on the political side: Note the Bernie phenomenon in the current election. He pulled the entire Democratic party to the left, including public provision of health care. Also note, if current polls are a good indicator, Trump and the Republicans could be headed towards an historic drubbing on election day. And Bernie drew overwhelming support from young people. So I think that politically, the US may very well be moving towards supporting public health care.
- verbify 10y ago
  If the polls are any indication, Trump is heading for a drubbing, and the Senate might go to the Democrats, but I very much doubt they'll win the House (the House favours Republicans for a variety of reasons, but you almost certainly won't get single payer with a Republican House).
pests 10y ago
No local government in America is required to provide anything more than K12 education. Many rural areas toy have to pay for fire or police.

refurb 10y ago

Because it's worked pretty well for Medicare and Medicaid? Large portions of both were privatized through Medicare Advantage and Managed Medicaid. The gov't pays private companies a flat rate per patient who selects their plan. A majority of Medicare coverage is provided through private companies (100% for the drug benefit). Last I saw 80%+ of Medicaid patients are covered by a private plan. What are the benfits? The private companies take on the risk. If the lump sum the gov't gives them isn't enough to cover costs, tough, the company takes a loss. Gov't loves it as it makes budgeting easy. The other benefit is choice. A patient can select from a multitude of plans that benefit them the most. Want a top doctor? Pick a plan where his/her hospital is in network. Have a chronic disease where you take a lot of meds chronically? Pick a plan with better drug benefits. Medicare Part D - the drug benefit created in 2005 that is entirely private - came in dramatically under cost forecasts.

chimeracoder 10y ago
> Because it's worked pretty well for Medicare and Medicaid? Large portions of both were privatized through Medicare Advantage and Managed Medicaid. The gov't pays private companies a flat rate per patient who selects their plan. Yeah, Original Medicare is pretty awful - I wouldn't recommend it to anyone who's able to get a Medicare Advantage plan. It's not just the cost-of-care and the overall expense to the patient (even though Medicare Advantage tends to win out on both of those aspects as well). It's that Original Medicare is a horribly frustrating experience for the patient as well. Of course, most people (especially most people under the age of 65) don't understand the difference, and when they think about Medicare, they think of a publicly-run program, even though around 40% of the Medicare population is on a Medicare Advantage plan.

codegeek 10y ago

You have a point. But Americans generally are not convinced that a Govt. provided healthcare (paid through taxes) is the right solution. I personally don't have a problem with that as long as the main problem of "fear" is resolved. Whatever it takes. The problem is that we are not able to get out of the whole "insurance-company-being-the-middleman-in-everything" business.

thesimon 10y ago

>Why do Americans not look at public provision, paid for via your tax system? Because raising taxes is bad, obviously one day you'll be big and don't want to pay health care for all the people down there. And of course it's a slippery slope. Today it's health care, tomorrow it's minimum wage and the day after you find yourself in a Gulag /s Just look at how hard republican states tried to push against Medicaid.

darkhorn 10y ago
You mean that the European Union is heading to Gulags?
- maxxxxx 10y ago
  He is being facetious.
  - pjc50 10y ago
    Yes, but some US politicians have literally tried to argue that way ("death panels " etc)

k-mcgrady 10y ago

>> "I don't understand the American (and it is American) obsession with having a free market in healthcare." I think part of it is the culture of believing you can be anything you want to be. It's the same reason the poor often vote against their interests in the US - they believe that soon they'll be rich and want low taxes and few regulations. That they are the exception.

refurb 10y ago
If you want those people to change how they vote you need to stop talking down to them. "Hey stupid! You're voting for people that hurt you." Or then again, maybe they just have a different opinion than you on what is important to them?
- gonvaled 10y ago
  Surely nobody can be tricked onto supporting positions contrary to his interests. That would be impossible, since people are rational, educated and perfectly informed. There is a minority of people who are actually completely out of touch with reality, so-called demagogues and populists, and to a less extent all politians: they are completely deluded in thinking that by repeating a point a thousand times they can mislead those perfectly informed masses.
- enraged_camel 10y ago
  If someone continuously keeps getting tricked into voting against their own self-interests, with the belief that their vote will actually benefit them, then yes, they absolutely deserve contempt. As the saying goes: "Fool me once, shame on you. Fool me twice, shame on me." A large part of the American populace has been getting fooled repeatedly for decades.
  - mindcrime 10y ago
    If someone continuously keeps getting tricked into voting against their own self-interests It has not been established that they are voting against their own self-interests. You are just assuming you know what their interests are better than they do.

rdtsc 10y ago

Reasons are historic and idelogical. A free market is considered sort of a religion here. In other words we don't usually evaluate and consider things based on their own merit (what is the best way to provide healthcare, what is the best way to fix infrastructure, like bridges, etc), but rather how will this make free market happy. We treat it as sort of a deity and if we don't abide by its likes we'll be severely punished.

milcron 10y ago
Reminds me of this interesting wiki article, "American Civil Religion" https://en.wikipedia.org/wiki/American_civil_religion https://en.wikipedia.org/wiki/American_civil_religion
- rdtsc 10y ago
  Or brilliant. That explains exactly how I understand it. Didn't know the phenomena had a name associated with it.
- maxxxxx 10y ago
  This article is great. It explains the reverence for the constitution and the founding fathers.
_superposition_ 10y ago
The healthcare "market" is anything but free. From insurance companies, negotiated prices, all the way down to the AMA limiting the supply of doctors and all the other things they do to keep prices high. It seems the only thing free about it is the freedom to get screwed over. So in those terms, I'm not sure what sort of diety it is that we're worshipping.
- rdtsc 10y ago
  > The healthcare "market" is anything but free. It is "free" in the propaganda domain. That it is sold to the voters as "free, therefore efficient and better than government controlled"

hibikir 10y ago

I Lived in Spain for a couple of decades, and I much prefer their government run hospitals to the way the US works. However, I do not believe that the US could just flip a switch and go to a public hospital system, so I would be happy with a more transparent, more competitive hospital system. The question here is not what system to create in a vacuum, but the road in the middle. I live surrounded by a whole lot of ultra-expensive, luxurious hospitals, staffed by extremely well paid professionals (and not so well paid residents), which, in many cases, have six figures worth of debt for the privilege. To move to a public system, all of those things would have to change: Those luxurious, privately owned hospitals are never going to give great prices to a single payer system. The doctors are not going to be happy with lower wages. Medical schools would have to change drastically, so they can actually provide a number of doctors that resembles the rest of the western world. This level of disruption is what makes major changes like that in a system that employs so many people unpopular: It's a bit like how the US military can't take big cuts, as they are political suicide. So overall, the change would be huge, and would be hard to make slowly. Therefore, I'd much rather solve it in the US through markets. Once the system has a whole lot less rent seeking behaviors, and the incentives are better aligned, a public option would actually be easier than from the catastrophe we live on now, where prices are secret, and yet, a hospitalization will often involve 10 to 20% coinsurance.

cylinder 10y ago
You do a public system for all and then a private system for whomever wants to buy in. You incentivize the private option by levying a tax on those in upper incomes who do not buy private health cover. This is the Australian system and it's the most reasonable option for the US but I guess in America we can never admit to looking to other countries and have to pretend nobody else has figured out healthcare.
- aianus 10y ago
  Wouldn't all of the best doctors only treat rich people? Why would you expect them to do the same work for less money over at the public hospital?

BurningFrog 10y ago

> Why do Americans not look at public provision, paid for via your tax system? Canada does it, so it demonstrably does work in North America, Europe does it, with varying degrees of efficiency, but it basically works. This article presents a good argument for why Single Payer won't work well in the US: https://www.bloomberg.com/view/articles/2014-04-30/single-payer-would-make-health-care-worse https://www.bloomberg.com/view/articles/2014-04-30/single-pa... > Americans are happy to send their children to school Americans are, on average not happy to send their children to public schools

jimbokun 10y ago
That was a great analysis from Bloomberg, thanks for the link.
- massysett 10y ago
  Look through all her articles, she writes a lot about US healthcare policy, generally with a skeptical eye toward recent legislative efforts.
keypusher 10y ago
Why are the vast majority of US children enrolled in public school if their parents are so unhappy about it?
- splintercell 10y ago
  Because they have no other option. One of the reasons why Americans are so vehemently against Universal Healthcare because once you go there, you don't easily get to come back. Once govt starts to provide a certain service, it kills the private sector market for that. Then no matter how terrible govt service is, there isn't much which can be done about it.

Kalium 10y ago

It should also be remembered that various levels of the American government have a record with public provision that is at best mixed. Walter Reed, anyone? Psychiatric institutions in the 80s and before? When you have a distressingly high chance of getting a terrible system, you wind up somewhat skeptical of people who want to tear down what's already in place and do public provisioning. Good and pure intentions are not an adequate substitute for competence.

jimbokun 10y ago
Of course, you cannot seriously associate "competence" with the current US free market healthcare system.
- Kalium 10y ago
  Depends a great deal on one's definition of "competent". If you define it by outcomes for those with access to service, it does reasonably well. If you define it by access to service, it does poorly. The fear is that a system that works for some will be replaced by system that everyone can access but works for nobody.

hiram112 10y ago

The US has far more diversity than most of the Western European nations, though this is obviously changing. Socialism really doesn't work here as well when 'other' people are getting more benefits than you. I'm sure part of it xenophobic, but part of it is actually legitimate. For example, a bad accident left my credit ruined in my early 20s due to medical bills. I do remember, several times, waiting in agonizing pain in an emergency room full of people who could not even speak English. Essentially, the reason my bills were so high was because the hospital was allowed to recoup the nonpayers' bills by upping mine. It would cost the average taxpaying couple tens of thousands of dollars to have a child in the US. So we have declining birthrates amongst educated people. In contrast, undocumented (illegal, whatever) purposefully come to the US to have an anchor baby. Those playing by the rules pick up the tab. This can rub even the most socially progressives the wrong way. Same with public education, unemployment benefits, and social security. I think that you are going to see many social services cut, and move towards the US style, in places like Canada, Western Europe, and Australia as more and more immigration creates a less homogeneous population. The fact that many immigrants purposefully head to the nations like Sweden and Germany with the most generous social systems shows that the end results will not be good for the native population.

jimbokun 10y ago

I do not have an ideological bent towards having a public health care system. But what this article indirectly points out, is the sheer, utter incompetency of US health care providers. The whole justification for a private system is supposed to be greater efficiency. In many markets, for whatever reason, this seems to work. Goods became cheaper and better due to competition, the invisible hand, etc. etc. "My cousin was triaged immediately. Within two minutes a nurse checked her ankle, gave her codeine, and then sent her off to an urgent care clinic. She wasn’t even registered in the ER." "The urgent care clinic had a few people ahead of us. It took about 10 minutes to check in and then no more than 15 minutes to be seen. A lovely nurse named Leslie triaged my cousin and agreed an x-ray was in order and made the arrangements. My cousin did not need to see a doctor or a nurse practitioner to get an x-ray. I’m not sure I’ve ever seen that happen in the U.S." "The nursing triage was wonderful and actually doing nursing (I hate seeing nurses relegated to charting)." In our wonderful US free market system, we have very highly trained professionals spending staggering amounts of their time on bureaucratic paper work and busy work, while the NHS just skips straight to treating patients efficiently and professionally. With a system this bad, people at every level of the health care industry should be getting fired every day for their gross incompetency. From the insurance companies to the health care executives to the health care professionals, they simply suck at their jobs and need to be held accountable. If a public system can deliver the benefits in reality that a private system is supposed to deliver in theory, let's go with the public system. Which is very near the top of my list with annoyances with the Republican party, by the way. They are so obsessed with the theory and ideal of private market capitalism, they don't care to observe whether their theory matches up with reality.

jrnichols 10y ago
"My cousin did not need to see a doctor or a nurse practitioner to get an x-ray. I’m not sure I’ve ever seen that happen in the U.S." I've had a few internet discussions with this particular doctor before and what I've learned is that she's used to things in California because what she describes above is definitely something that I've seen and experienced in the US. Kid fell off bike. We went to ER. Doc & tech met us in triage. Went right back to x-ray. We were in and out of the ER with imaging taken care of in less than 90 minutes. Also, being punted to urgent care isn't always a good thing. This is how Kaiser missed a damaged disc in my lower spine. They had a habit of turfing me to urgent care and brushing it off as sciatica. It was when I moved to Texas that a Baylor ER did an MRI, revealing the true source of the problem, and was shocked that in all the years before, nobody had ever done that. Health care systems aren't identical in every state, as I've found out the hard way. "The nursing triage was wonderful and actually doing nursing" This might be another reason things are so expensive. Not every single aspect of emergency department care needs a full blown RN to take care of it. But when attempts by other levels of provider (LVN, LPN, EMT-Paramedic) are made, nursing unions come in like a hawk and lobby to crush whatever efforts are being made. It's frustrating to see happen.

caseysoftware 10y ago

> Canada does it, so it demonstrably does work in North America, Europe does it, with varying degrees of efficiency, but it basically works. Without going into the politics, size and population/density are two major differences: - Canada has about 10% of the population of the US with much of it clustered around a handful of major cities so the vast majority of citizens can be covered by having good systems in a handful of places. - Compared to Europe, the difference is even more striking. Just considering Texas: it is roughly the size of France but with half the population despite having 3 of the top 10 biggest US cities. And that's still not even 10% of the US population. Whatever approach is tried in the US needs to take these differences into account.

raverbashing 10y ago
There's no secret to solving this problem, and it works basically the same way everywhere Yes, in France you might be 1h/2h by car from a hospital depending on what you need You have a tiered system: 1st level is "everyday stuff", 2nd level is regional centers (so you get routine surgeries and more complex stuff), and at the 3rd level you got your excellence centers for specialized stuff (think transplants, major surgeries, etc) In the US case yes, you might want to have a 3rd level center per state (might not be exaustive)
- apathy 10y ago
  Per state? Try per region. My department serves a tertiary referral facility and there's another one across town. Of course, "town" is 18 million people, but you get the idea. I guess I could see having one tertiary center to serve say VT and NH but if memory serves even they have one apiece.
philwelch 10y ago
The US "free market" health care system doesn't fix this. Outlying areas still have shitty hospitals and major cities still have world-class hospitals clustered together. If you're too sick for your local small town hospital they pop you in an ambulance and take you to the city. Texas might be "roughly the size of France" but a huge chunk of that is uninhabited desert.

jimbokun 10y ago

One more comment on the political side: Note the Bernie phenomenon in the current election. He pulled the entire Democratic party to the left, including public provision of health care. Also note, if current polls are a good indicator, Trump and the Republicans could be headed towards an historic drubbing on election day. And Bernie drew overwhelming support from young people. So I think that politically, the US may very well be moving towards supporting public health care.

verbify 10y ago
If the polls are any indication, Trump is heading for a drubbing, and the Senate might go to the Democrats, but I very much doubt they'll win the House (the House favours Republicans for a variety of reasons, but you almost certainly won't get single payer with a Republican House).

pests 10y ago

No local government in America is required to provide anything more than K12 education. Many rural areas toy have to pay for fire or police.