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The Economies With the Most and Least Efficient Health Care
- maxxxxx 8y agoMy favorite topic. And as always in the US there will be a lot of fingerpointing and no action....
- frockington 8y agoAs much as dissapointment the Affordable Care Act was, at least someone tried something. If only we could learn from those mistakes and make incremental changes. Politicians are to obsessed with either tearing it all down or healthcare for all for "free", no middle ground
- stephengillie 8y agoWe have a single-payer system - Medicare. ACA is just a jobs program for the insurance industry, perpetuating 2 types of bullshit jobs: medical billing and medical underwriting.
- nradov 8y agoMedical "insurance" companies actually don't do much underwriting any more. Most policies are self insured by large employers. The insurance company just manages the provider network and administers claims. Even medical billing is gradually going away with the shift to value-based care and accountable care organizations (ACOs).
- Frondo 8y agoNot free and no one's saying that. Free at point of service, like the NHS or the Canadian health care system, yes, but obviously everyone knows we'd pay for it with taxes. We could just do it, cover everyone, for less than we're paying now, by rejiggering the system under a "medicare for all" banner. There aren't any other serious options on the table. (replace and repeal, or whatever, is not a serious option.)
- ssambros 8y agoMedicare currently pays less than what it costs to provide for a lot of services. And providers are either declining medicare alltogether or recouping the missing funds from the other patients. Where would all those other patients come from if medicare will be "for all"?
- maxxxxx 8y ago"Medicare currently pays less than what it costs to provide for a lot of services" Is that even true? Personally I have my doubts.
- ssambros 8y agoAmerican Hospital Association: Underpayment by Medicare and Medicaid Fact Sheet, December 2017 Update [0] FINDINGS In the aggregate, both Medicare and Medicaid payments fell below costs in 2016: - Combined underpayments were $68.8 billion in 2016. This includes a shortfall of $48.8 billion for Medicare and $20.0 billion for Medicaid. -For Medicare, hospitals received payment of only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2016. - For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals caring for Medicaid patients in 2016. - In 2016, 66 percent of hospitals received Medicare payments less than cost, while 61 percent of hospitals received Medicaid payments less than cost. [0] https://www.aha.org/data-insights/2018-01-03-underpayment-medicare-and-medicaid-fact-sheet-december-2017-update https://www.aha.org/data-insights/2018-01-03-underpayment-me...
- maxxxxx 8y agoAfter having dealt with billing from hospitals for services they never delivered or obscenely overpriced I am inclined not to trust them on statements about their actual cost. In my view the billing practices of most hospitals are very dishonest and intentionally confusing and opaque.
- 8y ago
- ahoy 8y agoThe ACA was the middle ground and it's still bad.
- frockington 8y agoI agree with you, I'm saying we should learn from the mistakes and iterate on the current instead of fighting for extremes that will never work or be passed
- maxxxxx 8y agoOne thing the Republicans could have done was to iterate on Obamacare instead of trying to repeal it for 8 years and now that they are in power they show that they have no ideas and no interest in improving anything.
- rectang 8y agoWhile I think there's something to your point here, I wish for the sake of avoiding flamewars per the HN guidelines you could put it in less partisan terms. (For example by avoiding naming specific political parties.) I would have liked to see more experimentation on price transparency.
- maxxxxx 8y agoTotally agree about price transparency. Everybody but the people in the medical system who benefit from opaque pricing should be able to agree with this. I don't think my comment was partisan but it was a description of the last 10 years. Republicans voted to repeal Obamacare several times a year but never introduced anything for improving it. And now that they are in power they seem have no idea how to proceed. I am not saying that Obamacare was a good law. Actually it was pretty half assed but it could probably be made to work with some changes. I would have loved it opponents of it would have introduced steps for improvement but they never did.
- rectang 8y ago
- cmurf 8y agoPPACA is the incremental change. There wasn't the political capital to effectively destroy the health insurance industry by leaving only VIP insurance (really it's not insurance, it's a "pay extra to cut in front of the line" product). Democrats apparently didn't have the votes to even make Medicare or Medicaid an optional buy-in, to compete with marketplace insurance. This in particular is necessary in a huge land area of the U.S. where there's only one or two insurance providers.
- masonic 8y agoDemocrats apparently didn't have the votes Democrats had the only votes and the only say in every element of "Obamacare". Republicans were not even allowed to see the bill before the vote was taken, hence zero Republicans voting for it.
- dragonwriter 8y ago> Democrats had the only votes and the only say in every element of "Obamacare". That's not actually true (Republicans had a significant say, even though thet universally ended up voting no), but even if it was the public option had long been controversial among Democratic politicians despite it (and even moreso simple single payer, which had a majority support ) long being overwhelmingly popular among Democrstic voters and having stronger support nationally than the purchase mandate w/o public option approach. > Republicans were not even allowed to see the bill before the vote was taken, Yeah, they were, they were also involved in the Committee process in the Senate in which it was drafted. They also filibustered it for quite a while, which gave them even more time in which to read it. And of course Republicans in the House had still more time to read it, since it was voted on in the House after the vote in the Senate. There are lots of reasons you can argue might have been behind Republicans voting against, not being allowed to read it is not one of them.
- fifnir 8y agoAnd lots of explaining about how nationalized healthcare is actually a bad idea, nevermind all the examples to the contrary.
- claydavisss 8y agoWhy? In the US, if you can pay, you get better care than anywhere in the world. The question is, can you pay?
- En_gr_Student 8y agoIn the US, if you can pay, you pay more for the same or poorer care. You don't get the best anymore. It is shown elsewhere, not in this article. Obamacare killed the US as a medical mega-power. Economics 101: if you force the same prices for a much larger demand, then either the product sells out, or the service is watered down.
- TomMarius 8y agoIt still costs less than my European healthcare tax, and the standard is still higher. It's cheap only for people with the lowest income.
- maxxxxx 8y agoThe US system is only "cheap" if you don't have any major medical issues. Once you get sick there is a good chance that copays, out of network bills and other charges will bankrupt you.
- TomMarius 8y agoFrom my own research, this is not true - the US system is a little bit cheaper for an average software engineer, with much higher quality. We have to co-pay things in Europe as well; only basic ("medically necessary") care is free and of course you have to wait, sometimes years, and I'm not even speaking about the quality. E.g. my braces were more expensive than in the USA, in absolute money, not relative! And don't forget that a public system carries zero accountability of anyone ("you know, that's just how it is" is a perfectly acceptable argument here - even if you're paying out of pocket, even if someone died).
- 8y ago
- Fernicia 8y agoThe methodology here is not good. All they're doing is comparing average health care cost vs life expectancy. They don't measure standard of care, accessibility of treatment, etc. This is especially important when looking at end-of-life care, which I speculate affects these both of these metrics the most. A hospice with private rooms, friendly staff, and social engagement will score lower than a hospital that keeps someone alive in a coma.
- billsmithaustin 8y agoIf I were considering running for President in 2020, and I owned a large media company, I might publish articles like this, too. That aside, you can't tie all of life expectancy to health care. For example, diet, life style, genetics, and environment are all factors too.
- cuboidGoat 8y agoThe vast majority of the large scale increase in human lifespan you can put down to improvements in medical knowledge. People used to get their teeth knocked out and replaced with wooden ones as a wedding present, the idea being that the lucky couple would then have less risk of being killed by a tooth infection before the age of 40, as was common.
- caf 8y agoYou would have to keep a heck of a lot of people in comas for a heck of a long time to be able to move the needle on life expectancy by several years.
- cuboidGoat 8y agoCould you indicate which health care systems you think are skewing the results in this manner? As it would seem to require keeping large numbers of the very elderly alive in comas while also not providing widespread elderly care, which seems an unlikely policy to pursue.
- nabla9 8y agoBloomberg analysis gives one point of view. OECD has published data where you can compares 5-year survival rates after major cancers, heart attack 30-day survival after hospitalization, stroke, ischemic stroke etc. They also keep track of infant mortality, maternal mortality etc. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT# http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT# Data shows that Japan, South Korea, Israel and Nordics are have the best healthcare quality using these measures. US is often in top 10, or at least mid-tier. Beast cancer is treated very well in US. But what is wrong with the US and infant mortality and perinatal mortality? How can the US be so low?
- triviatise 8y agolife expectancy is a bad measure of healthcare effectiveness 1) infant mortality heavily impacts life expectancy. The us has a few subpopulations that have very high infant mortality regardless of socioeconomic status. 2) The us has a high teen murder rate 3) The US has very high levels of obesity 4) There is a tremendous genetic component to life expectancy. Some sub populations (asians) have very high life expectancy, their home countries reflect that. Little dogs for example can live 20 years, where large breeds die at 15. If you pull out 1 and 2, we are up there with other euro nations. Better measures are things like life expectancy after <pick an age where you think we start needing lots of healthcare> The sad thing is that the people who are experts in this know these things, but still push the narrative that it is our medical system.
- merpnderp 8y agoYou're absolutely right, this is the golden age of yellow journalism. Especially when the person who owns the magazine is about to run for president.
- terrywilcox 8y agoSo if you simply eliminate some of America's health care problems, America is like other nations? That's convenient.
- jlavine 8y agoThe above commenter mentioned demographic and lifestyle discrepancies not adequately accounted for in this comparison of outcomes among countries... not health care problems, as you're implying.
- terrywilcox 8y agoAn infant mortality rate far above other first world nations isn't a health care problem? We're talking about kids too young to be be gunned down, so they're not part of America's remarkable teen-gun-death statistics. They're predominantly kids from poor families, who don't live healthy lifestyles or have good health insurance. If the family doesn't have access to good healthcare, the kid's chances of survival are lessened. Maybe Russia could improve its placement on the list if they ignored the health care issues caused by alcoholism. And then America could improve its position by declaring obesity, and the health problems that come with it, a lifestyle issue instead of a health issue.
- oriol16 8y agoEnslaving the population of doctors would improve the index, since it reduces salaries drastically. Halfway between slavery and market wages is where you find Spain.
- jasonlotito 8y agoI always look at these types of reports, and it makes me laugh. It doesn't tell the whole story, and it doesn't tell the true story. We left Canada precisely because of its healthcare system and came to the US. Canada would have require substantially more out of pocket (10s of thousands) with a much longer wait (years), whereas in the US, the out-of-pocket was substantially less ($500) and substantially less time (-2 weeks) to receive assistance. And that was without using insurance from my job.
- jasonlotito 8y agoI hate meta comments, but I love how posting facts gets voted down here just because people don't like the facts. That's why autism support in Canada is a shit-show.
- bitxbit 8y agoYou look at the list of most efficient health care systems across the globe and they are not nearly as large as the US. They are typically small and homogeneous. I like the concept of single payor in the US but I do see big hurdles even if we get through the politics which is a big if. I'd point to heterogeneous population and a very wide range of care quality across the country and sometimes even within MSAs.
- NeedMoreTea 8y agoYou look at any list of anything across the globe relating to countries and they are not nearly as large as the US. For the very simple reason that most countries are smaller and more homogeneous than the US, so I don't think it really proves a lot. Unless you're suggesting US only compare itself to Russia and China in future?
- georgeecollins 8y agoChina is number twenty and climbing. People in China could say it is not fair to compare health care in China to the US because the China is four times as big, but I have never heard that.