5 ms·

This is one of those nice ideas that has some pretty serious hidden costs. You’d struggle to compare healthcare in the US to other countries, because the qualit

This is one of those nice ideas that has some pretty serious hidden costs. You’d struggle to compare healthcare in the US to other countries, because the quality of healthcare available (talking about availability, not accessibility) in the US is generally superior to other countries. So you could end up simply eroding the quality of care in the US. Another thing people tend not to talk about when discussing healthcare in the US is how much the US contributes to medical research and innovation. No other nation on earth even comes close. If you adjust the system so much that you remove the incentive to carry out that research, then the quality of care in literally the entire world would suffer.

cazum 8y ago
You're implying that both the quality of care and the amount of medical research done is a result of the profits of the medical companies. I'm not sure that this is the case.
- AmericanChopper 8y ago
  Profit is the only thing that drives investment in care and research. You’re asserting that you can reduce profits via price fixing and still deliver the same outcomes in both care and research.
  - eecc 8y ago
    Whose profit? If you refer to the professionals’ compensations that’s correct, but not that useful as it applies to all of the adult working population. If you’re referring to the capital accumulation of investments in healthcare companies, you’re off the mark, as there are several examples that falsify your statement, even in the US
  - grey-area 8y ago
    Profit is the only thing that drives investment in care and research This is manifestly untrue in so many domains, including medicine. Most research is heavily government funded, particularly pure research, and most academics are not interested in profit. The only orgs motivated by profit (drug companies, insurance companies) are the ones who push this misconception, because they profit from it. As one example, the UK runs large trials comstantly to improve care, without a profit motive. Nobody has to postulate that price fixing (as you call it), or single payer healthcare without insurers works better, because the rest of the developed world outside the US uses that system and delivers very similar outcomes for radically lower cost. The facts are clear.
intralizee 8y ago
I disagree from personal experience. Location of where you are in the US matters. I'm in Montreal right now and the mental healthcare here is superior than what I experienced in the US in Michigan (majority of my life). I would even go as far to write the mental healthcare in USA, which I received ruined my life. If only I had the pleasure of what is available in Canada for my whole life.
- trevyn 8y ago
  The further toward the poles you go, the more mental healthcare is needed, so it makes sense they would have the experience and infrastructure! (Completely serious.)
  - intralizee 8y ago
    This isn't necessarily the case with my situation. There was only one hospital for where I lived in Marquette, Michigan. My mental healthcare was pertaining to gender dysphoria and not depression which I think you're associating with longer winters. Anyway place I grew up was filled with religious nuts to make things short. They forcibly prescribed me with antipsychotics while ignoring my right & modern medical approach of gender dysphoria. Montreal is a large city compared to that place and is progressive like California. So basically where you're located when it comes to social structure is huge.
    - refurb 8y ago
      I think small rural town versus major metro center has more to do with the quality than US vs Canada. It’s no different in Canada - small towns don’t offer as good of care particularly when it’s something that’s not common.
  - TheSpiceIsLife 8y ago
    I think I might have heard this at some point in the past. Anyway, I found a reference to support your claim: Also consistent with the conclusions of Torrey1 and Saha et al,2 our analyses shown in table 3 found a strong tendency for prevalence to increase with latitude.[1] 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669590/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669590/
mikeash 8y ago
Medical research in the US comes out to something like $500/year per capita. It’s doesn't come anywhere close to accounting for the cost differences between the US and other first-world countries.
- AmericanChopper 8y ago
  I didn’t say research alone did. I said that when you compare investment in research, as well as the quality of care, you’d expect the cost of healthcare in the US to be higher. As much higher as they are? I don’t think so. But if you want to fix the accessibility issues without impacting innovation and quality of care, then you’re going to need a solution slightly more thought out than hamfisted price fixing.
  - DanBC 8y ago
    > as well as the quality of care, you’d expect the cost of healthcare in the US to be higher If the quality of care is so amazing I'd expect Americans to have longer life expectancy, and they don't.
    - eitally 8y ago
      As a parent poster noted, the system is optimized to provide amazing care for the people who can afford it ... and those people do have longer life expectancy. https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality https://www.vox.com/science-and-health/2018/1/9/16860994/lif...
torgian 8y ago
I disagree about quality/availability. In Japan, Taiwan, Mainland China, Thailand; I’ve had amazing health care for the fraction of the price. Shit, a full cancer check only cost me 90 dollars in Japan. Getting my eyes fully checked for retinal tears cost me nothing due to national insurance in China. In some cases, maybe the US has better care. But the cost of that is just way too damn high. Yes, medical research in the US is superior, but that shouldn’t be at the cost of peoples’ lives.
- AmericanChopper 8y ago
  In the developed world, the price of routine checkups are not what people would generally be referring to when discussing _quality_ of healthcare. Generally speaking, the US has the best facilities, technology, expertise and pharmaceuticals available. Which is why people come from all over the world for procedures that simply aren’t available elsewhere. Again, I’m not talking about the problems with accessibility, merely talking about available treatments. Reducing investment in medical research will absolutely come at the cost of people’s lives. More people’s infact, as anybody will die from a terminal illness that doesn’t have a treatment. As an example the US market constitutes something life 70% of _global_ pharmaceutical profits.
  - lostlogin 8y ago
    This weird argument pops up regularly. In relation to New Zealand (where I am) it’s argued that the US is subsidising the cost of drug scripts. It’s beyond me quite how NZs drug buying agency is running roughshod over the rights of drug companies that have multiple insurance companies in the US that are bigger customers. What’s the agenda behind this argument?
    - AmericanChopper 8y ago
      There’s no agenda behind it at all. If profits in the US market go down, they either have to go up elsewhere, or investment has to go down to match. This is very basic maths.
mirimir 8y ago
In my experience, Russia had a decent healthcare system in the Soviet era. Care was (obviously, I guess) pretty much free. Most physicians were female. And most of them were apparently driven by moral conviction. The US was rather a shock for me. Costs were mind-boggling, and most physicians struck me as jerks. At least, the male ones did, and they predominated. Nurses, on the other hand, generally seemed OK. Somehow the US healthcare system seems to attract jerks for physicians, and they seem to be mostly in it for the money. Not all of them, obviously. But enough to set the standard. I have no clue how that happened. Or how to reverse it. Edit: Some might ask why being "in it for the money" is bad. I mean, that's what "free enterprise" is about, isn't it? But think about it. Is it OK for priests/minster/rabbis to be "in it for the money"? Or politicians? I hope not. And then, why physicians?
- eitally 8y ago
  This is anecdotal. To counter, my family have had very good overall experience with physicians in the US. Moreover, my college friends who went on to become physicians are all people I'd happily take my own family to see. One of the problems with care in the US are clinics that treat Drs (and NPs and PAs) essentially as billing machines, and don't allow them any time to build any rapport or relationship with patients. Depending on your insurance coverage, your location, and your needs, your experience will vary wildly.
  - mirimir 8y ago
    Yes, it's just my experience. For what it's worth, my experience teaching premeds was also not so great :) That's also anecdotal. But colleagues had similar complaints. Also: > And we fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many. ... A result is that many rural areas, and less popular cities, experience more of a doctor shortage than others. > The other distribution issue is in specialization. When it comes to generalists, we ranked 24th of 28 countries in doctors per 1,000 people. Specialists are a different story. There, we were 11th. This is an important fact about the American health care system. We sometimes hear that we have too many specialists and too few generalists. That’s not necessarily the case. We have an average number of specialists compared with other advanced countries, and even shortages in some specialties. It’s the ratio of specialists to generalists that’s the problem. When you compare the percentage of physicians who are generalists with those who are specialists, the United States beats only Greece among developed economies. > Here, financial drivers play a role. Doctors who choose to specialize can make much more money, millions more dollars over a career, than primary care physicians. https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-lets-take-a-closer-look.html https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-... Also see https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557 https://www.politico.com/agenda/story/2017/10/25/doctors-sal...
scarejunba 8y ago
The Indians have better cardiac surgery outcomes. I don't care about anything but outcomes. It's no surprise, though. Their guy has done 150 surgeries in the last year. This guy has done maybe 40. No good. If things are so much better here, why are outcomes not as good? IMR, MMR, even with companies that have comparable or stronger definitions. The evidence is constantly against US healthcare except for experimental or rare treatments. The doctors aren't any worse, surely.
- eitally 8y ago
  At the top end, this will be true. Surely, a well-trained surgeon is a well-trained surgeon and mechanically they should all have roughly equivalent skills. The difference lies in experiential knowledge: knowing what to do whilst in a surgery, based on practical experience and seeing similar patients. We've interviewed four of the top pediatric cardiology centers in the past two months, searching for the best treatment option for our daughter, and only 1 of them has a research focus in the needed area, accompanied by a specific treatment protocol and specifically trained staff. That's not because the other hospitals are "worse". It's a result of our daughter's need being extremely rare, with very low demand. Even the above-mentioned hospital only sees ~1 patient per month (compared to maybe 1 per year or fewer at the other hospitals). I 100% agree: experience is key ... but so is a clinic's/hospital's internal investment in any given speciality. And if it's a teaching/research hospital, so then is publishing by its clinical experts.

cazum 8y ago

You're implying that both the quality of care and the amount of medical research done is a result of the profits of the medical companies. I'm not sure that this is the case.

AmericanChopper 8y ago
Profit is the only thing that drives investment in care and research. You’re asserting that you can reduce profits via price fixing and still deliver the same outcomes in both care and research.
- eecc 8y ago
  Whose profit? If you refer to the professionals’ compensations that’s correct, but not that useful as it applies to all of the adult working population. If you’re referring to the capital accumulation of investments in healthcare companies, you’re off the mark, as there are several examples that falsify your statement, even in the US
- grey-area 8y ago
  Profit is the only thing that drives investment in care and research This is manifestly untrue in so many domains, including medicine. Most research is heavily government funded, particularly pure research, and most academics are not interested in profit. The only orgs motivated by profit (drug companies, insurance companies) are the ones who push this misconception, because they profit from it. As one example, the UK runs large trials comstantly to improve care, without a profit motive. Nobody has to postulate that price fixing (as you call it), or single payer healthcare without insurers works better, because the rest of the developed world outside the US uses that system and delivers very similar outcomes for radically lower cost. The facts are clear.

intralizee 8y ago

I disagree from personal experience. Location of where you are in the US matters. I'm in Montreal right now and the mental healthcare here is superior than what I experienced in the US in Michigan (majority of my life). I would even go as far to write the mental healthcare in USA, which I received ruined my life. If only I had the pleasure of what is available in Canada for my whole life.

trevyn 8y ago
The further toward the poles you go, the more mental healthcare is needed, so it makes sense they would have the experience and infrastructure! (Completely serious.)
- intralizee 8y ago
  This isn't necessarily the case with my situation. There was only one hospital for where I lived in Marquette, Michigan. My mental healthcare was pertaining to gender dysphoria and not depression which I think you're associating with longer winters. Anyway place I grew up was filled with religious nuts to make things short. They forcibly prescribed me with antipsychotics while ignoring my right & modern medical approach of gender dysphoria. Montreal is a large city compared to that place and is progressive like California. So basically where you're located when it comes to social structure is huge.
  - refurb 8y ago
    I think small rural town versus major metro center has more to do with the quality than US vs Canada. It’s no different in Canada - small towns don’t offer as good of care particularly when it’s something that’s not common.
- TheSpiceIsLife 8y ago
  I think I might have heard this at some point in the past. Anyway, I found a reference to support your claim: Also consistent with the conclusions of Torrey1 and Saha et al,2 our analyses shown in table 3 found a strong tendency for prevalence to increase with latitude.[1] 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669590/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669590/

mikeash 8y ago

Medical research in the US comes out to something like $500/year per capita. It’s doesn't come anywhere close to accounting for the cost differences between the US and other first-world countries.

AmericanChopper 8y ago
I didn’t say research alone did. I said that when you compare investment in research, as well as the quality of care, you’d expect the cost of healthcare in the US to be higher. As much higher as they are? I don’t think so. But if you want to fix the accessibility issues without impacting innovation and quality of care, then you’re going to need a solution slightly more thought out than hamfisted price fixing.
- DanBC 8y ago
  > as well as the quality of care, you’d expect the cost of healthcare in the US to be higher If the quality of care is so amazing I'd expect Americans to have longer life expectancy, and they don't.
  - eitally 8y ago
    As a parent poster noted, the system is optimized to provide amazing care for the people who can afford it ... and those people do have longer life expectancy. https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality https://www.vox.com/science-and-health/2018/1/9/16860994/lif...

torgian 8y ago

I disagree about quality/availability. In Japan, Taiwan, Mainland China, Thailand; I’ve had amazing health care for the fraction of the price. Shit, a full cancer check only cost me 90 dollars in Japan. Getting my eyes fully checked for retinal tears cost me nothing due to national insurance in China. In some cases, maybe the US has better care. But the cost of that is just way too damn high. Yes, medical research in the US is superior, but that shouldn’t be at the cost of peoples’ lives.

AmericanChopper 8y ago
In the developed world, the price of routine checkups are not what people would generally be referring to when discussing _quality_ of healthcare. Generally speaking, the US has the best facilities, technology, expertise and pharmaceuticals available. Which is why people come from all over the world for procedures that simply aren’t available elsewhere. Again, I’m not talking about the problems with accessibility, merely talking about available treatments. Reducing investment in medical research will absolutely come at the cost of people’s lives. More people’s infact, as anybody will die from a terminal illness that doesn’t have a treatment. As an example the US market constitutes something life 70% of _global_ pharmaceutical profits.
- lostlogin 8y ago
  This weird argument pops up regularly. In relation to New Zealand (where I am) it’s argued that the US is subsidising the cost of drug scripts. It’s beyond me quite how NZs drug buying agency is running roughshod over the rights of drug companies that have multiple insurance companies in the US that are bigger customers. What’s the agenda behind this argument?
  - AmericanChopper 8y ago
    There’s no agenda behind it at all. If profits in the US market go down, they either have to go up elsewhere, or investment has to go down to match. This is very basic maths.

mirimir 8y ago

In my experience, Russia had a decent healthcare system in the Soviet era. Care was (obviously, I guess) pretty much free. Most physicians were female. And most of them were apparently driven by moral conviction. The US was rather a shock for me. Costs were mind-boggling, and most physicians struck me as jerks. At least, the male ones did, and they predominated. Nurses, on the other hand, generally seemed OK. Somehow the US healthcare system seems to attract jerks for physicians, and they seem to be mostly in it for the money. Not all of them, obviously. But enough to set the standard. I have no clue how that happened. Or how to reverse it. Edit: Some might ask why being "in it for the money" is bad. I mean, that's what "free enterprise" is about, isn't it? But think about it. Is it OK for priests/minster/rabbis to be "in it for the money"? Or politicians? I hope not. And then, why physicians?

eitally 8y ago
This is anecdotal. To counter, my family have had very good overall experience with physicians in the US. Moreover, my college friends who went on to become physicians are all people I'd happily take my own family to see. One of the problems with care in the US are clinics that treat Drs (and NPs and PAs) essentially as billing machines, and don't allow them any time to build any rapport or relationship with patients. Depending on your insurance coverage, your location, and your needs, your experience will vary wildly.
- mirimir 8y ago
  Yes, it's just my experience. For what it's worth, my experience teaching premeds was also not so great :) That's also anecdotal. But colleagues had similar complaints. Also: > And we fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many. ... A result is that many rural areas, and less popular cities, experience more of a doctor shortage than others. > The other distribution issue is in specialization. When it comes to generalists, we ranked 24th of 28 countries in doctors per 1,000 people. Specialists are a different story. There, we were 11th. This is an important fact about the American health care system. We sometimes hear that we have too many specialists and too few generalists. That’s not necessarily the case. We have an average number of specialists compared with other advanced countries, and even shortages in some specialties. It’s the ratio of specialists to generalists that’s the problem. When you compare the percentage of physicians who are generalists with those who are specialists, the United States beats only Greece among developed economies. > Here, financial drivers play a role. Doctors who choose to specialize can make much more money, millions more dollars over a career, than primary care physicians. https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-lets-take-a-closer-look.html https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-... Also see https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557 https://www.politico.com/agenda/story/2017/10/25/doctors-sal...

scarejunba 8y ago

The Indians have better cardiac surgery outcomes. I don't care about anything but outcomes. It's no surprise, though. Their guy has done 150 surgeries in the last year. This guy has done maybe 40. No good. If things are so much better here, why are outcomes not as good? IMR, MMR, even with companies that have comparable or stronger definitions. The evidence is constantly against US healthcare except for experimental or rare treatments. The doctors aren't any worse, surely.

eitally 8y ago
At the top end, this will be true. Surely, a well-trained surgeon is a well-trained surgeon and mechanically they should all have roughly equivalent skills. The difference lies in experiential knowledge: knowing what to do whilst in a surgery, based on practical experience and seeing similar patients. We've interviewed four of the top pediatric cardiology centers in the past two months, searching for the best treatment option for our daughter, and only 1 of them has a research focus in the needed area, accompanied by a specific treatment protocol and specifically trained staff. That's not because the other hospitals are "worse". It's a result of our daughter's need being extremely rare, with very low demand. Even the above-mentioned hospital only sees ~1 patient per month (compared to maybe 1 per year or fewer at the other hospitals). I 100% agree: experience is key ... but so is a clinic's/hospital's internal investment in any given speciality. And if it's a teaching/research hospital, so then is publishing by its clinical experts.