7 ms·

> This is probably also the reason USA is doing so badly. If you're in the bottom quintile, the quality and availability of medical care is awful. I've read se

> This is probably also the reason USA is doing so badly. If you're in the bottom quintile, the quality and availability of medical care is awful. I've read several times that medical outcomes across the board are worse in the US than in European countries with national health systems - i.e. even for the richest, privatised healthcare doesn't work (on average).

bonzini 8y ago
Singapore and Switzerland both have privatized healthcare, but it is extremely regulated at the same time.
- emn13 8y ago
  In a way, that's true of the US too; and various (perhaps most?) european systems have most care provided privately - with whatever regulations apply. The framing of "privatized" vs. government health care is, IMNSHO a holdover from the cold war when everything needed to be as ideologically distinct from USSR as possible. Now, it's just corrosive. This isn't a dichotomy; it's not even really a gradual scale - it's typically a whole host of choices of how to set up those regulations. Presuming in advance that privatization is a good (or bad) thing simply leads to worse outcomes.
  - bonzini 8y ago
    US healthcare is absolutely not regulated on the same level as Swiss or Singaporean healthcare.
    - jeffbax 8y ago
      It is probably regulated in a far more complicated manner. Singapore has forced savings accounts for basic care (out of pocket spending drives costs down), less barriers to entry into the medical profession (thus more doctors at lower wages than the US), less regulation that results in non-competitive hospital and medical practice like in the US. It's far more effective at delivering high quality at low cost due to more market forces. They spend 3% GDP for excellent results vs 16-20 in the US which is a regulatory death by a thousand cuts. Catastrophic care is covered by the government but this is far more efficient than universal systems elsewhere. If you think US Healthcare is a problem of a lack of regulation you don't understand US Healthcare… https://www.google.com/search?hl=en&q=Singapore%20Healthcare%20site%3Amarginalrevolution.com https://www.google.com/search?hl=en&q=Singapore%20Healthcare...
      - bonzini 8y ago
        The problem is not how much is regulated, it is what parts are regulated and whether they really matter. Opaque pricing is definitely an issue in the US, as is over-reliance on medications [1] which is correlated to shitty workers rights. [1] https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...
        emn13 8y ago
        Yeah, it's a complex issue with many interlocking parts. Which is why it's a shame when we get hung up on "privatized" vs. not - on that kind of topic people have often already made up their mind, and you're just not going to get anywhere anymore.
- Shacklz 8y ago
  At least for Switzerland it's also mandatory to be part of a "Krankenkasse" (health insurer); you cannot be uninsured.

bonzini 8y ago

Singapore and Switzerland both have privatized healthcare, but it is extremely regulated at the same time.

emn13 8y ago
In a way, that's true of the US too; and various (perhaps most?) european systems have most care provided privately - with whatever regulations apply. The framing of "privatized" vs. government health care is, IMNSHO a holdover from the cold war when everything needed to be as ideologically distinct from USSR as possible. Now, it's just corrosive. This isn't a dichotomy; it's not even really a gradual scale - it's typically a whole host of choices of how to set up those regulations. Presuming in advance that privatization is a good (or bad) thing simply leads to worse outcomes.
- bonzini 8y ago
  US healthcare is absolutely not regulated on the same level as Swiss or Singaporean healthcare.
  - jeffbax 8y ago
    It is probably regulated in a far more complicated manner. Singapore has forced savings accounts for basic care (out of pocket spending drives costs down), less barriers to entry into the medical profession (thus more doctors at lower wages than the US), less regulation that results in non-competitive hospital and medical practice like in the US. It's far more effective at delivering high quality at low cost due to more market forces. They spend 3% GDP for excellent results vs 16-20 in the US which is a regulatory death by a thousand cuts. Catastrophic care is covered by the government but this is far more efficient than universal systems elsewhere. If you think US Healthcare is a problem of a lack of regulation you don't understand US Healthcare… https://www.google.com/search?hl=en&q=Singapore%20Healthcare%20site%3Amarginalrevolution.com https://www.google.com/search?hl=en&q=Singapore%20Healthcare...
    - bonzini 8y ago
      The problem is not how much is regulated, it is what parts are regulated and whether they really matter. Opaque pricing is definitely an issue in the US, as is over-reliance on medications [1] which is correlated to shitty workers rights. [1] https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-ge...
      - emn13 8y ago
        Yeah, it's a complex issue with many interlocking parts. Which is why it's a shame when we get hung up on "privatized" vs. not - on that kind of topic people have often already made up their mind, and you're just not going to get anywhere anymore.
Shacklz 8y ago
At least for Switzerland it's also mandatory to be part of a "Krankenkasse" (health insurer); you cannot be uninsured.