4 ms·

American healthcare is frankly - and I say this as an American - disgusting and infuriating. It needs to be re-structured from the ground up.

ushealth 8y ago
As a Dutch person who spoke to US people in Dutch hospitals —- who needed to pay full price —- I daresay the US health care system is worse than some 3rd world countries their health care system. It is indeed infuriating.
- dmarlow 8y ago
  I think there are some differences though. "Worse" is a term that needs to define quantitatively what is worse. The quality is actually quite good here.
  - maxxxxx 8y ago
    the treatment is fine. The billing practices are plain corrupt.
  - yawz 8y ago
    Agreed. In the US (just like in many places) you're not exposed to many problems if you have a good insurance and/or have enough money. The system is usually fast, you're treated well and the infrastructure, equipment etc. are great.
  - davidw 8y ago
    Life expectancy vs % of GDP spent on healthcare. The US is a huge outlier: we spend way more than other countries and don't even live as long. There are other ways to measure it too, which is good to investigate, as it is a complicated subject. Here's a HN relevant way to measure it: how much time does your average 5, 50, and 500 person company spend dealing with health insurance stuff? The startup I worked for in Italy spent 0 time on it, because it's not relevant to the company at all. Of course, Italy has massive amounts of bureaucracy for other things, which more than make up for the lack of it in health care, but that's another story.
    - refurb 8y ago
      Using life expectancy to measure quality of health care is like using income to measure how smart you are. There may be some relationship, but too many confounding factors for it to be useful at all.
RcouF1uZ4gsC 8y ago
Part of this is because the US prices of drugs, subsidize the development of drugs around the world. Pharmaceutical companies rely on the US market to offset the R&D of the drugs, while then providing other countries with drugs above the marginal costs (which is still profitable). In this scheme, the pharma company benefits (they increase their profits) as do the other countries (they get cheap drugs). The loser in this arrangement is the US consumer who gets to pay high costs so everyone else can have ground-breaking drugs at low cost.
- acdha 8y ago
  Those companies spend far more money on marketing than R&D an they’re heavily reliant on US funded research — almost every erything they do starts with NIH funding.
  - Varcht 8y ago
    Source?
    - acdha 8y ago
      See e.g. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/ https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p... - it’s improved a little since then but it’s still nowhere near an explanation, especially since it’s not like drugs produced by non-US companies are massively cheaper in the US.
      - Varcht 8y ago
        Not quite the proof I'd like to see. Johnson&Johnson sells a lot of things, the more purely pharmaceutical companies are closer to 1:1 in the graphic. Then we have, Most of this marketing money is directed at the physicians who do the prescribing, rather than consumers. As Oliver pointed out, drug companies spent more than $3 billion a year marketing to consumers in the U.S. in 2012, but an estimated $24 billion marketing directly to health care professionals. $27B in marketing but the graphic shows over $65B in R&D?
tanilama 8y ago
Not even developing country standard, at least those countries still can afford some of it.
yawz 8y ago
I've lived and worked in a few countries including the US. In the US you are a "customer" first and then a patient. The entire healthcare system is run like a business that only cares about the money that they're making. (Edit: small typo)
- maxxxxx 8y ago
  You are not treated as customer. You are treated like a "resource" whose wallet needs to be exploited.
  - onlyrealcuzzo 8y ago
    Being a customer in a non-free/competitive market isn't that great.
- yawz 8y ago
  As an example, I still can't wrap my head around the price difference in a medical bill if one has insurance or pays out-of-pocket. Providers charge insurances excessively more than out-of-pocket prices. And this is done openly. Then the insurances are charging the patient with higher premiums. I mean, come on! How is this even legal?!?
  - howard941 8y ago
    I share your frustration. I've had it go both ways, never in my favor. A chain MRI imaging provider gave me 33% off for paying cash on the condition that I not file a claim or take advantage of it against my annual out of pocket. But while transitioning between insurance companies and lacking the new card two of two specialists I saw wanted cash in advance and charged me about three times more than they were getting from me+my insurer before and then after when I finally received the insurance card.

ushealth 8y ago

As a Dutch person who spoke to US people in Dutch hospitals —- who needed to pay full price —- I daresay the US health care system is worse than some 3rd world countries their health care system. It is indeed infuriating.

dmarlow 8y ago
I think there are some differences though. "Worse" is a term that needs to define quantitatively what is worse. The quality is actually quite good here.
- maxxxxx 8y ago
  the treatment is fine. The billing practices are plain corrupt.
- yawz 8y ago
  Agreed. In the US (just like in many places) you're not exposed to many problems if you have a good insurance and/or have enough money. The system is usually fast, you're treated well and the infrastructure, equipment etc. are great.
- davidw 8y ago
  Life expectancy vs % of GDP spent on healthcare. The US is a huge outlier: we spend way more than other countries and don't even live as long. There are other ways to measure it too, which is good to investigate, as it is a complicated subject. Here's a HN relevant way to measure it: how much time does your average 5, 50, and 500 person company spend dealing with health insurance stuff? The startup I worked for in Italy spent 0 time on it, because it's not relevant to the company at all. Of course, Italy has massive amounts of bureaucracy for other things, which more than make up for the lack of it in health care, but that's another story.
  - refurb 8y ago
    Using life expectancy to measure quality of health care is like using income to measure how smart you are. There may be some relationship, but too many confounding factors for it to be useful at all.

RcouF1uZ4gsC 8y ago

Part of this is because the US prices of drugs, subsidize the development of drugs around the world. Pharmaceutical companies rely on the US market to offset the R&D of the drugs, while then providing other countries with drugs above the marginal costs (which is still profitable). In this scheme, the pharma company benefits (they increase their profits) as do the other countries (they get cheap drugs). The loser in this arrangement is the US consumer who gets to pay high costs so everyone else can have ground-breaking drugs at low cost.

acdha 8y ago
Those companies spend far more money on marketing than R&D an they’re heavily reliant on US funded research — almost every erything they do starts with NIH funding.
- Varcht 8y ago
  Source?
  - acdha 8y ago
    See e.g. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/ https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p... - it’s improved a little since then but it’s still nowhere near an explanation, especially since it’s not like drugs produced by non-US companies are massively cheaper in the US.
    - Varcht 8y ago
      Not quite the proof I'd like to see. Johnson&Johnson sells a lot of things, the more purely pharmaceutical companies are closer to 1:1 in the graphic. Then we have, Most of this marketing money is directed at the physicians who do the prescribing, rather than consumers. As Oliver pointed out, drug companies spent more than $3 billion a year marketing to consumers in the U.S. in 2012, but an estimated $24 billion marketing directly to health care professionals. $27B in marketing but the graphic shows over $65B in R&D?

tanilama 8y ago

Not even developing country standard, at least those countries still can afford some of it.

yawz 8y ago

I've lived and worked in a few countries including the US. In the US you are a "customer" first and then a patient. The entire healthcare system is run like a business that only cares about the money that they're making. (Edit: small typo)

maxxxxx 8y ago
You are not treated as customer. You are treated like a "resource" whose wallet needs to be exploited.
- onlyrealcuzzo 8y ago
  Being a customer in a non-free/competitive market isn't that great.
yawz 8y ago
As an example, I still can't wrap my head around the price difference in a medical bill if one has insurance or pays out-of-pocket. Providers charge insurances excessively more than out-of-pocket prices. And this is done openly. Then the insurances are charging the patient with higher premiums. I mean, come on! How is this even legal?!?
- howard941 8y ago
  I share your frustration. I've had it go both ways, never in my favor. A chain MRI imaging provider gave me 33% off for paying cash on the condition that I not file a claim or take advantage of it against my annual out of pocket. But while transitioning between insurance companies and lacking the new card two of two specialists I saw wanted cash in advance and charged me about three times more than they were getting from me+my insurer before and then after when I finally received the insurance card.