4 ms·

A quote from the BMJ article that is the basis for the NPR article: > Long before covid-19, the US was at a disadvantage relative to other high income nations

A quote from the BMJ article that is the basis for the NPR article: > Long before covid-19, the US was at a disadvantage relative to other high income nations in terms of health and survival The US spends a lot more on healthcare than similar countries, but it gets results that are substantially worse. Providing good healthcare for its should be a responsibility for any country. The US does not score very well on this metric.

Arnt 5y ago
Should be, perhaps, but nothing requires the voters in a democracy to think so, or even to put that very high on their priority list. Viewed from my armchair, the American voters appear to really want some kind of health system that does not involve any form of the word "social". Given that constraint, what they have seems to be quite good.
- s1artibartfast 5y ago
  The problem is that federal policy is what is driving healthcare costs in the US. 45% of costs are paid by the government with no check on pricing, essentially a blank check. Similarly, private insurance is mandated to cover procedures not matter the cost. Given this, is it surprising that healthcare costs continue to expand? https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet#:~:text=Medicare%20spending%20grew%206.7%25%20to,31%20percent%20of%20total%20NHE https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta....
  - Arnt 5y ago
    If the US federal government were to assume an active role in setting prices, that could plausibly be called socialist medicine, no? And is therefore verboten.
    - s1artibartfast 5y ago
      I don't think so. Setting a pice you are willing to pay is fundamental to a functional capitalist market. The status now is no cap on coats, so I don't see how adding them to existing programs is more socialist. The key here is I'm not proposing the gov set a cap on prices across the board, just on what they are willing to pay for through their own programs. They should be able to say the ROI on X treatment is too low for the gov to pay for it, but someone with gold played insurance can still get it.
  - TheCoelacanth 5y ago
    How are government programs a blank check? I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid.
    - dragonwriter 5y ago
      > I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid. Its a whole lot more complicated than that, especially for Medicaid which is a bunch of different state programs with different rules, lots of which are exceptions from even the baseline federal rules due to waivers, and which is sometimes fee-for-service and sometimes capitated (and sometimes a mix of both for different services in the same state, and sometimes variable by geographic areas within a state.)
    - s1artibartfast 5y ago
      Indeed, Medicare and Medicaid base their pricing on what private insurers pay. This is the problem. Instead, they should base their decision on $X/QALY (quality adjusted life years) like most of the world with socialized medicine. Just because someone with private insurance can pay 500k for a cancer treatment to extend their life 1 day, doesn't mean that it is a valuable use of tax dollars and that Medicare or Medicaid should cover that treatment.
raxxorrax 5y ago
The argument is often that pharma giants keep massive amounts of profits and therefore can finance medical research. There is a hint of truth here, but there is much more than a hint of truth in Americans getting scammed for private profits.
rayiner 5y ago
The US spends more on a lot of things and gets less (education, transit). What’s weird about the life expectancy point is that the demographic within the US that has the least healthcare access, Hispanics, have a life expectancy comparable to people in Western Europe. Prior to covid, life expectancy for US Hispanics was 81.8, a year longer than people in Denmark. But almost 1 in 5 Hispanics lacks health insurance. Moreover, asians in the US are the longest lived people anywhere in the world. The life expectancy of Asians in the US is over 87 years, 3 years longer than Japan and 6 years longer than Denmark. But there is no special Asian healthcare system in the US (unless I didn’t get the memo). Asians actually have slightly less healthcare access than whites. So you can’t discount demographic (and diet and culture) differences in the US when looking at life expectancy. It’s not clear you’re comparing like with like.
- MeinBlutIstBlau 5y ago
  Not to mention state cultural differences. The US as a whole is not one unified set. NYC citizens probably have better access to healthcare than Alaskans. But clumping their collective data together is not a fair assessment. Thats like comparing the Netherlands to Bulgaria. Its very obvious who would have a better system.
  - Arnt 5y ago
    The USA chose to clump together, that's what the 'U' is short for.
    - MeinBlutIstBlau 5y ago
      So did the countries in the EU yet we still do compariaons by country. If you want a fairer assesment data-wise between countries, compare population and state by country. Headlines like painting the US as a whole as bad, but for instance, my state has life expectancy as many European countries. But if we just used US data compared to said European country, it would look like we don't live as long when that's incorrect compared to my states policies. All state governments are significantly autonomous to the degree of many EU countries. We can handle our own policies how we wish with minimal intervention elsewhere.
TurkishPoptart 5y ago
Does it look at Americans' health on average? Because I think with economic disparity comes disparity with access to quality care and preventative care. I would think that some upper percentile (those with good insurance plans in cities near providers) of Americans' health would equate to those of Western and Northern Europeans, while the middle and lower percentiles fall short of this.
- tfehring 5y ago
  The short answer is that income is a significant factor but it's complicated. The difference in life expectancy at 50 between the lowest and highest income quintiles is about 13 years in the US [0] vs. e.g. 8 in Denmark [1]. (Other European countries seem to be qualitatively similar to Denmark but I couldn't immediately find another apples-to-apples study to compare.) This gap has widened over time in the US, and in fact life expectancy for the bottom quintile has stayed flat or decreased, despite plummeting tobacco usage and general mortality improvement among black Americans. However, it seems like this is mostly driven by differences in behavior (smoking and obesity rates in particular), not by factors like access to medical care [2], though in general the effect is very heterogeneous. [0] https://fas.org/sgp/crs/misc/R44846.pdf https://fas.org/sgp/crs/misc/R44846.pdf, e.g. Figure 4 on page 14 [1] https://jech.bmj.com/content/75/2/145 https://jech.bmj.com/content/75/2/145 [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/, e.g. Figure 8

Arnt 5y ago

Should be, perhaps, but nothing requires the voters in a democracy to think so, or even to put that very high on their priority list. Viewed from my armchair, the American voters appear to really want some kind of health system that does not involve any form of the word "social". Given that constraint, what they have seems to be quite good.

s1artibartfast 5y ago
The problem is that federal policy is what is driving healthcare costs in the US. 45% of costs are paid by the government with no check on pricing, essentially a blank check. Similarly, private insurance is mandated to cover procedures not matter the cost. Given this, is it surprising that healthcare costs continue to expand? https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet#:~:text=Medicare%20spending%20grew%206.7%25%20to,31%20percent%20of%20total%20NHE https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta....
- Arnt 5y ago
  If the US federal government were to assume an active role in setting prices, that could plausibly be called socialist medicine, no? And is therefore verboten.
  - s1artibartfast 5y ago
    I don't think so. Setting a pice you are willing to pay is fundamental to a functional capitalist market. The status now is no cap on coats, so I don't see how adding them to existing programs is more socialist. The key here is I'm not proposing the gov set a cap on prices across the board, just on what they are willing to pay for through their own programs. They should be able to say the ROI on X treatment is too low for the gov to pay for it, but someone with gold played insurance can still get it.
- TheCoelacanth 5y ago
  How are government programs a blank check? I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid.
  - dragonwriter 5y ago
    > I thought that Medicare and Medicaid had strict rates that generally trend slightly below what most private insurers pay for Medicare and substantially below what most private insurers pay for Medicaid. Its a whole lot more complicated than that, especially for Medicaid which is a bunch of different state programs with different rules, lots of which are exceptions from even the baseline federal rules due to waivers, and which is sometimes fee-for-service and sometimes capitated (and sometimes a mix of both for different services in the same state, and sometimes variable by geographic areas within a state.)
  - s1artibartfast 5y ago
    Indeed, Medicare and Medicaid base their pricing on what private insurers pay. This is the problem. Instead, they should base their decision on $X/QALY (quality adjusted life years) like most of the world with socialized medicine. Just because someone with private insurance can pay 500k for a cancer treatment to extend their life 1 day, doesn't mean that it is a valuable use of tax dollars and that Medicare or Medicaid should cover that treatment.

raxxorrax 5y ago

The argument is often that pharma giants keep massive amounts of profits and therefore can finance medical research. There is a hint of truth here, but there is much more than a hint of truth in Americans getting scammed for private profits.

rayiner 5y ago

The US spends more on a lot of things and gets less (education, transit). What’s weird about the life expectancy point is that the demographic within the US that has the least healthcare access, Hispanics, have a life expectancy comparable to people in Western Europe. Prior to covid, life expectancy for US Hispanics was 81.8, a year longer than people in Denmark. But almost 1 in 5 Hispanics lacks health insurance. Moreover, asians in the US are the longest lived people anywhere in the world. The life expectancy of Asians in the US is over 87 years, 3 years longer than Japan and 6 years longer than Denmark. But there is no special Asian healthcare system in the US (unless I didn’t get the memo). Asians actually have slightly less healthcare access than whites. So you can’t discount demographic (and diet and culture) differences in the US when looking at life expectancy. It’s not clear you’re comparing like with like.

MeinBlutIstBlau 5y ago
Not to mention state cultural differences. The US as a whole is not one unified set. NYC citizens probably have better access to healthcare than Alaskans. But clumping their collective data together is not a fair assessment. Thats like comparing the Netherlands to Bulgaria. Its very obvious who would have a better system.
- Arnt 5y ago
  The USA chose to clump together, that's what the 'U' is short for.
  - MeinBlutIstBlau 5y ago
    So did the countries in the EU yet we still do compariaons by country. If you want a fairer assesment data-wise between countries, compare population and state by country. Headlines like painting the US as a whole as bad, but for instance, my state has life expectancy as many European countries. But if we just used US data compared to said European country, it would look like we don't live as long when that's incorrect compared to my states policies. All state governments are significantly autonomous to the degree of many EU countries. We can handle our own policies how we wish with minimal intervention elsewhere.

TurkishPoptart 5y ago

Does it look at Americans' health on average? Because I think with economic disparity comes disparity with access to quality care and preventative care. I would think that some upper percentile (those with good insurance plans in cities near providers) of Americans' health would equate to those of Western and Northern Europeans, while the middle and lower percentiles fall short of this.

tfehring 5y ago
The short answer is that income is a significant factor but it's complicated. The difference in life expectancy at 50 between the lowest and highest income quintiles is about 13 years in the US [0] vs. e.g. 8 in Denmark [1]. (Other European countries seem to be qualitatively similar to Denmark but I couldn't immediately find another apples-to-apples study to compare.) This gap has widened over time in the US, and in fact life expectancy for the bottom quintile has stayed flat or decreased, despite plummeting tobacco usage and general mortality improvement among black Americans. However, it seems like this is mostly driven by differences in behavior (smoking and obesity rates in particular), not by factors like access to medical care [2], though in general the effect is very heterogeneous. [0] https://fas.org/sgp/crs/misc/R44846.pdf https://fas.org/sgp/crs/misc/R44846.pdf, e.g. Figure 4 on page 14 [1] https://jech.bmj.com/content/75/2/145 https://jech.bmj.com/content/75/2/145 [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/, e.g. Figure 8