7 ms·

The American healthcare system is exceptionally bad when you compare it against the United States' relative wealth, for sure; the rest of the world hasn't solve

by least 5y ago

The American healthcare system is exceptionally bad when you compare it against the United States' relative wealth, for sure; the rest of the world hasn't solved healthcare, though. Even if you zoom in on the few countries most people are talking about when they say "the rest of the world," there's still a tons of issues present, a lot of which are directly a result of the system that they chose to utilize. This is an issue with a lot of nuance and I wish people wouldn't make such reductive statements like this.

curiousgal 5y ago
As long as those issues don't include people going broke because of a snake bite (and they don't) I'd say they pretty much did solve it.
- least 5y ago
  I think that you're not looking closely enough at the underlying issues of these systems if your only metric is people don't go broke from a snake bite, or more broadly, they don't pay immediate upfront costs for their healthcare, even though a whole lot of these places do have upfront costs as well. The healthcare industry has a lot of working parts, all of which require scrutiny, even in these mythical places of which you aspire American healthcare to look like. There's genuinely negative outcomes as a result of the policy decisions everywhere, too.
- refurb 5y ago
  When you can't get the latest cancer drugs because your gov't can't/won't pay for it, is it still solved?
  - altacc 5y ago
    This is somewhat of a straw man fallacy often cited by proponents of profit centric healthcare. In reality it happens relatively rarely and is usually linked to the effectiveness of that treatment. In the UK, a typical example of state provided healthcare, some extremely expensive treatments which can only increase life expectancy for a few weeks or months are not approved as there is little benefit. But not every health insurance policy in the US will cover this treatment, especially without some copay. On the other hand, a treatment was recently approved for use which costs £1.795 million per patient. The cost to the patient for that treatment is zero. I find this argument not only provably less relevant than the poster thinks is is, but also it's not much different from dying as you can't afford to pay even the copay for your cancer treatment. The USA can't even sort out decent healthcare for children, who haven't yet had the opportunity to get a job to pay for their healthcare. No healthcare system is perfect but that's not a reason to not seek something better, fairer and more efficient.
    - refurb 5y ago
      It's happens more often than you think. In single payer system, those therapies aren't even discussed with the patient since the physician knows if it's not paid for by the gov't it's effectively out of reach. Sure, the US system isn't perfect by any means, but one reason why it's so expensive is they throw everything plus the kitchen sink at patients. And this is even for Medicaid which covers the poorest Americans. Having lived in 4 different country with 4 different healthcare systems, if I got diagnosed with a serious cancer you can damn well be sure I'll get treated in the US. I have a friend who got diagnosed with breast cancer who did the same, moved back to the US and with ACA subsidies was getting the latest therapies with a monthly premium of $200. And the drugs she received weren't even paid for in her home country.
      - altacc 5y ago
        That's due to ACA, which is only about 7 years old and has an uncertain future. The cancer survival rates are a few percentage points better in the US than many other countries, but this is not uniform and still depends upon your level of insurance. If you are uninsured or underinsured your survival rate is significantly less than if you are fully insured. The "everything plus the kitchen sink" approach isn't ideal in all scenarios and the US healthcare system has a high level of overtreatment, often with potentially harmful interventions. It also pushes up the cost for everyone. However there are economic models that provide for a high level of universal healthcare equal to what the US has now and also cost less than the US spends right now. The difference is that is moves from a combination of clear personal cost and obfuscated public costs, to purely public costs and many in the US seem opposed to that relatively minor shift. It also means the politicians are even more responsible for their society's healthcare and I imagine many of them don't want that responsibility.
      - gambiting 5y ago
        >>In single payer system, those therapies aren't even discussed with the patient since the physician knows if it's not paid for by the gov't it's effectively out of reach. I genuienly don't think that's as common as you think it is. Anecdote time: when my dad was diagnosed with GIST in Poland(you know, not a very wealthy country), his prognosis was about 6-12 months if lucky. But the doctors at the oncology unit knew that the drug Glivec was being approved against GIST but not yet refunded by the Polish healthcare system. They basically applied and got approved to fund his therapy along with 5 other people(GIST was and remains super rare). The national healthcare system paid for his treatment with Glivec for the next 8 years(until he died), despite the huge cost of the medication. Like, maybe he was lucky. But again, I think you are misrepresenting the system by saying "doctors won't even try". Sure, maybe some won't. Some will. I've heard similar stories from US where doctors won't order certain medically necessary treatment because they know insurers won't pay for it - it doesn't mean anything in isolation.
  - number6 5y ago
    What was the plot of Breaking Bad again? Guess Heinsberg just wanted the latest cancer drug.
  - dv_dt 5y ago
    If you review data, the US indeed has higher cancer survival rates. But they’re marginally higher while overall US life expectancy is lower. That means basically that all-other-causes of shortened lifespan are higher in the US. https://worldpopulationreview.com/country-rankings/cancer-survival-rates-by-country https://worldpopulationreview.com/country-rankings/cancer-su... https://ourworldindata.org/grapher/life-expectancy-vs-gdp-per-capita https://ourworldindata.org/grapher/life-expectancy-vs-gdp-pe...
    - bumby 5y ago
      Is there any data that links cancer survival to where that treatment was developed? I’m genuinely curious and realize this is one of those topics that is easy to come across as combative, but please know that’s not my intent. The reason I ask is that I think roughly 40% of healthcare R&D globally is funded by the U.S. For its size, the U.S. scores relatively high on the access and quality dimensions, but as has been discussed is quite bad at cost. I wonder if the US has optimized for quality and access at the expense of cost. I have also heard from those in the field that the US effectively subsidizes other countries costs through their R&D and price policies. E.g., other countries may have tight drug price controls and the only way pharma is willing to invest in R&D is because they can make up those profits in America. It really makes me think all this discussion about one country’s healthcare vs another is myopic. Just like many other aspects of economics, healthcare to a certain extent is a global system.

by least 5y ago

curiousgal 5y ago

As long as those issues don't include people going broke because of a snake bite (and they don't) I'd say they pretty much did solve it.

least 5y ago
I think that you're not looking closely enough at the underlying issues of these systems if your only metric is people don't go broke from a snake bite, or more broadly, they don't pay immediate upfront costs for their healthcare, even though a whole lot of these places do have upfront costs as well. The healthcare industry has a lot of working parts, all of which require scrutiny, even in these mythical places of which you aspire American healthcare to look like. There's genuinely negative outcomes as a result of the policy decisions everywhere, too.
refurb 5y ago
When you can't get the latest cancer drugs because your gov't can't/won't pay for it, is it still solved?
- altacc 5y ago
  This is somewhat of a straw man fallacy often cited by proponents of profit centric healthcare. In reality it happens relatively rarely and is usually linked to the effectiveness of that treatment. In the UK, a typical example of state provided healthcare, some extremely expensive treatments which can only increase life expectancy for a few weeks or months are not approved as there is little benefit. But not every health insurance policy in the US will cover this treatment, especially without some copay. On the other hand, a treatment was recently approved for use which costs £1.795 million per patient. The cost to the patient for that treatment is zero. I find this argument not only provably less relevant than the poster thinks is is, but also it's not much different from dying as you can't afford to pay even the copay for your cancer treatment. The USA can't even sort out decent healthcare for children, who haven't yet had the opportunity to get a job to pay for their healthcare. No healthcare system is perfect but that's not a reason to not seek something better, fairer and more efficient.
  - refurb 5y ago
    It's happens more often than you think. In single payer system, those therapies aren't even discussed with the patient since the physician knows if it's not paid for by the gov't it's effectively out of reach. Sure, the US system isn't perfect by any means, but one reason why it's so expensive is they throw everything plus the kitchen sink at patients. And this is even for Medicaid which covers the poorest Americans. Having lived in 4 different country with 4 different healthcare systems, if I got diagnosed with a serious cancer you can damn well be sure I'll get treated in the US. I have a friend who got diagnosed with breast cancer who did the same, moved back to the US and with ACA subsidies was getting the latest therapies with a monthly premium of $200. And the drugs she received weren't even paid for in her home country.
    - altacc 5y ago
      That's due to ACA, which is only about 7 years old and has an uncertain future. The cancer survival rates are a few percentage points better in the US than many other countries, but this is not uniform and still depends upon your level of insurance. If you are uninsured or underinsured your survival rate is significantly less than if you are fully insured. The "everything plus the kitchen sink" approach isn't ideal in all scenarios and the US healthcare system has a high level of overtreatment, often with potentially harmful interventions. It also pushes up the cost for everyone. However there are economic models that provide for a high level of universal healthcare equal to what the US has now and also cost less than the US spends right now. The difference is that is moves from a combination of clear personal cost and obfuscated public costs, to purely public costs and many in the US seem opposed to that relatively minor shift. It also means the politicians are even more responsible for their society's healthcare and I imagine many of them don't want that responsibility.
    - gambiting 5y ago
      >>In single payer system, those therapies aren't even discussed with the patient since the physician knows if it's not paid for by the gov't it's effectively out of reach. I genuienly don't think that's as common as you think it is. Anecdote time: when my dad was diagnosed with GIST in Poland(you know, not a very wealthy country), his prognosis was about 6-12 months if lucky. But the doctors at the oncology unit knew that the drug Glivec was being approved against GIST but not yet refunded by the Polish healthcare system. They basically applied and got approved to fund his therapy along with 5 other people(GIST was and remains super rare). The national healthcare system paid for his treatment with Glivec for the next 8 years(until he died), despite the huge cost of the medication. Like, maybe he was lucky. But again, I think you are misrepresenting the system by saying "doctors won't even try". Sure, maybe some won't. Some will. I've heard similar stories from US where doctors won't order certain medically necessary treatment because they know insurers won't pay for it - it doesn't mean anything in isolation.
- number6 5y ago
  What was the plot of Breaking Bad again? Guess Heinsberg just wanted the latest cancer drug.
- dv_dt 5y ago
  If you review data, the US indeed has higher cancer survival rates. But they’re marginally higher while overall US life expectancy is lower. That means basically that all-other-causes of shortened lifespan are higher in the US. https://worldpopulationreview.com/country-rankings/cancer-survival-rates-by-country https://worldpopulationreview.com/country-rankings/cancer-su... https://ourworldindata.org/grapher/life-expectancy-vs-gdp-per-capita https://ourworldindata.org/grapher/life-expectancy-vs-gdp-pe...
  - bumby 5y ago
    Is there any data that links cancer survival to where that treatment was developed? I’m genuinely curious and realize this is one of those topics that is easy to come across as combative, but please know that’s not my intent. The reason I ask is that I think roughly 40% of healthcare R&D globally is funded by the U.S. For its size, the U.S. scores relatively high on the access and quality dimensions, but as has been discussed is quite bad at cost. I wonder if the US has optimized for quality and access at the expense of cost. I have also heard from those in the field that the US effectively subsidizes other countries costs through their R&D and price policies. E.g., other countries may have tight drug price controls and the only way pharma is willing to invest in R&D is because they can make up those profits in America. It really makes me think all this discussion about one country’s healthcare vs another is myopic. Just like many other aspects of economics, healthcare to a certain extent is a global system.