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It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of tha

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population. My hope is that this new-found energy in healthcare products doesn't follow the traditional VC-backed approach of building a product, taking over markets through aggressive marketing and shady closed-door dealings and operating at a loss only to then monetize the shit out of everything. Theranos really embodied some of these fears, and I'm not sure we'll live in a better world if our health will be in the hands of people that have a financial incentive to tell us we're more sick/healthy than we really are.

merpnderp 5y ago
I’m interested in this worst performing stat. By what measure? Because I’ve always read that when controlling for the relative poor health of the us population regarding diseases related to poor eating and exercise habits, the US was a top performer for heart and cancer treatments.
- mdoms 5y ago
  So if you imagine that USA was healthy then health outcomes look great?
- telxosser 5y ago
  I am pushing 50 years of age and one constant in my life is people shitting on the US healthcare system. I have family in Canada with family members the same age on both sides. Canada is great if you are a healthy broke college student. No one in their right mind would ever pick Canadian health care over the US though if you are 60+. There is no way you would rather have cancer in a country with free health care.
  - standardUser 5y ago
    "There is no way you would rather have cancer in a country with free health care." Unless you can't afford for-profit healthcare. Then any sane person would 100% prefer one of the fifty or so developed nations with free healthcare.
    - samoa42 5y ago
      also safe to say that a vast majority of ppl on the planet can't afford for-profit cancer treatment
- mbg721 5y ago
  At the very least, by billing transparency and paperwork load. Even Americans who are happy with their healthcare hate that.
causi 5y ago
Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. Not that your thesis isn't correct but be careful there. You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. The quality of care for Americans who can afford care is excellent.
- cntainer 5y ago
  > You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. Well that's the point, I think everybody should be taken into account in order to paint a comprehensive picture of the quality of the system at country level. The resulting stats reflect the health of a society as a whole not just of the part that can afford it. Not having universal healthcare is still part of the system, even if we don't like it. I get it that health outcomes of those left out are probably very different. But leaving those numbers out of the comparison doesn't really work with these type of statistics. At that point how could you compare it to the other countries that take everyone into consideration? The stats are GDP/capita percentages, should I remove the ones who can't afford healthcare from the GDP stats as well to not skew the ratio? I don't really like where I might end up taking this route. I don't have any experience with US healthcare and I'm sure the quality of the services is really high, but the fact that you need to afford basic healthcare and it's not guaranteed by the government for everyone makes me see it as closer to just another "consumer product" compared to other systems.
  - A4ET8a8uTh0 5y ago
    Yes, but anyone in US that has healthcare in US and reads the paragraph above will come to a conclusion along the lines of 'Wait, my experience wasn't bad; what am I missing?'. As a result, you may end up making an opposite of the point you are trying to make.
  - kayodelycaon 5y ago
    When it comes to healthcare in the US, a lot of people who can afford it don't care about people who can't afford it. Hence the common belief by the middle class that the US has the best healthcare in the world. (That's before you add in a large dose of American exceptionalism.)
ErikVandeWater 5y ago
> So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. The US healthcare is an example of the government being massively over-involved and creating massive inefficiencies.
- CraigJPerry 5y ago
  Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an aspect of healthcare costs. Cost of triple bypass heart surgery: US: $110,000, UK: £8,500 (paid by the taxpayer, not by the patient at the point of care - free for them). (P.s. private healthcare is available in the UK too - the procedure costs around £20,000 privately, payable by the patient or their insurance) Life expectancy… you get the idea.
  - JumpCrisscross 5y ago
    > NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US The American system’s problem is exclusion, not quality of care. If you get care in America, your outcomes are among the best in the world.
    - CraigJPerry 5y ago
      Yeah you’re right, s/patients/citizens/
    - rg111 5y ago
      Someone told me this a few years back and it stuck with me. "American healthcare is the best in the world like sportscars- Ferrari, Lamborghini, BMW, Bugatti, etc. are the best cars in the world. Surely they both are the bests in the world- but only for the small percentage of people that can actually afford them." This is sad. (Many, including me, wouldn't buy a sportscar even if they could afford one, and sportscars aren't the "best" in their opinion. But this comparison drives the point home.)
pjc50 5y ago
The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you retain choice of providers. It doesn't need to be a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from). There's also an informational problem; in a fully free speech environment it's much easier to sell people unreliable cures, Theranos passim.
- throwaway0a5e 5y ago
  Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (insurers) and then act surprised that they take a fat cut. The solution isn't to government-ize the middle man. That will almost certainly just be a wash. It's to get rid of the middle man where possible. There's no reason someone shouldn't be able to get a physical or a colonoscopy the same way cosmetic surgery and dental care are done. These are cookie cutter outpatient services. The deviation from instance to instance is small and predictable so insurance should not be needed on the consumer side. Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong?
  - netizen-936824 5y ago
    The healthcare industry already pisses away huge amounts of money. Its evident in all those stories we hear about people getting a huge $5000+ medical bill, then calling the hospital and suddenly its $100 or less. That $4900 is literally all wasted
  - andrekandre 5y ago
    > Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong? just a guess, but it might be because of... Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. ... one of the reasons most visits in the us is the er is precisely because preventative care is so expensive/hard-to-get in the u.s and people put off visiting the doctor regularly since its so expensive... the market isn't very amenable to these extra costs in the short run, whereas a state-run system might not have the same short-term cost concerns and encourage/subsidize regular visitation/preventative-care...
snarfy 5y ago
> Which doesn't really fit the view that less government involvement results in a more efficient system The government may not pay for the actual service but there is huge government involvement and mountains of regulations to climb.
- SamoyedFurFluff 5y ago
  I would argue some of those regulations are moat building explicitly to ensure healthcare as a commodity.
toolz 5y ago
I'm curious how you can suggest the US government spends the most money in the world, by far, on healthcare and the simultaneously suggest there's less government involvement. The government is involved in every step of American healthcare. As you can imagine of a system that gets all of its funding thru companies completely overseen by regulatory bodies or thru social programs.
- onlyrealcuzzo 5y ago
  Compared to a single-payer socialized system, this is less involvement - even if it is a lot of involvent.
  - toolz 5y ago
    by what metric?
- cntainer 5y ago
  I didn't really suggest that the US Government spends money on healthcare, I was merely quoting the article: "Health care consumes 18% of GDP in America" Please note that the wording implies that 18% of GDP is spent on health care overall not that the US Government is spending all that money out of its pocket directly on yearly budgets. The way I understand it is that it includes both money spent by public and private actors for all health related service. I see this type of stat a warning that something might be dysfunctional within the system, and it's the government's job to get to the bottom of it.
- stefan_ 5y ago
  There is some crazy amnesia here about the US healthcare system. Some 40% of the US are already covered through Medicaid/Medicare - "socialism" is long here!
onlyrealcuzzo 5y ago
One point that gets skipped over a lot - the US is also one of the most unhealthy countries in the advanced world. This is a big /part/ of the "worst outcomes" in the "highest cost, worst outcomes". It is possible that you can spend a ton of money on healthcare - yet smoke and drink, drive everywhere and not exercise at all, and eat trash - that the healthcare spending is doomed to fail. Europeans walk & bike more and don't eat as much garbage. Most Asians exercise much more, eat healthier, AND smoke and drink less. Maybe the healthcare part is secondary to just generally taking care of your health? It is well understood how terrible obesity is for you. Why should we expect the US to have better healthcare outcomes than Vietnam when Vietnam is 2.1% obese and the US is 42% obese. You can take all the heart medicine in the world. It would be better to simply not be obese in the first place! This never seems to be a talking point. Have the statisticians controlled for all this when they come to these conclusions??
- Bjartr 5y ago
  This is a good point, and it's important to also remember that these ideas aren't independent. How people interact with the healthcare system over their lifetimes has an impact on how they think about their health, and the health impacting decisions in their lives.
- mtberatwork 5y ago
  > Most Asians exercise much more, eat healthier, AND smoke and drink less. Tobacco consumption in Asia is incredibly high: https://en.wikipedia.org/wiki/Tobacco_consumption_by_country https://en.wikipedia.org/wiki/Tobacco_consumption_by_country
  - decafninja 5y ago
    Alcohol consumption is fairly high too. https://worldpopulationreview.com/country-rankings/alcohol-consumption-by-country https://worldpopulationreview.com/country-rankings/alcohol-c... Though I suppose China and India, which combined probably comprise the biggest block of population, are a slightly better shade of red than the US and Europe.
- 5y ago
syshum 5y ago
>>e most expensive and worst-performing in terms of outcomes compared to the other developed countries. That is only true if you cherry pick statics that over sample for life style choices, and under sample of actual health care. If you look at statics that are directly attributable to the care provided, not the life style choices of the patients then the US Healthcare system is far better than any other nation
rscho 5y ago
Yes, so. The typical American response to that is: "the government controls everything. Let the free market do its job!" And then wonder why they get shit care for a huge price BUT swith nice marketing and a smiling "health dealer" getting you a 0% lease... oh sorry, we got you confused with a Chevvy! And also, "we have the best care in the world because our docs are better selected". This one never fails to make me laugh, as a swiss MD
- mbg721 5y ago
  Yes, that's the response, but healthcare in America is far from a free market. It's more a circle of sloppy middlemen, in much the same way that I hear privatized passenger rail in the UK described.
wreath 5y ago
> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. In what way is it the worst-performing? I mean, what are the outcomes that are measured to determine its performance? Yes, healthcare is a lot cheaper in Europe (even if your employer wouldn't pay their part) compared to the US, but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance.
- dragonwriter 5y ago
  > but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance. That's exactly like US healthcare if you aren't either a wealthy private-pay client or someone with top-flight private insurance; we just pay twice as large a share of GDP and even a higher multiple per capita to have the same normal experience and many more people uninsured than any other developed economy (and we've only recently through the ACA, gotten it so the that your top-flight insurance plan wouldn't look to retroactively cancel your insurance when you got an expensive-to-treat condition, leaving you uninsured and uninsurable.)
  - wreath 5y ago
    > leaving you uninsured and uninsurable. This one is pretty messed up indeed. What's the purpose of being insured to begin with if it will fuck you over when you need the insurance?
    - lotsofpulp 5y ago
      It has not been true for 10+ years. Affordable Care Act (ACA) outlawed denying insurance to anyone, regardless of how much their future healthcare expenses will be. It is one of the reasons that everyone complained about ACA increasing health insurance costs - it had to because more people were getting more healthcare. ACA also outlaws pricing insurance on anything other than age, smoking status, and location. Even the pricing due to age is capped so that the premium for the oldest (riskiest) age is only allowed to be 3x the young age premium. ACA also implemented out of pocket maximum for in network care, so that there is a maximum cost per calendar year you would be responsible for. Recent law that went into effect Jan 1, 2022, extends this out of pocket maximum to all healthcare providers in the US if it is an emergency. Finally, ACA also instructed an appeal process if you think the insurance company is denying payment for treatment justified with evidence: https://www.healthcare.gov/appeal-insurance-company-decision/appeals/ https://www.healthcare.gov/appeal-insurance-company-decision...
jollybean 5y ago
US Healthcare is not the 'worst performing', that's a perennial clickbait theme. Health issues are bad in the US, and people use that as 'evidence' for quality of the Healthcare system, but that's not fair. People shooting each other, not eating well or exercising, isn't so much a function of the US Healthcare system. The US system is probably the most economically inefficient, but that's also expected at the highest end of quality. The US has most of the best quality systems in the world, it's just expensive and messed up financially, but the quality itself is something to behold. While I share your reservations about 'privately backed things' - for example, advertising arcane drugs in the US is ridiculous, this whole 'Ask Your Doctor' is an excuse for pushy patients to 'prescribe themselves' over the will of tired Doctors caving in ... ... that said, Theranos is the opposite example. If it had worked, it would have been because of VC backing and it would have been very beneficial to people. And there are many things like that. Like anything, it's complicated, and we need nuanced thinking about it. We probably should welcome a lot more VC spend, think of ways to empower doctors with the deluge of information, to empower individuals but at the same time get them to understand that they are not medical professionals and shouldn't be self-diagnosing, etc..
nradov 5y ago
There are huge variations in performance depending on what metric you look at. The US is at or near the top in 5-year survival rates for most types of cancer.
Quinner 5y ago
Much like US Defense spending subsidizes the rest of the globe, US for-profit healthcare spending spurs massive investment in pharma and biotech research that benefits the rest of the world. Are there inefficiencies and waste? Yes. But outcomes overall are much better for it.
- samoa42 5y ago
  i mean, why waste effort on curing ppl that contribute to global overpopulation.
mattparcens 5y ago
But isn't it the government that allows the healthcare system to hold you financially accountable for opaque and arbitrary bills?
xkbarkar 5y ago
in 2019 I would have agreed with you. In iceland you will not be charged for cancer treatment, but the medical costs of getting a long term illness in Iceland are not trivial. Add that to loss of income and the situation for many chronically ill is actually so terrible that laughing at the US is not something Iceland can afford. And covid has painfully displayed exactly how poorly managed the hospitals are and how starved the health care system really is. The equivalent of a bus accident will put the healthcare system on its knees or 80 people needing intensive care. of course Iceland has more hospital beds than 80, but it cannot handle a disease that may put 80 people in ICU ( not counting ventialtion here at all, just intensive care ). I think many in Iceland, myself included, are a bit in shock of exactly how poorly managed and starved the health care system is. Up until 2019 I laughed at the dumb americans and their awful health care, man did I get my sit-upon whopped in the past 2 years. Icelands is so bad that we are regularily filling hospital break rooms and garages with patients. THat is on a normal non-influenze season. Let alone sars-cov-2 introduction. I suspect Canada is having a similar realization as we are. Free care in all its honour. Starved free care, heh...... Shame on us. Really. Shame on us.
dr_orpheus 5y ago
> Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population. My favorite example of this is when I had to get an MRI. The lab imaging said it would be $800 if they billed it through insurance, or it would be $600 to just pay for it directly out of pocket. So the cost of having to deal with my insurance (which always advertises the "discounts" they negotiate and the "lowest cost") was actually more than what the insurance would actually cover.
- majormajor 5y ago
  This is always extra annoying because it might be a false savings to pay cash there. Let's say your MRI says you need a $5500 procedure, and your plan's deductible is $3000, 90% coverage after, and out of pocket max is $6000, and there's nothing else you've spent on the plan this year. Pay $800 for MRI with insurance, you'll then pay $2200 for the procedure to hit the deductible + 10% of the remaining $3300, so $2530 total for the procedure. $3330 total for the year between the two things. Pay $600 cash for MRI, you'll then pay $3000 for the procedure to hit the deductible, and 10% of the remaining $2000, so $3200 total for the procedure. Now you've paid $3800 total, so you've spent $470 more despite the MRI being "cheaper"! If you have other expenses so your out of pocket max comes into play, that difference approaches the full $600.
  - arethuza 5y ago
    Do you folks have to perform these calculations every time someone in your family gets sick or injured?
    - majormajor 5y ago
      Usually no, most people just use doctor-suggested or in-insurance-network providers and billing because it's easier than calling multiple places and hyper-optimizing on the math. But we have to pay the bills after the insurance company does the calculation, which often results in annoying surprises. The better your insurance, the less nasty surprises, which largely in the US means "the better you're paid, the less you have to pay out of pocket for health expenses" which is a nasty thing because then the people most likely to be hit with a big bill are those who can least afford it.
TrispusAttucks 5y ago
You hit the nail on the head. > So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population. Healthcare and Big Pharma have captured regulators at various federal health institutions. The mission is maximizing profit outcomes not health outcomes.
nonethewiser 5y ago
> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. Considered by whom?
majormajor 5y ago
It's not all bad to spend more - consider the extra hospital capacity that so far has helped absorb COVID shock impacts better than neighboring Canada. Hopefully we don't hit the limit of that, even, though. https://www.bloomberg.com/news/articles/2022-01-06/hospital-bed-shortage-shuts-down-canada-while-u-s-stays-open https://www.bloomberg.com/news/articles/2022-01-06/hospital-... US health outcomes also aren't so bad for those who have affordable access to the system, as I understand it. But the spending is something to keep in mind when anti-healthcare-for-all advocates say things like "do you want to have to wait months for procedures like in Canada" - if the US continues to spend more money per person, there's no reason it can't continue to have more capacity.
- hamter 5y ago
  idk canada has 806 covid deaths per 1M and usa has 2573, it's not exactly screaming 'success story' to me.
  - majormajor 5y ago
    Surely you aren't suggesting that having more hospital beds per capita in the US is causing more deaths? Capacity is hardly the only factor in how Covid is hitting the population (and having more hospital capacity reducing pressure to lock things down will itself affect the rate of spread). For instance, per https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million https://ourworldindata.org/grapher/total-covid-cases-deaths-... Canada has seen 66K cases per million and 807 deaths per 1M cumulatively. The US is at 180K and 2515. Slightly different numbers than yours, but close enough. Deaths/cases to date is very similar, 1.4% in US and 1.2% in Canada. So the difference in total deaths is largely policy and behavioral, the aggregate policy across the US has largely been one of "at this point we can't eradicate it so we need to live with it as best we can" where even the liberal US states remain quite open compared to initially in 2020 in the face of recent surges. Whether or not that's the right policy is separate from whether or not that policy would've even been realistic without as much health care capacity.
    - hamter 5y ago
bushbaba 5y ago
The us healthcare system is not capitalistic. If I get my flu shot I have no idea how much it cost my insurance company. CVS, Walgreens, Safeway all the same to me for a flu shot. If instead we use health insurance like home insurance for unforseen major issues, and had price transparency. Then prices would go down as people would shop around.
- terr-dav 5y ago
  What you're describing is the lack of a normal market, and even that only applies if you have insurance. For the millions of people without insurance, they do indeed shop around. It is very much a capitalist system, since the ownership (& control) of the system is not in the hands of the workers - in insurance companies, hospitals, pharma, etc - but in the hands of wealthy shareholders. To be fair, I suspect your definition of capitalism is very different from mine...
  - bushbaba 5y ago
    Those without insurance are quoted prices different than what insurance companies pay. Even getting a price quote is often impossible. Government should enforce the same pricing to all parties or allow everyone to get the same prices Medicare negotiated.
hitpointdrew 5y ago
> the fact that healthcare is already a consumer product in the US I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then: 1. It wouldn't be tied to or dependent on my employment. 2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers. 3. Insurance providers wouldn't be restricted by arbitrary/geographical boundaries. I think the debate over weather healthcare is a human right is an interesting one, and I personally haven't come to any conclusion on that yet. If you think healthcare is a basic human right then a single-payer system is probably the most reasonable solution, although I don't think single payer isn't without it's share of problems. If you think healthcare is not a basic human right then I think a real free-market solution is the most reasonable solution, again I don't think this is without problems either. I don't believe there is a "perfect" solution. But I think either a true free-market system, or a single-payer system would both undoubtedly be 100x better than the current system in the US. I would be in favor of moving to either of these solutions as my political stance isn't D or R but "lets make improvements" regardless if those improvements are seen as left or right.
- UnpossibleJim 5y ago
  I only put this out there because I feel it needs to be, but we can't just put all of health-care into a single basket. Emergency medicine should be separated out of these discussions as there is no "Free Market" option, just as there is no real free market option for police or fire services. For optional surgery or cosmetic treatment, sure. You can argue a free market option, but that's why I always think there should be separate baskets, for lack of a better term.
  - hitpointdrew 5y ago
    This is very fair point and distinction.
  - ksec 5y ago
    Which I think and correct me if I am wrong, is currently the norm for most developed countries? It is sort of strange it needs to be explicitly written out, at the same time for those of us not from US we just took it for granted and never think much about the system.

merpnderp 5y ago

I’m interested in this worst performing stat. By what measure? Because I’ve always read that when controlling for the relative poor health of the us population regarding diseases related to poor eating and exercise habits, the US was a top performer for heart and cancer treatments.

mdoms 5y ago
So if you imagine that USA was healthy then health outcomes look great?
telxosser 5y ago
I am pushing 50 years of age and one constant in my life is people shitting on the US healthcare system. I have family in Canada with family members the same age on both sides. Canada is great if you are a healthy broke college student. No one in their right mind would ever pick Canadian health care over the US though if you are 60+. There is no way you would rather have cancer in a country with free health care.
- standardUser 5y ago
  "There is no way you would rather have cancer in a country with free health care." Unless you can't afford for-profit healthcare. Then any sane person would 100% prefer one of the fifty or so developed nations with free healthcare.
  - samoa42 5y ago
    also safe to say that a vast majority of ppl on the planet can't afford for-profit cancer treatment
mbg721 5y ago
At the very least, by billing transparency and paperwork load. Even Americans who are happy with their healthcare hate that.

causi 5y ago

Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. Not that your thesis isn't correct but be careful there. You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. The quality of care for Americans who can afford care is excellent.

cntainer 5y ago
> You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. Well that's the point, I think everybody should be taken into account in order to paint a comprehensive picture of the quality of the system at country level. The resulting stats reflect the health of a society as a whole not just of the part that can afford it. Not having universal healthcare is still part of the system, even if we don't like it. I get it that health outcomes of those left out are probably very different. But leaving those numbers out of the comparison doesn't really work with these type of statistics. At that point how could you compare it to the other countries that take everyone into consideration? The stats are GDP/capita percentages, should I remove the ones who can't afford healthcare from the GDP stats as well to not skew the ratio? I don't really like where I might end up taking this route. I don't have any experience with US healthcare and I'm sure the quality of the services is really high, but the fact that you need to afford basic healthcare and it's not guaranteed by the government for everyone makes me see it as closer to just another "consumer product" compared to other systems.
- A4ET8a8uTh0 5y ago
  Yes, but anyone in US that has healthcare in US and reads the paragraph above will come to a conclusion along the lines of 'Wait, my experience wasn't bad; what am I missing?'. As a result, you may end up making an opposite of the point you are trying to make.
- kayodelycaon 5y ago
  When it comes to healthcare in the US, a lot of people who can afford it don't care about people who can't afford it. Hence the common belief by the middle class that the US has the best healthcare in the world. (That's before you add in a large dose of American exceptionalism.)

ErikVandeWater 5y ago

> So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. The US healthcare is an example of the government being massively over-involved and creating massive inefficiencies.

CraigJPerry 5y ago
Counter point: the NHS in the UK has more government involvement than the US healthcare system. The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. “Better outcomes” needs more detail: Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an aspect of healthcare costs. Cost of triple bypass heart surgery: US: $110,000, UK: £8,500 (paid by the taxpayer, not by the patient at the point of care - free for them). (P.s. private healthcare is available in the UK too - the procedure costs around £20,000 privately, payable by the patient or their insurance) Life expectancy… you get the idea.
- JumpCrisscross 5y ago
  > NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US The American system’s problem is exclusion, not quality of care. If you get care in America, your outcomes are among the best in the world.
  - CraigJPerry 5y ago
    Yeah you’re right, s/patients/citizens/
  - rg111 5y ago
    Someone told me this a few years back and it stuck with me. "American healthcare is the best in the world like sportscars- Ferrari, Lamborghini, BMW, Bugatti, etc. are the best cars in the world. Surely they both are the bests in the world- but only for the small percentage of people that can actually afford them." This is sad. (Many, including me, wouldn't buy a sportscar even if they could afford one, and sportscars aren't the "best" in their opinion. But this comparison drives the point home.)

pjc50 5y ago

The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you retain choice of providers. It doesn't need to be a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from). There's also an informational problem; in a fully free speech environment it's much easier to sell people unreliable cures, Theranos passim.

throwaway0a5e 5y ago
Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (insurers) and then act surprised that they take a fat cut. The solution isn't to government-ize the middle man. That will almost certainly just be a wash. It's to get rid of the middle man where possible. There's no reason someone shouldn't be able to get a physical or a colonoscopy the same way cosmetic surgery and dental care are done. These are cookie cutter outpatient services. The deviation from instance to instance is small and predictable so insurance should not be needed on the consumer side. Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong?
- netizen-936824 5y ago
  The healthcare industry already pisses away huge amounts of money. Its evident in all those stories we hear about people getting a huge $5000+ medical bill, then calling the hospital and suddenly its $100 or less. That $4900 is literally all wasted
- andrekandre 5y ago
  > Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong? just a guess, but it might be because of... Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. ... one of the reasons most visits in the us is the er is precisely because preventative care is so expensive/hard-to-get in the u.s and people put off visiting the doctor regularly since its so expensive... the market isn't very amenable to these extra costs in the short run, whereas a state-run system might not have the same short-term cost concerns and encourage/subsidize regular visitation/preventative-care...

snarfy 5y ago

> Which doesn't really fit the view that less government involvement results in a more efficient system The government may not pay for the actual service but there is huge government involvement and mountains of regulations to climb.

SamoyedFurFluff 5y ago
I would argue some of those regulations are moat building explicitly to ensure healthcare as a commodity.

toolz 5y ago

I'm curious how you can suggest the US government spends the most money in the world, by far, on healthcare and the simultaneously suggest there's less government involvement. The government is involved in every step of American healthcare. As you can imagine of a system that gets all of its funding thru companies completely overseen by regulatory bodies or thru social programs.

onlyrealcuzzo 5y ago
Compared to a single-payer socialized system, this is less involvement - even if it is a lot of involvent.
- toolz 5y ago
  by what metric?
cntainer 5y ago
I didn't really suggest that the US Government spends money on healthcare, I was merely quoting the article: "Health care consumes 18% of GDP in America" Please note that the wording implies that 18% of GDP is spent on health care overall not that the US Government is spending all that money out of its pocket directly on yearly budgets. The way I understand it is that it includes both money spent by public and private actors for all health related service. I see this type of stat a warning that something might be dysfunctional within the system, and it's the government's job to get to the bottom of it.
stefan_ 5y ago
There is some crazy amnesia here about the US healthcare system. Some 40% of the US are already covered through Medicaid/Medicare - "socialism" is long here!

onlyrealcuzzo 5y ago

One point that gets skipped over a lot - the US is also one of the most unhealthy countries in the advanced world. This is a big /part/ of the "worst outcomes" in the "highest cost, worst outcomes". It is possible that you can spend a ton of money on healthcare - yet smoke and drink, drive everywhere and not exercise at all, and eat trash - that the healthcare spending is doomed to fail. Europeans walk & bike more and don't eat as much garbage. Most Asians exercise much more, eat healthier, AND smoke and drink less. Maybe the healthcare part is secondary to just generally taking care of your health? It is well understood how terrible obesity is for you. Why should we expect the US to have better healthcare outcomes than Vietnam when Vietnam is 2.1% obese and the US is 42% obese. You can take all the heart medicine in the world. It would be better to simply not be obese in the first place! This never seems to be a talking point. Have the statisticians controlled for all this when they come to these conclusions??

Bjartr 5y ago
This is a good point, and it's important to also remember that these ideas aren't independent. How people interact with the healthcare system over their lifetimes has an impact on how they think about their health, and the health impacting decisions in their lives.
mtberatwork 5y ago
> Most Asians exercise much more, eat healthier, AND smoke and drink less. Tobacco consumption in Asia is incredibly high: https://en.wikipedia.org/wiki/Tobacco_consumption_by_country https://en.wikipedia.org/wiki/Tobacco_consumption_by_country
- decafninja 5y ago
  Alcohol consumption is fairly high too. https://worldpopulationreview.com/country-rankings/alcohol-consumption-by-country https://worldpopulationreview.com/country-rankings/alcohol-c... Though I suppose China and India, which combined probably comprise the biggest block of population, are a slightly better shade of red than the US and Europe.
5y ago

syshum 5y ago

>>e most expensive and worst-performing in terms of outcomes compared to the other developed countries. That is only true if you cherry pick statics that over sample for life style choices, and under sample of actual health care. If you look at statics that are directly attributable to the care provided, not the life style choices of the patients then the US Healthcare system is far better than any other nation

rscho 5y ago

Yes, so. The typical American response to that is: "the government controls everything. Let the free market do its job!" And then wonder why they get shit care for a huge price BUT swith nice marketing and a smiling "health dealer" getting you a 0% lease... oh sorry, we got you confused with a Chevvy! And also, "we have the best care in the world because our docs are better selected". This one never fails to make me laugh, as a swiss MD

mbg721 5y ago
Yes, that's the response, but healthcare in America is far from a free market. It's more a circle of sloppy middlemen, in much the same way that I hear privatized passenger rail in the UK described.

wreath 5y ago

> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. In what way is it the worst-performing? I mean, what are the outcomes that are measured to determine its performance? Yes, healthcare is a lot cheaper in Europe (even if your employer wouldn't pay their part) compared to the US, but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance.

dragonwriter 5y ago
> but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance. That's exactly like US healthcare if you aren't either a wealthy private-pay client or someone with top-flight private insurance; we just pay twice as large a share of GDP and even a higher multiple per capita to have the same normal experience and many more people uninsured than any other developed economy (and we've only recently through the ACA, gotten it so the that your top-flight insurance plan wouldn't look to retroactively cancel your insurance when you got an expensive-to-treat condition, leaving you uninsured and uninsurable.)
- wreath 5y ago
  > leaving you uninsured and uninsurable. This one is pretty messed up indeed. What's the purpose of being insured to begin with if it will fuck you over when you need the insurance?
  - lotsofpulp 5y ago
    It has not been true for 10+ years. Affordable Care Act (ACA) outlawed denying insurance to anyone, regardless of how much their future healthcare expenses will be. It is one of the reasons that everyone complained about ACA increasing health insurance costs - it had to because more people were getting more healthcare. ACA also outlaws pricing insurance on anything other than age, smoking status, and location. Even the pricing due to age is capped so that the premium for the oldest (riskiest) age is only allowed to be 3x the young age premium. ACA also implemented out of pocket maximum for in network care, so that there is a maximum cost per calendar year you would be responsible for. Recent law that went into effect Jan 1, 2022, extends this out of pocket maximum to all healthcare providers in the US if it is an emergency. Finally, ACA also instructed an appeal process if you think the insurance company is denying payment for treatment justified with evidence: https://www.healthcare.gov/appeal-insurance-company-decision/appeals/ https://www.healthcare.gov/appeal-insurance-company-decision...

jollybean 5y ago

US Healthcare is not the 'worst performing', that's a perennial clickbait theme. Health issues are bad in the US, and people use that as 'evidence' for quality of the Healthcare system, but that's not fair. People shooting each other, not eating well or exercising, isn't so much a function of the US Healthcare system. The US system is probably the most economically inefficient, but that's also expected at the highest end of quality. The US has most of the best quality systems in the world, it's just expensive and messed up financially, but the quality itself is something to behold. While I share your reservations about 'privately backed things' - for example, advertising arcane drugs in the US is ridiculous, this whole 'Ask Your Doctor' is an excuse for pushy patients to 'prescribe themselves' over the will of tired Doctors caving in ... ... that said, Theranos is the opposite example. If it had worked, it would have been because of VC backing and it would have been very beneficial to people. And there are many things like that. Like anything, it's complicated, and we need nuanced thinking about it. We probably should welcome a lot more VC spend, think of ways to empower doctors with the deluge of information, to empower individuals but at the same time get them to understand that they are not medical professionals and shouldn't be self-diagnosing, etc..

nradov 5y ago

There are huge variations in performance depending on what metric you look at. The US is at or near the top in 5-year survival rates for most types of cancer.

Quinner 5y ago

Much like US Defense spending subsidizes the rest of the globe, US for-profit healthcare spending spurs massive investment in pharma and biotech research that benefits the rest of the world. Are there inefficiencies and waste? Yes. But outcomes overall are much better for it.

samoa42 5y ago
i mean, why waste effort on curing ppl that contribute to global overpopulation.

mattparcens 5y ago

But isn't it the government that allows the healthcare system to hold you financially accountable for opaque and arbitrary bills?

xkbarkar 5y ago

in 2019 I would have agreed with you. In iceland you will not be charged for cancer treatment, but the medical costs of getting a long term illness in Iceland are not trivial. Add that to loss of income and the situation for many chronically ill is actually so terrible that laughing at the US is not something Iceland can afford. And covid has painfully displayed exactly how poorly managed the hospitals are and how starved the health care system really is. The equivalent of a bus accident will put the healthcare system on its knees or 80 people needing intensive care. of course Iceland has more hospital beds than 80, but it cannot handle a disease that may put 80 people in ICU ( not counting ventialtion here at all, just intensive care ). I think many in Iceland, myself included, are a bit in shock of exactly how poorly managed and starved the health care system is. Up until 2019 I laughed at the dumb americans and their awful health care, man did I get my sit-upon whopped in the past 2 years. Icelands is so bad that we are regularily filling hospital break rooms and garages with patients. THat is on a normal non-influenze season. Let alone sars-cov-2 introduction. I suspect Canada is having a similar realization as we are. Free care in all its honour. Starved free care, heh...... Shame on us. Really. Shame on us.

dr_orpheus 5y ago

> Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population. My favorite example of this is when I had to get an MRI. The lab imaging said it would be $800 if they billed it through insurance, or it would be $600 to just pay for it directly out of pocket. So the cost of having to deal with my insurance (which always advertises the "discounts" they negotiate and the "lowest cost") was actually more than what the insurance would actually cover.

majormajor 5y ago
This is always extra annoying because it might be a false savings to pay cash there. Let's say your MRI says you need a $5500 procedure, and your plan's deductible is $3000, 90% coverage after, and out of pocket max is $6000, and there's nothing else you've spent on the plan this year. Pay $800 for MRI with insurance, you'll then pay $2200 for the procedure to hit the deductible + 10% of the remaining $3300, so $2530 total for the procedure. $3330 total for the year between the two things. Pay $600 cash for MRI, you'll then pay $3000 for the procedure to hit the deductible, and 10% of the remaining $2000, so $3200 total for the procedure. Now you've paid $3800 total, so you've spent $470 more despite the MRI being "cheaper"! If you have other expenses so your out of pocket max comes into play, that difference approaches the full $600.
- arethuza 5y ago
  Do you folks have to perform these calculations every time someone in your family gets sick or injured?
  - majormajor 5y ago
    Usually no, most people just use doctor-suggested or in-insurance-network providers and billing because it's easier than calling multiple places and hyper-optimizing on the math. But we have to pay the bills after the insurance company does the calculation, which often results in annoying surprises. The better your insurance, the less nasty surprises, which largely in the US means "the better you're paid, the less you have to pay out of pocket for health expenses" which is a nasty thing because then the people most likely to be hit with a big bill are those who can least afford it.

TrispusAttucks 5y ago

You hit the nail on the head. > So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population. Healthcare and Big Pharma have captured regulators at various federal health institutions. The mission is maximizing profit outcomes not health outcomes.

nonethewiser 5y ago

> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. Considered by whom?

majormajor 5y ago

It's not all bad to spend more - consider the extra hospital capacity that so far has helped absorb COVID shock impacts better than neighboring Canada. Hopefully we don't hit the limit of that, even, though. https://www.bloomberg.com/news/articles/2022-01-06/hospital-bed-shortage-shuts-down-canada-while-u-s-stays-open https://www.bloomberg.com/news/articles/2022-01-06/hospital-... US health outcomes also aren't so bad for those who have affordable access to the system, as I understand it. But the spending is something to keep in mind when anti-healthcare-for-all advocates say things like "do you want to have to wait months for procedures like in Canada" - if the US continues to spend more money per person, there's no reason it can't continue to have more capacity.

hamter 5y ago
idk canada has 806 covid deaths per 1M and usa has 2573, it's not exactly screaming 'success story' to me.
- majormajor 5y ago
  Surely you aren't suggesting that having more hospital beds per capita in the US is causing more deaths? Capacity is hardly the only factor in how Covid is hitting the population (and having more hospital capacity reducing pressure to lock things down will itself affect the rate of spread). For instance, per https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million https://ourworldindata.org/grapher/total-covid-cases-deaths-... Canada has seen 66K cases per million and 807 deaths per 1M cumulatively. The US is at 180K and 2515. Slightly different numbers than yours, but close enough. Deaths/cases to date is very similar, 1.4% in US and 1.2% in Canada. So the difference in total deaths is largely policy and behavioral, the aggregate policy across the US has largely been one of "at this point we can't eradicate it so we need to live with it as best we can" where even the liberal US states remain quite open compared to initially in 2020 in the face of recent surges. Whether or not that's the right policy is separate from whether or not that policy would've even been realistic without as much health care capacity.
  - hamter 5y ago

bushbaba 5y ago

The us healthcare system is not capitalistic. If I get my flu shot I have no idea how much it cost my insurance company. CVS, Walgreens, Safeway all the same to me for a flu shot. If instead we use health insurance like home insurance for unforseen major issues, and had price transparency. Then prices would go down as people would shop around.

terr-dav 5y ago
What you're describing is the lack of a normal market, and even that only applies if you have insurance. For the millions of people without insurance, they do indeed shop around. It is very much a capitalist system, since the ownership (& control) of the system is not in the hands of the workers - in insurance companies, hospitals, pharma, etc - but in the hands of wealthy shareholders. To be fair, I suspect your definition of capitalism is very different from mine...
- bushbaba 5y ago
  Those without insurance are quoted prices different than what insurance companies pay. Even getting a price quote is often impossible. Government should enforce the same pricing to all parties or allow everyone to get the same prices Medicare negotiated.

hitpointdrew 5y ago

> the fact that healthcare is already a consumer product in the US I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then: 1. It wouldn't be tied to or dependent on my employment. 2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers. 3. Insurance providers wouldn't be restricted by arbitrary/geographical boundaries. I think the debate over weather healthcare is a human right is an interesting one, and I personally haven't come to any conclusion on that yet. If you think healthcare is a basic human right then a single-payer system is probably the most reasonable solution, although I don't think single payer isn't without it's share of problems. If you think healthcare is not a basic human right then I think a real free-market solution is the most reasonable solution, again I don't think this is without problems either. I don't believe there is a "perfect" solution. But I think either a true free-market system, or a single-payer system would both undoubtedly be 100x better than the current system in the US. I would be in favor of moving to either of these solutions as my political stance isn't D or R but "lets make improvements" regardless if those improvements are seen as left or right.

UnpossibleJim 5y ago
I only put this out there because I feel it needs to be, but we can't just put all of health-care into a single basket. Emergency medicine should be separated out of these discussions as there is no "Free Market" option, just as there is no real free market option for police or fire services. For optional surgery or cosmetic treatment, sure. You can argue a free market option, but that's why I always think there should be separate baskets, for lack of a better term.
- hitpointdrew 5y ago
  This is very fair point and distinction.
- ksec 5y ago
  Which I think and correct me if I am wrong, is currently the norm for most developed countries? It is sort of strange it needs to be explicitly written out, at the same time for those of us not from US we just took it for granted and never think much about the system.