8 ms·

A bit confusing because the hospitals in Boston have wings for foreigners with luxury accommodations, and people all over the world fly in to get top-tier proce

A bit confusing because the hospitals in Boston have wings for foreigners with luxury accommodations, and people all over the world fly in to get top-tier procedures done. My son was born with complications and my insurance paid for all of it at such a top-tier Boston hospital (I am a Boston resident and US citizen). So maybe things aren’t so simple. https://www.bostonmagazine.com/health/2015/11/24/boston-hospitals-luxury-rooms-amenities/ https://www.bostonmagazine.com/health/2015/11/24/boston-hosp...

jpgvm 4y ago
The existence of very expensive private care in the US isn't counter to my point if anything it's an embodiment of it. Furthermore it's probably much more expensive than you realize. Premium contributions and deductibles totaled 11.6% of median income in 2020, compared to 2% Medicare levy in Australia across the income spectrum. The US system isn't defendable. You can say things like "Well I'm rich so it works for me" but you can't make assertions that it's good as a whole.
- seibelj 4y ago
  I will assert that the US medical system has pros and cons, and I would advocate for significant structural reform. But such reform has not occurred despite decades of trying, and that’s because the system is not without the pros, and the pros make it infeasible to reform it at this time. Pretending that the system is completely useless and broken is ignoring basic facts - such as overwhelming majorities of Americans that like their primary care doctor and their current insurance. So it’s difficult to make such clear statements when the facts disagree with the progressive shrieking. Furthermore - https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor- https://www.spectator.co.uk/article/why-is-canada-euthanisin... > When the family of a 35-year-old disabled man who resorted to euthanasia arrived at the care home where he lived, they encountered ‘urine on the floor… spots where there was feces on the floor… spots where your feet were just sticking. Like, if you stood at his bedside and when you went to walk away, your foot was literally stuck.’ According to the Canadian government, the assisted suicide law is about ‘prioritis[ing] the individual autonomy of Canadians’; one may wonder how much autonomy a disabled man lying in his own filth had in weighing death over life. The world is very complex and nothing is black and white
  - jpgvm 4y ago
    That is part of the problem, you have taken something that can be measured objectively and instead politicised it. Not a uniquely American phenomenon but definitely practiced most commonly there. The system is without pros but that doesn't matter because of the existence of lobbyists. The American political system assigns representation proportionally by wealth of interests, that is just how it is. You can see it play out over and over again from tobacco, oil, healthcare etc. Preservation of outsized corporate profits at the expense of normal people is simply the norm in America and is ingrained in its political system. It has nothing to do with the pros and cons of actual healthcare provided to people (or the cost at which that care is provided), simply that those that stand to lose from making the system more efficient are willing to spend anything and everything to prevent that from happening. Unfortunately too much of the American population are happy to be duped into thinking the current system is good in some way AND that they should tie their political identity to it's preservation regardless of the facts. It's a tragedy tbh but maybe one day logic and economics will win out. Spending this much of GDP on healthcare is just stupidly inefficient, especially when you still have so many simply not seeking care because of the financial ramifications of doing so - cheating the economy out of their productivity.
    - frumper 4y ago
      All doom and gloom. Having experienced some very good treatments and excellent outcomes for my daughter, I have a different opinion than "the system is without pros".
  - matthewmacleod 4y ago
    But such reform has not occurred despite decades of trying, and that’s because the system is not without the pros, and the pros make it infeasible to reform it at this time. This seems like a faulty assertion. It’s possible that this system offers benefits to some subset of people. But you can’t really draw much of a conclusion simply from its continued existence. If one of your “pro”s is “makes so much profit for insurance companies that they are willing to spend huge amounts of money to fight reform”… well, I can’t imagine that’s really what you mean by “pro”.
forum_ghost 4y ago
Medicine, first and foremost, is a BUSINESS. It is also a game of super-sub-specialization. The entire field. There essentially numerous subspecialties within each specialty. Some surgeons do nothing but the same apnea surgery 5 times a day. Some oncologists do nothing but specific neuroendocrine cancers all day. Some diagnosticians are good for a specific area of their field - and utterly useless elsewhere, because they just couldn’t care less and want to work on what they find interesting. Just like anyone else. If you want to see someone who actually knows what they are doing, sees the same exact issue you are having 10 times per day instead of once per decade, you WILL travel. Of course, you can always settle for the clueless doctor nearby who will do the bare minimum, or maybe even nothing. Remember: patient outcomes are not part of the standard of care. There are no real incentives to do better than bare minimum, as a physician. Sometimes the talent is in Switzerland. Sometimes Germany. Korea has some leading talents in niche areas. It just so happens that the US pays the best, and just like engineers who can write their ticket that move to Bay Area, so do the physicians that move to the US. Real life example: many neonatal surgeons only begin practising on their own, independently, in literally their late 30s, if not 40s. In training until then, whew. Slightly different than picking up a new JavaScript framework. Would you seek to maximise your income if you had to study for 20 years after high school? Neonatal surgery is often $1-2 million per surgery. There are only a handful of such centres. Only some of them operated on a specific condition more than 10 times. The same really goes for anything else from diagnostic to operators. Even in the US, you’d often have to travel out of state if you want to get a proper opinion. Easier with imaging or biopsies because these can be mailed. Tons of people travel for surgeries. 250k Canadians every year travel to the US to get care they cannot get on time (or at all) at home. I’ve seen it all, even Saudis flying over for dental work. Next time you see your doctor ask them who would they pick for their surgery: someone who does the procedure 100x per year, or someone who maybe does 1-2 cases per year. Then guess where the most super-specialized talent can maximise their income. Probably not the remote Australia with a population of ~10% of the US. US simply has the best talent. If you can afford it. As for Canada/NHS/Australia being better - that’s just laughable. Canada is actually dead last among top 10 richest countries, and happens to have the second highest drug prices after Switzerland. Also has as many beds per capita as Mexico. You’d be better off going literally anywhere else. Mayo at Rochester has a larger diagnostic antibody library than anything in those three countries combined, and can arrive at your diagnosis within two days instead of two decades. Guess where your tertiary centre in Canada/Aus/Uk often mails your blood work and biopsies once they are at the end of the rope? That’s right. USA.

jpgvm 4y ago

The existence of very expensive private care in the US isn't counter to my point if anything it's an embodiment of it. Furthermore it's probably much more expensive than you realize. Premium contributions and deductibles totaled 11.6% of median income in 2020, compared to 2% Medicare levy in Australia across the income spectrum. The US system isn't defendable. You can say things like "Well I'm rich so it works for me" but you can't make assertions that it's good as a whole.

seibelj 4y ago
I will assert that the US medical system has pros and cons, and I would advocate for significant structural reform. But such reform has not occurred despite decades of trying, and that’s because the system is not without the pros, and the pros make it infeasible to reform it at this time. Pretending that the system is completely useless and broken is ignoring basic facts - such as overwhelming majorities of Americans that like their primary care doctor and their current insurance. So it’s difficult to make such clear statements when the facts disagree with the progressive shrieking. Furthermore - https://www.spectator.co.uk/article/why-is-canada-euthanising-the-poor- https://www.spectator.co.uk/article/why-is-canada-euthanisin... > When the family of a 35-year-old disabled man who resorted to euthanasia arrived at the care home where he lived, they encountered ‘urine on the floor… spots where there was feces on the floor… spots where your feet were just sticking. Like, if you stood at his bedside and when you went to walk away, your foot was literally stuck.’ According to the Canadian government, the assisted suicide law is about ‘prioritis[ing] the individual autonomy of Canadians’; one may wonder how much autonomy a disabled man lying in his own filth had in weighing death over life. The world is very complex and nothing is black and white
- jpgvm 4y ago
  That is part of the problem, you have taken something that can be measured objectively and instead politicised it. Not a uniquely American phenomenon but definitely practiced most commonly there. The system is without pros but that doesn't matter because of the existence of lobbyists. The American political system assigns representation proportionally by wealth of interests, that is just how it is. You can see it play out over and over again from tobacco, oil, healthcare etc. Preservation of outsized corporate profits at the expense of normal people is simply the norm in America and is ingrained in its political system. It has nothing to do with the pros and cons of actual healthcare provided to people (or the cost at which that care is provided), simply that those that stand to lose from making the system more efficient are willing to spend anything and everything to prevent that from happening. Unfortunately too much of the American population are happy to be duped into thinking the current system is good in some way AND that they should tie their political identity to it's preservation regardless of the facts. It's a tragedy tbh but maybe one day logic and economics will win out. Spending this much of GDP on healthcare is just stupidly inefficient, especially when you still have so many simply not seeking care because of the financial ramifications of doing so - cheating the economy out of their productivity.
  - frumper 4y ago
    All doom and gloom. Having experienced some very good treatments and excellent outcomes for my daughter, I have a different opinion than "the system is without pros".
- matthewmacleod 4y ago
  But such reform has not occurred despite decades of trying, and that’s because the system is not without the pros, and the pros make it infeasible to reform it at this time. This seems like a faulty assertion. It’s possible that this system offers benefits to some subset of people. But you can’t really draw much of a conclusion simply from its continued existence. If one of your “pro”s is “makes so much profit for insurance companies that they are willing to spend huge amounts of money to fight reform”… well, I can’t imagine that’s really what you mean by “pro”.

forum_ghost 4y ago

Medicine, first and foremost, is a BUSINESS. It is also a game of super-sub-specialization. The entire field. There essentially numerous subspecialties within each specialty. Some surgeons do nothing but the same apnea surgery 5 times a day. Some oncologists do nothing but specific neuroendocrine cancers all day. Some diagnosticians are good for a specific area of their field - and utterly useless elsewhere, because they just couldn’t care less and want to work on what they find interesting. Just like anyone else. If you want to see someone who actually knows what they are doing, sees the same exact issue you are having 10 times per day instead of once per decade, you WILL travel. Of course, you can always settle for the clueless doctor nearby who will do the bare minimum, or maybe even nothing. Remember: patient outcomes are not part of the standard of care. There are no real incentives to do better than bare minimum, as a physician. Sometimes the talent is in Switzerland. Sometimes Germany. Korea has some leading talents in niche areas. It just so happens that the US pays the best, and just like engineers who can write their ticket that move to Bay Area, so do the physicians that move to the US. Real life example: many neonatal surgeons only begin practising on their own, independently, in literally their late 30s, if not 40s. In training until then, whew. Slightly different than picking up a new JavaScript framework. Would you seek to maximise your income if you had to study for 20 years after high school? Neonatal surgery is often $1-2 million per surgery. There are only a handful of such centres. Only some of them operated on a specific condition more than 10 times. The same really goes for anything else from diagnostic to operators. Even in the US, you’d often have to travel out of state if you want to get a proper opinion. Easier with imaging or biopsies because these can be mailed. Tons of people travel for surgeries. 250k Canadians every year travel to the US to get care they cannot get on time (or at all) at home. I’ve seen it all, even Saudis flying over for dental work. Next time you see your doctor ask them who would they pick for their surgery: someone who does the procedure 100x per year, or someone who maybe does 1-2 cases per year. Then guess where the most super-specialized talent can maximise their income. Probably not the remote Australia with a population of ~10% of the US. US simply has the best talent. If you can afford it. As for Canada/NHS/Australia being better - that’s just laughable. Canada is actually dead last among top 10 richest countries, and happens to have the second highest drug prices after Switzerland. Also has as many beds per capita as Mexico. You’d be better off going literally anywhere else. Mayo at Rochester has a larger diagnostic antibody library than anything in those three countries combined, and can arrive at your diagnosis within two days instead of two decades. Guess where your tertiary centre in Canada/Aus/Uk often mails your blood work and biopsies once they are at the end of the rope? That’s right. USA.