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Going off the topic a bit- I was recently listening to an American podcast and it was talking about a single mother who worked multiple jobs finally getting a g

Going off the topic a bit- I was recently listening to an American podcast and it was talking about a single mother who worked multiple jobs finally getting a good full time job who said that they would visit the doctor even though they aren't sick "just because they can", and this made me, a non American, tear up. how could people in the developed world, even poor people, not have access to healthcare, when even our government with a fraction of the US govt budget provides free basic Healthcare and people are generally able to see doctors.. seems like a very strange thing right? has the word "developed" lost all meaning? or is the US not a developed country anymore?

spoonjim 4y ago
I saw a Tweet to the effect of "Instead of thinking of the US as a version of Norway or the Netherlands that happens to be failing on virtually every metric, it's more accurate to think of the US as a version of Brazil that happens to be rich."
- shreyshnaccount 4y ago
  would be very interesting to see what metrics one can use to visualise this sentiment, and if it's true or not (my feeling is it's true). imo metrics like GDP, healthy birth, education etc provide a distorted and inaccurate view of citizen welfare. to have a good society, we need to choose metrics that will rank a perfect utopia better than a dystopia (which we don't have, a slave state will have higher GDP, cuz, well, slaves) . but ofc, everyone can't agree on what utopia looks like, so how do you get the metrics? maybe by agreeing on some basic ground rules (slavery bad, murder bad, work-life balance good etc) and build metrics based on these. ofc now no one will agree on the ground rules, but I suppose it's the elected governments job to decide those based on the specific culture of a country. ofc this is a very simplified view of reality and will fall apart in mere minutes in the real world, but kight serve as a starting point, no?
  - kwhitefoot 4y ago
    > see what metrics one can use to visualise this sentimen the Gini coefficient goes some way. In percent: Norway 27.6 US 41.5 Brazil 53.4 See https://worldpopulationreview.com/country-rankings/gini-coefficient-by-country https://worldpopulationreview.com/country-rankings/gini-coef...
- arwhatever 4y ago
  That’s a hilarious and great point. I’ve had the same thought before - America does a great job within its population bracket, but it doesn’t make sense at all comparing us to, say, a Switzerland or a New Zealand.
  - vinay427 4y ago
    Switzerland has what may be one of the more comparable health insurance systems to that in the US. I definitely thought twice or three times before contacting a doctor (and ended up not doing so), and somewhat regretted an ambulance being called for me due to the ensuing bill.
- toyg 4y ago
  This is the correct approach, but I think the real answer is "a version of Brazil that fully capitalized on European wobbles in the first half of the XX century". The US effectively conquered Europe in WW2, hence acquiring complete leadership of the rich world.
db48x 4y ago
I blame WWII, and the idiots we had in Congress at the time. Before WWII, health care was super cheap. It was so inexpensive that nobody budgeted for it, or considered how they would ever pay for it. Health insurance technically existed, but it was rarely used; most people would never have high medical bills, so most people saw no advantage in paying a monthly fee for the insurance instead of just paying for the health care as they needed it. During WWII, Congress wanted to be seen to help the war effort, so they started passing bills. Some of those were ok, some were terrible. The worst were the price and wage controls. Price controls create shortages, and wage controls create shortages of workers. Since the supply of employees went down drastically (with so many people going into the military), naturally wages had to rise. But once wage controls were in place, employers could not offer more money. The best that they could do was to offer perks instead. Waiters started asking for tips. White–collar employers started offering free health insurance and other perks. Others offered free housing, and even whole company towns. Pensions are another good example. By the time the war ended, these and other perks were rapidly becoming ubiquitous. Free housing and company towns were too easily abused, so in the 50s those were gradually done away with. You can read about the problems with tipping elsewhere. Ever since the end of WWII, the cost of healthcare has risen steadily. (So did the quality of the care, of course.) People no longer pay for health care as they need it. They no longer shop around for the best prices, even for predictable expenses such as childbirth. Most hospitals won’t even tell you what their prices are, even though they are now technically required to maintain a webpage with that information. (Most primary care physicians are much more reasonable about such things, but even they might not know ahead of time what everything will cost, since it might depend on what insurance you have.) It’s pretty easy to see why prices are rising. People pay thousands of dollars per year for insurance, whether they need any health care or not. Nobody knows exactly what anything will actually cost until afterwards, when they are arguing with their insurance company about it. In fact, prices are so opaque that hundreds or thousands of people every year make simple mistakes that cost them tens of thousands of dollars. There are as many sob stories as you care to listen to from people who went to a hospital with an injury that wasn’t immediately life threatening and were billed some outrageous amount. They could have gone to their normal doctor to have their broken bone set for a couple hundred dollars, but they instead have to pay thousands for the ambulance ride, thousands for the hospital bed, thousands for consultations with doctors whose names they don’t remember, etc. Now it is true that in situations like this it is difficult to go back in time and replay history with different choices, so I admit that this is not all as obvious to people as I make it sound. There is plenty of scope for disagreement about causes and effects. However, there is another source of evidence. Instead of going back in time and making different choices, we could do an A–B test. Have one group of people go with ubiquitous health insurance and another group avoid it, then compare the outcomes. You might think that this would be hard to arrange, but it actually happened! The Amish arranged their own lives to avoid most of the complications of modern life and high technology, and apparently that includes insurance as well. As I understand it, their health care is still very inexpensive; they haven’t had the same continual rise in prices that the rest of us have had.
notagoodidea 4y ago
Developed never really has the meaning that you think it has, imho. In Europe, during a long time, it really meant "like us" without thinking that each European country have a lot of different country. Looks at the difference in the Health system between Belgium and the Nederlands. Actually the terminology shifted in some organizations as a continum of Low to High income countries (set by the World Bank). It is far from perfect but it frames the differences and terminology differently in your mind.
thedailymail 4y ago
Going further off topic, inspired by the US single mother story. There's a joke in Japan about a group of old people sitting in the waiting room at a doctors office. One of them asks, "Hey, where's Tanaka-san?" Another one answers, "She couldn't make it. She's sick."
rmbyrro 4y ago
When it comes to classifying countries, "developed" does not mean "equal access". US healthcare system is arguably one of the most advanced (if not the most) in the world. It's just not affordable for a good chunk of their population.

spoonjim 4y ago

I saw a Tweet to the effect of "Instead of thinking of the US as a version of Norway or the Netherlands that happens to be failing on virtually every metric, it's more accurate to think of the US as a version of Brazil that happens to be rich."

shreyshnaccount 4y ago
would be very interesting to see what metrics one can use to visualise this sentiment, and if it's true or not (my feeling is it's true). imo metrics like GDP, healthy birth, education etc provide a distorted and inaccurate view of citizen welfare. to have a good society, we need to choose metrics that will rank a perfect utopia better than a dystopia (which we don't have, a slave state will have higher GDP, cuz, well, slaves) . but ofc, everyone can't agree on what utopia looks like, so how do you get the metrics? maybe by agreeing on some basic ground rules (slavery bad, murder bad, work-life balance good etc) and build metrics based on these. ofc now no one will agree on the ground rules, but I suppose it's the elected governments job to decide those based on the specific culture of a country. ofc this is a very simplified view of reality and will fall apart in mere minutes in the real world, but kight serve as a starting point, no?
- kwhitefoot 4y ago
  > see what metrics one can use to visualise this sentimen the Gini coefficient goes some way. In percent: Norway 27.6 US 41.5 Brazil 53.4 See https://worldpopulationreview.com/country-rankings/gini-coefficient-by-country https://worldpopulationreview.com/country-rankings/gini-coef...
arwhatever 4y ago
That’s a hilarious and great point. I’ve had the same thought before - America does a great job within its population bracket, but it doesn’t make sense at all comparing us to, say, a Switzerland or a New Zealand.
- vinay427 4y ago
  Switzerland has what may be one of the more comparable health insurance systems to that in the US. I definitely thought twice or three times before contacting a doctor (and ended up not doing so), and somewhat regretted an ambulance being called for me due to the ensuing bill.
toyg 4y ago
This is the correct approach, but I think the real answer is "a version of Brazil that fully capitalized on European wobbles in the first half of the XX century". The US effectively conquered Europe in WW2, hence acquiring complete leadership of the rich world.

db48x 4y ago

I blame WWII, and the idiots we had in Congress at the time. Before WWII, health care was super cheap. It was so inexpensive that nobody budgeted for it, or considered how they would ever pay for it. Health insurance technically existed, but it was rarely used; most people would never have high medical bills, so most people saw no advantage in paying a monthly fee for the insurance instead of just paying for the health care as they needed it. During WWII, Congress wanted to be seen to help the war effort, so they started passing bills. Some of those were ok, some were terrible. The worst were the price and wage controls. Price controls create shortages, and wage controls create shortages of workers. Since the supply of employees went down drastically (with so many people going into the military), naturally wages had to rise. But once wage controls were in place, employers could not offer more money. The best that they could do was to offer perks instead. Waiters started asking for tips. White–collar employers started offering free health insurance and other perks. Others offered free housing, and even whole company towns. Pensions are another good example. By the time the war ended, these and other perks were rapidly becoming ubiquitous. Free housing and company towns were too easily abused, so in the 50s those were gradually done away with. You can read about the problems with tipping elsewhere. Ever since the end of WWII, the cost of healthcare has risen steadily. (So did the quality of the care, of course.) People no longer pay for health care as they need it. They no longer shop around for the best prices, even for predictable expenses such as childbirth. Most hospitals won’t even tell you what their prices are, even though they are now technically required to maintain a webpage with that information. (Most primary care physicians are much more reasonable about such things, but even they might not know ahead of time what everything will cost, since it might depend on what insurance you have.) It’s pretty easy to see why prices are rising. People pay thousands of dollars per year for insurance, whether they need any health care or not. Nobody knows exactly what anything will actually cost until afterwards, when they are arguing with their insurance company about it. In fact, prices are so opaque that hundreds or thousands of people every year make simple mistakes that cost them tens of thousands of dollars. There are as many sob stories as you care to listen to from people who went to a hospital with an injury that wasn’t immediately life threatening and were billed some outrageous amount. They could have gone to their normal doctor to have their broken bone set for a couple hundred dollars, but they instead have to pay thousands for the ambulance ride, thousands for the hospital bed, thousands for consultations with doctors whose names they don’t remember, etc. Now it is true that in situations like this it is difficult to go back in time and replay history with different choices, so I admit that this is not all as obvious to people as I make it sound. There is plenty of scope for disagreement about causes and effects. However, there is another source of evidence. Instead of going back in time and making different choices, we could do an A–B test. Have one group of people go with ubiquitous health insurance and another group avoid it, then compare the outcomes. You might think that this would be hard to arrange, but it actually happened! The Amish arranged their own lives to avoid most of the complications of modern life and high technology, and apparently that includes insurance as well. As I understand it, their health care is still very inexpensive; they haven’t had the same continual rise in prices that the rest of us have had.

notagoodidea 4y ago

Developed never really has the meaning that you think it has, imho. In Europe, during a long time, it really meant "like us" without thinking that each European country have a lot of different country. Looks at the difference in the Health system between Belgium and the Nederlands. Actually the terminology shifted in some organizations as a continum of Low to High income countries (set by the World Bank). It is far from perfect but it frames the differences and terminology differently in your mind.

thedailymail 4y ago

Going further off topic, inspired by the US single mother story. There's a joke in Japan about a group of old people sitting in the waiting room at a doctors office. One of them asks, "Hey, where's Tanaka-san?" Another one answers, "She couldn't make it. She's sick."

rmbyrro 4y ago

When it comes to classifying countries, "developed" does not mean "equal access". US healthcare system is arguably one of the most advanced (if not the most) in the world. It's just not affordable for a good chunk of their population.