14 ms·

My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost.

My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary

coredog64 4y ago
As two quick examples, both Switzerland and France have private healthcare providers and insurers. I think that’s enough to falsify your assumption :)
- simonw 4y ago
  Those countries both have "less generally" than the USA.
- e_i_pi_2 4y ago
  I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. Also FWIW France and Switzerland both have universal healthcare, under different systems where France splits payments 3 ways and covers more with the govt[1], and Switzerland seems to have a system like the ACA in the US where it's compulsory, but they also set caps on the deductibles and maximum price. [1]: https://en.wikipedia.org/wiki/Health_care_in_France https://en.wikipedia.org/wiki/Health_care_in_France [2]: https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
  - JumpCrisscross 4y ago
    > France and Switzerland both have universal healthcare You said private healthcare/insurance were to blame. Switzerland has private health insurance. Universal healthcare is a separate goal post. For what it’s worth, I’m unclear its comprehensive iteration is compatible with America’s immigration model. (It absolutely is for life-saving measures.)
    - PaulDavisThe1st 4y ago
      What aspect of America's immigration model do you think intersects with this? > You said private healthcare/insurance were to blame. Switzerland has private health insurance. Private business in all western countries operates within the regulations and laws that cover them. The health insurance industry in Switzerland operates under a very different set of regulations and laws than the same industry in the USA. If you want to blame the OP for not being more explicit - "private healthcare/insurance and the regulatory framework are to blame" - then fine, but ... this is actually the crux of the issue.
      - JumpCrisscross 4y ago
        > but ... this is actually the crux of the issue I'm not sure it is. Universal healthcare is orthogonal to private health insurance. That's the lesson of Switzerland's example. I don't believe this is commonly known or accepted in American politics. Instead, any attempt at reform is pitched and vilified as an attempt to end private health insurance and healthcare.
        bhupy 4y ago
        Not sure why you're getting downvoted, but this is exactly correct. Universal healthcare != public healthcare.
        PaulDavisThe1st 4y ago
        It may not be commonly known in the USA. However, I'm a european immigrant of 33 years, and it's well known to me. However, "private health insurance" is not, in and of itself, really "a thing". Only "private health insurance plus a regulatory structure for it". It is in this department that the US falls over so badly, while, for example, Switzerland gets it (mostly) right.
    - ggrrhh_ta 4y ago
      Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance, with regulated yearly price adjustments and on top of that, publicly funded hospitals and clinics (mostly unprofitable but of high quality and offering treatments that would not be profitable for private hospitals) that issue their bills to the health insurances. And, to put the icing on the cake, there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. Switzerland's compulsory private health insurance is nothing comparable to other countries' private insurance. There is "additional private insurance" in Switzerland (covering alternative medicine treatments, access to single bed rooms in hospitals, etc.) which do operate as private insurances elsewhere.
  - bhupy 4y ago
    It's not just Switzerland and France; the Netherlands also has a private-only health insurance system. It's also very difficult to draw decisive conclusions since, across countries, there are hundreds of confounding variables — it's not just public vs private, but it's also which regulations exist in each country, whether it's employer-sponsored vs individual, general willingness to pay, etc. You're correct that Switzerland has a system like the ACA in the US, but the biggest difference is that it's not common for the Swiss to get their private insurance from their employers; it's all on the individual market. The US is actually unique in that regard, and is probably the most significant difference — the vast majority of working age adults in the US get their insurance from their employers, and as a result the ACA's individual market has been in a dire state since the program's inception. Also "socialization" is very different from "nationalization". The general trend you're talking about is more to do with the fact that having society subsidize healthcare for the poor can lead to better outcomes. As it relates to who actually does the insuring, underwriting, and payment (public vs private), one isn't necessarily better than the other; each has its trade-offs. It's just that the US (in particular) has chosen the worst of both worlds. I work in this industry, and from where I sit, the closest thing we have to a clean A/B test that controls for all of those confounding variables is actually being run in the US right now, with Medicare. When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare. - 48% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly that the CBO projects that by 2023, the majority of beneficiaries with choose the private over the public option. The CBO further projects this proportion to increase to 61%(!!) by 2032. (https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/ https://www.kff.org/medicare/issue-brief/medicare-advantage-...) - For most beneficiaries, Medicare Advantage costs about 40% less than Original Medicare and are, on average, of higher quality than Original Medicare (https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare https://healthpayerintelligence.com/news/medicare-advantage-...) - In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan (https://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less-traditional-medicare https://www.commonwealthfund.org/publications/issue-briefs/2...) So no, you cannot look the cost difference between the US and other countries and simply conclude that it's because of private insurance, because the actual data tells a different story. And "universal healthcare" is not the same as "public" healthcare. It might help to think about it this way: universal access to food can be achieved without nationalizing the food industry, or the food payment industry.
  - jaarse 4y ago
    As a Canadian I have only know completely socialized healthcare. One of our largest problems right now is that our system is failing and can’t keep up. The solutions being rolled out by the provinces to fix the huge backlog of people waiting for care is to privatize more of the service delivery (while keeping single payer).
  - BurningFrog 4y ago
    > I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. You also haven't given even a hint of proof for this alleged trend. Maybe there is a trend, but let's look at some serious data before we just assume it's an obvious fact.
    - specialist 4y ago
      Google healthcare cost per capita vs life expectancy. Last time I checked, Canada, for example, spent 1/3rd less than the USA and Canadians lived a few years longer. IIRC, of the "universal coverage" systems, Switzerland's ACA-like system had the highest per capita, but still less than USA's system. Much has changed these last few years. eg Our life expectancy in the USA has fallen.
      - BurningFrog 4y ago
        I know this is really counterintuitive, but last I heard, health care isn't a major contributor to average life span. A much bigger factor is GDP per person. I think of it as: The more material wealth you have, the better your life is, and you get less risk of bad health.
      - refurb 4y ago
        Life expectancy is a terrible measure for quality of healthcare. It ignore so many other factors. The only way it could be a suitable measure if you assumed every human in every country was the same except for the healthcare they receive. It's pretty clear they aren't - lifestyle, smoking rates, alcohol and drug abuse, accidents, suicides, genetics. You’re far better to look at things like “survival after cancer diagnosis” where the US has some of the world’s best outcomes. https://www.healio.com/news/hematology-oncology/20180131/us-cancer-survival-rates-remain-among-highest-in-world https://www.healio.com/news/hematology-oncology/20180131/us-...
        specialist 4y ago
        > Life expectancy is a terrible measure for quality of healthcare. ...lifestyle, smoking rates, alcohol and drug abuse, accidents, suicides, genetics. Only if we assume public health is unrelated to individual health.
- Bayart 4y ago
  Private healthcare in France is supplementary to public healthcare and mostly abides by regulations dictating what can be reimbursed by the social security system, there's quite a bit of price control. It only gets wild in niche products (say very fancy dental implants).
mikem170 4y ago
Across the board price controls seem to be a common to the various European health care systems. It is my understanding that upper limits are set for the cost of medicine. There is quite a bit of variety across Europe - U.K. is 100% government run, France is a public/private mix, Germany is similar to Obamacare in some ways, others are single payer, apparently some are private, also. But I've read that they all have cost controls.
- Barrin92 4y ago
  beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.
  - dominotw 4y ago
    > Singapore which has exceptionally low healthcare spending yea because they have healthy population, its not because of some smart govt policy( if only it was that easy). singapore obesity rate = 10% usa obesity rate = 42 % usa obesity healthcare spend = 90%
    - groby_b 4y ago
      That 90% number is plain not true. Please cite any source for that. The costs for obese folk are on average 90%-100% higher than for non-obese folk, but that's not 90% of total spending. (See e.g. https://pubmed.ncbi.nlm.nih.gov/33470881/ https://pubmed.ncbi.nlm.nih.gov/33470881/) Total cost approaches 20% of spending: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/ https://www.hsph.harvard.edu/obesity-prevention-source/obesi...
      - imapeopleperson 4y ago
        Don’t get so hung up on precise numbers. We all know Americans are obese and that greatly adds to healthcare costs. I can’t imagine any downside of trying to prioritize lowering obesity.
pessimizer 4y ago
> countries without that or with less generally have better outcomes at less cost. This isn't necessarily a great metric, because almost all countries have better outcomes and all countries have lower per capita cost, whether their systems are public, private, or mixed. The US spends more public funds on healthcare than countries with universal socialized health care systems. The fact that we're also personally bankrupted after spending the same tax proportion on healthcare is just a bonus. It's not specifically private healthcare or insurance that's the problem, it's the specific corruption of the people who own the healthcare industry and their legislators.
- californical 4y ago
  Wow, I had to check your facts here, and I can’t believe it. The US federal healthcare spending is very close to the UK healthcare spending, but we cover WAY less for individuals. The US federal govt spends >8% of GDP on healthcare, with the current system of all of our insurance and payments and everything that we have to pay in addition, totaling nearly 20% of GDP: https://www.crfb.org/papers/american-health-care-health-spending-and-federal-budget https://www.crfb.org/papers/american-health-care-health-spen... The UK spent 9.6% of GDP on healthcare in that same year (2017) for their publicly-funded full healthcare system: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
  - deburo 4y ago
    >but we cover WAY less for individuals. That has to be related to the fact that American drugs are sold to a lesser price abroad than at home, right? In Quebec, cancer treatment is free. Given that even late-stage cancer patients live much longer nowadays, and those treatments are probably expensive as heck, I wonder how we can afford it.
rayiner 4y ago
Most countries have private healthcare (meaning private providers). Many others have a mix of for profit and non profit insurance companies. There’s not a whole lot of difference between Obamacare and say the system in say the Netherlands, Switzerland, or Japan. Those are also “individual mandate” systems.
throw123123123 4y ago
Argentina has public free healthcare and it still has growing expenditures in the private health sector.
- cypress66 4y ago
  Here in Argentina you only use the public free healthcare if you aren't insured or can't afford private healthcare. Also anybody legally employed must have insurance (of varying quality).
dominotw 4y ago
> countries without that or with less generally have better outcomes at less cost. > Looking for evidence to the contrary There was no evidence behind your claim either. 90% of US healthcare costs go to managing ( not treating ) obesity/metabolic disease . Yes 90% [1]. Which country with similar metabolic disease rate has better outcomes with less costs? 1. https://www.cdc.gov/chronicdisease/about/costs/index.htm https://www.cdc.gov/chronicdisease/about/costs/index.htm
- groby_b 4y ago
  That is not at all what your link says. "90% of the nation's $4.1 trillion in annual health care expenditures go to people with chronic and mental health conditions" Obesity is $173 billion, diabetes $327 billion. We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. Diabetes cost is roughly the same percentage of total expenditure as it is in other industrialized nations. (I didn't check obesity) It stands to reason that really, the problem is the size of the pie, not the size of the slice.
  - dominotw 4y ago
    see: page 20 https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221/RAND_TL221.pdf https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221... > We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. How so? Only recommendation for all these chronic conditions is 'diet and exercise' is it not ? Obesity isn't the only one. I am not obese , not even close, but I have hyperlipidemia. I am managing it with 'diet and exercise' after initially being put on statins. Same with hypertension, heart disease ect. All of these are metabolic diseases. Sure, I'll give you 'mental health conditions' may not be a lifestyle disease ( Even those are being now linked to diet ) .
    - groby_b 4y ago
      No, "diet and exercise" is not the only recommendation. I don't even know what point you're trying to make there - if that were the only recommendation, health care costs would be fairly low. And it's not just mental health issues (~25% of all chronic health issues), it's also respiratory issues (~10%). Then add to that the fact that many metabolic diseases have long lists of causes that amount to "not really sure". Atherosclerosis? Can be caused by physical activity. Hypertension? Being older than 65 is a cause. What the Rand paper does say is "90% of all health care cost is incurred by people with at least one chronic condition". Not metabolic diseases. What it also doesn't say is that the entire 90% are attributable to chronic diseases. (It's sort of akin to claiming that 10% of all healthcare costs are incurred by people named John, Robert, or James. True, but certainly not causal) Again, I'm not saying that chronic diseases aren't contributing a huge cost burden. I am saying that they're far from the only cause of the cost burden, and that blaming it on metabolic diseases is highly misleading even if you just focus on chronic diseases.
stefan_ 4y ago
Last I checked some >30% of the population were already on Medicare/Medicaid. You already have the "socialism" healthcare.
dang 3y ago
(This subthread was originally a reply to https://news.ycombinator.com/item?id=32743267 https://news.ycombinator.com/item?id=32743267.)

My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary

coredog64 4y ago

As two quick examples, both Switzerland and France have private healthcare providers and insurers. I think that’s enough to falsify your assumption :)

simonw 4y ago
Those countries both have "less generally" than the USA.
e_i_pi_2 4y ago
I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. Also FWIW France and Switzerland both have universal healthcare, under different systems where France splits payments 3 ways and covers more with the govt[1], and Switzerland seems to have a system like the ACA in the US where it's compulsory, but they also set caps on the deductibles and maximum price. [1]: https://en.wikipedia.org/wiki/Health_care_in_France https://en.wikipedia.org/wiki/Health_care_in_France [2]: https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
- JumpCrisscross 4y ago
  > France and Switzerland both have universal healthcare You said private healthcare/insurance were to blame. Switzerland has private health insurance. Universal healthcare is a separate goal post. For what it’s worth, I’m unclear its comprehensive iteration is compatible with America’s immigration model. (It absolutely is for life-saving measures.)
  - PaulDavisThe1st 4y ago
    What aspect of America's immigration model do you think intersects with this? > You said private healthcare/insurance were to blame. Switzerland has private health insurance. Private business in all western countries operates within the regulations and laws that cover them. The health insurance industry in Switzerland operates under a very different set of regulations and laws than the same industry in the USA. If you want to blame the OP for not being more explicit - "private healthcare/insurance and the regulatory framework are to blame" - then fine, but ... this is actually the crux of the issue.
    - JumpCrisscross 4y ago
      > but ... this is actually the crux of the issue I'm not sure it is. Universal healthcare is orthogonal to private health insurance. That's the lesson of Switzerland's example. I don't believe this is commonly known or accepted in American politics. Instead, any attempt at reform is pitched and vilified as an attempt to end private health insurance and healthcare.
      - bhupy 4y ago
        Not sure why you're getting downvoted, but this is exactly correct. Universal healthcare != public healthcare.
      - PaulDavisThe1st 4y ago
        It may not be commonly known in the USA. However, I'm a european immigrant of 33 years, and it's well known to me. However, "private health insurance" is not, in and of itself, really "a thing". Only "private health insurance plus a regulatory structure for it". It is in this department that the US falls over so badly, while, for example, Switzerland gets it (mostly) right.
  - ggrrhh_ta 4y ago
    Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance, with regulated yearly price adjustments and on top of that, publicly funded hospitals and clinics (mostly unprofitable but of high quality and offering treatments that would not be profitable for private hospitals) that issue their bills to the health insurances. And, to put the icing on the cake, there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. Switzerland's compulsory private health insurance is nothing comparable to other countries' private insurance. There is "additional private insurance" in Switzerland (covering alternative medicine treatments, access to single bed rooms in hospitals, etc.) which do operate as private insurances elsewhere.
- bhupy 4y ago
  It's not just Switzerland and France; the Netherlands also has a private-only health insurance system. It's also very difficult to draw decisive conclusions since, across countries, there are hundreds of confounding variables — it's not just public vs private, but it's also which regulations exist in each country, whether it's employer-sponsored vs individual, general willingness to pay, etc. You're correct that Switzerland has a system like the ACA in the US, but the biggest difference is that it's not common for the Swiss to get their private insurance from their employers; it's all on the individual market. The US is actually unique in that regard, and is probably the most significant difference — the vast majority of working age adults in the US get their insurance from their employers, and as a result the ACA's individual market has been in a dire state since the program's inception. Also "socialization" is very different from "nationalization". The general trend you're talking about is more to do with the fact that having society subsidize healthcare for the poor can lead to better outcomes. As it relates to who actually does the insuring, underwriting, and payment (public vs private), one isn't necessarily better than the other; each has its trade-offs. It's just that the US (in particular) has chosen the worst of both worlds. I work in this industry, and from where I sit, the closest thing we have to a clean A/B test that controls for all of those confounding variables is actually being run in the US right now, with Medicare. When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare. - 48% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly that the CBO projects that by 2023, the majority of beneficiaries with choose the private over the public option. The CBO further projects this proportion to increase to 61%(!!) by 2032. (https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/ https://www.kff.org/medicare/issue-brief/medicare-advantage-...) - For most beneficiaries, Medicare Advantage costs about 40% less than Original Medicare and are, on average, of higher quality than Original Medicare (https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare https://healthpayerintelligence.com/news/medicare-advantage-...) - In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan (https://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less-traditional-medicare https://www.commonwealthfund.org/publications/issue-briefs/2...) So no, you cannot look the cost difference between the US and other countries and simply conclude that it's because of private insurance, because the actual data tells a different story. And "universal healthcare" is not the same as "public" healthcare. It might help to think about it this way: universal access to food can be achieved without nationalizing the food industry, or the food payment industry.
- jaarse 4y ago
  As a Canadian I have only know completely socialized healthcare. One of our largest problems right now is that our system is failing and can’t keep up. The solutions being rolled out by the provinces to fix the huge backlog of people waiting for care is to privatize more of the service delivery (while keeping single payer).
- BurningFrog 4y ago
  > I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. You also haven't given even a hint of proof for this alleged trend. Maybe there is a trend, but let's look at some serious data before we just assume it's an obvious fact.
  - specialist 4y ago
    Google healthcare cost per capita vs life expectancy. Last time I checked, Canada, for example, spent 1/3rd less than the USA and Canadians lived a few years longer. IIRC, of the "universal coverage" systems, Switzerland's ACA-like system had the highest per capita, but still less than USA's system. Much has changed these last few years. eg Our life expectancy in the USA has fallen.
    - BurningFrog 4y ago
      I know this is really counterintuitive, but last I heard, health care isn't a major contributor to average life span. A much bigger factor is GDP per person. I think of it as: The more material wealth you have, the better your life is, and you get less risk of bad health.
    - refurb 4y ago
      Life expectancy is a terrible measure for quality of healthcare. It ignore so many other factors. The only way it could be a suitable measure if you assumed every human in every country was the same except for the healthcare they receive. It's pretty clear they aren't - lifestyle, smoking rates, alcohol and drug abuse, accidents, suicides, genetics. You’re far better to look at things like “survival after cancer diagnosis” where the US has some of the world’s best outcomes. https://www.healio.com/news/hematology-oncology/20180131/us-cancer-survival-rates-remain-among-highest-in-world https://www.healio.com/news/hematology-oncology/20180131/us-...
      - specialist 4y ago
        > Life expectancy is a terrible measure for quality of healthcare. ...lifestyle, smoking rates, alcohol and drug abuse, accidents, suicides, genetics. Only if we assume public health is unrelated to individual health.
Bayart 4y ago
Private healthcare in France is supplementary to public healthcare and mostly abides by regulations dictating what can be reimbursed by the social security system, there's quite a bit of price control. It only gets wild in niche products (say very fancy dental implants).

mikem170 4y ago

Across the board price controls seem to be a common to the various European health care systems. It is my understanding that upper limits are set for the cost of medicine. There is quite a bit of variety across Europe - U.K. is 100% government run, France is a public/private mix, Germany is similar to Obamacare in some ways, others are single payer, apparently some are private, also. But I've read that they all have cost controls.

Barrin92 4y ago
beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.
- dominotw 4y ago
  > Singapore which has exceptionally low healthcare spending yea because they have healthy population, its not because of some smart govt policy( if only it was that easy). singapore obesity rate = 10% usa obesity rate = 42 % usa obesity healthcare spend = 90%
  - groby_b 4y ago
    That 90% number is plain not true. Please cite any source for that. The costs for obese folk are on average 90%-100% higher than for non-obese folk, but that's not 90% of total spending. (See e.g. https://pubmed.ncbi.nlm.nih.gov/33470881/ https://pubmed.ncbi.nlm.nih.gov/33470881/) Total cost approaches 20% of spending: https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/ https://www.hsph.harvard.edu/obesity-prevention-source/obesi...
    - imapeopleperson 4y ago
      Don’t get so hung up on precise numbers. We all know Americans are obese and that greatly adds to healthcare costs. I can’t imagine any downside of trying to prioritize lowering obesity.

pessimizer 4y ago

> countries without that or with less generally have better outcomes at less cost. This isn't necessarily a great metric, because almost all countries have better outcomes and all countries have lower per capita cost, whether their systems are public, private, or mixed. The US spends more public funds on healthcare than countries with universal socialized health care systems. The fact that we're also personally bankrupted after spending the same tax proportion on healthcare is just a bonus. It's not specifically private healthcare or insurance that's the problem, it's the specific corruption of the people who own the healthcare industry and their legislators.

californical 4y ago
Wow, I had to check your facts here, and I can’t believe it. The US federal healthcare spending is very close to the UK healthcare spending, but we cover WAY less for individuals. The US federal govt spends >8% of GDP on healthcare, with the current system of all of our insurance and payments and everything that we have to pay in addition, totaling nearly 20% of GDP: https://www.crfb.org/papers/american-health-care-health-spending-and-federal-budget https://www.crfb.org/papers/american-health-care-health-spen... The UK spent 9.6% of GDP on healthcare in that same year (2017) for their publicly-funded full healthcare system: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
- deburo 4y ago
  >but we cover WAY less for individuals. That has to be related to the fact that American drugs are sold to a lesser price abroad than at home, right? In Quebec, cancer treatment is free. Given that even late-stage cancer patients live much longer nowadays, and those treatments are probably expensive as heck, I wonder how we can afford it.

rayiner 4y ago

Most countries have private healthcare (meaning private providers). Many others have a mix of for profit and non profit insurance companies. There’s not a whole lot of difference between Obamacare and say the system in say the Netherlands, Switzerland, or Japan. Those are also “individual mandate” systems.

throw123123123 4y ago

Argentina has public free healthcare and it still has growing expenditures in the private health sector.

cypress66 4y ago
Here in Argentina you only use the public free healthcare if you aren't insured or can't afford private healthcare. Also anybody legally employed must have insurance (of varying quality).

dominotw 4y ago

> countries without that or with less generally have better outcomes at less cost. > Looking for evidence to the contrary There was no evidence behind your claim either. 90% of US healthcare costs go to managing ( not treating ) obesity/metabolic disease . Yes 90% [1]. Which country with similar metabolic disease rate has better outcomes with less costs? 1. https://www.cdc.gov/chronicdisease/about/costs/index.htm https://www.cdc.gov/chronicdisease/about/costs/index.htm

groby_b 4y ago
That is not at all what your link says. "90% of the nation's $4.1 trillion in annual health care expenditures go to people with chronic and mental health conditions" Obesity is $173 billion, diabetes $327 billion. We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. Diabetes cost is roughly the same percentage of total expenditure as it is in other industrialized nations. (I didn't check obesity) It stands to reason that really, the problem is the size of the pie, not the size of the slice.
- dominotw 4y ago
  see: page 20 https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221/RAND_TL221.pdf https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221... > We could certainly do much better, but blaming health care cost on metabolic diseases is disingenuous. How so? Only recommendation for all these chronic conditions is 'diet and exercise' is it not ? Obesity isn't the only one. I am not obese , not even close, but I have hyperlipidemia. I am managing it with 'diet and exercise' after initially being put on statins. Same with hypertension, heart disease ect. All of these are metabolic diseases. Sure, I'll give you 'mental health conditions' may not be a lifestyle disease ( Even those are being now linked to diet ) .
  - groby_b 4y ago
    No, "diet and exercise" is not the only recommendation. I don't even know what point you're trying to make there - if that were the only recommendation, health care costs would be fairly low. And it's not just mental health issues (~25% of all chronic health issues), it's also respiratory issues (~10%). Then add to that the fact that many metabolic diseases have long lists of causes that amount to "not really sure". Atherosclerosis? Can be caused by physical activity. Hypertension? Being older than 65 is a cause. What the Rand paper does say is "90% of all health care cost is incurred by people with at least one chronic condition". Not metabolic diseases. What it also doesn't say is that the entire 90% are attributable to chronic diseases. (It's sort of akin to claiming that 10% of all healthcare costs are incurred by people named John, Robert, or James. True, but certainly not causal) Again, I'm not saying that chronic diseases aren't contributing a huge cost burden. I am saying that they're far from the only cause of the cost burden, and that blaming it on metabolic diseases is highly misleading even if you just focus on chronic diseases.

stefan_ 4y ago

Last I checked some >30% of the population were already on Medicare/Medicaid. You already have the "socialism" healthcare.

dang 3y ago

(This subthread was originally a reply to https://news.ycombinator.com/item?id=32743267 https://news.ycombinator.com/item?id=32743267.)