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Healthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becom

Healthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becoming a healthcare provider of all sorts is dramatically more expensive and limited than other countries, what healthcare providers are paid is dramatically more than other countries, we invest many times per capita what other countries put into basic medical research, the way are population is taxed is very different than other countries, our patient population is very different from other countries, our expectations are very different from other countries, our scale is dramatically different than other countries, and so on. The US is a singular animal politically in that it is a compact of individual states that especially in regards to healthcare, the federal goverments powers (though it may not seem so at times) are actually quite limited. It's all but impossible to come up with reasonable numerators and denominators for comparison.

anonymouse008 4y ago
> Healthcare is such a base layer of the economy Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.
- rgrieselhuber 4y ago
  And add on top the oft-repeated that “health insurance is healthcare.” That’s how you obfuscate a whole of things.
- skybrian 4y ago
  I'm not sure what that proves, given that you went to a grocery store instead of a pharmacy.
  - QuarterReptile 4y ago
    I'm guessing parent was saying that most medical spending is payback for terrible US American eating habits?
    - Forgeties79 4y ago
      I hope his view isn’t so myopic/“boot straps” but I guess it’s possible.
      - anonymouse008 4y ago
        Thanks for the benefit of doubt, 'hoo!
- refurb 4y ago
  After you criticized the comment as only “sounding enlightening” I was eager to hear your thoughts. Unfortunately I think your comment is even less enlightening. I mean, not all healthcare problems are caused by lifestyle. So clearly healthcare is a base layer - there is no situation where it wouldn’t exist.
  - anonymouse008 4y ago
    I'll concede that the comment was vague and relied too heavily on a shared intuition. Though I will admit, the reward became well played dry comedy throughout your sibling comments. So I'll break down my reasoning a bit. It requires a full blog post to get out, so please forgive the abridged version. Healthcare is a catch all for all the other problems of society. The top costly conditions in the US are (in order of this barely sourced article): Mental Disorders, Heart Conditions, Trauma-Related Injuries, Diabetes, Cancer, COPD and Asthma. Every single one of these is plainly racking up unneeded costs by the daily actions of all of us. My quip on the supermarket was a remark on the total view of health (from mental to reproductive care to basic carcinogens to ...). How many people are mindlessly scrolling on Instagram while performing another task, how many people smell of cigarettes, the marketing of 'sinful goods' (depending on the state), the near impossibility to avoid added sugar in every packaged foodstuff, the number of 'alcohol noses' you can see down a 50ft isle, the parenting of children, the smell of fossil fuel exhaust from the parking lot, the gait of the elderly, injured, or soon-to-be, the accommodations (or lack thereof) for those in wheelchairs and with living assistance, and still the primary food at checkout - And to include everyone in the conversation: think of the anyone working two jobs and has 0 time to prepare fresh food for themselves or anyone else, the eventual cost is in the habitual behaviors made in the constraints of under-compensated labor.... I could keep going and I've left out other observations contributing to other conditions but I think you understand. The thing I'm trying to say is that there are interventions all over the place - however, the up-front costs (ignoring all else) of a 'double blind randomized trial' for every single one of them to earn the proper authority to define its relative utility to cost is unrealistic at the moment (also most governments do not allow for risk based price of care) - an economic externality. Couple this externality behavior with a market of near perfect inelasticity for good health (and before someone comments, yes, suicide / assisted euthanasia may not be inelastic in price on this metric) - and you can't say "Healthcare is such a base layer of the economy" - an alternative analysis is "Healthcare is an externality that is priced in a government controlled market" [Edit] I completely left out the externality of the high reward litigation industry on malpractice and all of the above conditions as evidence of harm - adding pressure on compensation to the highest paid professionals.
- ericmay 4y ago
  Walk around the supermarket that you drive to, hopefully not being maimed or maiming someone else on the way. A ludicrous expenditure of energy to avoid physical activity so that you can buy products to help alleviate the symptoms of the energy expenditure and laziness. Can’t walk, or bike, or take the non-existent public transit. That’s for sure.
  - jjeaff 4y ago
    I don't think driving is merely to avoid physical expenditure. Driving is a result of rural and suburban living as well as poor urban planning. Lots more people would walk or bike if it was reasonably feasible.
    - trashtester 4y ago
      I suspect it's a bit of a chicken/egg problem (based on my opservations from visiting the US). Even in suburban areas there seems to be roads everywhere, often very hard to cross without a car. Where I live in Europe, the expectation is that the kids will walk or take the bike to school. 95% of the paths they need to travel is covered by walkways (usually separated from the roads, and in many cases with dedicated bike lanes). Everywhere the kids need to cross, there are crosswalks, and every morning before school a team of parents is organized to safeguard these crosswalks. Meanwhile, driving is slowed down significantly by the efforts above. The roads are underfunded and lines tend to form around the school (some parents still do drive their kids, up to about half when the weather is really bad). But with parents blocking the crosswalk every time a kid is near, bottlenecks do form. Basically, if you're in a car, you're treated as a 2nd rate citizen. :) Oh, and I suppose one benefit of all this walking is that hospital bills go down. Mostly because of the exercise, but also to some extent due reduction in air polution (which is helped further by most of the remaining cars being electric, most of which, ironically, are of a certain American brand).
      - JosephGuerra 4y ago
        Where i live in the suburbs we don't even have sidewalks ffs. I live about 3 blocks from my kids' school, yet they are driven or take the bus to school because kids are not allowed to bike or walk to elementary or middle school, unfortunately. wow, didn't realize so much of EU can afford electric vehicles. They are more expensive over here in the U.S. - especially compared to a decent used car. Is this a function of the cost of fuel being much higher over there? Or are there subsidies for purchasing electric or something else?
kev33 4y ago
- profile53 4y ago
  This reads as very hostile. Someone is taking time out of their day, for free, to answer questions and provide context.
  - kev33 4y ago
    - pc86 4y ago
      There's no reason to come on here and be nasty to someone you've never met because you or some relative of yours had a bad experience. If it's that big of a deal for you, work to fix it and you can come on here with your credentials and blah blah instead of whining about people who have experience in what they're talking about :)
      - kev33 4y ago
      - wahnfrieden 4y ago
        Civility is a little overrated and what an obnoxiously condescending response to say well go fix it yourself before you talk. Go talk to children like that
- nradov 4y ago
  About 90% of Americans have medical insurance. Coverage caps were eliminated years ago, and the out-of-pocket maximum is low enough that the medical expenses from a single incident are unlikely to drive middle class people to bankruptcy. Where bankruptcy becomes an issue is when a medical condition leaves someone unable to work for months. With no income they can burn through savings and credit quickly. Then when they file for bankruptcy of course they have some medical debts, but those medical debts are typically not the primary cause of the bankruptcy and even if the medical debts were eliminated they would still be insolvent.
xyzzy123 4y ago
It's a confusopoly! They're most obvious with "basic" products like energy and comms - in theory what is delivered is mostly undifferentiated kWh or GB but through the magic of "confusing plans", marketers have succeeded in making comparisons very difficult for regular people. (You can do it, but you need OCD, a year of billing data and a spreadsheet - which greatly exceeds the cognitive effort most people will invest in choosing a mobile or energy provider). The US healthcare sector seems to be the largest, most intricate and most successful (in terms of gdp extraction) confusopoly in history.
- dannyw 4y ago
  Huh? I look on a comparison website for price per kWh.
- seaourfreed 4y ago
  ...because the healthcare corporations get congress to sell out citizens. $3.5 BILLION flow through lobbyists every year (all industries). Healthcare being a huge part of that. Congress sells out US citizens & corporations fuel it
  - gruez 4y ago
    That's a pretty good deal considering US federal spending alone amounts to 7.3 trillion dollars.
    - diordiderot 4y ago
      Lobbying American reps has the highest ROI of any investment in human history. Ted Cruz would probably cosign a bill to 'throw all puppies off a mountain' for an all inclusive trip to Tulum
      - broguinn 4y ago
        This is an underrated joke.
- 4y ago
3pt14159 4y ago
I understand you're the relative expert here, but even so I must disagree with your general thrust. I've been hospitalized in four different countries. The least sane was America. The sanest was a private hospital in England, but the public hospital in England was fine too. My home country of Canada is sane, reliable, and reliably slow and mediocre bordering on subpar. Cyprus lacked toilet seats, but at least the food was fantastic. America's healthcare system is bananas. Even trying to come up with a metaphor here is difficult. It's $5k a day stays with Wonderbread, tuna, and bad not-actually-mayo-mayo for lunch. It's well groomed, well respected, monied indentured second and third opinion servants. It's Moloch's own mediation on Moloch[0] sold on the discount rack of the bookstore pharmacy downstairs. You can think Americans are different. They are not. They move to Canada all the time and we service their bum knees just fine. You can think Americans do all the medical research in the world. They don't. Plenty comes out of Europe, China, and elsewhere. You can think your tax code is unique. Ok this one I kinda agree with. It's almost as bananas as your medical system. But it doesn't change the fact that Americans put up with absolute bananaspants insanity for a healthcare system when they're perfectly capable of funding their libraries and roads. China beats you on scale. And so on. The basic fact is that Americans have what is essentially a psychopathic medical system at the best of times. One can negotiate with a psychopath, but Kafka returns your offer with a can of stale soup and doesn't even laugh. [0] https://slatestarcodex.com/2014/07/30/meditations-on-moloch/ https://slatestarcodex.com/2014/07/30/meditations-on-moloch/
- Der_Einzige 4y ago
  You're coping. Americans are responsible for about half of the world's medical research.
  - 3pt14159 4y ago
    That's factually untrue. China and Japan alone match the USA, and when adjusting for percent of GDP the USA isn't even in the top five countries. https://en.wikipedia.org/wiki/List_of_countries_by_research_and_development_spending https://en.wikipedia.org/wiki/List_of_countries_by_research_...
robertlagrant 4y ago
> e invest many times per capita what other countries put into basic medical research This is a big thing. I'm in the UK, where healthcare is very socialised, but I very much appreciate the fact that the US invests in making and productionising the next generation of healthcare, which we can then buy in bulk at a discount.
c7b 4y ago
> our patient population is very different from other countries > our expectations are very different from other countries > our scale is dramatically different than other countries > the way are population is taxed is very different than other countries do you have evidence to support these claims? what makes the US patient population or their expectations or the US taxation system unique in the world?
- hpkuarg 4y ago
  Not the OP, but Americans as a whole are very unhealthy (with 42% of the population being obese and over two-thirds being overweight) and culturally have very high expectations of what medicine can do for them, as opposed to making difficult changes to their lifestyle. A part of the latter is based on the actual superiority of the quality of medical care in this country -- due to the high levels of wealth produced by this (mostly market-oriented) economy and advanced medical technology, doctors can in fact perform miracles here that they cannot elsewhere.
  - Broken_Hippo 4y ago
    A part of the latter is based on the actual superiority of the quality of medical care in this country... How is it superior? Sure, some countries fare worse. But folks aren't getting the healthcare they need because of cost, and the results aren't exactly the best in the world. I'm not convinced that "culturally" folks have high expectations either, and sure, you might want to change your lifestyle to lose weight - but at the same time, you might just need medical oversight to do so. Not to mention that a bunch of things medicine helps are not things that lifestyle just fixes.
    - hpkuarg 4y ago
      Yes, folks are being priced out of healthcare, but the healthcare that is being provided is of superior quality than can be found in other countries -- even first world countries with socialized healthcare. I mean it in that narrow sense, that the service that is being delivered is of higher quality. It sounds like your point is that wider delivery of healthcare would be superior overall. That's fine, but I contend that the best way to achieve that is by increasing the supply of healthcare providers, instead of applying a price ceiling, which leads to shortages (as seen elsewhere on this thread[0]) and quality deterioration. [0]: https://news.ycombinator.com/item?id=32745467 https://news.ycombinator.com/item?id=32745467

anonymouse008 4y ago

> Healthcare is such a base layer of the economy Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.

rgrieselhuber 4y ago
And add on top the oft-repeated that “health insurance is healthcare.” That’s how you obfuscate a whole of things.
skybrian 4y ago
I'm not sure what that proves, given that you went to a grocery store instead of a pharmacy.
- QuarterReptile 4y ago
  I'm guessing parent was saying that most medical spending is payback for terrible US American eating habits?
  - Forgeties79 4y ago
    I hope his view isn’t so myopic/“boot straps” but I guess it’s possible.
    - anonymouse008 4y ago
      Thanks for the benefit of doubt, 'hoo!
refurb 4y ago
After you criticized the comment as only “sounding enlightening” I was eager to hear your thoughts. Unfortunately I think your comment is even less enlightening. I mean, not all healthcare problems are caused by lifestyle. So clearly healthcare is a base layer - there is no situation where it wouldn’t exist.
- anonymouse008 4y ago
  I'll concede that the comment was vague and relied too heavily on a shared intuition. Though I will admit, the reward became well played dry comedy throughout your sibling comments. So I'll break down my reasoning a bit. It requires a full blog post to get out, so please forgive the abridged version. Healthcare is a catch all for all the other problems of society. The top costly conditions in the US are (in order of this barely sourced article): Mental Disorders, Heart Conditions, Trauma-Related Injuries, Diabetes, Cancer, COPD and Asthma. Every single one of these is plainly racking up unneeded costs by the daily actions of all of us. My quip on the supermarket was a remark on the total view of health (from mental to reproductive care to basic carcinogens to ...). How many people are mindlessly scrolling on Instagram while performing another task, how many people smell of cigarettes, the marketing of 'sinful goods' (depending on the state), the near impossibility to avoid added sugar in every packaged foodstuff, the number of 'alcohol noses' you can see down a 50ft isle, the parenting of children, the smell of fossil fuel exhaust from the parking lot, the gait of the elderly, injured, or soon-to-be, the accommodations (or lack thereof) for those in wheelchairs and with living assistance, and still the primary food at checkout - And to include everyone in the conversation: think of the anyone working two jobs and has 0 time to prepare fresh food for themselves or anyone else, the eventual cost is in the habitual behaviors made in the constraints of under-compensated labor.... I could keep going and I've left out other observations contributing to other conditions but I think you understand. The thing I'm trying to say is that there are interventions all over the place - however, the up-front costs (ignoring all else) of a 'double blind randomized trial' for every single one of them to earn the proper authority to define its relative utility to cost is unrealistic at the moment (also most governments do not allow for risk based price of care) - an economic externality. Couple this externality behavior with a market of near perfect inelasticity for good health (and before someone comments, yes, suicide / assisted euthanasia may not be inelastic in price on this metric) - and you can't say "Healthcare is such a base layer of the economy" - an alternative analysis is "Healthcare is an externality that is priced in a government controlled market" [Edit] I completely left out the externality of the high reward litigation industry on malpractice and all of the above conditions as evidence of harm - adding pressure on compensation to the highest paid professionals.
ericmay 4y ago
Walk around the supermarket that you drive to, hopefully not being maimed or maiming someone else on the way. A ludicrous expenditure of energy to avoid physical activity so that you can buy products to help alleviate the symptoms of the energy expenditure and laziness. Can’t walk, or bike, or take the non-existent public transit. That’s for sure.
- jjeaff 4y ago
  I don't think driving is merely to avoid physical expenditure. Driving is a result of rural and suburban living as well as poor urban planning. Lots more people would walk or bike if it was reasonably feasible.
  - trashtester 4y ago
    I suspect it's a bit of a chicken/egg problem (based on my opservations from visiting the US). Even in suburban areas there seems to be roads everywhere, often very hard to cross without a car. Where I live in Europe, the expectation is that the kids will walk or take the bike to school. 95% of the paths they need to travel is covered by walkways (usually separated from the roads, and in many cases with dedicated bike lanes). Everywhere the kids need to cross, there are crosswalks, and every morning before school a team of parents is organized to safeguard these crosswalks. Meanwhile, driving is slowed down significantly by the efforts above. The roads are underfunded and lines tend to form around the school (some parents still do drive their kids, up to about half when the weather is really bad). But with parents blocking the crosswalk every time a kid is near, bottlenecks do form. Basically, if you're in a car, you're treated as a 2nd rate citizen. :) Oh, and I suppose one benefit of all this walking is that hospital bills go down. Mostly because of the exercise, but also to some extent due reduction in air polution (which is helped further by most of the remaining cars being electric, most of which, ironically, are of a certain American brand).
    - JosephGuerra 4y ago
      Where i live in the suburbs we don't even have sidewalks ffs. I live about 3 blocks from my kids' school, yet they are driven or take the bus to school because kids are not allowed to bike or walk to elementary or middle school, unfortunately. wow, didn't realize so much of EU can afford electric vehicles. They are more expensive over here in the U.S. - especially compared to a decent used car. Is this a function of the cost of fuel being much higher over there? Or are there subsidies for purchasing electric or something else?

kev33 4y ago

profile53 4y ago
This reads as very hostile. Someone is taking time out of their day, for free, to answer questions and provide context.
- kev33 4y ago
  - pc86 4y ago
    There's no reason to come on here and be nasty to someone you've never met because you or some relative of yours had a bad experience. If it's that big of a deal for you, work to fix it and you can come on here with your credentials and blah blah instead of whining about people who have experience in what they're talking about :)
    - kev33 4y ago
    - wahnfrieden 4y ago
      Civility is a little overrated and what an obnoxiously condescending response to say well go fix it yourself before you talk. Go talk to children like that
nradov 4y ago
About 90% of Americans have medical insurance. Coverage caps were eliminated years ago, and the out-of-pocket maximum is low enough that the medical expenses from a single incident are unlikely to drive middle class people to bankruptcy. Where bankruptcy becomes an issue is when a medical condition leaves someone unable to work for months. With no income they can burn through savings and credit quickly. Then when they file for bankruptcy of course they have some medical debts, but those medical debts are typically not the primary cause of the bankruptcy and even if the medical debts were eliminated they would still be insolvent.

xyzzy123 4y ago

It's a confusopoly! They're most obvious with "basic" products like energy and comms - in theory what is delivered is mostly undifferentiated kWh or GB but through the magic of "confusing plans", marketers have succeeded in making comparisons very difficult for regular people. (You can do it, but you need OCD, a year of billing data and a spreadsheet - which greatly exceeds the cognitive effort most people will invest in choosing a mobile or energy provider). The US healthcare sector seems to be the largest, most intricate and most successful (in terms of gdp extraction) confusopoly in history.

dannyw 4y ago
Huh? I look on a comparison website for price per kWh.
seaourfreed 4y ago
...because the healthcare corporations get congress to sell out citizens. $3.5 BILLION flow through lobbyists every year (all industries). Healthcare being a huge part of that. Congress sells out US citizens & corporations fuel it
- gruez 4y ago
  That's a pretty good deal considering US federal spending alone amounts to 7.3 trillion dollars.
  - diordiderot 4y ago
    Lobbying American reps has the highest ROI of any investment in human history. Ted Cruz would probably cosign a bill to 'throw all puppies off a mountain' for an all inclusive trip to Tulum
    - broguinn 4y ago
      This is an underrated joke.
4y ago

3pt14159 4y ago

I understand you're the relative expert here, but even so I must disagree with your general thrust. I've been hospitalized in four different countries. The least sane was America. The sanest was a private hospital in England, but the public hospital in England was fine too. My home country of Canada is sane, reliable, and reliably slow and mediocre bordering on subpar. Cyprus lacked toilet seats, but at least the food was fantastic. America's healthcare system is bananas. Even trying to come up with a metaphor here is difficult. It's $5k a day stays with Wonderbread, tuna, and bad not-actually-mayo-mayo for lunch. It's well groomed, well respected, monied indentured second and third opinion servants. It's Moloch's own mediation on Moloch[0] sold on the discount rack of the bookstore pharmacy downstairs. You can think Americans are different. They are not. They move to Canada all the time and we service their bum knees just fine. You can think Americans do all the medical research in the world. They don't. Plenty comes out of Europe, China, and elsewhere. You can think your tax code is unique. Ok this one I kinda agree with. It's almost as bananas as your medical system. But it doesn't change the fact that Americans put up with absolute bananaspants insanity for a healthcare system when they're perfectly capable of funding their libraries and roads. China beats you on scale. And so on. The basic fact is that Americans have what is essentially a psychopathic medical system at the best of times. One can negotiate with a psychopath, but Kafka returns your offer with a can of stale soup and doesn't even laugh. [0] https://slatestarcodex.com/2014/07/30/meditations-on-moloch/ https://slatestarcodex.com/2014/07/30/meditations-on-moloch/

Der_Einzige 4y ago
You're coping. Americans are responsible for about half of the world's medical research.
- 3pt14159 4y ago
  That's factually untrue. China and Japan alone match the USA, and when adjusting for percent of GDP the USA isn't even in the top five countries. https://en.wikipedia.org/wiki/List_of_countries_by_research_and_development_spending https://en.wikipedia.org/wiki/List_of_countries_by_research_...

robertlagrant 4y ago

> e invest many times per capita what other countries put into basic medical research This is a big thing. I'm in the UK, where healthcare is very socialised, but I very much appreciate the fact that the US invests in making and productionising the next generation of healthcare, which we can then buy in bulk at a discount.

c7b 4y ago

> our patient population is very different from other countries > our expectations are very different from other countries > our scale is dramatically different than other countries > the way are population is taxed is very different than other countries do you have evidence to support these claims? what makes the US patient population or their expectations or the US taxation system unique in the world?

hpkuarg 4y ago
Not the OP, but Americans as a whole are very unhealthy (with 42% of the population being obese and over two-thirds being overweight) and culturally have very high expectations of what medicine can do for them, as opposed to making difficult changes to their lifestyle. A part of the latter is based on the actual superiority of the quality of medical care in this country -- due to the high levels of wealth produced by this (mostly market-oriented) economy and advanced medical technology, doctors can in fact perform miracles here that they cannot elsewhere.
- Broken_Hippo 4y ago
  A part of the latter is based on the actual superiority of the quality of medical care in this country... How is it superior? Sure, some countries fare worse. But folks aren't getting the healthcare they need because of cost, and the results aren't exactly the best in the world. I'm not convinced that "culturally" folks have high expectations either, and sure, you might want to change your lifestyle to lose weight - but at the same time, you might just need medical oversight to do so. Not to mention that a bunch of things medicine helps are not things that lifestyle just fixes.
  - hpkuarg 4y ago
    Yes, folks are being priced out of healthcare, but the healthcare that is being provided is of superior quality than can be found in other countries -- even first world countries with socialized healthcare. I mean it in that narrow sense, that the service that is being delivered is of higher quality. It sounds like your point is that wider delivery of healthcare would be superior overall. That's fine, but I contend that the best way to achieve that is by increasing the supply of healthcare providers, instead of applying a price ceiling, which leads to shortages (as seen elsewhere on this thread[0]) and quality deterioration. [0]: https://news.ycombinator.com/item?id=32745467 https://news.ycombinator.com/item?id=32745467