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US still has the worst, most expensive health care of any high-income country
- Nekhrimah 4y agoFairly axiomatic since US health care is for-profit by design.
- throwawaymaths 4y agogenerally untrue, probably about half of US healthcare providers are not for profit.
- spoils19 4y agoInteresting. Would you be able to list all of those that are not for profit? Just trying to make an informed decision, and I don't trust my google search - would rather get it from a fellow HNer.
- throwawaymaths 4y agoI looked it up, and it's actually more like 80%
- renewedrebecca 4y ago"non-profit" in the US is kind of a BS designation though. The Ohio State University is "non-profit", but pays its head football coach over $9,500,000.
- throwawaymaths 4y agoIt's also completely wrong to suggest that OSU is motivated by the same incentives as Amazon. If anything the equivalent bullshit to paying a football coach that much would not fly at a for profit.
- xtracto 4y agoI've always thought of American "non-profit" labels for orgs to he similar to the "democratic" label of the DDR or the "people's " republic of China, or all other "adjectives" that people put when they need others to believe their bullshit.
- mcast 4y agoPhysicians in the US are also paid exceptionally more than their counterparts outside of the US. As an extreme example, Cuban doctors can make less than Cuban taxi drivers.
- lkois 4y agoAnd in Australia they dominate the list of highest paid professions, so I immediately wonder how many other wealthy countries were skipped before settling on Cuba as a comparison.
- mcast 4y agoI know Australia has public and private healthcare systems, do physicians get paid the same in both markets?
- fifteenforty 4y agoMore in private, but not the difference on an hourly basis is not necessarily that much.
- fifteenforty 4y agoI’ve had lawyer patients just giggle at the fact that I’m near the top of the income rankings in Australia. ‘Clearly doctors don’t hide their income very well!’ Patients pay less, and I get paid relatively more in Australia (less in absolute terms than the US). There are fewer middlemen clipping the ticket.
- defrost 4y agoIt is a truth universally acknowledged that in any discussion regarding the US and social policy Australia simply does not exist. The only viable comparisons permitted are that Socialism == Communisim == Stalinism and that if not rampant capitalism then obviously Cuba or Venezuela.
- sshine 4y ago> Cuban doctors can make less than Cuban taxi drivers. "make" here is such a capitalist term. Can Cuban doctors fulfill their oath less?
- gardenfelder 4y agoMy recollection is that BlueCross was a non-profit until Reagan became president.
- tptacek 4y agoBlue Cross is still a non-profit.
- throwawaymaths 4y agodepends on the state.
- pjmorris 4y agoI've got a friend who works at a big non-profit hospital. There's a budget term of art, 'Revenue in excess of expenses,' into which flows a large amount of money that would be called profit elsewhere. I haven't found a detailed report on BCBS finances, but I'm looking now. Non-profit doesn't mean there's no extra money, it only means an entity is organized in a particular way.
- idontpost 4y ago[dead]
- mc32 4y agoBy definition, in order to continue as a going concern, they have to have more revenue than expenses. There is new equipment, treatments, raises, maintenance, inflation, etc. I guess one could have an all-volunteer hospital where everything is donated, from time, and equipment to land and buildings, etc.
- pjmorris 4y ago> new equipment, treatments, raises, maintenance, inflation, etc Much of these are expenses. Other organizations have ways of distinguishing between what's needed and what's extra, why do you think hospitals have nothing extra?
- nly 4y agoYeah... Go read up on the news wrt the NHS of late here in the UK
- BEEdwards 4y agoYeah sabotage works...
- defrost 4y agoA fine example of how twelve years of continuous conservative party rule can gut and drive into the ground what was once a beacon of national health that the world looked to for reference.
- brailsafe 4y agoHere in Canada we've had 8 years of continuous Liberal administration and our healthcare system is probably doing just as poorly. Not that we'd trade it for the U.S system
- 2muchcoffeeman 4y agoI was put on the list for a procedure in the Australian system. Took well over a year of waiting to eventually get a call to schedule it. But I could afford it through private health insurance, so I had already had it. But I‘d rather an inefficient system that manages to treat some people that can’t afford procedures.
- wk_end 4y agoHealth care in Canada is a responsibility of the provinces, so the guy in Ottawa is to some extent irrelevant. Although in BC we've had an NDP government for five years and it's not like things are doing so hot.
- deskamess 4y agoSimilarly, the conservative in ON is hell bent on making sure private systems are in play. At this point I just want something to work and be accessible. So if private can take the load off the public system where possible then let it happen. There are serious concerns about healthcare staff moving out of the public system if that happens but I am not expecting Ford to increase provincial health care spending.
- snshn 4y agoYeah, it's nothing but a sham.
- narrator 4y agoThe solution is not to spend more money on it.
- mc32 4y agoIt's fairly obvious we need to rejigger our Healthcare in the US. Liability insurance plays a part, but so do many other things and it would almost require an Authoritarian to re-arrange things. My naive proposal would be to have a two-tiered system. One public where most preventive things are taken care of along with your ordinary emergency care --but allow private care for those who want above and beyond what everyone else gets. Also you get the public care by default when you turn 18. Obviously this is ultra-simplistic and there are many things one has to consider such as rare diseases, or things that arise from poor lifestyle choices. Where is the cutoff, and when does private insurance take over, etc.
- beebmam 4y ago>it would almost require an Authoritarian to re-arrange things This presumes that an authoritarian wouldn't simply just pocket all that money for themselves and their friends, which is exactly what happens in all authoritarian countries around the world.
- mc32 4y agoYeah, true, but I meant the power necessary to make it happen, rather than the tendency toward corruption.
- maxerickson 4y agoImproving baseline access is a worthwhile goal, but you aren't describing changes to the system. Like how do you provide better emergency care to everyone without figuring out how to make the provision cheaper? The only answer to that question is that you spend more money.
- mc32 4y agoOr remove unnecessary things that add cost. Ability to buy drugs on the open market (including India), capping insurance payouts, reducing intermediaries, adding more people to the service side of things and removing people from the administration side.
- smokey_the_bear 4y agoWe had kaiser for years, and it was fine. I was able to receive care for pregnancy, stitches, vaccinations, etc with little hassle and mostly reasonable billing. Then we moved. Omg, I can’t even get appointments to get a rash looked at, or a sinus issue, or vaccinations. And most of those are pediatric issues! My son minorly broke his arm, and didn’t even need a cast and I got thousands of dollars in bills from four different companies.
- johndevor 4y agoSorry I don't follow, what did moving have to do with it? Did you have a plan that was valid in only a certain state?
- deathanatos 4y agoKaiser is not nation-wide. I had it too, in CA. They are excellent. They're not an option where I've moved too, and the alternatives are not as good, thus far.
- tptacek 4y agoThe trick in a lot of places is to start routine care at your providers urgent care clinics, which are often staffed with NPs instead of physicians; the NPs at those clinics are plugged directly into your family medicine provider. It takes a couple weeks to schedule appointments with doctors in our practice (especially our specific doctors), but I can be in and out of the clinic in under 30 minutes on no notice. It's not a bad system (aside from billing, which is a catastrophe).
- yencabulator 4y ago> [...] routine care at [...] urgent care [...] I think that says it all. That's a broken system you're just gaming & claiming nothing's wrong.
- tptacek 4y agoI'm assuming you believe "urgent care" means "the emergency room". It does not.
- tptacek 4y agoThis seems facile. It's easy to criticize the US system and there's a lot wrong with it, to be sure. We do spend vastly more than other countries do (though it's worth remembering that other countries fund universal care with high-end marginal rates that kick in around teacher salaries, and the typical citizen of a single-payer system has less income after factoring in health care than in the US). Certainly, if you're going to critique the system, spending is a good place to start, and this post avoids the trap of centering its coverage on private health insurance --- which is probably not the problem. It's difficult to track infant mortality across countries, because countries have different standards for reporting infant mortality. My understanding is that our ranking there is in significant part an artifact of measurement. The same thing is likely true of the "multiple chronic conditions" thing. There is a significant problem of overdiagnosis and overtreatment in the US. Specialist care is harder to obtain in many single-payer countries (talk to a Canadian), and fewer procedures are done outpatient (talk to a Brit). Our system is structured to quickly find diagnoses and move patients through a funnel to billable procedures. On the other hand, there are other metrics of health care quality. For instance, you can easily get a ranking of health care systems by breast cancer survival likelihood, and the answer to that question is hard to square with us having the "worst" health care in the world.
- oaktrout 4y agoArguably more chronic conditions might point to US health care being better. These individuals with multiple chronic conditions might not be alive except for high quality US medicine. It also argues that we suck at primary prevention, but that's a whole different can of worms.
- wheats 4y ago>It's difficult to track infant mortality across countries, because countries have different standards for reporting infant mortality. My understanding is that our ranking there is in significant part an artifact of measurement. I hadn't heard that before. What specific artifacts are you talking about and do all organizations in the U.S. always use different standards than all other developed countries... have you seen any studies that control for those? I've always heard this is the measure chosen specifically because it is the easiest to track as nearly all infant deaths are reported in developed countries and death doesn't lend itself to nuanced definitions.
- anotheraccount9 4y agoIn Canada, my pharmacist is assessing my thyroid hormone level. It's an easy job. I got the blood drawn in the pharmacy for... $15. That part was considered private healthcare. How much would it cost me in US to get a blood sample sent to a clinician for my TSH to be checked?
- Bilal_io 4y agoNot sure what "minimum" means here, but here is some data: https://www.findlabtest.com/lab-test/thyroid-testing/ https://www.findlabtest.com/lab-test/thyroid-testing/ https://health.costhelper.com/thyroid.html https://health.costhelper.com/thyroid.html
- tptacek 4y agoIt depends on whether you called your family care doctor or went to urgent care.
- olliej 4y agoI mean yes, but also unhelpful. The majority of people aren’t going to urgent care for random checkups. The over reliance on urgent care in the US is a byproduct of a system that means people often have no other option (dr doesn’t take your particular insurance, your insurance doesn’t actually cover checkups, …) and the general cost of preventative care in the US meaning people don’t get things looked at prior to them becoming much bigger problems, where they do become urgent.
- tptacek 4y agoThe majority of people should go to urgent care for routine stuff. NPs are just as qualified to do that work as doctors, and have better escalation paths to the doctors. Just so we're clear: "urgent care" doesn't mean "ER".
- tharne 4y ago> The majority of people should go to urgent care for routine stuff Most medical providers would advise against this. Managing someone's health is not the same thing as changing the oil in a car. It's immensely helpful for the medical provider to develop a working relationship with the patient and understand the person's conditions and medications.
- ghastmaster 4y agoThis headline is backed up by overbroad metrics. Life expectancy, infant/maternal mortality, rate of avoidable deaths, and multiple chronic conditions(perhaps because of obesity they say) are how this author determined the US still has the worst... Obesity actually might account for most of these problems. This article is brief and uninformative. The author overtly implies that guaranteed health coverage is the answer. I disagree.
- olliej 4y agoEvery study I have ever seen shows the us pays more for less. You’d think that if the US system was actually better we’d see some studies showing that, even with publication and political biases.
- dzonga 4y agomy take is going all out socialized health care isn't the answer. you need to socialize basic care that benefits everyone e.g maternal care, wounds etc, sprains etc so that you always have workers available in the economy. and that productivity doesn't go down because people have chronic conditions. then privatize the special things e.g plastic surgery for the instagram influenzas, people that need special care that goes beyond what the social healthcare system provides etc. having the gvt responsible for all the healthcare can go amiss as we see in the uk - it just takes one administration to gut the whole system.
- olliej 4y agoI think this is something people in the US don’t understand. Many (most?) countries with national healthcare don’t cover elective surgery (cosmetic surgery, etc). Many also have parallel (though obviously smaller) private healthcare providers. Of course because there is large national healthcare people who are paying extra for private healthcare are being gouged - because a facility’s ability to gouge customers is limited by competition. The problem with the US health system is that it is essentially for profit, there is no “lower priced alternative” you can choose instead, and you cannot discharge medical debt so gouging is a safe and secure source of perpetual income for medical providers. It doesn’t matter if a patient can’t afford the debt, in many cases they literally do not have a choice, and then just pay interest on that until they die. So you have swathes of the population that have comparatively expensive health insurance (compared to taxes paying for national healthcare), but who can’t afford to get any medical care anyway because the insurance is essentially just a “stop bankruptcy if you have a heart attack” insurance not actual healthcare. Despite that they are often avoiding bankruptcy but still being left with 10s of thousands of dollars in copays which they can “afford”.
- hotpotamus 4y agoThis comment doesn't track for me. I'm not an expert, but I don't think you're using the term elective like a Doctor would - I believe they refer to that for surgeries that aren't really emergent and can be done as desired, like joint replacements, for instance. And I don't think private insurance has ever covered purely cosmetic surgeries. I assume there is also some cosmetic surgery that is medically advisable for quality of life even if it's not strictly necessary that might be covered in private or public systems. I'm also pretty sure that medical debt is dis-chargeable; it's student debt that is essentially permanent in the US. I can agree that profit motives for healthcare are probably inherently problematic.
- mensetmanusman 4y agoI wish Obama would have outlawed employer provided healthcare.
- torstenvl 4y agoCurrently, employers more-or-less do a good job complying with OSHA regulations. Far better than complying with, say, EPA regulations, or ADA regulations. What's your analysis for why it would be good public policy to reverse their incentives for workplace safety?
- lotsofpulp 4y agoEmployer subsidized health insurance does not mean all employers are self insuring. I do not see any link between employers caring or not caring about employee safety and employers being able to offer a tax free subsidized health insurance to employees. >Currently, employers more-or-less do a good job complying with OSHA regulations. Far better than complying with, say, EPA regulations, or ADA regulations. Why would you think this? In my opinion, everyone should have been dumped onto healthcare.gov to prevent the hoarding of healthier people into the risk pools of rich, white collar businesses.
- maxerickson 4y agoThey pay for workplace injuries separately from health insurance benefits, they aren't really connected.
- mensetmanusman 4y agoNo employer is big enough to apply real pressure. We need state farm sized coops.
- consumer451 4y agoIIRC, the reasoning for not going single-payer was because it would have hurt the economy too much in the short term. Too big to fail.
- Barrin92 4y agoa lot of the debate always centers around the policies of the healthcare system but I think it's good that the article at the end also spells out a very obvious point, Americans are much sicker than many other countries. A complicated and expensive healthcare system does certainly not help, but there isn't enough talk about how obesity, diabetes, chronic pain, infections and other conditions are linked and mutually reinforcing. Even infant mortality which always is cited in the US is much higher in obese women. People can marvel at Singapore's technocracy and how efficient their healthcare is but also, you won't see that many unhealthy people there as you do in many other industrialized countries, and that shaves countless billions off the budget by itself. In many rich countries we seem to be completely unwilling to discuss or we even create taboos around how to improve population health.
- hackeraccount 4y agoThis. Give me a population that gets some exercise, doesn't smoke, doesn't drink, won't kill someone or themselves over a pair of shoes, keeps up on their vaccinations and eats because they're hungry and I'll give you a population with any health care system in the world but the the US population - See who's got a better life expectancy. I'll come out ahead every time no matter how healthcare is delivered for my population. Heck, I'd probably come out ahead with no doctors at all in my population.
- jopython 4y agoThe US has the best, most expensive health care of any high-income country. Corrected the heading.
- hackeraccount 4y agoHealthcare as it's commonly stated is oversold when it comes to mortality. I've always thought that most of mortality is public health stuff that has almost nothing to do with hospitals or doctors. I'm happy to be proven wrong on this.