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I really don't understand why the US doesn't have a grown up healthcare system. Do you just not see how much better healthcare is in the rest of the developed
by rwmj 3y ago
I really don't understand why the US doesn't have a grown up healthcare system. Do you just not see how much better healthcare is in the rest of the developed world?
- vkou 3y agoThe healthcare system in the US is much better for a small group of people who make a lot of money from it, and they have bought the entirety of one, and much of another political party to ensure that it stays that way.
- wing-_-nuts 3y agoThis is exactly it. Everyone asks why the American people put up with this, as if our congress actually gives a damn about the average American. Congressional votes are bought and paid for by corporations which benefit from the current, broken system.
- AmericanChopper 3y agoI’ve lived in quite a few different countries (including a couple that are frequently praised for their public healthcare systems), and the quality of the healthcare I’ve received in the US is far better than anything I’ve had anywhere else.
- causi 3y agoThe quality of care you did receive in those countries may have been lesser, but what could you have gotten if you paid as much there as you pay in the US?
- AmericanChopper 3y ago> but what could you have gotten if you paid as much there as you pay in the US? If you ignore the fact that I was already paying substantially more for it with higher taxes, the answer is still nothing. Countries with public healthcare don’t have expansive private healthcare systems, and nowhere in the world has a healthcare system that offers the level of service that the US system does. For example my sister was giving birth in New Zealand, and I wanted to just pay out of pocket for a private hospital for her. There are zero private hospitals in the country that offer this service, so her only option was to go to her local (and notoriously bad) hospital. She remained in the maternity ward for nearly a week, because while she was there that hospital had its 15th norovirus outbreak for the year.
- beej71 3y agoLast I checked, Americans already pay more tax for health care than anybody except the Norwegians.
- AmericanChopper 3y agoOverall perhaps, but the taxes I paid in NZ were much, much higher than what I paid in the US, even when accounting for health insurance and other out of pocket costs.
- beej71 3y agoHere's an interesting chart on the matter: https://www.oecd-ilibrary.org/sites/154e8143-en/index.html?itemId=/content/component/154e8143-en https://www.oecd-ilibrary.org/sites/154e8143-en/index.html?i...
- AmericanChopper 3y agoPer capita statistics have no affect on me personally given the level of taxes I paid in the US and NZ was substantially higher than their respective per capita averages.
- causi 3y agoThe maternal mortality rate for the US is 4.7 times higher than New Zealand's. The infant mortality rate is 61% higher.
- AmericanChopper 3y agoI could also cherry-pick some statistics to try prove a point. But the point I’m actually making is that the healthcare I had access to in the US was far better than the healthcare I had access to in New Zealand (or anywhere else), regardless of how much I was willing to pay. Complaints about systemic issue of healthcare costs in the US are perfectly valid (and there are other somewhat unique problems with it as well). But are completely seperate from the fact that the best healthcare facilities, and most qualified healthcare professionals in the world are generally located in the US.
- pierat 3y ago....If you can afford it. Which, you having lived in multiple countries, sounds like you can. If you cant afford it, you're fucked in hundreds of different ways, including basically signing for any care "i agree to pay whatever im told for the rest of my life" blank check. And healthcare is the leading cause of bankruptcy. This sort of crap doesn't happen in a decent country. https://www.forbes.com/2010/03/25/why-people-go-bankrupt-personal-finance-bankruptcy.html?sh=1862a717c253 https://www.forbes.com/2010/03/25/why-people-go-bankrupt-per...
- HDThoreaun 3y agoUS healthcare system works for people with money, and people with money make up most of the voting base.
- wing-_-nuts 3y agoNo, it's that congress generally only cares about those that donate to their campaign, and that just so happens to be the corporations that benefit from the current broken system.
- r00fus 3y agoNo, it doesn't even work (the most) for them. And they don't find out until that critical time that they're not covered. What it does is give the illusion of high-level coverage so those profitable users keep paying the dole and keep supporting the industry politically.
- HDThoreaun 3y agoSure, let's say they believe it works for them so they don't politically support reworking it.
- varjag 3y agoIf you can afford it the healthcare in the States can be quite good. And there's a massive number of Americans who can afford it. I can't say off the cuff what share of the population is that but Americans being ever on the verge of bankruptcy is mostly a cliche.
- orwin 3y agoI mean, in France we have a 'life expectancy' metric (82.5) and a 'life expectancy with good health', which is on average, the age someone born in 2023 will reach before getting daily pain or start loosing independence. The number is 76.5 year old (10th in Europe). What's 'funny' is that our life expectancy with good health match USA life expectancy this year.
- soco 3y agoMaybe because on average in USA you die from your first illness. Yes, I'm sarcastic.
- HDThoreaun 3y agoAmerican culture places a lot of importance on individualism. This means people are free to make choices that will lower their life expectancy without fear of judgement. So Americans don't live as long. Doesn't really prove anything about the quality of health care.
- rwmj 3y agoI can assure you that eating and drinking yourself to death is entirely possible in France too :-)
- HDThoreaun 3y agoUs obesity rate 36%, france 17%
- soco 3y agoThe case presented by the article is of an American who can afford it, yet I would still call it legalized abuse. Just like the other cases here in the comments, none of them of Americans on the verge of bankruptcy. And either way: the real possibility of getting bankrupted by your health bills signals systemic disinterest towards the (even when poorer) tax-payers. Maybe you agree with it, state models can be different and I guess there are advantages and disadvantages to each, but at least let's call it for what it is.
- gaulish 3y agoI love my quality of care in the US. My insurance is quite reasonable compared to what my increased tax burden might look like overseas. I can’t imagine living in a nation that would make me wait months for something like an MRI, I love living in a nation where I can get an MRI for myself and my dog in the same day. I also enjoy living in a nation that doesn’t suggest I kill myself over trivial situations and backlogs, let alone suggest I kill myself at all. The only thing I hate is dealing with Byzantine clerical processes in the occasions they make a mistake. Have to waste 3 hours on back and forth phone calls because a low-level nurse made a typo is obnoxious.
- Jare 3y ago> I love living in a nation where I can get an MRI for myself and my dog in the same day You love living in a nation where millions of people can't afford basic healthcare for themselves but your dog can get an MRI same day.
- gaulish 3y ago[flagged]
- Workaccount2 3y agoThe reason you have those things is because others don't have access to them. You being able to get an MRI in a week might have the social cost of 3 people not being able to get an MRI at all.
- gaulish 3y ago[flagged]
- grecy 3y ago> I love my quality of care in the US. My insurance is quite reasonable Does it matter to you that 27.6 million of your countrymen have no insurance? [1] Does it matter to you that 66.5% of all bankruptcies are due to medical bills [2] and that Almost 1 in 5 adults with health care debt either lose their homes or declare bankruptcy ? [2] Do you simply not care that the people in your community and society struggle to get the bare minimum? [1] https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2023/202305.htm https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2023/... [2] https://www.retireguide.com/retirement-planning/risks/medical-bankruptcy-statistics/ https://www.retireguide.com/retirement-planning/risks/medica...
- Analemma_ 3y agoI'm very dissatisfied with the quality of the replies to your post so far, a lot of them are deepities about corruption and class. The actual reasons involve a whole bunch of factors: - principal-agent problems - health-insurance and hidden cost mean the people paying aren't the people getting the product - concentrated benefits, diffuse costs. There are tons of actors (pharmas, hospitals, insurers, doctors, etc.) each skimming off the top. Each of these is a small enough effect that it's not worth anybody's time to stop it, especially when it's worth it for the skimmer to fight to the death to protect their cut, and together they all add up to massive amounts of waste. - the US healthcare system is a Frankenstein's monster of public and private elements, and has ended up with the worst parts of both - the US healthcare system probably would be better (at least in terms of cost-effectiveness) if it become either more libertarian or more socialized, but since moving a little in either direction would be seen by half the population as the top of a slippery slope towards a dystopia they hate, everybody fights hard to keep it in the local minimum
- cypherpunks01 3y agoCorporate regulatory capture.
- kelseyfrog 3y agoAnd the institutionalization and legal enshrining[1] of work ethic. Basically the two tier healthcare system has a legal basis for it's existence and structural support in the form of economic incentives to continue in perpetuity, and sustain itself. This is going to seem either extremely obvious or completely bonkers depending on your point of view. so it makes an interesting scissor statement. Furthermore one component of the system is the foundational belief that "work is virtuous," and healthcare is a boon based in reaping rewards of that virtue. 1. I wanted to say legalization. It's the right word, but it has the wrong meaning.
- db48x 3y agoThat’s not quite true. It is true that we often see work as virtuous, but it’s not enshrined in law. It’s just a side effect that health insurance (not health _care_, just health _insurance_) is a perk offered by your employer. During WWII, Congress enacted price and wage controls that have caused us a lot of problems. With millions of men out of the labor force (because they were conscripted), and no way to compete with other employers by raising salaries, employers started offering perks instead. Things like tipping in restaurants and health insurance paid for by your employer became common and eventually ubiquitous. Before WWII, only a few percent of the population used health insurance. Everyone paid for health care out of pocket, and overall it was such a low percentage of people’s incomes that nobody worried much about it. You could trivially compare prices between doctors, for one thing.
- kelseyfrog 3y agoYep, we're all well aware of the origins of employer healthcare in the United States. However, I don't want to confuse the etiology of employer healthcare and the social reproduction of employer healthcare as it exists today. In other words, just because a thing has an origin, doesn't mean that the original cause continues to exist nor can we avoid examining proximal causes. I'm a bit confused what you meant by "it's not enshrined in law." I think we both agree that there doesn't exist a statement of law like "Employer healthcare is a benefit of virtuous employment." Rather, the motivating factors for the ACA compliance[1] are congruent in the minds of a contingent with the idea that a work ethic justifies rewards. There are many such programs that are congruent with work ethic such as Earned Income Tax Credit(EITC)[2], unemployment benefit requirements(looking for work[3]), and FMLA requirements(work >12 months)[4]. I want to be transparent and stress that this is much more in line with a critical analysis of the US legal code and policy than a logical argument, and carries with it all of the nuance and assumptions that any critical legal analysis does. 1. "ACA, employers with 50 or more full-time employees (or the equivalent in part-time employees) must provide health insurance to 95% of their full-time employees or pay a penalty to the IRS." https://www.nolo.com/legal-encyclopedia/is-my-employer-required-to-provide-health-care.html https://www.nolo.com/legal-encyclopedia/is-my-employer-requi... 2. "Encouraging work" https://obamawhitehouse.archives.gov/blog/2016/01/29/earned-income-tax-credit-encouraging-work-boosting-incomes-and-reducing-poverty https://obamawhitehouse.archives.gov/blog/2016/01/29/earned-... 3. https://www.usa.gov/unemployment-benefits https://www.usa.gov/unemployment-benefits 4. https://www.dol.gov/general/topic/benefits-leave/fmla https://www.dol.gov/general/topic/benefits-leave/fmla
- AnthonyMouse 3y agoThe problem in the US is that each of the parties wants to solve it in a different way, so neither has broad enough political support to easily pass, but both of them have strong opposition from a different constituency. The Democrats keep proposing some kind of single payer system, but without addressing any of the causes of the existing high prices (because that would gore the ox of all those healthcare providers, who have a lot of political power), so in practice the result would be to move the absurdly high cost fully onto the taxpayer, but they can't get through a tax increase that high. There are also some aspects of the US heathcare system (certainly not the price) that people do like, and their proposals would tend to make those parts worse. The Republicans are mostly content to do nothing, but their main proposal when they have one is to push things like price transparency and regulatory reform. Those proposals have a lot of potential, but they would come entirely out of the margins of the aforementioned healthcare providers, so they can't get any meaningful support from across the aisle or even within their own party. Which is why they're mostly content to do nothing. It also doesn't help that most of the reform efforts have been attempts to do the first one, which doesn't reduce the cost, but consumes activism resources to promote a proposal that either doesn't work or doesn't pass.
- boringg 3y agoClarification. US health is great if you are employed, have a good income or are retired and on medicare. If you don't fall into those categories it is pretty tough
- maerF0x0 3y agoThis. Which is why US averages are so bad, on average folks have shitty insurance and thus healthcare. But if you purchase, or negotiate excellent coverage you can get excellent care. (You still have to do some research to find the best providers)
- MisterBastahrd 3y agoUS healthcare isn't great regardless of what metric you choose to use. It's mid-tier all the way around except for cost, where it far exceeds any other system in the world. Never being able to access the healthcare you're paying for because you can't afford the insane deductibles is even worse than not having healthcare at all, because when you DO have an emergency that you need to see a doctor for, your rates would often be lower out of pocket with the money you could have saved.
- stusmall 3y agoI have great insurance through my employer. Last week my spouse was suppose to go in for a surgery that multiple doctors made it clear she needed. We were on the books for months for the surgery. Insurance denied it the day before, throwing all our plans up into the air. The surgeon suggested getting a different surgery that wouldn't fix the problem. The idea is that when it didn't work it would act as evidence to convince insurance to pay for the original one. We have a terrible, stupid, inefficient system. It's drowning in its own chaos and bureaucracy.
- maerF0x0 3y agoCanadian chiming in here. Sorry, but it's just not true of at least Canada that the single payer&provider system is working or working well. We get better _average_ outcomes because we do some preventative work, but if you're really sick you get far better care in the US if you can afford it. There's probably some nice middle ground around having a national preventative program (screening, weight loss, nutritionists etc), and allow insurance to cover "you're fucked" scenarios like Cancer, Heart attacks, car wrecks, Gun shot wounds etc.
- malfist 3y agoAre you sure you're canadian? You talk about having insurance for US Healthcare here: https://news.ycombinator.com/item?id=36818747#36819112 https://news.ycombinator.com/item?id=36818747#36819112
- maerF0x0 3y agoNice attempt. Canadian, former resident of Canada (for decades), and lately in the USA on a visa. Plenty of connections and family in Canada who can vouch first hand for what I'm saying, both as patients and as care providers.
- washadjeffmad 3y agoLast year, maerF0x0 said they were $age years old. This year, they said they were $age+1. Which is it, maerF0x0? Where do the lies end?
- maerF0x0 3y agonice attempt.
- nsvd 3y agoDo you really not understand? Powerful people are making tons of money at the expense of everyone else. Isn't that how the system is designed? What's confusing about it?