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I don't think it's necessarily true that we need to keep letting Americans needlessly die due to unaffordable healthcare in order to maintain our nation's lead

I don't think it's necessarily true that we need to keep letting Americans needlessly die due to unaffordable healthcare in order to maintain our nation's lead in innovation. We should be able to continue to invest in medical science without continuing to fall behind other developed nations in actual health outcomes for patients. There are certainly many opportunities to drastically reduce the costs of healthcare without impacting the budgets for research.

Aerroon 2y ago
Does the US actually fall behind other nations in health outcomes? The US has two big factors working against them: much more widespread obesity (and the level of morbid obesity) and the insurance bureaucracy. These two factors should negatively impact health statistics without the treatments being worse.
- autoexec 2y ago
  > Does the US actually fall behind other nations in health outcomes? For the world's richest people you couldn't do better than to be a patient in America. For most Americans though, the US healthcare system is failing them. America does worse compared to other nations in some very basic measures like having a lower average life expectancy, a higher infant morality rate, more obesity and congestive heart failure and more hospital/pharmacy screw ups. A child or teenager in the US is less likely to live to adulthood compared to those in other developed countries. It's not any better when it comes to mental health either. The US is one of the worst nations when it comes to mental health outcomes and suicide and drug related deaths are higher in the US. Over thirty percent of the US population has been forced to put off getting the care they need due to the cost and preventative care is usually the first thing that people cut back on leading to bigger problems that could have been avoided entirely.
  - nxm 2y ago
    - 90% of Americans have health insurance - I would say it works for more than half (most) of Americans. Granted, not all health insurance is created equally. - The obesity and congestive heart failure issues is a function of poor dietary choices most Americans make (choosing fast/process food over cooking/making healthy foods), and not a function of healthcare access
    - autoexec 2y ago
      > 90% of Americans have health insurance Clearly having health insurance isn't enough to make healthcare affordable or prevent patient outcomes from being worse for Americans than patients in other nations. > The obesity and congestive heart failure issues is a function of poor dietary choices I also suspect that obesity and congestive heart failure issues are heavily influenced by diet, although I think that "choices" might be misleading here and that being unable to afford basic and preventative healthcare likely does have a major impact in healthcare outcomes even when the problems come from obesity and heart failure. It's certainly not as if people in other nations don't also enjoy ultra-processed foods or are any less fond of sugar, fat, and salt. They just often have better access to healthier foods, and more stringent regulations concerning what companies are and aren't allowed to put in foods, what they are allowed to advertise, and how they are sold. There is a huge difference between the number of people in the US who have little to no access to healthy foods when compared to those in other developed nations. Sometimes it's physical access (food deserts) and sometimes it's a matter of costs, but I don't think there's anything inherent to Americans that forces them to make bad choices. I'm guessing that instead Americans tend to have less choice and fewer opportunities for healthy foods in the first place, while having unhealthy ultra-processed foods that would be banned in other countries readily available, easily affordable, and heavily advertised to them.
      - Aerroon 2y ago
        I call bs on the second part. It's not unhealthy food that makes you gain weight, it's how much food you have. On top of that, the healthiest foods are among the cheapest foods you can buy. Milk, oatmeal, potatoes, rice, macaroni, chicken are all cheap compared to most foods you can get. This stuff is available almost everywhere. >but I don't think there's anything inherent to Americans that forces them to make bad choices. It's partly cultural. But this isn't a uniquely American problem. It's just worse in the US. 72% of Americans are obese or overweight. On top of that there was a recent study that found that BMR has decreased in the last ~30 years. Among men it was even up to 7%. That's a big enough difference to take someone from barely overweight to obese over a lifetime. But this is only a single study so far.
  - hgomersall 2y ago
    The US has significant problems with over-treatment. I struggle to believe this isn't worse for the wealthy.
    - autoexec 2y ago
      It's not all roses. I'm sure that even the wealthy who get healthcare in the US do have to deal with things like over-treatment, a lack of regulations, excessive costs, etc. It doesn't seem to hurt their outcomes enough to offset the fact that they'll have far more options, greater access to the best avilable technology/treatments, and that they'll be treated like absolute royalty.
  - ffgjgf1 2y ago
    If you adjust by factors like obesity, state and drug use US is quite close or more or less on the same level as Western European countries. Even if you don’t do that there is a higher variance in life expectancy between different US states than inside the EU. e.g. California is about on par with the Netherlands, Germany, Britain while Mississippi and West Virginia are slightly below Bulgaria (of course mainly because of drugs..). IMHO that kinds of makes generalized comparisons semi-meaningless.
    - allendoerfer 2y ago
      "The US has a poverty problem. People are dying." "Yeah, but just unimportant people from flyover states. We have to divide our analysis of the United States: Over here in California - you now were the people we care about live - life is just as good as in these other fancy European countries we don't look down upon."
      - ffgjgf1 2y ago
        > Yeah, but just unimportant people from flyover states That’s not what I said at all..
        allendoerfer 2y ago
        Why does it matter which Americans are dying? Other countries are not uniform either, averages are still applicable.
        deleted 2y ago
        [deleted]
        ffgjgf1 2y ago
        > Why does it matter which Americans are dying? Because they are dying due to different reasons which can’t be solved all at once using the same methods. > averages are still applicable. For what? What do you think is the purpose of any statistics or metrics?
  - literallycancer 2y ago
    People who can't do basic math and skip prevention are responsible for their own shit outcome. People in Portugal, where healthcare is "free", i.e. the government pays for it, frequently wait for years before being able to see a specialist due to long waitlists. The obvious outcome is that only poor people use the system and if you can you use private healthcare. People in Czechia with single payer healthcare system with e.g. average wage of 2000 USD pay from 100 euros a month for health insurance (unemployed) to e.g. 500 euros (with 4000 USD salary) or more if you make more. You get the same shitty service (something like 20 years behid the US), you just pay a lot more if you make anything resembling a US salary. There's no such thing as free healthcare. Can you make a single payer healthcare system that works better? Sure, it's just hard and even if everything is ideal you get maybe 50% discount. The main way to make healthcare cheaper is to drop coverage for diseases that are expensive to treat.
dyauspitr 2y ago
I mean we have Medicaid, if you’re poor don’t you get healthcare for free?
- autoexec 2y ago
  No. If you get something like cancer, at best you can expect Medicaid to be comparable to basic private health insurance, which can easily leave people with out of pocket costs they can't possibly afford. Medicaid has a ton of other problems starting with eligibility, but even if you are eligible and you successfully jump through all the hoops to keep it (which are sometimes totally insane: https://youtube.com/watch?v=bVIsnOfNfCo https://youtube.com/watch?v=bVIsnOfNfCo), you still may not be able to get the services you need. Many doctors won't accept it and you can die just waiting for an appointment. Studies have shown there was effectively one psychiatrist for every 8,834 Medicaid beneficiaries and just one cardiologist for every 4,543 Medicaid beneficiaries. These doctors can't possibly see, let alone adequately treat and manage the care of, everyone who needs them. The closest we get to free healthcare in the US is care in the emergency room which is only required to "stabilize" you. They'll try their best to keep you alive if you're actively dying, but then they push you out the door and send you a massive bill. They won't give you chemo or radiation to keep your cancer from spreading

Aerroon 2y ago

Does the US actually fall behind other nations in health outcomes? The US has two big factors working against them: much more widespread obesity (and the level of morbid obesity) and the insurance bureaucracy. These two factors should negatively impact health statistics without the treatments being worse.

autoexec 2y ago
> Does the US actually fall behind other nations in health outcomes? For the world's richest people you couldn't do better than to be a patient in America. For most Americans though, the US healthcare system is failing them. America does worse compared to other nations in some very basic measures like having a lower average life expectancy, a higher infant morality rate, more obesity and congestive heart failure and more hospital/pharmacy screw ups. A child or teenager in the US is less likely to live to adulthood compared to those in other developed countries. It's not any better when it comes to mental health either. The US is one of the worst nations when it comes to mental health outcomes and suicide and drug related deaths are higher in the US. Over thirty percent of the US population has been forced to put off getting the care they need due to the cost and preventative care is usually the first thing that people cut back on leading to bigger problems that could have been avoided entirely.
- nxm 2y ago
  - 90% of Americans have health insurance - I would say it works for more than half (most) of Americans. Granted, not all health insurance is created equally. - The obesity and congestive heart failure issues is a function of poor dietary choices most Americans make (choosing fast/process food over cooking/making healthy foods), and not a function of healthcare access
  - autoexec 2y ago
    > 90% of Americans have health insurance Clearly having health insurance isn't enough to make healthcare affordable or prevent patient outcomes from being worse for Americans than patients in other nations. > The obesity and congestive heart failure issues is a function of poor dietary choices I also suspect that obesity and congestive heart failure issues are heavily influenced by diet, although I think that "choices" might be misleading here and that being unable to afford basic and preventative healthcare likely does have a major impact in healthcare outcomes even when the problems come from obesity and heart failure. It's certainly not as if people in other nations don't also enjoy ultra-processed foods or are any less fond of sugar, fat, and salt. They just often have better access to healthier foods, and more stringent regulations concerning what companies are and aren't allowed to put in foods, what they are allowed to advertise, and how they are sold. There is a huge difference between the number of people in the US who have little to no access to healthy foods when compared to those in other developed nations. Sometimes it's physical access (food deserts) and sometimes it's a matter of costs, but I don't think there's anything inherent to Americans that forces them to make bad choices. I'm guessing that instead Americans tend to have less choice and fewer opportunities for healthy foods in the first place, while having unhealthy ultra-processed foods that would be banned in other countries readily available, easily affordable, and heavily advertised to them.
    - Aerroon 2y ago
      I call bs on the second part. It's not unhealthy food that makes you gain weight, it's how much food you have. On top of that, the healthiest foods are among the cheapest foods you can buy. Milk, oatmeal, potatoes, rice, macaroni, chicken are all cheap compared to most foods you can get. This stuff is available almost everywhere. >but I don't think there's anything inherent to Americans that forces them to make bad choices. It's partly cultural. But this isn't a uniquely American problem. It's just worse in the US. 72% of Americans are obese or overweight. On top of that there was a recent study that found that BMR has decreased in the last ~30 years. Among men it was even up to 7%. That's a big enough difference to take someone from barely overweight to obese over a lifetime. But this is only a single study so far.
- hgomersall 2y ago
  The US has significant problems with over-treatment. I struggle to believe this isn't worse for the wealthy.
  - autoexec 2y ago
    It's not all roses. I'm sure that even the wealthy who get healthcare in the US do have to deal with things like over-treatment, a lack of regulations, excessive costs, etc. It doesn't seem to hurt their outcomes enough to offset the fact that they'll have far more options, greater access to the best avilable technology/treatments, and that they'll be treated like absolute royalty.
- ffgjgf1 2y ago
  If you adjust by factors like obesity, state and drug use US is quite close or more or less on the same level as Western European countries. Even if you don’t do that there is a higher variance in life expectancy between different US states than inside the EU. e.g. California is about on par with the Netherlands, Germany, Britain while Mississippi and West Virginia are slightly below Bulgaria (of course mainly because of drugs..). IMHO that kinds of makes generalized comparisons semi-meaningless.
  - allendoerfer 2y ago
    "The US has a poverty problem. People are dying." "Yeah, but just unimportant people from flyover states. We have to divide our analysis of the United States: Over here in California - you now were the people we care about live - life is just as good as in these other fancy European countries we don't look down upon."
    - ffgjgf1 2y ago
      > Yeah, but just unimportant people from flyover states That’s not what I said at all..
      - allendoerfer 2y ago
        Why does it matter which Americans are dying? Other countries are not uniform either, averages are still applicable.
        deleted 2y ago
        [deleted]
        ffgjgf1 2y ago
        > Why does it matter which Americans are dying? Because they are dying due to different reasons which can’t be solved all at once using the same methods. > averages are still applicable. For what? What do you think is the purpose of any statistics or metrics?
- literallycancer 2y ago
  People who can't do basic math and skip prevention are responsible for their own shit outcome. People in Portugal, where healthcare is "free", i.e. the government pays for it, frequently wait for years before being able to see a specialist due to long waitlists. The obvious outcome is that only poor people use the system and if you can you use private healthcare. People in Czechia with single payer healthcare system with e.g. average wage of 2000 USD pay from 100 euros a month for health insurance (unemployed) to e.g. 500 euros (with 4000 USD salary) or more if you make more. You get the same shitty service (something like 20 years behid the US), you just pay a lot more if you make anything resembling a US salary. There's no such thing as free healthcare. Can you make a single payer healthcare system that works better? Sure, it's just hard and even if everything is ideal you get maybe 50% discount. The main way to make healthcare cheaper is to drop coverage for diseases that are expensive to treat.

dyauspitr 2y ago

I mean we have Medicaid, if you’re poor don’t you get healthcare for free?

autoexec 2y ago
No. If you get something like cancer, at best you can expect Medicaid to be comparable to basic private health insurance, which can easily leave people with out of pocket costs they can't possibly afford. Medicaid has a ton of other problems starting with eligibility, but even if you are eligible and you successfully jump through all the hoops to keep it (which are sometimes totally insane: https://youtube.com/watch?v=bVIsnOfNfCo https://youtube.com/watch?v=bVIsnOfNfCo), you still may not be able to get the services you need. Many doctors won't accept it and you can die just waiting for an appointment. Studies have shown there was effectively one psychiatrist for every 8,834 Medicaid beneficiaries and just one cardiologist for every 4,543 Medicaid beneficiaries. These doctors can't possibly see, let alone adequately treat and manage the care of, everyone who needs them. The closest we get to free healthcare in the US is care in the emergency room which is only required to "stabilize" you. They'll try their best to keep you alive if you're actively dying, but then they push you out the door and send you a massive bill. They won't give you chemo or radiation to keep your cancer from spreading