8 ms·

The deep roots of Americans' hatred of their health care system

66 points by lr0 2y ago

AIFounder 2y ago
[dead]
mnky9800n 2y ago
It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one. I don’t think hating any of the players makes sense. Those that set the rules are ultimately responsible.
- School-Cotton 2y ago
  The American government doesn’t have the power to change laws. The requirement to have 60/100 votes in the senate makes it almost impossible to pass anything except the most uncontroversial bills.
  - lapcat 2y ago
    > The requirement to have 60/100 votes in the senate makes it almost impossible to pass anything except the most uncontroversial bills. The filibuster is not enshrined in the Constitution. It's only a Senate rule that could be abolished at any time via a simple majority vote in the Senate. The Senators have chosen not to abolish the filibuster.
  - smt88 2y ago
    > makes it almost impossible to pass anything except the most uncontroversial bills It's actually worse than this. Popular bills, like the Dreamers Act, become political footballs. Neither party wants to pass it while the other party is "in power" (in the minds of the electorate), and they want to keep it around as a bargaining chip, campaign promise, etc. So the bills that get 60 votes aren't just uncontroversial, they're usually not even meaningful to voters.
  - BeFlatXIII 2y ago
    Even those get spiked for political grandstanding on some off-topic issue.
- jimbob45 2y ago
  The root of the problem is that American health insurance is employer-sponsored so you don’t get to choose your carrier and your employer can choose entirely because of bribes if they so choose. As such, the vaunted American invisible hand doesn’t get to play its part.
- dgacmu 2y ago
  Well, that gets us into the question of the influence of money on American politics. The incumbent players make a ton of money from the current system, and they use a lot of that money to lobby to maintain the system, and the system is responsive to their money. Made worse by Citizens United, but it's been a problem for a long time. Combine this with a distrust of government that is encouraged by many of those same interests and you have, well, us.
  - s1artibartfast 2y ago
    Voters still control the ballot box, and have rejected single payer propositions. When polled, they say they want healthcare reform, but hate every option when they are described to them.
    - dgacmu 2y ago
      Yeah. There's a lot of fear-based marketing aimed at getting people to reject single-payer. It seems effective. A lot of our voting seems to suffer from the "but it won't happen to me" fallacy, whether that be about health care and medical debt, conditions in jails, climate change, social services, etc. with the irony being that it often happens to most people in the long run.
      - s1artibartfast 2y ago
        Often times that is true. Most people dont end up in jail, with medial debt, and reliant social services, ect.
- jmclnx 2y ago
  Political Contributions (or known as bribes elsewhere) is why :(
  - Ekaros 2y ago
    Also fun rotation in jobs. Work on one side and then have expertise to work on the other. And wise-versa... Unless you are true idealist, which will get steered out, why would you ruin the good thing going on...
- llama_person 2y ago
  The current one makes a lot of money for a lot of parties uninterested in change, who then also lobby to prevent any reform. Health spending accounts for ~17.3% of GDP as of 2022. Source: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical https://www.cms.gov/data-research/statistics-trends-and-repo...
- lr0 2y ago
  >It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one Because the regime decisions in the US. are much defined by the corporatocracy and lobbyists interests rather than the people's. Some further readings/videos on that: [0]: https://harpers.org/archive/1960/10/the-politics-of-medicine/ https://harpers.org/archive/1960/10/the-politics-of-medicine... (The Politics of Medicine) [1]: https://www.youtube.com/watch?v=RoHq6dBpxYU https://www.youtube.com/watch?v=RoHq6dBpxYU (The Lobby) [2]: https://chomsky.info/20100124/ https://chomsky.info/20100124/ (The Corporate Takeover of U.S. Democracy) [3]: https://chomsky.info/20110407-2/ https://chomsky.info/20110407-2/ (The State-Corporate Complex)
- paulpauper 2y ago
  higher taxes would make it unpopular Lower taxes and employer-sponsored health care is cheaper than single payer and higher taxes
  - microtonal 2y ago
    Except it's more expensive. Health care is far more expensive per capita in the US than other Western countries, all while having worse outcomes. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 https://www.commonwealthfund.org/publications/issue-briefs/2...
- jfengel 2y ago
  It is extremely hard to get people to agree on any one alternative. Any system has pluses and minuses, and it's easy to scare people away from any particular choice. It took superhuman effort, a once-in-a-lifetime political opportunity, and some outright shenanigans even to get the Affordable Care Act passed. It was a very minor tweak to the existing system, and half the country viewed it as an apocalypse. The political party that passed it ran away from it in the next election, and got massacred. But now that it is law, it too is nearly impossible to alter because the alternatives all terrify people.
  - ghaff 2y ago
    At least making insurance available for people with pre-existing conditions was a pretty big win for some. And the penalties for just passing on it are pretty small. However, as I wrote elsewhere, Medicare is still expensive if you recently had a high-ish income. It's been perfectly fine insurance for me so far but it's probably what many would consider unreasonably expensive.
- benlivengood 2y ago
  Because political decisions are aligned with special interest groups such as giant insurance companies [0], not the policies that average voters want. [0] https://www.cambridge.org/core/journals/perspectives-on-politics/article/testing-theories-of-american-politics-elites-interest-groups-and-average-citizens/62327F513959D0A304D4893B382B992B https://www.cambridge.org/core/journals/perspectives-on-poli...
- thfuran 2y ago
  >I don’t think hating any of the players makes sense. Those that set the rules are ultimately responsible. If it were legal in certain circumstances to kill someone and take all their stuff, you'd hold the people who arrange for those circumstances to arise as often as possible for the purposes of plundering from their former neighbors blameless because "they're just playing the game"? What if it were torture instead of just murder? Does there ever come a point when a person is responsible for their actions?
  - ModernMech 2y ago
    > Does there ever come a point when a person is responsible for their actions? This is it right here. People have been holding out for an answer to that question and I think they are learning every day the answer is no. People can't watch families like the Sacklers inflict untold harm on the population and then get away with a fine less than what they made inflicting that harm, and come away to believe the system works, and that rich people's "due process" is the same as the rest of ours. If I murder 1, 10, or 100 people I go to jail for life or get the death penalty. If I make a business that murders half a million people by pushing pills and I make a billion dollars doing that, absolute worst case scenario I get a relatively small fine compare to my earnings, and I continue the rest of my life in luxurious freedom. And that's only IF the issue goes to trial after I exhaust my endless resources to massage the justice system by choosing the venue, the judge, and the jury. Lifetime jail and death isn't even on the table. I guess until now that is... maybe that changes the cost/benefit analysis in boardrooms. Maybe they need to start estimating the likelihood their decisions are so immoral they will actually radicalize their customers to murder them. Because it seems like that possibility doesn't even cross their minds and they feel they can race to the bottom with no repercussions except a fine.
    - thfuran 2y ago
      I'm not asking about whether the legal system will hold someone responsible. I'm asking whether they are culpable, ethically speaking. The whole "don't hate the player; hate the game" thing seems to just be a total abdication of responsibility. Of course incentives shape behavior, but saying that only the incentive structure is to blame serves the interests of no one but the sort of person who would do absolutely anything they can get away with that makes them a buck and then insist that it wasn't bad because someone else would've done it if they hadn't.
- LudwigNagasena 2y ago
  There is no European healthcare system. European countries have very different healthcare systems.
- abeppu 2y ago
  Isn't it just that there's too much money and too big an industry (with lobbyists and campaign contributions)? People are not happy with the system but they're less dedicated to pressuring politicians than companies who depend on the status quo. We all also hate the overly complex tax system that obliges individuals to calculate their own taxes and get penalized if they do it wrong, but tax preparers like Intuit can kill efforts to simplify it. I think in general we all hate some subsidies but recipient industries are effective in lobbying to preserve them. Etc etc.
- ccppurcell 2y ago
  Well ok except that healthcare companies are big political donors. In fact I think they are the biggest lobbyists in the states.
- geremiiah 2y ago
  Because the European market based insurance models like the ones in the Netherlands and Germany are completely redundant bureaucracy without any actual market mechanism, and Americans are typically above that kind of nonsense. Americans want choice, but that necessitates having choice.
  - InsideOutSanta 2y ago
    I can't tell if you're serious or sarcastic, but you can get private health insurance in all European countries, and an important thing the "redundant bureaucracy" does is negotiate and/or control pricing, which keeps the overal healthcare cost down. One of the issues with healthcare in the US is that every actor other than the patient benefits from higher cost and worse service. It increases revenue and decreases cost for healthcare providers, for pharma, and, importantly, also for insurance companies. There is no competition to improve service and decrease costs.
    - geremiiah 2y ago
      I don't know what you are talking about, but I have lived in both the Netherlands and Germany and in both instances, you have a "choice" of insurance providers, but the list of services and the pricing is mandated by law. There is virtually no difference between being with one insurer compared to the other, except for whom will process your application and handle the money. In that respect it's just a bunch of useless added bureaucracy compared to an NHS-style system with just one country-wide insurer.
      - InsideOutSanta 2y ago
        Like I said, you can get private health insurance in both the Netherlands and Germany. Basic service is mandated by law, and will be the same across all providers, but you can get any additional insurance you want. I do agree that it makes more sense to have basic healthcare covered by a single national government program, rather than mandating basic coverage and allowing private insurance companies to "compete" by offering the same mandatory coverage as each other. If that's specifically what you're referring to by "useless added bureaucracy", then I agree.
- skirge 2y ago
  but which European system? in Poland we go private otherwise we wait two years (so you can die without a debt). In Sweden you need to pay for a doctor appoitnment. Netherlands you cover first few hundreds euros. Every country is little different.
- benreesman 2y ago
  Somewhere along the way a firmware bug was discovered in the American psyche that judges whether or not something is “capitalism” by whether or not there are “companies” involved, but is completely insensitive to whether or not “competition” is involved: this is how you get a Vox piece that includes “private industry” and “legally allowed to negotiate prices” in the same paragraph but lacks “fucking ridiculous”. The pharmaceutical companies have patents on the drugs and so they rent seek. The hospitals have geographic locations and generally don’t get built across the street from each other. The pharmacies are owned by the same parent companies as the insurers. But somehow you can take this mess of central committee grift and pay some CEO 8 figures a year and now comrade, now we are doing the capitalism. We are rocking and rolling.
  - sneak 2y ago
    It’s also illegal to build new hospitals without permission, even if you have the demand and ability to build one across the street from the existing one. There are MANY firms who would love to open discount clinics across the street from a bunch of existing medical centers and out-compete them on price and service and eat their lunch; anyone who has used the american medical system knows what a low bar that is to clear. The problem is that in most cases the supply of doctors is capped by law and the ability to open new hospitals and clinics is restricted, so prices remain astronomical and service remains terrible, just like your other public utilities. Somehow this government-mandated lack of competition is blamed on “free market capitalism”.
- jasode 2y ago
  >It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one. There have been various attempts and proposals to change the system. An example of one attempt among many is called "Medicare for All Act": https://en.wikipedia.org/wiki/Medicare_for_All_Act https://en.wikipedia.org/wiki/Medicare_for_All_Act Scroll down that article to see that for the last 21 years of revisiting it by every legislative body, it always ends "Died in Committee". Every 2 years, some new representatives get elected, and yet it still dies. The proposal doesn't even make it out to the House floor to officially vote on. Why? A lot of vested interests in keeping the current system. (Aka "money".) The intuition is to think only the greedy health insurance companies are against it. But doctors' associations and many American workers with decent health insurance from their employers are against it too.
  - andyjohnson0 2y ago
    > But doctors' associations and many Americans with decent health insurance from their employers are against it too. Why? And why?
    - mnky9800n 2y ago
      Doctors often are compensated for the money they bring to their hospitals by the treatments they prescribe. That is, there is an incentive for doctors to prescribe costly treatments because they will net more payments from insurance raising hospital revenues.
- mastax 2y ago
  In the American political system currently the reward for passing a large piece of legislation, even one which eventually becomes popular, is to be voted out at the next midterm elections. So why bother? Don’t worry about legislation, just tweet.
- mmmBacon 2y ago
  There’s a presumption that European healthcare systems are better. Can we define what better is? Is it actually true that European systems are better?
- InsideOutSanta 2y ago
  Surveys show that a majority of Americans support a single national government program for healthcare. The reason this does not exist is because it has become increasingly easy to distract people with wedge issues and make them focus on what divides them, rather than what unites them.
- aithrowawaycomm 2y ago
  Many European countries were able to implement universal healthcare without much of a fight because their economies were utterly devastated after WW2, along with their health care systems. (An exception that proves the rule: France nationalized its private insurance companies that survived the war.) So there weren't really any stakeholders arguing for the old system - notably this is not just hospitals and insurers, patients are also stakeholders. One problem with the US is that "universal healthcare" is popular in the abstract, but "we're gonna take away your BCBS plan and put you on Medicaid" is extremely unpopular.[1] The US is actually closer to the Canadian example, though Canada started earlier and doesn't have a Big Pharma burden. But like the US, Canada is a hybrid private-public system with a lot of provincial variation. There wasn't a Canadian federal health law until the 80s, after 20 years of patchwork provincial laws, and Canada continues to have big gaps and inequities (e.g. mental health coverage is quite a bit worse in Canada than the US, dental isn't covered, and people on work visas get screwed). A large majority of Canadians have supplementary private insurance. So I think the US will get close to the Canadian system via slowly pushing up the Medicaid eligibility line and eating away at private insurance, and not a big sweeping law. [1] "Medicare for all" is dishonest, it has to be Medicaid for all. But for classist political reasons nobody wants to say that.
Glyptodon 2y ago
The basic concept of connecting employment with insurance coverage is just so broken and backwards.
- akgoel 2y ago
  I hear this all the time, and I somewhat disagree. The problem is that unhealthy people do not want to pay the full amount of their risk-adjusted rate into the risk-pool. Therefore, they need healthy people to subsidize them. It makes sense that pooling a group of employees together would be uncorrelated to health status, and would therefore make a good proxy for a risk-pool.
  - throawayonthe 2y ago
    [dead]
  - fsmv 2y ago
    The risk pool should be as large as possible, the whole country, to minimize costs for everyone. It's deeply unfair to tell someone that lost their job that they also now have no access to healthcare.
    - mgh95 2y ago
      > The risk pool should be as large as possible, the whole country, to minimize costs for everyone. The risk pool being larger does not necessarily improve the risk pool.
      - SketchySeaBeast 2y ago
        Shouldn't insurance risk pools be trying to move towards the large and average? This allows insurance to be more resilient to sudden changes in health by accepting that people are going to get sick. I don't know how having tiers of health care with low risk pool and high risk pools would be advantageous to anyone but the young and healthy who inevitably become the old and sick, which is painfully short term thinking for the former and unfairly punishing for the latter.
tayo42 2y ago
[flagged]
- RobotToaster 2y ago
  Neither party pledged to introduce universal healthcare. Obama had the votes to do so but passed a half-assed compromise instead.
  - mtalantikite 2y ago
    He almost did - Joe Lieberman held it hostage and refused from what I remember: https://www.theguardian.com/world/2009/dec/16/joe-lieberman-barack-obama-us-healthcare https://www.theguardian.com/world/2009/dec/16/joe-lieberman-...
  - smt88 2y ago
    This is because Republicans are beholden to the companies profiting from the existing system, and Democrats are beholden to unions[1]. Our unions are a reason we have no actual labor movement in this country. They're socially conservative and oppose universal health-care because it invalidates hard-won health benefits in the contracts they've negotiated with employers. They spent decades fighting brutal legal battles and taking hits to their pay from striking, and one of the things they got was health insurance. It's painful to feel like that was for nothing. 1. https://www.politico.com/news/2020/02/18/medicare-for-all-labor-union-115873 https://www.politico.com/news/2020/02/18/medicare-for-all-la...
- School-Cotton 2y ago
  No mainstream politician has a realistic plan to reform healthcare. Bernie may have said he supported it, but he had no explanation how he’d get his reforms through the senate.
  - tayo42 2y ago
    Those things dont go through the senate because of how americans vote (the senators voted into congress)
arealaccount 2y ago
How does this piece hold up when the same entity controls the providers, the insurance agency, and the pharmaceutical company?
- dredmorbius 2y ago
  Do you have specific example(s) in mind?
- relaxing 2y ago
  To be accurate it’s not the pharmaceutical companies, but the pharmacies and pharmacy benefit middlemen that influence pharmaceutical prices that are increasingly owned by the insurers.
Mistletoe 2y ago
So deep that we did absolutely nothing about it when we had the chance and now have elected someone that will make it even worse. Americans don’t realize that the country is exploitative in so many ways because they keep voting completely opposite from candidates that will help make their life better. >John Steinbeck once said that socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires.
- tmpz22 2y ago
  Historically exploitation is the back bone of America. Before we were even a country we were exploiting the British to clear the Ohio river valley for commercial gain. We didn’t want to pay for that so we took the opportunity to revolt which was paid for largely by the French. Then between manifest destiny and sniping half the continent from the French in the Louisiana purchase. Our early economy exploited hundreds of thousands of African slaves. And that’s just the first hundred years.
- computerthings 2y ago
  As an outsider what I see is that Trump claimed to stand for change, while the Democrats seemed to champion the status quo. Just the fact Biden promised to run for one term, then they lied about him not being senile, then Harris was anointed saying she'll basically be Biden, and don't you dare not go along because Trump is the end of democracy - that is just incredibly astonishing to me. And people wonder why that didn't work out? To me that's like talking about why this car with perfectly good tires hasn't won the race, when it has no engine and no driver and it's not even on the racing track but at the bottom on the ocean. With perfectly good tires admittedly, which pundits are examining with microscopes. From what I can tell all they ever offered is playing for time and rationalizations for why the boat should not be rocked, preaching to people who are treading water, who will never be in that boat. Basically "we're so proud of our achievements and excited to face even greater challenges with you" -- whereas Trump was screaming about making "them" pay and flipping tables. And even though "they" are a scapegoat, and even though he'll make it (so much) worse, at least the anger is something people vaguely recognize, whereas what came from the Democrats is mostly alien and alienating ivory tower talk. At the end of the day, I think the US needs at least one more major party. Two sides hiding all their own flaws behind the other is just unworkable. It makes people incredibly lazy intellectually.
paulpauper 2y ago
America's problem are similar to elsewhere: to too much demand, overworked staff, long lines . There are tons of articles about problems with the NHS
- microtonal 2y ago
  America's problem are similar to elsewhere: to too much demand, overworked staff, long lines . The NHS is not a particularly good example. I live in another Western European country. It's easy to get an appointment quickly and an appointment means an appointment (if the appointment is at 11:15, you typically have to wait 10 minutes at most). My experience has been the same in another Western/Northern European country when I had what turned out to be kidney stones when we were on vacation. It used to be different when I was young, but the system was made more efficient. Both of my parents were/are dealing with a severe illness, but both were quick to get appointments for tests/surgery and they haven't paid a cent.
  - Cumpiler69 2y ago
    >It's easy to get an appointment quickly and an appointment means an appointment (if the appointment is at 11:15, you typically have to wait 10 minutes at most) Where is that?
- MattPalmer1086 2y ago
  15 years ago the NHS would have held up as an example of a very successful health organisation. We just went through 14 years of Tory government who are ideologically opposed to the NHS.
  - relaxing 2y ago
    It’s the standard right-wing playbook — cut services then claim the system doesn’t work.
- verteu 2y ago
  I think US healthcare is an outlier in terms of its poor outcomes-per-dollar: https://upload.wikimedia.org/wikipedia/commons/d/d6/Life_expectancy_vs_healthcare_spending.jpg https://upload.wikimedia.org/wikipedia/commons/d/d6/Life_exp...
microtonal 2y ago
From the outside, it seems that many Americans are opposed to regulation in general and universal healthcare is seen as 'socialist'. This is fed by politicians lobbied by corporations with deep pockets. To make it worse, large employers have a stake in keeping the system, because it reduces employee mobility and makes employees more obedient (since they don't want to or can't risk losing health care). It seems that these problems can only be resolved if Americans accept more broadly that regulation can be good and that even though regulation can be 'socialist' it does not necessarily mean bad.
- tmpz22 2y ago
  Americans are fine with regulation but struggle with nuanced regulation and long term regulation that has a short term cost. Culturally we’ll also rush to a perceived moral high ground on various issues with a regional bias - for example cities will pass a minimum wage law on moral grounds and small towns will reject the same law on moral grounds (small business). Like all thinks it’s nuanced and blanket statements don’t really help.
  - microtonal 2y ago
    Thank you for the clarification! It's just something that I encounter a lot when talking to Americans, there is a lot of aversion to regulation, government support, etc.
shermantanktop 2y ago
This article is just a giant shrug with no ideas, even while it tries to label popular outrage as “misguided.”
turdprincess 2y ago
America is a land of inequality. There are many people (poor) which have bad healthcare, but for many others (the wealthy, stably employed), healthcare is excellent. If you have a good job with a good PPO plan, this healthcare is just incredible. You are free to see any doctor you want, including specialists without any gatekeeping. Want to see the best orthopedic surgeon in the world who just fixed Lebron James's knee? Make a call and get an appointment within a few weeks paying a 30 dollar fee. Want to see 10 more orthopedic surgeons to get 2nd, 3rd and 4th opinions? Same process. Decide to have a surgery? Sure! Sign up to have that done in a few weeks, eventually paying $250 out of pocket for the whole experience, including overnight hospital stays and physical therapy. Having spent some good time hanging out in facebook groups for my condition with international patients, its pretty much always evident that they dont have this kind of freedom in picking their doctor, getting a surgery quickly, and also often lack cutting edge and modern treatments that are offered in the states. I totally understand that this system is very unfair, and there is whole subset of people that have no access to care, but it should be noted that if you are in the top 50% of society financially, and especially if you have a difficult health condition you manage there is no healthcare system better in the world to do that then the USA.
- bryanrasmussen 2y ago
  I'm pretty sure it can't be the top 50% of society that has this, because that would mean it was average or even median. I expect it can probably start to happen from the top 25% up
drweevil 2y ago
This is a canonical example of an establishment media outlet steering (misdirecting?) the conversation into more "acceptable" directions. "The killing of a human being is morally repugnant — full stop." Yup. But this industry's business model is predicated on withholding care, sometimes costing lives. So, by definition, it too is morally repugnant. "But prices have continued to spiral upward, accelerated by the aging of the baby boomers and by important but costly advancements in medical science." Note how deftly this sidesteps profit taking as a driver. It's a big one, estimated to be nearly $2 Trillion in 2022 (as compared to other peer countries, who face the same aging population constraints and "costly" advances in medical science. https://www.msn.com/en-us/health/other/the-cost-of-corporate-profit-in-u-s-health-care-reaches-2-trillion/ar-AA1tdpoo https://www.msn.com/en-us/health/other/the-cost-of-corporate...). "The passage of Obamacare over industry opposition..." I was around and paying close attention when that happened. The industry practically wrote the ACA. Sure, they made some concessions, but anything they really opposed--like the Public Option--didn't stand a chance. And when the individual mandate went before SCOTUS it was of course upheld. The industry was happy to have people pay a penalty for not using its products! This last is in fact the biggest sin of this piece: the obfuscation of the role that the industry's lobby plays in opposing change. Any attempt to get to a more rational system is met with full frontal opposition in the media and in our legislatures. People who advocate for systems like Medicare for All are labeled nuts, out of touch, and get the "Harry and Louise" treatment. There is no safety valve. So the pressure keeps rising and rising, until something really bad happens.
jdenning 2y ago
Do any of us really care which of these mega-bureaucracies is to blame for each particular hurdle to receiving healthcare? From the patient’s perspective, they are all conspiring to gouge us, deny us care, and perpetuate their gold-plated monopolies. The constant factor is that the patient always loses. It’d be nice if we could have a political system where politicians represented their constituents, rather than their financial backers. But I fear that the culture war has made that very unlikely. It’ll get worse before it gets better.
tzs 2y ago
There's something that is often overlooked in discussions of the problems with and how to fix the American healthcare system. Two of the biggest problems are that (1) America pays quite a bit more for a given level of care than they do in most other first world countries, and (2) the cost keeps going up significantly more than can be explained just be normal inflation. The discussion then usually focuses on the differences between the American system and the systems of places like Europe and Japan, with people arguing about which of those differences are why we've got problems and whether or not adopting some ideas from those other systems would fix our high cost and rising cost problems. The problem with that is while those other systems do indeed cost a lot less than the US, they also have a rising cost problem. For example here are the ratios the per capita costs when up in the US during the decades starting from the '70s [1]: 3.2, 2.6, 1.7, 1.7, 1.5. Pretty horrible. Here are the numbers for the UK: 3.1, 2.0, 2.4, 1.8, 1.5. Here they are for France: 3.4, 2.2, 2.0, 1.4, 1.4. Also pretty horrible, and about the same level of horribleness as the US. Here's the ratio of 2018 to 2000 per capita health care costs for a few countries: Japan 2.6, UK 2.6, US 2.3, Germany 2.1, Canada 2.0, France 1.8, Italy 1.7. This suggests that perhaps the US problem with rising costs does not stem from the differences between the US system and those of most other places. It also suggests that the problem with higher costs than those other places might not be due to relatively recent changes in the US system that much discussion often focuses on. Instead it might be we pay much more than Europe and Japan now mostly because we paid much more than Europe and Japan 50 years ago. [1] My data came from https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm which used to have a wonderful interface that allowed you to easily generate various views and reports of OECD country health care costs from 1970 to almost the present that let me get the data I wanted in a convenient form. The have since reorganized things and that now redirects to https://www.oecd.org/en/data/indicators/health-spending.html https://www.oecd.org/en/data/indicators/health-spending.html which has a different interface and still has, I think, the same data but I no longer know how to get it as conveniently.

66 points by lr0 2y ago

[dead]

It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one. I don’t think hating any of the players makes sense. Those that set the rules are ultimately responsible.

School-Cotton 2y ago
The American government doesn’t have the power to change laws. The requirement to have 60/100 votes in the senate makes it almost impossible to pass anything except the most uncontroversial bills.
- lapcat 2y ago
  > The requirement to have 60/100 votes in the senate makes it almost impossible to pass anything except the most uncontroversial bills. The filibuster is not enshrined in the Constitution. It's only a Senate rule that could be abolished at any time via a simple majority vote in the Senate. The Senators have chosen not to abolish the filibuster.
- smt88 2y ago
  > makes it almost impossible to pass anything except the most uncontroversial bills It's actually worse than this. Popular bills, like the Dreamers Act, become political footballs. Neither party wants to pass it while the other party is "in power" (in the minds of the electorate), and they want to keep it around as a bargaining chip, campaign promise, etc. So the bills that get 60 votes aren't just uncontroversial, they're usually not even meaningful to voters.
- BeFlatXIII 2y ago
  Even those get spiked for political grandstanding on some off-topic issue.
jimbob45 2y ago
The root of the problem is that American health insurance is employer-sponsored so you don’t get to choose your carrier and your employer can choose entirely because of bribes if they so choose. As such, the vaunted American invisible hand doesn’t get to play its part.
dgacmu 2y ago
Well, that gets us into the question of the influence of money on American politics. The incumbent players make a ton of money from the current system, and they use a lot of that money to lobby to maintain the system, and the system is responsive to their money. Made worse by Citizens United, but it's been a problem for a long time. Combine this with a distrust of government that is encouraged by many of those same interests and you have, well, us.
- s1artibartfast 2y ago
  Voters still control the ballot box, and have rejected single payer propositions. When polled, they say they want healthcare reform, but hate every option when they are described to them.
  - dgacmu 2y ago
    Yeah. There's a lot of fear-based marketing aimed at getting people to reject single-payer. It seems effective. A lot of our voting seems to suffer from the "but it won't happen to me" fallacy, whether that be about health care and medical debt, conditions in jails, climate change, social services, etc. with the irony being that it often happens to most people in the long run.
    - s1artibartfast 2y ago
      Often times that is true. Most people dont end up in jail, with medial debt, and reliant social services, ect.
jmclnx 2y ago
Political Contributions (or known as bribes elsewhere) is why :(
- Ekaros 2y ago
  Also fun rotation in jobs. Work on one side and then have expertise to work on the other. And wise-versa... Unless you are true idealist, which will get steered out, why would you ruin the good thing going on...
llama_person 2y ago
The current one makes a lot of money for a lot of parties uninterested in change, who then also lobby to prevent any reform. Health spending accounts for ~17.3% of GDP as of 2022. Source: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical https://www.cms.gov/data-research/statistics-trends-and-repo...
lr0 2y ago
>It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one Because the regime decisions in the US. are much defined by the corporatocracy and lobbyists interests rather than the people's. Some further readings/videos on that: [0]: https://harpers.org/archive/1960/10/the-politics-of-medicine/ https://harpers.org/archive/1960/10/the-politics-of-medicine... (The Politics of Medicine) [1]: https://www.youtube.com/watch?v=RoHq6dBpxYU https://www.youtube.com/watch?v=RoHq6dBpxYU (The Lobby) [2]: https://chomsky.info/20100124/ https://chomsky.info/20100124/ (The Corporate Takeover of U.S. Democracy) [3]: https://chomsky.info/20110407-2/ https://chomsky.info/20110407-2/ (The State-Corporate Complex)
paulpauper 2y ago
higher taxes would make it unpopular Lower taxes and employer-sponsored health care is cheaper than single payer and higher taxes
- microtonal 2y ago
  Except it's more expensive. Health care is far more expensive per capita in the US than other Western countries, all while having worse outcomes. https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 https://www.commonwealthfund.org/publications/issue-briefs/2...
jfengel 2y ago
It is extremely hard to get people to agree on any one alternative. Any system has pluses and minuses, and it's easy to scare people away from any particular choice. It took superhuman effort, a once-in-a-lifetime political opportunity, and some outright shenanigans even to get the Affordable Care Act passed. It was a very minor tweak to the existing system, and half the country viewed it as an apocalypse. The political party that passed it ran away from it in the next election, and got massacred. But now that it is law, it too is nearly impossible to alter because the alternatives all terrify people.
- ghaff 2y ago
  At least making insurance available for people with pre-existing conditions was a pretty big win for some. And the penalties for just passing on it are pretty small. However, as I wrote elsewhere, Medicare is still expensive if you recently had a high-ish income. It's been perfectly fine insurance for me so far but it's probably what many would consider unreasonably expensive.
benlivengood 2y ago
Because political decisions are aligned with special interest groups such as giant insurance companies [0], not the policies that average voters want. [0] https://www.cambridge.org/core/journals/perspectives-on-politics/article/testing-theories-of-american-politics-elites-interest-groups-and-average-citizens/62327F513959D0A304D4893B382B992B https://www.cambridge.org/core/journals/perspectives-on-poli...
thfuran 2y ago
>I don’t think hating any of the players makes sense. Those that set the rules are ultimately responsible. If it were legal in certain circumstances to kill someone and take all their stuff, you'd hold the people who arrange for those circumstances to arise as often as possible for the purposes of plundering from their former neighbors blameless because "they're just playing the game"? What if it were torture instead of just murder? Does there ever come a point when a person is responsible for their actions?
- ModernMech 2y ago
  > Does there ever come a point when a person is responsible for their actions? This is it right here. People have been holding out for an answer to that question and I think they are learning every day the answer is no. People can't watch families like the Sacklers inflict untold harm on the population and then get away with a fine less than what they made inflicting that harm, and come away to believe the system works, and that rich people's "due process" is the same as the rest of ours. If I murder 1, 10, or 100 people I go to jail for life or get the death penalty. If I make a business that murders half a million people by pushing pills and I make a billion dollars doing that, absolute worst case scenario I get a relatively small fine compare to my earnings, and I continue the rest of my life in luxurious freedom. And that's only IF the issue goes to trial after I exhaust my endless resources to massage the justice system by choosing the venue, the judge, and the jury. Lifetime jail and death isn't even on the table. I guess until now that is... maybe that changes the cost/benefit analysis in boardrooms. Maybe they need to start estimating the likelihood their decisions are so immoral they will actually radicalize their customers to murder them. Because it seems like that possibility doesn't even cross their minds and they feel they can race to the bottom with no repercussions except a fine.
  - thfuran 2y ago
    I'm not asking about whether the legal system will hold someone responsible. I'm asking whether they are culpable, ethically speaking. The whole "don't hate the player; hate the game" thing seems to just be a total abdication of responsibility. Of course incentives shape behavior, but saying that only the incentive structure is to blame serves the interests of no one but the sort of person who would do absolutely anything they can get away with that makes them a buck and then insist that it wasn't bad because someone else would've done it if they hadn't.
LudwigNagasena 2y ago
There is no European healthcare system. European countries have very different healthcare systems.
abeppu 2y ago
Isn't it just that there's too much money and too big an industry (with lobbyists and campaign contributions)? People are not happy with the system but they're less dedicated to pressuring politicians than companies who depend on the status quo. We all also hate the overly complex tax system that obliges individuals to calculate their own taxes and get penalized if they do it wrong, but tax preparers like Intuit can kill efforts to simplify it. I think in general we all hate some subsidies but recipient industries are effective in lobbying to preserve them. Etc etc.
ccppurcell 2y ago
Well ok except that healthcare companies are big political donors. In fact I think they are the biggest lobbyists in the states.
geremiiah 2y ago
Because the European market based insurance models like the ones in the Netherlands and Germany are completely redundant bureaucracy without any actual market mechanism, and Americans are typically above that kind of nonsense. Americans want choice, but that necessitates having choice.
- InsideOutSanta 2y ago
  I can't tell if you're serious or sarcastic, but you can get private health insurance in all European countries, and an important thing the "redundant bureaucracy" does is negotiate and/or control pricing, which keeps the overal healthcare cost down. One of the issues with healthcare in the US is that every actor other than the patient benefits from higher cost and worse service. It increases revenue and decreases cost for healthcare providers, for pharma, and, importantly, also for insurance companies. There is no competition to improve service and decrease costs.
  - geremiiah 2y ago
    I don't know what you are talking about, but I have lived in both the Netherlands and Germany and in both instances, you have a "choice" of insurance providers, but the list of services and the pricing is mandated by law. There is virtually no difference between being with one insurer compared to the other, except for whom will process your application and handle the money. In that respect it's just a bunch of useless added bureaucracy compared to an NHS-style system with just one country-wide insurer.
    - InsideOutSanta 2y ago
      Like I said, you can get private health insurance in both the Netherlands and Germany. Basic service is mandated by law, and will be the same across all providers, but you can get any additional insurance you want. I do agree that it makes more sense to have basic healthcare covered by a single national government program, rather than mandating basic coverage and allowing private insurance companies to "compete" by offering the same mandatory coverage as each other. If that's specifically what you're referring to by "useless added bureaucracy", then I agree.
skirge 2y ago
but which European system? in Poland we go private otherwise we wait two years (so you can die without a debt). In Sweden you need to pay for a doctor appoitnment. Netherlands you cover first few hundreds euros. Every country is little different.
benreesman 2y ago
Somewhere along the way a firmware bug was discovered in the American psyche that judges whether or not something is “capitalism” by whether or not there are “companies” involved, but is completely insensitive to whether or not “competition” is involved: this is how you get a Vox piece that includes “private industry” and “legally allowed to negotiate prices” in the same paragraph but lacks “fucking ridiculous”. The pharmaceutical companies have patents on the drugs and so they rent seek. The hospitals have geographic locations and generally don’t get built across the street from each other. The pharmacies are owned by the same parent companies as the insurers. But somehow you can take this mess of central committee grift and pay some CEO 8 figures a year and now comrade, now we are doing the capitalism. We are rocking and rolling.
- sneak 2y ago
  It’s also illegal to build new hospitals without permission, even if you have the demand and ability to build one across the street from the existing one. There are MANY firms who would love to open discount clinics across the street from a bunch of existing medical centers and out-compete them on price and service and eat their lunch; anyone who has used the american medical system knows what a low bar that is to clear. The problem is that in most cases the supply of doctors is capped by law and the ability to open new hospitals and clinics is restricted, so prices remain astronomical and service remains terrible, just like your other public utilities. Somehow this government-mandated lack of competition is blamed on “free market capitalism”.
jasode 2y ago
>It’s unclear to me why the American government doesn’t change the laws and create a new system more like a European one. There have been various attempts and proposals to change the system. An example of one attempt among many is called "Medicare for All Act": https://en.wikipedia.org/wiki/Medicare_for_All_Act https://en.wikipedia.org/wiki/Medicare_for_All_Act Scroll down that article to see that for the last 21 years of revisiting it by every legislative body, it always ends "Died in Committee". Every 2 years, some new representatives get elected, and yet it still dies. The proposal doesn't even make it out to the House floor to officially vote on. Why? A lot of vested interests in keeping the current system. (Aka "money".) The intuition is to think only the greedy health insurance companies are against it. But doctors' associations and many American workers with decent health insurance from their employers are against it too.
- andyjohnson0 2y ago
  > But doctors' associations and many Americans with decent health insurance from their employers are against it too. Why? And why?
  - mnky9800n 2y ago
    Doctors often are compensated for the money they bring to their hospitals by the treatments they prescribe. That is, there is an incentive for doctors to prescribe costly treatments because they will net more payments from insurance raising hospital revenues.
mastax 2y ago
In the American political system currently the reward for passing a large piece of legislation, even one which eventually becomes popular, is to be voted out at the next midterm elections. So why bother? Don’t worry about legislation, just tweet.
mmmBacon 2y ago
There’s a presumption that European healthcare systems are better. Can we define what better is? Is it actually true that European systems are better?
InsideOutSanta 2y ago
Surveys show that a majority of Americans support a single national government program for healthcare. The reason this does not exist is because it has become increasingly easy to distract people with wedge issues and make them focus on what divides them, rather than what unites them.
aithrowawaycomm 2y ago
Many European countries were able to implement universal healthcare without much of a fight because their economies were utterly devastated after WW2, along with their health care systems. (An exception that proves the rule: France nationalized its private insurance companies that survived the war.) So there weren't really any stakeholders arguing for the old system - notably this is not just hospitals and insurers, patients are also stakeholders. One problem with the US is that "universal healthcare" is popular in the abstract, but "we're gonna take away your BCBS plan and put you on Medicaid" is extremely unpopular.[1] The US is actually closer to the Canadian example, though Canada started earlier and doesn't have a Big Pharma burden. But like the US, Canada is a hybrid private-public system with a lot of provincial variation. There wasn't a Canadian federal health law until the 80s, after 20 years of patchwork provincial laws, and Canada continues to have big gaps and inequities (e.g. mental health coverage is quite a bit worse in Canada than the US, dental isn't covered, and people on work visas get screwed). A large majority of Canadians have supplementary private insurance. So I think the US will get close to the Canadian system via slowly pushing up the Medicaid eligibility line and eating away at private insurance, and not a big sweeping law. [1] "Medicare for all" is dishonest, it has to be Medicaid for all. But for classist political reasons nobody wants to say that.

Glyptodon 2y ago

The basic concept of connecting employment with insurance coverage is just so broken and backwards.

akgoel 2y ago
I hear this all the time, and I somewhat disagree. The problem is that unhealthy people do not want to pay the full amount of their risk-adjusted rate into the risk-pool. Therefore, they need healthy people to subsidize them. It makes sense that pooling a group of employees together would be uncorrelated to health status, and would therefore make a good proxy for a risk-pool.
- throawayonthe 2y ago
  [dead]
- fsmv 2y ago
  The risk pool should be as large as possible, the whole country, to minimize costs for everyone. It's deeply unfair to tell someone that lost their job that they also now have no access to healthcare.
  - mgh95 2y ago
    > The risk pool should be as large as possible, the whole country, to minimize costs for everyone. The risk pool being larger does not necessarily improve the risk pool.
    - SketchySeaBeast 2y ago
      Shouldn't insurance risk pools be trying to move towards the large and average? This allows insurance to be more resilient to sudden changes in health by accepting that people are going to get sick. I don't know how having tiers of health care with low risk pool and high risk pools would be advantageous to anyone but the young and healthy who inevitably become the old and sick, which is painfully short term thinking for the former and unfairly punishing for the latter.

tayo42 2y ago

[flagged]

RobotToaster 2y ago
Neither party pledged to introduce universal healthcare. Obama had the votes to do so but passed a half-assed compromise instead.
- mtalantikite 2y ago
  He almost did - Joe Lieberman held it hostage and refused from what I remember: https://www.theguardian.com/world/2009/dec/16/joe-lieberman-barack-obama-us-healthcare https://www.theguardian.com/world/2009/dec/16/joe-lieberman-...
- smt88 2y ago
  This is because Republicans are beholden to the companies profiting from the existing system, and Democrats are beholden to unions[1]. Our unions are a reason we have no actual labor movement in this country. They're socially conservative and oppose universal health-care because it invalidates hard-won health benefits in the contracts they've negotiated with employers. They spent decades fighting brutal legal battles and taking hits to their pay from striking, and one of the things they got was health insurance. It's painful to feel like that was for nothing. 1. https://www.politico.com/news/2020/02/18/medicare-for-all-labor-union-115873 https://www.politico.com/news/2020/02/18/medicare-for-all-la...
School-Cotton 2y ago
No mainstream politician has a realistic plan to reform healthcare. Bernie may have said he supported it, but he had no explanation how he’d get his reforms through the senate.
- tayo42 2y ago
  Those things dont go through the senate because of how americans vote (the senators voted into congress)

arealaccount 2y ago

How does this piece hold up when the same entity controls the providers, the insurance agency, and the pharmaceutical company?

dredmorbius 2y ago
Do you have specific example(s) in mind?
relaxing 2y ago
To be accurate it’s not the pharmaceutical companies, but the pharmacies and pharmacy benefit middlemen that influence pharmaceutical prices that are increasingly owned by the insurers.

Mistletoe 2y ago

So deep that we did absolutely nothing about it when we had the chance and now have elected someone that will make it even worse. Americans don’t realize that the country is exploitative in so many ways because they keep voting completely opposite from candidates that will help make their life better. >John Steinbeck once said that socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires.

tmpz22 2y ago
Historically exploitation is the back bone of America. Before we were even a country we were exploiting the British to clear the Ohio river valley for commercial gain. We didn’t want to pay for that so we took the opportunity to revolt which was paid for largely by the French. Then between manifest destiny and sniping half the continent from the French in the Louisiana purchase. Our early economy exploited hundreds of thousands of African slaves. And that’s just the first hundred years.
computerthings 2y ago
As an outsider what I see is that Trump claimed to stand for change, while the Democrats seemed to champion the status quo. Just the fact Biden promised to run for one term, then they lied about him not being senile, then Harris was anointed saying she'll basically be Biden, and don't you dare not go along because Trump is the end of democracy - that is just incredibly astonishing to me. And people wonder why that didn't work out? To me that's like talking about why this car with perfectly good tires hasn't won the race, when it has no engine and no driver and it's not even on the racing track but at the bottom on the ocean. With perfectly good tires admittedly, which pundits are examining with microscopes. From what I can tell all they ever offered is playing for time and rationalizations for why the boat should not be rocked, preaching to people who are treading water, who will never be in that boat. Basically "we're so proud of our achievements and excited to face even greater challenges with you" -- whereas Trump was screaming about making "them" pay and flipping tables. And even though "they" are a scapegoat, and even though he'll make it (so much) worse, at least the anger is something people vaguely recognize, whereas what came from the Democrats is mostly alien and alienating ivory tower talk. At the end of the day, I think the US needs at least one more major party. Two sides hiding all their own flaws behind the other is just unworkable. It makes people incredibly lazy intellectually.

paulpauper 2y ago

America's problem are similar to elsewhere: to too much demand, overworked staff, long lines . There are tons of articles about problems with the NHS

microtonal 2y ago
America's problem are similar to elsewhere: to too much demand, overworked staff, long lines . The NHS is not a particularly good example. I live in another Western European country. It's easy to get an appointment quickly and an appointment means an appointment (if the appointment is at 11:15, you typically have to wait 10 minutes at most). My experience has been the same in another Western/Northern European country when I had what turned out to be kidney stones when we were on vacation. It used to be different when I was young, but the system was made more efficient. Both of my parents were/are dealing with a severe illness, but both were quick to get appointments for tests/surgery and they haven't paid a cent.
- Cumpiler69 2y ago
  >It's easy to get an appointment quickly and an appointment means an appointment (if the appointment is at 11:15, you typically have to wait 10 minutes at most) Where is that?
MattPalmer1086 2y ago
15 years ago the NHS would have held up as an example of a very successful health organisation. We just went through 14 years of Tory government who are ideologically opposed to the NHS.
- relaxing 2y ago
  It’s the standard right-wing playbook — cut services then claim the system doesn’t work.
verteu 2y ago
I think US healthcare is an outlier in terms of its poor outcomes-per-dollar: https://upload.wikimedia.org/wikipedia/commons/d/d6/Life_expectancy_vs_healthcare_spending.jpg https://upload.wikimedia.org/wikipedia/commons/d/d6/Life_exp...

microtonal 2y ago

From the outside, it seems that many Americans are opposed to regulation in general and universal healthcare is seen as 'socialist'. This is fed by politicians lobbied by corporations with deep pockets. To make it worse, large employers have a stake in keeping the system, because it reduces employee mobility and makes employees more obedient (since they don't want to or can't risk losing health care). It seems that these problems can only be resolved if Americans accept more broadly that regulation can be good and that even though regulation can be 'socialist' it does not necessarily mean bad.

tmpz22 2y ago
Americans are fine with regulation but struggle with nuanced regulation and long term regulation that has a short term cost. Culturally we’ll also rush to a perceived moral high ground on various issues with a regional bias - for example cities will pass a minimum wage law on moral grounds and small towns will reject the same law on moral grounds (small business). Like all thinks it’s nuanced and blanket statements don’t really help.
- microtonal 2y ago
  Thank you for the clarification! It's just something that I encounter a lot when talking to Americans, there is a lot of aversion to regulation, government support, etc.

shermantanktop 2y ago

This article is just a giant shrug with no ideas, even while it tries to label popular outrage as “misguided.”

turdprincess 2y ago

America is a land of inequality. There are many people (poor) which have bad healthcare, but for many others (the wealthy, stably employed), healthcare is excellent. If you have a good job with a good PPO plan, this healthcare is just incredible. You are free to see any doctor you want, including specialists without any gatekeeping. Want to see the best orthopedic surgeon in the world who just fixed Lebron James's knee? Make a call and get an appointment within a few weeks paying a 30 dollar fee. Want to see 10 more orthopedic surgeons to get 2nd, 3rd and 4th opinions? Same process. Decide to have a surgery? Sure! Sign up to have that done in a few weeks, eventually paying $250 out of pocket for the whole experience, including overnight hospital stays and physical therapy. Having spent some good time hanging out in facebook groups for my condition with international patients, its pretty much always evident that they dont have this kind of freedom in picking their doctor, getting a surgery quickly, and also often lack cutting edge and modern treatments that are offered in the states. I totally understand that this system is very unfair, and there is whole subset of people that have no access to care, but it should be noted that if you are in the top 50% of society financially, and especially if you have a difficult health condition you manage there is no healthcare system better in the world to do that then the USA.

bryanrasmussen 2y ago
I'm pretty sure it can't be the top 50% of society that has this, because that would mean it was average or even median. I expect it can probably start to happen from the top 25% up

drweevil 2y ago

This is a canonical example of an establishment media outlet steering (misdirecting?) the conversation into more "acceptable" directions. "The killing of a human being is morally repugnant — full stop." Yup. But this industry's business model is predicated on withholding care, sometimes costing lives. So, by definition, it too is morally repugnant. "But prices have continued to spiral upward, accelerated by the aging of the baby boomers and by important but costly advancements in medical science." Note how deftly this sidesteps profit taking as a driver. It's a big one, estimated to be nearly $2 Trillion in 2022 (as compared to other peer countries, who face the same aging population constraints and "costly" advances in medical science. https://www.msn.com/en-us/health/other/the-cost-of-corporate-profit-in-u-s-health-care-reaches-2-trillion/ar-AA1tdpoo https://www.msn.com/en-us/health/other/the-cost-of-corporate...). "The passage of Obamacare over industry opposition..." I was around and paying close attention when that happened. The industry practically wrote the ACA. Sure, they made some concessions, but anything they really opposed--like the Public Option--didn't stand a chance. And when the individual mandate went before SCOTUS it was of course upheld. The industry was happy to have people pay a penalty for not using its products! This last is in fact the biggest sin of this piece: the obfuscation of the role that the industry's lobby plays in opposing change. Any attempt to get to a more rational system is met with full frontal opposition in the media and in our legislatures. People who advocate for systems like Medicare for All are labeled nuts, out of touch, and get the "Harry and Louise" treatment. There is no safety valve. So the pressure keeps rising and rising, until something really bad happens.

jdenning 2y ago

Do any of us really care which of these mega-bureaucracies is to blame for each particular hurdle to receiving healthcare? From the patient’s perspective, they are all conspiring to gouge us, deny us care, and perpetuate their gold-plated monopolies. The constant factor is that the patient always loses. It’d be nice if we could have a political system where politicians represented their constituents, rather than their financial backers. But I fear that the culture war has made that very unlikely. It’ll get worse before it gets better.

tzs 2y ago

There's something that is often overlooked in discussions of the problems with and how to fix the American healthcare system. Two of the biggest problems are that (1) America pays quite a bit more for a given level of care than they do in most other first world countries, and (2) the cost keeps going up significantly more than can be explained just be normal inflation. The discussion then usually focuses on the differences between the American system and the systems of places like Europe and Japan, with people arguing about which of those differences are why we've got problems and whether or not adopting some ideas from those other systems would fix our high cost and rising cost problems. The problem with that is while those other systems do indeed cost a lot less than the US, they also have a rising cost problem. For example here are the ratios the per capita costs when up in the US during the decades starting from the '70s [1]: 3.2, 2.6, 1.7, 1.7, 1.5. Pretty horrible. Here are the numbers for the UK: 3.1, 2.0, 2.4, 1.8, 1.5. Here they are for France: 3.4, 2.2, 2.0, 1.4, 1.4. Also pretty horrible, and about the same level of horribleness as the US. Here's the ratio of 2018 to 2000 per capita health care costs for a few countries: Japan 2.6, UK 2.6, US 2.3, Germany 2.1, Canada 2.0, France 1.8, Italy 1.7. This suggests that perhaps the US problem with rising costs does not stem from the differences between the US system and those of most other places. It also suggests that the problem with higher costs than those other places might not be due to relatively recent changes in the US system that much discussion often focuses on. Instead it might be we pay much more than Europe and Japan now mostly because we paid much more than Europe and Japan 50 years ago. [1] My data came from https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm which used to have a wonderful interface that allowed you to easily generate various views and reports of OECD country health care costs from 1970 to almost the present that let me get the data I wanted in a convenient form. The have since reorganized things and that now redirects to https://www.oecd.org/en/data/indicators/health-spending.html https://www.oecd.org/en/data/indicators/health-spending.html which has a different interface and still has, I think, the same data but I no longer know how to get it as conveniently.