5 ms·

Regarding US healthcare costs, I cannot understand why people are not in the streets with pitchforks. Most of Europe has this problem solved. What is the root

by xyzal 6mo ago

Regarding US healthcare costs, I cannot understand why people are not in the streets with pitchforks. Most of Europe has this problem solved. What is the root cause w.r.t. the current situation? Are there any obvious ways out? Do any US politicians have any plans for a change? Are there any discussed proposals how to reform?

skippyboxedhero 6mo ago
the US has a bigger public healthcare system than, afaik, every European country. the reason why there aren't pitchforks is also because the US is a much richer country than Europe so people are happy to pay for more healthcare. if you are rich, the marginal value of money vs more time being alive is zero (an example is orthapedics for the elderly, the US spends a huge amount in this area relative to most European countries). it is worth considering whether could a rational person could possibly disagree with the idea that the government is best placed to decide whether extending your life is a good investment (there are European systems that are not well run which resolve this unusual ways i.e. being unable to provide basic healthcare whilst giving hundreds of millions to PR agencies, sometimes run by people who happened to work for the government...total coincidence, to run media campaigns to "prevent" ill health). it is not simple. there are largely private systems that run very well, funnily enough most of these are in Europe. there are public systems that run very badly, again many of these are in Europe. the discussion of public vs private is largely not relevant or particularly interesting (do people think that doctors just work for free in Europe? they do not, the incentives when you try to create a cheaper healthcare system by underpaying doctors, which exists in parts of Europe, creates some very bad situations i.e. an overreliance on doctors from Africa who have unknown training, Americans tend not to have imagined the scenario where healthcare is "free"/paid with taxes but they are being operated on by someone who can't speak English).
- thrance 6mo ago
  > the US has a bigger public healthcare system than, afaik, every European country In which metric(s)? Afaik, life expectancy is lower in the US than in most of western Europe. And Americans are known to pay much more than Europeans on healthcare, on average.
  - joe_mamba 6mo ago
    > life expectancy is lower in the US than in most of western Europe Could be more tied to poor diet and lifestyle, and not the healthcare system itself. Like if you sit on the chair all day on your remote job, then move to the couch for after-work Netflix and PS5, while you drink soda and eat processed food, then the only time you leave your house is you drive your Tesla/F-150 to Walmart and McDonald's, there's no magic healthcare system in the world that can undo decades of self inflicted damage. Meanwhile people in some impoverished balkan town could end up living longer because they spend their entire lives moving outdoor all day in fresh air and only eat organic what they grow on their plot of land, even if their hospitals and healthcare systems are significantly worse than what americans have. There's way more variables to life expectancy than just the healthcare system.
    - skippyboxedhero 6mo ago
      No, you don't understand, the government must do everything.
    - thrance 6mo ago
      So, are American just inherently less disciplined that Europeans? Is that the issue with healthcare in America? I find this explanation very unsatisfying. You have to look at systems to understand what is actually happening.
      - joe_mamba 6mo ago
        >So, are American just inherently less disciplined that Europeans? I never said anything like that but you could be right on that. A lot of those lifestyle issues are creeping in other highly urbanized rich western countries. Especially mental illnesses due to loneliness, lack of family unit, poor economic outlook, etc >I find this explanation very unsatisfying. Then come up with a better one and share it. If you want to compare the success of health systems you need to compare just the health systems between them alone, not the life expectancy with is a cumulus of several other factors beyond the public + privately managed health systems, such as lifestyles, agriculture, diet, weather, genetics, income, exercise, pollution, etc. For example, compare waiting times for MRIs, treatments, operations, procedures, post-op infection rates, etc then compare the life expectancy of those who undergo those procedures/treatments, etc. >You have to look at systems to understand what is actually happening. I just did.
- RandomLensman 6mo ago
  The US also pays relatvely more, not just absolute. Where could I see the US system delivering then? Not sure the data is so clear cut there.
  - skippyboxedhero 6mo ago
    Because aggregate statistics completely fail to recognise the massive philosophical differences in the system. It is like saying someone who buys Ferrari is getting ripped off because they aren't choosing to ride a bike. The US pays more because it provides significantly greater coverage outside of aggregate statistics. All of the innovation in rare diseases is because of the US, in public healthcare systems some diseases are simply not treated because it isn't regarded as economic to do so. How do you even quantify that difference? It is like making a GDP comparison between 1800 and today, what price would someone in 1800 not to die of TB? Life expectancy of 20 years old in many countries? Anyone who compares the two things in terms of cost is a lunatic. In short though, it is not obvious that a high-cost healthcare system is worse. The US system is inefficient, almost all of this relates to their decision not to use universal healthcare which leads to problems pricing insurance. However, this is not related to the system, there are many countries in Europe and worldwide which have effective private healthcare systems.
    - RandomLensman 6mo ago
      Not saying a high cost system is worse rather that seeing the benefits in data isn't so easy. Not clear what the "right" costs for a system should be, I reckon. As to drug discovery etc.: I think, not easy to say how the world would look like if the US weren't offering the opportunities. What would be new equilibrium RoIs needed if the world were quite different (and, yes, I am aware of studies there).
- joe_mamba 6mo ago
  >the US has a bigger public healthcare system than, afaik, every European country. Probably because Europeans commenting don't know how big Medicare and Medicaid are.
thrance 6mo ago
> What is the root cause w.r.t. the current situation? The current US is built to accomodate the top 0.1%. Their profiteering is more important than the good health of the population. > Are there any obvious ways out? Not really. Get money out of politics? Aggressively tax the wealthy and nationalize the entire health apparatus? Easier said than done. > Do any US politicians have any plans for a change? The only ones serious about it are on the progressive left, fought harshly by both Republicans and Establishment Democrats, under the guise of their respective patrons.
jackdoe 6mo ago
> Most of Europe has this problem solved. With paracetamol :) (Dutch people know what I am talking about)
- Leynos 6mo ago
  For those of us who aren't Dutch, please enlighten

by xyzal 6mo ago

skippyboxedhero 6mo ago

the US has a bigger public healthcare system than, afaik, every European country. the reason why there aren't pitchforks is also because the US is a much richer country than Europe so people are happy to pay for more healthcare. if you are rich, the marginal value of money vs more time being alive is zero (an example is orthapedics for the elderly, the US spends a huge amount in this area relative to most European countries). it is worth considering whether could a rational person could possibly disagree with the idea that the government is best placed to decide whether extending your life is a good investment (there are European systems that are not well run which resolve this unusual ways i.e. being unable to provide basic healthcare whilst giving hundreds of millions to PR agencies, sometimes run by people who happened to work for the government...total coincidence, to run media campaigns to "prevent" ill health). it is not simple. there are largely private systems that run very well, funnily enough most of these are in Europe. there are public systems that run very badly, again many of these are in Europe. the discussion of public vs private is largely not relevant or particularly interesting (do people think that doctors just work for free in Europe? they do not, the incentives when you try to create a cheaper healthcare system by underpaying doctors, which exists in parts of Europe, creates some very bad situations i.e. an overreliance on doctors from Africa who have unknown training, Americans tend not to have imagined the scenario where healthcare is "free"/paid with taxes but they are being operated on by someone who can't speak English).

thrance 6mo ago
> the US has a bigger public healthcare system than, afaik, every European country In which metric(s)? Afaik, life expectancy is lower in the US than in most of western Europe. And Americans are known to pay much more than Europeans on healthcare, on average.
- joe_mamba 6mo ago
  > life expectancy is lower in the US than in most of western Europe Could be more tied to poor diet and lifestyle, and not the healthcare system itself. Like if you sit on the chair all day on your remote job, then move to the couch for after-work Netflix and PS5, while you drink soda and eat processed food, then the only time you leave your house is you drive your Tesla/F-150 to Walmart and McDonald's, there's no magic healthcare system in the world that can undo decades of self inflicted damage. Meanwhile people in some impoverished balkan town could end up living longer because they spend their entire lives moving outdoor all day in fresh air and only eat organic what they grow on their plot of land, even if their hospitals and healthcare systems are significantly worse than what americans have. There's way more variables to life expectancy than just the healthcare system.
  - skippyboxedhero 6mo ago
    No, you don't understand, the government must do everything.
  - thrance 6mo ago
    So, are American just inherently less disciplined that Europeans? Is that the issue with healthcare in America? I find this explanation very unsatisfying. You have to look at systems to understand what is actually happening.
    - joe_mamba 6mo ago
      >So, are American just inherently less disciplined that Europeans? I never said anything like that but you could be right on that. A lot of those lifestyle issues are creeping in other highly urbanized rich western countries. Especially mental illnesses due to loneliness, lack of family unit, poor economic outlook, etc >I find this explanation very unsatisfying. Then come up with a better one and share it. If you want to compare the success of health systems you need to compare just the health systems between them alone, not the life expectancy with is a cumulus of several other factors beyond the public + privately managed health systems, such as lifestyles, agriculture, diet, weather, genetics, income, exercise, pollution, etc. For example, compare waiting times for MRIs, treatments, operations, procedures, post-op infection rates, etc then compare the life expectancy of those who undergo those procedures/treatments, etc. >You have to look at systems to understand what is actually happening. I just did.
RandomLensman 6mo ago
The US also pays relatvely more, not just absolute. Where could I see the US system delivering then? Not sure the data is so clear cut there.
- skippyboxedhero 6mo ago
  Because aggregate statistics completely fail to recognise the massive philosophical differences in the system. It is like saying someone who buys Ferrari is getting ripped off because they aren't choosing to ride a bike. The US pays more because it provides significantly greater coverage outside of aggregate statistics. All of the innovation in rare diseases is because of the US, in public healthcare systems some diseases are simply not treated because it isn't regarded as economic to do so. How do you even quantify that difference? It is like making a GDP comparison between 1800 and today, what price would someone in 1800 not to die of TB? Life expectancy of 20 years old in many countries? Anyone who compares the two things in terms of cost is a lunatic. In short though, it is not obvious that a high-cost healthcare system is worse. The US system is inefficient, almost all of this relates to their decision not to use universal healthcare which leads to problems pricing insurance. However, this is not related to the system, there are many countries in Europe and worldwide which have effective private healthcare systems.
  - RandomLensman 6mo ago
    Not saying a high cost system is worse rather that seeing the benefits in data isn't so easy. Not clear what the "right" costs for a system should be, I reckon. As to drug discovery etc.: I think, not easy to say how the world would look like if the US weren't offering the opportunities. What would be new equilibrium RoIs needed if the world were quite different (and, yes, I am aware of studies there).
joe_mamba 6mo ago
>the US has a bigger public healthcare system than, afaik, every European country. Probably because Europeans commenting don't know how big Medicare and Medicaid are.

thrance 6mo ago

> What is the root cause w.r.t. the current situation? The current US is built to accomodate the top 0.1%. Their profiteering is more important than the good health of the population. > Are there any obvious ways out? Not really. Get money out of politics? Aggressively tax the wealthy and nationalize the entire health apparatus? Easier said than done. > Do any US politicians have any plans for a change? The only ones serious about it are on the progressive left, fought harshly by both Republicans and Establishment Democrats, under the guise of their respective patrons.

jackdoe 6mo ago

> Most of Europe has this problem solved. With paracetamol :) (Dutch people know what I am talking about)

Leynos 6mo ago
For those of us who aren't Dutch, please enlighten