9 ms·

U.S. health is lousy compared with peer nations, report says

64 points by kafkaesque 14y ago

Irregardless 14y ago
And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. News Flash: The U.S. isn't a welfare state. To benefit from everything this country has to offer, you need to pay for it. Yes, it would be better if that didn't apply to healthcare, but there needs to be some method of exclusion when demand is high and supply is low. Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)
- andrewcooke 14y ago
  isn't the point that on average, rational actors would prefer the wait, since, on average, that is correlated with better outcomes? perhaps partly because you presented a false choice - it's often a choice between waiting or not being able to afford it? what i mean is, well, great rhetoric, but you know, facts, man. facts.
- maushu 14y ago
  > Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? At least we get treatment not dependent on the quantity of money we have.
  - zanny 14y ago
    I'm American, but I know a lot of people from Canada, and after many conversations, the "2 months for a specialist" is bullshit. In practice, preventative medicine and not having to fear to afford healthcare when you need it drastically reduce the demand on the most expensive and specialized doctors and practices because you deal with problems before they end up in the emergency room. I have no health insurance right now. If I got sick in Canada, I would absolutely visit my doctor, get a prescription and diagnosis, and be on my way. In the US, I have to pray I don't have a severe disease and try using over the counter meds because I can't afford upwards of $800 doctors visits if they perform any tests. It is around $150 just to walk in the door.
    - seanx 14y ago
      How the hell can a doctors visit run to $800?
      - potatolicious 14y ago
        Probably on the high end of things, but it's really not that hard. Based on what I've seen from my insurance co. the base rate for my doctor is about ~$250, even for something as simple as simple consultation about the flu (i.e., no tests or other treatment/equipment). If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.
- viraptor 14y ago
  Yes, but on average it seems not to work that well, which the article tries to show. Apparently the possibility of waiting 2 months for a specialist (in reality I very rarely see such situation) seems to be better than the current system in the US.
  - njs12345 14y ago
    Also, in many systems (excepting Canada, where I believe there is no alternate private system) you can see a specialist with no wait if you're willing to pay for it.
- dataminer 14y ago
  What you are referring to are elective procedures, and 2 months of waiting time wouldn't kill you. There is no waiting time for emergencies in Canada or Europe. Yes if you throw alot of money, you get state of art facilities and top doctors, but are you getting the return on investment if the healthcare system is lagging behind the "welfare states".
  - refurb 14y ago
    Not true in Canada. The Supreme Court ruled that the wait times in Canada violated the Quebec Charter of Human Rights and Freedoms because there was no private option. http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_General) http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...
- colmvp 14y ago
  Better to wait than in a lot of cases not have access to it at all.
- scarmig 14y ago
  My US-based dad recently had to wait a month for a knee replacement surgery. And, of course, for people who can't afford the inflated prices we've got here... the waiting time is infinite.
  - rm999 14y ago
    A surgery can involve a lot of resources, they tend to have long wait times. For comparison, this article from 2007 says the average wait for a surgery in canada is 4.5 months: http://www.cbc.ca/news/health/story/2007/10/15/waittimes-fraser.html http://www.cbc.ca/news/health/story/2007/10/15/waittimes-fra...
- gramsey 14y ago
  What kind of point are you trying to make? > And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. People fly to many first-world countries for medical care, including "Canada and Europe". Yes, if people have vast sums of money, they can receive excellent medical treatment in the US (as they could in many countries). However, that's not the problem though, is it. The problem is that in general, most Americans fall behind in health compared to other first-world nations. > but there needs to be some method of exclusion when demand is high and supply is low Are you arguing that the state of health of the majority of the country is irrelevant as long as high-income earners can receive the best medical care?
- FireBeyond 14y ago
  That's not a valid comparison. "State of the art" facilities are not being argued against, but "health of the populace". People also used to (maybe still do) fly to Australia for cardiac surgery. The US may be able to pull in doctors from around the world with salaries that are high (correlating to high healthcare costs), but the regular individuals access to such doctors is limited: if I, talking to my insurance provider in Washington, said I wanted to go to the East Coast and have Dr Oz do my cardiac surgery (leaving aside any, and indeed valid, controversy over him - I was just looking for a notable/famous surgeon), I'm fairly certain they'd balk (and I'm fairly certain because I've worked on software systems that determine such things for insurance providers).
- potatolicious 14y ago
  > "And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities." Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior. As a Canadian who lives in the US it's often shocking how different the perception of the Canadian health care system is between the US and Canada. Canadians by and large are quite satisfied with the system, while even reasonably liberal Americans I've met seem to believe it's some kind of waitlist-filled hellhole. I've had more than one American express incredulity when I pointed out going to the US for major medical procedures isn't really a thing in Canada, where they thought it was widespread and relatively common. By my own observation, there are a few isolated cases of this happening (mostly among the extremely wealthy), and is not at all widespread. > "but there needs to be some method of exclusion when demand is high and supply is low." The supply of medical capacity is not fixed or subject to a real physical limitation (like, say, rare earth metals). In Canada the response to constricted supply has been expanding the supply, as well as reducing per-use costs to make this possible. The supply is not infinite, but is high enough that people who need it, get it, and at a cost affordable to them (amortized across the entire population). [edit] It's worth mentioning that, due to the economic incentive of single-payer health care, Canada invests a tremendous amount of money in preventative care and screening, which serves to dramatically reduce demand for the most expensive, most supply-constrained treatments. In fact I have a friend who works for the Canadian government right now doing computational screening for early cancer detection. It's interesting stuff, saves lives, and saves money, but requires a dramatic economic incentive to build out that simply doesn't exist in privatized care. > "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)" Citation, again, sorely needed. I grew up in Canada and have never waited 2 months to see a specialist, nor 2 months for treatment. The longest I've waited for a specialist was a few days. I've also (unfortunately) been to both Canadian ERs and American ERs, and the wait times are not substantially different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).
  - graeme 14y ago
    Also a Canadian, just want to confirm this. I can see a doctor instantly, for free, at any one of the clinics near my house. If I need to see a specialist, the referral usually happens within a few days or a week for anything urgent. Ditto for bloodwork, you just take the referral to a hospital. There are some exceptions, but generally things work well.
- slurry 14y ago
  This kind of argument probably worked better in the 90s or something, but it does not hold as much water today. First, the exorbitant rate of medical inflation in our "market" healthcare system is a fiscal menace not only to the public sector, but to the private sector as well. Secondly, the deteriorating health of the American workforce is an increasing threat to global competitiveness. An overweight employee pool with high prevalence of unmanaged diabetes is not an attractive one for global capital. Expanding access, controlling costs and emphasizing preventive care are things we need to get better at out of naked self-interest. Saudi sheiks who want to fly in for a quadruple bypass may continue to do so, but if we lose them to somewhere that bows and scrapes to the mega-rich more than we do, good riddance.
- amalcon 14y ago
  Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe) I would really prefer not to have to do this. Do you have a suggestion for how I could avoid that wait? I live in the U.S. and those timeframes don't seem particularly high compared to what I'm used to.
- fatbird 14y ago
  My brother in Columbus, Ohio, with a health plan for a director level position in a Fortune 1000 company, got a referral to a neurologist for a pinched nerve. Took six months to actually get inside a neurologist's office. This, in a health care market of 1.5 million people. What's that about wait times in nationalized healthcare countries again? I'm sure he'd have been much more quickly served in Vancouver or Toronto or Manchester.
- dguaraglia 14y ago
  "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do?" This is so misinformed it's borderline laughable (if it wasn't thrown out there by someone who is a member of the HN community and, I'd assume, an intelligent peer.) I have been treated in Argentina for urgent and non-urgent issues and never, ever, had to wait 2 months for anything. When I was referred to a specialist (best of her branch of medicine in a city of almost a million inhabitants) I got an appointment the following week and started treatment within a month. Whenever I needed something, like an X-ray or bloodwork, I could either get it free of charge at the local hospitals or just pay for it (incredibly, a CT Scan with the same machines they use in the US costs 1/6 the price in Argentina. How's that for free market economy?) and get a result immediately. So, all in all, this is complete bunk. People who have never experienced any other system are by definition the worst to make a comparison with the US system. I've used the Brazilian, the Argentinian, the British and the US system and by far my worst experience has always been in the US, even while paying through my nose to get the same care I'd get for free in either of the 'developing' nations. Heck, I've used the _private_ system in the UK and even if I paid the extra bit to be seen by a doctor (20' wait at the practice; Oh! The horrors of endless lines and dead panels!) I only had to pay ~£2.50 to get all the medicine he prescribed (that's the upper bound, after that everything else is free.) So yeah, definitely the US is not a welfare state. If anything, it's the contrary: a profiteering system where healthcare is just secondary to profit.
jere 14y ago
My first thought was "what the hell does health have to do with accidents?", which I learned was justified by the first article I found after googling for "life expectancy without accidents": http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-americans-poor-life-expectancy/ http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-amer... >A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.
- digeridoo 14y ago
  Perhaps I'm tired, but how can the Japanese life expectancy figure be higher when considering fatal injuries?
  - whatshisface 14y ago
    The figure doesn't go up, the ranking goes up. (Meaning all the other figures go down.)
  - jere 14y ago
    The article has an updated section on that question. >I asked Robert Ohsfeldt about this, who responded that the adjustment factor was based on fatal injury rates relative to the average. Hence, the adjusted numbers shouldn’t be seen as hard numerical estimates of life expectancy, but rather as a way of understanding the true relative ranking of the various countries on life expectancy excluding fatal injuries.
mattmiller 14y ago
I think an easy way to improve the health care industry would be to quadruple the number of urgent cares and keep them all open 24 hours a day. Financially the system encourages urgent care use, but they are often tough to access. Many times in the middle of the night we have to consider taking a child to the ER or just waiting until morning. I don't know if this would improve general health, but it sure would make me feel like I am getting more for what I pay.
kafkaesque 14y ago
Darn. I should've posted this NY Times article instead: http://www.nytimes.com/2013/01/10/health/americans-under-50-fare-poorly-on-health-measures-new-report-says.html http://www.nytimes.com/2013/01/10/health/americans-under-50-... It provides a little more detail.
RyanMcGreal 14y ago
The US is at or very near the worst among OECD countries in: infant mortality, child poverty, child health and safety, life expectancy at birth, healthy life expectancy, rate of obesity, disability-adjusted life years, doctors per 1000 people, deaths from treatable conditions, rate of mental health disorders, rate of drug abuse, rate of prescription drug use, incarceration rate, rate of assaults, rate of homicides, income inequality, wealth inequality, and economic mobility.
- w1ntermute 14y ago
  Do you know if these things are demographically linked, like education is[0]? I haven't done any research, but my gut tells me they are. 0: http://super-economy.blogspot.com/2010/12/amazing-truth-about-pisa-scores-usa.html http://super-economy.blogspot.com/2010/12/amazing-truth-abou...
  - tokenadult 14y ago
    You should learn not to rely on that link for your understanding of the world. It is crap.
    - w1ntermute 14y ago
      Why do you think my worldview would be based on a single blog post? And can you elaborate on why you think the post is wrong?
      - tokenadult 14y ago
        (First reply, for courtesy.) I'll give your fair question the long answer it deserves probably tomorrow (United States time zones) after traveling to a meeting in another town this evening). I'll probably reply in this same thread, under your question, so it's easy for you to find the reply.
      - tokenadult 14y ago
        I'll be writing off-forum today (in between work tasks) to provide an answer to your kind question, And can you elaborate on why you think the post is wrong? Meanwhile, in response to your Why do you think my worldview would be based on a single blog post? I am wondering why you have submitted that link so often in previous Hacker News discussions of international comparisons among countries. (This most recent time is far from the first time you have submitted the link.) That link is the only external source you have submitted here. What do you think makes that a better post to consider for the issues under discussion in this immediate thread than some of the links shared on health issues in other subthreads here? What does that link actually have to do with health at all?
127001brewer 14y ago
I found the following blurb from the article interesting as it tries to make the information relevant the gun control debate: Gun use emerged as a factor: Americans were seven times more likely to die in a homicide and 20 times more likely to die in a shooting than their peers. In all, two-thirds of the mortality disadvantage for American men was attributable to people under the age of 50 -- and slightly over half of that resulted from injuries... However, why is this article interesting to the Hacker News crowd?
- npsimons 14y ago
  Why is health interesting to anyone? Viewed in a more hackish light: here's a problem; how can we fix it?
  - 127001brewer 14y ago
    I find the entire "health care" topic interesting because I believe it to be "broken" (as a general term). But what to fix?
  - roc 14y ago
    It's not a problem that can be 'hacked'. Much like hunger in the third world: it's a political problem. Practical solutions have long since been developed and proved in other places. The problems persist where they do, because there's no political will to actually implement the solutions in those places.
    - viraptor 14y ago
      > It's not a problem that can be 'hacked'. While I agree it's a political problem in general, there's apparently a lot that can be hacked. Starting with lowering the cost of diagnostics and improving the information flow... There were a couple of interesting companies interviewed on Mendelspod (http://mendelspod.com/ http://mendelspod.com/) - if you're interested in what can be hacked, give it a go. There are also projects like http://nhshackday.com/ http://nhshackday.com/
deleted 14y ago
[deleted]
jchrisa 14y ago
No mention of corn and petroleum subsidies.
- lostlogin 14y ago
  Please could you expand on that. I'm mystified.
  - wtn 14y ago
    Grain subsidies indirectly subsidize high–calorie, low–nutrition foods like bread, cookies, crackers, soda drinks (corn syrup), and other stuff that is terrible for you. Fuel policy promotes more driving, less walking. It is an interesting question as to where to draw the line between personal responsibility and governmental responsibility. Of course most people in the US can afford to buy quality food, if they really wanted to, and some Americans are doing well. But Americans clearly aren't doing well at keeping up their health, and gov policy is making obesity worse. I saw some data point recently that suggested we may have passed an inflection point (for the better), hopefully it turns out to be true in the long run.
  - DanBC 14y ago
    I'm guessing that corn subsidies in the US mean a glut of high fructose corn syrup. Too much cheap sugar in the diet is bad. (And then there's some extra stuff about too much fructose over other sugars.) Oil subsidies mean people drive everywhere rather than cycling or walking.
- cma 14y ago
  The bulk of corn subsidies are for ethanol, which should result in prices of i.e. HFCS going up, not down, right?
  - roc 14y ago
    Only if we assume that absent ethanol, that farmland would be used to grow corn for food/HFCS. Which isn't true. We also subsidize not farming. So much of the land used for ethanol would be otherwise left fallow.
aresant 14y ago
This is a great example of how macro-statistics are inherently useless to predict individual outcomes (or even individual group outcome). I'd go so far to say irresponsible to publish without disclaimers since these kinds of studies are so easy to regurgitate and buy into about the "state of the USA". A glaring example - how can you even consider Japan a "peer" nation to the USA when comparing health? Ethnicity has been shown, again and again, to have a gigantic impact on life expectancy - so a more compelling study may be USA Japanese with Japanese parents vs. Japanese in Japan. But then again what about RICH Japanese in USA vs. RICH Japanese in Japan? Or broken out by Japenese that follow different diets? Or Japanese that smoke? Or any of the other "studies" that try to identify individualized trends. If we're trying to glean anything from this data beyond pageviews for newspapers then segment & compare the data along actually comparable lines - class, ethnicity, and regional lines.
- scarmig 14y ago
  That correction might make sense for ethnicity. But class? Defending the USA's health system by saying "well, it has a stark class divide which pre-ordains that a large proportion of its population will get inadequate health care compared to other countries" is only valuable in that it tells us that to improve health outcomes, we've got to break down our class system.
- graeme 14y ago
  When Japanese immigrate to America, their health outcomes quickly converge with those of other Americans. 'Ethnicity' isn't the culprit, usually - more likely culture and national policies.
CletusTSJY 14y ago
Look, you can't convince me life is worse in America than other countries. I watch House Hunters International, I see the size of those kitchens.
tptacek 14y ago
Worth remembering some things here: * The US is thought by some economists to have an artificially high infant mortality because the US is more rigorous about reporting live births than other countries which might write up the same events as stillbirths. * Outcomes in the US for chronic serious illnesses are at or near the top of the rankings. * Life expectancy figures in the US are anchored down by suicides and, more importantly, traffic fatalities, which the US leads the world in. While that's not something we should be OK with, it's also a direct consequence of the vast land mass and wide population dispersal in the US.
- loceng 14y ago
  I think quality of life is a much more important factor to include.
- avalind 14y ago
  This report[1] claims that the difference in reporting child mortality isn't the chief cause of the difference in infant mortality between the U.S and similarly developed countries. Instead the claim that most of this difference is due to the high percentage of pre-term births in the US compared to other developed countries. [1] http://www.cdc.gov/nchs/data/databriefs/db23.pdf http://www.cdc.gov/nchs/data/databriefs/db23.pdf
  - tptacek 14y ago
    Isn't a preterm baby which fails to survive exactly the kind of event that wouldn't be documented as an infant mortality at all in a less rigorous country?
    - avalind 14y ago
      Yes. But I'm not sure I follow here, both Sweden and the US use the same criteria to report a live birth (All live births are reported) and seem to use the same definition of Infant mortality rate, (Death before first birthday). I fail to see how reporting differences explain the difference in infant mortality between the two countries. Of course, compared to countries that use extra conditions for live births (weight limits etc.) the US would get a higher rate of infant mortality due to having more laxed conditions for what constitutes a live birth.
elchief 14y ago
US health care is amazing for rich people, and terrible for the rest. On average, it is lousy.
tokenadult 14y ago
In a top-level comment, the HN participant who kindly submitted the L.A. Times article that opens the thread here notes with regret that the New York Times report http://www.nytimes.com/2013/01/10/health/americans-under-50-fare-poorly-on-health-measures-new-report-says.html http://www.nytimes.com/2013/01/10/health/americans-under-50-... on the same report provides more detail. The lede paragraph shows the importance of cultural and lifestyle factors rather than health-care-as-such in the mortality and morbidity outcomes: "Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States." Drug addiction in particular is a severe problem in the United States to a degree not seen in (for example) east Asia. The stark historical memory of the Opium Wars imposing Western drug-pushing on east Asian populations makes many countries on the other side of the Pacific Rim very wary of letting young people start drug use. Illicit drugs were all but unknown in the childhood experience of my wife under Taiwan's former military dictatorship. Growing up free of harmful psychoactive substances allows young people clear heads to learn a lot (including learning other languages for international understanding) and to grow up to promote social improvements, such as the steady democratization and upgrades in provision of health care in Taiwan during my adult life. So let's be clear what the report tells us: health outcomes in the United States often fare poorly compared to the health outcomes in other countries approximately as rich. But the challenges to health in the United States sometimes differ in ways that reflect long-standing differences in United States culture that still need to be nudged in healthier directions. AFTER EDIT: There has been some hand-waving (without specific deep links) about OECD health statistics in this thread. In fact, the United States does not fare as badly in comparison to other OECD countries http://www.oecd-ilibrary.org/sites/factbook-2011-en/12/01/01/12-01-01-g1.html?contentType=&itemId=/content/chapter/factbook-2011-104-en&containerItemId=/content/serial/18147364&accessItemIds=&mimeType=text/html http://www.oecd-ilibrary.org/sites/factbook-2011-en/12/01/01... as some of the statements in this thread have suggested. The decline in all-cause mortality at all age ranges during my lifetime in the United States http://www.scientificamerican.com/article.cfm?id=longevity-why-we-die-global-life-expectancy http://www.scientificamerican.com/article.cfm?id=longevity-w... has been steady, so people in general in the United States are living longer, healthier lives than ever before in history.
seivan 14y ago
I suspect mostly it's your high medication and food. Too much "low fat" stuff being shipped around as "healthy" alternatives, when they are filled with sugar, instead of healthy fat.
tsotha 14y ago
>The study listed nine health areas in which Americans came in below average: infant mortality and low birth weight, injuries and homicides, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease and disability. I hope people don't think this is some condemnation of the US health care system. No matter how good your health care system is you're not going to be able to correct for serious lifestyle problems.

64 points by kafkaesque 14y ago

And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. News Flash: The U.S. isn't a welfare state. To benefit from everything this country has to offer, you need to pay for it. Yes, it would be better if that didn't apply to healthcare, but there needs to be some method of exclusion when demand is high and supply is low. Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)

andrewcooke 14y ago
isn't the point that on average, rational actors would prefer the wait, since, on average, that is correlated with better outcomes? perhaps partly because you presented a false choice - it's often a choice between waiting or not being able to afford it? what i mean is, well, great rhetoric, but you know, facts, man. facts.
maushu 14y ago
> Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? At least we get treatment not dependent on the quantity of money we have.
- zanny 14y ago
  I'm American, but I know a lot of people from Canada, and after many conversations, the "2 months for a specialist" is bullshit. In practice, preventative medicine and not having to fear to afford healthcare when you need it drastically reduce the demand on the most expensive and specialized doctors and practices because you deal with problems before they end up in the emergency room. I have no health insurance right now. If I got sick in Canada, I would absolutely visit my doctor, get a prescription and diagnosis, and be on my way. In the US, I have to pray I don't have a severe disease and try using over the counter meds because I can't afford upwards of $800 doctors visits if they perform any tests. It is around $150 just to walk in the door.
  - seanx 14y ago
    How the hell can a doctors visit run to $800?
    - potatolicious 14y ago
      Probably on the high end of things, but it's really not that hard. Based on what I've seen from my insurance co. the base rate for my doctor is about ~$250, even for something as simple as simple consultation about the flu (i.e., no tests or other treatment/equipment). If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.
viraptor 14y ago
Yes, but on average it seems not to work that well, which the article tries to show. Apparently the possibility of waiting 2 months for a specialist (in reality I very rarely see such situation) seems to be better than the current system in the US.
- njs12345 14y ago
  Also, in many systems (excepting Canada, where I believe there is no alternate private system) you can see a specialist with no wait if you're willing to pay for it.
dataminer 14y ago
What you are referring to are elective procedures, and 2 months of waiting time wouldn't kill you. There is no waiting time for emergencies in Canada or Europe. Yes if you throw alot of money, you get state of art facilities and top doctors, but are you getting the return on investment if the healthcare system is lagging behind the "welfare states".
- refurb 14y ago
  Not true in Canada. The Supreme Court ruled that the wait times in Canada violated the Quebec Charter of Human Rights and Freedoms because there was no private option. http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_General) http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...
colmvp 14y ago
Better to wait than in a lot of cases not have access to it at all.
scarmig 14y ago
My US-based dad recently had to wait a month for a knee replacement surgery. And, of course, for people who can't afford the inflated prices we've got here... the waiting time is infinite.
- rm999 14y ago
  A surgery can involve a lot of resources, they tend to have long wait times. For comparison, this article from 2007 says the average wait for a surgery in canada is 4.5 months: http://www.cbc.ca/news/health/story/2007/10/15/waittimes-fraser.html http://www.cbc.ca/news/health/story/2007/10/15/waittimes-fra...
gramsey 14y ago
What kind of point are you trying to make? > And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities. People fly to many first-world countries for medical care, including "Canada and Europe". Yes, if people have vast sums of money, they can receive excellent medical treatment in the US (as they could in many countries). However, that's not the problem though, is it. The problem is that in general, most Americans fall behind in health compared to other first-world nations. > but there needs to be some method of exclusion when demand is high and supply is low Are you arguing that the state of health of the majority of the country is irrelevant as long as high-income earners can receive the best medical care?
FireBeyond 14y ago
That's not a valid comparison. "State of the art" facilities are not being argued against, but "health of the populace". People also used to (maybe still do) fly to Australia for cardiac surgery. The US may be able to pull in doctors from around the world with salaries that are high (correlating to high healthcare costs), but the regular individuals access to such doctors is limited: if I, talking to my insurance provider in Washington, said I wanted to go to the East Coast and have Dr Oz do my cardiac surgery (leaving aside any, and indeed valid, controversy over him - I was just looking for a notable/famous surgeon), I'm fairly certain they'd balk (and I'm fairly certain because I've worked on software systems that determine such things for insurance providers).
potatolicious 14y ago
> "And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities." Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior. As a Canadian who lives in the US it's often shocking how different the perception of the Canadian health care system is between the US and Canada. Canadians by and large are quite satisfied with the system, while even reasonably liberal Americans I've met seem to believe it's some kind of waitlist-filled hellhole. I've had more than one American express incredulity when I pointed out going to the US for major medical procedures isn't really a thing in Canada, where they thought it was widespread and relatively common. By my own observation, there are a few isolated cases of this happening (mostly among the extremely wealthy), and is not at all widespread. > "but there needs to be some method of exclusion when demand is high and supply is low." The supply of medical capacity is not fixed or subject to a real physical limitation (like, say, rare earth metals). In Canada the response to constricted supply has been expanding the supply, as well as reducing per-use costs to make this possible. The supply is not infinite, but is high enough that people who need it, get it, and at a cost affordable to them (amortized across the entire population). [edit] It's worth mentioning that, due to the economic incentive of single-payer health care, Canada invests a tremendous amount of money in preventative care and screening, which serves to dramatically reduce demand for the most expensive, most supply-constrained treatments. In fact I have a friend who works for the Canadian government right now doing computational screening for early cancer detection. It's interesting stuff, saves lives, and saves money, but requires a dramatic economic incentive to build out that simply doesn't exist in privatized care. > "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)" Citation, again, sorely needed. I grew up in Canada and have never waited 2 months to see a specialist, nor 2 months for treatment. The longest I've waited for a specialist was a few days. I've also (unfortunately) been to both Canadian ERs and American ERs, and the wait times are not substantially different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).
- graeme 14y ago
  Also a Canadian, just want to confirm this. I can see a doctor instantly, for free, at any one of the clinics near my house. If I need to see a specialist, the referral usually happens within a few days or a week for anything urgent. Ditto for bloodwork, you just take the referral to a hospital. There are some exceptions, but generally things work well.
slurry 14y ago
This kind of argument probably worked better in the 90s or something, but it does not hold as much water today. First, the exorbitant rate of medical inflation in our "market" healthcare system is a fiscal menace not only to the public sector, but to the private sector as well. Secondly, the deteriorating health of the American workforce is an increasing threat to global competitiveness. An overweight employee pool with high prevalence of unmanaged diabetes is not an attractive one for global capital. Expanding access, controlling costs and emphasizing preventive care are things we need to get better at out of naked self-interest. Saudi sheiks who want to fly in for a quadruple bypass may continue to do so, but if we lose them to somewhere that bows and scrapes to the mega-rich more than we do, good riddance.
amalcon 14y ago
Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe) I would really prefer not to have to do this. Do you have a suggestion for how I could avoid that wait? I live in the U.S. and those timeframes don't seem particularly high compared to what I'm used to.
fatbird 14y ago
My brother in Columbus, Ohio, with a health plan for a director level position in a Fortune 1000 company, got a referral to a neurologist for a pinched nerve. Took six months to actually get inside a neurologist's office. This, in a health care market of 1.5 million people. What's that about wait times in nationalized healthcare countries again? I'm sure he'd have been much more quickly served in Vancouver or Toronto or Manchester.
dguaraglia 14y ago
"Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do?" This is so misinformed it's borderline laughable (if it wasn't thrown out there by someone who is a member of the HN community and, I'd assume, an intelligent peer.) I have been treated in Argentina for urgent and non-urgent issues and never, ever, had to wait 2 months for anything. When I was referred to a specialist (best of her branch of medicine in a city of almost a million inhabitants) I got an appointment the following week and started treatment within a month. Whenever I needed something, like an X-ray or bloodwork, I could either get it free of charge at the local hospitals or just pay for it (incredibly, a CT Scan with the same machines they use in the US costs 1/6 the price in Argentina. How's that for free market economy?) and get a result immediately. So, all in all, this is complete bunk. People who have never experienced any other system are by definition the worst to make a comparison with the US system. I've used the Brazilian, the Argentinian, the British and the US system and by far my worst experience has always been in the US, even while paying through my nose to get the same care I'd get for free in either of the 'developing' nations. Heck, I've used the _private_ system in the UK and even if I paid the extra bit to be seen by a doctor (20' wait at the practice; Oh! The horrors of endless lines and dead panels!) I only had to pay ~£2.50 to get all the medicine he prescribed (that's the upper bound, after that everything else is free.) So yeah, definitely the US is not a welfare state. If anything, it's the contrary: a profiteering system where healthcare is just secondary to profit.

jere 14y ago

My first thought was "what the hell does health have to do with accidents?", which I learned was justified by the first article I found after googling for "life expectancy without accidents": http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-americans-poor-life-expectancy/ http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-amer... >A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.

digeridoo 14y ago
Perhaps I'm tired, but how can the Japanese life expectancy figure be higher when considering fatal injuries?
- whatshisface 14y ago
  The figure doesn't go up, the ranking goes up. (Meaning all the other figures go down.)
- jere 14y ago
  The article has an updated section on that question. >I asked Robert Ohsfeldt about this, who responded that the adjustment factor was based on fatal injury rates relative to the average. Hence, the adjusted numbers shouldn’t be seen as hard numerical estimates of life expectancy, but rather as a way of understanding the true relative ranking of the various countries on life expectancy excluding fatal injuries.

mattmiller 14y ago

I think an easy way to improve the health care industry would be to quadruple the number of urgent cares and keep them all open 24 hours a day. Financially the system encourages urgent care use, but they are often tough to access. Many times in the middle of the night we have to consider taking a child to the ER or just waiting until morning. I don't know if this would improve general health, but it sure would make me feel like I am getting more for what I pay.

kafkaesque 14y ago

Darn. I should've posted this NY Times article instead: http://www.nytimes.com/2013/01/10/health/americans-under-50-fare-poorly-on-health-measures-new-report-says.html http://www.nytimes.com/2013/01/10/health/americans-under-50-... It provides a little more detail.

RyanMcGreal 14y ago

The US is at or very near the worst among OECD countries in: infant mortality, child poverty, child health and safety, life expectancy at birth, healthy life expectancy, rate of obesity, disability-adjusted life years, doctors per 1000 people, deaths from treatable conditions, rate of mental health disorders, rate of drug abuse, rate of prescription drug use, incarceration rate, rate of assaults, rate of homicides, income inequality, wealth inequality, and economic mobility.

w1ntermute 14y ago
Do you know if these things are demographically linked, like education is[0]? I haven't done any research, but my gut tells me they are. 0: http://super-economy.blogspot.com/2010/12/amazing-truth-about-pisa-scores-usa.html http://super-economy.blogspot.com/2010/12/amazing-truth-abou...
- tokenadult 14y ago
  You should learn not to rely on that link for your understanding of the world. It is crap.
  - w1ntermute 14y ago
    Why do you think my worldview would be based on a single blog post? And can you elaborate on why you think the post is wrong?
    - tokenadult 14y ago
      (First reply, for courtesy.) I'll give your fair question the long answer it deserves probably tomorrow (United States time zones) after traveling to a meeting in another town this evening). I'll probably reply in this same thread, under your question, so it's easy for you to find the reply.
    - tokenadult 14y ago
      I'll be writing off-forum today (in between work tasks) to provide an answer to your kind question, And can you elaborate on why you think the post is wrong? Meanwhile, in response to your Why do you think my worldview would be based on a single blog post? I am wondering why you have submitted that link so often in previous Hacker News discussions of international comparisons among countries. (This most recent time is far from the first time you have submitted the link.) That link is the only external source you have submitted here. What do you think makes that a better post to consider for the issues under discussion in this immediate thread than some of the links shared on health issues in other subthreads here? What does that link actually have to do with health at all?

127001brewer 14y ago

I found the following blurb from the article interesting as it tries to make the information relevant the gun control debate: Gun use emerged as a factor: Americans were seven times more likely to die in a homicide and 20 times more likely to die in a shooting than their peers. In all, two-thirds of the mortality disadvantage for American men was attributable to people under the age of 50 -- and slightly over half of that resulted from injuries... However, why is this article interesting to the Hacker News crowd?

npsimons 14y ago
Why is health interesting to anyone? Viewed in a more hackish light: here's a problem; how can we fix it?
- 127001brewer 14y ago
  I find the entire "health care" topic interesting because I believe it to be "broken" (as a general term). But what to fix?
- roc 14y ago
  It's not a problem that can be 'hacked'. Much like hunger in the third world: it's a political problem. Practical solutions have long since been developed and proved in other places. The problems persist where they do, because there's no political will to actually implement the solutions in those places.
  - viraptor 14y ago
    > It's not a problem that can be 'hacked'. While I agree it's a political problem in general, there's apparently a lot that can be hacked. Starting with lowering the cost of diagnostics and improving the information flow... There were a couple of interesting companies interviewed on Mendelspod (http://mendelspod.com/ http://mendelspod.com/) - if you're interested in what can be hacked, give it a go. There are also projects like http://nhshackday.com/ http://nhshackday.com/

deleted 14y ago

[deleted]

jchrisa 14y ago

No mention of corn and petroleum subsidies.

lostlogin 14y ago
Please could you expand on that. I'm mystified.
- wtn 14y ago
  Grain subsidies indirectly subsidize high–calorie, low–nutrition foods like bread, cookies, crackers, soda drinks (corn syrup), and other stuff that is terrible for you. Fuel policy promotes more driving, less walking. It is an interesting question as to where to draw the line between personal responsibility and governmental responsibility. Of course most people in the US can afford to buy quality food, if they really wanted to, and some Americans are doing well. But Americans clearly aren't doing well at keeping up their health, and gov policy is making obesity worse. I saw some data point recently that suggested we may have passed an inflection point (for the better), hopefully it turns out to be true in the long run.
- DanBC 14y ago
  I'm guessing that corn subsidies in the US mean a glut of high fructose corn syrup. Too much cheap sugar in the diet is bad. (And then there's some extra stuff about too much fructose over other sugars.) Oil subsidies mean people drive everywhere rather than cycling or walking.
cma 14y ago
The bulk of corn subsidies are for ethanol, which should result in prices of i.e. HFCS going up, not down, right?
- roc 14y ago
  Only if we assume that absent ethanol, that farmland would be used to grow corn for food/HFCS. Which isn't true. We also subsidize not farming. So much of the land used for ethanol would be otherwise left fallow.

aresant 14y ago

This is a great example of how macro-statistics are inherently useless to predict individual outcomes (or even individual group outcome). I'd go so far to say irresponsible to publish without disclaimers since these kinds of studies are so easy to regurgitate and buy into about the "state of the USA". A glaring example - how can you even consider Japan a "peer" nation to the USA when comparing health? Ethnicity has been shown, again and again, to have a gigantic impact on life expectancy - so a more compelling study may be USA Japanese with Japanese parents vs. Japanese in Japan. But then again what about RICH Japanese in USA vs. RICH Japanese in Japan? Or broken out by Japenese that follow different diets? Or Japanese that smoke? Or any of the other "studies" that try to identify individualized trends. If we're trying to glean anything from this data beyond pageviews for newspapers then segment & compare the data along actually comparable lines - class, ethnicity, and regional lines.

scarmig 14y ago
That correction might make sense for ethnicity. But class? Defending the USA's health system by saying "well, it has a stark class divide which pre-ordains that a large proportion of its population will get inadequate health care compared to other countries" is only valuable in that it tells us that to improve health outcomes, we've got to break down our class system.
graeme 14y ago
When Japanese immigrate to America, their health outcomes quickly converge with those of other Americans. 'Ethnicity' isn't the culprit, usually - more likely culture and national policies.

CletusTSJY 14y ago

Look, you can't convince me life is worse in America than other countries. I watch House Hunters International, I see the size of those kitchens.

tptacek 14y ago

Worth remembering some things here: * The US is thought by some economists to have an artificially high infant mortality because the US is more rigorous about reporting live births than other countries which might write up the same events as stillbirths. * Outcomes in the US for chronic serious illnesses are at or near the top of the rankings. * Life expectancy figures in the US are anchored down by suicides and, more importantly, traffic fatalities, which the US leads the world in. While that's not something we should be OK with, it's also a direct consequence of the vast land mass and wide population dispersal in the US.

loceng 14y ago
I think quality of life is a much more important factor to include.
avalind 14y ago
This report[1] claims that the difference in reporting child mortality isn't the chief cause of the difference in infant mortality between the U.S and similarly developed countries. Instead the claim that most of this difference is due to the high percentage of pre-term births in the US compared to other developed countries. [1] http://www.cdc.gov/nchs/data/databriefs/db23.pdf http://www.cdc.gov/nchs/data/databriefs/db23.pdf
- tptacek 14y ago
  Isn't a preterm baby which fails to survive exactly the kind of event that wouldn't be documented as an infant mortality at all in a less rigorous country?
  - avalind 14y ago
    Yes. But I'm not sure I follow here, both Sweden and the US use the same criteria to report a live birth (All live births are reported) and seem to use the same definition of Infant mortality rate, (Death before first birthday). I fail to see how reporting differences explain the difference in infant mortality between the two countries. Of course, compared to countries that use extra conditions for live births (weight limits etc.) the US would get a higher rate of infant mortality due to having more laxed conditions for what constitutes a live birth.

elchief 14y ago

US health care is amazing for rich people, and terrible for the rest. On average, it is lousy.

tokenadult 14y ago

In a top-level comment, the HN participant who kindly submitted the L.A. Times article that opens the thread here notes with regret that the New York Times report http://www.nytimes.com/2013/01/10/health/americans-under-50-fare-poorly-on-health-measures-new-report-says.html http://www.nytimes.com/2013/01/10/health/americans-under-50-... on the same report provides more detail. The lede paragraph shows the importance of cultural and lifestyle factors rather than health-care-as-such in the mortality and morbidity outcomes: "Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States." Drug addiction in particular is a severe problem in the United States to a degree not seen in (for example) east Asia. The stark historical memory of the Opium Wars imposing Western drug-pushing on east Asian populations makes many countries on the other side of the Pacific Rim very wary of letting young people start drug use. Illicit drugs were all but unknown in the childhood experience of my wife under Taiwan's former military dictatorship. Growing up free of harmful psychoactive substances allows young people clear heads to learn a lot (including learning other languages for international understanding) and to grow up to promote social improvements, such as the steady democratization and upgrades in provision of health care in Taiwan during my adult life. So let's be clear what the report tells us: health outcomes in the United States often fare poorly compared to the health outcomes in other countries approximately as rich. But the challenges to health in the United States sometimes differ in ways that reflect long-standing differences in United States culture that still need to be nudged in healthier directions. AFTER EDIT: There has been some hand-waving (without specific deep links) about OECD health statistics in this thread. In fact, the United States does not fare as badly in comparison to other OECD countries http://www.oecd-ilibrary.org/sites/factbook-2011-en/12/01/01/12-01-01-g1.html?contentType=&itemId=/content/chapter/factbook-2011-104-en&containerItemId=/content/serial/18147364&accessItemIds=&mimeType=text/html http://www.oecd-ilibrary.org/sites/factbook-2011-en/12/01/01... as some of the statements in this thread have suggested. The decline in all-cause mortality at all age ranges during my lifetime in the United States http://www.scientificamerican.com/article.cfm?id=longevity-why-we-die-global-life-expectancy http://www.scientificamerican.com/article.cfm?id=longevity-w... has been steady, so people in general in the United States are living longer, healthier lives than ever before in history.

seivan 14y ago

I suspect mostly it's your high medication and food. Too much "low fat" stuff being shipped around as "healthy" alternatives, when they are filled with sugar, instead of healthy fat.

tsotha 14y ago

>The study listed nine health areas in which Americans came in below average: infant mortality and low birth weight, injuries and homicides, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease and disability. I hope people don't think this is some condemnation of the US health care system. No matter how good your health care system is you're not going to be able to correct for serious lifestyle problems.