7 ms·

The brutal truth about America’s healthcare

37 points by blogimus 17y ago

DocSavage 17y ago
Here's a very interesting article about Stan Brock, the Brit and former Wild Kingdom star who has taken a vow of poverty and runs the Remote Area Medical organization. http://women.timesonline.co.uk/tol/life_and_style/women/ariel_leve/article6015125.ece http://women.timesonline.co.uk/tol/life_and_style/women/arie...
chasingsparks 17y ago
This article was shit, but not worse than most on either side of the argument. One thing that has been frustrating me most is the persistent argument that Americans have treatment outcomes that are subpar. Infant mortality rates and life expectancy measures are of limited utility when comparing wealthy countries. Concerning infant mortality, different countries count infant deaths differently, leading to over and under statements. Concerning life expectancy, Americans live lives that are relatively unhealthy when compared people in other countries. It is not a giant intellectual leap to conclude life style can account for the life expectancy gap. Concerning actual treatment outcomes, America typically leads they way. We have a higher incidence rate of many diseases but the best treatments if you view the outcome-to-incidence rates. Furthermore (anecdote warning), as someone who had a rare disease that still lacks any curative treatment, I have personally met a lot of foreigners. They were all seeking treatment in the US because we are pioneering most of the advances. Why? Because there is good money in it.
- joe_the_user 17y ago
  You say "This article was shit" - could we have a bit more civility here!
- joe_the_user 17y ago
  Also - "One thing that has been frustrating me most is the persistent argument that Americans have treatment outcomes that are subpar. Infant mortality rates and life expectancy measures are of limited utility when comparing wealthy countries." This is dubious in and of itself - what evidence do you have? But also, there have been a number of studies which quantified, to various degrees the effect of hospital infections, medical errors and similar things - and these real, honest-to-god quantitative studies show that these are significant cause of death in the US - any relation to the lower life expectancy in the US? That's further puzzle but we're got pretty strong evidence. And, I would agree that US leads in pioneering treatments for rare disease. That doesn't solve that other problems here.
martythemaniak 17y ago
I have to say, it is quite bizarre, watching the US health "debate" from up here in Canada. At the end of the day, it's a philosophical difference. I see people in Sicko, or read any of the thousands upon thousands of horror stories (like the ones in the article) and my stomach turns. I find situations like that downright amoral, so I think having to pay higher taxes for UHC is great value. OTOH, opponents look at the same people and start to get mad that these people should get "something for nothing", that their tax dollars are used to help people that may have made bad choices. Call me a pessimist, but I don't think this will turn out well for you guys. Any bill that is passed will be very watered-down and if the republicans get back into power before American UHC gets ingrained in the social fabric, then they'll do their best to kill it or cripple it.
- jfornear 17y ago
  You're right that there is a philosophical difference, but opponents of Obama's plan are being represented unfairly by those who frame the "debate" in the way in which you just did. All anecdotal arguments aside, the premise that more government is the only avenue for reform (held by yourself and other "progressives") is why both sides can't seem to agree on anything more than the idea that reform is needed. Around 40% of the American health care system is already managed by the government. The idea that we have a free market health care system that is failing the less fortunate in our country is downright false. In Obama's current plan, there are plenty of free market solutions to expand coverage and bring down costs that are being ignored and avoided (some due to lobbyists and special interests and others by, IMO, power-hungry politicians with a deeper, anti-capitalist agenda). Furthermore, there are plenty of examples of unintended consequences from prior government policies (with good intentions) that have created some of the problems we have today. Without going into the specifics or giving your last sentence a serious thought, I would just like to say this: Both sides (for the most part) have good intentions so let's not paint each other as evil. Here's a good place to start to understand the other side: http://online.wsj.com/article/SB10001424052970203609204574316172512242220.html http://online.wsj.com/article/SB1000142405297020360920457431...
  - javanix 17y ago
kiba 17y ago
Free healthcare will never survive one fact: The fact that scarcity exists. The fact that healthcare are so expensive in America are numerous. The limited supply of doctors due to medical cartels, patents on drugs, overusage of the system by medicaid users, insurance companies being used for paying everyday medical cost, and more. But in Canada and other places where social medicine or universial health care exists, there has been rationing of improtant services. It is also where capital structures simply rot. I believe wealthy nations' medical system are going to crash and burn decades from now because government deemed healthcare too improtant to regulate or control, never mind the consquences of unintended effects from regulations. The only solution is to return control of the healthcare to individuals, which are embodied in a free market. Only individuals have any chance to find a solution where centralized regulatory power and decision makers fails miserably.
- gdp 17y ago
  My experiences of the New Zealand health system and the NHS in Britain have been nothing but positive. What's all this talk of crashing and burning? Really, the free market and the individual as the fundamental unit of society rarely act in the best interests of the society as a whole. That's why many governments provide centralised healthcare. They can essentially take all the money (as taxes) that would have been spent on health care or insurance in a given year, and use it to build hospitals and medical facilities that the public own. The public then gets to use these facilities that they paid for at no cost, or at a heavily subsidised rate. If more people need more health care, taxes go up, and more hospitals are built. It's a surprisingly efficient way of doing things. Much more so than having lots of private companies, each with shareholders demanding profits be returned on top of something as basic as healthcare.
  - CWuestefeld 17y ago
    It's a surprisingly efficient way of doing things. Much more so than having lots of private companies, each with shareholders demanding profits be returned It's remarkable how our historical examples of this efficiency are so often ignored by all. I mean, consider how the soviets of the USSR succeeded in making that nation an economy to be reckoned with. And Chairman Mao's great leap forward was able to engineer a populace that succeeded in its grand goal of vaulting beyond the waste of the capitalist West. If only the industry of South Korea could prosper in the way that Kim Jong Il has guided his people into a paradise of plenty, then all Korean people could join hands in brotherhood.
cubicle67 17y ago
What the hell is up with your country, people? And what the hell is up with your fellow Americans? Why are the very people who suffer so much under the utter crap that passes for a healthcare system so eager to defend it. Seriously, I just don't understand.
- jsz0 17y ago
  It's a fairly complex issue. The class warfare angle is the rich and upper middle class simply don't want to pay for the poor. The financial angle is health care industry is a big business in America and it makes lots of people money. The religious angle is that some modern medical procedures conflict with their religious views and they don't want to pay for them. It really goes back to the core political divide in America of small government vs. big government. The two ideologies are pretty evenly matched in popular opinion so progress is slow.
  - cubicle67 17y ago
    The class warfare angle is the rich and upper middle class simply don't want to pay for the poor Every time you put measures in place to stop people getting something their not entitled to, you make a compromise between the percentage of people you stop vs the pain you inflict on those who are entitled. Eg - DRM. The harder it works to make sure no one can copy something, the more pain it inflicts on those who've purchased the item legitimately. At some point you need to decide that you're willing to let a certain number of people get away with something to ease the pain on everyone else. Where you draw the line is the difficult bit. I think that's what's happening here, but there's a certain demographic who are so determined to make sure that absolutely no one gets any sort of free ride/handout that they're willing to take the risk that they too will be disadvantaged. Instead of deciding that for the benefit of most people a few may receive a free ride, they'd rather members of their own demographic face the possibility of bankruptcy and/or death at the hand of your insurance companies. Like I said, I honestly cannot understand this mentality.
- deleted 17y ago
  [deleted]
- 17y ago
ojbyrne 17y ago
Interesting thing about this article. Most of it is about dental care, which isn't covered in Canada. Not sure about other places with nationalized health care.
- StrawberryFrog 17y ago
  Teeth are covered in the UK. You don't just randomly exclude body parts from healthcare.
jimbokun 17y ago
"Health spending as a share of GDP US 16% UK 8.4% Public spending on healthcare (% of total spending on healthcare) US 45% UK 82%" The most interesting thing about this, is that the U.S. government is spending about the same percentage of GDP on healthcare as the U.K. government. So, throw out the entire private health insurance system in the U.S., and we would still be spending roughly the same amount of GDP on health care as the U.K. So the real question then becomes, why can we not get the same health care system as the U.K. for the money our government is already spending? That's a good starting point for this whole discussion, I think.
- philwelch 17y ago
  When you compare public spending, you have to keep in mind the military. Unlike most European welfare states, the US has significant military obligations around the world. In fact, it's probably because of our military obligations to Europe that Europe can afford a welfare state--if they had to pay fully for their own national defense rather than being able to call on the United States, they would have serious problems maintaining a solvent national government.
ars 17y ago
Ignore the article, look instead at the numbers at the end: Health spending per head US $7,290 UK $2,992 Practising physicians (per 1,000 people) US 2.4 UK 2.5 U.S. doctors earn more than twice as much as UK doctors. This is the only real problem. It will cost the US twice as much as it costs other countries to provide healthcare for everyone. The US can't, or can barely, afford that. Reduce the cost to be on par with the UK and watch the entire debate fall away. I think something like 80% of people in the US have health insurance. If you dropped the costs just a little, it would be easy to cover the final 20%.
- mahmud 17y ago
  U.S. doctors earn more than twice as much as UK doctors. How much of that money goes to doctors vs how much of it goes to insurance companies, middle-men, lobbying, trial lawyers, billing and debt collection and what have you?
- prodigal_erik 17y ago
  Maybe 80% think they have insurance, but US health insurers are notorious for finding ways to weasel out of paying and cancel policies of sick people. An industry that actually delivered what this one promises would cost substantially more. (Not that we shouldn't spend that money.)
DanielBMarkham 17y ago
This subject area (and story) are littered with anecdotal data. Makes for great reading, but I'm not so sure it makes for good material for public debate. Most interesting were the life expectancy numbers, which if I remember correctly, are skewed in the U.S. due to violent death. Taking out the chance that you're going to get shot in a liquor store holdup, the life expectancy numbers are very close, perhaps even showing an edge for the U.S. (I don't have a link closeby, sorry) In fact, looking at life expectancy worldwide and spending, it looks like people are living to about the same age in the industrial world regardless of the type of health care program they have. This, of course, doesn't address quality-of-life issues. If people live about the same amount everywhere, then why does the U.S. spend twice as much? And that money spent across the board. In other words, it's not that public health care has any cost effectiveness to it, Americans everywhere are spending twice as much. If I had to guess, I'd say it comes at the end of life -- a huge amount of medical expenses go into that last six months. If you cut those expenses off and made them more managed (rationed?) I bet you'd end up with very similar figures. At the end of the day, if you make health care into something that you go to a politician to fix, you do a lot of interesting things to a democracy. Now might be a good time to think those through, instead of just pointing out how broken things are (they are broken) I favor an immediate, simple solution without government control that tries a few simple changes instead of a complex, intricate solution that few understand and fewer could fix if it didn't work. Do simple things repeatedly and fail often. Don't engineer a paperwork version of a nuclear submarine and then expect to be sailing it around the world next week.
- jacquesm 17y ago
  Yes, from a healthcare point of view it makes sense to have the two figures (violent death / others) separated out. But every country combines those numbers, I don't see why the US should get a free pass on that. And the two do mix, when you get shot in the liquor store but you don't die suddenly healthcare is very much in play, it might even remove that potential violent death from the statistics.
  - DanielBMarkham 17y ago
    Nobody's looking for a free pass, just an honest view of how long people are going to live. When the numbers are skewed, the resulting debate is skewed. Along those lines, another well-quoted stat is infant mortality rate, which also drives down life expectancy. But in the U.S., premature babies are routinely saved much earlier than elsewhere in the world. This means that lots of premature babies are more often lost too -- thereby making the infant mortality rates look like something from a third-world country. You can't manage something unless you measure it, but you can't measure it unless you define it. I'm perfectly happy with a very high infant death-rate and a slightly lower life expectancy rate now that I understand the definitions. But a common understanding is a key component of discussion. So now every time somebody trots out those same old tired stats we have to have the same conversation over and over again. It's like the old myth that paying money for prevention saves money in the long run -- lots of stats sound reasonable and seem to make a simple point but don't mean what people think they mean. That's not a good situation.

37 points by blogimus 17y ago

Here's a very interesting article about Stan Brock, the Brit and former Wild Kingdom star who has taken a vow of poverty and runs the Remote Area Medical organization. http://women.timesonline.co.uk/tol/life_and_style/women/ariel_leve/article6015125.ece http://women.timesonline.co.uk/tol/life_and_style/women/arie...

chasingsparks 17y ago

This article was shit, but not worse than most on either side of the argument. One thing that has been frustrating me most is the persistent argument that Americans have treatment outcomes that are subpar. Infant mortality rates and life expectancy measures are of limited utility when comparing wealthy countries. Concerning infant mortality, different countries count infant deaths differently, leading to over and under statements. Concerning life expectancy, Americans live lives that are relatively unhealthy when compared people in other countries. It is not a giant intellectual leap to conclude life style can account for the life expectancy gap. Concerning actual treatment outcomes, America typically leads they way. We have a higher incidence rate of many diseases but the best treatments if you view the outcome-to-incidence rates. Furthermore (anecdote warning), as someone who had a rare disease that still lacks any curative treatment, I have personally met a lot of foreigners. They were all seeking treatment in the US because we are pioneering most of the advances. Why? Because there is good money in it.

joe_the_user 17y ago
You say "This article was shit" - could we have a bit more civility here!
joe_the_user 17y ago
Also - "One thing that has been frustrating me most is the persistent argument that Americans have treatment outcomes that are subpar. Infant mortality rates and life expectancy measures are of limited utility when comparing wealthy countries." This is dubious in and of itself - what evidence do you have? But also, there have been a number of studies which quantified, to various degrees the effect of hospital infections, medical errors and similar things - and these real, honest-to-god quantitative studies show that these are significant cause of death in the US - any relation to the lower life expectancy in the US? That's further puzzle but we're got pretty strong evidence. And, I would agree that US leads in pioneering treatments for rare disease. That doesn't solve that other problems here.

martythemaniak 17y ago

I have to say, it is quite bizarre, watching the US health "debate" from up here in Canada. At the end of the day, it's a philosophical difference. I see people in Sicko, or read any of the thousands upon thousands of horror stories (like the ones in the article) and my stomach turns. I find situations like that downright amoral, so I think having to pay higher taxes for UHC is great value. OTOH, opponents look at the same people and start to get mad that these people should get "something for nothing", that their tax dollars are used to help people that may have made bad choices. Call me a pessimist, but I don't think this will turn out well for you guys. Any bill that is passed will be very watered-down and if the republicans get back into power before American UHC gets ingrained in the social fabric, then they'll do their best to kill it or cripple it.

jfornear 17y ago
You're right that there is a philosophical difference, but opponents of Obama's plan are being represented unfairly by those who frame the "debate" in the way in which you just did. All anecdotal arguments aside, the premise that more government is the only avenue for reform (held by yourself and other "progressives") is why both sides can't seem to agree on anything more than the idea that reform is needed. Around 40% of the American health care system is already managed by the government. The idea that we have a free market health care system that is failing the less fortunate in our country is downright false. In Obama's current plan, there are plenty of free market solutions to expand coverage and bring down costs that are being ignored and avoided (some due to lobbyists and special interests and others by, IMO, power-hungry politicians with a deeper, anti-capitalist agenda). Furthermore, there are plenty of examples of unintended consequences from prior government policies (with good intentions) that have created some of the problems we have today. Without going into the specifics or giving your last sentence a serious thought, I would just like to say this: Both sides (for the most part) have good intentions so let's not paint each other as evil. Here's a good place to start to understand the other side: http://online.wsj.com/article/SB10001424052970203609204574316172512242220.html http://online.wsj.com/article/SB1000142405297020360920457431...
- javanix 17y ago

kiba 17y ago

Free healthcare will never survive one fact: The fact that scarcity exists. The fact that healthcare are so expensive in America are numerous. The limited supply of doctors due to medical cartels, patents on drugs, overusage of the system by medicaid users, insurance companies being used for paying everyday medical cost, and more. But in Canada and other places where social medicine or universial health care exists, there has been rationing of improtant services. It is also where capital structures simply rot. I believe wealthy nations' medical system are going to crash and burn decades from now because government deemed healthcare too improtant to regulate or control, never mind the consquences of unintended effects from regulations. The only solution is to return control of the healthcare to individuals, which are embodied in a free market. Only individuals have any chance to find a solution where centralized regulatory power and decision makers fails miserably.

gdp 17y ago
My experiences of the New Zealand health system and the NHS in Britain have been nothing but positive. What's all this talk of crashing and burning? Really, the free market and the individual as the fundamental unit of society rarely act in the best interests of the society as a whole. That's why many governments provide centralised healthcare. They can essentially take all the money (as taxes) that would have been spent on health care or insurance in a given year, and use it to build hospitals and medical facilities that the public own. The public then gets to use these facilities that they paid for at no cost, or at a heavily subsidised rate. If more people need more health care, taxes go up, and more hospitals are built. It's a surprisingly efficient way of doing things. Much more so than having lots of private companies, each with shareholders demanding profits be returned on top of something as basic as healthcare.
- CWuestefeld 17y ago
  It's a surprisingly efficient way of doing things. Much more so than having lots of private companies, each with shareholders demanding profits be returned It's remarkable how our historical examples of this efficiency are so often ignored by all. I mean, consider how the soviets of the USSR succeeded in making that nation an economy to be reckoned with. And Chairman Mao's great leap forward was able to engineer a populace that succeeded in its grand goal of vaulting beyond the waste of the capitalist West. If only the industry of South Korea could prosper in the way that Kim Jong Il has guided his people into a paradise of plenty, then all Korean people could join hands in brotherhood.

cubicle67 17y ago

What the hell is up with your country, people? And what the hell is up with your fellow Americans? Why are the very people who suffer so much under the utter crap that passes for a healthcare system so eager to defend it. Seriously, I just don't understand.

jsz0 17y ago
It's a fairly complex issue. The class warfare angle is the rich and upper middle class simply don't want to pay for the poor. The financial angle is health care industry is a big business in America and it makes lots of people money. The religious angle is that some modern medical procedures conflict with their religious views and they don't want to pay for them. It really goes back to the core political divide in America of small government vs. big government. The two ideologies are pretty evenly matched in popular opinion so progress is slow.
- cubicle67 17y ago
  The class warfare angle is the rich and upper middle class simply don't want to pay for the poor Every time you put measures in place to stop people getting something their not entitled to, you make a compromise between the percentage of people you stop vs the pain you inflict on those who are entitled. Eg - DRM. The harder it works to make sure no one can copy something, the more pain it inflicts on those who've purchased the item legitimately. At some point you need to decide that you're willing to let a certain number of people get away with something to ease the pain on everyone else. Where you draw the line is the difficult bit. I think that's what's happening here, but there's a certain demographic who are so determined to make sure that absolutely no one gets any sort of free ride/handout that they're willing to take the risk that they too will be disadvantaged. Instead of deciding that for the benefit of most people a few may receive a free ride, they'd rather members of their own demographic face the possibility of bankruptcy and/or death at the hand of your insurance companies. Like I said, I honestly cannot understand this mentality.
deleted 17y ago
[deleted]
17y ago

ojbyrne 17y ago

Interesting thing about this article. Most of it is about dental care, which isn't covered in Canada. Not sure about other places with nationalized health care.

StrawberryFrog 17y ago
Teeth are covered in the UK. You don't just randomly exclude body parts from healthcare.

jimbokun 17y ago

"Health spending as a share of GDP US 16% UK 8.4% Public spending on healthcare (% of total spending on healthcare) US 45% UK 82%" The most interesting thing about this, is that the U.S. government is spending about the same percentage of GDP on healthcare as the U.K. government. So, throw out the entire private health insurance system in the U.S., and we would still be spending roughly the same amount of GDP on health care as the U.K. So the real question then becomes, why can we not get the same health care system as the U.K. for the money our government is already spending? That's a good starting point for this whole discussion, I think.

philwelch 17y ago
When you compare public spending, you have to keep in mind the military. Unlike most European welfare states, the US has significant military obligations around the world. In fact, it's probably because of our military obligations to Europe that Europe can afford a welfare state--if they had to pay fully for their own national defense rather than being able to call on the United States, they would have serious problems maintaining a solvent national government.

ars 17y ago

Ignore the article, look instead at the numbers at the end: Health spending per head US $7,290 UK $2,992 Practising physicians (per 1,000 people) US 2.4 UK 2.5 U.S. doctors earn more than twice as much as UK doctors. This is the only real problem. It will cost the US twice as much as it costs other countries to provide healthcare for everyone. The US can't, or can barely, afford that. Reduce the cost to be on par with the UK and watch the entire debate fall away. I think something like 80% of people in the US have health insurance. If you dropped the costs just a little, it would be easy to cover the final 20%.

mahmud 17y ago
U.S. doctors earn more than twice as much as UK doctors. How much of that money goes to doctors vs how much of it goes to insurance companies, middle-men, lobbying, trial lawyers, billing and debt collection and what have you?
prodigal_erik 17y ago
Maybe 80% think they have insurance, but US health insurers are notorious for finding ways to weasel out of paying and cancel policies of sick people. An industry that actually delivered what this one promises would cost substantially more. (Not that we shouldn't spend that money.)

DanielBMarkham 17y ago

This subject area (and story) are littered with anecdotal data. Makes for great reading, but I'm not so sure it makes for good material for public debate. Most interesting were the life expectancy numbers, which if I remember correctly, are skewed in the U.S. due to violent death. Taking out the chance that you're going to get shot in a liquor store holdup, the life expectancy numbers are very close, perhaps even showing an edge for the U.S. (I don't have a link closeby, sorry) In fact, looking at life expectancy worldwide and spending, it looks like people are living to about the same age in the industrial world regardless of the type of health care program they have. This, of course, doesn't address quality-of-life issues. If people live about the same amount everywhere, then why does the U.S. spend twice as much? And that money spent across the board. In other words, it's not that public health care has any cost effectiveness to it, Americans everywhere are spending twice as much. If I had to guess, I'd say it comes at the end of life -- a huge amount of medical expenses go into that last six months. If you cut those expenses off and made them more managed (rationed?) I bet you'd end up with very similar figures. At the end of the day, if you make health care into something that you go to a politician to fix, you do a lot of interesting things to a democracy. Now might be a good time to think those through, instead of just pointing out how broken things are (they are broken) I favor an immediate, simple solution without government control that tries a few simple changes instead of a complex, intricate solution that few understand and fewer could fix if it didn't work. Do simple things repeatedly and fail often. Don't engineer a paperwork version of a nuclear submarine and then expect to be sailing it around the world next week.

jacquesm 17y ago
Yes, from a healthcare point of view it makes sense to have the two figures (violent death / others) separated out. But every country combines those numbers, I don't see why the US should get a free pass on that. And the two do mix, when you get shot in the liquor store but you don't die suddenly healthcare is very much in play, it might even remove that potential violent death from the statistics.
- DanielBMarkham 17y ago
  Nobody's looking for a free pass, just an honest view of how long people are going to live. When the numbers are skewed, the resulting debate is skewed. Along those lines, another well-quoted stat is infant mortality rate, which also drives down life expectancy. But in the U.S., premature babies are routinely saved much earlier than elsewhere in the world. This means that lots of premature babies are more often lost too -- thereby making the infant mortality rates look like something from a third-world country. You can't manage something unless you measure it, but you can't measure it unless you define it. I'm perfectly happy with a very high infant death-rate and a slightly lower life expectancy rate now that I understand the definitions. But a common understanding is a key component of discussion. So now every time somebody trots out those same old tired stats we have to have the same conversation over and over again. It's like the old myth that paying money for prevention saves money in the long run -- lots of stats sound reasonable and seem to make a simple point but don't mean what people think they mean. That's not a good situation.