It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm.
Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries.
So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system.
Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population.
My hope is that this new-found energy in healthcare products doesn't follow the traditional VC-backed approach of building a product, taking over markets through aggressive marketing and shady closed-door dealings and operating at a loss only to then monetize the shit out of everything.
Theranos really embodied some of these fears, and I'm not sure we'll live in a better world if our health will be in the hands of people that have a financial incentive to tell us we're more sick/healthy than we really are.
The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less.
Note that many of the European systems are semi-private, so you retain choice of providers. It doesn't need to be a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from).
There's also an informational problem; in a fully free speech environment it's much easier to sell people unreliable cures, Theranos passim.
I agree. The "everything is a market" ideology had a good run of almost half a century, but it should be heavily criticized in hindsight.
Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. The "in large parts" is important here: A community should agree on what that means and let the market play out on the edges, or the bureaucratic costs become too heavy _and_ unfair. Decentralization is key here.
US healthcare is a four-party arrangement since employers are also intermediaries. Employers select the plan (or plan options) and they pay the bulk of the premiums. Their check is always bigger than yours even if you pay more for your policy than they do. As such, most of the sales effort by health insurance companies is directed at the employer and they exercise a lot of judgment. In contrast, I have never once spoken to a representative of the health insurance company during open enrollment, it is always HR.
In my book, it’s a big red flag when a market is intermediated by anyone. The whole point of markets is to crowd source decision making, so if you remove the crowd, then what is it that you actually have left?
> a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from)
That's more because we've had decades of deliberate underfunding due to the "austerity"/"capitalism++" lunatics in charge than a natural consequence of a state-run system though.
Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US.
Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (insurers) and then act surprised that they take a fat cut. The solution isn't to government-ize the middle man. That will almost certainly just be a wash. It's to get rid of the middle man where possible.
There's no reason someone shouldn't be able to get a physical or a colonoscopy the same way cosmetic surgery and dental care are done. These are cookie cutter outpatient services. The deviation from instance to instance is small and predictable so insurance should not be needed on the consumer side.
Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong?
> the fact that healthcare is already a consumer product in the US
I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then:
1. It wouldn't be tied to or dependent on my employment.
2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers.
3. Insurance providers wouldn't be restricted by arbitrary/geographical boundaries.
I think the debate over weather healthcare is a human right is an interesting one, and I personally haven't come to any conclusion on that yet.
If you think healthcare is a basic human right then a single-payer system is probably the most reasonable solution, although I don't think single payer isn't without it's share of problems.
If you think healthcare is not a basic human right then I think a real free-market solution is the most reasonable solution, again I don't think this is without problems either.
I don't believe there is a "perfect" solution. But I think either a true free-market system, or a single-payer system would both undoubtedly be 100x better than the current system in the US. I would be in favor of moving to either of these solutions as my political stance isn't D or R but "lets make improvements" regardless if those improvements are seen as left or right.
The Japanese system is not a single payer healthcare system and in terms of outcomes vs. cost is one of the best in the world, so I am not so sure that single-payer is the most reasonable solution. Particularly in the US where voters are averse to giving up their private insurance.
Japanese system does have a public option and much tighter price controls, which we are missing here.
I only put this out there because I feel it needs to be, but we can't just put all of health-care into a single basket. Emergency medicine should be separated out of these discussions as there is no "Free Market" option, just as there is no real free market option for police or fire services.
For optional surgery or cosmetic treatment, sure. You can argue a free market option, but that's why I always think there should be separate baskets, for lack of a better term.
It's not (just) about whether healthcare is a human right. E.g., interstate transportation on surface roads isn't a human right, but markets lost out to collective action. Why? Because building a well-functioning market for 8 lane interstates across an entire mostly-rural country was impossible in the 20th century (and probably still is).
So, the other important question to ask is the following: how feasible is it to create a well-functioning market for this product?
So far, we don't have an existence proof that such a well-functioning market is possible to construct in the healthcare space.
One point that gets skipped over a lot - the US is also one of the most unhealthy countries in the advanced world.
This is a big /part/ of the "worst outcomes" in the "highest cost, worst outcomes".
It is possible that you can spend a ton of money on healthcare - yet smoke and drink, drive everywhere and not exercise at all, and eat trash - that the healthcare spending is doomed to fail.
Europeans walk & bike more and don't eat as much garbage. Most Asians exercise much more, eat healthier, AND smoke and drink less.
Maybe the healthcare part is secondary to just generally taking care of your health?
It is well understood how terrible obesity is for you. Why should we expect the US to have better healthcare outcomes than Vietnam when Vietnam is 2.1% obese and the US is 42% obese. You can take all the heart medicine in the world. It would be better to simply not be obese in the first place!
This never seems to be a talking point. Have the statisticians controlled for all this when they come to these conclusions??
That's a good point, life style does play a major part.
But I think this point also opens another subject, preventive healthcare. Many modern healthcare systems are starting to focus on prevention for 2 main reasons: increase quality of life and reduce long-term healthcare costs.
For example, in Finland public tobacco smoking is(was?) considered a public health issue. The government got actively involved to reduce consumption and this resulted in better overall outcomes in their healthcare systems for diseases caused or exacerbated by smoking.
IMO, obesity is a problem affecting the healthcare systems of many developed countries (Vietnam is not yet considered a developed country) arguably not at the same levels as in the US. But this again is part of how government chooses to get involved in fixing the healthcare system by enforcing policies or passing laws that help with prevention.
My father is getting old and our healthcare system has done a great job at keeping him alive while he can still eat shit loads of pizza, drink beer and be a 80lbs overweight.
All this medication and treatment he takes is not just to keep him alive but to keep him alive without having to change a single bad habit.
This is a good point, and it's important to also remember that these ideas aren't independent. How people interact with the healthcare system over their lifetimes has an impact on how they think about their health, and the health impacting decisions in their lives.
There is so much wrong with the US healthcare system, from physical therapy centers, ambulance companies and prosthetists, to hospitals and surgery centers, to doctors, to insurance companies, to drug companies, to laws, patents, and the US government. Maybe you don't know the system well?
> This never seems to be a talking point. Have the statisticians controlled for all this when they come to these conclusions??
I never see this as a talking point of folks who are in favor of universal / state-funded healthcare, but it is often a talking point for those who are opposed. They point to the links between state-funded healthcare and the soda tax in the UK as an example of how allowing the government to control your healthcare results in more aggressive and manipulative social policy to control health outcomes societally. Many people opposed to state-funded healthcare feel rather strongly that you should be able to do pretty much whatever you like with your body as long as you're paying for it yourself. I consider this take to be missing quite a lot, but it does seem to be a common one. I am personally in favor of universal single-payer healthcare systems, so I've had this conversation a lot due to my surroundings and have heard just such this argument many times.
> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries.
In what way is it the worst-performing? I mean, what are the outcomes that are measured to determine its performance?
Yes, healthcare is a lot cheaper in Europe (even if your employer wouldn't pay their part) compared to the US, but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance.
> but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance.
That's exactly like US healthcare if you aren't either a wealthy private-pay client or someone with top-flight private insurance; we just pay twice as large a share of GDP and even a higher multiple per capita to have the same normal experience and many more people uninsured than any other developed economy (and we've only recently through the ACA, gotten it so the that your top-flight insurance plan wouldn't look to retroactively cancel your insurance when you got an expensive-to-treat condition, leaving you uninsured and uninsurable.)
Unless there are some clear symptoms of deficiency, vitamin D or testosterone tests aren't usually justified from an evidence based medicine perspective. Insurance companies usually won't cover such tests unless the patient meets their medical necessity criteria. However in many countries you can order such lab tests yourself and pay for them out of pocket.
As a separate issue, there is now significant clinical evidence that hypovitaminosis D is a major risk factor for COVID-19. So I hope that medical guidelines will be updated to make those tests a routine part of preventive care screening, in the same way that we test for lipids and blood glucose levels.
>the quality of the service is rather poor with very long waiting lists
I can get in to see an Urgent Care doctor in any major US city within 30 minutes of walking in the door. If it's not urgent, who cares what the wait is?
> So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population.
Healthcare and Big Pharma have captured regulators at various federal health institutions. The mission is maximizing profit outcomes not health outcomes.
US Healthcare is not the 'worst performing', that's a perennial clickbait theme.
Health issues are bad in the US, and people use that as 'evidence' for quality of the Healthcare system, but that's not fair.
People shooting each other, not eating well or exercising, isn't so much a function of the US Healthcare system.
The US system is probably the most economically inefficient, but that's also expected at the highest end of quality.
The US has most of the best quality systems in the world, it's just expensive and messed up financially, but the quality itself is something to behold.
While I share your reservations about 'privately backed things' - for example, advertising arcane drugs in the US is ridiculous, this whole 'Ask Your Doctor' is an excuse for pushy patients to 'prescribe themselves' over the will of tired Doctors caving in ...
... that said, Theranos is the opposite example. If it had worked, it would have been because of VC backing and it would have been very beneficial to people. And there are many things like that.
Like anything, it's complicated, and we need nuanced thinking about it.
We probably should welcome a lot more VC spend, think of ways to empower doctors with the deluge of information, to empower individuals but at the same time get them to understand that they are not medical professionals and shouldn't be self-diagnosing, etc..
There are huge variations in performance depending on what metric you look at. The US is at or near the top in 5-year survival rates for most types of cancer.
It's not all bad to spend more - consider the extra hospital capacity that so far has helped absorb COVID shock impacts better than neighboring Canada. Hopefully we don't hit the limit of that, even, though. https://www.bloomberg.com/news/articles/2022-01-06/hospital-...
US health outcomes also aren't so bad for those who have affordable access to the system, as I understand it.
But the spending is something to keep in mind when anti-healthcare-for-all advocates say things like "do you want to have to wait months for procedures like in Canada" - if the US continues to spend more money per person, there's no reason it can't continue to have more capacity.
> Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population.
My favorite example of this is when I had to get an MRI. The lab imaging said it would be $800 if they billed it through insurance, or it would be $600 to just pay for it directly out of pocket. So the cost of having to deal with my insurance (which always advertises the "discounts" they negotiate and the "lowest cost") was actually more than what the insurance would actually cover.
This is always extra annoying because it might be a false savings to pay cash there. Let's say your MRI says you need a $5500 procedure, and your plan's deductible is $3000, 90% coverage after, and out of pocket max is $6000, and there's nothing else you've spent on the plan this year.
Pay $800 for MRI with insurance, you'll then pay $2200 for the procedure to hit the deductible + 10% of the remaining $3300, so $2530 total for the procedure. $3330 total for the year between the two things.
Pay $600 cash for MRI, you'll then pay $3000 for the procedure to hit the deductible, and 10% of the remaining $2000, so $3200 total for the procedure. Now you've paid $3800 total, so you've spent $470 more despite the MRI being "cheaper"!
If you have other expenses so your out of pocket max comes into play, that difference approaches the full $600.
Yes, so. The typical American response to that is: "the government controls everything. Let the free market do its job!"
And then wonder why they get shit care for a huge price BUT swith nice marketing and a smiling "health dealer" getting you a 0% lease... oh sorry, we got you confused with a Chevvy!
And also, "we have the best care in the world because our docs are better selected". This one never fails to make me laugh, as a swiss MD
Yes, that's the response, but healthcare in America is far from a free market. It's more a circle of sloppy middlemen, in much the same way that I hear privatized passenger rail in the UK described.
in 2019 I would have agreed with you.
In iceland you will not be charged for cancer treatment, but the medical costs of getting a long term illness in Iceland are not trivial.
Add that to loss of income and the situation for many chronically ill is actually so terrible that laughing at the US is not something Iceland can afford.
And covid has painfully displayed exactly how poorly managed the hospitals are and how starved the health care system really is.
The equivalent of a bus accident will put the healthcare system on its knees or 80 people needing intensive care.
of course Iceland has more hospital beds than 80, but it cannot handle a disease that may put 80 people in ICU ( not counting ventialtion here at all, just intensive care ).
I think many in Iceland, myself included, are a bit in shock of exactly how poorly managed and starved the health care system is.
Up until 2019 I laughed at the dumb americans and their awful health care, man did I get my sit-upon whopped in the past 2 years.
Icelands is so bad that we are regularily filling hospital break rooms and garages with patients.
THat is on a normal non-influenze season. Let alone sars-cov-2 introduction.
I suspect Canada is having a similar realization as we are. Free care in all its honour.
Starved free care, heh...... Shame on us. Really. Shame on us.
Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries.
Not that your thesis isn't correct but be careful there. You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. The quality of care for Americans who can afford care is excellent.
> The quality of care for Americans who can afford care is excellent.
As a Canadian who knows many Americans, works for a US company and has extended US family, this is not quite true.
Most Americans "who can afford care", maximum 70%, have access to medical care that is on par with Canadian health care, but is fraught with peril; "booby traps" such as out of network costs, high co-pay fees that can bankrupt, surprise billing (though 2022 is starting to deal with that). Care may be excellent, but losing your house if you get cancer seems unnecessary.
A few percent of Americans (the rich and the very well insured; FANNG/MAMAA, investment bank employees, etc.) have access to the possibly best health care in the world.
20% of Americans are uninsured or under-insured and have access to the worst healthcare in the G20.
I think it's strange to want to only include the first two categories in the outcome calculation. Strange may not be the right word here ...
> You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care.
Well that's the point, I think everybody should be taken into account in order to paint a comprehensive picture of the quality of the system at country level. The resulting stats reflect the health of a society as a whole not just of the part that can afford it. Not having universal healthcare is still part of the system, even if we don't like it.
I get it that health outcomes of those left out are probably very different. But leaving those numbers out of the comparison doesn't really work with these type of statistics.
At that point how could you compare it to the other countries that take everyone into consideration? The stats are GDP/capita percentages, should I remove the ones who can't afford healthcare from the GDP stats as well to not skew the ratio? I don't really like where I might end up taking this route.
I don't have any experience with US healthcare and I'm sure the quality of the services is really high, but the fact that you need to afford basic healthcare and it's not guaranteed by the government for everyone makes me see it as closer to just another "consumer product" compared to other systems.
There is a sad trend where the small doctors -- who can't survive without group power -- join conglomerates, the conglomerates buy hospitals, and finally the conglomerates close the less performant facilities. You get large states with vast underserved geographies.
The OP headline is we are careening towards a luxury retail arrangement like Trader Joes: they will only have "outlets" in the richest areas. There's no regulation around closing hospitals so this is coming fast. Two in my county closed this year and I am far from rural.
I’m interested in this worst performing stat. By what measure? Because I’ve always read that when controlling for the relative poor health of the us population regarding diseases related to poor eating and exercise habits, the US was a top performer for heart and cancer treatments.
> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries.
>>e most expensive and worst-performing in terms of outcomes compared to the other developed countries.
That is only true if you cherry pick statics that over sample for life style choices, and under sample of actual health care.
If you look at statics that are directly attributable to the care provided, not the life style choices of the patients then the US Healthcare system is far better than any other nation
I'm curious how you can suggest the US government spends the most money in the world, by far, on healthcare and the simultaneously suggest there's less government involvement.
The government is involved in every step of American healthcare. As you can imagine of a system that gets all of its funding thru companies completely overseen by regulatory bodies or thru social programs.
I didn't really suggest that the US Government spends money on healthcare, I was merely quoting the article: "Health care consumes 18% of GDP in America"
Please note that the wording implies that 18% of GDP is spent on health care overall not that the US Government is spending all that money out of its pocket directly on yearly budgets. The way I understand it is that it includes both money spent by public and private actors for all health related service.
I see this type of stat a warning that something might be dysfunctional within the system, and it's the government's job to get to the bottom of it.
There is some crazy amnesia here about the US healthcare system. Some 40% of the US are already covered through Medicaid/Medicare - "socialism" is long here!
Much like US Defense spending subsidizes the rest of the globe, US for-profit healthcare spending spurs massive investment in pharma and biotech research that benefits the rest of the world. Are there inefficiencies and waste? Yes. But outcomes overall are much better for it.
The us healthcare system is not capitalistic. If I get my flu shot I have no idea how much it cost my insurance company. CVS, Walgreens, Safeway all the same to me for a flu shot.
If instead we use health insurance like home insurance for unforseen major issues, and had price transparency. Then prices would go down as people would shop around.
What you're describing is the lack of a normal market, and even that only applies if you have insurance. For the millions of people without insurance, they do indeed shop around.
It is very much a capitalist system, since the ownership (& control) of the system is not in the hands of the workers - in insurance companies, hospitals, pharma, etc - but in the hands of wealthy shareholders.
To be fair, I suspect your definition of capitalism is very different from mine...
> So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system.
The US healthcare is an example of the government being massively over-involved and creating massive inefficiencies.
Counter point: the NHS in the UK has more government involvement than the US healthcare system.
The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US.
“Better outcomes” needs more detail:
Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an aspect of healthcare costs.
Cost of triple bypass heart surgery: US: $110,000, UK: £8,500 (paid by the taxpayer, not by the patient at the point of care - free for them). (P.s. private healthcare is available in the UK too - the procedure costs around £20,000 privately, payable by the patient or their insurance)
As opposed to what, the Singaporean system where you get sent to jail for charging above government mandated price caps?
American healthcare has the least involved government of any first world country.
Only an overly credulous interpretation of Koch-style market-knows-best propaganda would make you think that the "level" of government involvement was the root cause of its problems.
I guess my initial phrase is a bit superficial, from my European-centric point of view the US government seems less interested/involved in the health of their healthcare system compared to what I'm seeing in europe.
The point I was trying to make is that government involvement is needed to make sure that the right incentives are in place at all times for all involved actors (public or private). And if the system becomes dysfunctional or is abused it's the government's job to fix it.
Most of the countries that have universal healthcare in Europe have their own take on how it should be done:
- France has state funded insurance and (mostly) state funded services
- Switzerland private insurance and private/public services
Two totally different takes with arguably very similar (good) results.
The goal of government involvement should be to make sure everyone has access to basic healthcare and avoid double standards and abuse.
The greatest healthcare improvements in the US could be brought about by:
- Dismantling the insurance/big hospital complex that milks the US population for the enrichment of c-suite executives.
- Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies (so they're less able to price gouge consumers).
- Price transparency on all links of the chain of healthcare delivery.
- Changing the incentives for physicians and other providers towards expensive, often harmful and unnecessary interventions.
- Facilitating improved therapeutic relationships between providers and patients (More time spent, more communication, more incentives for harm reduction).
- Social changes including less stigma for things like drug use, greater emphasis on community cohesion and care.
- Demilitarization (Not only are absurd amounts of money spent on the military that could be redirected to better community health services; but innumerable veterans (not to mention foreign and local civilians) are injured psychologically and physically annually in the absurd pursuit of 'global security'.
- Better end of life care. I think something around 40% of healthcare expenditure is on patients in the last 2 years of life. Patients and families would benefit from earlier access to hospice care and less aggressive therapies that only prolong suffering.
- A greater emphasis on preventative health and lifestyle choices (better diet, exercise and sleep regimes - ideally within the context of a long term health care provider relationship).
Its very typical of modernism (especially in the US) to think that the way to address everything is a nice app with a better UI. This also facilitates the corporate narrative of marketing the shiny new thing to throw money at (make money for the company) to solve everything whilst digging the hole even deeper (and letting society absorb the collateral damage).
EDIT* Thanks for the feedback, I have added some of the points made by others to the list above.
This probably also is the hardest part. And the most alien to the whole American model of which lobbying is an integral part. IMHO you can only counter lobbying by allocating more to fact checking so it would be harder for them lobby things which are objectively wrong.
There's a really, really, really fine line to walk between preventing the AMA from lobbying congress to screw us and preventing actual grass roots people from paying someone to argue on their behalf.
> - Better end of life care. I think something around 40% of healthcare expenditure is on patients in the last 2 years of life. Patients and families would benefit from earlier access to hospice care and less aggressive therapies that only prolong suffering.
I feel like the choice has to be removed from families as our current system has proven that life will be extended regardless of quality simply due to the fact nobody wants to make a difficult choice. As the only quantitative item on the list and a very substantial one this should be ranked much higher in terms of priority (not sure if list was unordered or not).
Yes check the app while your limp unconscious body is shoved into the back of an ambulance. Type in appendectomy near me while you're writhing in pain in the passenger seat and decided, the hospital the next town over is a better deal
So you're not qualified enough to fix what you don't know is wrong (is this pain in your leg a simple thing, is it an actual fracture you're just surviving on on pure adrenalin, is it microfractures that might take more to heal), but you think for some reason you (or an app) would be qualified enough to tell you how much you'd pay for "leg pain" ?
In my view, the fact that we don't know, is a major part of the problem. Our system is such an entangled web of business entities, that we probably have no idea where the money is coming from and going to. Everybody says that somebody else is gouging us, which means that they're all probably gouging us.
And they are all invested in each others bags. For instance I've read that doctors are major investors in health providers, are often the owners of the expensive equipment, and also heavily invested in the malpractice insurance industry.
Half of billing is multiple businesses billing one another.
It seems quite possible that what makes government health care more efficient is simply knowing where the money is going, if it's all coming out of one checkbook.
Predominantly (there's also general overall bureaucratic bloat with absurd numbers of administrators at all levels) .
It's certainly not the majority of healthcare workers.
Physicians are often scapegoated as responsible for healthcare costs when in reality physicians in Canada, New Zealand and Australia earn similar salaries without the massive cost blowout.
The app thing is very true and so ridiculous, I at one point contracted for a health insurance company (with a team of 10 people) for over a year working on an app that never saw the light of day.
It was essentially a calorie and exercise tracker that also displayed your health insurance info, absolutely nothing special compared to fitness apps already out there, but millions of dollars down the drain.
Not everyone agrees on what “better” means though. When you start putting dollars and days into formulae around dying, many people lose their damn minds…
The simplest changes we could make would be to ban the addition of sugar to certain mainstream food categories (drinks, bread, sauces), and also to require nutritional information to be listed as per 100g, not per serving size.
Follow that by banning burning of coal and oil, we also remove a significant amount of noise and air pollution.
Next we can ban any hormone-disrupting chemicals (including as plastic additives) from being used in anything that will ever touch human food or drink, or ground water.
Finally we can legaize euthanasia for anyone aged 70 or older and with a terminal health condition.
With these changes you have a human population much healthier and less reliant on expensive healthcare.
You missed maybe the most important thing: Allow cities for humans to be built. The American suburbia model is unhealthy on so many different levels. This only became apparent to me on my trips back stateside after living in Europe for a while.
So, folks under 70 get out of suffering, but someone dying in their 30's can't get euthanasia? This seems cruel, especially so given the number of folks that suffer and die before they reach 70.
And it shouldn't be for financial reasons. I fully support someone's right to death, but I do not support creating systems that might encourage it. I also don't realistically care if the health condition is terminal: I care more that folks are suffering and want death to escape it.
On the euthanasia point I would agree that this should be a legal option (but on a humanitarian rather than a financial basis).
We definitely need do do a better job with end of life care/terminal diseases - in practice this would look like earlier/more hospice/compassionate care, less needless end of life treatments and interventions).
seems symptomatic that you would rather give away some really basic freedoms and be treated like cattle just to avoid making the healthcare system public
It is 100% obvious that amounts spent on the military in the U.S. today are insufficient and will have to go much, MUCH higher than they are today. Probably 5x higher - to the Cold War 10-12% levels - because of standoff with China and Russia at same time.
It will still not be enough to win over China, but at least enough to keep the free world in existence. Otherwise democracy will be just simply gone from the world altogether in one generation.
Continuing to head in the direction of militarism, will continue the disaster of a world that we live in, and almost certainly guarantee the end of mankind.
>>Here's some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period.
*
>>Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009. [3])
In contrast, areas of medicine which are subject to much fewer subsidies and regulations, as a consequence of being electives, have seen prices actually decline in inflation adjusted terms. [4]
Regulations and subsidies do not seem to make other countries' systems inefficient. They make it so that folks are safe and that they can actually get health care.
I really want regulation in health care. I do not want medication to be a free-for-all like supplements are in the US. I'm not a doctor, after all, and they are slow to take supplements off the market even if they are harming or killing folks (take a look at diet pills to see this effect). I do not want average folks to be able to get antibiotics willy-nilly because I want to be able to take them when I'm old. And so on.
This seems more like a symptom of the wildly broken American health-care system than anything else.
In countries with a more functioning healthcare system, disruption of the status quo (especially by VC-funded private companies seeking a large payday) is neither necessary or desirable, slow iterative improvements are the name of the game.
Furthermore, the US spends far more per capita than every other country on healthcare, and receives worse healthcare outcomes as a result [1], [2]. If you think that the solution is throwing more VC money at the problem, well, I have a bridge to sell you.
Sadly for Americans, the obvious solution that most (~70%) Americans apparently want (Medicare for all) seems very unlikely to happen anytime soon.
To add to this, the absurdity of the 'healthcare' system in the US is made even more apparent as a non-US citizen buying health insurance for (long-term) international travel.
Firstly (loosely regulated) insurance is an absolutely stupid way to provide healthcare. Pre-existing conditions? Maybe you just don't deserve to live, either way we're witholding life-saving care from you because our tables say so. Need to claim near the start of your cover? You must be lying about pre-existing conditions. Need to fix something that wasn't acute enough to seek care about previously? Nope, no cover for you. And on and on and on. Anyone who thinks an insurance market is a solution for healthcare is just an idiot, there's no way around that. (I realise some universal systems run on a private insurance basis but they're a lot more regulated)
But then, even in that entirely messed up system, designed to cut you off from urgently needed medical care, all policies are divided into 'regions'. There's not much cost difference between regions until you get to any region "including the US". It's even named, the only country in the world they do that for. That's how badly those guys have messed up their healthcare system. And if you select that? It's at least double the cost, for no extra cover in terms of policy limits.
That for me clarified that, no, I wasn't missing anything. Anyone who supports the current US system is so far removed from the commonly inhabited reality that none of their opinions are worth listening to.
Yep. This is like writing an article about the increasing prevalence of gas generators and storage batteries, and saying that "electricity generation is turning into a consumer product". Really the centralized providers are failing with no hope in sight, so people are opting for distributed means to take care of their needs. If you tell someone they can pay a well-defined price for a device that might help them, or they can spend hours on the phone to make an appointment three months out that will result in indeterminate bills and likely further cycles through the bureaucracy, obviously they'll prefer the straightforward option!
I don't know how any American can accept the pile of trash that the US healthcare is. The only good thing is that in some cases you will get state of the art care, this is "rare" and may not result in better outcomes.
1. The cost is insane. It doesn't matter how much money you have, if you stay long term in a hospital your bill will be insane and more than an average cost of a house.
2. Single ER visit? 10 different bills over the next few months. Apparently, there is a new law trying to tackle this but hospital can opt-out by having you sign paperwork.
3. If you have an illness and need to see many doctors and have many tests in a short period of time get ready for your insurance to fight you and deny claims. You will be calling them all the time.
4. There are now 3rd party businesses set up to "VERIFY" no other party is responsible for the care you received(meaning you did not have an accident). If you fail to respond to their letters, your claim will be denied.
5. MRI, X-rays, dental work, physician visits are SO MUCH more than other developed nations. It is a joke. I'm talking without insurance here, just going to a private clinic and paying out of pocket as these also exist in Poland even though it has socialized healthcare.
6. The insurance prices are out of control, and the insurance company don't give a shit. In fact, they welcome the high prices. Obamacare capped insurance companies profit margins at a percentage of money spent, this is the result. The more they pay out, the more they make. The cost falls on the policy holders.
7. Covid is really showing cracks in for-profit healthcare. I have friends who work in the field and are complaining about people coming in with positive covid tests because they are asymptomatic. If they don't want to come in they risk getting fired, and in some areas large hospital networks own many smaller clinics and being fired may result in not being able to find a job without relocating.
The problem from my point of view is conflating ongoing healthcare with catastrophic coverage. Outpatient care should absolutely be a free market (prescriptions, lab tests, specialist visits etc.). Catastrophic incidents/diagnoses should be a simple lump sum payout (Cancer, Hear Attack, Stroke, etc.).
Alternative options I've seen being offered for ongoing healthcare is Direct Primary Care where essentially you pay a membership fee to have unlimited access to a primary care physician.
I think the root of the problem is subsidization and the patch work of legislation that gets piled on year after year to "fix" the issue. The entire price function is completely out of wack and as long as the patient is stuck between the provider, insurance carrier, and government debating who has to pay, they will lose.
Your average American doesn’t have the pull to effect change. The majority of Americans support government taking a greater role in healthcare (per Pew Research), but Congressional reps won’t vote for it, so you have to wait for people to age out for change. In the interim, everyone overpays and suffers.
Pfizer was BioNTech, developed in Germany. They might have also had Astrazeneca (UK) or any number of vaccines developed in tandem globally. Also, worth pointing out that healthcare is a separate and distinct industry from pharma. Co-dependent but dealt with under very different rules globally.
The current healthcare system in the US is just as bad for service providers as it is for service recipients, maybe even worse.
My girlfriend has worked with children with special needs for around 20 years, mostly children with autism. A few years ago, the field began migrating from almost entirely state-funded to funding from private insurance (California, not sure about other states). The problems with private insurance funding began almost immediately and couldn't be clearer. Under the state-funded program that existed for decades, her company met monthly with the state funding agency, discussed individual cases, and got funded. Easy, efficient. With private insurance, well, the best way to describe it is that her small company had to hire a full-time person just to manage the billing/funding with the insurance companies. And this is not a do-nothing position. This position is responsible for much of the company's revenue, which is inherently important. Also, understanding all the different processes/procedures/BS of each insurance company is highly skilled. That might sound ridiculous, but it's totally true. I hear the stories about fighting with insurance companies, trying to get paid for services rendered months prior. Quick example: one private insurance company (a big one, you've heard of them) only accepts payment requests via fax. Yes, fax. But it gets better. The fax line is only "active" during regular business hours, and the line is almost always busy, because as you might expect, other companies are trying to get paid, too.
At least in my mind, "consumer product" quite clearly implies that the price is advertised, or at least easily found. And it does not change during the transaction.
Which is definitely not the case in American health care - unless you have "For the Top 1%" health insurance, or are buying at the bottom end (a bottle of aspirin, maybe an eye exam or dental cleaning).
I really believe in this general category. Giving people healthcare that isn't a shitty experience will change the world.
I'm not confident a typical telehealth-style consultation with one of these direct-to-consumer companies is that great, but by the same token, I am confident the medical care I get in a traditional setting is mediocre. For example, the time an MD tried to convince me I couldn't be feeling pain... after I told him I was specifically there for pain.
Readit News
Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries.
So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population.
My hope is that this new-found energy in healthcare products doesn't follow the traditional VC-backed approach of building a product, taking over markets through aggressive marketing and shady closed-door dealings and operating at a loss only to then monetize the shit out of everything.
Theranos really embodied some of these fears, and I'm not sure we'll live in a better world if our health will be in the hands of people that have a financial incentive to tell us we're more sick/healthy than we really are.
Note that many of the European systems are semi-private, so you retain choice of providers. It doesn't need to be a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from).
There's also an informational problem; in a fully free speech environment it's much easier to sell people unreliable cures, Theranos passim.
Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. The "in large parts" is important here: A community should agree on what that means and let the market play out on the edges, or the bureaucratic costs become too heavy _and_ unfair. Decentralization is key here.
That's more because we've had decades of deliberate underfunding due to the "austerity"/"capitalism++" lunatics in charge than a natural consequence of a state-run system though.
Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (insurers) and then act surprised that they take a fat cut. The solution isn't to government-ize the middle man. That will almost certainly just be a wash. It's to get rid of the middle man where possible.
There's no reason someone shouldn't be able to get a physical or a colonoscopy the same way cosmetic surgery and dental care are done. These are cookie cutter outpatient services. The deviation from instance to instance is small and predictable so insurance should not be needed on the consumer side.
Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong?
I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then:
I think the debate over weather healthcare is a human right is an interesting one, and I personally haven't come to any conclusion on that yet.If you think healthcare is a basic human right then a single-payer system is probably the most reasonable solution, although I don't think single payer isn't without it's share of problems.
If you think healthcare is not a basic human right then I think a real free-market solution is the most reasonable solution, again I don't think this is without problems either.
I don't believe there is a "perfect" solution. But I think either a true free-market system, or a single-payer system would both undoubtedly be 100x better than the current system in the US. I would be in favor of moving to either of these solutions as my political stance isn't D or R but "lets make improvements" regardless if those improvements are seen as left or right.
Japanese system does have a public option and much tighter price controls, which we are missing here.
For optional surgery or cosmetic treatment, sure. You can argue a free market option, but that's why I always think there should be separate baskets, for lack of a better term.
So, the other important question to ask is the following: how feasible is it to create a well-functioning market for this product?
So far, we don't have an existence proof that such a well-functioning market is possible to construct in the healthcare space.
This is a big /part/ of the "worst outcomes" in the "highest cost, worst outcomes".
It is possible that you can spend a ton of money on healthcare - yet smoke and drink, drive everywhere and not exercise at all, and eat trash - that the healthcare spending is doomed to fail.
Europeans walk & bike more and don't eat as much garbage. Most Asians exercise much more, eat healthier, AND smoke and drink less.
Maybe the healthcare part is secondary to just generally taking care of your health?
It is well understood how terrible obesity is for you. Why should we expect the US to have better healthcare outcomes than Vietnam when Vietnam is 2.1% obese and the US is 42% obese. You can take all the heart medicine in the world. It would be better to simply not be obese in the first place!
This never seems to be a talking point. Have the statisticians controlled for all this when they come to these conclusions??
Tobacco consumption in Asia is incredibly high: https://en.wikipedia.org/wiki/Tobacco_consumption_by_country
But I think this point also opens another subject, preventive healthcare. Many modern healthcare systems are starting to focus on prevention for 2 main reasons: increase quality of life and reduce long-term healthcare costs.
For example, in Finland public tobacco smoking is(was?) considered a public health issue. The government got actively involved to reduce consumption and this resulted in better overall outcomes in their healthcare systems for diseases caused or exacerbated by smoking.
IMO, obesity is a problem affecting the healthcare systems of many developed countries (Vietnam is not yet considered a developed country) arguably not at the same levels as in the US. But this again is part of how government chooses to get involved in fixing the healthcare system by enforcing policies or passing laws that help with prevention.
My father is getting old and our healthcare system has done a great job at keeping him alive while he can still eat shit loads of pizza, drink beer and be a 80lbs overweight.
All this medication and treatment he takes is not just to keep him alive but to keep him alive without having to change a single bad habit.
Maybe you want to control for the cold weather too?
US is also a super bad infant mortality rate compared to other countries:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844390/
I never see this as a talking point of folks who are in favor of universal / state-funded healthcare, but it is often a talking point for those who are opposed. They point to the links between state-funded healthcare and the soda tax in the UK as an example of how allowing the government to control your healthcare results in more aggressive and manipulative social policy to control health outcomes societally. Many people opposed to state-funded healthcare feel rather strongly that you should be able to do pretty much whatever you like with your body as long as you're paying for it yourself. I consider this take to be missing quite a lot, but it does seem to be a common one. I am personally in favor of universal single-payer healthcare systems, so I've had this conversation a lot due to my surroundings and have heard just such this argument many times.
In what way is it the worst-performing? I mean, what are the outcomes that are measured to determine its performance?
Yes, healthcare is a lot cheaper in Europe (even if your employer wouldn't pay their part) compared to the US, but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance.
Here's a recent report that measures: - Access to Care - Care Process - Administrative Efficiency - Equity - Healthcare Outcomes.
US comes last in all but Care Process among developed countries. https://www.commonwealthfund.org/publications/fund-reports/2...
That's exactly like US healthcare if you aren't either a wealthy private-pay client or someone with top-flight private insurance; we just pay twice as large a share of GDP and even a higher multiple per capita to have the same normal experience and many more people uninsured than any other developed economy (and we've only recently through the ACA, gotten it so the that your top-flight insurance plan wouldn't look to retroactively cancel your insurance when you got an expensive-to-treat condition, leaving you uninsured and uninsurable.)
As a separate issue, there is now significant clinical evidence that hypovitaminosis D is a major risk factor for COVID-19. So I hope that medical guidelines will be updated to make those tests a routine part of preventive care screening, in the same way that we test for lipids and blood glucose levels.
https://vitamin-d-covid.shotwell.ca/
I can get in to see an Urgent Care doctor in any major US city within 30 minutes of walking in the door. If it's not urgent, who cares what the wait is?
The government may not pay for the actual service but there is huge government involvement and mountains of regulations to climb.
> So you basically get the worst performing being also the most expensive. Which doesn't really fit the view that less government involvement results in a more efficient system. Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population.
Healthcare and Big Pharma have captured regulators at various federal health institutions. The mission is maximizing profit outcomes not health outcomes.
Health issues are bad in the US, and people use that as 'evidence' for quality of the Healthcare system, but that's not fair.
People shooting each other, not eating well or exercising, isn't so much a function of the US Healthcare system.
The US system is probably the most economically inefficient, but that's also expected at the highest end of quality.
The US has most of the best quality systems in the world, it's just expensive and messed up financially, but the quality itself is something to behold.
While I share your reservations about 'privately backed things' - for example, advertising arcane drugs in the US is ridiculous, this whole 'Ask Your Doctor' is an excuse for pushy patients to 'prescribe themselves' over the will of tired Doctors caving in ...
... that said, Theranos is the opposite example. If it had worked, it would have been because of VC backing and it would have been very beneficial to people. And there are many things like that.
Like anything, it's complicated, and we need nuanced thinking about it.
We probably should welcome a lot more VC spend, think of ways to empower doctors with the deluge of information, to empower individuals but at the same time get them to understand that they are not medical professionals and shouldn't be self-diagnosing, etc..
US health outcomes also aren't so bad for those who have affordable access to the system, as I understand it.
But the spending is something to keep in mind when anti-healthcare-for-all advocates say things like "do you want to have to wait months for procedures like in Canada" - if the US continues to spend more money per person, there's no reason it can't continue to have more capacity.
My favorite example of this is when I had to get an MRI. The lab imaging said it would be $800 if they billed it through insurance, or it would be $600 to just pay for it directly out of pocket. So the cost of having to deal with my insurance (which always advertises the "discounts" they negotiate and the "lowest cost") was actually more than what the insurance would actually cover.
Pay $800 for MRI with insurance, you'll then pay $2200 for the procedure to hit the deductible + 10% of the remaining $3300, so $2530 total for the procedure. $3330 total for the year between the two things.
Pay $600 cash for MRI, you'll then pay $3000 for the procedure to hit the deductible, and 10% of the remaining $2000, so $3200 total for the procedure. Now you've paid $3800 total, so you've spent $470 more despite the MRI being "cheaper"!
If you have other expenses so your out of pocket max comes into play, that difference approaches the full $600.
And then wonder why they get shit care for a huge price BUT swith nice marketing and a smiling "health dealer" getting you a 0% lease... oh sorry, we got you confused with a Chevvy!
And also, "we have the best care in the world because our docs are better selected". This one never fails to make me laugh, as a swiss MD
of course Iceland has more hospital beds than 80, but it cannot handle a disease that may put 80 people in ICU ( not counting ventialtion here at all, just intensive care ).
I think many in Iceland, myself included, are a bit in shock of exactly how poorly managed and starved the health care system is.
Up until 2019 I laughed at the dumb americans and their awful health care, man did I get my sit-upon whopped in the past 2 years.
Icelands is so bad that we are regularily filling hospital break rooms and garages with patients. THat is on a normal non-influenze season. Let alone sars-cov-2 introduction.
I suspect Canada is having a similar realization as we are. Free care in all its honour. Starved free care, heh...... Shame on us. Really. Shame on us.
Not that your thesis isn't correct but be careful there. You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. The quality of care for Americans who can afford care is excellent.
As a Canadian who knows many Americans, works for a US company and has extended US family, this is not quite true.
Most Americans "who can afford care", maximum 70%, have access to medical care that is on par with Canadian health care, but is fraught with peril; "booby traps" such as out of network costs, high co-pay fees that can bankrupt, surprise billing (though 2022 is starting to deal with that). Care may be excellent, but losing your house if you get cancer seems unnecessary.
A few percent of Americans (the rich and the very well insured; FANNG/MAMAA, investment bank employees, etc.) have access to the possibly best health care in the world.
20% of Americans are uninsured or under-insured and have access to the worst healthcare in the G20.
I think it's strange to want to only include the first two categories in the outcome calculation. Strange may not be the right word here ...
Well that's the point, I think everybody should be taken into account in order to paint a comprehensive picture of the quality of the system at country level. The resulting stats reflect the health of a society as a whole not just of the part that can afford it. Not having universal healthcare is still part of the system, even if we don't like it.
I get it that health outcomes of those left out are probably very different. But leaving those numbers out of the comparison doesn't really work with these type of statistics.
At that point how could you compare it to the other countries that take everyone into consideration? The stats are GDP/capita percentages, should I remove the ones who can't afford healthcare from the GDP stats as well to not skew the ratio? I don't really like where I might end up taking this route.
I don't have any experience with US healthcare and I'm sure the quality of the services is really high, but the fact that you need to afford basic healthcare and it's not guaranteed by the government for everyone makes me see it as closer to just another "consumer product" compared to other systems.
There is a sad trend where the small doctors -- who can't survive without group power -- join conglomerates, the conglomerates buy hospitals, and finally the conglomerates close the less performant facilities. You get large states with vast underserved geographies.
The OP headline is we are careening towards a luxury retail arrangement like Trader Joes: they will only have "outlets" in the richest areas. There's no regulation around closing hospitals so this is coming fast. Two in my county closed this year and I am far from rural.
I have family in Canada with family members the same age on both sides.
Canada is great if you are a healthy broke college student.
No one in their right mind would ever pick Canadian health care over the US though if you are 60+.
There is no way you would rather have cancer in a country with free health care.
Considered by whom?
That is only true if you cherry pick statics that over sample for life style choices, and under sample of actual health care.
If you look at statics that are directly attributable to the care provided, not the life style choices of the patients then the US Healthcare system is far better than any other nation
The government is involved in every step of American healthcare. As you can imagine of a system that gets all of its funding thru companies completely overseen by regulatory bodies or thru social programs.
Please note that the wording implies that 18% of GDP is spent on health care overall not that the US Government is spending all that money out of its pocket directly on yearly budgets. The way I understand it is that it includes both money spent by public and private actors for all health related service.
I see this type of stat a warning that something might be dysfunctional within the system, and it's the government's job to get to the bottom of it.
If instead we use health insurance like home insurance for unforseen major issues, and had price transparency. Then prices would go down as people would shop around.
To be fair, I suspect your definition of capitalism is very different from mine...
The US healthcare is an example of the government being massively over-involved and creating massive inefficiencies.
The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US.
“Better outcomes” needs more detail:
Medical bankruptcies per year: ~200k in US, ~0 in UK. Caveat: bankruptcies often don’t have one clear root cause, the other ~600k bankruptcies per year in the US may or may not have an aspect of healthcare costs.
Cost of triple bypass heart surgery: US: $110,000, UK: £8,500 (paid by the taxpayer, not by the patient at the point of care - free for them). (P.s. private healthcare is available in the UK too - the procedure costs around £20,000 privately, payable by the patient or their insurance)
Life expectancy… you get the idea.
American healthcare has the least involved government of any first world country.
Only an overly credulous interpretation of Koch-style market-knows-best propaganda would make you think that the "level" of government involvement was the root cause of its problems.
The point I was trying to make is that government involvement is needed to make sure that the right incentives are in place at all times for all involved actors (public or private). And if the system becomes dysfunctional or is abused it's the government's job to fix it.
Most of the countries that have universal healthcare in Europe have their own take on how it should be done: - France has state funded insurance and (mostly) state funded services - Switzerland private insurance and private/public services
Two totally different takes with arguably very similar (good) results.
The goal of government involvement should be to make sure everyone has access to basic healthcare and avoid double standards and abuse.
- Dismantling the insurance/big hospital complex that milks the US population for the enrichment of c-suite executives.
- Removing the capacity for lobbying by insurance companies, large hospital groups, device and pharma companies (so they're less able to price gouge consumers).
- Price transparency on all links of the chain of healthcare delivery.
- Changing the incentives for physicians and other providers towards expensive, often harmful and unnecessary interventions.
- Facilitating improved therapeutic relationships between providers and patients (More time spent, more communication, more incentives for harm reduction).
- Social changes including less stigma for things like drug use, greater emphasis on community cohesion and care.
- Demilitarization (Not only are absurd amounts of money spent on the military that could be redirected to better community health services; but innumerable veterans (not to mention foreign and local civilians) are injured psychologically and physically annually in the absurd pursuit of 'global security'.
- Better end of life care. I think something around 40% of healthcare expenditure is on patients in the last 2 years of life. Patients and families would benefit from earlier access to hospice care and less aggressive therapies that only prolong suffering.
- A greater emphasis on preventative health and lifestyle choices (better diet, exercise and sleep regimes - ideally within the context of a long term health care provider relationship).
Its very typical of modernism (especially in the US) to think that the way to address everything is a nice app with a better UI. This also facilitates the corporate narrative of marketing the shiny new thing to throw money at (make money for the company) to solve everything whilst digging the hole even deeper (and letting society absorb the collateral damage).
EDIT* Thanks for the feedback, I have added some of the points made by others to the list above.
This should be step one, always.
While those perverse incentives exist everything else is an uphill battle.
No, no it shouldn't
There's a really, really, really fine line to walk between preventing the AMA from lobbying congress to screw us and preventing actual grass roots people from paying someone to argue on their behalf.
I feel like the choice has to be removed from families as our current system has proven that life will be extended regardless of quality simply due to the fact nobody wants to make a difficult choice. As the only quantitative item on the list and a very substantial one this should be ranked much higher in terms of priority (not sure if list was unordered or not).
I'd be happy if the app could show medical expenses before the treatment.
And they are all invested in each others bags. For instance I've read that doctors are major investors in health providers, are often the owners of the expensive equipment, and also heavily invested in the malpractice insurance industry.
Half of billing is multiple businesses billing one another.
It seems quite possible that what makes government health care more efficient is simply knowing where the money is going, if it's all coming out of one checkbook.
It's certainly not the majority of healthcare workers.
Physicians are often scapegoated as responsible for healthcare costs when in reality physicians in Canada, New Zealand and Australia earn similar salaries without the massive cost blowout.
It was essentially a calorie and exercise tracker that also displayed your health insurance info, absolutely nothing special compared to fitness apps already out there, but millions of dollars down the drain.
Follow that by banning burning of coal and oil, we also remove a significant amount of noise and air pollution.
Next we can ban any hormone-disrupting chemicals (including as plastic additives) from being used in anything that will ever touch human food or drink, or ground water.
Finally we can legaize euthanasia for anyone aged 70 or older and with a terminal health condition.
With these changes you have a human population much healthier and less reliant on expensive healthcare.
And it shouldn't be for financial reasons. I fully support someone's right to death, but I do not support creating systems that might encourage it. I also don't realistically care if the health condition is terminal: I care more that folks are suffering and want death to escape it.
We definitely need do do a better job with end of life care/terminal diseases - in practice this would look like earlier/more hospice/compassionate care, less needless end of life treatments and interventions).
Most things have added sugar in them.
It will still not be enough to win over China, but at least enough to keep the free world in existence. Otherwise democracy will be just simply gone from the world altogether in one generation.
https://worldbeyondwar.org/ - is an organization dedicated to the abolition of war. I encourage you and anyone reading this to take a look.
Also take a look at possible alternatives. (A global security system that doesn't require violence) - there's an ebook discussing this system in full.
https://worldbeyondwar.org/alternative/
Continuing to head in the direction of militarism, will continue the disaster of a world that we live in, and almost certainly guarantee the end of mankind.
https://www.athenahealth.com/knowledge-hub/practice-manageme...
>>Here's some food for thought: The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period.
*
>>Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009. [3])
In contrast, areas of medicine which are subject to much fewer subsidies and regulations, as a consequence of being electives, have seen prices actually decline in inflation adjusted terms. [4]
[1] https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...
[2] https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg...
[3] https://www.hhs.gov/hipaa/for-professionals/special-topics/h...
[4] http://healthblog.ncpathinktank.org/why-cant-the-market-for-...
I really want regulation in health care. I do not want medication to be a free-for-all like supplements are in the US. I'm not a doctor, after all, and they are slow to take supplements off the market even if they are harming or killing folks (take a look at diet pills to see this effect). I do not want average folks to be able to get antibiotics willy-nilly because I want to be able to take them when I'm old. And so on.
In countries with a more functioning healthcare system, disruption of the status quo (especially by VC-funded private companies seeking a large payday) is neither necessary or desirable, slow iterative improvements are the name of the game.
Furthermore, the US spends far more per capita than every other country on healthcare, and receives worse healthcare outcomes as a result [1], [2]. If you think that the solution is throwing more VC money at the problem, well, I have a bridge to sell you.
Sadly for Americans, the obvious solution that most (~70%) Americans apparently want (Medicare for all) seems very unlikely to happen anytime soon.
[1] https://ourworldindata.org/grapher/life-expectancy-vs-health...
[2] https://www.nytimes.com/2021/04/08/learning/whats-going-on-i...
Firstly (loosely regulated) insurance is an absolutely stupid way to provide healthcare. Pre-existing conditions? Maybe you just don't deserve to live, either way we're witholding life-saving care from you because our tables say so. Need to claim near the start of your cover? You must be lying about pre-existing conditions. Need to fix something that wasn't acute enough to seek care about previously? Nope, no cover for you. And on and on and on. Anyone who thinks an insurance market is a solution for healthcare is just an idiot, there's no way around that. (I realise some universal systems run on a private insurance basis but they're a lot more regulated)
But then, even in that entirely messed up system, designed to cut you off from urgently needed medical care, all policies are divided into 'regions'. There's not much cost difference between regions until you get to any region "including the US". It's even named, the only country in the world they do that for. That's how badly those guys have messed up their healthcare system. And if you select that? It's at least double the cost, for no extra cover in terms of policy limits.
That for me clarified that, no, I wasn't missing anything. Anyone who supports the current US system is so far removed from the commonly inhabited reality that none of their opinions are worth listening to.
1. The cost is insane. It doesn't matter how much money you have, if you stay long term in a hospital your bill will be insane and more than an average cost of a house.
2. Single ER visit? 10 different bills over the next few months. Apparently, there is a new law trying to tackle this but hospital can opt-out by having you sign paperwork.
3. If you have an illness and need to see many doctors and have many tests in a short period of time get ready for your insurance to fight you and deny claims. You will be calling them all the time.
4. There are now 3rd party businesses set up to "VERIFY" no other party is responsible for the care you received(meaning you did not have an accident). If you fail to respond to their letters, your claim will be denied.
5. MRI, X-rays, dental work, physician visits are SO MUCH more than other developed nations. It is a joke. I'm talking without insurance here, just going to a private clinic and paying out of pocket as these also exist in Poland even though it has socialized healthcare.
6. The insurance prices are out of control, and the insurance company don't give a shit. In fact, they welcome the high prices. Obamacare capped insurance companies profit margins at a percentage of money spent, this is the result. The more they pay out, the more they make. The cost falls on the policy holders.
7. Covid is really showing cracks in for-profit healthcare. I have friends who work in the field and are complaining about people coming in with positive covid tests because they are asymptomatic. If they don't want to come in they risk getting fired, and in some areas large hospital networks own many smaller clinics and being fired may result in not being able to find a job without relocating.
Alternative options I've seen being offered for ongoing healthcare is Direct Primary Care where essentially you pay a membership fee to have unlimited access to a primary care physician.
I think the root of the problem is subsidization and the patch work of legislation that gets piled on year after year to "fix" the issue. The entire price function is completely out of wack and as long as the patient is stuck between the provider, insurance carrier, and government debating who has to pay, they will lose.
There are significant problems but whose Vaccine did you take for Covid-19? Pfizer (Us), Moderna (US), Johnson and Johnson (US)...
https://www.nhsinform.scot/covid-19-vaccine/the-vaccines/cor...
Johnson and Johnson was developed by Janssen which is based in the Netherlands and Belgium [1].
And as others have pointed out, Pfizer was developed by BioNTech in Germany [2].
[1] https://en.wikipedia.org/wiki/Janssen_COVID-19_vaccine
[2] https://en.wikipedia.org/wiki/Pfizer%E2%80%93BioNTech_COVID-...
I think it would not be relevant to the vaccines as we would still spend money on R&D under the pandemic threat.
My girlfriend has worked with children with special needs for around 20 years, mostly children with autism. A few years ago, the field began migrating from almost entirely state-funded to funding from private insurance (California, not sure about other states). The problems with private insurance funding began almost immediately and couldn't be clearer. Under the state-funded program that existed for decades, her company met monthly with the state funding agency, discussed individual cases, and got funded. Easy, efficient. With private insurance, well, the best way to describe it is that her small company had to hire a full-time person just to manage the billing/funding with the insurance companies. And this is not a do-nothing position. This position is responsible for much of the company's revenue, which is inherently important. Also, understanding all the different processes/procedures/BS of each insurance company is highly skilled. That might sound ridiculous, but it's totally true. I hear the stories about fighting with insurance companies, trying to get paid for services rendered months prior. Quick example: one private insurance company (a big one, you've heard of them) only accepts payment requests via fax. Yes, fax. But it gets better. The fax line is only "active" during regular business hours, and the line is almost always busy, because as you might expect, other companies are trying to get paid, too.
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Which is definitely not the case in American health care - unless you have "For the Top 1%" health insurance, or are buying at the bottom end (a bottle of aspirin, maybe an eye exam or dental cleaning).
I'm not confident a typical telehealth-style consultation with one of these direct-to-consumer companies is that great, but by the same token, I am confident the medical care I get in a traditional setting is mediocre. For example, the time an MD tried to convince me I couldn't be feeling pain... after I told him I was specifically there for pain.