The fact is; US healthcare sucks

[Joe Republic]

Comparatively speaking, that is.

Part of the healthcare debate over the last five years has been the indisputable fact that US healthcare is the best in the world, and expanding accessibility to it runs the risk of damaging that quality.

Well, just like nearly everything else, that assumption was flat wrong from the beginning as well:

[AggregateDemand]

Our healthcare system is both the best and the worst.

The private healthcare system is the best by far. Unfortunately, few people can afford to have the best and few companies can afford to buy the best for their employees.

The US public healthcare system is the worst in the developed world by a wide margin. We approve risky procedures during the final year of life that generate about $200B in Medicare bills and another $50B in long-term hospice care. Medicare also has the distinction of providing the lowest life expectancy in the developed world.

It seems the most obvious solution is to stop subjecting the elderly to risky surgical procedures that rarely work, and to develop a more comprehensive system of long-term care (similar to our public hospitals). Spread the Medicare and Medicaid budget as widely as possible to reduce labor costs, improve health, and reduce infant mortality. The private sector should be left alone so the upper classes can buy as much healthcare insurance as they can afford, which will pull the medical development plow.

I don't particularly want single-payer, but I'm surprised Democrats can't make it happen. The taxes have already been levied. The necessary bureaucracies already exist. The youngs and the lower-middle class are overwhelmingly supportive. In the end, Dems choose to subsidize the past, and lash out against the private sector, which has nothing to do with the terrible state of our public care. Incompetence on an incomprehensible scale.

[IceSpear]

Facts don't end right wing talking points.

[Oswald Acted Alone, You Kook]

It's kind of a tradition to ignore facts in politics.

[Matty]

Private insurance in the US is extremely good. As was said above, the big problem lies with medicaid and medicare. A lot of doctors (especially the good ones) do not accept it. Another problem that ruins debate is that the left often characterizes American Health Care as "evil free market profit menace", but the facts are quite startling. First, our elderly, our veterans, and our poor currently have insurance funded by the government. That is a huge number of people. 15.7% of Americans have medicare, and another 40 million have medicaid. 37% of all births are currently paid for by medicaid.

I don't necessarily oppose those programs;  I just think it is completely wrong to look at American healthcare and blame it on the free market. The free market is not even close to the right word to describe the American system, even before Obamacare.

Ultimately, the problem is the insurance model itself. Before the second world war, health insurance was largely only meant to be used for catastrophic injuries. After the FDR administration imposed wage controls on businesses to prevent inflation, businesses had to find other ways to attract employees, such as offering Health insurance which is meant to be used for every little thing. Before that, you paid in cash for routine checkups and small procedures. There was real competition and the system flourished. Now, due to the insurance model, the average American is not a consumer for health care, but rather insurance, putting no downward pressure on prices for actual healthcare.

Whether we have a free market, what we have currently, or completely government-owned system does not change a fact of nature:scarcity. Health care is ultimately just like any other commodity. It's supply is not unlimited, so you will not be able to get whatever care you need whenever you need it. The free market solves that problem through a price system, while governments solve the problem through rationing.

Perhaps by biggest critique of Obamacare, then, is that is fails to get rid of the insurance system we have currently, an ugly remnant of government regulation of the new deal era. If Americans bought their healthcare like they do their cars, houses, or groceries, the system would be a lot better.

[Matty]

Let me also point out that many of the European models have growth and spending trajectories that are simply not sustainable.

[SUSAN CRUSHBONE]

The US public healthcare system is the worst in the developed world by a wide margin. We approve risky procedures during the final year of life that generate about $200B in Medicare bills and another $50B in long-term hospice care.

[...]

It seems the most obvious solution is to stop subjecting the elderly to risky surgical procedures that rarely work

so basically you're saying you want death panels?

[🐒Gods of Prosperity🔱🐲💸]

That chart shows that the US is fairly good in terms of quality, but not on access and other measures.  It also shows that there tends to be an inverse relationship between cost-related access one the one hand and quality and timeliness of care on the other, with UK as a notable exception. So it is possible to have both high quality and expanded access, and it's possible to be like Canada or France and be mediocre at both, but to say there is no risk of a trade-off in any particular system isn't accurate.  The overall ranking used here may have Sweden at number 3, but those quality scores are not something that I expect Americans would feel good about transforming to.

[Matty]

I'm abandoning my libertarian beliefs a bit, but you are kidding yourself if you think there are "problems" with health care in other European nations. Besides the immense cost to the government, people in Germany, Denmark, etc get a superb product. So not, unless you take into account people who work for private insurance companies, there is no "trade-off" taking place.

[🐒Gods of Prosperity🔱🐲💸]

I'm abandoning my libertarian beliefs a bit, but you are kidding yourself if you think there are "problems" with health care in other European nations. Besides the immense cost to the government, people in Germany, Denmark, etc get a superb product. So not, unless you take into account people who work for private insurance companies, there is no "trade-off" taking place.

I am looking at the chart in the thread here, whether it is accurate I don't know but it makes sense based on what I know already, at least in the case of the US.

Where some places have both high quality and good access, it is likely because they have worked through the problem in a way that has found an adequate solution, not that a potential for such a problem does not exist.  You were just referring to scarcity after all.

[politicus]

I'm abandoning my libertarian beliefs a bit, but you are kidding yourself if you think there are "problems" with health care in other European nations. Besides the immense cost to the government, people in Germany, Denmark, etc get a superb product. So not, unless you take into account people who work for private insurance companies, there is no "trade-off" taking place.

Danish Health care is mediocre. It used to be pretty good 20 years ago, but not anymore.

[Matty]

What about danish Health Care makes it mediocre?

[politicus]

What about Danish Health Care makes it mediocre?

Treatments available (some treatments are just too expensive), long waiting lists, lack of resources: patients being seen by a stream of doctors with very little time and having to repeat their stories endlessly, some patients being kept in hallways because there isn't enough rooms available etc. Bad food/poor cleaning at times.

Waiting lists and stressed staff with too little time are the most important problems.

EDIT: The standard differ quite a bit from region to region and between hospitals, but on average  I would rate it as mediocre. Not bad, but not excellent either. There are private hospitals as a supplement and they are excellent.

[True Federalist (진정한 연방 주의자)]

I note that despite the UK being at or near the top of the chosen health care metrics, it sucks when it comes to actual health.  Just goes to show that lifestyle can be an even greater influence on health than access to treatments to fix the results of an unhealthy lifestyle.

[Matty]

What exactly is the "healthy lives" measurement anyway, and what does that have to do with the health care system of a country? Seems to me that "healthy lives" is largely a personal behavior measurement.

[Simfan34]

I wonder how this is weighted. Norway has just as many "11th" rankings and yet they place sixth.

[SUSAN CRUSHBONE]

I wonder how this is weighted. Norway has just as many "11th" rankings and yet they place sixth.

you're reading the subcategories as normal categories
norway is 11/6/4/6/6, usa is 5/9/11/11/11

[ingemann]

What about Danish Health Care makes it mediocre?

Treatments available (some treatments are just too expensive), long waiting lists, lack of resources: patients being seen by a stream of doctors with very little time and having to repeat their stories endlessly, some patients being kept in hallways because there isn't enough rooms available etc. Bad food/poor cleaning at times.

Waiting lists and stressed staff with too little time are the most important problems.

EDIT: The standard differ quite a bit from region to region and between hospitals, but on average  I would rate it as mediocre. Not bad, but not excellent either. There are private hospitals as a supplement and they are excellent.

I'm going to disagree with you somewhat (not on the whole mediocre part), the Danish healthcare are not worse than it was 20 years ago. We had in the late 90ties a big waiting list problem and the ones we have today do really not compare with it. As for the whole being sent around doctors it also happened 20 years ago, there was just longer time between when the patient was send between doctors. If we can say anything nice about the old government and LLR it's that.

As for cleaning I agree, the outsourcing of cleaning functions to private actors have been a disaster, it's not really cheap (rather it's more expensive) and the quality of the work have fallen.

But all in all the healthcare we have now are superior to 20 years ago, even if by first world standards it's mediocre, especially when we discuss cancer (other areas may pull them up to good).

[AggregateDemand]

so basically you're saying you want death panels?

If public care then death panels.

It's not an option. Rationing is a necessity and both parties have borrowed money, raised taxes, and cut vital spending for populist programs to pretend that rationing (death panels) are not required. If people don't like it, they should request vouchers so they can get healthcare tailored to their own health issues.

[AggregateDemand]

Ultimately, the problem is the insurance model itself. Before the second world war, health insurance was largely only meant to be used for catastrophic injuries. After the FDR administration imposed wage controls on businesses to prevent inflation, businesses had to find other ways to attract employees, such as offering Health insurance which is meant to be used for every little thing. Before that, you paid in cash for routine checkups and small procedures. There was real competition and the system flourished. Now, due to the insurance model, the average American is not a consumer for health care, but rather insurance, putting no downward pressure on prices for actual healthcare.

The diabolical development in the insurance industry is the flat rate copay, but it's the kind of irresistible abdication of responsibility that Americans love. Unfortunately, it subverts natural consumptive behavior. If you're payment is only $25, what do you care if the actual cost is $150 or $250? If anything, consumers are motivated to consume the $250 service because it makes their flat rate copay seem more valuable. Healthcare begins functioning like a giffen good, and healthcare costs spiral out of control.

[Matty]

I wish reform was geared more towards increasing the supply, rather than demand, for healthcare.

[TheDeadFlagBlues]

I wish reform was geared more towards increasing the supply, rather than demand, for healthcare.

Why are you applying an economic analysis used to determine the price of widgets, wheat or dildos to the provision of healthcare?

[Matty]

Why not? Healthcare (drugs, medicines, routine checkups) is a commodity like any other good. It is a scarce service. It is not unlimited. It is absolutely subject to the same economic laws as other goods.

[7,052,770]

Why not? Healthcare (drugs, medicines, routine checkups) is a commodity like any other good. It is a scarce service. It is not unlimited. It is absolutely subject to the same economic laws as other goods.

No it's not. If I get in a car wreck and am un/barely conscious, the ambulance is just going to take me to a hospital to get treated. I wouldn't get to call hospitals around and price-check or anything. I wouldn't get to choose what procedures are and aren't performed on me. I'd just be stuck with the bill no matter what.

In fact, it would be pretty hard to do all the research ahead of time and leave detailed instructions behind because hospitals are very secretive and squirrely with their prices.

You could argue that non-essential physician visits are a free market, but emergency medicine definitely isn't.

[TheDeadFlagBlues]

You know very well that healthcare is not a commodity like any other good. The demand for healthcare is driven by entirely different factors than the demand for coco puffs or pornography or cigarettes and the desire to neglect the factors that drive demand is intellectual malpractice when discussing public policy or social science. The so-called "extraneous factors" that change consumer preferences are the factors that are central to the discussion of the provision of healthcare. When we avoid discussing these factors in order to describe healthcare in terms of the market, we justify/rationalize systems that are in conflict with basic human values that actually drive these systems. Therein lies the problem with our healthcare system that has managed to neglect people's desire to live healthier lives in favor of providing them with "goods" that meet immediate needs.