

The brutal truth about America’s healthcare - blogimus
http://www.independent.co.uk/news/world/americas/the-brutal-truth-about-americarsquos-healthcare-1772580.html

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martythemaniak
I have to say, it is quite bizarre, watching the US health "debate" from up
here in Canada.

At the end of the day, it's a philosophical difference. I see people in Sicko,
or read any of the thousands upon thousands of horror stories (like the ones
in the article) and my stomach turns. I find situations like that downright
amoral, so I think having to pay higher taxes for UHC is great value.

OTOH, opponents look at the same people and start to get mad that these people
should get "something for nothing", that their tax dollars are used to help
people that may have made bad choices.

Call me a pessimist, but I don't think this will turn out well for you guys.
Any bill that is passed will be very watered-down and if the republicans get
back into power before American UHC gets ingrained in the social fabric, then
they'll do their best to kill it or cripple it.

~~~
TomOfTTB
For the record, if you want to deal in conjecture and annecdotal evidence
there's just as much stacked up against the health care system in canada. I
can't tell you how many times I've read of people dying while waiting for a
test or surgery. There are even the proven stories of wealthy canadians flying
to the U.S. and paying for surgeries privately.

More than anything stories like this (or the ones about Canada) are scare
tactics to support a political agenda. The fact still remains, a hospital in
the U.S. by law CAN NOT turn away a patient for financial reasons. No one is
dying on the street for lack of health care. At the same time Canada generally
manages to take care of the great majority of its citizens without killing
them by making them wait.

Bottom Line: The U.S. system has problems but so does the system in Canada,
the U.K. and elsewhere. What we in the U.S. need to be doing is looking for a
third option.

~~~
mgrouchy
I'm Canadian, and I don't really care very much what people think of our
system here in Canada. In my opinion it is great. I think wait times are
overstated, in situations where wait times matter. To espouse some personal
stories to compare and contrast here, my girlfriends father had some pretty
serious colon cancer, from the time it was found it took around a month to get
the surgery he needed(including consults and whatnot) and to start treatment.
Cost to him and his family 0$.

My uncle lives in Texas, (I love Texas Btw :P ) and he had some serious issues
with his spleen. It took him about a month to get his surgery(including
consults), he is fine now but still requires continuing monitoring.Cost to him
and his family with his insurance coverage ~40K.

I honestly hope that everyone everywhere(not just in the US) gets free and
available healthcare.

While there might be some hybrid model in the middle somewhere that may work.
I think dealing with a teired model of healthcare will leave people who can
only get the public healthcare the shaft.

~~~
jfornear
To counter your Texas anecdote... I live in Texas, and my dad was diagnosed
with stage 4 metastatic melanoma (extremely low survival rate). The cancer
doctors we have in Dallas are some of the best in the world. My dad had
insurance and it covered an upwards of $200k. My dad's fine today, and has
been cancer-free for 5 years.

The only things that stood out as being broken was the doctors' paranoia of
being sued.

~~~
psranga
You did not mention what your father's out of pocket expenses were. In the
Canada example, out of pocket was $0.

~~~
jfornear
I don't know, but it couldn't have been much since my dad makes less than $50k
a year. In the Canadian example, you need to figure in taxes.

~~~
nanijoe
I don't think your father's income has anything to do with how much he would
have had to pay out of pocket. And since I understand you object to the
government running things, do you have philosophical objections to the USPS
delivering your mail? Or receiving Social Security benefits when the time
comes? (These are serious questions, I really would like to know)

~~~
jfornear
My dad's income does have something to do with it because I didn't notice
anything change for us financially despite all that he had to go through.
Ergo, it couldn't have been that much. I know most doctors don't care how much
you make when they bill you. Sorry that I wasn't clear.

I can object to things on a philosophical level and still use them. We become
reliant on programs that should have never been created in the first place.

------
jimbokun
"Health spending as a share of GDP

US 16%

UK 8.4%

Public spending on healthcare (% of total spending on healthcare)

US 45%

UK 82%"

The most interesting thing about this, is that the U.S. government is spending
about the same percentage of GDP on healthcare as the U.K. government. So,
throw out the entire private health insurance system in the U.S., and we would
still be spending roughly the same amount of GDP on health care as the U.K.

So the real question then becomes, why can we not get the same health care
system as the U.K. for the money our government is already spending?

That's a good starting point for this whole discussion, I think.

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

------
chasingsparks
This article was shit, but not worse than most on either side of the argument.

One thing that has been frustrating me most is the persistent argument that
Americans have treatment outcomes that are subpar. Infant mortality rates and
life expectancy measures are of limited utility when comparing wealthy
countries.

Concerning infant mortality, different countries count infant deaths
differently, leading to over and under statements. Concerning life expectancy,
Americans live lives that are relatively unhealthy when compared people in
other countries. It is not a giant intellectual leap to conclude life style
can account for the life expectancy gap.

Concerning actual treatment outcomes, America typically leads they way. We
have a higher incidence rate of many diseases but the best treatments if you
view the outcome-to-incidence rates.

Furthermore (anecdote warning), as someone who had a rare disease that still
lacks any curative treatment, I have personally met a lot of foreigners. They
were all seeking treatment in the US because we are pioneering most of the
advances. Why? Because there is good money in it.

~~~
joe_the_user
You say _"This article was shit"_ \- could we have a bit more civility here!

------
ars
Ignore the article, look instead at the numbers at the end:

Health spending per head

    
    
      US $7,290
      UK $2,992
    

Practising physicians (per 1,000 people)

    
    
      US 2.4
      UK 2.5
    

U.S. doctors earn more than twice as much as UK doctors.

This is the only real problem. It will cost the US twice as much as it costs
other countries to provide healthcare for everyone.

The US can't, or can barely, afford that.

Reduce the cost to be on par with the UK and watch the entire debate fall
away. I think something like 80% of people in the US have health insurance. If
you dropped the costs just a little, it would be easy to cover the final 20%.

~~~
mahmud
_U.S. doctors earn more than twice as much as UK doctors._

How much of that money goes to doctors vs how much of it goes to insurance
companies, middle-men, lobbying, trial lawyers, billing and debt collection
and what have you?

------
DocSavage
Here's a very interesting article about Stan Brock, the Brit and former Wild
Kingdom star who has taken a vow of poverty and runs the Remote Area Medical
organization.

[http://women.timesonline.co.uk/tol/life_and_style/women/arie...](http://women.timesonline.co.uk/tol/life_and_style/women/ariel_leve/article6015125.ece)

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

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

------
kiba
Free healthcare will never survive one fact: The fact that scarcity exists.

The fact that healthcare are so expensive in America are numerous. The limited
supply of doctors due to medical cartels, patents on drugs, overusage of the
system by medicaid users, insurance companies being used for paying everyday
medical cost, and more.

But in Canada and other places where social medicine or universial health care
exists, there has been rationing of improtant services. It is also where
capital structures simply rot.

I believe wealthy nations' medical system are going to crash and burn decades
from now because government deemed healthcare too improtant to regulate or
control, never mind the consquences of unintended effects from regulations.

The only solution is to return control of the healthcare to individuals, which
are embodied in a free market. Only individuals have any chance to find a
solution where centralized regulatory power and decision makers fails
miserably.

~~~
gdp
My experiences of the New Zealand health system and the NHS in Britain have
been nothing but positive.

What's all this talk of crashing and burning?

Really, the free market and the individual as the fundamental unit of society
rarely act in the best interests of the society as a whole. That's why many
governments provide centralised healthcare. They can essentially take all the
money (as taxes) that would have been spent on health care or insurance in a
given year, and use it to build hospitals and medical facilities that the
public own. The public then gets to use these facilities that they paid for at
no cost, or at a heavily subsidised rate. If more people need more health
care, taxes go up, and more hospitals are built.

It's a surprisingly efficient way of doing things. Much more so than having
lots of private companies, each with shareholders demanding profits be
returned on top of something as basic as healthcare.

~~~
CWuestefeld
_It's a surprisingly efficient way of doing things. Much more so than having
lots of private companies, each with shareholders demanding profits be
returned_

It's remarkable how our historical examples of this efficiency are so often
ignored by all. I mean, consider how the soviets of the USSR succeeded in
making that nation an economy to be reckoned with. And Chairman Mao's great
leap forward was able to engineer a populace that succeeded in its grand goal
of vaulting beyond the waste of the capitalist West. If only the industry of
South Korea could prosper in the way that Kim Jong Il has guided his people
into a paradise of plenty, then all Korean people could join hands in
brotherhood.

~~~
gdp
Erm, yeah, about that.

You understand the the US is _atypical_ in the way that it treats health care?
The implication that pretty much the rest of the western world is communist
because they ensure that everyone has access to at least some kind of health
care is completely insane. You're using the "labelling it" technique, which is
essentially, "If I can give a name to the thing I'm arguing against, then it's
wrong!" (see what I just did there?)

A legitimately elected government providing services that its citizens may
choose to use or not use is not communism. It's also not nazism or the
boogeyman.

See, I would consider healthcare a much more basic service than a huge
standing military, but nobody seems to question that that should be
government-operated. The USSR also had a 100% government-operated military!
Wow, so does China! And North Korea! And Iran! My word, the USA must be the
most terrible country on earth!

~~~
CWuestefeld
_A legitimately elected government providing services that its citizens may
choose to use or not use is not communism. It's also not nazism or the
boogeyman._

You seem to have a strange definition of communism, as well as the history of
nazism. Rather, you seem to be buying into the American propaganda that
"democracy is the great good".

A pure implementation of communism is necessarily democratic. Think about it.
If all goods, and all production, are controlled by the body of people, then
everything must be done by consensus.

And you'll recall that in Germany, Hitler was democratically elected to power,
and later assumed complete control again by election.

 _You understand the the US is atypical in the way that it treats health
care?_

You're just using the eight-year-old's "but johnny gets to stay up late"
technique. And the answer is the same: just because one party does something
really has not connection to whether it's the right thing for a different
party to do.

Anyway, the problem here politically is that the treatment of disease will
immediately become politicized. In fact, it is already. People with mundane
diseases will plod along, without any real progress made in cures.

But diseases having real political constituencies -- AIDS/HIV is the big
example -- will get enormous research, despite the fact that they account for
a relatively small portion of the populace. Today, AIDS gets many _times_ more
funding per-sufferer than does, e.g., breast cancer.

Today the government is the largest single funder of healthcare. But once they
crowd out other actors, the entire medical profession will be political. That
means that treatments will be put onto the approved list, and research dollars
will be allocated, as a way of pandering for votes.

This isn't an abstract fear: the government does this _immediately_ upon
getting involved. For example, look at the recent GM takeover. Despite Obama's
claims (continuing to this day) that they don't want to micro-manage GM,
Congress _immediately_ set out preventing measures to make GM financially
viable, such as closing dealerships. Local car dealerships are a surprisingly
powerful constituency, and they get the bureaucrats working in their own
interests in no time.

~~~
gdp
> _You seem to have a strange definition of communism, as well as the history
> of nazism. Rather, you seem to be buying into the American propaganda that
> "democracy is the great good"_

I was being ironic and parroting the sentiments expressed in the post I
replied to, which implied that my assertion that there are gains to be made by
centralised government providing basic services was akin to Mao's "great leap
forward" and various other things generally considered "communist". I cited
Nazism just to invoke Godwin's law and make the utter preposterousness of the
argument evident. Basically, the post I was responding to made the leap from
"elected government providing services to citizens" to "THAT'S
COMMUNISM/TERRORISM/-ISM-ISM!", which is patently absurd.

I used the "democractically elected" argument to differentiate from a
totalitarian state that removes the freedom of choice from its citizens. I'm
not making any value-based statement about that, rather I'm just providing a
point of reference, considering that all of the countries we were referring to
with government-provided healthcare are "western democracies" in the very
traditional sense.

> _You're just using the eight-year-old's "but johnny gets to stay up late"
> technique. And the answer is the same: just because one party does something
> really has not connection to whether it's the right thing for a different
> party to do._

Once again, I was responding to the tone of the post, which seemed to suggest
that the entire world would crumble if they went down this path. I was simply
countering that the US is one of the few countries that _doesn't_ provide
healthcare in the way I described, which suggests that it's likely that it
would succeed in the US in the same way that it has succeeded elsewhere.

It's a particularly arrogant brand of exceptionalism that would suggest that
something that the rest of the developed world does is somehow totally
unsuitable for implementation in the US. I mean, is the suggestion there that
the US is completely different from other countries with similarly-structured
economies and demographics?

> _Today the government is the largest single funder of healthcare. But once
> they crowd out other actors, the entire medical profession will be
> political. That means that treatments will be put onto the approved list,
> and research dollars will be allocated, as a way of pandering for votes._

> _But diseases having real political constituencies -- AIDS/HIV is the big
> example -- will get enormous research, despite the fact that they account
> for a relatively small portion of the populace. Today, AIDS gets many times
> more funding per-sufferer than does, e.g., breast cancer._

There are not necessarily efficiencies of scale in medical research. Providing
10 times more funding will not provide a cure 10 times faster. Also, the
general umbrella of "cancer research" almost certainly gets more funding than
HIV/AIDS research. I'm not a medical professional, but I assume that
significant advances made in one sub-field of cancer research are likely to
have impacts within many other sub-fields (in terms of increased understanding
or promising treatment/prevention avenues).

> _Today the government is the largest single funder of healthcare. But once
> they crowd out other actors, the entire medical profession will be
> political. That means that treatments will be put onto the approved list,
> and research dollars will be allocated, as a way of pandering for votes._

That sounds like a problem with a particular instance of a government, not
with governments everywhere. Most scientific and medical research funding in
any country I've lived in is administered by a reasonably apolitical body
consisting largely of senior members of relevant research communities. Policy
makers then provide strategic direction to these bodies by setting priorities
and earmarking some funding. It's really not as though political entities are
governing the entire process. It's more likely that policy analysts are
looking at diseases and demographics, and managing limited funds on the basis
of where it can be best spent.

Not that I'm saying research funding models are perfect. In fact, they are
completely bonkers. But they are not completely bonkers because of high-level
political intervention.

Finally, I know I'm going to regret asking, but what is the "real political
constituency" of HIV/AIDS that makes it different from any other disease with
a similar number of sufferers and similar treatment/prevention options?

------
cubicle67
What the hell is up with your country, people?

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

~~~
jsz0
It's a fairly complex issue.

The class warfare angle is the rich and upper middle class simply don't want
to pay for the poor.

The financial angle is health care industry is a big business in America and
it makes lots of people money.

The religious angle is that some modern medical procedures conflict with their
religious views and they don't want to pay for them.

It really goes back to the core political divide in America of small
government vs. big government. The two ideologies are pretty evenly matched in
popular opinion so progress is slow.

~~~
cubicle67
_The class warfare angle is the rich and upper middle class simply don't want
to pay for the poor_

Every time you put measures in place to stop people getting something their
not entitled to, you make a compromise between the percentage of people you
stop vs the pain you inflict on those who are entitled.

Eg - DRM. The harder it works to make sure _no one_ can copy something, the
more pain it inflicts on those who've purchased the item legitimately. At some
point you need to decide that you're willing to let a certain number of people
get away with something to ease the pain on everyone else. Where you draw the
line is the difficult bit.

I think that's what's happening here, but there's a certain demographic who
are so determined to make sure that absolutely no one gets any sort of free
ride/handout that they're willing to take the risk that they too will be
disadvantaged. Instead of deciding that for the benefit of most people a few
may receive a free ride, they'd rather members of their own demographic face
the possibility of bankruptcy and/or death at the hand of your insurance
companies.

Like I said, I honestly cannot understand this mentality.

------
DanielBMarkham
This subject area (and story) are littered with anecdotal data. Makes for
great reading, but I'm not so sure it makes for good material for public
debate.

Most interesting were the life expectancy numbers, which if I remember
correctly, are skewed in the U.S. due to violent death. Taking out the chance
that you're going to get shot in a liquor store holdup, the life expectancy
numbers are very close, perhaps even showing an edge for the U.S. (I don't
have a link closeby, sorry)

In fact, looking at life expectancy worldwide and spending, it looks like
people are living to about the same age in the industrial world regardless of
the type of health care program they have. This, of course, doesn't address
quality-of-life issues.

If people live about the same amount everywhere, then why does the U.S. spend
twice as much? And that money spent across the board. In other words, it's not
that public health care has any cost effectiveness to it, Americans everywhere
are spending twice as much.

If I had to guess, I'd say it comes at the end of life -- a huge amount of
medical expenses go into that last six months. If you cut those expenses off
and made them more managed (rationed?) I bet you'd end up with very similar
figures.

At the end of the day, if you make health care into something that you go to a
politician to fix, you do a lot of interesting things to a democracy. Now
might be a good time to think those through, instead of just pointing out how
broken things are (they are broken) I favor an immediate, simple solution
without government control that tries a few simple changes instead of a
complex, intricate solution that few understand and fewer could fix if it
didn't work. Do simple things repeatedly and fail often. Don't engineer a
paperwork version of a nuclear submarine and then expect to be sailing it
around the world next week.

~~~
jacquesm
Yes, from a healthcare point of view it makes sense to have the two figures
(violent death / others) separated out. But every country combines those
numbers, I don't see why the US should get a free pass on that.

And the two do mix, when you get shot in the liquor store but you don't die
suddenly healthcare is very much in play, it might even remove that potential
violent death from the statistics.

~~~
DanielBMarkham
Nobody's looking for a free pass, just an honest view of how long people are
going to live. When the numbers are skewed, the resulting debate is skewed.

Along those lines, another well-quoted stat is infant mortality rate, which
also drives down life expectancy. But in the U.S., premature babies are
routinely saved much earlier than elsewhere in the world. This means that lots
of premature babies are more often lost too -- thereby making the infant
mortality rates look like something from a third-world country.

You can't manage something unless you measure it, but you can't measure it
unless you define it. I'm perfectly happy with a very high infant death-rate
and a slightly lower life expectancy rate now that I understand the
definitions. But a common understanding is a key component of discussion.

So now every time somebody trots out those same old tired stats we have to
have the same conversation over and over again. It's like the old myth that
paying money for prevention saves money in the long run -- lots of stats sound
reasonable and seem to make a simple point but don't mean what people think
they mean.

That's not a good situation.

~~~
jacquesm
I think it is mainly a problem of uniform data gathering. Every country has
their own methodology, international organzations have theirs but don't do the
whole world, just some subset.

None of the numbers are comparable because of all this, it is a big mess. The
error bars would have to be drawn so wide as to make any comparison
essentially meaningless.

