Curiously, however, for a system apparently stultified by the dead hand of government, Australia’s health system far outperforms the free market-based US healthcare system, which spends nearly twice as much per capita as Australia to deliver far worse outcomes — including Americans dying five years younger than us.
The shocking truth: Australia has a world-leading health system — because of governments
Overall, we now have the fourth-highest life expectancy in the world.
This is contrary to the narrative that pervades the media about our health system — one in which our “frontline” health workers heroically battle to overcome government neglect and inadequate spending, while the population is beset by various “epidemics” — obesity, alcohol, illicit drugs.
In fact, Australian longevity is so remarkable that in August The Economist published a piece simply titled “Why do Australians live so long?”
It's not a very free market when there is such a large power differential between the buyer and the seller. You can't exactly shop around for the ambulance or the hospital when you need it, nor can you realistically circumvent the artificially constrained supply [1] of doctors to get cheaper healthcare (unless you live next to the border).
When the alternative is a one-sided market like this, government becomes rather more appealing.
The US healthcare system is deeply flawed but only a small fraction of spending goes to emergency care involving ambulance transportation. The vast majority of healthcare spending is for elective services and patients do have time to shop around. Self-insured employers have been cutting costs by pushing employees to high-deductible health plans with HSAs, which gives plan members a financial incentive to find cheaper options. Of course there are still challenges around getting meaningful price estimates from providers despite recent federal regulations on this topic.
In fact it's almost impossible to get a price estimate up front in many cases. A procedure may involve multiple codes which may or may not be covered by your insurance, and the only way to find out if they are covered is to have the procedure and then check the bill. Frequently you won't even get the codes up front. If you call they can't even say if a particular procedure will be covered or not, the call centers are just not set up to do that. There is incredible complexity as the procedure may or may not be covered depending on patient, provider, plan, how much they've spent this year, region, if the doctor's front office made a clerical error at any point, if the insurance company made a clerical error, if the claim is processed on a Wednesday vs. a Friday, etc... If you have a procedure done twice the coverage may be totally different on the second time, with some parts covered that were previously not covered and vice versa.
Thankfully you can often get denials reversed after the fact by calling and complaining, but that takes an hour and is another roll of the dice. The only people who like the US system are wall street people who own stock in the companies.
> the patient does not pay for insurance their employer does
Not really true, as the employer could otherwise pay that money to the employee who would then shop for his own insurance. So the employee pays, but doesn't have a choice.
Because they compete with other employers? If an employee costs X, it doesn't matter to the employer if X is all cash to the employee or split with the insurance provider.
The entire reason health insurance got so mixed up with employment was as a workaround to WW-II era wage freezes. Employers couldn't pay more salary, so they offered other benefits including insurance to attract and retain employees. Now we're stuck with that.
The free market aspect is the insurance marketplace.
If you’re poor, you’re fucked. If you’re old you’re ok. If you work for the government or certain companies, you have access to world class care. Everyone else is on a spectrum from high quality PPO to the shittiest Cigna plan.
There is nothing free about the health insurance market. It is regulated to hell to the point where a common complaint of actuaries I know is that they are not allowed to price your health risk.
It's usually not the same amount. The Affordable Care Act (Obamacare) explicitly allows health plans to set premiums based on age and smoking status. However, this might not capture the full risk differential for some members.
There's a deeper philosophical question here about how we should spread risks and costs across society. Like should some plan members pay more because they have a history of cancer, or because they engage in risky activities like flying light airplanes?
Ironically, two of his three factors are still able to be priced in: age and smoking status. Weight, gender, and many other risk factors are not, though.
> ^ When the grossly overweight 60yo smoker pays the same amount as a health-conscious 30yo, we have a problem.
It depends on what your goals are. The reasoning behind why the ACA ("Obamacare") is the way it is:
> Suppose you want to make health coverage available to everyone, including people with pre-existing conditions. Most of the health economists I know would love to see single-payer — Medicare for all. Realistically, however, that’s too heavy a lift for the time being.
> For one thing, the insurance industry would not take kindly to being eliminated, and has a lot of clout. Also, a switch to single-payer would require a large tax increase. Most people would gain more from the elimination of insurance premiums than they would lose from the tax hike, but that would be a hard case to make in an election campaign.
> Beyond that, most Americans under 65 are covered by their employers, and are reasonably happy with that coverage. They would understandably be nervous about any proposal to replace that coverage with something else, no matter how truthfully you assured them that the replacement would be better.
> So the Affordable Care Act went for incrementalism — the so-called three-legged stool.
> It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.
> So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.
> But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.
The goal of the ACA in the US was getting closer to universal coverage, and that means 'subsidizing' bad behaviour to a certain extant.
Certainly smokers and such should practice more (so-called) 'personal responsibility', but there are a lot of situation where the pre-existing condition is not smoking or other lifestyle choice, but something genetic / congenital. So unless we want to get into (social) Darwinism and leave those folks on the sidelines, the lifestyle folks can end up coming along for the ride when society decides to protect other non-lifestyle pre-existing people.
The problem with your outlook is you can’t follow through unless you’re a sociopath. Are you willing watch your parent/child/friend/spouse reap the consequences of their “lifestyle choices” and suffer and/or die? I have watched that happen - i guarantee you that you wouldn’t.
Last year, my wife died from a recurrence of metastatic melanoma. By your standard, that suffering was her “fault”, because she failed to use sunscreen as a teenager. If insurance was rated like general liability insurance, she would have been dropped 8 years ago when the original cancerous lesion was removed. Fuck that noise.
I would have bankrupted the entire family to fight for the 60% survival rate in a few months, and she would have suffered even more without adequate care at the end.
We have Medicare “socialism” because social security was allowing the elderly to support themselves and live longer. Many were neglected and dying in inhumane ways, or saddling families with the burden of being a full time caretaker. It’s gross that we live in a society drowning in riches, but we take a principled stance to avoid taxation for rich people, at an incalculable human cost.
Maybe but I'm more concerned about a) easily demonstrable and measurable risks not being addressed and b) separating people from the consequences of their own choices.
Ignoring risk and consequences doesn't make them go away.
On the subject of (b), shouldn't tobacco companies be paying the risk premium for their customers? Why does the buck stop at the individual consumers and not those making money from their misery?
To put it into more technical, economic terms: why should the individual tobacco consumer bear the full cost of their externalities while the tobacco company does not?
> shouldn't tobacco companies be paying the risk premium for their customers
How would that even work? Any such tax would be priced in into the price of the product. It doesn’t really matter if the government is collecting it directly or through the tobacco companies.
Or if we wanted tobacco companies to pay for all the damage they did retroactively they would just go bankrupt, since they don’t have even remotely enough cash/assets to cover it.
The tobacco company (also composed of people) is well aware of the health consequence of smoking to its customers yet freely chooses to continues to sell tobacco products. Where's the difference?
Actually it's much worse than that. The tobacco company is not just selling tobacco products, it's marketing them and actively encouraging their use!
What about the 60 year old with autoimmune issues? That have expensive drugs but it wasn’t “their actions” that led to this?
The entire system only works if healthy 30 year olds are putting in somewhat similarly (it will be cheaper regardless). Insurance is based on the idea of spreading risk. Without it insurance cannot function.
Even the insurance side isn't really a free market. I've only ever gotten like two choices of insurance provider at any job I've had. More than two plans, but very limited provider choices. You can't get a job offer and then during onboarding say, "sorry, this insurer is unreliable, can we use this other provider instead?"
It is incredibly frustrating to have only one option for insurance provider, and then discover that a solid majority of the health care providers in your area don't take that insurance because they have such a bad reputation.
Then you get into the wonderful world of getting receipts for every procedure and manually submitting them, only for them to be rejected so you have to call and tell them to provide the service they promised you. The insurance isn't even cheap! My monthly deduction would be close to the same price as an Obamacare plan, and that doesn't include the employer contribution. Healthcare is such a racket.
There's also a lot of regulation and lots of subsidies (the US has similar per capita public spending to Canada - old people on Medicare are not cheap). If something is so heavily regulated and subsidised that the private sector is only there to outsmart the government to line their pockets, it's inferior to even a public system.
You’re still significantly limited by your insurance carrier’s network and also the consolidation of the healthcare industry. I used to live in a city of 1 million that had essentially two hospital networks that bought everything. You could not find a specialist not associated with those two companies. Pre-natal, allergy, cardiac, two choices. When my seventy year old doctor who ran a practice out of his house retired he sold the practice to one of the two.
It’s not shopping for a tv. You can’t choose not to buy. It’s often time sensitive even if by appointment. Pricing is incredibly complex as are the details of the product. Your average person does not have the information necessary to navigate the market.
That "medical professional" has literally 90 seconds to review your case and say yes/no. They've never met you. They don't know your doctor. All they have are some notes on the case, a billing code, and a quota to reach every day. They get bonuses based on how much money they save the insurance company.
All of that cost savings makes US healthcare cost double what it does anywhere else in the world.
I think you're a little confused about causality. All healthcare systems, including fully socialized ones, perform similar types of case review to ration care and hold down costs. US healthcare costs might be high now but would be even higher if the payers (including the Medicare / Medicaid government payers) paid every claim that came in without denying those that fail to mean plan coverage rules.
If we want to hold down costs then we'll have to put a greater focus on preventative care, stop expensive treatments for terminal patients, impose price controls on providers, and stop subsidizing drug development for the rest of the world. None of those measures are politically popular.
Yes, exactly. Since demand for healthcare services is essentially unlimited, creating artificial shortages is one way to ration care and hold down public spending. The US government already creates healthcare shortages in other ways, such as constraining the number of residency slots to limit Medicare spending. (I don't support this, but it is somewhat effective from a fiscal policy perspective.)
Legally speaking the insurance company isn't overruling medical professionals. They're simply refusing to pay. Patients still have the option of paying for treatments out of pocket. (I do understand that for poor patients this is a distinction without a difference, I'm just clarifying the legal issue.)
Some states have recently passed laws which limit the authority of health plans to conduct medical reviews or deny payment for services that providers deem medically necessary. This will reduce hassles and expenses for some patients, but it will also accelerate the inflation of insurance premiums paid by everyone else.
other than normal doctor’s office visits, i have no idea what i’m going to pay when i get a small procedure done.
a basic heart ultrasound cost me over $1k while my vasectomy cost me a $60 copay. i was expecting those prices to be flipped.
and don’t get me started on labs. i’ve gotten bills for basic screens years later for thousands of dollars.
you can’t shop around if you don’t know what you’ll pay until months after it happens. if you call the insurance company beforehand you wait on a static filled line with a call center in india, and even with the CPT code they can’t give you a straight answer.
They don't know. Nobody does until the bill is processed. There are a thousand factors that might affect your coverage. This is the nightmare I'm living through right now. Even if you have the code and doctor and patient the help desk at the insurance company can't say for sure if they will cover it or not. That comes down to the discretion of the claims adjuster. You won't know if something is going to cost $100 or $10,000 until after it is done.
The provider or the insurance company? The provider can give you the cash price, but that's a made up number with no relation to reality. The Insurance company can give you what the standard discount would be on that procedure, but they can't say if they'll cover it, give only that discount, give nothing, or anything in between.
if you ask the provider you will eventually get burned. they can only give you the cash price as a backstop.
if you ask the insurance company you’ll never get an answer. providers are usually more helpful about what “should be covered”, but that’s not guaranteed.
seems like prior authorization is the only way to really make sure charges are covered but takes forever. but even then, if your insurance covers $x and they bill $y, you might get a balance bill in the mail.
point is, the market is heavily skewed against the consumer.
Even so, when was the last time someone needed cancer treatment but said "ooh, that's pricey, nah, I'd rather buy a new car instead".
This is my main argument against private healthcare: there's no real choice involved. Without even getting into what a free market is and perfect information etc, the main advantage of a capitalist society is you get to choose what you like. Nobody chooses healthcare (at least, not the super expensive part).
A large portion of healthcare could be free market. Insurance should be for unlikely events not every single thing deemed "medical". My home and auto insurance don't cover regular costs for maintenance. Why must health insurance cover a checkup with the doctor?
To me that is the funny thing today if you look at markets Chinese markets under it's communist system are actually freer than US. China is not interested any 1 company getting a monopoly and becoming more powerful than the government so they promote finance multiple companies resulting in a truer capitalist market than the US.
> Chinese markets under it's communist system are actually freer than US
Right up until the moment that the CCP decides to purge your entire sector, sure. I don't know if it counts as "free" if the government stands ready to nuke the sandbox they so generously let you play in.
You would expect market cap of the largest players to decline if the market becomes more competitive... which was China's primary goal with their recent crackdown.
They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google.
If the same happens here (through act of congress, or legal outcomes), you can expect their market caps to decline as well. A decline in market cap doesn't speak at all to whether it's beneficial to the industry or consumers
> They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google.
WeChat is the inspiration for the idea of the "everything app" that so many US companies want to create but have always failed to. Has it somehow been newly limited in its ability to control an absurd percentage of all Chinese internet-connected activity?
"China is planning to introduce a new mobile payment regulation aimed at reducing the market share of Tencent Holdings' WeChat app, similar to efforts made by the National Payments Corporation of India to curb Google Pay and Phone's growing dominance in the market"
China's methods are more authoritarian than are viable in the west. But the general premise of a competitive market being better for society than dominance by a small number of firms is supported well by history
> China is not interested any 1 company getting a monopoly and becoming more powerful than the government
Those are 2 different things.
Monopoly doesn't mean "more powerful than the government". I'm not sure what that means, since the CCP disappears or coerces anyone who might threaten the supremacy of the CCP (or Pooh Bear) in any way.
Capitalism results in a single winner, for many industries. CCP prefers kingmaking in various industries, because it's easier for the government to control a few players than a multitude. This isn't what "fair market" means, in context. It's modern communism. State owned companies that are directed by government, rather than direct investment or day to day management. China learned from Russia's failures, I would say. I would also concede it's less regulated, under a political lens.
Not really. Chinese SOEs comprise around 60% of market capitalization and around 23% of GDP, far higher than USA or other developed economies.
While they do have a competitive market, the government very much does pick and choose winners and loosers here like Huawei, resulting in consolidation into a few large conglomerates like every other country. Their (software) tech scene certainly dosen't like more particularly "capitalist" than Big Tech, nor is the Fed pumping subsidies to Tesla like BYD, if anything they're sidelining Elon Musk.
Always when I read this I think they are comparing too very different societies where healthcare is just one factor. Americans are so much less healthy than Australians due to lack of exercise, poor diets, stress, no holidays, guns and crime. Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Part of the Australian national, state, and local health care system is policy to encourage healthy life styles and to discourage, limit, or ban food additives, tobacco, etc.
Back in the 1970s the AU Government was running campaigns such as Life. Be In It: https://www.youtube.com/watch?v=GNjEge3Awl8 (many short segments airing with commercials on TV).
Planning requirements typically require open spaces, walking paths, sporting facilities, etc.
A "healthcare system" needs to be more than simply "immediate care for the injured, sick, and|or dying".
> Part of the Australian national, state, and local health care system is policy to encourage healthy life styles and to discourage, limit, or ban food additives, tobacco, etc.
, realise that mental health services also had poor inclusion at times and that "gambling" is being implied to fall under mental health services (and hence not addressed).
On a more serious note, gambling in Australia has some serious industry influence that's preventing it being properly addressed - see: (for example) Media Watch -s2024e31- Monday 2024-09-09 They're Addicted
This honestly feels like the kind of thing where 20 years from now we'll be more aware of the side effects and people will shake heads about how stupid "we" were today.
If this is going to be an exception, it'd be truly interesting.
There are already a bunch of studies showing that the ozempic causes massive muscle loss and lessens bone density. And before anyone remarks "just do resistance training", I doubt the people that take the easy solution will do it in conjunction.
Do they cause it in excess of normal weight loss in the same time period? I'm asking because regular weight loss that's quick will have both of these effects too.
Correct me if I'm wrong but Ozempic doesn't cause you to lose weight, instead it controls your appetite. It's not something like DNP, right?
'Normal weight loss' here refers to eating the same amount of calories without taking Ozempic. You should lose weight at the same speed as with Ozempic, because it's the calories that matter when it comes to fat loss.
Weight loss always comes with some muscle loss and bone density loss, because the structure now supports less weight than before, and our bodies dislike to maintain muscle apparatus beyond what is necessary.
Unless Ozempic causes significantly more muscle loss than other ways of losing weight, that news isn't really news.
I cannot possibly even imagine how this could be the case, considering just how deadly and miserable obesity is. I don't see how we can hypothetically "solve" obesity and then go back to an obese population because the drug makes you nauseous or something. And that's not even considering the, what I can only assume to be, trillions of dollars of healthcare cost savings over time.
>Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Or its a ticking time bomb: 39.6% of Americans are Obese(BMI 30 or higher). Fast forward 15 years and this will probably collapse the country. It certainly will be the No 1 issue in the country bar none. Ozempic may actually give the country a chance of some sort of future.
"Free market" is one of the best examples of a technical term people use with complete confidence despite not knowing what it really means. Furthermore, even if you do know what it means you probably remember it as something you learnt on day 1 of economics class before learning all the reasons they never really exist and what governments try to do about that.
I’ve studied economics for years and I’m still of the opinion that the only government intervention to the market should be breaking monopolies and cartels. I’m waiting for a piece of literature that would convince me otherwise, maybe you could provide one?
I can't, but I'm curious how you think problems like externalities would sort themselves out. Also what about natural monopolies like utilities and infrastructure that can't really be broken up?
I think humans are excellent survivors. I don’t lose sleep over externalities because of that alone. What I mean by that is that once people realise their daily lives are being affected by a negative externality, they start making decisions that alleviate that hardship.
I do recognise though that it’s an unsolved problem, and will lead to some form of regulation as our understanding is lacking.
I think only harmful monopolies should be broken up by force, since they’re a legitimate market force. I’m conceding some ground on that because I’m not prepared to claim that monopolies aren’t always harmless.
Australians (and other outsiders) use that term when talking about aspects of the US because that is the Hollywood picture of how the US functions.
That is the lie that is sold, and people outside have no way to know it’s not true. Even today there are hundreds of millions of Americans who say they live in a free market and that it’s the best thing ever.
> Australians .. use that term when talking about aspects of the US because
Australians have a weird sense of humour - it's clear from here that most aspects of US economics are decidedly not free markets but so many US citizens never shut up about "free markets" and have such a bicameral Capitalist v. Communist view of the world that it makes sense to just deadpan nod along.
Maybe reread https://news.ycombinator.com/item?id=41856242 and ask yourself if the article really thinks the US health system is a proper Adam Smith free market .. or just a "US free market" with extra heavy air quotes.
Is the US health system free market? The government provides healthcare via Medicare and Medicaid for seniors, the people for whom life expectancy and healthcare quality have the highest correlation.
It’s a mixed bag, but the funding source doesn’t necessarily make it a controlled market, to the degree that Medicare and Medicaid pay non-government providers and allow competition (which again, is mixed). Medicare and Medicaid coverage make up one third of the US population. The other two thirds are on group/employer insurance, private insurance, or no insurance at all.
For non-seniors, the medical insurance system certainly sometimes doesn’t feel like a free market from the consumer perspective, but the insurance companies are private for-profit institutions, and the medical providers are too, so it may well fit the definition.
> the people for whom life expectancy and healthcare quality have the highest correlation.
What do you mean by this? Fatalities among the young will have a much larger impact on lowering nationwide life expectancy than fatalities among the elderly.
The quote is from a Crikey reporter, I (an Australian) wouldn't agree that the US health system is classic free market .. but it appears to have more regulatory capture by vested commercial non government profit orientated interests than by social policy best outcome for the masses civil authorities.
( Describing various systems in various countries as either communist of free market capitalist is pretty simplistic, it's not much as a linear spectrum either )
I'd also argue that the foundation for a high life expectancy doesn't start with good health care for seniors .. unless the metric is "life support via artificial means" .. life expectancy is grounded in healthy living and excerise from an early age well maintained with good health programs.
AFAIK Australian healthcare system is mixed public private with a heavy lean on private. The healthcare market is open to market forces as the government works through subsidies. Plus I think many of the hospitals are religiously run institutions which helps protect from private equity influence.
The US has massive government regulation and dysfunctional state intervention in healthcare if not directly then vicariously with rules around Medicare. The US government helps make the dysfunction that private equity later exploits.
So I’m not sure that it would be correct to use Aus and the US as examples of the either end of the private / public continuum.
I would use UK or France as an example of a public system and Singapore as a light touch private, and perhaps India or Turkey as a laissez-faire system.
The UK and France systems appear to be degrading and do not appear long term affordable and I think they will soon be adopting Canadian style Maid systems to cut cost.
Germany is a weird one because it seems like half the doctors there are homeopaths and the Germans love their insurance but I’m not sure if they get value for it.
Personally I’d prefer the Australian or Singaporean style systems but I’d classify those as mostly private.
Australia absolutely has a hybrid health care industry with layers; health, medical, surgery, pharmacy and mostly outcomes based regulation rather than much assistance to maximise financial profits.
The current system grew out of a more fully public system under a many years past Whitlam government, people like the universal health for all aspects and wanted additional private services in the mix. It's evolved from there, with government oversight directed towards keeping things accessable and fair.
The US appears to have "massive government regulation and dysfunctional state intervention" as the end result of a lot of fingers in the pie bending regulation toward "middlecare" providers that don't apply splints or save lives, just diddle about with insurance schemes. (Admittedly that's just an impression from afar).
> The US government helps make the dysfunction that private equity later exploits.
My feeling is the US government is largely an arm of private interests in many matters.
Health Care in Australia embraces public policy such as Food Regulation to ban and limit additives, parks and sports grounds to encourage exercise, limiting access to tobacco, and some interesting national level drug acquisition deals to keep pharmacy costs low.
These cause a flow on of less per capita input into the medical side; lower heart disease, less smoking related issues, etc.
I don't disagree that there is a lot that Australia does right and the US would be better off with an Australian style system complete with a universal healthcare. Australia could have gone the NHS route but did pivot to the mixed system under Howard. Additionally it does appear to me that the National Disability Insurance Scheme is absolutely rife with fraud - I'm not even sure who'd you'd blame for that as it seems intentionally set up for such an outcome to undermine the very idea. So I'm not sure how well the Australian system will last even if it has lasted well up until now. Of course being Australia they'd combine NDIS with Robo-Debt and mistakenly hound a bunch of poor people to death.
I'm assuming the rational behind drawing the distinction between the US and Aus systems is to somehow inform what the US should do, I don't think giving an already corrupted government system more power will help. It's very hard to uncorrupt things and because of that reason I think the US would benefit from a more laissez-faire system.
Additionally Australia has many advantages that the US does not and the US could not emulate Australia even if they wanted to. I don't know how long that'll last either - mathematically I would assume a country could not get rich and stay rich repeatedly selling houses to each other but it does seem to have lasted a very long time. I assume at some point the Aus government will run out of ways to prop up the housing market. The combination of negative gearing and all sorts of first home buyer grants is just insane.
I had private health insurance in Germany. It was quite expensive and had a very high deductible — so pretty bad incentives around routine health care, I never made a claim in 13 years.
The upside was that if you needed, say, a brain transplant for ten million Euros, as long as it was medically necessary they would pay for it.
Now I have a policy elsewhere that is cheaper, still covers me when I go to Europe, and has a much better copay structure while being 100% private. Downside is I can’t afford that brain transplant, but I’ll probably be OK for everything else.
But if a procedure is medically necessary in Germany, public insurance pays for it too (and if they deny, you can, often successfully, appeal or sue them). The biggest difference is that you’ll get an appointment much faster due to the quota system for public insurance patients, and that private insurance can cover more things that aren’t strictly necessary.
The crazy thing is that I originally signed up for private because it was cheaper than public… at the beginning anyway. I much prefer the Austrian model, in which — I believe anyway — everyone has to pay for public, but then you can get extra private on top if you like.
I was an employee so this didn’t apply to me, but for my freelancer friends it seemed very unfair that they had to use private.
>But if a procedure is medically necessary in Germany, public insurance pays for it too (and if they deny, you can, often successfully, appeal or sue them
When you're very sick you hardly have time, money and energy do deal with a lawsuits so that you can get the care you desperately need. By the time you win your lawsuit you could be dead or your condition worse from the stress.
Next to the USA, Australia provides some of the highest earning opportunities for medical specialists thanks to its very well-developed private sector. A doctor might clock AU$300/400k for a 0.5FTE role at a public hospital, and then bring in another AU$500/600k+ from their private practice (and that's a very low figure for a lot of specialities). As a result, Australia can attract and retain extremely high-quality doctors with the public sector essentially riding the back of the earning potential provided by the private sector. Interestingly, I think the reason you don't often see full private specialists is that due to lack of market forces applying to public healthcare, the public system crowds out the private system on complex/innovative care -- so as a specialist you need to retain a public presence to get access to the high-profile work that you use to support your private billings.
"less likely to die from drug overdoses. Older age groups are also less likely to die from chronic diseases such as circulatory problems and heart disease. Cancer mortality rates are lower in Australia than they are in all other Anglophone countries, except among American men aged over 65. And Australians are also less likely to die in road accidents than other countries"
So what does this have anything to do with healthcare system ( govt or free market) .
The issue with most of these is that they have better health outcomes overall but when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US. The difference is a lot of poor folk without adequate healthcare die of relatively straightforward conditions like diabetes while if you do have healthcare you end up getting the state of the art though it might bankrupt you.
There's nothing in the Australian health care system that precludes people with uncommon conditions seeking specialist treatments either in Australia or abroad.
> she will have a much higher chance of survival in the US.
Without a deep dive it looks ballpark the same, to be honest.
AU Cancer Survival Rates:
The 5-year survival for cancer in 1991–1995 was 55% and by 2016–2020, the rate had increased to 71%. Even with decreasing mortality rates and increasing survival, the number of deaths from cancer has been increasing.
Five-year survival rates have also been increasing for an even longer period of time. The overall cancer survival rate was 49 percent in the mid-1970s. It currently sits at 68 percent
We/Australia has a massive focus on early detection of skin cancer due to our overly sunny weather. It's possibly that we detect more cancer and treat it earlier thus the better outcomes?
> when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US.
A few years back my Mum in Australia was diagnosed with stage 4 lung cancer, given 12 months to live.
For just shy of 3 years she had radiation, chemo, trial drugs worth nearly a million a pop all in a brand new cancer Center. Because she lived a couple of hours away she got free transport to and from and free hotel. Not pay and claim it back, fully free.
She was on an enormous cocktail of drugs that dad would get at the pharmacy that raised a lot of eyebrows for the strength of the opiates among other things.
For three years they never paid a cent. They never paid a cent of health insurance, never had private cover, never had a deductible. That would all be the same if they had never worked or took a decade off to pursue some hobby.
Trust me when I say it was stressful and emotional enough without adding money or paperwork or insurance into the equation
The comparison to my friends in the US who couldn’t get a separated shoulder fixed because it was “out of network” or had to move hospitals the day after a C section because the insurance didn’t want to pay anymore is downright disgusting.
For real people living their lives the two systems are vastly different.
Obesity's definitely a factor, but other developed countries haven't seen the same level of stagnation despite their own skyrocketing obesity rates. For that matter, Americans also smoke less compared to most of Europe.
There's likely at least one other major factor, and I would assume that it's some variation of "inability to access high-quality care for financial reasons" given how much of a wealth disparity there is in various healthcare outcomes.
Older age groups are also less likely to die from chronic diseases such as circulatory problems and heart disease. Cancer mortality rates are lower in Australia than they are in all other Anglophone countries
So you get less cancer because you have 'access high quality healthcare' ? how does that work?
wealth disparity there is in various healthcare outcomes.
Wealthy have access to good food. have less stress and engage in mental and physical recreation more and ofcourse regular screenings.
Why would it depend just on one factor like hospital access?
Plausibly you can get less cancer by encouraging people to stop smoking, drink less, be less exposured to known carcinogens (either by awareness or regulation). A good healthcare system can also mean you catch cancers early or treat them earlier.
less likely to die from drug overdoses. Older age groups are also less likely to die from chronic diseases such as circulatory problems and heart disease. Cancer mortality rates are lower in Australia than they are in all other Anglophone countries, except among American men aged over 65. And Australians are also less likely to die in road accidents than other countries
So why are they getting less chronic diseases despite being equally obese.
yep exactly. 'healthcare' should be called 'disease care' . Most ppl are too far gone to recover from their illness by the time they go to the doctor.
All the medicines they prescribe are merely to manage symptoms. I have GERD and reflux. I was given PPI after many many tests. How does taking PPI extend my lifespan. Whatever has gone wrong with my body is still there.
How is this not obvious to ppl making this absurd correlation between hospital care and lifespan.
Medicine doesn't have shit of new breed of diseases and disorders ppl are dying from. Doctors don't have answers to any of modern illnesses so how does it matter if access to a useless person is govt funded or 'free market'.
> I have GERD and reflux. I was given PPI after many many tests. How does taking PPI extend my lifespan. Whatever has gone wrong with my body is still there.
It can potentially extend your life by reducing your probability of developing esophageal cancers, improve your quality of life in the meantime, and there are other complications from untreated GERD I can't recall but would negatively impact your life.
They are only approved for short term use because of myriad of side effects ( including things like life threatening colon inflammation, kidney disease ect)
The people have never specifically asked for anything, because we're not a direct democracy and we don't have federal referenda. What does that matter?
Bernard is well across many aspects of US, UK, and AU political views, government systems, media etc. with his own particular views as we all have.
In context he's writing for an Australian audience about a conservative Australian trope that the Australian health system is weighed down with government meddling and would do better with, for example, a "US free market" approach.
I think we all appreciate that's an illusion, a myth spun for children.
I think it’s extremely important to see that it is neither a myth nor an illusion spun for children.
It is a carefully constructed plan that will ensure rich people get a whole lot richer and poorer people get worse care. It’s not an accident or nice story. It’s class warfare
Depends on what you mean by health care. Medicare is insurance, not care, and while insurance is part of the system, Medicare often pays private healthcare providers for service. Medicare only insures ~14% of the US, less than one sixth and is only available for people 65 and older. For those reasons, your example maybe doesn’t demonstrate what you imply.
The healthcare system in the US is far, far from a free market. Most people would describe it as a crony capitalist market. There's a lack of transparency, lack of competition, and lobbyists of established players have too much say in the lawmaking process.
I assume you are referring to a larger amount of people living in poverty in the US?
Could this also (partially) be explained by the cost of healthcare? Something like a downwards spiral where average people end up poor either due to direct costs of healthcare or neglecting their own healthcare due to cost?
- greater usage of surgeries and prescriptions, leading to greater exposure to medical malpractice (the 3rd leading cause of death in the US.)
- higher birthrate. more pregnancies.
- less cultural tolerance of abortion. Greater willingness to take on risky pregnancies
- single parent homes (people with less family support)
- ethnicities which are more susceptible to certain disease and lifestyle risks
- greater exposure to crime in impoverished areas
- more life time spent traveling in cars
- more restricted access to health insurance (as you said only accessing healthcare in dire emergency)
The US is a different world than most countries which tend to be geographically tight and culturally homogenous. It's very difficult to make comparisons, not to mention differences in data collection and reporting ethics.
The CDC doesn’t record medical malpractice as a category for cause of death or injury. It’s grouped under “accidents” in their statistics (their official 3rd ranked category).
> The CDC’s published mortality statistics, however, count only the “underlying cause of death,” defined as the condition that led a person to seek treatment.
Because of this political choice the information comes from 3rd parties digging into the accidents category.
> The US is a different world than most countries which tend to be geographically tight and culturally homogenous
So, if this was the issue, you'd probably expect outcomes to be better in less diverse, physically smaller US states. Looking at, say, life expectancy by state (https://commons.wikimedia.org/wiki/File:Life_expectancy_map_...) doesn't seem to bear this out, really; on your theory you'd probably expect, say, West Virgina to be handily beating California or Texas.
Also, of course, _Australia_, which started the thread, could hardly be called either geographically tight or culturally homogenous. Australia is roughly the size of the contiguous United States.
Indeed. On the spectrum of health risks Australia is more like the US than France, but it’s far away. The most similar country is possibly Russia or Brazil.
Demographics (I assume you mean race?) can't be the reason. West Virgina is IIRC almost exclusively white and has a lower live expectancy than North Korea.
Source: https://www.crikey.com.au/2024/10/16/pubic-private-healthcar...
Bypass: https://clearthis.page/?u=https%3A%2F%2Fwww.crikey.com.au%2F...
Other references:The Economist: https://www.economist.com/graphic-detail/2024/08/23/why-do-a...
AU Gov Report: Advances in measuring healthcare productivity https://www.pc.gov.au/research/completed/measuring-healthcar...