Comment by w0utert | Hacker News Reader

Comment by w0utert | Hacker News Reader

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>> What's the Dutch perspective on American media?

My perspective on American media is that even though everyone has access to (mostly) unbiased, factual sources, quality investigative journalism, uncensored internet etc, for some reason a very large cross-section of the population willingly chooses to believe the partisan crap and plain and simple bullshit peddled by outlets like Fox News and (to a somewhat lesser degree) MSNBC. I regularly visit the US, and frankly I'm appalled by the downright evil crap that seems to be on 90% of the time on televisions everywhere in public. I would be thoroughly embarrassed if the situation at home would be even remotely comparable. And now you have a POTUS that actively promotes to make the situation even worse by labeling anything he dislikes as 'fake news', while at the same time spreading easily falsifiable information as truth.

I really have no idea how the US got to this place. The problem is not that the US does not have free press, but there seems to be a level of partisanship that feeds this vicious cycle of misinformation, always putting the blame at the other side, and a total disregard for simple facts that things could be so much better for everyone if the two sides would actually try to work together and find compromises for once.

The health care system is just an example of this. Even though there are countless examples of developed countries that have a much better system with significantly lower costs because of things like single-payer insurance, maximum tariffs, etc, somehow the american people don't want it 'because socialism' or whatever nonsensical argument based on the in-grained illusion of the 'American Dream' of a merit-based society where everyone decides their own fortune. Meanwhile social mobility in the US is among the lowest of all developed nations. The level of cognitive dissonance really is mind-blowing.

I think what people in Europe don't appreciate about American healthcare is that the quality of care is a bi-modal (or maybe even more than 2 modes) distribution where a very large fraction of the population does in fact have the best access and quality of care in the world. On the other hand, there is a significant fraction of the population that has a lower overall access and quality of care. It is not irrational for the 40% to 70% (the fractions are debatable) of the population to not want to reduce their quality of care to average European care, which is in fact a lower standard for them.

Right...

According to the WHO [1] the US health care system scores first on exactly one metric, which is cost...

It boggles the mind that someone could rationalize a healthcare system that leaves millions of people uninsured, bankrupts and destroys people unfortunate enough to attract even minor health problems, and results in higher costs than anywhere in the world as ‘better’ than ‘average European care’, because it is ‘bimodal’. What does that even mean, practically speaking? What does the US health care system offer the more fortunate citizens that you won’t have in, say, Japan, or Sweden, Malaysia, the Netherlands?

Question: do you think people live longer in the US, compared to other countries? Die less of common illnesses? Can get treatments for covering the 99% most common health care needs that are available exclusively in the US? I don’t think so...

[1] https://en.m.wikipedia.org/wiki/World_Health_Organization_ra...

I think you completely missed what I said...you are again pointing at numbers that compare averages and I am saying that the averages are irrelevant. If half the people do great and half do terrible, the avergage will look merely ok but the people doing great aren't irrational to want to continue to do great. How is that in any way in conflict with WHO metrics?

I understand what you were saying, but my point is that it doesn't make a lot of sense.

What I'm saying is that you can have a system that is great for probably close to 95% of all health care needs, at lower cost and for all of your population. This is what the WHO data shows. For the remaining health care needs there may be differences between countries, but I don't see any evidence the US is leading in all forms of advanced treatments (obviously they are in some, but not all). For example, survival rates for the most common forms of cancer are not all that different between US and Europe or Asia, and not highest in the US for all of them [1].

What I don't understand is what you mean by 'half the people do great' in the US system, and in which way it is 'better' than other countries? Do you assume they fix a broken leg better in the US than in say Canada? That better medicines for common illness are only available in the US? Is the hospital staff more friendly, or do the ambulances drive faster because you paid more for your insurance? I'm not trolling, I'm sincerely curious what you mean.

Whether it is rational to prefer a system where you pay (a lot) more for probably all the health care you will ever need in your whole life, under the premise that there is a very small chance you would attract a condition that requires treatment that may not be 'best in the world' in your country and health care system, that's a different question. It does not seem rational to me, for lack of evidence the quality of care would go down if the system were built on solidarity instead of egoism. Anyway, I don't think it actually matters when comparing health care systems. In the end only survival rates and available treatments are relevant, and I don't see any signs the rest of the developed world is severely trailing the US in that regard.

By the way, I cannot speak for other countries, but e.g. in the Dutch health care system you are also insured for treatments that are only available overseas. For example rare forms of cancer or genetic diseases. So even under the assumption such treatments are always exclusively available in the US, this does not mean you are left hung to dry if you are unfortunate enough to suffer from them.

[1] https://www.cdc.gov/cancer/dcpc/research/articles/concord-2....

Because it's not true. I think there's very cogent arguments to be made to say that, should you have certain severe conditions (cardiovascular, cancer), some of the best treatments in the world are indeed to be found in the US.

I think it's equally plausible to say that over the last 30 years, family/general/primary care practice has deteriorated, significantly, where priorities have shifted to billing from patient care, witness less times spent on visits, more of a rush to prescribe at times often unneeded medications, a swarm of at times invasive imaging to prevent not just deterioration, but litigation. I think it's hard to argue that the above is automatically a "higher standard of care" than received by the "average European".

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