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Comment by pdonis | Hacker News Reader

> The US, in particular, spends more and sees worse outcomes than other counties.

I think this "conclusion" depends strongly on how you define "worse outcomes".

> An individual is going to not make very good decisions about how healthcare dollars are allocated over the course of their life.

Not if they have no incentive to learn how, no. And our current system gives them no such incentive, since they don't control the dollars to begin with.

In other words, the system complains that people don't do something that the system prevents them from doing.

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It's not very hard to define "worse outcomes"... the US trails other developed nations in just about every wide-reaching healthcare metric at this point. If you have counter-examples, feel free to raise them.

> In other words, the system complains that people don't do something that the system prevents them from doing.

Uh, this has nothing to do with the system, and mostly everything to do with behavioral economics and risk pooling. People are poor at investing in preventative care, because the benefit is extremely hard to perceive at the individual level. And they over-invest in end of life care, because, well, they don't want to die. That's not the result of "the system", that's human nature. Attempting to build a healthcare system on how we "should" act instead of how we actually do isn't a plan.

In addition, the "market-based" proposals to address this problem mostly exacerbate it. The suggestion is always that patients need more "skin in the game" -- in other words, that they need to be responsible for even more costs out-of-pocket -- and yet it's completely predictable that fewer people are going to seek preventative care if they have trouble paying for medicine now.

This also ends up being a pretty unfair way to apportion care because a rich man couldn't care less about a $100 fee and a poor man can find it prohibitive.

> I think this "conclusion" depends strongly on how you define "worse outcomes".

One example would be how the US has one of the worst infant mortality rates in the developed world.

Not to mention higher rates of preventable diseases, lower life expectancy and these are averages across the country.

If you stratify by income then the lower end of the income scale have it far worse than equivalent cohorts in many other developed countries.

I mean sure if you are upper middle class and work for a large national or international company then healthcare is probably up there with world class but that's not a lot of people percentage wise.

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