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Comment by ixtli | Hacker News Reader

Don't even get me started. I did a year and a half of university in Tokyo and I used and paid for the health care system there a few times. Cavities filled for 20 dollars at high end central Tokyo offices. Skin doctors for zero dollars and prescribed creams for 800 yen. I knew a brain surgeon there who told me that the max price you could pay for his services was equivalent to 700 dollars. He didn't even bother going to conferences in America, and this was 10 years ago.

Oh, and people love to talk about wait and access to doctors: not only did none of my experiences have a wait they didn't even have a schedule. I simply walked in to an office and was seen immediately, and the Tokyo metro area has 35 million people living in it.

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I don't have anything to prove it but I swear countries like Japan and Germany are very good at this sort of thing because the people have a culture of strict obedience to authority be it the government or whatever. They love having and following well defined rules and are nonplussed (in the original sense of the word) when people break the rules.

People in USA have the opposite attitude towards authority and rules.

Go someplace in Europe that doesn't have this culture and it breaks down. Italy's healthcare is a circus. When I was in Italy not even that long ago a doctor came in to see me with a lit cigarette in his mouth.

The USA's ethos in based in the motto of doing it their own way. Sometimes that's good: when everybody is doing the same, it breaks from the status quo and can become a leader in an industry, or just generally break ground in scientific and civil progress. That has happened many times in the past.

The flipside is that there are many things are a consensus worldwide because they _are actually better_ but that the US still refuses to adopt, generally because it would mean following others' lead, or because there are special interests in keeping the current status quo.

To me nothing is more emblematic of this problem than the country's refusal to adopt the metric system: the alternative is objectively worse, but the country is pretty much the last developed country on earth to refuse to use it.

It's more short-term pain avoidance based.

The reason we aborted the conversion to the metric system is because a generation of idiots couldn't stand the pain of switching, and the longer we delay the more painful it will be.

I don't think your analogy holds unless you cherry pick a bit - neither the French nor the British are particularly known as rule followers in the sense you are suggesting. Both have good (even great, in Frances case) health care.

The line you are drawing probably has at least as much to do with economics as culture.

Oh I bet someone in Italy got visited by a doctor with a cigarette (30 minutes late, lunch) today.

And yes, the systems work in Germany and Japan because they're culturally and racially homogeneous (Japan).

The United States was founded by people who didn't like their home country and decided to leave, rather than bend the knee.

As such, we fight about everything. It's inefficient for some stuff.

Italy's health care is pretty good actually.

Lived there for 15 years, on and off. My son was born there. My father in law survived a bad heart attack there.

Yes, there are areas in the south where it's not so good, but any reasonably large country probably has some areas where things don't work as well.

People live long, healthy, happy productive lives there.

> Yes, there are areas in the south where it's not so good

I was in Naples at the time and was a little disturbed by how lax the doctors (well, really everyone) seemed. I guess I shouldn't judge Italy's government/healthcare based on my experience in Naples, I have heard that northern Italy is on the ball for the most part.

Naples is a world unto itself. Much has been written on the subject, but yeah, it's kind of a mess. In some ways it's sort of the distilled essence of some of the worst - and best - of Italy.

> Italy's healthcare is a circus

1 - Italy was the 4th European country to introduce a smoking ban in public places.

2 - https://www.bloomberg.com/news/articles/2018-09-19/u-s-near-...

"Spain’s health system efficiency ranked third behind Hong Kong and Singapore, followed by that of Italy, which moved up two spots from a year earlier. Italy ranked as the world’s healthiest country in a separate Bloomberg gauge."

> Italy was the 4th European country to introduce a smoking ban in public places.

Is the ban enforced? If not, it's just lip service. When I went there 3 years ago (Rome, Naples), people smoked in public EVERYWHERE, even on public transportation. Sometimes I would get on a bus and there would be some guy in the back blowing smoke out of a cracked window

> people smoked in public EVERYWHERE

There are people smoking in Italy as there are everywhere. They were probably smoking down the street and that's fine. But I have never seen anyone smoking in hospitals, restaurants, cafe, buses, etc .. it is illegal and people wouldn't tolerate that.

That being said, of course, there are always people that do not respect the laws as everywhere else in the world.

The thing about American healthcare is that the solution politicians offer is to spend more money on it when the cost is vastly higher than what it should be. Spending more money on it will only increase costs, but this is what we get. Other high income countries have semi-private health care and have much much lower costs than we do. A politician who can figure out why the COSTS are so high and make concrete proposals to do something about it will have my vote. I think there was an idea around that said that the maximum you can bill for anything is 150% of the medicare reimbursement. Sounds reasonable.

You didn't have a wait because that's the ER. Scheduling a complex plan of care would probably have a different story.

> He didn't even bother going to conferences in America

Might there be content in these professional conferences that would be relevant and beneficial for patient care? Is not going to professional development conferences a badge of honor or a mark of quality that I fail to grasp?

IMO you could find the same information at European, Canadian or Australian conferences, etc. I speculate it has to do with the idea that the focus in the US isn't on patient care and outcomes but rather on profits.

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