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Comment by georgebarnett | Hacker News Reader

Australian here.

I’m curious about what you see as wrong with our standard of care?

I can see my GP same day, bulk-billed via Medicare (so no out of pocket cost to me) for whatever I need. Likewise, with a day or two notice I can see a specialist at my local clinic. Also bulk billed.

Out of hours, I can order an in home doctor service over the internet with an average wait time of 4 hrs. Again, bulk billed so no out of pocket cost to me.

I don’t think I’ve ever waited for longer than 24 hrs for a doctors appointment in the 12 years I’ve lived here.

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My usual example is the NHS. A lot of medical imaging AI papers are published using NHS data with great claims like

"Normal chest radiographs were detected by our AI system with a sensitivity of 71%, specificity of 95%, PPV of 73%, and NPV of 94%. The average reporting delay was reduced from 11.2 to 2.7 days for critical imaging findings (P < .001) and from 7.6 to 4.1 days for urgent imaging findings (P < .001) in the simulation compared with historical data." https://pubs.rsna.org/doi/10.1148/radiol.2018180921

Except their baseline image interpretation turnaround times (TAT) are completely incompatible with the US. If any radiology group sat on an exam for 11 days, they'd fired by the end of the month. Many hospital medical staff bylaws require final signed reports within 24-48 hours, not even including the professional fee interpretation contracts which can set TATs at 30 minutes.

You can't provide that level of service with NHS-type funding. Oz is probably one of the few systems that's currently functioning well. There's a ton of reasons British consultants leave for there.

> You can't provide that level of service with NHS-type funding.

The crisis with the NHS is not only a mismanagement crisis but also a funding crisis so I think they'd agree. Happily, healthcare funding could be increased to more normal levels (in comparison to other well functioning public healthcare systems as a share of GDP) and still be well short of the high costs of the US. The UK government just prefers austerity over properly functioning healthcare.

So combining your comments with the other comments on the thread.

Radiology has to have a 48 turn-around but it's OK if many patient don't actually see a doctor without multi day waiting times and some portion can't see doctors in any reasonable timeframe. But radiology, we got that covered! It is an important part of health care but it is clear US priorities as reflected in "standards of care" are completely off-kilter (if you're not seeing a doctor at all, radiology turn-around can't help you or is there something I'm missing).

The way standards of care drives up costs seems like a scam but I know not all of it's a scam. In ways it's worse, in the sense it's harder to get a handle-on and stop, being a spectrum that shades from mostly scam to actually good but sometimes too-expensive approaches and so-forth.

>You can't provide that level of service with NHS-type funding

Places like Singapore do well at providing good service on sub NHS funding. Also people actually like the system there unlike the US and to some extent the NHS. (Brit here - NHS is ok but a bit rubbish at times). I think it's worthy of study / emulation.

I think they are something like 1/3 or 1/4 of US spend and #1 life expectancy in 2019 vs like #30 something for the US.

I hate the US' health care system as much as anyone, but I don't think it's reasonable to compare Singapore to the USA that way

Singapore is the size of a US city and has a population of 6 million

It doesn’t come free, you or another demographic is losing. Public schools comes to mind, slow congested public transport ... etc limited beds in public hospitals

Lower quality of life because of High taxes

Waste because old people see a doc as a free social interaction

I don’t know both systems are not right

So you're saying US public schools are great, US public transport is great, and people can easily get treatment in public hospitals for the same price that they would suffer bed shortages for in Country X?

Just trying to understand your points because I think they are quite easily refutable.

I live in Germany and am not a fan of the high taxes but see more from the 42% I pay here than the 33-36% I paid in the US.

Your points are all very handwavy, but to answer. There are good public schools in my district.

The state is currently building a huge new high school a block from me to cover upcoming demand.

I’ve gotten a bed whenever I’ve needed one in hospital. Perhaps that one is not even everywhere and can tend to be an issue in rural areas, but not where I live specifically.

Public transport here is good. It’s congested, sure, but nowhere near as bad as other cities I’ve lived in. The state is currently building several new transit lines.

In terms of tax, I pay roughly the same overall as my US peers. I do earn a bit less, but that’s because it’s AUD.

I don’t even know what to make of your comment about old people. That sounds completely weird. I certainly don’t know any of my older (70+) friends who do that because there are lots of social programs and activities in my local area.

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