Comment by neuroma | Hacker News Reader

Comment by neuroma | Hacker News Reader

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I presume you are in the USA. I watch and marvel at how the USA has such expensive health care and yet apparently has poorer outcomes than other G10 nations, in aggregate. The NHS in my home country is undergoing privatisation of the more lucrative or self-contained components. But it seems important for other countries to watch and learn from this example because free market economics are so often heralded as a solution to inefficiency, cartels, and high prices. Why healthcare is not as amenable to the benefits of capitalism is no doubt complex, but if I may speculate, I'd suggest that choice is not really a good thing in healthcare. All we want is good care, and we want it quickly and conveniently. Choice is only needed if we are getting poor care. Furthermore, the infrastructure (buildings, equipment, supply chains, specialists) are sufficiently costly that often the market cannot entertain multiple variations. In other words, we can't always have many equally equipped hospitals competing to do the same things.

>>yet apparently has poorer outcomes than other G10 nations

I assume you have data for this? Something more than the flawed infant mortality rate that is often cited but is a very poor judge of a health system in reality?

Something like 5 year cancer survival rates. Time a person waits on Specialist Wait List, the time it takes a person to get a replacement Hip, MIR, or Heart Stent. All of which I believe the US is very high or at the top of those statistics

The US does really well at high end care. It does less well in terms of overall agregate health outcomes. As I recall last time I saw a really good analysis if this posted to HN, You have to take into account a few other risk factors (obesity etc) in addition (to how infant mortality it reported) to get the US health outcomes inline with other developed nation. Even then, the US ends up paying way more to achieve that level of care per capita.

Edit: Took me a bit but I tracked down the article that my recollections are based on: https://news.ycombinator.com/item?id=21737795

>>You have to take into account a few other risk factors (obesity etc) i

I disagree, we have a free society, and one of my concerns about a government run health care system is that it would allow encroachments upon that freedom. I do not need or want a parent via the government. I neither need nor want the government passing laws to control what food I eat, how much food I eat, or what health choices I make

The questions comes down at that point to if you desire a collectivist authoritarian government, one that "the greater good" (which is subjectively defined) always over rules the individuals rights, or do you want individualism and individual rights to reign supreme over the collective

I support individualism

You entirely misunderstood what I was saying. Take a moment be read stuff carefully before you start arguing.

Oh Jesus fuck, what is it about (some) Americans that makes them so aggressively unable to see beyond their own blinkered horizons? Is it something in the water?

Approximately none of your screed had anything whatsofuckingever to do with reality.

Canada has socialized healthcare.

200 to 300 thousand travel to the US for healthcare every year. That's with population of ~30 million. Extremely common.

Which begs the question, why do they travel to the terrible USA, when wonderful social care in Canada is so amazing on paper, with wait lists measured in years?

Getting an accurate portrait of Canada as a whole is very difficult, as healthcare is a provincial responsibility.

As a Canadian however, it would not surprise me if most of the people traveling were upper class people trying to bypass the waiting lists.

You have to understand that this is inevitable as long as our systems don't have the same level of fairness and people are allowed to "choose" their system. Of course privileged people will choose the system that they can benefit from most, whereas unprivileged people cannot afford to choose.

This is not to say that our Canadian healthcare systems are perfect (far from it), but rather that some of them attempt to promote fairness (in service quality and rapidity), thereby negating the greater privilege of wealth relative to less fair systems such as yours.

This practice of healthcare tourism does of course take some pressure off the system for unprivileged people, so it's hard to say it's all bad on the whole. But don't expect the situation to change regardless, as we are also ruled by the wealthy, and they do so like to have freedom of choice.

By the way, the position on the waiting list is often adjusted according to the urgency of one's situation, so people who travel to reduce waiting time would not have been in critical condition on average, not to mention they may simply be traveling to get services that are legislated differently in Canada (as I believe cosmetic surgery can be, depending on the province).

>>By the way, the position on the waiting list is often adjusted according to the urgency of one's situation

This is only technically true, and ignores the fact that many medical procedures that are done when something is not critical means making a full and complete recovery with no life long effects but delaying the treatment while sitting on a wait list until the issue becomes "critical" means the problem may only be able to be partially rectified and the person may suffer from life long effects due to the delay in treatment

At the end of the day government run health systems control costs by limiting the supply and ignoring the demand. This creates an untenable system that can never be "fair" to anyone.

You have to remember that to some, as long as everyone is in abject misery, it's "fair".

I note that all your statistics are based on figures that only involve the number of people that successfully obtained healthcare which seems like it's ignoring the possibility that a significant percentage don't have access to those wait lists at all.

If you only let half of your population on the list in the first place, I don't think it's overly shocking that metrics across the board would appear better.

I'd be interested to know the percentage of people in each country that require hip replacements, MIR's or Heart Stents but have no effective chance at even seeking out the preliminary care that would lead to them.

Ok show me the stat that 50% of people that desire healthcare do not have access to it?

Even the most aggressive numbers on uninsured in the use put it about 15% to 20% of the population, no where near the 50% you are claiming in your comment

There was a time in my 20's where I did not have insurance, I still had (and got) care when I needed it. Sure it was expensive but I was never denied services.

Yes you can find stories of people that do not have access to care, and we should do what we can to eliminate those edge cases where there are clearly gaps in the system but paint these edge cases as the rule is just disingenuous at best

> Ok show me the stat that 50% of people that desire healthcare do not have access to it?

That was an example, simplified so as to make the impact more obvious. Take any country on the planet, and look at their healthcare figures - now exclude the poorest 50% of people from accessing the medical system in those countries. Bet the numbers look better now.

> There was a time in my 20's where I did not have insurance, I still had (and got) care when I needed it. Sure it was expensive but I was never denied services.

I'm not sure how relevant personal anecdotes are when you're talking about the healthcare of an entire population. But hey - good work mate.

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