US still has the worst, most expensive health care of any high-income country | Hacker News Reader

US still has the worst, most expensive health care of any high-income country

arstechnica.com

86 pointsclouddrover115 comments

This seems facile. It's easy to criticize the US system and there's a lot wrong with it, to be sure.

We do spend vastly more than other countries do (though it's worth remembering that other countries fund universal care with high-end marginal rates that kick in around teacher salaries, and the typical citizen of a single-payer system has less income after factoring in health care than in the US). Certainly, if you're going to critique the system, spending is a good place to start, and this post avoids the trap of centering its coverage on private health insurance --- which is probably not the problem.

It's difficult to track infant mortality across countries, because countries have different standards for reporting infant mortality. My understanding is that our ranking there is in significant part an artifact of measurement.

The same thing is likely true of the "multiple chronic conditions" thing. There is a significant problem of overdiagnosis and overtreatment in the US. Specialist care is harder to obtain in many single-payer countries (talk to a Canadian), and fewer procedures are done outpatient (talk to a Brit). Our system is structured to quickly find diagnoses and move patients through a funnel to billable procedures.

On the other hand, there are other metrics of health care quality. For instance, you can easily get a ranking of health care systems by breast cancer survival likelihood, and the answer to that question is hard to square with us having the "worst" health care in the world.

Funny that you'd call out the subjectivity of some measures, then bring immediately introduce another, breast cancer survival, that has also been called misleading, and only an indicator of higher screening. https://theconversation.com/when-talking-about-cancer-screen.... The US gov even explains why 5 year survival rates are "illusory" https://www.cancer.gov/about-cancer/screening/research/what-... Life expectancy, and perhaps maternal deaths, seems less subject to reporting variations.

As for other countries having less income after health care, is that actually a comparison of health costs, or simply average incomes? Because dollar value incomes don't translate at all between countries, as an indicator of wealth and living standards.

The big hole in all that is that costs without insurance can quickly exceed affordability, especially for the unemployed/poorer folk more likely to be without insurance. Which, as well as being unacceptable to much of the world, probably also removes a lot of terribly sick people from any measurement at all.

> It's difficult to track infant mortality across countries, because countries have different standards for reporting infant mortality. My understanding is that our ranking there is in significant part an artifact of measurement.

I'm pretty skeptical of this, at least that there is such a significant difference in reporting that it would actually change the end result. Do you have any links to studies or other resources to add to this?

> On the other hand, there are other metrics of health care quality.

Sure, you can effectively game the system by choosing the right statistic, but broadly speaking the US performs poorly or "the worst" on many, many metrics. Like it is hard to square up the US not being worst or almost worst when it's got almost double maternal mortality than the next country on the graph in the article (New Zealand) and almost 2.5 times the OECD average.

Life expectancy seems similarly hard to game and pretty poor for the US.

Actually, life expectancy is badly skewed by the rates of fatal injury when people are in their 20s, which ruins the average.

The US has anomalously high fatal injury rates in young people due to things like automotive accidents and homicides. If you remove fatal injuries and similar from the statistics, Americans have among the highest life expectancies.

I suspect drug overdoses are mixed in there too. I believe there are also significant differences between the states (with fairly predictable trends). I suppose it all depends on how you measure public health, but the picture seems grim regardless.

Life expectancy in the US is heavily biased because of traffic fatalities. That's bad, but not an indicator of poor health care.

That statement dopes not tell us much without you also telling us how that is handled in other countries. If you look at "List of countries by traffic-related death rate" the USA is far from the top of that list, so other countries would have it much worse with their own life-expectancy impact.

[0] https://en.wikipedia.org/wiki/List_of_countries_by_traffic-r...

Compared to developed European countries (that you should compare them to), it is at the top of the list, 2-5x higher rates per capita.

Same goes for homicide rates which the above poster also mentioned.

>It's difficult to track infant mortality across countries, because countries have different standards for reporting infant mortality. My understanding is that our ranking there is in significant part an artifact of measurement.

I hadn't heard that before. What specific artifacts are you talking about and do all organizations in the U.S. always use different standards than all other developed countries... have you seen any studies that control for those?

I've always heard this is the measure chosen specifically because it is the easiest to track as nearly all infant deaths are reported in developed countries and death doesn't lend itself to nuanced definitions.

For instance:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681443/

> There is a significant problem of overdiagnosis and overtreatment in the US

Reasonably true. Which is funny, because we also have a significant problem of undertreatment for the causes of most chronic disease, notably obesity.

The US refuses to perform a proper RCA of healthcare spending. Bring back fat shaming and start prosecuting soft drink, snack food, and fast food executives (as well as the lobbyists they employ), and you'll likely see these costs fall dramatically over time.

We did it with smoking, and it worked. The same needs to happen with the nation's food addiction.

Arguably more chronic conditions might point to US health care being better. These individuals with multiple chronic conditions might not be alive except for high quality US medicine.

It also argues that we suck at primary prevention, but that's a whole different can of worms.

The problem is that health care in the USA is treating an inelastic product as an elastic product. Market fundamentals don't really work and medical suppliers can charge much more than they could in a truly competitive market. If you have a stroke or heart attack without good insurance, your choice is basically "do you want to live and go bankrupt or die and leave an inheritance", most people choose the former.

I looked up breast cancer survival numbers by country and the US looks about on par with the rest of the developed world.

I do agree with your general sentiment that there’s a lot of nuance that’s certainly worthy of deeper conversation. But I’m not sure that nuance accumulates into a meaningful argument for the system not being a scam when looking at the price tag.

Cancer survival rates are gameable anyway. They depend highly on early screening. As a statistic I mean. You can have pretty solid 5 year stats without treatment, if it takes 10 years to kill people. OTOH, without screening, finding it 8 years later might make the best treatment futile, and the stats worse.

> and the typical citizen of a single-payer system has less income after factoring in health care than in the US

Do you have an article or paper to confirm that please?

Physicians in the US are also paid exceptionally more than their counterparts outside of the US. As an extreme example, Cuban doctors can make less than Cuban taxi drivers.

And in Australia they dominate the list of highest paid professions, so I immediately wonder how many other wealthy countries were skipped before settling on Cuba as a comparison.

I’ve had lawyer patients just giggle at the fact that I’m near the top of the income rankings in Australia. ‘Clearly doctors don’t hide their income very well!’

Patients pay less, and I get paid relatively more in Australia (less in absolute terms than the US). There are fewer middlemen clipping the ticket.

I know Australia has public and private healthcare systems, do physicians get paid the same in both markets?

More in private, but not the difference on an hourly basis is not necessarily that much.

It is a truth universally acknowledged that in any discussion regarding the US and social policy Australia simply does not exist.

The only viable comparisons permitted are that Socialism == Communisim == Stalinism and that if not rampant capitalism then obviously Cuba or Venezuela.

Physicians' pay in the US has absolutely no meaningful impact on the cost of healthcare in general. Additionally doctors per capita in the US is nearly half what it is in a lot of European countries. Half the doctors doing the same amount of work effectively cuts their pay in half in terms of expense.

There's absolutely no way that's true. A day has only so many hours and person can work only so many hours in that day. I am a resident of EU. Every single doctor I know is severely overworked and there's a significant shortage of doctors. Other factors must be at play.

There is a strong push in the US for doctors to spend as little time as possible on each patient. I've had doctor visits that billed my insurance $350 where my doctor talked to me for literally 120 seconds. Everything else was done by an intake assistant. I would be surprised if it was this bad in other places, but explains why US doctors can handle more patients.

> Cuban doctors can make less than Cuban taxi drivers.

"make" here is such a capitalist term.

Can Cuban doctors fulfill their oath less?

my take is going all out socialized health care isn't the answer.

you need to socialize basic care that benefits everyone e.g maternal care, wounds etc, sprains etc so that you always have workers available in the economy. and that productivity doesn't go down because people have chronic conditions.

then privatize the special things e.g plastic surgery for the instagram influenzas, people that need special care that goes beyond what the social healthcare system provides etc.

having the gvt responsible for all the healthcare can go amiss as we see in the uk - it just takes one administration to gut the whole system.

Your first sentence describes how pretty much all socialised healthcare operates.

Cosmetic and elective surgeries are generally private in the UK. The NHS generally only deal with these procedures when they relate to another health matter e.g. reconstructive surgery due to injury or gastric bands for the severely overweight.

There's also a private healthcare market for more general care, which frankly needs to be destroyed due to the ongoing damage it's causing.

The current government are a bunch of crooks. Hopefully, they'll soon be dining with Thatcher.

I think this is something people in the US don’t understand. Many (most?) countries with national healthcare don’t cover elective surgery (cosmetic surgery, etc).

Many also have parallel (though obviously smaller) private healthcare providers. Of course because there is large national healthcare people who are paying extra for private healthcare are being gouged - because a facility’s ability to gouge customers is limited by competition.

The problem with the US health system is that it is essentially for profit, there is no “lower priced alternative” you can choose instead, and you cannot discharge medical debt so gouging is a safe and secure source of perpetual income for medical providers. It doesn’t matter if a patient can’t afford the debt, in many cases they literally do not have a choice, and then just pay interest on that until they die.

So you have swathes of the population that have comparatively expensive health insurance (compared to taxes paying for national healthcare), but who can’t afford to get any medical care anyway because the insurance is essentially just a “stop bankruptcy if you have a heart attack” insurance not actual healthcare. Despite that they are often avoiding bankruptcy but still being left with 10s of thousands of dollars in copays which they can “afford”.

This comment doesn't track for me. I'm not an expert, but I don't think you're using the term elective like a Doctor would - I believe they refer to that for surgeries that aren't really emergent and can be done as desired, like joint replacements, for instance. And I don't think private insurance has ever covered purely cosmetic surgeries. I assume there is also some cosmetic surgery that is medically advisable for quality of life even if it's not strictly necessary that might be covered in private or public systems.

I'm also pretty sure that medical debt is dis-chargeable; it's student debt that is essentially permanent in the US.

I can agree that profit motives for healthcare are probably inherently problematic.

you cannot discharge medical debt

Yes, you can.

Out of pocket maximums do tend to be high, but they are typically still less than $20,000 for a family insurance plan. The less expensive option (in terms of my contribution to the premiums) at my employer has an out of pocket maximum considerably lower than that.

> Yes, you can.

Not only that, but you can wait it out. The statute of limitations on medical debt is 5 years in FL and 4 in CA, for example.

Once that date has passed, you can just tell the credit agencies and it goes away.

It's fairly obvious we need to rejigger our Healthcare in the US. Liability insurance plays a part, but so do many other things and it would almost require an Authoritarian to re-arrange things.

My naive proposal would be to have a two-tiered system. One public where most preventive things are taken care of along with your ordinary emergency care --but allow private care for those who want above and beyond what everyone else gets. Also you get the public care by default when you turn 18. Obviously this is ultra-simplistic and there are many things one has to consider such as rare diseases, or things that arise from poor lifestyle choices. Where is the cutoff, and when does private insurance take over, etc.

>it would almost require an Authoritarian to re-arrange things

This presumes that an authoritarian wouldn't simply just pocket all that money for themselves and their friends, which is exactly what happens in all authoritarian countries around the world.

Yeah, true, but I meant the power necessary to make it happen, rather than the tendency toward corruption.

Improving baseline access is a worthwhile goal, but you aren't describing changes to the system.

Like how do you provide better emergency care to everyone without figuring out how to make the provision cheaper?

The only answer to that question is that you spend more money.

> Like how do you provide better emergency care to everyone without figuring out how to make the provision cheaper?

> The only answer to that question is that you spend more money.

You assume that the only costs are from the actual care provided. Eliminating all the middlemen and complications of billing, insurance coverage, etc, should already shave off plenty.

One time, I needed emergency care in a Nordic country. I had strong acid in my eye. I stayed for just under two hours, but didn't need much more than saline solution, regular pH tests and a nurse that wondered in & out. When the eye's pH stabilized, they let me go. They never asked for my ID, and I didn't pay anything beyond taxes. The cost of that visit to the department was a bag or two of saline solution, some pH measurement strips, tape, gauze for drying things, some labor, and a bed that was occupied for two hours. Now imagine the "billed cost" and overhead labor in the US system.

Or remove unnecessary things that add cost. Ability to buy drugs on the open market (including India), capping insurance payouts, reducing intermediaries, adding more people to the service side of things and removing people from the administration side.

The "Medicare can't negotiate drug prices" is about Health and Human Services not being able to negotiate prices. The companies they contract with to operate Medicare Part D are free to establish formularies and negotiate prices on the open market.

In Canada, my pharmacist is assessing my thyroid hormone level. It's an easy job. I got the blood drawn in the pharmacy for... $15. That part was considered private healthcare. How much would it cost me in US to get a blood sample sent to a clinician for my TSH to be checked?

And yet getting an appointment to see a Doctor is a multi-week process (Ontario). The last time I wanted to see my own Doctor was a 3 week wait for in-person and 10 day for a phone. I took the phone option because I had the issue before and wanted some feedback as soon as possible - I did get prescribed the same antibiotics - until then I self treated with OTC hoping it did not make matters worse. However there are many who do not have a provider and the walk-in system is not working effectively - most offices are not taking walk in patients. In Ontario, I think even online health provider systems are off, exacerbating the systemic problems. The rest of the family is losing their Dr in March due to retirement. Right now healthcare in Ontario is free and unavailable (empty store syndrome).

The US system has always seemed available, especially Doctor/urgent care visits. Clearly there are procedures that are inaccessible to certain demographics.

Meantime, a friend of mine here in the US (with excellent insurance) just made an appointment with a gastroenterologist in January.

2024.

Presumably something on the wait list will open up sooner... somebody who made an appointment in February 2023 and got treated by somebody else. Or just died. Meantime, we'll try to find somebody else.

But the notion of "Americans always get health care quickly compared to everybody else" strikes me as absurd. Some things work well, but other things work very, very badly.

> And yet getting an appointment to see a Doctor is a multi-week process (Ontario).

And there's the rub; in the U.S. you pay for healthcare with your money, and in Canada you pay with your time. There's no such thing as a free lunch.

I've heard this but no one ever cites any relevant studies that shows any such disparity.

You don't need a study. Enough people, myself included, have used the healthcare system multiple countries or have family in other places, that this is mostly common knowledge. That might not satisfy a debate judge, but it's good enough for most of us.

You also pay with your money, just through less direct means.

That wait time to see your doctor is not much different in the US where we are. We may not wait as long for procedures, hard to tell, but just basic health care is not easy to get. Just glad my company provides decent health insurance.

In most states in the U.S. you can order many tests for yourself, paying cash, no insurance involved. The TSH test you mentioned can be purchased for $49 [0] at the first place I found. Places doing this will coordinate the test appointment for you at a nearby local testing center, the same companies doctors might use, and the testing center would draw the blood sample for you. There's several states that may not allow tests like this to be ordered outside of a doctor visit, for your own good presumably.

Using insurance and going through a doctor it can be difficult (understatement!) to find out what something will cost ahead of time. Your insurance may charge you $150 for a sick visit to the doctor, and the doctor may tell you there is no charge for the test, but unless you ask the right questions you won't find out that they are just talking about their part of taking the blood sample and ordering the test, they won't volunteer that there may be third party lab charges, and they and their office staff will have no idea what those charges might be. It can take a lot of time to chase down all the parties involved - your insurance company, the doctor, the lab, for other things maybe a radialogist, an anaesthesiologist, and/or facility charges at a hospital or clinic, medications from pharmacist, and so on, trying to find out what the total bill might be, and there are no guarantees, any of them can tell you one price and bill something different, it might depend on which billing codes are used for each procedure, and you may not get all the bills for months. Doctors have you sign a paper saying you will pay for anything deemed medically necessary, and these third parties will threaten to send you to collections based on that, if you complain. Typical insurance plans have a yearly deductable of several thousand dollars, applicable to non-preventive care, with the idea being to incentivize people to pay attention to the costs for routine care (there's also an out of pocket maximum, perhaps $10-15k per year). But the costs are obfuscated. It's not a free market system, it's a scam, a jobs program for health care administrators (3200% increase from 1975 to 2010) [1].

[0] https://www.testing.com/tests/thyroid-stimulating-hormone-ts...

[1] https://www.athenahealth.com/knowledge-hub/practice-manageme...

GP said the TSH test was available for $15 in Canada. I found it also for $15 [0] in the USA as well as for $50 [1].

I also believe you can sometimes pay out of pocket for things like x-rays / MRI's in the USA and get them for surprisingly "affordable" rates (trivially affordable to those making >$100,000/year USD, utterly out of reach for kitchen workers). Sometimes though, the diagnostic facilities with the MRI machines will require a prescription, but that's nt mandated by law.

0: https://www.discountedlabs.com/thyroid-stimulating-hormone-t...

1: https://www.privatemdlabs.com/lab_tests.php?q=tsh&view=searc...

thanks for honorable mention (i'm the ceo at PrivateMDLabs). Please email me when you get a chance, have a small token of appreciation for you. j [AT]privatemdlabs.com

Not sure what "minimum" means here, but here is some data:

https://www.findlabtest.com/lab-test/thyroid-testing/

https://health.costhelper.com/thyroid.html

It depends on whether you called your family care doctor or went to urgent care.

I mean yes, but also unhelpful.

The majority of people aren’t going to urgent care for random checkups. The over reliance on urgent care in the US is a byproduct of a system that means people often have no other option (dr doesn’t take your particular insurance, your insurance doesn’t actually cover checkups, …) and the general cost of preventative care in the US meaning people don’t get things looked at prior to them becoming much bigger problems, where they do become urgent.

The majority of people should go to urgent care for routine stuff. NPs are just as qualified to do that work as doctors, and have better escalation paths to the doctors.

Just so we're clear: "urgent care" doesn't mean "ER".

> Just so we're clear: "urgent care" doesn't mean "ER".

Ok, that changes my response quite a bit - because there's a real issue in the US where the set up of the healthcare system means people have to go to the ER, but urgent care is substantially different.

However a lot of my points still stand: many urgent cares are associated with specific insurance or medical groups which means they simply aren't available. Additionally urgent care typically comes with a significant increase in costs, ruling them out for most.

If you're in a major metro, they're likely as available as your PCP, if not more so; your PCP is probably affiliated with a chain of them.

> The majority of people should go to urgent care for routine stuff

Most medical providers would advise against this. Managing someone's health is not the same thing as changing the oil in a car. It's immensely helpful for the medical provider to develop a working relationship with the patient and understand the person's conditions and medications.

The point of going to your provider's urgent care is that those links are already present. They're all working off the same charts.

"routine stuff" probably isn't the best term to get people on the same page.

You talk about availability in a couple other comments; at my provider, I can usually get an appointment with my PCP within a couple days, vs almost certainly waiting at least 30 minutes at the urgent care.

I think the last routine thing I went in for was a sprain evaluation (I wanted advice on strengthening the joint more than I was expecting any immediately useful treatment). There wasn't any urgency there really, and I wanted to discuss it with the doctor. If I thought I needed antibiotics for something I would just go to the urgent care.

Sore throats, fevers, rashes, allergic reactions, sprains, ear congestion, that kind of thing. Most people go to their PCP for these things, and urgent care is perfectly good at doing first line care for all of them; in fact, I've gotten more extensive care at the urgent care clinic than I ever have from a PCP.

I won't go to urgent care for a physical.

We had kaiser for years, and it was fine. I was able to receive care for pregnancy, stitches, vaccinations, etc with little hassle and mostly reasonable billing.

Then we moved. Omg, I can’t even get appointments to get a rash looked at, or a sinus issue, or vaccinations. And most of those are pediatric issues! My son minorly broke his arm, and didn’t even need a cast and I got thousands of dollars in bills from four different companies.

The trick in a lot of places is to start routine care at your providers urgent care clinics, which are often staffed with NPs instead of physicians; the NPs at those clinics are plugged directly into your family medicine provider. It takes a couple weeks to schedule appointments with doctors in our practice (especially our specific doctors), but I can be in and out of the clinic in under 30 minutes on no notice. It's not a bad system (aside from billing, which is a catastrophe).

> [...] routine care at [...] urgent care [...]

I think that says it all. That's a broken system you're just gaming & claiming nothing's wrong.

I'm assuming you believe "urgent care" means "the emergency room". It does not.

I am aware of the difference between "urgent" and "emergency". But when "routine" implies "urgent", something has gone wrong.

Sorry I don't follow, what did moving have to do with it? Did you have a plan that was valid in only a certain state?

Kaiser is not nation-wide. I had it too, in CA. They are excellent. They're not an option where I've moved too, and the alternatives are not as good, thus far.

This headline is backed up by overbroad metrics. Life expectancy, infant/maternal mortality, rate of avoidable deaths, and multiple chronic conditions(perhaps because of obesity they say) are how this author determined the US still has the worst...

Obesity actually might account for most of these problems. This article is brief and uninformative. The author overtly implies that guaranteed health coverage is the answer. I disagree.

Every study I have ever seen shows the us pays more for less. You’d think that if the US system was actually better we’d see some studies showing that, even with publication and political biases.

a lot of the debate always centers around the policies of the healthcare system but I think it's good that the article at the end also spells out a very obvious point, Americans are much sicker than many other countries.

A complicated and expensive healthcare system does certainly not help, but there isn't enough talk about how obesity, diabetes, chronic pain, infections and other conditions are linked and mutually reinforcing. Even infant mortality which always is cited in the US is much higher in obese women.

People can marvel at Singapore's technocracy and how efficient their healthcare is but also, you won't see that many unhealthy people there as you do in many other industrialized countries, and that shaves countless billions off the budget by itself. In many rich countries we seem to be completely unwilling to discuss or we even create taboos around how to improve population health.

This. Give me a population that gets some exercise, doesn't smoke, doesn't drink, won't kill someone or themselves over a pair of shoes, keeps up on their vaccinations and eats because they're hungry and I'll give you a population with any health care system in the world but the the US population - See who's got a better life expectancy.

I'll come out ahead every time no matter how healthcare is delivered for my population. Heck, I'd probably come out ahead with no doctors at all in my population.

Healthcare as it's commonly stated is oversold when it comes to mortality.

I've always thought that most of mortality is public health stuff that has almost nothing to do with hospitals or doctors. I'm happy to be proven wrong on this.

I wish Obama would have outlawed employer provided healthcare.

Currently, employers more-or-less do a good job complying with OSHA regulations. Far better than complying with, say, EPA regulations, or ADA regulations. What's your analysis for why it would be good public policy to reverse their incentives for workplace safety?

They pay for workplace injuries separately from health insurance benefits, they aren't really connected.

No employer is big enough to apply real pressure. We need state farm sized coops.

Employer subsidized health insurance does not mean all employers are self insuring. I do not see any link between employers caring or not caring about employee safety and employers being able to offer a tax free subsidized health insurance to employees.

>Currently, employers more-or-less do a good job complying with OSHA regulations. Far better than complying with, say, EPA regulations, or ADA regulations.

Why would you think this?

In my opinion, everyone should have been dumped onto healthcare.gov to prevent the hoarding of healthier people into the risk pools of rich, white collar businesses.

IIRC, the reasoning for not going single-payer was because it would have hurt the economy too much in the short term.

Too big to fail.

The US has the best, most expensive health care of any high-income country. Corrected the heading.

Yeah... Go read up on the news wrt the NHS of late here in the UK

I know, when you have a bunch of conservative governments that have explicitly stated that hate nationalized healthcare, they can do a lot of damage to it.

Also, I really don’t think when people are complaining about the NHS in the UK that for the majority of them the US system would be at best no better, for many would be worse, and for all would be more expensive.

Yeah sabotage works...

A fine example of how twelve years of continuous conservative party rule can gut and drive into the ground what was once a beacon of national health that the world looked to for reference.

I'm not from the UK and don't have a horse in the race, but a lot of people from the UK have been coming to where I live (Thailand) to receive medical care since I have lived here (more than 20 years) to escape the wait times. The few I spoke with definitely did not call NHS a beacon.

My few conversations are certainly anecdotal. However, the numbers of UK medical tourists isn't; it was around 4,000 in 2010 and estimated to be around that number each year, according to this paper [1], although it acknowledges the number is underestimated.

[1] https://globalizationandhealth.biomedcentral.com/articles/10...

I over simplified - the recent 12 years of UK conservatives have been really sticking the knife to the UK's NHS .. but it already had problems from prior rounds of UK conservative governance ... I suspect Thatcher started the trend as she was such a fan of privatised benefits at with socialised costs.

no-one has ever looked at the NHS as a reference to be copied, it is a unique system worldwide

it is one of the worlds largest employers but has essentially no economies of scale due to its structure

an example: until very recently it had no centralised procurement: trusts fought each other for resources (with its suppliers benefiting enormously)

it is exceptional and efficient at treatment if your condition(s) slot neatly into its "production line", but god help you otherwise

(but it's still vastly, vastly preferable to the US system which is an embarrassment for the richest nation on earth)

> no-one has ever looked at the NHS as a reference to be copied

You added "to be copied".

Many countries (eg: Canada, Australia, other Commonwealth countries) have looked to the NHS as a reference, both for the intial launching of their own national health services and for ongoing comparison as the decades have passed.

Australia has a hybrid health care system that works better than the US system, it was built with reference to several other global health care systems and is still modified to this day.

Much as Australia has a "Washminster" system of government that was designed with reference to both Washingtond and to Westminster.

> You added "to be copied".

well, if you are going to be that pedantic: I agree it definitely serves as a reference

... on how not to structure your health service

Pedantic is splitting hairs over choosing near identical shades of biege.

You altered the meaning of what I wrote by adding "to be copied".

Own it, don't throw that on me.

Here in Canada we've had 8 years of continuous Liberal administration and our healthcare system is probably doing just as poorly. Not that we'd trade it for the U.S system

Health care in Canada is a responsibility of the provinces, so the guy in Ottawa is to some extent irrelevant.

Although in BC we've had an NDP government for five years and it's not like things are doing so hot.

Similarly, the conservative in ON is hell bent on making sure private systems are in play. At this point I just want something to work and be accessible. So if private can take the load off the public system where possible then let it happen. There are serious concerns about healthcare staff moving out of the public system if that happens but I am not expecting Ford to increase provincial health care spending.

I like J.J Mucullough's video on that

I was put on the list for a procedure in the Australian system. Took well over a year of waiting to eventually get a call to schedule it. But I could afford it through private health insurance, so I had already had it.

But I‘d rather an inefficient system that manages to treat some people that can’t afford procedures.

> A fine example of how twelve years of continuous conservative party rule can gut and drive into the ground what was once a beacon of national health that the world looked to for reference.

And this right here is the exact reason why Americans have resisted national healthcare. Do you see the kind of people we regularly elect to the presidency and to congress? As bad as our healthcare system is, something tells me that turning it over to our government would only make things worse.

My recollection is that BlueCross was a non-profit until Reagan became president.

Blue Cross is still a non-profit.

I've got a friend who works at a big non-profit hospital. There's a budget term of art, 'Revenue in excess of expenses,' into which flows a large amount of money that would be called profit elsewhere. I haven't found a detailed report on BCBS finances, but I'm looking now. Non-profit doesn't mean there's no extra money, it only means an entity is organized in a particular way.

By definition, in order to continue as a going concern, they have to have more revenue than expenses. There is new equipment, treatments, raises, maintenance, inflation, etc. I guess one could have an all-volunteer hospital where everything is donated, from time, and equipment to land and buildings, etc.

> new equipment, treatments, raises, maintenance, inflation, etc

Much of these are expenses. Other organizations have ways of distinguishing between what's needed and what's extra, why do you think hospitals have nothing extra?

Yes, but people typically think of expenses as more or less operating expenses.

The parent association that owns the Blue Cross brand is non-profit. However the individual companies (at least all the ones I've examined) are for profit - and in fact are quite profitable. For example, the entire revenue of the parent association is smaller than the profits of only Blue Cross South Carolina.

That's what I was talking about. That happened when Reagan took office.

It's a meaningless distinction if you're still allowed to raise your prices and then adjust your "costs" within a giant opaque black box that you call the chargemaster.

Lack of price controls and transparency is one (of many) of the reasons health care is so expensive.

depends on the state.

Fairly axiomatic since US health care is for-profit by design.

generally untrue, probably about half of US healthcare providers are not for profit.

"non-profit" in the US is kind of a BS designation though.

The Ohio State University is "non-profit", but pays its head football coach over $9,500,000.

I've always thought of American "non-profit" labels for orgs to he similar to the "democratic" label of the DDR or the "people's " republic of China, or all other "adjectives" that people put when they need others to believe their bullshit.

It's also completely wrong to suggest that OSU is motivated by the same incentives as Amazon.

If anything the equivalent bullshit to paying a football coach that much would not fly at a for profit.

Interesting. Would you be able to list all of those that are not for profit? Just trying to make an informed decision, and I don't trust my google search - would rather get it from a fellow HNer.

I looked it up, and it's actually more like 80%

Yeah, it's nothing but a sham.

The solution is not to spend more money on it.

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