I really don't understand why the US doesn't have a grown up healthcare system. Do you just not see how much better healthcare is in the rest of the developed world?
There's probably some nice middle ground around having a national preventative program (screening, weight loss, nutritionists etc), and allow insurance to cover "you're fucked" scenarios like Cancer, Heart attacks, car wrecks, Gun shot wounds etc.
Canadian, former resident of Canada (for decades), and lately in the USA on a visa. Plenty of connections and family in Canada who can vouch first hand for what I'm saying, both as patients and as care providers.
Which is it, maerF0x0? Where do the lies end?
US health is great if you are employed, have a good income or are retired and on medicare. If you don't fall into those categories it is pretty tough
But if you purchase, or negotiate excellent coverage you can get excellent care. (You still have to do some research to find the best providers)
It's mid-tier all the way around except for cost, where it far exceeds any other system in the world.
Never being able to access the healthcare you're paying for because you can't afford the insane deductibles is even worse than not having healthcare at all, because when you DO have an emergency that you need to see a doctor for, your rates would often be lower out of pocket with the money you could have saved.
We have a terrible, stupid, inefficient system. It's drowning in its own chaos and bureaucracy.
Healthcare insurance doesn't get to dictate your healthcare directly. They aren't doctors, and open themselves up to liability if we don't push back.
[0] https://www.healthcare.gov/appeal-insurance-company-decision...
Life isn't always easy or fair, but standing up for yourself is important as you are your best advocate.
I don't think "do it out of pocket and try and claw the money out of them after the fact" was ever on our list of options. I wouldn't consider that unless the lawyers suggested it. We were looking into going overseas to have to done, which honestly its another big indictment of this system.
The point still stands about how insanely inefficient this whole system is at the macro level. The fact that lawyers are getting involved in routine medical procedures or doctors are suggesting what they know is incorrect treatment is a sign of deep inefficiencies. We aren't an outlier either. It is profitable for the insurance companies to jerk you around, fight you, try and sneak past denials were they can.
https://www.healthcare.gov/appeal-insurance-company-decision...
But I appreciate that it's a tough topic and not engage further. Good luck with it.
They aren't supposed to, but in reality, of course they do. They just have an on staff doctor who rubber stamps the decision.
With expensive procedures, they have a financial incentive to find a way to say no.
My wife probably burned 10+ hours of her life making phone calls that amount to "No no, I've already called the insurance company and they say the record is wrong on your side! I have to call your other office? No, I already called them! Why am I still getting a bill when it must be covered by the insurance ...!!!"
And none in our family is even badly sick. Don't want to imagine what will happen if one of us actually gets sick.
US healthcare system fucking sucks.
This is also usually necessary to find out if something will be covered.
Some of these change when you're truly end of life and in the ICU, and otherwise there are brief flashes of doctors actually giving you attention. But for the most part trying to receive healthcare in the US is like squeezing blood from a stone, independent of the soul crushing billing shakedowns.
It's more like you can imagine US healthcare is great if you don't need it, or don't proactively think about what needs to be done. Of course that's a great way for something to go unaddressed and kicked down the road until the next appointment (or ER visit).
I can't speak to other country's failings, but I can say this bogeyman narrative about "government run health care" is utterly fallacious. We already have the equivalent in the form of corporate-bureaucracy-first health care.
I can point you to several people who have great jobs, great insurance, and tens of thousands of dollars in medical expenses. Nowhere else in the civilized world does this happen.
Every other developed country has a better system than ours. Every one.
And for those who say "oh, well wait times are so much higher" - well you can get supplemental insurance in many of those countries as well - so the baseline isn't abysmal, but wealthy can get even better.
- principal-agent problems - health-insurance and hidden cost mean the people paying aren't the people getting the product
- concentrated benefits, diffuse costs. There are tons of actors (pharmas, hospitals, insurers, doctors, etc.) each skimming off the top. Each of these is a small enough effect that it's not worth anybody's time to stop it, especially when it's worth it for the skimmer to fight to the death to protect their cut, and together they all add up to massive amounts of waste.
- the US healthcare system is a Frankenstein's monster of public and private elements, and has ended up with the worst parts of both
- the US healthcare system probably would be better (at least in terms of cost-effectiveness) if it become either more libertarian or more socialized, but since moving a little in either direction would be seen by half the population as the top of a slippery slope towards a dystopia they hate, everybody fights hard to keep it in the local minimum
What's 'funny' is that our life expectancy with good health match USA life expectancy this year.
The Democrats keep proposing some kind of single payer system, but without addressing any of the causes of the existing high prices (because that would gore the ox of all those healthcare providers, who have a lot of political power), so in practice the result would be to move the absurdly high cost fully onto the taxpayer, but they can't get through a tax increase that high. There are also some aspects of the US heathcare system (certainly not the price) that people do like, and their proposals would tend to make those parts worse.
The Republicans are mostly content to do nothing, but their main proposal when they have one is to push things like price transparency and regulatory reform. Those proposals have a lot of potential, but they would come entirely out of the margins of the aforementioned healthcare providers, so they can't get any meaningful support from across the aisle or even within their own party. Which is why they're mostly content to do nothing.
It also doesn't help that most of the reform efforts have been attempts to do the first one, which doesn't reduce the cost, but consumes activism resources to promote a proposal that either doesn't work or doesn't pass.
What it does is give the illusion of high-level coverage so those profitable users keep paying the dole and keep supporting the industry politically.
Basically the two tier healthcare system has a legal basis for it's existence and structural support in the form of economic incentives to continue in perpetuity, and sustain itself.
This is going to seem either extremely obvious or completely bonkers depending on your point of view. so it makes an interesting scissor statement.
Furthermore one component of the system is the foundational belief that "work is virtuous," and healthcare is a boon based in reaping rewards of that virtue.
1. I wanted to say legalization. It's the right word, but it has the wrong meaning.
During WWII, Congress enacted price and wage controls that have caused us a lot of problems. With millions of men out of the labor force (because they were conscripted), and no way to compete with other employers by raising salaries, employers started offering perks instead. Things like tipping in restaurants and health insurance paid for by your employer became common and eventually ubiquitous. Before WWII, only a few percent of the population used health insurance. Everyone paid for health care out of pocket, and overall it was such a low percentage of people’s incomes that nobody worried much about it. You could trivially compare prices between doctors, for one thing.
However, I don't want to confuse the etiology of employer healthcare and the social reproduction of employer healthcare as it exists today. In other words, just because a thing has an origin, doesn't mean that the original cause continues to exist nor can we avoid examining proximal causes.
I'm a bit confused what you meant by "it's not enshrined in law." I think we both agree that there doesn't exist a statement of law like "Employer healthcare is a benefit of virtuous employment." Rather, the motivating factors for the ACA compliance[1] are congruent in the minds of a contingent with the idea that a work ethic justifies rewards.
There are many such programs that are congruent with work ethic such as Earned Income Tax Credit(EITC)[2], unemployment benefit requirements(looking for work[3]), and FMLA requirements(work >12 months)[4].
I want to be transparent and stress that this is much more in line with a critical analysis of the US legal code and policy than a logical argument, and carries with it all of the nuance and assumptions that any critical legal analysis does.
1. "ACA, employers with 50 or more full-time employees (or the equivalent in part-time employees) must provide health insurance to 95% of their full-time employees or pay a penalty to the IRS." https://www.nolo.com/legal-encyclopedia/is-my-employer-requi...
2. "Encouraging work" https://obamawhitehouse.archives.gov/blog/2016/01/29/earned-...
If you ignore the fact that I was already paying substantially more for it with higher taxes, the answer is still nothing. Countries with public healthcare don’t have expansive private healthcare systems, and nowhere in the world has a healthcare system that offers the level of service that the US system does. For example my sister was giving birth in New Zealand, and I wanted to just pay out of pocket for a private hospital for her. There are zero private hospitals in the country that offer this service, so her only option was to go to her local (and notoriously bad) hospital. She remained in the maternity ward for nearly a week, because while she was there that hospital had its 15th norovirus outbreak for the year.
Complaints about systemic issue of healthcare costs in the US are perfectly valid (and there are other somewhat unique problems with it as well). But are completely seperate from the fact that the best healthcare facilities, and most qualified healthcare professionals in the world are generally located in the US.
Can you back that up with data?
Basically, healthcare quality in places that are both very rural and very poor (e.g. West Virginia and Mississippi) can be awful and it brings down the average even though the system provides better outcomes for most people in most other parts of the US.
No, it wasn't.
Factually, your sister is 4.7 times more likely to die giving birth in the US than in New Zealand.
The outcomes in US healthcare are terrible, and it's extremely expensive.
Factually, that’s completely wrong, and I don’t think you know what maternal mortality is. It’s any death that occurs during pregnancy, during or with 42 days of childbirth. There’s a lot of reason that the number is so high in the US (including unequal access to healthcare in the first place), but the quality of the healthcare provided isn’t one of them.
In one sentence you acknowledge that the US has a VASTLY higher maternal mortality rate than developed countries, then you say that has nothing to do with the quality of healthcare provided.
That's.... impressive.
If you cant afford it, you're fucked in hundreds of different ways, including basically signing for any care "i agree to pay whatever im told for the rest of my life" blank check.
And healthcare is the leading cause of bankruptcy. This sort of crap doesn't happen in a decent country.
https://www.forbes.com/2010/03/25/why-people-go-bankrupt-per...
The only thing I hate is dealing with Byzantine clerical processes in the occasions they make a mistake. Have to waste 3 hours on back and forth phone calls because a low-level nurse made a typo is obnoxious.
You love living in a nation where millions of people can't afford basic healthcare for themselves but your dog can get an MRI same day.
You being able to get an MRI in a week might have the social cost of 3 people not being able to get an MRI at all.
Does it matter to you that 27.6 million of your countrymen have no insurance? [1]
Does it matter to you that 66.5% of all bankruptcies are due to medical bills [2] and that Almost 1 in 5 adults with health care debt either lose their homes or declare bankruptcy ? [2]
Do you simply not care that the people in your community and society struggle to get the bare minimum?
[1] https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2023/...
[2] https://www.retireguide.com/retirement-planning/risks/medica...