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Comment by anonym29 | Hacker News Reader

The optimal approach appears domain specific and granular, too.

As for domain specificity:

I don't know any Europeans who'd prefer to have American healthcare.

I don't know any European technology companies that hold a candle to the sheer breadth and depth of capabilities brought into the world by Google, Apple, Microsoft, Amazon, Nvidia, AMD, Intel, OpenAI, or Anthropic.

Yes, Mistral, Nokia, OVH, and SAP exist, but compared to the alternarives, they exist in the way the American healthcare system exists compared to its alternatives.

As for granularity:

Perhaps we want American style governance for building the tech, but then European style governance for running it?

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The American model of governance was created for a world with very distant nation-state threats but a large number of colonial threats, which is why it's centered around "every man for themselves" (in spite of FDR's best efforts). On the contrary, European governance was basically developed during the Revolutionary Wave, which was sweeping all across Europe, that monarchies found that the only way to appease the people was to give into their reforms - and often rapidly because of the domino effects of revolutions. In other words, American governance was built from the ground up, while European governance had to be adjusted within the existing environment and monarchical government frameworks.

In fact, European governments weren't even well-defined in their current state up until the end of WW2, in spite of how much Europeans like to take potshots against USA for being a "young" nation.

This does make the American form great for working with uncharted territory (how to handle new tech, how to exploit the earth in new ways, etc.) while the European form is more reactionary (how do we keep the people appeased, how do we provide a better standard of living, how do we alleviate hardship).

Perhaps the ideal mix of the two, between the frontier-style governance and European-style reactionism, like the Swiss model.

> I don't know any Europeans who'd prefer to have American healthcare.

Selfishly I think my American healthcare is better than anything I ever had in the UK. I can see a doctor within 2 weeks even a specialist, I can actually get a sleep study, my doctor will actually listen to me rather than tell me I'm just getting old, go home and take an ibuprofen.

specialists in two weeks is definitely not the norm everywhere in the US. it's certainly not in Seattle.

This is likely very regional. As a single data point, raising the family in the Boston area for the last 25 years I do not recall not being able to see a doctor the same day for the regular scares, from ear pains and high fever to falling and later vomiting (is this a concussion?).

A few times when we needed to see specialists, we often saw them within 24 hours; occasionally longer but I would say with a median of 48-72 hours. Even things that are clearly not urgent (for dermatologist "hey, I have forgotten about skin checks for the last 2 years, can we do the next one now", for ENT "hey, my son is getting nosebleeds during high intensity sports; can you check if there is a specific blood vessel that is causing problems"?) always happened well within two weeks. Three caveats to this happy story:

1. This is Boston area with likely the highest concentration of medical practitioners of all kinds in the US. I had good insurance with a large network, decent out-of-network coverage and for most cases not needed a pre-approval to see a specialist.

2. Everyone is generally healthy and our "specialist needs" were likely well trodden paths with many available specialists.

3. Our usage of the doctors, as the kids became generally healthy teenagers and adults, dropped significantly in the last 5-7 years. I hear post-covid the situation is changing and I may be heavily skewing to the earlier period.

At least from what I can see, COVID and the changes in attitudes towards medical professionals are driving a lot of burnout and leaving the profession; and since then economic pressures are squeezing private practices out of existence and a lot of specialists end up working for private equity now.

You can and get that in the UK, surely?

Most UK healthcare these days is someone tells you to take a paracetamol over the phone. Even dentists...

That's largely due to austerity effects and not the inherent model of UK healthcare. That's what happens when political appointees and ministers bully civil servants and doctors that the best minds all leave, while the government significantly cuts funding to the NHS while forcing it to move to AWS.

If you cough up for private healthcare maybe, when it comes to the NHS if it's not going to kill you immediately it's more or less 'take a spot in the waiting list and God will sort it out' these days.

I think you should also balance your take by asking people who recently lost their job what they think about their healthcare. I’m sure you’re aware of that, and my point is rhetorical, but that’s the trade off here, it isn’t only about what it looks like when things go right, you should also consider what happens when things go wrong. It’s also enlightening to see what happens many times when people “did everything right” and still got shafted by the US system. See: Sicko for instance https://m.youtube.com/watch?v=YbEQ7acb0IE

In terms of health outcomes, the UK generally has higher life expectancy and lower maternal mortality rates than the US - but that said, even the richest Americans face shorter lifespans than their European counterparts.

The real focus and point of contention should be that the US healthcare system is exponentially more expensive per capita than any European model, but is worse for almost all health outcomes including the major litmus tests of life expectancy and infant mortality. In some cases, the wealthiest Americans have survival rates on par with the poorest Europeans in western parts of Europe such as Germany, France and the Netherlands.

https://www.brown.edu/news/2025-04-02/wealth-mortality-gap

Americans average spend on inpatient and outpatient care was $8,353 per person vs $3,636 in peer countries - but this higher spending on providers is driven by higher prices rather than higher utilization of care. Pretty much all other insights in comparing the two systems can be extrapolated from that fact alone imo.

https://www.kff.org/global-health-policy/health-policy-101-i...

This is probably incredibly naive so apologies if so - are things like differing obesity or other health problem causing conditions accounted for when looking at overall outcomes of the system?

The higher cost makes perfect sense to me but calculating an apples to apples comparison of health outcomes between potentially very different populations seems potentially very difficult? Again sorry it's probably a solved problem but figured I'd ask :)

The lower life expectancy in the US is almost entirely down to young people dying at a much higher rate than Europe due to car accidents, murder, and drug overdoses. It skews the averages pretty badly. If those individual risks don't apply to you then life expectancy is actually pretty decent.

There is a wide variance in the general healthiness of the population depending on where you live in the US, which does affect life expectancy. Where I live in the US my life expectancy is in the mid-80s despite the number of young people that die.

That's because mortality rates are only weakly correlated with healthcare quality. The US has much higher death rates in some young demographics, which skews the average, but those people didn't die due to lack of medical care.

You can have exceptional healthcare quality and relatively low life expectancy in the same population.

The Brown study I cited above concludes differently, and is strictly a longitudinal, retrospective cohort study involving adults 50 to 85 years of age.

https://www.nejm.org/doi/full/10.1056/NEJMsa2408259

Within that 50-85 cohort, among 73,838 adults (mean [±SD] age, 65±9.8 years), the participants in the top wealth quartiles in northern and western Europe and southern Europe appeared to be higher than that among the wealthiest Americans. Survival in the wealthiest U.S. quartile appeared to be similar to that in the poorest quartile in northern and western Europe.

The US has world-class healthcare, if you can pay for it. If you can't, then you're getting the healthcare equivalent to a third-world country.

That's ridiculous. Nobody gets healthcare equivalent to a third world country unless they just don't try. (Think, an addict or mentally ill person, which is still not a good thing, but much smaller of a carve-out than you've represented)

I suspect the time it takes to see a specialist in the UK depends on how urgently the issue needs to be addressed. The real advantage you have is that you can be seen by a specialist within two weeks even for non-urgent stuff. That’s not to dismiss your need though. The definition of medical urgency and comfort don’t align well.

> I don't know any Europeans who'd prefer to have American healthcare.

Probably depends a lot on where you are in Europe. Some countries have long waiting lists for surgeries (life saving ones) and access to doctors is very limited (too few, months to get an appointment) so it sucks as well if you are in such a situation

Here in America we have to wait months for the privilege of paying out the nose.

>I don't know any Europeans who'd prefer to have American healthcare.

Some 50-100k Europeans fly to the US to get American healthcare every year.

I couldn't find a source for this with a quick couple of searches, could you provide one?

I'm not GP, but https://www.trade.gov/survey-international-air-travelers-sia... suggests that in 2024 about 0.4% of European travellers to the US told the government they were coming to receive medical treatment, and https://www.trade.gov/feature-article/december-and-annual-20... says about 13 million people from Western Europe visited the US in 2024, and if you multiply those numbers you get 50k.

That isn’t the flex you think it is lol

So the other 99.987% of Europeans agree with the parent comment?

No, they just can’t afford it or don’t need it.

Most people prefer healthcare they afford over healthcare they can’t. (Most, not all. There are a surprisingly large chunk of Americans who seem to vote Against their best interests in a lot of areas.)

I would argue that "don't need it" could just as easily be because they have better healthcare closer to home.

Ok, so about 0.0134%, Parent comment’s point is that -the average European- absolutely does not want the US healthcare system in Europe. Simply due to our shared believe healthcare is a basic right and should be universally available to everyone.

Those who have the financial means to travel to the USA for medical treatment do so largely due to running out of conventional options at home, experimental treatments or specific doctors who are regarded as the best in their particular field.

Most of the US outbound medical travel is due to treatment at home being too expensive and risking pushing entire families to bankruptcy.

The fact that 100k europeans fly to the US for medical treatment is factual, but does not equal them wanting the US healthcare system in Europe.

That's about how many need it, can afford it, and can't wait for an appointment in half a year.

Idk .. I injured my knee playing soccer (tore a bunch of ligaments) a few months ago. Wasn't life threatening. Still, got care after waiting for about an hour, xray and all. On a Saturday. In Sweden, single payer insurance. I paid only about $20 out of pocket.

Just as a contrasting data point, some estimates are that well over a million Americans travel overseas for medical care every year.

https://www.amjmed.com/article/S0002-9343%2818%2930620-X/ful...

This is mostly to obtain cheaper care. In general America does seem to have some of the best care in terms of quality. It’s just also some of the least affordable.

US is not the only destination for Europeans, they also go to Thailand and wherever. Few Americans go to Europe. It's not affordable, but when money is not the issue you go to the US.

i'm one of the Americans. went to South america for a dental procedure that was 12k in the US, 2.5k there. very modern facilities, they had some better tech than my american dentist. if you can speak a bit of spanish, i highly recommend looking into it for expensive dental stuff.

I don’t want to rain on your parade, but you would be more fair by replacing these companies with VCs, because they’re the ones lifting real weight here.

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