> Society should find a better way to pay for ambulances
Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.
Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.
Unwilling. It's absolutely feasible to find a solution, as seen everywhere else in the world.
From the article:
> In Tulsa and Oklahoma City, meanwhile, the government buys staffed unit-hours from an ambulance operator, while households can prepay a few dollars a month on their utility bill and owe nothing if the ambulance ever comes.
My favorite example is universal school breakfast and lunch. Without fail, someone will argue that some kids don't deserve it. It doesn't matter that all of the data shows it is more economically efficient and the benefits to kids is overwhelming.
The Republicans seem to see it as immoral to potentially give a few people support they don't need even if that means that most of the people who need the support actually get it. And, instead, they believe that having an inconsistent array of private interests will somehow be more able to service an enormous population than having an organization (like government...) that is large enough to match that population's needs.
The Libertarians seem to either genuinely not care about the rest of the world or, more often than not, seem to be naive about how life can be for the less privileged.
It's the lie of the "rugged individualist" in America. Most "successful" people come from successful families. Social mobility, in the US, is part of that lie. Here, we celebrate the person who rises from poverty to become wealthy as a member of a sports team, or as an actor, or similar, while disregarding that these massive successes are outliers.
I'm so often disappointed in my own country.
Good news is that if you want the democratic party to become the party of labor, now is the absolutely best time to have a real impact in your community.
I will tar and feather the "right" constantly. The "left", here, is somewhat better. As you say, though, neoliberalism has infected both parties.
Personally, I'll take the DSA over both. However, the population is unlikely to accept Sam's. And both political parties would sooner collude than accept the DSA as a modern inheritor of American Liberalism.
No, they just put boundaries on what services they want handled by the government. Government programs are the least efficient and most wasteful way of getting a job done, and there are endless examples of this.
Churches were historically the places people went to for assistance, and churches held people accountable and would push them to fix their underlying issues. Government programs have none of this, you can keep making the same bad decisions and nobody will hold you accountable and the benefits will keep coming in.
https://news.gallup.com/poll/697676/drop-religiosity-among-l...
Women commit just as much sexual abuse as men, it's just not talked about by society.
Please provide a citation for this assertion. Here’s mine refuting it.
https://www.ussc.gov/sites/default/files/pdf/research-and-pu...
https://smart.ojp.gov/somapi/chapter-2-etiology-adult-sexual...
https://www.humanrights.unsw.edu.au/news/study-finds-one-10-...
I agree that what you need here is someone(s) with leverage and respect in your life to interfere with systemic bad behaviors if they exist, but that takes community, government merely gets leverage, and churches are often not a welcoming place to many people's eyes, rightly or wrongly, around the US.
As I get older, I'm increasingly of the opinion that the best you can do is unconditional support from the government (because it's the only kind you can rely on no humans in the chain acting in bad faith to condition), and well funded local support structures for people to subsist while fucking up their lives and also help them get out of that spiral if they want to.
Not because I believe in some fundamental good in man or something, but because I think that's the only way you can design this that isn't subject to people's bad faith manipulation, and I've personally seen too many cases go wildly differently for "objective" criteria where the main difference seemed to be whether the person reading it went into it assuming you were lying or not.
It just boggles my mind how the poor are supposed to be continually punished just for being poor and should always be denied, almost by rote, any sort of government aid because, you know, did you hear that story about that fentanyl addict who was found with THREE active EBT cards in his wallet?
Yeah for sure...how dare some dirty addict should be able to eat!
Many choose ignorance because it’s comfortable.
they happen to be in the Fortune 50, or top 10.
serious, go look at the F500 list and see how many of the largest, meanest companies in the US (and world) world also happen to be healthcare
if you wanna know why it's never gonna happen -- there is the list. they will spend more money than god on social media, bribes, and whatever else they need to keep the system the way it is
https://companiesmarketcap.com/
Mostly only pharmaceutical healthcare in the upper tiers of that, but these businesses still have market caps and net incomes literally one or two orders of magnitude separating them. Grouping top 10, 50, and 500 makes no sense.
IIRC if you look at the cost of Medicaide, Medicare, VA, and other federal and state spending it's the same as most other countries per capita or as a percent of GDP. The US taxpayer pays about as much as Canadians to fund their public system, then pays the same amount again for private cover since it's not universal.
No I'm not making a typo. Medicare, Medicaide, and the US system is such a rip off that per capita Americans are paying similar tax dollars to their joke of a public system.
But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.
17% of GDP is healthcare. So between 1:10 and 2:10 people in this country are making more than they otherwise would (note I did not say wealthier) because the system is screwed up and hoovers up more of everyone else's wealth than it ought to.
Slavery was 12% and (while obviously geographic concentration of industry plays a lot into it) it took a war for them to take a haircut.
The fact that that pie is not sliced evenly does not change the fact that is an integer multiple larger than it ought to be.
Systemic inertia is unimaginably strong.
I easily see that changing the USA to be more socialist, especially in areas where game theory indicates its the best solution, will likely take a civil war.
That also aligns with Marx's writings, that the capitalists will not acquiesce without a fight, and a big fight at that.
The slavery and Civil War connection is a comparison of similar economic magnitudes.
Certain specialities probably are overpaid (orthopedics), but others like pediatricians or general practitioners usually aren’t.
And nurses!? From the nurses I know they are underpaid for what they deal with.
The ones making loads of many are willing to travel around the country and uproot their life once or more every year. Not exactly a lifestyle without its drawbacks.
Yeah, most pink / blue collar workers in the US are badly underpaid, but IIRC ones in the health sector are some of the best off, relative to medium salaries.
Compare teachers and nurses. In most countries they make about the same AFAIK (and I'd say nurses do deserve more, telling a parent Billy did badly on a math test has got to be easier than explaining a bad medical test). But in the US it's about 75k vs 95k. There's a huge premium for working in health in the USA, EVEN in the underpaid blue collar end.
Doctors make out even better in the US, and the c suite in health can have salaries that are just insane.
McKinsey did a nice analysis of what is driving US healthcare costs. It compares category spending to OECD then compared price and volume.
Turns out the US pays a bit more for drugs (relative to total spend), a little more for inpatient care and a TON more for outpatient care but half of the increase is volume, not price.
As someone who works in healthcare globally, the difference in US care is stark. Americans get much early and more access to new technology than other countries.
If your lymphoma has returned and you have a 20% of living more than a few years the best care is CAR-T with cure rates close to 60%.
Check out CAR-T rates in the US versus Europe, it’s almost 3x. The US started using it in 2014 and Singapore just started paying for last year (11 years later). Even in Europe adopt only ramped up in the last 5 years.
So yes prices are higher, but a big part is more aggressive care with more expensive treatment.
“Canadian health care” is not a thing. Each province administers its own completely independent system.
Someone on PEI is in a healthcare system that has as much to do with Alberta’s healthcare system as it does their neighbours in Maine. As a result, anyone referencing Canadian healthcare is talking about a dozen or so unrelated systems that do things very differently. The closest it comes is that there are interprovincial billing systems so you don’t have to do the paperwork to get covered for an urgent visit out of province, and not all provinces are signed on.
You can safely dismiss anyone that has reduced that complexity, or is completely ignorant of it. It’s a great way to tell when a foreigner is spouting talking points they picked up from an unreliable source and did not do even a minimal fact check on. “Canadian health care” as it is talked about in the US media is frequently fiction for propaganda purposes.
Canadians almost always talk about problems within a province. What's happening in the Maritimes has nothing to do with BC.
The feds set a minimum standard for a province to qualify for federal funding, and that's about the limit of their influence.
No idea if the rest of his statement is poorly sourced propaganda as the first sentence.
So yes there may be differences between provinces in terms of when they fund what restrictions are put on it, the overall trend across Canada is pretty consistent.
And as I said Canadians don’t get the same care as Americans so concluding the higher cost is entirely higher prices for the same thing is false.
You're talking about cutting edge technologies available to the tiniest sliver of people - I'm not even able to get access to much of them with my private FAANG insurance - and drawing a false comparison.
And it's not "the tiniest sliver of people", we're talking about disease like cancer. Check out the CAR-T rates in the US vs. Canada, the difference is stark. And CAR-T is standard of care in some types of lymphoma.
Hell, ask parents with autistic kids what kind of early intervention is available to them in Canada. I had a coworker who moved to the US so he'd have much better access for his kid at a time when it had a big impact.
Look at access to the cystic fibrosis therapy that effectively cures it (e.g. Orkambi). It was paid for by insurance (and Medicaid!) from the day it was launched and avaiable to everyone it could help. In Canada some provinces just started paying for it, but only kids, adults are shit outta luck.
And I don't know the details of your FAANG insurance, but my US insurance (typical corporate insurance) pays for all these new technologies.
Canada is great if you have a routine issue. If you need something specialized you're going to be treated with therapies that are a decade or more old. Hell, even the CBC wrote a whole story about 2 friends with breast cancer and the differences in treatment.
https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-...
"Then I found out that this other country — which I thought had a healthcare system that was so superior to the U.S. — doesn't test for the tumour marker that saved my life, and doesn't cover this drug that is responsible for pushing my cancer into remission after traditional chemotherapy failed to do that."
Life expectancy shows that while the US is the best place to have stage 4 cancer, it's probably not the best place overall. Most places do the 80/20 stuff better.
But yeah, you are right that the US does some stuff well. Just not efficiently.
Life expectancy doesn't measure quality of healthcare, there are far too many confounding variables like genetics, diet, accidental deaths, etc. No serious study of healthcare quality relies on it.
Look at 5-year cancer survival rates. The US is better (significantly better) in many of them than other countries. A big part of that is access to the latest technology.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2...
The US leans aggressive on tests and heroic end of life care. I doubt you really disagree (except maybe on whether you think it's the right call). That is where the money is, since the insurance company can be forced to pay. It's kind of good for the rest of the world though if the US wants to pay (in both money and other issues) to be early adoptors.
Read "When doctors die", the US is the total opposite - everything goes to the big ticket aggressive (and yes, modern and cutting edge) treatment where it's hitting diminishing returns. https://pmc.ncbi.nlm.nih.gov/articles/PMC6179868/
Sure!
Turns out the CDC changed the way it counts maternal deaths, while other countries didn't, so you're comparing different measures.
The old US measure was deaths that occurred during birth or shortly thereafter, now it's within six months and they added a check box only asking if the woman had been pregnant in the last year.
Not "this woman died because of poor maternal care", but rather "this woman who died had been pregnant in the last year".
This change immediately doubled the number. The data was wildly overestimating maternal deaths and in fact the CDC and many states are revising data collection to improve the number.
Median pay for a Nurse Practitioner is $132K/yr [0]. I think that's reasonable.
Average pay for physicians ranges from $220-450K depending on specialty. [1]
Personally, I think doctors should be paid more than software engineers, so I think those numbers are all reasonable, especially when you consider what it takes just to enter the field. Nurses require a Master's degree. Physicians need a Bachelor's degree PLUS another 4 years of med school AND THEN a residency program that lasts 3-9 years depending on specialty before they finally earn their medical license.
IMO, the idea that nurses and doctors are overpaid is quite simply ludicrous.
[0] https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-...
[1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
You'll find that salaries across the board are lower in other countries. Software developers in Europe make half of what they do in the USA. In exchange, they get far better benefits.
Also, physician salary only makes up about 8% of total healthcare costs [0]. Cutting salaries in half wouldn't significantly lower our healthcare costs.
[0] https://www.medicaleconomics.com/view/physician-pay-makes-up...