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Comment by rayiner | Hacker News Reader

The U.S. spends more money on education per student than any OECD country other than Norway and Luxembourg. Yet it gets quite mediocre results. Why do you think the U.S. will be able to do public health care in a more cost efficient way than it does public education?

I favor universal health insurance, but you’re going to pay more, not less. European countries didn’t flip some magic switch where they saved a bunch of money by just “cutting out the profit.” They do it through measures like the UK NHS setting the standards of care, so in a malpractice lawsuit the entity that says what the doctor ought to have done is the same entity that bears the cost of unnecessary tests and procedures. Efficiency is also achieved by aggressively rationing providers such as MRIs, keeping health worker salaries low, etc. There is no stomach to do any of that in the U.S.

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>European countries didn’t flip some magic switch where they saved a bunch of money by just “cutting out the profit.”

They sort of have with pharmaceuticals (which to be clear is only maybe 10-15% of overall healthcare spending) by having the government negotiate drug prices nationally, instead of having individual insurers negotiate. This has monopsonistic effects, which really does cut the profit margins of drug manufacturers substantially. Of course, in many ways, they’re free riding on drug discovery funded by profits made overseas (particularly in America) but it does result in appreciable savings.

Yes, good point. That’s one of the switches that will have to be flipped.

Primary Education (K–5): The U.S. spends 21% of its GDP per capita per student. This is exactly in line with the OECD average, which is also 21%.

Secondary Education (6–12): The U.S. spends 23% of its GDP per capita per student. This sits just slightly below the OECD average of 24%.

We spend only 5% of our GDP on food, which is much lower than other OECD countries. Does it mean we are starving?

It probably means the quality of a lot of our food is inferior and we overly rely upon heavily industrialized production, overly processed foods and exploitative labor.

I think that the obesity rate is a lot higher in the US than a lot of other OECD countries, so people aren't starving but its hard to say their nutritionally thriving.

That could be more attributed to the income gap and concentration of wealth in the US as well.

How would obesity rate be related to “exploitive labor” or “income gap?” It seems like you’ve got a hammer and are looking for a nail.

Obesity rates don’t follow any predictable pattern: https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r.... The countries around the U.S. on the obesity scale are places like Egypt, Chile, Mexico, Saudi, etc. What do these countries have in common? Probably nothing other than idiosyncratic cuisine and lifestyle habits and maybe genetics (non-asian versus asian).

If you want to adjust for cost levels in different countries, you’d use a PPP adjustment: https://www.visualcapitalist.com/ranked-education-spending-p...

The U.S. is at $20k, well over the OECD average of $15k. O my Austria, Norway, and Luxembourg are higher.

The U.S. system is neither fish nor fowl, there is more spending per capita than other countries' public systems and endless amounts of red tape because instead of one government bureaucracy you're also dealing with the insurance networks, the providers, etc. I certainly don't think it'll be automatically cheaper, but one can't help but think that the current system encourages hop-ons that exploit the inconsistencies and convolutions. It's like one big nightmarish parody of public–private partnerships.

But our publicly run systems are full of inefficient bureaucracy and red tape, too. Why shouldn’t we assume our public healthcare system would be operated the same way as the public school systems in Chicago, New York, or Los Angeles?

Moreover, there is a massive amount of overcare that americans aren’t willing to confront. My wife’s grandmother had a stroke at 87 and was airlifted from rural oregon to a hospital in portland. She had only 3/4 of her lungs after having cancer in her 60s. The doctors wanted to do an intensive intervention, which didn’t happen only because she refused and died peacefully the next day. My parents are on medicare and they just wander into the ER every time their blood pressure goes too high. I took my 7 y/o son in for a black eye after he ran into a table. The doctor looked at him, concluded there was almost no chance of internal bleeding, but ordered an MRI (or CAT scan, I forget which) “just in case.” We got one and the results within 90 minutes because we just have million dollar machines lying around “just in case.” My daughter went to get her retainer at a small dental office in exurban Maryland, and the office had four people working at the checkin desk. I think this practice has only three dentists total.

America’s “customer is always right” culture means it will be politically impossible to roll back any of this.

Frankly, dealing with healthcare claims as an American consumer is an excruciating experience and it is at the situation where “try anything else” is worth considering.

Also, as your description of overcare is happening under the current system, a profit-oriented one at that (which incentivizes the ordering of unnecessary tests and procedures) it sounds like you would actually benefit from a non-market-controlled, more modest (even austere), system!

Postwar America was built on the customer being right. The healthcare system is one of the glaring major examples of the customer not getting what it wants. Give the customer a better system.

> Also, as your description of overcare is happening under the current system, a profit-oriented one at that (which incentivizes the ordering of unnecessary tests and procedures)

Profit is part of it, but the legal system and culture are equally big parts. Malpractice claims are handled by jury trial in the U.S., and you can always get a doctor on the stand as an expert who will tell a jury that it was negligent not to order a million tests. The UK NHS avoids that by having the NHS set the standard of care. And malpractice claims have to go through an administrative system before resorting to court. And culture is big, too. Americans aren’t going to tolerate being sent to hospice before blowing through $1 million on heroic but futile end of life care.

> it sounds like you would actually benefit from a non-market-controlled, more modest (even austere), system!

I support such a system. My point is that there would be no political will to enforce modesty and austerity.

Not how I view it as a 74 yo. Patients get what their doctors want as part of a culture of minimal preventive care (it does not pay) and massive medical care (procedures pay handsomely).

Try to get a unilateral diagnostic mammogram. Sorry in the system I am in there is no code for a unilateral diagnostic, only bilateral, even if only one side actually requires diagnosis.

Why? Because 2X the charge and income fir little extra care cost. And who would ever complain about such “excellent” care? Recent experience.

There is zero evidence we would pay more for healthcare under medicare for all, what a bunch of neoliberal nonsense.

The idea that a for-profit system is more efficient than say medicare is hilariously out of touch. Medicare is one of the most popular programs in the country (like >80% from overall public, >90% from active users). There is no reason to deny such a program from the vast majority of Americans, unless you stand to profit from it.

Medicare is cross-subsidized by private health insurance: https://chatgpt.com/s/t_6a5838016cf88191bce90f346ee16ab6

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