U.S. health is lousy compared with peer nations, report says
latimes.com
latimes.com
In the US, premature births occur at a much higher rate than other country and account for a large portion of the higher infant mortality rate. Those stats also don't tell you that if you have a premature baby, it's most likely to survive if treated in the US.
[1] http://en.wikipedia.org/wiki/Infant_mortality#Measuring_IMR
To further your point about statistics not telling you the whole story. I often see statistics that suggest you are more likely to be shot in the US than another country. This suggests that living in the US is a highly dangerous thing and that we all fear being shot on a daily basis. But if you look at the numbers it's generally not as dangerous as it sounds since you are more likely to shoot yourself than be shot by another person. The reason being is that suicide deaths by firearms are often much higher than homicides. The same for the statement I keep seeing that you having a gun in your house increases the likelihood you'll be shot. It's because you're more likely to shoot yourself with it than be shot by someone else.
Statistics can be presented in different ways to support different agendas. You have to be willing to look at the raw numbers objectively and consider how they are tabulated to get any meaning out of them.
Ty Cobb must have sucked at baseball because over his entire career he failed to get a base hit about 65% of the time at bat.
As for the other measures, how you count is important. Without seeing the actual data, it's hard to say exactly how relevant it is.
Pretty much what you'd expect for a system that doesn't emphasize accessible prenatal care.
Prenatal care has a minimal impact on premature births.
I picked access to prenatal care because it's one of the easiest ones to improve, it has a positive impact on a variety of metrics, and it should be desirable in itself to anyone who isn't a sociopath.
0: http://super-economy.blogspot.com/2010/12/amazing-truth-abou...
And can you elaborate on why you think the post is wrong?
And can you elaborate on why you think the post is wrong?
Meanwhile, in response to your
Why do you think my worldview would be based on a single blog post?
I am wondering why you have submitted that link so often in previous Hacker News discussions of international comparisons among countries. (This most recent time is far from the first time you have submitted the link.) That link is the only external source you have submitted here. What do you think makes that a better post to consider for the issues under discussion in this immediate thread than some of the links shared on health issues in other subthreads here? What does that link actually have to do with health at all?
Deleted comment
>A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.
>I asked Robert Ohsfeldt about this, who responded that the adjustment factor was based on fatal injury rates relative to the average. Hence, the adjusted numbers shouldn’t be seen as hard numerical estimates of life expectancy, but rather as a way of understanding the true relative ranking of the various countries on life expectancy excluding fatal injuries.
* The US is thought by some economists to have an artificially high infant mortality because the US is more rigorous about reporting live births than other countries which might write up the same events as stillbirths.
* Outcomes in the US for chronic serious illnesses are at or near the top of the rankings.
* Life expectancy figures in the US are anchored down by suicides and, more importantly, traffic fatalities, which the US leads the world in. While that's not something we should be OK with, it's also a direct consequence of the vast land mass and wide population dispersal in the US.
The lede on stories about US infant mortality isn't that Sweden outdoes us. It's things like "the US ranks alongside Qatar and Croatia". Those are the assertions I think we need to be more careful about.
The population has no impact when we're looking at per-capita statistics.
Canada and Australia have the highest immigration rates in the world, so their homogeneity is going down, yet statistics like these are not going up.
The point is that Sweden is a cherry-picked comparison.
Choose any other OECD country then. The results are the same.
It would be really interesting to see data comparing the healthiest people in the US and other similarly developed countries.
I always read your replies to threads about health care in the US and I'm always left with two thoughts: "what does that even mean and how does it further the conversation?"
If you bothered to actually follow the link to the data (http://sites.nationalacademies.org/DBASSE/CPOP/DBASSE_080393), you'd see that none of what you said is accurate. The US is either at the end or, sometimes, in the middle of the rankings for everything. The Violence graph is particularly interesting.
This is because we have so many people with chronic serious illnesses that we know what to do with them better (at high costs). This isn't something to be proud of.
If you want to come up with a way to produce a low rank for the US on some holistic indicator, you will not have a hard time doing it. Are we the "healthiest" country in the world? Certainly not! We don't even have mandatory military service.
The issue here is that we need to be clear on what lessons we're trying to draw from the rankings. People definitely want to use rankings like this in inappropriate ways. If you want to look at this and say "America has an obesity crisis", nobody credible will argue with you --- but you didn't need this ranking to do that anyways.
On the other hand, if you want to say "America has a crisis of unavailable health care", well, you're wrong. The statistics don't bear that out. We have other health services problems, like bankrupting the uninsured, but measured by effectiveness and outcome, we have a top tier system.
I replied, because often apologists for American healthcare (I'm not saying you are one) neglect to mention why we have a good treatment outcome for certain conditions.
http://en.wikipedia.org/wiki/List_of_countries_by_number_of_...
I would be very surprised if countries like New Zealand and Australia do not have more deployed troops per capita than America does.
http://www.nytimes.com/2013/01/10/health/americans-under-50-...
It provides a little more detail.
I'd go so far to say irresponsible to publish without disclaimers since these kinds of studies are so easy to regurgitate and buy into about the "state of the USA".
A glaring example - how can you even consider Japan a "peer" nation to the USA when comparing health?
Ethnicity has been shown, again and again, to have a gigantic impact on life expectancy - so a more compelling study may be USA Japanese with Japanese parents vs. Japanese in Japan.
But then again what about RICH Japanese in USA vs. RICH Japanese in Japan?
Or broken out by Japenese that follow different diets?
Or Japanese that smoke?
Or any of the other "studies" that try to identify individualized trends.
If we're trying to glean anything from this data beyond pageviews for newspapers then segment & compare the data along actually comparable lines - class, ethnicity, and regional lines.
Defending the USA's health system by saying "well, it has a stark class divide which pre-ordains that a large proportion of its population will get inadequate health care compared to other countries" is only valuable in that it tells us that to improve health outcomes, we've got to break down our class system.
I don't know if this would improve general health, but it sure would make me feel like I am getting more for what I pay.
I hope people don't think this is some condemnation of the US health care system. No matter how good your health care system is you're not going to be able to correct for serious lifestyle problems.
Gun use emerged as a factor: Americans were seven times more likely to die in a homicide and 20 times more likely to die in a shooting than their peers. In all, two-thirds of the mortality disadvantage for American men was attributable to people under the age of 50 -- and slightly over half of that resulted from injuries...
However, why is this article interesting to the Hacker News crowd?
But what to fix?
Much like hunger in the third world: it's a political problem.
Practical solutions have long since been developed and proved in other places. The problems persist where they do, because there's no political will to actually implement the solutions in those places.
While I agree it's a political problem in general, there's apparently a lot that can be hacked. Starting with lowering the cost of diagnostics and improving the information flow... There were a couple of interesting companies interviewed on Mendelspod (http://mendelspod.com/) - if you're interested in what can be hacked, give it a go.
There are also projects like http://nhshackday.com/
So because X number of people get X-Rays that will never be paid for, providers have to try to find some amount they can charge those who do pay, to cover the difference. And the trick with that, is that insurance companies know damn well what X-Rays should cost and have the bargaining power to squeeze out much of the padding in the cost of an X-Ray. [1]
Which means those costs are eating into profits in a big way and has healthcare providers struggling to make the math work out. Particularly for those that service poorer areas, where fewer well-ensured patients can offset the cost of uninsured patients.
And when you don't have a lot of slack in your budget, it's pretty difficult to add beds and professionals to increase your ability to supply healthcare.
[1] Which is another perverse incentive for the hospitals to use new machines/drugs/methods when old ones will do just fine. Firstly, they're incentivized because their profit is largely function of the percent of raw cost the insurance companies allow for profit. So an X-Ray++ brings in more profit than a bog-standard X-Ray for the same amount of professional time.
Secondly, because newer tools are by definition not yet commoditized, they can squeeze more 'buffer' into those prices, until the insurance companies can sort out what it 'should' be and more hospitals get in on tool X and begin essentially competing with one another, by accepting lower rates.
The point being is that fraud is a significant problem, but it's not easily solvable.
News Flash: The U.S. isn't a welfare state. To benefit from everything this country has to offer, you need to pay for it. Yes, it would be better if that didn't apply to healthcare, but there needs to be some method of exclusion when demand is high and supply is low. Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)
> And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities.
People fly to many first-world countries for medical care, including "Canada and Europe". Yes, if people have vast sums of money, they can receive excellent medical treatment in the US (as they could in many countries).
However, that's not the problem though, is it. The problem is that in general, most Americans fall behind in health compared to other first-world nations.
> but there needs to be some method of exclusion when demand is high and supply is low
Are you arguing that the state of health of the majority of the country is irrelevant as long as high-income earners can receive the best medical care?
At least we get treatment not dependent on the quantity of money we have.
I have no health insurance right now. If I got sick in Canada, I would absolutely visit my doctor, get a prescription and diagnosis, and be on my way. In the US, I have to pray I don't have a severe disease and try using over the counter meds because I can't afford upwards of $800 doctors visits if they perform any tests. It is around $150 just to walk in the door.
If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.
What's that about wait times in nationalized healthcare countries again? I'm sure he'd have been much more quickly served in Vancouver or Toronto or Manchester.
what i mean is, well, great rhetoric, but you know, facts, man. facts.
First, the exorbitant rate of medical inflation in our "market" healthcare system is a fiscal menace not only to the public sector, but to the private sector as well.
Secondly, the deteriorating health of the American workforce is an increasing threat to global competitiveness. An overweight employee pool with high prevalence of unmanaged diabetes is not an attractive one for global capital.
Expanding access, controlling costs and emphasizing preventive care are things we need to get better at out of naked self-interest. Saudi sheiks who want to fly in for a quadruple bypass may continue to do so, but if we lose them to somewhere that bows and scrapes to the mega-rich more than we do, good riddance.
People also used to (maybe still do) fly to Australia for cardiac surgery.
The US may be able to pull in doctors from around the world with salaries that are high (correlating to high healthcare costs), but the regular individuals access to such doctors is limited: if I, talking to my insurance provider in Washington, said I wanted to go to the East Coast and have Dr Oz do my cardiac surgery (leaving aside any, and indeed valid, controversy over him - I was just looking for a notable/famous surgeon), I'm fairly certain they'd balk (and I'm fairly certain because I've worked on software systems that determine such things for insurance providers).
Yes if you throw alot of money, you get state of art facilities and top doctors, but are you getting the return on investment if the healthcare system is lagging behind the "welfare states".
http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...
Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior.
As a Canadian who lives in the US it's often shocking how different the perception of the Canadian health care system is between the US and Canada. Canadians by and large are quite satisfied with the system, while even reasonably liberal Americans I've met seem to believe it's some kind of waitlist-filled hellhole.
I've had more than one American express incredulity when I pointed out going to the US for major medical procedures isn't really a thing in Canada, where they thought it was widespread and relatively common.
By my own observation, there are a few isolated cases of this happening (mostly among the extremely wealthy), and is not at all widespread.
> "but there needs to be some method of exclusion when demand is high and supply is low."
The supply of medical capacity is not fixed or subject to a real physical limitation (like, say, rare earth metals). In Canada the response to constricted supply has been expanding the supply, as well as reducing per-use costs to make this possible. The supply is not infinite, but is high enough that people who need it, get it, and at a cost affordable to them (amortized across the entire population).
[edit] It's worth mentioning that, due to the economic incentive of single-payer health care, Canada invests a tremendous amount of money in preventative care and screening, which serves to dramatically reduce demand for the most expensive, most supply-constrained treatments. In fact I have a friend who works for the Canadian government right now doing computational screening for early cancer detection. It's interesting stuff, saves lives, and saves money, but requires a dramatic economic incentive to build out that simply doesn't exist in privatized care.
> "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)"
Citation, again, sorely needed. I grew up in Canada and have never waited 2 months to see a specialist, nor 2 months for treatment. The longest I've waited for a specialist was a few days. I've also (unfortunately) been to both Canadian ERs and American ERs, and the wait times are not substantially different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).
So I waited for 6 months behind a number of people including those who had similar non-critical injuries but were diagnosed earlier and those who had severe knee injuries requiring reconstruction or replacement. Rationing was done on a need basis rather than my ability to pay. Some people may talk about how terrible this is, and to be honest I probably could have afforded the surgery in a "private" system. Then again, when I was much younger and needed my first knee surgery I would have been hosed in a private system. And no, I wouldn't have been covered under my parent's policy in a private system.
Furthermore, when I have required urgent care, I have received it immediately. The longest I have waited is a few hours in the emergency room. Close friends who have dealt with much more serious life-threatening diseases have started receiving treatment/surgery within a few days or even the same day.
So yes, I experienced the terrible gulag that are Canadian medical wait lists and it really wasn't that bad. The wait lists are based on triaging, rather than wealth, and having wait times based on medical decisions made by professionals rather than economic incentives seems a much more humane system to me. I understand that some will call this "unfair" but that just means our definition of fair is different.
There are some exceptions, but generally things work well.
And, of course, for people who can't afford the inflated prices we've got here... the waiting time is infinite.
This is so misinformed it's borderline laughable (if it wasn't thrown out there by someone who is a member of the HN community and, I'd assume, an intelligent peer.)
I have been treated in Argentina for urgent and non-urgent issues and never, ever, had to wait 2 months for anything. When I was referred to a specialist (best of her branch of medicine in a city of almost a million inhabitants) I got an appointment the following week and started treatment within a month. Whenever I needed something, like an X-ray or bloodwork, I could either get it free of charge at the local hospitals or just pay for it (incredibly, a CT Scan with the same machines they use in the US costs 1/6 the price in Argentina. How's that for free market economy?) and get a result immediately.
So, all in all, this is complete bunk. People who have never experienced any other system are by definition the worst to make a comparison with the US system. I've used the Brazilian, the Argentinian, the British and the US system and by far my worst experience has always been in the US, even while paying through my nose to get the same care I'd get for free in either of the 'developing' nations. Heck, I've used the _private_ system in the UK and even if I paid the extra bit to be seen by a doctor (20' wait at the practice; Oh! The horrors of endless lines and dead panels!) I only had to pay ~£2.50 to get all the medicine he prescribed (that's the upper bound, after that everything else is free.)
So yeah, definitely the US is not a welfare state. If anything, it's the contrary: a profiteering system where healthcare is just secondary to profit.
I would really prefer not to have to do this. Do you have a suggestion for how I could avoid that wait? I live in the U.S. and those timeframes don't seem particularly high compared to what I'm used to.
It is an interesting question as to where to draw the line between personal responsibility and governmental responsibility. Of course most people in the US can afford to buy quality food, if they really wanted to, and some Americans are doing well. But Americans clearly aren't doing well at keeping up their health, and gov policy is making obesity worse. I saw some data point recently that suggested we may have passed an inflection point (for the better), hopefully it turns out to be true in the long run.
Oil subsidies mean people drive everywhere rather than cycling or walking.
http://www.nytimes.com/2013/01/10/health/americans-under-50-...
on the same report provides more detail. The lede paragraph shows the importance of cultural and lifestyle factors rather than health-care-as-such in the mortality and morbidity outcomes:
"Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States."
Drug addiction in particular is a severe problem in the United States to a degree not seen in (for example) east Asia. The stark historical memory of the Opium Wars imposing Western drug-pushing on east Asian populations makes many countries on the other side of the Pacific Rim very wary of letting young people start drug use. Illicit drugs were all but unknown in the childhood experience of my wife under Taiwan's former military dictatorship. Growing up free of harmful psychoactive substances allows young people clear heads to learn a lot (including learning other languages for international understanding) and to grow up to promote social improvements, such as the steady democratization and upgrades in provision of health care in Taiwan during my adult life.
So let's be clear what the report tells us: health outcomes in the United States often fare poorly compared to the health outcomes in other countries approximately as rich. But the challenges to health in the United States sometimes differ in ways that reflect long-standing differences in United States culture that still need to be nudged in healthier directions.
AFTER EDIT: There has been some hand-waving (without specific deep links) about OECD health statistics in this thread. In fact, the United States does not fare as badly in comparison to other OECD countries
http://www.oecd-ilibrary.org/sites/factbook-2011-en/12/01/01...
as some of the statements in this thread have suggested. The decline in all-cause mortality at all age ranges during my lifetime in the United States
http://www.scientificamerican.com/article.cfm?id=longevity-w...
has been steady, so people in general in the United States are living longer, healthier lives than ever before in history.
Too much "low fat" stuff being shipped around as "healthy" alternatives, when they are filled with sugar, instead of healthy fat.