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Comment by dlokshin | Hacker News Reader

The irony is that if we were to have a single payer or other form of universal healthcare like they do in France, this little girl likely would have died. In France they use "Statistical prognostic" approach which in these sorts of cases withhold NICU services for infants with statistically low outcomes.

Edit: couldn't find data for premies at 25 weeks, but at 37 weeks and below, survival rate in the US is higher than European countries. http://www.cdc.gov/nchs/data/databriefs/db23.htm

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The irony is that France didn't even allow most withholding of heroic neonatal care until 2004+ (e.g, la loi Leonetti, etc), whereas the US regularly refused such care until 1984 and then enacted statutory allowances for refusing futile neonatal care in 1986 (Baby Doe revised). Also see the Texas Advance Directives Act of 1999 and withdrawal of futile neonatal care pursuant to it.

In fact, France still does not allow withholding of nutrition and fluids from an infant not on a ventilator, a practice that is permissible in the US when care is deemed futile.

If you want an example of a state that practices more aggressive withholding of care in the NICU, look at the Netherlands, which has a private insurance model more akin to the US. According to the Nuffield report on neonatal medicine, "In the Netherlands, a consensus had been reached by 2003 that ... Dutch perinatal centers should not normally resuscitate and treat extremely premature babies born before 25 weeks of gestation, because of poor outcomes."

According to the report, the difference between the US model and the Netherlands could be seen in that twice as many premature infants born in the US survived to the age of two, but in the US five times as many premature infants had disabling cerebral palsy.

Where does this myth come from that universal healthcare systems like the European ones deny coverage for black swan events? They don't. What procedures are covered has little to do with whether the system is single payer or not.

I have a relative who works in a NICU. A 1 in 3 chance of death is actually pretty good odds (relatively speaking) for a premature baby in intensive care, so no, socialized medicine would not have killed this child.

Are you sure about that? France's Infant Mortality Rate is lower than the US.

France: 3.34 US: 5.90 (Per 1000 live births)

Source: https://www.cia.gov/library/publications/the-world-factbook/...

The assumption here being that a live birth is as likely in France as it is in the US. What we should be looking for is percentage of survival for infants born sub 25ish weeks or something like that (I don't have that data).

UPDATE: And as we see from this paper from the WHO, live birth in the US is not what it means in France, for example. In the US it's any sign of life, in France and Belgium it's living for some period of time: "it has also been common practice in several countries (e.g. Belgium, France, Spain) to register as live births only those infants who survived for a specified period beyond birth"

http://www.who.int/bulletin/volumes/86/6/07-043471/en/

Those statistics aren't exactly Apples to Apples between countries. There are just too many ways countries can cheat.

For instance, some countries (like France) ignore births before x weeks whereas most countries (including the U.S.) include all births.

Beyond that, the U.S. leads the world in premature birth survival despite also leading the world in assisting people with fertility problems to become pregnant and add to the statistics that on the surface seem problematic for the U.S.

http://www.cdc.gov/nchs/data/databriefs/db23.htm

Even your own data completely undermines your point. All those other countries have very comparable preterm infant mortality rates when measured against the US. You say the girl "likely" would have died in France, but in Norway and Sweden (two of the most socialist countries in the world) the girl would have had a better chance of surviving at 25 weeks. By your own data that is supposedly proving the ineffectiveness of single payer healthcare.

Go back to Fox News where people don't actually care about facts if you want to make sensational arguments with zero evidence.

Except for the part where this is 37 weeks and not 25 weeks which is 30% of the entire duration of pregnancy. The story is from AOL is at the 5 month mark which means it could be even earlier than that.

Can't go back to watching Fox News because I don't have a TV. Nice, red herring, though.

.. and in the universal-healthcare UK, my brother survived being 12 weeks premature.

Do you have a cite for the French system, specifically that withdrawal of care in NICU? English or French will be fine.

In the UK they give services, and reasses on an ongoing basis, so different than the French. Added some info for under 37 weeks, where the US comes out on top.

So are you admitting that your original point about single payer healthcare is totally BS? Because the UK has single payer and apparently you think they do a decent job with this situation.

My first comment was directly pertinent to the French model, but same for UK--US survival rates are higher for sub 37 week old babies.

If you had government mandated "socialised" health care like the majority of the developed world, the actual cost to provide health care would have been nowhere near as much.

I cannot fathom that people accept "12 to 18 $K" as a reasonable amount of money for health care.

Got reliable sources for that claim?

> in these sorts of cases withhold NICU services for infants with statistically low outcomes

Do you have any source for these claims?

It's not super recent, but this paper discusses attitudes in the U.S.:

http://pediatrics.aappublications.org/content/120/3/519.full...

It sounds like 23 weeks and 500 grams are (were in 2007?) important benchmarks.

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