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Comment by viggity | Hacker News Reader

I support health care reforms, but the only reforms I support involve reducing the government's role, not massively increasing it. Things like policy portability, a greater ability to create risk pools, the ability to buy policies originating in a different state and the simplification of red tape and bureaucracy.

The currently proposed health care reforms try to ignore the laws of supply and demand because they don't seem fair. But as we found out in the 70's with gasoline price controls, it is better that 10% of people don't get a service because they can't afford it than 60% of people not getting a service because it isn't available.

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But that doesn't reflect the reality of health care throughout the western world. I'm an American who lives in Europe. The health care is not comparable. The Czech Republic, where I live now, has infinitely better health care and no one is denied "a service because it isn't available." Trust me.

This is one of the big problems America faces: it has been so successful for so long, that it thinks it can't learn from anyone else -- that it has all the answers. It's how big firms fail, and countries are no different.

Please tell me how a health care in Easter Europe has a better quality than here in US? I agree healthcare system here in US needs reforms and in my opinion the problem is that it is insurance based, but the quality is the best - I can tell from personal experience - living in Eastern Europe, then Western Europe and now in US.

I'm not sure how long you lived in each of these places. The infant mortality rate (deaths per 1,000) is a popular metric among those in the industry, and in the Czech Republic it's 3.8; in America, it's 6.3. In the Czech Republic everyone is covered. There's no way to lose a house, a car, or even a chunk of savings over some expensive operation. There's no "qualification"; no one is turned down or turned away. Rich or poor, you're simply covered.

Infant mortality rates are not a fair metric for comparison because the point of viability is significantly earlier in the US that in most other countries in the world. When adjusted, US infant mortality rates are some of the best in the world. The US is also one of the best in terms of experimental treatments, emergency room care, cutting edge surgery techniques and specialty care for diseases such as cancer. The downside is that care is generally more costly in the US, but there is a reason why the wealthy individuals in many other countries come to the US when they need heart surgery etc. The challenge of reform will by to preserve the really innovative and successful aspects of the US health care system, while expanding coverage affordably.

Infant mortality rates are not a fair metric for comparison because the point of viability is significantly earlier in the US that in most other countries in the world.

People may not know what this means so I'll spell it out for you: a baby born three months premature to a drug-addled mother is very unlikely to survive. In the U.S., that baby will be treated and damn the cost. In most other countries, that baby will be scored as a miscarriage (i.e. not the hospital's fault) if it dies. It receives care accordingly.

You know the saying "We only improve what we measure?" Many countries do not measure the healthcare of severely premature infants.

This is a good thing to keep in mind the next time you hear about "rationing", because this difference is the rationing that dare not speak its name. After all, if they're not acknowledged to be human quite yet, then if you withhold care to them it isn't rationing.

While that's a very interesting point, and I haven't heard it before so I'll look it up, my main point remains. Because of socialized health care, other countries can focus on prevention, which is much cheaper and effective then dumping money and effort at the point of crisis.

A quick anecdote: my friend and I here were laughing because in both cases our pregnant wives went to the doctor about a small concern and were put in the hospital for a week for testing. But I thought about it later, and that wouldn't happen in America. You're churned out as fast as possible. The great side effect, and I think you'll see this on infant mortality rates as well, despite what you've said, is that if health care is free, people use it earlier than the crisis point. And that's cheaper and better for everyone.

Prevention does not save money.

Or rather, it saves money for the individual who has something worthy of being prevented. For that person, it's much easier to find something and/or prevent it early rather than wait until it gets serious. This is why prevention seems like such a common sense thing.

For society at large, however, testing and servicing all of the other people -- the people who never will get the thing you're trying to prevent -- ends up spending more than the treating person who got it later.

It's one of those things that sounds good when you say it, but the statistics don't back it up.

That's a horribly spurious statement. What statistics? What the hell kind of statistics can you have that would back up something like that? 1) It depends on how you do the prevention, and how you handle the event itself. 2) A lot of people would probably die without preventative measures, making it very cheap indeed. 3) What is the point of medicine if we afraid it's going to cost more? Medicine is about preventing.

But it's not more expensive. Most European countries spend much less on health care, but much more on prevention. It's very effective, and at the end of the day, it's really what medicine is about.

Here's an article written before the current debate

http://www.medscape.com/viewarticle/540199

...After all the consequences are accounted for, very few services of any kind save more money than the cost incurred. Childhood vaccines are among the rare examples that actually are cost-saving...

Of course, there's more to universal health care than just saving money. Once you politicize it, it's more about doing and saying things to keep those votes coming in.

I lived a long enough to know and I don't know about metrics but about real living.

Not sure about "everyone covered" part because in other Eastern Europe countries if you don't pay in cash nobody is looking at you. I don't believe the Czech are more advanced.

The official "coverage" is a myth. If you are over 60 better don't go in hospital because the "policy" is to increase the mortality rate. Why - because the government do not have to pay the pension. Don't believe it? My wife is talking with her mother every Saturday by the phone and I know how it is.

Do you believe a simple over the counter medicine for arthritis is considered a miracle there? This is what many people here in US do not know - here in US we have the best medications that are really effective when compared with medications from other countries.

The technology - this is beyond comparison - for example the scanners - in Eastern Europe there is 1 scanner to probably 1 mil people.

These are the facts I have from personal experience.

That's funny. I'm talking about the Czech Republic. You are countering with some stories of some miserably poor country in Eastern Europe (yes a few of them still exist). I don't know where it is you're talking about, but God bless them.

Apples oranges. Compare Czech republic to the Minneapolis metro. I don't actually know the numbers, but I bet Czech republic loses.

These low immigration, long industrialized European nations are NOT comparable to the US as a whole. Huge swathes of the US were borderline feudal agriculture all of 80 years ago. The populations are very different and it has nothing to do with health care.

I'm confused. You say you support reforming healthcare by reducing the role of government, but what exactly do you mean by this? Reducing medicare? medicaid (although that is more of a state run program)?

Perhaps you could enlighten me by specifying what exactly you'd like to reduce, and what you hope to achieve? (Note: statements such as "reduce government involvement" are soundbites, not answers).

What are you talking about? I gave 3 very specific examples in my post.

Quote: Things like policy portability, a greater ability to create risk pools, the ability to buy policies originating in a different state.

The Government restricts all of these things.

In addition, the government could drastically reduce the barriers to creating new drugs and treatments. Do these barriers save some lives: yes. But they end up killing many more because the FDA is always going to error on the side of caution, thereby denying the treatments that work to people who desperately need them.

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