Five Myths About Health Care Around the World | Hacker News Reader

Five Myths About Health Care Around the World

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34 pointstimf26 comments

Nevertheless, the formulation that insurer profits account for the difference is simplistic and, in itself, woefully inadequate.

Health insurance isn't a business with such fat margins as to account for a difference between a $1500 MRI and a $98 MRI, say. That's the kind of rate the doctor charges the insurer, which in turn passes it on in a derivative way. The insurer is the customer.

Now, why doesn't an MRI cost something batshit insane like $1500 in other countries where the practitioners are also private? That's an interesting question. I don't think the cost controlling abilities of government committees or agencies account for the whole story; historically, committees of any kind - in the public or private sector - are pretty bad at keeping a lid on costs.

Still, I'd point the finger much more at doctors' profits than insurers' profits, though obviously neither is irrelevant.

I think this rather famous article treats of the matter fairly well:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...

Some of the cost goes to profit/shareholders, but most of it's just pissed right down the drain with our 20% administrative rate.

Things about radeology and prices:

Many people are not aware but it makes a BIG difference what radeologist you go to. The radeologist is the person who distinguises between a normal and abnormal growths. This is the specialist that can spot a tumor in a haystack! So you are paying for skills just like you pay for a surgeon, and no less important.

In new york I haven't seen 1500 radeologists unless I go to some rich-people places. I pay about 400 bucks for my brain mris. Fortunately the insurance covers most of it. The price is for the doctor, the machine time (hey its an expensive machine), operator time, etc. Though some machines work much faster than others. (a 5-10 minute procedure vs a 30-50 minute one).

And don't forget, lots of the great prices of lawyers suing doctors for everything are passed right on to you. And the fact that some americans are uninsured and have to be treated at hospitals means that those who are paying get to be charged extra to offset the problem.

So yea a universal health care system would benefit everyone and drive down prices.

According to WHO's Health Report 2008, Taijikistan has the most cost-effective health care in the world.

They achieve the same health-adjusted life expectancy (HALE) as the US, but with less than $100 spent per capita, compared to above $2500 of the US.

"For what and for whom money is spent matters considerably. Particularly in countries where the envelope for health is very small, every dollar that is allocated sub-optimally seems to make a disproportionate difference."

Ref: http://www.who.int/whr/2008/whr08_en.pdf (page 30)

"Instead of dismissing these models as "socialist...." Is 'socialist' such a dirty word to the author, who also describes these countries as "developed democracies" in the same sentence? I actually find this quite shocking. Give me the British NHS any day over the American health care system.

There are many, many flaws in the NHS, but what it does is pretty awesome, even if a lot of the time it's not perfect.

The Bugle (http://www.timesonline.co.uk/tol/news/world/us_and_americas/...) pointed out quite correctly that until the US started talking smack about the NHS, bitching about the NHS was a favorite past time of the British. Now it seems that everyone is up in arms defending it.

I lived in the UK for many years and have both good and bad experiences with them. I think as a general rule NHS and similar appear fine to you if all that happens to you are routine patches and checkups.

But if something really bad happens like cancer or the like, you really want to be in the US where there are more advanced treatments. This is also why you always hear about fundraising events to send children with rare cancers to the US. There are many things wrong with the US health care system, but none of those things change the fact the the US still have the highest level of advanced care in the world.

And oh yes "Socialist" is a dirty word. According to U of Hawaii Socialists killed nearly 170 million people in the 20th century (http://www.hawaii.edu/powerkills/20TH.HTM). That would qualify it as a dirty word. To create an egalitarian socialist society with job safety and free health care for all you must create a web of control and get rid of all the annoying people such as small businessmen, farmers and intellectuals might prove your ideas are wrong.

Now Western European Socialism (I spent 6 of my formative years in the Social Democratic Youth in Denmark and was a true believer) is not out to kill off their opponents, rather they bribe them to convert over to the dark side. In my country an incredible 55% of voters receive their primary income from the government, as you can imagine even the "right" don't dare to propose real changes. I have heard similar figures for the UK.

Besides to make a "socialist" welfare state economically viable you need conformance. This comes with a huge loss of privacy. Tony Blair created an incredible surveillance state, Hitler and Stalin would have been proud.

Contact Point the social services database of all UK children and their school and medical activities went live a few months ago, to make sure no one falls through the cracks. UK parents are supposed to be happy that the database is only available to 390,000 individuals. Sorry that scares the hell out of me.

I believe

    * Socialism = Preventing race to bottom
    * Capitalism = Promoting race to top

You can't really have a race to the top. That type of competition "narrows" the top. The race becomes an illusion.

In the US, "socialism" is one of those push-button emotional words that immediately ends a debate. There's probably a parallel to Godwin's Law: As the length of a conversation about US health care increases, the probability of labeling any change to the status quo as "socialist" approaches one.

This gave me the strong desire to learn a lot more about how the Japanese manage health care.

In Japan, waiting times are so short that most patients don't bother to make an appointment.

At my local hospital they stop taking new appointments for the day at 10:30 in the morning, sharp, because they're booked by that point. I got myself there at 11:00 while severely ill, was told by the receptionist to come back tomorrow, stupidly decided to walk home rather than protesting or calling a cab or ambulance, and very nearly passed out in the middle. A coworker wondering why I didn't come into work dropped by my house, found me, and took me across town to a different hospital.

Aside from nearly dying in the street despite having both insurance and ample means to pay for treatment, my experience with Japanese healthcare has been mostly positive.

P.S. Don't get me started on dentistry, though.

Sounds (but is not clear) like maybe you were trying to get 'regular' care rather than emergency care, and that the receptionist didn't bother trying to check whether the latter might indeed have been needed, and you thought "well, I guess I can wait..." or something like that. That sort of thing can happen anywhere, I think.

Or are the Japanese so organized that they make appointments for emergency care?:-)

Medical care is not bad here in Italy, but has some drawbacks compared to the US. On the other hand, you really have "peace of mind" in the sense of not having to worry about it at all. You go to the doctor and you get fixed up, end of story. Austria's system seemed a bit more complex (mostly because I never learned the language very well, I suppose), but better than Italy's. I think it's a German/Swiss style system with non-profit insurers that everyone has to have, which seems to be a bit roundabout, but apparently works well.

Padova is a bit of a special case, because there's a big medical University, so there are actually some very good doctors in certain fields, it's just the "extras" aren't nearly as good in the US: more people per room, shoddier looking stuff.

And a final note: I walked into our local doctor's office this morning because of a bad cough, and the guy didn't have time to see me because I got there near the end of his office hours, but I think that's less of a system thing than this guy being a dick (my wife didn't like him either), so we'll change doctors if the local Death Panel lets us. In reality, we don't have to ask anyone, we can just switch.

Dentistry's pretty bad anywhere.

I have noticed this too - does anyone know why? In the UK, the NHS provides excellent healthcare for everything except dentistry, which is noticeably poorer in both availability and (arguably) quality.

As far as I can see, dentistry has seen very little innovation since the invention of pneumatic drills and amalgam filling by the Victorians over a century ago - 'modern' dentistry is basically just an electrified version of that. The only other noticeable improvements, except fluoride toothpaste, are slightly updated versions of those same basic technologies, or have just been borrowed directly from general medicine, where all the research and innovation seems to take place.

Given that, even on subsidized NHS rates, dentistry is expensive (and massively so without) - why is this?

dentistry has seen very little innovation

I'm only 27, but I've seen significant innovation in my lifetime. In America at least, they've made the filling of cavities less time consuming, stressful, and painful. (They have this little das blinkenlights contraption that can auto-harden a paste in your mouth.) They've also got some real improvements in cosmetic dentistry -- invisi-braces, for example. Retainer technology is apparently getting better, too.

In Japan, they have the tech but the payment system is severely borked, so getting a routine teeth-cleaning takes four days, one per quadrant, because they get paid based on patient-days not based on procedures performed. I had to have 3 cavities filled and a routine cleaning. I was quoted 6 visits, and bargained him down to merely 4. I still have to go to the last 2, because I can't justify that much time off of work when its a simple in-and-out anywhere in the US. (Paying cash, naturally.)

Yes, there is UV hardening resin - but this is just a slightly improved version of the old amalgam fillings - and does the same job: drill hole, fill with stuff. It's considered better in that it doesn't contain heavy metals, but worse because the silver in amalgam prevents bacterial growth under the fillings and the resin is harder to apply properly.

Maybe the issues with dentistry are just because of the financial incentives. The UK NHS used to pay dentists per treatment course but have recently changed to some kind of per patient/treatment hybrid system (http://news.bbc.co.uk/1/hi/health/7485012.stm). The old pay-per-treatment system was a) complex and b) unsurprisingly, led to a 'drill and fill' culture of lots of treatments, most of which tended to be fillings. Things have changed and got much simpler, but it's arguable if it's 'better' overall.

Maybe it's just because dentists are on piecework? If A&E/ER/emergency medicine departments were paid so much per stitch, then I guess everyone would come out looking like Frankenstein's monster.

interesting story. Do you think it would have made a difference if they felt your illness was an "emergency"? Even in the U.S. paying out of pocket for a well respected doctor, you still have to wait for an appointment. The only way you really get immediate treatment just about anywhere is to go to an emergency room and let them prioritize based on who's there at the time.

Interesting, but not entirely new.

One thing, I've heard before that removing profits does not stifle innovation, but the economics/game theoretic argument (essentially lack of motivation) seems convincing. I'd be interested to see if anyone has an explanation for the continuing innovation.

If everyone has to use the cheapest tech, that basically means they're forced to be your customers if you invent a cheaper and/or more efficient way of performing something. That'd be a pretty good incentive for innovation - a free customer base and a monopoly in return for a good innovation (until someone else thinks of an even better way).

I'd guess that since quite a bit of research is funded through universities by government grant that you'll still see a trickle of new tech. of course you can never know whether you would have had more innovation given competition.

University researchers are quite competitive. Whether the price is money or professional fame shouldn't make much of a difference in that sense. It might change the types of people that choose to play the game though.

right but the ultimate reward isn't geared towards results, but rather towards pleasing the grant approval process. see the other big discussion thread about open sourcing research results.

You can invent something in the UK and run a bunch of trials there, then make your profits by selling it in the US market.

Scarcity creates innovation.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.).

This seems highly suspect. Even if the Japanese labs invented this technique, why aren't American labs using it? There are few organizations that won't adopt an obvious, proven way to save 93% in costs.

> In Japan, the identical scan costs $98.

I don't doubt that the marginal cost of doing a scan (including the amortized the cost of the machine) is significantly less than $98, but who is interpreting the results?

I note that medical equipment in the US must be used under the supervision of an MD and often in a regulated environment (read hospital). If an MRI could be installed in a gas station, they'd be quite cheap.

However, increased govt regulation of health care isn't going to make that possible.

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