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US health system ranks last compared with peer nations – report
- alexbadinici 2y ago[dead]
- naming_the_user 2y agoWhat does the ranking look like if you compare percentiles? Naively I would assume as a non-American that if you're in the top 20% by income in the US you end up much better off than the top 20% income Brit, for example. Or is it just actually worse for everyone? It feels intuitively obvious that the average will be worse because, well, the average person is skint and the US is less socialist.
- shiroiushi 2y agoIf you're a billionaire or close to it, the US healthcare system is fantastic, unless of course you're traveling in one of the "medical deserts" and have an acute emergency.
- brtkdotse 2y agoIf you’re a billionaire EVERYTHING is fantastic.
- shiroiushi 2y agoNot necessarily: if you're famous, you might have a hard time going out in public.
- highwaylights 2y agoHire your own public and make them act normal when you’re around.
- ben_w 2y agoI think that's more a problem with being famous: the top of the Wikipedia list* as I write this is "Bernard Arnault & family", who I've never heard of and therefore couldn't spot in a lineup much less a crowd. But I did double-take when walking past Russell T Davis (or a lookalike) in Sheffield a decade and a half ago, and Richard Osman in Cambridge train station some other time. * https://en.wikipedia.org/wiki/The_World's_Billionaires https://en.wikipedia.org/wiki/The_World's_Billionaires
- shiroiushi 2y agoThat's why I said "if". Some billionaires are not well-known publicly, and then there's Elon Musk or Bill Gates.
- ben_w 2y agoIndeed, though I think he likes it that way, and that it's a choice.
- MrDresden 2y agoThere are 2781 billioners in the world (according to first search result). I'm fairly sure most of those can go out for dinner or drinks and no one would know who they were.
- impossiblefork 2y agoYou'd still stuck with the built environment as it is, just as everybody else. A billion is just three Manhattan skyscrapers, so it can't change a city. Depending on where you live, you might well experience the exhaust, dust and noise of these environments, no matter how luxurious your individual dwelling.
- trimethylpurine 2y agoThe US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills. In all cases treatment is required by law, regardless of payment.
- shiroiushi 2y ago>In all cases treatment is required by law, regardless of payment. No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for free.
- trimethylpurine 2y agoI'm not sure where this is happening, and I'm not saying you're wrong, but where I live, doctors are paid salary and they care for patients, so from my perspective what you're referring to sounds like a myth. My friends, who are doctors, operate all the time on people who have no identification and they do their absolute best. And there is no monetary incentive to do otherwise and they would quit and find a different hospital if there were. Anecdotal? Maybe. I'm open to hear from a doctor that says otherwise. As best I can tell, the medical community and education system would reject a doctor in the US from licensure for any other attitude towards health care.
- shiroiushi 2y agoDoctors have absolutely nothing to do with who gets care and who doesn't: that's controlled by hospital administration and other hospital staff. The doctors are just employees. When was the last time you saw a doctor in the ER reception room talking to new arrivals and deciding if they need to see a doctor or not?
- zjp 2y agoAlso: an unironic 1%-er income in France is like literally the bottom of the barrel Bay Area salary. If you're at or above the median America is great, outside of some very high cost of living cities.
- naming_the_user 2y agoYeah, I've always found the "meme" of the 1% kind of amusing. The 95th percentile US taxpayer earns as much as the 99th percentile Brit. Huge, huge difference.
- HPsquared 2y agoThe the UK is quite "unequal pay" as far as Europe goes.
- chgs 2y agoReally teachers and baristas and builders get paid more than 99% of people in France Or are you just talking specific tech jobs.
- deleted 2y ago[deleted]
- MediumOwl 2y agoAccording to this article (https://www.lemonde.fr/en/france/article/2022/06/03/france-has-4-5-million-rich-people_5985520_7.html https://www.lemonde.fr/en/france/article/2022/06/03/france-h...), top 1% earner in France in 2021 was 7180€ monthly, so ~8000$.
- vidarh 2y agoAs someone in the UK with income in the top 1%, I have never bothered with private insurance because I genuinely don't feel I need it. I occasionally pay for private GP services, and I've paid for some private services for my son, but for the most part the NHS works. It has waiting times for non-essential things, and if you don't want that, you can pay for insurance that gets you seen faster and it costs a pittance. But if you need treatment, you get it. Overall, paying cash for healthcare here is also so much cheaper that for Americans, for elective procedures with short-ish recovery, flying to London can be a cost-effective option compared to US hospitals. I'm sure that if you're rich enough, you have fantastic care available in the US, but from what I've seen of prices for pretty basic stuff, I'm not so convinced most of the top 20% in the US have healthcare I'd consider tolerable.
- mytailorisrich 2y agoAs soon as you need treatment beyond standard GP/prescriptions, like checks/analyses or specialised consultation/treatment then private insurance comes very handy to get good care quickly. Waiting times are not only for non-essential things. The only thing with no waiting time is A&E if you are in immediate danger of death. The NHS is some "safety net" that does the bare minimum at this point, or no longer anything at all (eg. dentistry). Interestingly, nowadays if you have a good job and private insurance in China you get better routine checks than in Europe/UK. Even Chinese hospitals are extremely thorough and quick compared to British ones (at least the main Chinese cities)
- vidarh 2y agoI have had extensive rounds of tests for various things with the NHS over the last several years, and never had a problem sufficient to feel private insurance, even as cheap as it is in the UK, to be worth it. I don't doubt it's worth it for some, but there's a reason - and while costs will stop some, costs does not explain nearly all of it, given how cheap it is - that only about 10% of the UK population has private insurance, even with the underfunding of the NHS in recent years (e.g. 20%-30% lower healthcare spend for capita PPP adjusted than comparable economies does have an effect). There's an inflection point, sure, where you start spending enough privately that the insurance is worth it, but so many of these things are so cheap here anyway that the gap from between where it starts to pay off until you're ill enough to get reasonably fast treatment with the NHS is quite narrow. Sometimes people think it is wider than it really is because people want and push for treatments that are not medically indicated. E.g. patients pushing for pointless MRIs is common enough that same-day MRIs is a huge industry here even though they only make an impact on outcomes for very specific symptoms.
- deleted 2y ago[deleted]
- jimbob45 2y agoIt's unfair to judge the EU piecewise but then judge the US as a whole. Either let us compare apples to apples by judging the whole EU against the US or let us judge individual European member states against individual US states.
- c1sc0 2y agoWhy? Europe is a collection of sovereign nations, not a federation of states like the US?
- daanvd 2y agoAha! But Germany is also a federation. So it's only fair to compare Alabama to Saarland. Oh, wait...
- ben_w 2y agoWell, Bavaria is famously the Texas of Germany…
- short_sells_poo 2y agoDoes the Bavarian power grid also routinely go down because they don't invest in it and at the same time also refuse to add interconnects with other regions?
- ben_w 2y agoNot sure, but I think the grid integration is international with significant connections to e.g. France, rather than federal states within DE having their own thing? More that the stereotypes people have of Germany/USA are really of Bavaria/Texas (beef, guns, lederhosen), more (small c) conservative, and there are occasional mumbles and grumbles of independence but they don't have any substance to them. At least, that's what it seems. My grasp of German means there's a game of telephone between reality and my understanding of Bavaria, and I've never even been to Texas so I'm judging them by what people say online.
- fuckyah 2y agoI'm sure it has nothing to do with the almost ~100 vaccine doses children are being subjected here...
- ein0p 2y agoLately I can’t even get a doctor - both the specialist and primary care doctors are booked months in advance. And I have one of the best insurance coverages currently available. Remember how we laughed at Canadians and Brits waiting for months to see their free/cheap doctors? Well we’re at a point where we have to wait _and_ pay through the nose. And then they can’t really do anything or fuck you up even worse.
- usr1106 2y agoYou forgot to mention what country you are talking about. That seems to be American. Difficulties to get an appointment is also common in at least some areas of the EU countries I am familiar with.
- Simon_ORourke 2y agoSame here - and I'm always left wondering what manner of trivial/cosmetic cases are taking up these bookings and leaving more urgent medical cases to wait.
- vidarh 2y agoNot that I'm trying to make you feel worse about it: In the UK we pay less per capita in taxes toward healthcare than you do in the US (or at least did last I added up the numbers - Medicare and Medicaid alone added up to a higher per capita cost than the NHS), and if we do want private health insurance, which here is basically "queue skip insurance", it costs a fraction of in the US because they only need to provide the "extras" - you'll normally try your NHS GP first, call your insurer if you can't get an appointment, or ask them to refer you privately for things there are queues to get done on the NHS. For a lot of elective procedures, the price is even low enough that it'd pay you to fly to the UK and stay in a hotel to get things done here if the recovery isn't too long.
- deleted 2y ago[deleted]
- cat_plus_plus 2y agoBecause we are paying for the rest of the world. Allow prescription drug imports from abroad. Pharma companies will be forced to charge more in the rest of the world and less in US. Allow insurance plans based on medical tourism for expensive procedures. Some countries will say no, but a lot of countries will say yes for profit. Once you have a choice of a hip replacement in Mexico or India, hospitals in these countries will compete for safety, cost, pleasant aftercare. Let's stop being the suckers.
- jraby3 2y agoA huge portion of our healthcare goes to paying health insurance providers, high rates for pharmaceuticals, and hospitals. There's a reason these industries in the US are some of the most profitable. They act as middle men and make massive profits.
- croes 2y agoBecause everything else is communism according to many US citizens.
- shiroiushi 2y ago>Once you have a choice of a hip replacement in Mexico or India This is already being done actually.
- croes 2y ago>Because we are paying for the rest of the world Don't blame a domestic problem on the rest of the world
- ahoef 2y agoSo is the EU. Most of it goes to stockholders.
- croes 2y agoThe US is a completely different level.
- arjie 2y agoOne thing that's surprised me about the US is the general slowness of most things. In India, you can get MRIs and CT Scans same day. Or you could the last time I was there. And it didn't cost very much in comparison. My doctors have all been good (attested to by my parents who are surgeons themselves) but the healthcare system is wonky. One thing I didn't expect is that the Indian system where you just drag your health records around paper copy yourself is superior to US EMR systems - which doctors seem to always have trouble with. But now I have some friends in medicine and I always have them pull my records and keep a copy myself. It's usually a fax but it's better that way. Clearly electronic interop isn't working most of the time.
- rscho 2y agoElectronic health records have dismal ergonomy, usually. They're profiled for billing performance instead of care performance.
- askonomm 2y agoIn Estonia all of our records (incl. Health) are digitized and online in a central system that both doctors and you can access. It works wonders. Every doctor I go to can see my entire medical history with a press of a button, and I don't have to deal with any of that. Likewise when they prescribe new things, I can see my prescriptions right there, and so forth. We're a 100% online nation now, and clearly when done well it's remarkably good.
- diogenescynic 2y agoQuality of care is shit. Doctors barely care about their patients. It’s all a racket. Most areas seem to have a local monopoly that takes over the local hospitals. Obamacare has done nothing to really change anything meaningfully.
- DavidPeiffer 2y agoObamacare is a mixed bag, but I don't think I'd go back to a pre-obamacare era if I had a choice. So many people stayed at jobs for longer than ideal because they had pre-existing conditions that wouldn't be covered under a new insurance plan. The consolidation of the last 20 years has been a real black mark on the system. It was supposed to improve outcomes by making all the records easily available in one system. Instead we've seen the independent doctors office largely go by the wayside and local competition decrease. Not all outcomes are comparable or worse though. The outcomes most improved seem to be net worth of executives.
- fellowniusmonk 2y agoPre ACA was absolutely insane. Literally any change would have been better. The artificially limited and abusive process of training doctors is still completely broken. The training pipeline is pure protectionism. The rise of nurse practitioners and the creep of doctor like responsibilities for nurses is a sign of the complete failure of our doctor training pipeline. Approximately each year we have 1 doctor finishing residency for every 120 births, compare that to Portugal which has 1 new doctor for every 57 births. Horrible individual, family and economy destroying things from pre-ACA: 1. Because I wasn't born with a perfect body I was literally forced to work for a company until ACA because I was uninsurable. I started my first successful startup immediately after ACA became law with an idea I had fully fleshed out a decade prior. It's a horrid drag on the economy to introduce infinite health (and bankruptcy) risk to any attempt to be an entrepreneur. 2. If you WERE ever eligible for private insurance and every stopped paying for it (because you had insurance through your company) you were unable to quit that job and go back to private coverage, if you tried you would be denied if you weren't in perfect health. Fully contiguous coverage would still get you fully denied for "pre-existing conditions". Coverage was not guaranteed to transfer between states. 3. My family was bankrupted and financially destroyed because my mother was diagnosed with cancer during a short interstitial period where the company my father was working for suddenly went out of business and keeping cobra would have cost 15k a month so they didn't. It was so messed up she qualified for state medicare but that meant that my families income couldn't be above ~15k, my parents only option for my dad to get a normal paying job was to divorce (which they refused to do on religious grounds), this meant that I had to enter the workforce full-time to pay for my family to have a roof and food over their heads at 15. Even though so much of the brunt of this was put on my childhood shoulders I was able to make it out ok all things considered because I am a complete bastard of a person, my siblings who were less resilient were absolutely destroyed, we were all in the top 10% of intelligence based on standardized testing. The pre ACA system was a kafkaesque nightmare that was completely different state to state so many people found themselves unable to move states for work because coverage and eligibility was effectively unparsable between states for the laymen.
- Madmallard 2y agoSo how do you get complex necessary medical care effectively in the United States?
- s5300 2y ago[dead]
- l5870uoo9y 2y agoThe UK performs better (third place) than, for example, Germany (second last place). The UK's healthcare system is often heavily criticized as being on the brink of collapse - any explanation for this?
- wickedsight 2y ago> any explanation for this? Everything is relative. Most people only use health care in their own countries and therefore can only compare to another time in their own country. So if it used to be better in the UK, it might feel really bad now. If it's always been meh in Germany, it probably feels ok there, since it's always been that way. Also, populism. Healthcare is a major point in the UK elections. It's been a major talking point for the left that healthcare is awful now due to bad policy by the right. Something doesn't have to be objectively true for people to feel like it is true. Just like everyone always thinks crime is up even when it's down.
- xvector 2y ago> It's been a major talking point [...] doesn't have to be objectively true for people to feel like it is true. Just like everyone always thinks crime is up even when it's down. I'm sorry, but no. It's not just a talking point. As someone with family in both countries, as well as having parents that have worked in both medical systems: The NHS waiting lists are genuinely bad and this isn't all in peoples' heads. It's not even a "left vs right" issue; no one thinks the system is working right now.
- hnbad 2y ago> It's not even a "left vs right" issue; no one thinks the system is working right now. That's true but as always the difference between left vs right (populism) is not what is being said but what the proposed solution is. This goes for many things: healthcare, immigration, poverty, etc. The issues are hot button topics but the proposed or implied solutions vary drastically. Alas of course the left in countries like the UK and Germany have become very centrist and instead of proposing different solutions from the right often join the moderate conservatives in suggesting what the right says "but less". This results in aimless reformism, means testing and bureaucracy which further feeds into far right populism by demonstrating "the left" as incompetent.
- croes 2y agoSo Australia the #1 has the best outcome but is second to last in access to care? Sounds like a lottery. If you win a place it's good otherwise not.
- kidsil 2y agoI find it hard to trust a report that puts Canada above Germany in any healthcare related ranking. In terms of access, quality, and coverage, there's absolutely no comparison.
- timbit42 2y agoWhere did it put Canada above Germany? All it has is a list but doesn't claim it is in any order except they are all above the United States.
- davidguetta 2y agoYeah that's the funny part: in the US you should pay thousands of dollars for the basic exam / ambulance ride and many people don't have coverage while in entirety of europe is basically free, but the US gov is still paying 50% more in GDP than the other
- alpineidyll3 2y agoThe US likes to pretend free markets are our principle, but we have completely destroyed every notion of a free two-sided market on healthcare. That's the simple explanation for our outcome.
- Private1ant419 2y ago[dead]