It's 2023. You shouldn't have to struggle as much as you have to just for basic necessities like shelter, food, medicine, education and utilities. This is true of most places in the world. It is sad. Because it doesn't have to be this way. There isn't a lack of resources. There's unequal and unjust distribution of resources.
There is absolutely a lack of resources when it comes to medical care. There aren't enough nurses, doctors, mental health professionals, specialized medical equipment, or in some instances even blood, to go around right now.
This "post scarcity" mentality isn't based on reality.
There's enough to go around in every country approaching a significant fraction of America's average per capita GDP. No structural reason America couldn't make it work either.
Not really no, those countries generally ration with very long wait times instead of by price. (Not defending the US system, which is 100% captured by special interest sleazebags, and in need of total regulatory overhaul. But there is no magic bullet to fix all problems here)
They generally have better health outcomes at the population level, so functionally speaking I think that's "plenty to go around" in the most useful sense of the term.
It's a matter of priorities. If we decide these things are important as a nation they don't have to be scarce. We make the best war machines on the planet and spend a lot of money on them. That is more of a priority than the good health of our nation.
A war machine can be built once and maintained for a long time. Medical care is a personal and time consuming process with multiple parties and tests that need to be coordinated across. All of this is expensive because for every person being given that time of day, there's someone else that needs it. There aren't enough hours in the day and smart people in the country to scale up healthcare.
Contrary to what we would like to believe, there is a scarcity of intelligent people willing to devote their entire lives to the study of medicine across specialties.
If you cannot afford it, the US healthcare is terrible. If you have the means to afford it, the US healthcare system is one of if not the best in the world.
The drivers of poor US life expectancy is mostly guns and cars. Cars are the #1 killer of Americans between 5 and 45 (approximately). That doesn’t have much to do with the medical system.
Someone dying a few years earlier than otherwise has a smaller impact on _life expectancy_ than someone dying young. Furthermore, the #1 cause is correlated with lifestyle factors which medical treatment has little control over.
You missed the point. Cancer and heart disease primary kill people when they're already old. Treatment of those diseases, while important and necessary, doesn't impact average life expectancy much either way. Whereas fentanyl overdoses are now the leading cause of death for adults 18 - 45. That has a huge impact on average life expectancy because those people would have otherwise lived many more years.
Your information is outdated. The rate of accidental death among younger adults due to opioid poisonings has increased significantly in just the last few years.
My primary assertion was that life expectancy does not inform you about the quality of the US medical system. I focused on guns and cars, but adding opioids (and even lifestyle issues like obesity) doesn’t change my argument or the conclusion.
It depends on which metric you look at. The USA is at or near the top in 5-year survival rates for most types of cancer. We also have unrivalled trauma care. In other metrics we're well many behind other developed countries.
Many of our worse outcomes though have nothing to do with the healthcare system. The decrease in life expectancy is being driven by factors like obesity, substance abuse, sedentary lifestyles, vehicle crashes, suicide, and violence.
survival rates are a pretty bad metric because you can easily change them by changing the amount of screening without making people live longer or healthier. when you compare cancer mortality rates, the US is not doing well.
Nope. Certain types of cancer screening are helpful in making people live longer and healthier. It is much easier to treat cancer when it is caught early.
Absolutely, but 5 survival rates are still a really bad metric because they make things look better even for uncurable cancer (or cancer that was curable but treatment was given up on because of price). Also, if a 90 year old gets a slow growing cancer that doesn't require treatment (cause they'll be dead before it's a problem), screening for it will increase survival rates even though you didn't actually treat anything.
I’m not at all convinced they look carefully at health outcome and cost efficiency metrics before deciding where to point their private jets. Instead, I’ll bet (in part) they use high cost as a surrogate for quality. And the immediate availability of any test or consultation they desire.
A big part of why we spend more is cultural and environmental. The government incentives encourage unhealthy food to be everywhere and subsidizes things like adding corn syrup products to everything. Policy also encourages driving instead of walking. And we've made it culturally acceptable to be fat. There are big movements trying to convince people their weight is not a problem, not something they have control over, and you can be "healthy at any size". Many doctors have stopped warning patients about their obesity because of social pressure not to fat shame! I started with a doctor like that when facing blood pressure and related issues and have since ditched them. Caring more about sensitivity, being accused of fat shaming, and expediency than my health is malpractice in my book.
> A war machine can be built once and maintained for a long time.
This might be true in theory but is somewhat irrelevant here given the gargantuan levels of waste in US military spending.
There is also gargantuan waste in healthcare costs, but those are spread out via insurance, not taxes.
The presence of gargantuan waste in both sectors and the different avenues of spending both make any after-the-fact, simplified explanation of why one costs more than the other kind of moot.
The presence of gargantuan waste should also be addressed before implying that the costs of healthcare are all presumed necessary.
> Contrary to what we would like to believe, there is a scarcity of intelligent people willing to devote their entire lives to the study of medicine across specialties
Why? Are money and social status insufficient motivators? Or is there another reason?
We spend 5-8x more on healthcare than defense. You have to ration somehow. If everyone use as much of the healthcare system as we wanted it would consume our society.
In the US, we ration by price… “the doctors expensive and I don’t feel too bad so I’m not going to go”. In Europe, they ration via lines… you’ll get your free healthcare eventually.
Either way there are problems, but seems like other countries might be onto something
We pay a lot for healthcare, but that money is not spent on healthcare.
It is an important distinction. For example, about 33% of healthcare dollars go to paying “claims proceesing” people at your insurance company and your doctors office to haggle with each other and produce duplicate paperwork.
If the low end of your estimate (5x) is the correct multiplier, the money that goes to claims processing would be enough to pay for universal healthcare in pretty much any other first world country.
Other things, like absurdly high drug prices, also are not healthcare spending. 90+% of drug discovery research money is spent at universities, and not by pharmaceutical companies. Also, those companies pay more for prescription drug advertising than for drug research.
Your numbers are way off. The Affordable Care Act capped the insurance company's share at 20% (minimum 80% medical loss ratio). In practice most commercial payers are taking less than that. Certainly nowhere near 33%.
I'm not sure what point you're trying to make about drug discovery research. The major expense in bringing a new drug to market is not in the basic research but in the phase-3 clinical trials. Those often cost pharmaceutical companies upwards of $1B now.
How much do pharmaceutical companies make off of that $1b investment though? The scale of the investment only matters if they don't have the capital to cover.
> It is an important distinction. For example, about 33% of healthcare dollars go to paying “claims proceesing” people at your insurance company and your doctors office to haggle with each other and produce duplicate paperwork.
This is not true, but there is a big non patient healthcare services culprit in US healthcare costs, and that is legal liability. In the US, every entity in the healthcare chain is doing so much extra to prevent themselves from being liable, and charging extra in case they are found liable, that it inflates all costs dramatically.
Without tort reform, I doubt we see much improvement.
Tort reform is a red herring here in that most insurance companies do things that they deserve to be sued over as a matter of routine, and they like to talk about ways to statutorily limit your right to sue them like having a system of complaints with a commissioner who has no time to process complaints. I think healthcare costs are a result of lots of different insane things that snowball rather than something simple like too many lawsuits.
Here in TX they put caps on awards for medical malpractice. As far as I can tell it hasn't helped costs all that much. Also if my Dr. leaves me paralyzed I can only get 500k damages. Malpractice law is a problem, but I don't think it's the one to focus on.
"90+% of drug discovery research money is spent at universities"
Afaik this is simply not true, and even if it was, this would be misleading if you consider that most costs are made during clinical trials, which test the effectiveness of the drug.
It’s a common argument that somehow people who live in countries with good health coverage have to wait a very long time for health services. Things that are not urgent, this can be true. And you can certainly hear anecdotes here and there about more serious problems. But most of the time for the vast majority of people in the vast majority of situations, healthcare is delivered when it’s needed, on time, without dangerous delay. This talking point that somehow elevates the American approach because it is faster is misguided.
There is no country on the planet that doesn't have a scarcity of medical resources. In fact there is an entire set of academics devoted to the appropriate utilization of medical resources - healthcare economics.
The US medical system has been systematically optimized for extracting the maximum possible amount of money from every patient, part of which is artificially restricting available supply of medical care (although things are slightly getting better in that regard with practicing nurses and PAs)
The other thing it was optimized for was hiding this from the patients.
And only now, in 2023 are we beginning to see the horrible extent of this, because of price transparency rules.
Are you trying to argue that beneficiaries of tax-funded systems like roads, medicare, unemployment, etc don’t pay taxes? Because everyone in the US pays some kind of tax to fund something unless they’re not an adult yet. I’ve worked with several very competent people who were on unemployment at some point but who also paid into unemployment for most of their lives.
Sure, everyone pays taxes. I'm pretty well set and I'm still not sure I'll ever pay enough in taxes to cover one of those famous US hospital bills.
Then again, it should be matter of at least a majority agreement that things like that should be paid from taxes, and it's obvious that in the US the agreement is not there.
> someone should be working to provide you with medicine, education…
Are you seriously arguing against taxpayer-funded education? As broken as U.S. public education is, managed as it is by hyper-local, ideologically-motivated officials, withdrawing the opportunity to raise one’s lot in life through community-funded education would be pretty dystopian.
Or perhaps you were referring to post-secondary education only?
The most weird thing for me is that there _are_ places in the world where that’s not the case, places where shelter / food / medicine / security are if not solved, at least close to stress free, and why others are not studying them intensely to try to replicate it is just bonkers. Not invented here syndrome is so strong when it comes to politics…
It doesn't even have to be "end of life" care (the last ten years, say). You just start doing more and more procedures "just in case". MRIs and CAT scans for everything! It'll probably catch something.
> shelter, food, medicine, education and utilities
Many of these really aren't resources though. Lumber, iron, and oil are resources but shelter, medicine, and utilities are all products made with resources. Education isn't even either, it's a service.
Whether they are all necessities today is up to opinion, and I expect the are good arguments to be made that they are all necessary, but they definitely aren't resources.
The only one to blame for people not getting healthcare is the federal US government.
These articles help politicians deflect from the fact that no one other than the US government could possibly provide unlimited healthcare. An individual hospital or healthcare business deciding it cannot afford the losses is just that, a business decision. And since it does not have the power to raise taxes, that is what they have to do.
> No one other than the US government could possibly provide unlimited healthcare.
Not even they could do that. I've lived in a country with universal government-funded healthcare; many things are better than the US system (low bar, I know), but wait times are very long and standards of care aren't magically any less sucky.
I agree, a more accurate version would be whatever the closest thing to unlimited healthcare would be, while still being able to operate the rest of society.
Medicare, Medicaid (Some states better than others), Veteran Affairs Health system.
There are definitely examples of universal healthcare that seems to operate well in small universes.
From CMS on National Health Expenditure [1]:
> NHE grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP).
> On average over 2021-30, National Health Expenditures (NHE) and Gross Domestic Product (GDP) are both projected to grow 5.1 percent per year; as a result, the projected NHE share of GDP in 2030 (19.6 percent) is similar to 2020 (19.7 percent).
McKinsey [2] cites
> Of the nearly $4 trillion spent on healthcare annually in the United States, administrative spending is about one-quarter of the total; delivery of care is about three-quarters.
Nearly a trillion dollars in administrative spending that could otherwise go into care delivery! (Yes, some administrative spending will remain, but the pie is so large).
That just shows that entrenched forces are strong.
Ever heard of preeclampsia? Me neither, till last week. Now my wife and I will be in the hospital for another 8 weeks. I’m super looking forward to the bill.
In reality I’m grateful we live in the future. One overlooked thing with medical debt is that while it’s awful, you still end up healthy at the end of it. A hundred years ago we wouldn’t have been so lucky.
It’s weird waking up in a hospital each day. Time starts to lose meaning. There are only so many times you can count the ceiling tiles.
I wonder what nine weeks in the hospital will end up being though. $100k seems not even close to the bottom line price.
Forgive me for asking but does your insurance not have a max out of pocket associated with your plan?
Btw I understand and feel you how rough the hospital is, had 4 little ones each spending several months in the NICU hold on it gets better and the debt will eventually be gone.
This is what I don't get about discussions of US healthcare online. Everyone has a max out of pocket.
Yes, 7% of the US isn't insured, which is a lot, but it's hard to believe they make up 99.9% of healthcare discourse.
Are people genuinely getting $100k in debt, or are they only telling the internet how much the total bill was and forgetting to add that their insurance picked up $94k of that.
I’m 51 and had this conversation too many times to indulge this. All I can say is that I wish you luck if you or your loved ones ever have a serious medical issue in the US. And you may be lucky. Or you may spend years on telephone calls trying to get a pharmacy benefits manager to send you the prescription your doctor prescribed. Or calls with your insurance company to get them to pay what they are supposed to pay.
Yeah been there with my partner. She spent at least two days a week on the phone with the insurance company from 2021 to January of this year. Private insurance is the worst, and open enrollment is terrible. We should’ve outlawed employer-provided insurance but required employer stipends for insurance and forced everyone to buy through the marketplace with open enrollment once a month. As a patient you have zero control over your insurance while your employer has no incentive to get good insurance.
I have a close family member who has had multiple significant surgeries, and it was all covered, and they didn't pay a penny over their annual out-of-pocket maximum.
Maybe the difference is that it was all "elective" and therefore planned out weeks or months in advance, with ample time for insurance pre-approvals?
I've had a harder time getting reimbursed for psychotherapy than they had getting covered for their surgeries.
Interesting, I’ve had somewhat similar experiences. Big one-time events were handled no problem. But chronic illnesses have always been a nightmare - for my daughter to get her meds, she pretty much has to have the same chain of conversations once a quarter with doctor, pharmacy benefits manager, and insurance. PBMs are the worst though, by far.
However, prior to the No Surprises Act, you could get hit with unlimited costs from out of network providers in the event of an emergency. For example, if an anesthesiologist that was not employed by the hospital put you under, and you get a separate out of network bill from them (but that should not happen since 2022).
Not 100k, but I recently dumped most of my then current savings (12k) to cover a family member’s medical bills after what insurance covered. It wasn’t the first time, and it’s a lot easier to imagine it adding up the second time. Never mind that not everyone just has 12k lying around to cover those bills, or that they start collecting interest once they get scooped up by debt consolidators.
I know people get huge bills. Meeting that $4k or $5k oop is tough for the average person. It's the hundreds of thousands or millions of debt that I don't get.
What about the people who don’t fight it? Folks who don’t know how the system works or get an especially aggressive billing department? Folks who are depressed or suffer from mental illness?
These systems aren’t in place for the people who fight back. They’re in place for the people who give up.
You go in for X. Insurance company defines X as a set of ICD-9 procedure codes for that health care organization, for that treatment for that indication. Not all providers will use all of those codes, usually some subset as the exact treatment may vary across providers under that health care organization. The health care organization instead sends over claims for those ICD-9 procedure codes, plus some other ones that your insurance company feels aren't appropriate for your treatment.
You then get an explanation of benefits from your insurance company, stating that they covered X, Y and Z, but A, B, C, D, E, F and G are your responsibility, because it exceeds the negotiated or "allowable rate" between the insurance company and that health care organization.
Or worse, the whole claim was merely coded incorrectly by the health care organization. Insurance company feels it's then not their obligation, and straight up denies the claim.
A through G is some amount of money that would absolutely crush the average person.
Your insurance company stands behind what they laid out in their statement of benefits for the claim, and won't budge beyond that, saying the rest of the costs are your responsibility. After all, they feel those procedures weren't relevant for the treatment, and it exceeds the negotiated allowance with that health care organization for that treatment. The health care organization's billing department is aggressive, and says since your insurance company won't pay, you need to.
Entirely unrelated to the specific scenario I laid out is ending up in an out-of-network emergency room. Again, easy to end up with a $20,000 hospital bill for falling off a bicycle because your insurance company says it's not their problem: https://www.vox.com/health-care/2019/1/24/18195686/vox-zucke...
I ended up forking out $58,000 (excluding 10 months of my lost wages fighting it) to attorneys to have a $412,000 balance bill for my mom ultimately withdrawn by a hospital.
There’s lots of different insurance plans. I had a legacy PPO from a large public employer that covered everything with copays between $20 and $100.
When I had back surgery a few years ago, my out of pocket was something like $600. The surgery itself and inpatient was $250k, PT and follow ups went on for a year. For most HMO patients, it would be more like $5000 or more. Stuff like the supportive vest you wear for weeks is typically uncovered, cost $2500. Some plans will only cover PT for a few weeks. Today with a high deductible plans, it’s nutty - my brothers 4 kids got a nasty infection, which required an antibiotic that costs $15. Total cost? $1200 out of pocket for the visits, etc.
For chronic conditions like diabetes, supplies and scripts get expensive quickly. For cancer, if you work for Google or the US Government you’ll get treatment at MD Anderson, Dana Farber, MSK, etc for $0 and get travel reimbursement. If you have a high deductible plan, you’re going to be shelling out $10k or more a year just for the deductible, and may find yourself paying out of pocket for labs, drugs, etc.
When I lived in the United States, the annual deductible was in the many thousands, even with a fairly good health insurance plan, you could easily end up with a bill for $10,000 if you spent a few nights in the hospital. This was also the fact that the insurance would only cover up to a certain percentage of the total bill, so even if you are left owing five or 10%, that could still be quite a lot of money when the hospital is charging well into the six figures.
Depends on the policy, but in my experience the out of pocket deductible is usually before any insurance is used, so you pay 100% up to the max deductible (no help from insurance on many costs), then you pay 5-10% of bills after that. But that was a few years ago so maybe policies are different now (though I doubt it).
Also, take note that out of pocket medical costs are only deductible on Federal taxes once they exceed 7.5% of your AGI, and of course, only the amount above that counts. Assuming an average AGI of 65K, the government certainly doesn't feel any pity for you until you pay almost 5K per year.
A few thousand to meet the OOP max shouldn't break you, or at least the government isn't going to cut you a break.
The reality is your health insurance will deny shit until it's blue in the face. In the meantime you have an angry hospital breathing down your neck and sending you bills for $xxxxxx. They don't necessarily talk much to eachother so its now your part time job to make sure everything happens smoothly.
We had a surgery that wasn't completely resolved until about 8 months after the fact after spending 10-15 hours per week on phone calls. The hospital billing told me this was all normal and they usually have to resort to lawyers before stuff gets paid. SOUNDS LIKE EFFICIENCY TO ME! This is just one of a half dozen shitty experiences I've had even with $3k/mo health insurance.
So yeah, in my experience it sucks even if you are insured. The whole system is a dumbass way to do things and a huge waste of fucking time.
I could rant for DAYS about my awful experiences with the US medical billing system but I’m too tired after spending literally months of my life on paying US medical bills and even more time removing erroneous collections claims from my credit report.
For "covered" expenses. Have to go out of network for a specialist? Not covered. The insurance company considers the life-saving procedure you need "experimental"? Not covered. The insurance company rejects the optimal treatment for your injury, disease or malady as being not necessary? Not covered.
> This is what I don't get about discussions of US healthcare online. Everyone has a max out of pocket.
Max out of pocket doesn't mean what the insurance company marketing arm wants you to believe (and most people believe).
When you actually have large medical expenses, the insurance company will use the full strenght of their lawyer army to deny everything, claim it was all unnecessary and unauthorized and deny deny deny. Your "max out of pocket" doesn't apply to any of that since they get to unilaterally say it wasn't covered. That's how you end up with hundreds of thousands in debt even though the paperwork claimed your max out of pocket is 7K or whatever.
As others mention here, you can fight it but it will become a full time job for a very long time and you'll be an amateur fighting full-time professionals at denying. You can win some but it'll be an uphill battle.
If that number is too high, and it really does seem ridiculous, we need to be questioning why care is so expensive rather than what insurance policies are available.
True, there is a reason why many international health insurance plans will cover services anywhere in the world except the United States. The US is quite an outlier on what it charges for healthcare compared to most of the rest of the world. And the odd thing is that the care is not justified by the price, it’s not like it’s significantly different than what you get in most European nations.
Well of course the prices are just fraud. Maybe it’s legal fraud, but it’s fraud nonetheless. I mean you’ll see bills for 20k that insurance would have covered for 1k. It’s just bullshit.
Frankly negotiated prices should just be illegal. They should just provide prices for services. Insurers should have plans on how much they’ll cover you, but they don’t change any pricing. The hidden bullshit smoke and mirrors producing fraudulent pricing that may or may cover you depending on a million different reason is as far from market competition as it gets.
Oh hey, thanks for asking! Apparently ours is max $10k per individual. I honestly had no idea that max out of pocket was a thing. Was fully ready to go bankrupt from this.
There's also a per-family maximum (and somewhere deep in the documents may be a maximum total the insurance company will pay out, but they can't do this for essential health benefits anymore; doesn't mean they won't try).
Sadly, if you're sitting around a hospital room, researching and reading up on insurance billing is probably a worthwhile use of time.
“Max out of pocket” only applies to the bill amount the insurance accepts. If the bill is for $100k and insurance says it should cost $30k and your “max out of pocket” is $10k then you owe $80k ($10k for the max + $70k that insurance says shouldn’t be billed.)
Do some research about your healthcare coverage. There is no rush to settle the bill once the baby arrives, push the hospital on every little thing and lean on your insurance.
It does suck that the burden of the payment falls on the patients, but if you know the system well it doesn't have to be that stressful.
> It does suck that the burden of the payment falls on the patients
Who should the burden of payment fall on it not the patient seeking care?
A huge majority of Americans do at least have some level of insurance coverage with a max out of pocket which helps, and our Healthcare system is horribly designed with regards to keeping costs low, but really where else should they send the bill?
It's more complex in the US, but idealy they could send the majority of the bill to a government, since you pay them taxes to provide essential services.
The abnormally high costs of medical services in the US stem from more issues than just the lack of universal healthcare though, and I have no idea how to solve that problem.
Sending the bill to the government just means that we all pay it through taxes or we all lose when the government prints more cash to cover deficit spending. The cost didn't just disappear because it's charged to the government rather than the patient.
There are at least a few easy changes that could help bring down costs, but they wouldn't be popular. Rolling back much of the legal precedent for malpractice lawsuits would definitely help. Doctors need to be given the freedom to do what they do best, problem solve and treat each patient individually rather than cover their own ass.
roughly 30% of the cost of healthcare is insurance company and hospital staff arguing about who should pay for stuff. another decent chunk (that isn't typically reported) is the cost of judges and lawyers to administer bankruptcy proceedings. getting rid of all the beurocracy would absolutely bring costs down. in fact, one of the hardest parts of single payer healthcare is that moving there quickly would likely cause a recession due to the ~5% of the population that would be laid off
> Sending the bill to the government just means that we all pay it through taxes
Yes that is not a surprising caveat, that is the point. It's fairer to everyone, in my opinion, and in practice in many countries. I understand it's not that simple in the US but the concept of spreading the cost across everyone's taxes is the same. That is what insurance is afterall, and people seem to be fine with that.
That’s just the vanity bill. It’s complete bullshit to make you think your getting some deal with insurance.
In reality, there’s some hidden, pre-determined rate that the hospital and insurer have agreed on.
We forgot to add our daughter to insurance when she was born. Dr provided us with “uninsured best estimates “ that were 1/10th what’s billed to insurance. That’s the true cost of healthcare.
I'm not so sure that there's enough evidence in any cases that there is an improvement on health or outcome. Some domains, absolutely. However, many areas we have made very little progress in either mechanistic understanding, or theranostic capability. Diagnostics may be the area of the most amount of progress in the past 100 years, but that doesn't always help much with health outcomes. You're correct in that it is a lot of money however.
Our response to emergency care (broken bones, concussion, etc) is beyond par, we routinely save people who would have been considered "dead or nearly so" fifty years ago.
Our response to issues like obesity and other long-term things is just horrendous - almost always trying to treat symptoms instead of causes.
>Our response to issues like obesity and other long-term things is just horrendous - almost always trying to treat symptoms instead of causes.
There isn't much you can do about the causes: many of them are intrinsic to the American lifestyle. Come to a country/city where people have to walk everywhere, and you won't see many obese people. That isn't doable in America because almost the entire country (except Manhattan NYC) is designed around everyone using cars to go everywhere, and walking being almost impossible or at least horribly dangerous without getting in your car and going someplace far away specifically meant for that activity.
It’s unfortunate that debt must be seen in the United States as a precursor to getting healthy. Most of the western world has long ago moved past such notions, and the concept of any kind of medical debt is foreign in many European countries, for example.
Capitalism is weird. Competition does nothing to reduce costs in healthcare. Perhaps demand outweighs supply several times over? Instead, doctors are treated like royalty (and they deserve it after what they’ve been through/sacrifices they’ve made). But it feels a bit like renting a Lamborghini to do grocery shopping.
We need more layers below doctors that can very effectively treat typical healthcare conditions. We need more NPs and PAs. Perhaps more doctors too - if we can lower the rigor and regulation for family doctors. Make it easier to become one - preferably without losing one’s shirt.
An analogy to healthcare today would be to only allow someone to code once they reach Staff Eng (MD) skill level. Most of them spend the majority of their time fixing bugs that a Jr. Eng (PA in training?) could fix with guidance, or a SE 3/4 (PA/NP) could fix on their own.
So, no - filling the work with Staff+ Eng (MD+) is not the most optimal or cost effective way of dealing with this.
Staff (pun) aside, there’s also the whole drug price gouging situation. I don’t know how will we fix that.
Competition does nothing to reduce hospital prices because in many cases it's illegal to start a competitor and either way insurance companies are footing the bill so you have no incentive to price-shop.
Competition does nothing to reduce isolated under-patent drug prices because it's not supposed to.
Competition does nothing to reduce one of a couple of specific generic drug prices like insulin and epinephrine because of some very, very stupid FDA policies that make it like they're under patent without any of the drawback of the patent actually expiring.
Competition is incredibly good at bringing down the prices of generic drugs, competing separate under-patent drugs like depression treatments, and things you do mostly pay for yourself like glasses.
Re: doctors, we don't need less-skilled doctors, we need less-debted doctors so doctors are less likely to seek high pay despite less fulfillment. We currently require a four-year degree in literally anything before you can start medical school; Ireland does not and just pads med school with a single extra year for GE, and their doctors are about as good as ours. Competition also doesn't work when it would drive your prices below cost, and medical school debt makes it effectively like that.
There's not a whole lot of capitalism happening in American healthcare: medical systems, insurers and the AMA all act as cartels to limit competition in their respective areas. There is no price transparency, and the captive market has inelastic demand.
Once a company in the US has figured out a treatment for eclampsia, Europe can steal this knowledge for free (i.e. price-control them according to cost) while the US company must price-gouge against the manufacturing cost to recoup the R&D costs. This factors heavily into how much healthcare costs in the US (not to be interpreted as 'it's the only reason'); it's the same dynamic as 'world police'. If under-patent drug prices went up in Europe they would go down in America.
First time I’ve ever heard such a strange story. Do you have any evidence for your sweeping radical claims?
All other evidence I’ve heard of points to the USA being the only major country without public healthcare and price controls in place, but maybe you can blow my mind with facts.
> Once a company in the US has figured out a treatment for eclampsia, Europe can steal this knowledge for free (i.e. price-control them according to cost) while the US company must price-gouge against the manufacturing cost to recoup the R&D costs. This factors heavily into how much healthcare costs in the US (not to be interpreted as 'it's the only reason')
Recouping R&D costs has been disproven time and again. Medical companies spend far more on average on marketing (and lobbying) than on actual R&D.
Good luck to you. A close relative just spent a few weeks in the hospital, it was awful. I think Covid really took something out of the medical profession-- the hospital workers were mostly de-motivated, hard to find, and did not seem engaged in their tasks. It was an eye-opener.
It seems that two very different but similar issues get lumped under the "healthcare" umbrella.
1. Is prescriptions people talk about how medicine is too expensive and they have to ration it.
2. The other problem is the surprise medical billing that people get hit with. that lasts forever and cripples them.
These seems to be the.major complaints I hear about the healthcare system, and yet are 2 very different issues with different origins and solutions.
Yet no one seems interested in solving the problems but instead just arguing (for and against) about universal healthcare or single payer healthcare or whatever the euphemism of the week is.
One of the handful of objectively positive things to come out of the COVID19 pandemic is a significantly increased awareness amongst many citizens of the USA just how uniquely awful their healthcare system (and to a lesser extent welfare system and award conditions) is/are.
I'm sure the comparisons have been made for many years, but by mid-2020 it felt like almost everyone in the USA must have been exposed to some hard truths about how 'the rest of the west' handles these fairly fundamental services.
As an Australian, and I suspect the Brits and others feel similarly, the pandemic also reminded us of what we stand to lose if we were to allow the eagerly nefarious agents to talk us out of (AU) Medicare or (UK) NHS, etc.
> I'm sure the comparisons have been made for many years, but by mid-2020 it felt like almost everyone in the USA must have been exposed to some hard truths about how 'the rest of the west' handles these fairly fundamental services.
You'd hope, but that type of facts and rhetoric wasn't seized upon by the media or political parties. A good amount of people were never exposed to that information nor its consequences, let alone the consequences of our negligence towards health and social services.
People were happy to get some checks and extended unemployment, and a lot of people were angry about those checks and extended unemployment. A good chunk of people wouldn't have given a shit about how well your country was doing if you were wearing masks.
Yeah, I suspect it's more nuanced than it seemed to me at the time.
You say it wasn't seized upon by media etc, but perhaps it just wasn't by the media you (or I) was consuming? The USA media I consumed - Seth Meyer, John Oliver, some reddit / imgur - tends towards the more thoughtful / empathetic / liberal demographics, but unarguably is a bubble of sorts.
I suspect, but also have no hard data, that the younger generation, generally more 'connected' and exposed to more of this type of information, was instrumental in extracting that orange chap, and I speculate much of that motivation came from this vector. Though how much of that was pandemic-highlighting of poor and unfair health services vs other factors .. well, who knows. Exit polls only get you so far, assuming these kinds of questions were ever asked.
During the pandemic response weren't the Australians imprisoning those who refused to get vaccinated or broke curfew laws and similar? Is the idea here that draconian measures were justified and the US should have implemented similar camps as well?
I apologise for any ambiguity there - I was, as smt88 suggests, mainly focusing on the healthcare system comparisons between basically every other western / democratic mildly advanced society, and the USA.
My greater point was that during COVID19 we had the unique situation of a health crisis that presented almost equally to everyone on the planet, so deltas in responses were very obvious, and depending where you were and what your politics were, very useful for finger-pointing (of the 'at least we're doing better than them' or 'we should do what they're doing' varieties).
To your point - I don't think we were imprisoning people who declined to be vaccinated - not sure where you may have got that story from. We had the benefit of vaccines not being anywhere near so politicised, and our local Faux News outpost certainly wasn't promoting any anti-vaccine nonsense.
Lockdown laws I think in most western democracies were similarly orchestrated and enforced, but obviously I only lived through one set. Whether they were perceived as draconian, or successful, probably depends on your sense of social concern / obligation.
Fact checked myself and I was m wrong in my memory of what the campus where for. Looks like it a forced quarantine for those infected or believed to be exposed, I w thinking they also force quarantined those who didn't get the jab as well.
Sorry for the confusion! I guess different stories are starting to blend together from all the pandemic response hysteria and I should have checked that myself before posting.
I had friends that tried to get back from the UK to here around that time, and the delays were awful (several months) though somewhat complicated by immigration for one, rather than outright citizen return for both. As it happens they spent two weeks in that same center, before being allowed to proceed back to the southern states. From the outside looking in, it felt like a small price to pay. Most of our escapes through 2020 and early 2021 were due to poor process control at airports
I think that AU and NZ citizens were pretty happy, for the most part, with the isolation & controls --> good health outcomes, so the two week quarantine was doubtless uncomfortable for many, but these exceptional cases of some tiny number of sociopaths trying to selfishly circumvent due process were so rare that they were necessarily notable, especially amongst the international press.
BBC was probably pretty even-handed, but certainly some more reactionary media outlets (you know who I mean) were keen to try to beat-up the situation into something it was not.
The major difference is the US gov is bound by the Constitution, and the Constitution does not enumerate Healthcare as a power over which Congress can legislate or for which it can levy taxes.
ACA/Obamacare is unconstitutional as it is.
Not saying whether this is good/bad. Simply stating the facts.
"Ms. Blaido, a mechanic, said she racked up nearly $200,000 in bills from a two-week stay at Allina’s Mercy Hospital in 2009 for complications from pneumonia, along with several visits to the emergency department for asthma flare-ups. Ms. Blaido, a mother of four, said that most of the hospital stay was not covered by her health insurance"
I'm confused. There is out of pocket maximum of $18,000 for a family that caps what patient has to pay for in a given year. That's the law. For ER room, you don't have to worry about out of network hospital.
No amount of medical intervention is going to fix terrible lifestyle choices and a culture that promotes them. There are a multitude of factors that go into making our lives decay to the point of needing medical treatment and those are things we should be focusing on.
Doctors aren't miracle workers. Why is the CEO of McDonalds not required, by law, to eat Big Macs for 2/3s of his/her meals every day?
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[ 4.1 ms ] story [ 152 ms ] threadThere is absolutely a lack of resources when it comes to medical care. There aren't enough nurses, doctors, mental health professionals, specialized medical equipment, or in some instances even blood, to go around right now.
This "post scarcity" mentality isn't based on reality.
Contrary to what we would like to believe, there is a scarcity of intelligent people willing to devote their entire lives to the study of medicine across specialties.
If you cannot afford it, the US healthcare is terrible. If you have the means to afford it, the US healthcare system is one of if not the best in the world.
This is untrue according to all metrics I have seen (such as life expectancy). Do you have any evidence to back this statement up?
10 of the leading 12 causes of death are diseases, with the first non-disease cause coming in at #4.
You can see the breakdown of life expectancy reducing factors here, none of which are attributable to "limited specialized treatment": https://ourworldindata.org/us-life-expectancy-low
https://www.gbhoh.com/fentanyl-becomes-leading-cause-of-deat...
I still fail to see cars and guns being the leading cause of death.
Do you see something I don't?
https://peterattiamd.com/anthonyhipolito/
https://www.statesman.com/story/news/politics/politifact/202...
The point under debate is guns and car accidents being asserted as the leading cause of death. I continue to assert it is not true.
Many of our worse outcomes though have nothing to do with the healthcare system. The decrease in life expectancy is being driven by factors like obesity, substance abuse, sedentary lifestyles, vehicle crashes, suicide, and violence.
That's unfortunately not even the case. Americans spend more money on healthcare AND have worse outcomes.
https://jamanetwork.com/journals/jama/article-abstract/27843...
https://www.healthsystemtracker.org/chart-collection/quality...
https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare...
None discuss outcomes among only those who "have the means to afford it" so none of them refute GP's claim.
This might be true in theory but is somewhat irrelevant here given the gargantuan levels of waste in US military spending.
There is also gargantuan waste in healthcare costs, but those are spread out via insurance, not taxes.
The presence of gargantuan waste in both sectors and the different avenues of spending both make any after-the-fact, simplified explanation of why one costs more than the other kind of moot.
The presence of gargantuan waste should also be addressed before implying that the costs of healthcare are all presumed necessary.
Why? Are money and social status insufficient motivators? Or is there another reason?
In the US, we ration by price… “the doctors expensive and I don’t feel too bad so I’m not going to go”. In Europe, they ration via lines… you’ll get your free healthcare eventually.
Either way there are problems, but seems like other countries might be onto something
It is an important distinction. For example, about 33% of healthcare dollars go to paying “claims proceesing” people at your insurance company and your doctors office to haggle with each other and produce duplicate paperwork.
If the low end of your estimate (5x) is the correct multiplier, the money that goes to claims processing would be enough to pay for universal healthcare in pretty much any other first world country.
Other things, like absurdly high drug prices, also are not healthcare spending. 90+% of drug discovery research money is spent at universities, and not by pharmaceutical companies. Also, those companies pay more for prescription drug advertising than for drug research.
I'm not sure what point you're trying to make about drug discovery research. The major expense in bringing a new drug to market is not in the basic research but in the phase-3 clinical trials. Those often cost pharmaceutical companies upwards of $1B now.
https://www.gao.gov/products/gao-18-40
By comparison, several major tech companies have significantly higher profit margins.
This is not true, but there is a big non patient healthcare services culprit in US healthcare costs, and that is legal liability. In the US, every entity in the healthcare chain is doing so much extra to prevent themselves from being liable, and charging extra in case they are found liable, that it inflates all costs dramatically.
Without tort reform, I doubt we see much improvement.
Afaik this is simply not true, and even if it was, this would be misleading if you consider that most costs are made during clinical trials, which test the effectiveness of the drug.
The US medical system has been systematically optimized for extracting the maximum possible amount of money from every patient, part of which is artificially restricting available supply of medical care (although things are slightly getting better in that regard with practicing nurses and PAs)
The other thing it was optimized for was hiding this from the patients.
And only now, in 2023 are we beginning to see the horrible extent of this, because of price transparency rules.
Then again, it should be matter of at least a majority agreement that things like that should be paid from taxes, and it's obvious that in the US the agreement is not there.
Are you seriously arguing against taxpayer-funded education? As broken as U.S. public education is, managed as it is by hyper-local, ideologically-motivated officials, withdrawing the opportunity to raise one’s lot in life through community-funded education would be pretty dystopian.
Or perhaps you were referring to post-secondary education only?
Many of these really aren't resources though. Lumber, iron, and oil are resources but shelter, medicine, and utilities are all products made with resources. Education isn't even either, it's a service.
Whether they are all necessities today is up to opinion, and I expect the are good arguments to be made that they are all necessary, but they definitely aren't resources.
> “Allina Health’s goal is, and will always be, to have zero patients go without services for financial reasons,”
... while explaining why they made the choice to withhold services for financial reasons. It's their right to do so, but don't lie about it.
These articles help politicians deflect from the fact that no one other than the US government could possibly provide unlimited healthcare. An individual hospital or healthcare business deciding it cannot afford the losses is just that, a business decision. And since it does not have the power to raise taxes, that is what they have to do.
Not even they could do that. I've lived in a country with universal government-funded healthcare; many things are better than the US system (low bar, I know), but wait times are very long and standards of care aren't magically any less sucky.
There are definitely examples of universal healthcare that seems to operate well in small universes.
From CMS on National Health Expenditure [1]:
> NHE grew 2.7% to $4.3 trillion in 2021, or $12,914 per person, and accounted for 18.3% of Gross Domestic Product (GDP).
> On average over 2021-30, National Health Expenditures (NHE) and Gross Domestic Product (GDP) are both projected to grow 5.1 percent per year; as a result, the projected NHE share of GDP in 2030 (19.6 percent) is similar to 2020 (19.7 percent).
McKinsey [2] cites
> Of the nearly $4 trillion spent on healthcare annually in the United States, administrative spending is about one-quarter of the total; delivery of care is about three-quarters.
Nearly a trillion dollars in administrative spending that could otherwise go into care delivery! (Yes, some administrative spending will remain, but the pie is so large).
That just shows that entrenched forces are strong.
[1]: https://www.cms.gov/research-statistics-data-and-systems/sta...
[2]: https://www.mckinsey.com/industries/healthcare/our-insights/...
In reality I’m grateful we live in the future. One overlooked thing with medical debt is that while it’s awful, you still end up healthy at the end of it. A hundred years ago we wouldn’t have been so lucky.
It’s weird waking up in a hospital each day. Time starts to lose meaning. There are only so many times you can count the ceiling tiles.
I wonder what nine weeks in the hospital will end up being though. $100k seems not even close to the bottom line price.
Btw I understand and feel you how rough the hospital is, had 4 little ones each spending several months in the NICU hold on it gets better and the debt will eventually be gone.
Yes, 7% of the US isn't insured, which is a lot, but it's hard to believe they make up 99.9% of healthcare discourse.
Are people genuinely getting $100k in debt, or are they only telling the internet how much the total bill was and forgetting to add that their insurance picked up $94k of that.
Maybe the difference is that it was all "elective" and therefore planned out weeks or months in advance, with ample time for insurance pre-approvals?
I've had a harder time getting reimbursed for psychotherapy than they had getting covered for their surgeries.
However, prior to the No Surprises Act, you could get hit with unlimited costs from out of network providers in the event of an emergency. For example, if an anesthesiologist that was not employed by the hospital put you under, and you get a separate out of network bill from them (but that should not happen since 2022).
I'm not sure if you know how hard a surprise 10-20K bill can be. And some out of pocket maximums are huge (generally, the worse the plan is)
These systems aren’t in place for the people who fight back. They’re in place for the people who give up.
You go in for X. Insurance company defines X as a set of ICD-9 procedure codes for that health care organization, for that treatment for that indication. Not all providers will use all of those codes, usually some subset as the exact treatment may vary across providers under that health care organization. The health care organization instead sends over claims for those ICD-9 procedure codes, plus some other ones that your insurance company feels aren't appropriate for your treatment.
You then get an explanation of benefits from your insurance company, stating that they covered X, Y and Z, but A, B, C, D, E, F and G are your responsibility, because it exceeds the negotiated or "allowable rate" between the insurance company and that health care organization.
Or worse, the whole claim was merely coded incorrectly by the health care organization. Insurance company feels it's then not their obligation, and straight up denies the claim.
A through G is some amount of money that would absolutely crush the average person.
Your insurance company stands behind what they laid out in their statement of benefits for the claim, and won't budge beyond that, saying the rest of the costs are your responsibility. After all, they feel those procedures weren't relevant for the treatment, and it exceeds the negotiated allowance with that health care organization for that treatment. The health care organization's billing department is aggressive, and says since your insurance company won't pay, you need to.
TL;DR: "Balance billing."
-- -----
Here's a case where your child falling off a bicycle and needing stitches could cost you $19,000 if you don't lawyer up: https://wamu.org/story/20/11/25/a-kid-a-minor-bike-accident-...
Entirely unrelated to the specific scenario I laid out is ending up in an out-of-network emergency room. Again, easy to end up with a $20,000 hospital bill for falling off a bicycle because your insurance company says it's not their problem: https://www.vox.com/health-care/2019/1/24/18195686/vox-zucke...
I ended up forking out $58,000 (excluding 10 months of my lost wages fighting it) to attorneys to have a $412,000 balance bill for my mom ultimately withdrawn by a hospital.
When I had back surgery a few years ago, my out of pocket was something like $600. The surgery itself and inpatient was $250k, PT and follow ups went on for a year. For most HMO patients, it would be more like $5000 or more. Stuff like the supportive vest you wear for weeks is typically uncovered, cost $2500. Some plans will only cover PT for a few weeks. Today with a high deductible plans, it’s nutty - my brothers 4 kids got a nasty infection, which required an antibiotic that costs $15. Total cost? $1200 out of pocket for the visits, etc.
For chronic conditions like diabetes, supplies and scripts get expensive quickly. For cancer, if you work for Google or the US Government you’ll get treatment at MD Anderson, Dana Farber, MSK, etc for $0 and get travel reimbursement. If you have a high deductible plan, you’re going to be shelling out $10k or more a year just for the deductible, and may find yourself paying out of pocket for labs, drugs, etc.
But only up to the max out of pocket, right? Once you hit the max out of pocket, you stop paying the 10%.
So while you pay the full burden of the first $1500-$3000, you only pay a percentage of anything after that and not one penny more than your max.
Do you have a link to a real policy like you're talking about?
A few thousand to meet the OOP max shouldn't break you, or at least the government isn't going to cut you a break.
We had a surgery that wasn't completely resolved until about 8 months after the fact after spending 10-15 hours per week on phone calls. The hospital billing told me this was all normal and they usually have to resort to lawyers before stuff gets paid. SOUNDS LIKE EFFICIENCY TO ME! This is just one of a half dozen shitty experiences I've had even with $3k/mo health insurance.
So yeah, in my experience it sucks even if you are insured. The whole system is a dumbass way to do things and a huge waste of fucking time.
For "covered" expenses. Have to go out of network for a specialist? Not covered. The insurance company considers the life-saving procedure you need "experimental"? Not covered. The insurance company rejects the optimal treatment for your injury, disease or malady as being not necessary? Not covered.
Max out of pocket doesn't mean what the insurance company marketing arm wants you to believe (and most people believe).
When you actually have large medical expenses, the insurance company will use the full strenght of their lawyer army to deny everything, claim it was all unnecessary and unauthorized and deny deny deny. Your "max out of pocket" doesn't apply to any of that since they get to unilaterally say it wasn't covered. That's how you end up with hundreds of thousands in debt even though the paperwork claimed your max out of pocket is 7K or whatever.
As others mention here, you can fight it but it will become a full time job for a very long time and you'll be an amateur fighting full-time professionals at denying. You can win some but it'll be an uphill battle.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
Frankly negotiated prices should just be illegal. They should just provide prices for services. Insurers should have plans on how much they’ll cover you, but they don’t change any pricing. The hidden bullshit smoke and mirrors producing fraudulent pricing that may or may cover you depending on a million different reason is as far from market competition as it gets.
Sadly, if you're sitting around a hospital room, researching and reading up on insurance billing is probably a worthwhile use of time.
It does suck that the burden of the payment falls on the patients, but if you know the system well it doesn't have to be that stressful.
Who should the burden of payment fall on it not the patient seeking care?
A huge majority of Americans do at least have some level of insurance coverage with a max out of pocket which helps, and our Healthcare system is horribly designed with regards to keeping costs low, but really where else should they send the bill?
The abnormally high costs of medical services in the US stem from more issues than just the lack of universal healthcare though, and I have no idea how to solve that problem.
There are at least a few easy changes that could help bring down costs, but they wouldn't be popular. Rolling back much of the legal precedent for malpractice lawsuits would definitely help. Doctors need to be given the freedom to do what they do best, problem solve and treat each patient individually rather than cover their own ass.
Yes that is not a surprising caveat, that is the point. It's fairer to everyone, in my opinion, and in practice in many countries. I understand it's not that simple in the US but the concept of spreading the cost across everyone's taxes is the same. That is what insurance is afterall, and people seem to be fine with that.
In reality, there’s some hidden, pre-determined rate that the hospital and insurer have agreed on.
We forgot to add our daughter to insurance when she was born. Dr provided us with “uninsured best estimates “ that were 1/10th what’s billed to insurance. That’s the true cost of healthcare.
Our response to issues like obesity and other long-term things is just horrendous - almost always trying to treat symptoms instead of causes.
There isn't much you can do about the causes: many of them are intrinsic to the American lifestyle. Come to a country/city where people have to walk everywhere, and you won't see many obese people. That isn't doable in America because almost the entire country (except Manhattan NYC) is designed around everyone using cars to go everywhere, and walking being almost impossible or at least horribly dangerous without getting in your car and going someplace far away specifically meant for that activity.
We need more layers below doctors that can very effectively treat typical healthcare conditions. We need more NPs and PAs. Perhaps more doctors too - if we can lower the rigor and regulation for family doctors. Make it easier to become one - preferably without losing one’s shirt.
An analogy to healthcare today would be to only allow someone to code once they reach Staff Eng (MD) skill level. Most of them spend the majority of their time fixing bugs that a Jr. Eng (PA in training?) could fix with guidance, or a SE 3/4 (PA/NP) could fix on their own.
So, no - filling the work with Staff+ Eng (MD+) is not the most optimal or cost effective way of dealing with this.
Staff (pun) aside, there’s also the whole drug price gouging situation. I don’t know how will we fix that.
Competition does nothing to reduce isolated under-patent drug prices because it's not supposed to.
Competition does nothing to reduce one of a couple of specific generic drug prices like insulin and epinephrine because of some very, very stupid FDA policies that make it like they're under patent without any of the drawback of the patent actually expiring.
Competition is incredibly good at bringing down the prices of generic drugs, competing separate under-patent drugs like depression treatments, and things you do mostly pay for yourself like glasses.
Re: doctors, we don't need less-skilled doctors, we need less-debted doctors so doctors are less likely to seek high pay despite less fulfillment. We currently require a four-year degree in literally anything before you can start medical school; Ireland does not and just pads med school with a single extra year for GE, and their doctors are about as good as ours. Competition also doesn't work when it would drive your prices below cost, and medical school debt makes it effectively like that.
All other evidence I’ve heard of points to the USA being the only major country without public healthcare and price controls in place, but maybe you can blow my mind with facts.
Recouping R&D costs has been disproven time and again. Medical companies spend far more on average on marketing (and lobbying) than on actual R&D.
This is patently false. You might be alive at the end of it but that isn't the same as healthy.
1. Is prescriptions people talk about how medicine is too expensive and they have to ration it.
2. The other problem is the surprise medical billing that people get hit with. that lasts forever and cripples them.
These seems to be the.major complaints I hear about the healthcare system, and yet are 2 very different issues with different origins and solutions.
Yet no one seems interested in solving the problems but instead just arguing (for and against) about universal healthcare or single payer healthcare or whatever the euphemism of the week is.
I'm sure the comparisons have been made for many years, but by mid-2020 it felt like almost everyone in the USA must have been exposed to some hard truths about how 'the rest of the west' handles these fairly fundamental services.
As an Australian, and I suspect the Brits and others feel similarly, the pandemic also reminded us of what we stand to lose if we were to allow the eagerly nefarious agents to talk us out of (AU) Medicare or (UK) NHS, etc.
You'd hope, but that type of facts and rhetoric wasn't seized upon by the media or political parties. A good amount of people were never exposed to that information nor its consequences, let alone the consequences of our negligence towards health and social services.
People were happy to get some checks and extended unemployment, and a lot of people were angry about those checks and extended unemployment. A good chunk of people wouldn't have given a shit about how well your country was doing if you were wearing masks.
You say it wasn't seized upon by media etc, but perhaps it just wasn't by the media you (or I) was consuming? The USA media I consumed - Seth Meyer, John Oliver, some reddit / imgur - tends towards the more thoughtful / empathetic / liberal demographics, but unarguably is a bubble of sorts.
I suspect, but also have no hard data, that the younger generation, generally more 'connected' and exposed to more of this type of information, was instrumental in extracting that orange chap, and I speculate much of that motivation came from this vector. Though how much of that was pandemic-highlighting of poor and unfair health services vs other factors .. well, who knows. Exit polls only get you so far, assuming these kinds of questions were ever asked.
My greater point was that during COVID19 we had the unique situation of a health crisis that presented almost equally to everyone on the planet, so deltas in responses were very obvious, and depending where you were and what your politics were, very useful for finger-pointing (of the 'at least we're doing better than them' or 'we should do what they're doing' varieties).
To your point - I don't think we were imprisoning people who declined to be vaccinated - not sure where you may have got that story from. We had the benefit of vaccines not being anywhere near so politicised, and our local Faux News outpost certainly wasn't promoting any anti-vaccine nonsense.
Lockdown laws I think in most western democracies were similarly orchestrated and enforced, but obviously I only lived through one set. Whether they were perceived as draconian, or successful, probably depends on your sense of social concern / obligation.
https://ourworldindata.org/grapher/cumulative-excess-deaths-...
Sorry for the confusion! I guess different stories are starting to blend together from all the pandemic response hysteria and I should have checked that myself before posting.
https://www.bbc.com/news/world-australia-59486285
I had friends that tried to get back from the UK to here around that time, and the delays were awful (several months) though somewhat complicated by immigration for one, rather than outright citizen return for both. As it happens they spent two weeks in that same center, before being allowed to proceed back to the southern states. From the outside looking in, it felt like a small price to pay. Most of our escapes through 2020 and early 2021 were due to poor process control at airports
I think that AU and NZ citizens were pretty happy, for the most part, with the isolation & controls --> good health outcomes, so the two week quarantine was doubtless uncomfortable for many, but these exceptional cases of some tiny number of sociopaths trying to selfishly circumvent due process were so rare that they were necessarily notable, especially amongst the international press.
BBC was probably pretty even-handed, but certainly some more reactionary media outlets (you know who I mean) were keen to try to beat-up the situation into something it was not.
ACA/Obamacare is unconstitutional as it is.
Not saying whether this is good/bad. Simply stating the facts.
I'm confused. There is out of pocket maximum of $18,000 for a family that caps what patient has to pay for in a given year. That's the law. For ER room, you don't have to worry about out of network hospital.
No amount of medical intervention is going to fix terrible lifestyle choices and a culture that promotes them. There are a multitude of factors that go into making our lives decay to the point of needing medical treatment and those are things we should be focusing on.
Doctors aren't miracle workers. Why is the CEO of McDonalds not required, by law, to eat Big Macs for 2/3s of his/her meals every day?