The US is at or very near the worst among OECD countries in: infant mortality, child poverty, child health and safety, life expectancy at birth, healthy life expectancy, rate of obesity, disability-adjusted life years, doctors per 1000 people, deaths from treatable conditions, rate of mental health disorders, rate of drug abuse, rate of prescription drug use, incarceration rate, rate of assaults, rate of homicides, income inequality, wealth inequality, and economic mobility.
If you dig into the statistics [1] you'll see that for the average Joe on the street, daily quality of life in America is below that of all other Developed nations, and is comparable to the upper-end of Developing nations.
There's been a fair bit of research that even when you control for income, affluent people living in societies with high levels of inequality fare more poorly than affluent people in societies with lower levels of inequality.
The spirit level claims that a variety of factors, one of which is inequality, are all correlated. It provides very little empirical evidence that inequality is the cause (apart from being on the x-axis).
(First reply, for courtesy.) I'll give your fair question the long answer it deserves probably tomorrow (United States time zones) after traveling to a meeting in another town this evening). I'll probably reply in this same thread, under your question, so it's easy for you to find the reply.
I'll be writing off-forum today (in between work tasks) to provide an answer to your kind question,
And can you elaborate on why you think the post is wrong?
Meanwhile, in response to your
Why do you think my worldview would be based on a single blog post?
I am wondering why you have submitted that link so often in previous Hacker News discussions of international comparisons among countries. (This most recent time is far from the first time you have submitted the link.) That link is the only external source you have submitted here. What do you think makes that a better post to consider for the issues under discussion in this immediate thread than some of the links shared on health issues in other subthreads here? What does that link actually have to do with health at all?
Dig a bit deeper and you'll see that those statistics don't tell you the whole story.
In the US, premature births occur at a much higher rate than other country and account for a large portion of the higher infant mortality rate. Those stats also don't tell you that if you have a premature baby, it's most likely to survive if treated in the US.
Also, the exact same event can take place in two different countries, but be classified called "live birth, dead baby" in the US and "stillbirth" in another country. [1]
I've heard that and am not sure whether the comparative statistics control for this. However, even if it's true, that still leaves child poverty, child health and safety, life expectancy at birth, healthy life expectancy, rate of obesity, disability-adjusted life years, doctors per 1000 people, deaths from treatable conditions, rate of mental health disorders, rate of drug abuse, rate of prescription drug use, incarceration rate, rate of assaults, rate of homicides, income inequality, wealth inequality, and economic mobility.
True, some other things have a greater impact on premature births than prenatal care, and the US system is shitty at those things as well.
I picked access to prenatal care because it's one of the easiest ones to improve, it has a positive impact on a variety of metrics, and it should be desirable in itself to anyone who isn't a sociopath.
I can't recall where I read about it, but I seem to remember that in some cases one country may count infant mortality differently than another. For example, one country may mark a baby's death after birth saying it was born while another may not consider the baby that dies soon after birth as not having been born in the first place. When comparing numbers from country to country one has to make sure they are allowing tallying the numbers the same way.
To further your point about statistics not telling you the whole story. I often see statistics that suggest you are more likely to be shot in the US than another country. This suggests that living in the US is a highly dangerous thing and that we all fear being shot on a daily basis. But if you look at the numbers it's generally not as dangerous as it sounds since you are more likely to shoot yourself than be shot by another person. The reason being is that suicide deaths by firearms are often much higher than homicides. The same for the statement I keep seeing that you having a gun in your house increases the likelihood you'll be shot. It's because you're more likely to shoot yourself with it than be shot by someone else.
Statistics can be presented in different ways to support different agendas. You have to be willing to look at the raw numbers objectively and consider how they are tabulated to get any meaning out of them.
Ty Cobb must have sucked at baseball because over his entire career he failed to get a base hit about 65% of the time at bat.
I found the following blurb from the article interesting as it tries to make the information relevant the gun control debate:
Gun use emerged as a factor: Americans were seven times more likely to die in a homicide and 20 times more likely to die in a shooting than their peers. In all, two-thirds of the mortality disadvantage for American men was attributable to people under the age of 50 -- and slightly over half of that resulted from injuries...
However, why is this article interesting to the Hacker News crowd?
Much like hunger in the third world: it's a political problem.
Practical solutions have long since been developed and proved in other places. The problems persist where they do, because there's no political will to actually implement the solutions in those places.
They're grappling with costs because their professional ethics require they treat people who can't pay, yet their business obligations require they don't treat those people until it's serious and likely expensive.
So because X number of people get X-Rays that will never be paid for, providers have to try to find some amount they can charge those who do pay, to cover the difference. And the trick with that, is that insurance companies know damn well what X-Rays should cost and have the bargaining power to squeeze out much of the padding in the cost of an X-Ray. [1]
Which means those costs are eating into profits in a big way and has healthcare providers struggling to make the math work out. Particularly for those that service poorer areas, where fewer well-ensured patients can offset the cost of uninsured patients.
And when you don't have a lot of slack in your budget, it's pretty difficult to add beds and professionals to increase your ability to supply healthcare.
[1] Which is another perverse incentive for the hospitals to use new machines/drugs/methods when old ones will do just fine. Firstly, they're incentivized because their profit is largely function of the percent of raw cost the insurance companies allow for profit. So an X-Ray++ brings in more profit than a bog-standard X-Ray for the same amount of professional time.
Secondly, because newer tools are by definition not yet commoditized, they can squeeze more 'buffer' into those prices, until the insurance companies can sort out what it 'should' be and more hospitals get in on tool X and begin essentially competing with one another, by accepting lower rates.
I meant national health systems. Costs are going up everywhere (or at least, spending) and lots of places are having some issues providing enough treatment.
While I agree it's a political problem in general, there's apparently a lot that can be hacked. Starting with lowering the cost of diagnostics and improving the information flow... There were a couple of interesting companies interviewed on Mendelspod (http://mendelspod.com/) - if you're interested in what can be hacked, give it a go.
Agree. Patients need better information if we are ever going to be serious health care consumers. Doctors have very little incentive to help us shop for services. Co-payments, lack of reimbursement, etc are all tools used by insurers to reduce cost (combat moral hazard, etc), but very little has been done by patients historically to systematically lower costs.
(1) Help Medicare track cost-effectiveness of tests/procedures involving really expensive technology (development of which will only get more & more expensive); (2) Teach Medicare patients how to become actual consumers of health care (how to shop for price/compare treatment options) -- i.e. help transfer some of the burden of reducing cost from payers to patients w/out causing mass hysteria
I don't think #2 will work without reforming the system to incentivize that kind of behavior. My grandmother goes to the podiatrist to have him cut her toenails (diabetes). There's barely any risk of her doing it herself, but he charges $200 every week for this treatment to Medicare. With her supplemental insurance, she pays nothing for these visits out of pocket. Why wouldn't she go?
Chicken/egg. I'm not sure reform is practical until consumers have the help necessary to shop / compare. Otherwise, you basically have a bunch of old, angry voters.
Interestingly, the trimming of toe nails can be abused with "up-coding" as "minor surgery". When I worked with a group investigating Medicare/Medicaid fraud, this procedure was a commonly abused (with up-coding).
The point being is that fraud is a significant problem, but it's not easily solvable.
I'm guessing that corn subsidies in the US mean a glut of high fructose corn syrup. Too much cheap sugar in the diet is bad. (And then there's some extra stuff about too much fructose over other sugars.)
Oil subsidies mean people drive everywhere rather than cycling or walking.
Grain subsidies indirectly subsidize high–calorie, low–nutrition foods like bread, cookies, crackers, soda drinks (corn syrup), and other stuff that is terrible for you. Fuel policy promotes more driving, less walking.
It is an interesting question as to where to draw the line between personal responsibility and governmental responsibility. Of course most people in the US can afford to buy quality food, if they really wanted to, and some Americans are doing well. But Americans clearly aren't doing well at keeping up their health, and gov policy is making obesity worse. I saw some data point recently that suggested we may have passed an inflection point (for the better), hopefully it turns out to be true in the long run.
Only if we assume that absent ethanol, that farmland would be used to grow corn for food/HFCS. Which isn't true. We also subsidize not farming. So much of the land used for ethanol would be otherwise left fallow.
This is a great example of how macro-statistics are inherently useless to predict individual outcomes (or even individual group outcome).
I'd go so far to say irresponsible to publish without disclaimers since these kinds of studies are so easy to regurgitate and buy into about the "state of the USA".
A glaring example - how can you even consider Japan a "peer" nation to the USA when comparing health?
Ethnicity has been shown, again and again, to have a gigantic impact on life expectancy - so a more compelling study may be USA Japanese with Japanese parents vs. Japanese in Japan.
But then again what about RICH Japanese in USA vs. RICH Japanese in Japan?
Or broken out by Japenese that follow different diets?
Or Japanese that smoke?
Or any of the other "studies" that try to identify individualized trends.
If we're trying to glean anything from this data beyond pageviews for newspapers then segment & compare the data along actually comparable lines - class, ethnicity, and regional lines.
When Japanese immigrate to America, their health outcomes quickly converge with those of other Americans. 'Ethnicity' isn't the culprit, usually - more likely culture and national policies.
That correction might make sense for ethnicity. But class?
Defending the USA's health system by saying "well, it has a stark class divide which pre-ordains that a large proportion of its population will get inadequate health care compared to other countries" is only valuable in that it tells us that to improve health outcomes, we've got to break down our class system.
And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities.
News Flash: The U.S. isn't a welfare state. To benefit from everything this country has to offer, you need to pay for it. Yes, it would be better if that didn't apply to healthcare, but there needs to be some method of exclusion when demand is high and supply is low. Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)
isn't the point that on average, rational actors would prefer the wait, since, on average, that is correlated with better outcomes? perhaps partly because you presented a false choice - it's often a choice between waiting or not being able to afford it?
what i mean is, well, great rhetoric, but you know, facts, man. facts.
> Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do?
At least we get treatment not dependent on the quantity of money we have.
I'm American, but I know a lot of people from Canada, and after many conversations, the "2 months for a specialist" is bullshit. In practice, preventative medicine and not having to fear to afford healthcare when you need it drastically reduce the demand on the most expensive and specialized doctors and practices because you deal with problems before they end up in the emergency room.
I have no health insurance right now. If I got sick in Canada, I would absolutely visit my doctor, get a prescription and diagnosis, and be on my way. In the US, I have to pray I don't have a severe disease and try using over the counter meds because I can't afford upwards of $800 doctors visits if they perform any tests. It is around $150 just to walk in the door.
Probably on the high end of things, but it's really not that hard. Based on what I've seen from my insurance co. the base rate for my doctor is about ~$250, even for something as simple as simple consultation about the flu (i.e., no tests or other treatment/equipment).
If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.
Yes, but on average it seems not to work that well, which the article tries to show. Apparently the possibility of waiting 2 months for a specialist (in reality I very rarely see such situation) seems to be better than the current system in the US.
Also, in many systems (excepting Canada, where I believe there is no alternate private system) you can see a specialist with no wait if you're willing to pay for it.
What you are referring to are elective procedures, and 2 months of waiting time wouldn't kill you. There is no waiting time for emergencies in Canada or Europe.
Yes if you throw alot of money, you get state of art facilities and top doctors, but are you getting the return on investment if the healthcare system is lagging behind the "welfare states".
Not true in Canada. The Supreme Court ruled that the wait times in Canada violated the Quebec Charter of Human Rights and Freedoms because there was no private option.
> And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities.
People fly to many first-world countries for medical care, including "Canada and Europe". Yes, if people have vast sums of money, they can receive excellent medical treatment in the US (as they could in many countries).
However, that's not the problem though, is it. The problem is that in general, most Americans fall behind in health compared to other first-world nations.
> but there needs to be some method of exclusion when demand is high and supply is low
Are you arguing that the state of health of the majority of the country is irrelevant as long as high-income earners can receive the best medical care?
That's not a valid comparison. "State of the art" facilities are not being argued against, but "health of the populace".
People also used to (maybe still do) fly to Australia for cardiac surgery.
The US may be able to pull in doctors from around the world with salaries that are high (correlating to high healthcare costs), but the regular individuals access to such doctors is limited: if I, talking to my insurance provider in Washington, said I wanted to go to the East Coast and have Dr Oz do my cardiac surgery (leaving aside any, and indeed valid, controversy over him - I was just looking for a notable/famous surgeon), I'm fairly certain they'd balk (and I'm fairly certain because I've worked on software systems that determine such things for insurance providers).
> "And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities."
Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior.
As a Canadian who lives in the US it's often shocking how different the perception of the Canadian health care system is between the US and Canada. Canadians by and large are quite satisfied with the system, while even reasonably liberal Americans I've met seem to believe it's some kind of waitlist-filled hellhole.
I've had more than one American express incredulity when I pointed out going to the US for major medical procedures isn't really a thing in Canada, where they thought it was widespread and relatively common.
By my own observation, there are a few isolated cases of this happening (mostly among the extremely wealthy), and is not at all widespread.
> "but there needs to be some method of exclusion when demand is high and supply is low."
The supply of medical capacity is not fixed or subject to a real physical limitation (like, say, rare earth metals). In Canada the response to constricted supply has been expanding the supply, as well as reducing per-use costs to make this possible. The supply is not infinite, but is high enough that people who need it, get it, and at a cost affordable to them (amortized across the entire population).
[edit] It's worth mentioning that, due to the economic incentive of single-payer health care, Canada invests a tremendous amount of money in preventative care and screening, which serves to dramatically reduce demand for the most expensive, most supply-constrained treatments. In fact I have a friend who works for the Canadian government right now doing computational screening for early cancer detection. It's interesting stuff, saves lives, and saves money, but requires a dramatic economic incentive to build out that simply doesn't exist in privatized care.
> "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)"
Citation, again, sorely needed. I grew up in Canada and have never waited 2 months to see a specialist, nor 2 months for treatment. The longest I've waited for a specialist was a few days. I've also (unfortunately) been to both Canadian ERs and American ERs, and the wait times are not substantially different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).
Also a Canadian, just want to confirm this. I can see a doctor instantly, for free, at any one of the clinics near my house. If I need to see a specialist, the referral usually happens within a few days or a week for anything urgent. Ditto for bloodwork, you just take the referral to a hospital.
There are some exceptions, but generally things work well.
As a Canadian I'll chime in and say that I waited 6 months for knee surgery. In a way it sucked, but on the other hand it made sense. I waited 6 months because all I had was a meniscus tear, so I could still do many forms of exercise, drive, walk, run, and work. My chief limitation was my inability to do Judo and soccer.
So I waited for 6 months behind a number of people including those who had similar non-critical injuries but were diagnosed earlier and those who had severe knee injuries requiring reconstruction or replacement. Rationing was done on a need basis rather than my ability to pay. Some people may talk about how terrible this is, and to be honest I probably could have afforded the surgery in a "private" system. Then again, when I was much younger and needed my first knee surgery I would have been hosed in a private system. And no, I wouldn't have been covered under my parent's policy in a private system.
Furthermore, when I have required urgent care, I have received it immediately. The longest I have waited is a few hours in the emergency room. Close friends who have dealt with much more serious life-threatening diseases have started receiving treatment/surgery within a few days or even the same day.
So yes, I experienced the terrible gulag that are Canadian medical wait lists and it really wasn't that bad. The wait lists are based on triaging, rather than wealth, and having wait times based on medical decisions made by professionals rather than economic incentives seems a much more humane system to me. I understand that some will call this "unfair" but that just means our definition of fair is different.
This kind of argument probably worked better in the 90s or something, but it does not hold as much water today.
First, the exorbitant rate of medical inflation in our "market" healthcare system is a fiscal menace not only to the public sector, but to the private sector as well.
Secondly, the deteriorating health of the American workforce is an increasing threat to global competitiveness. An overweight employee pool with high prevalence of unmanaged diabetes is not an attractive one for global capital.
Expanding access, controlling costs and emphasizing preventive care are things we need to get better at out of naked self-interest. Saudi sheiks who want to fly in for a quadruple bypass may continue to do so, but if we lose them to somewhere that bows and scrapes to the mega-rich more than we do, good riddance.
Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)
I would really prefer not to have to do this. Do you have a suggestion for how I could avoid that wait? I live in the U.S. and those timeframes don't seem particularly high compared to what I'm used to.
My brother in Columbus, Ohio, with a health plan for a director level position in a Fortune 1000 company, got a referral to a neurologist for a pinched nerve. Took six months to actually get inside a neurologist's office. This, in a health care market of 1.5 million people.
What's that about wait times in nationalized healthcare countries again? I'm sure he'd have been much more quickly served in Vancouver or Toronto or Manchester.
"Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do?"
This is so misinformed it's borderline laughable (if it wasn't thrown out there by someone who is a member of the HN community and, I'd assume, an intelligent peer.)
I have been treated in Argentina for urgent and non-urgent issues and never, ever, had to wait 2 months for anything. When I was referred to a specialist (best of her branch of medicine in a city of almost a million inhabitants) I got an appointment the following week and started treatment within a month. Whenever I needed something, like an X-ray or bloodwork, I could either get it free of charge at the local hospitals or just pay for it (incredibly, a CT Scan with the same machines they use in the US costs 1/6 the price in Argentina. How's that for free market economy?) and get a result immediately.
So, all in all, this is complete bunk. People who have never experienced any other system are by definition the worst to make a comparison with the US system. I've used the Brazilian, the Argentinian, the British and the US system and by far my worst experience has always been in the US, even while paying through my nose to get the same care I'd get for free in either of the 'developing' nations. Heck, I've used the _private_ system in the UK and even if I paid the extra bit to be seen by a doctor (20' wait at the practice; Oh! The horrors of endless lines and dead panels!) I only had to pay ~£2.50 to get all the medicine he prescribed (that's the upper bound, after that everything else is free.)
So yeah, definitely the US is not a welfare state. If anything, it's the contrary: a profiteering system where healthcare is just secondary to profit.
I think an easy way to improve the health care industry would be to quadruple the number of urgent cares and keep them all open 24 hours a day. Financially the system encourages urgent care use, but they are often tough to access. Many times in the middle of the night we have to consider taking a child to the ER or just waiting until morning.
I don't know if this would improve general health, but it sure would make me feel like I am getting more for what I pay.
My first thought was "what the hell does health have to do with accidents?", which I learned was justified by the first article I found after googling for "life expectancy without accidents": http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-amer...
>A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.
The article has an updated section on that question.
>I asked Robert Ohsfeldt about this, who responded that the adjustment factor was based on fatal injury rates relative to the average. Hence, the adjusted numbers shouldn’t be seen as hard numerical estimates of life expectancy, but rather as a way of understanding the true relative ranking of the various countries on life expectancy excluding fatal injuries.
* The US is thought by some economists to have an artificially high infant mortality because the US is more rigorous about reporting live births than other countries which might write up the same events as stillbirths.
* Outcomes in the US for chronic serious illnesses are at or near the top of the rankings.
* Life expectancy figures in the US are anchored down by suicides and, more importantly, traffic fatalities, which the US leads the world in. While that's not something we should be OK with, it's also a direct consequence of the vast land mass and wide population dispersal in the US.
This report[1] claims that the difference in reporting child mortality isn't the chief cause of the difference in infant mortality between the U.S and similarly developed countries.
Instead the claim that most of this difference is due to the high percentage of pre-term births in the US compared to other developed countries.
Isn't a preterm baby which fails to survive exactly the kind of event that wouldn't be documented as an infant mortality at all in a less rigorous country?
Yes. But I'm not sure I follow here, both Sweden and the US use the same criteria to report a live birth (All live births are reported) and seem to use the same definition of Infant mortality rate, (Death before first birthday). I fail to see how reporting differences explain the difference in infant mortality between the two countries. Of course, compared to countries that use extra conditions for live births (weight limits etc.) the US would get a higher rate of infant mortality due to having more laxed conditions for what constitutes a live birth.
It would be shocking if the US had infant mortality rates that were apples-apples close to Sweden. Sweden has just 9 million people, and they're very homogenous.
The lede on stories about US infant mortality isn't that Sweden outdoes us. It's things like "the US ranks alongside Qatar and Croatia". Those are the assertions I think we need to be more careful about.
According to yesterday's article in the NYT, this trend of the US's not keeping up with this group of 14 wealthy countries was absent in 1950 and only really started picking up steam after 1980. Since the US population was already significantly more heterogenous in 1950, why didn't that heterogeneity show through in the life-expectancy data for 1950?
The difference in heterogeneity between the US and the other countries has probably increased from 1950 to today. But I also suspect that some of this difference in life-expectancy between the US and the 14 others is that it might be easier to implement preventive health care measures that reach the whole population in societies that have more comprehensive health care insurance by default.
It would be really interesting to see data comparing the healthiest people in the US and other similarly developed countries.
"Outcomes in the US for chronic serious illnesses are at or near the top of the rankings."
This is because we have so many people with chronic serious illnesses that we know what to do with them better (at high costs). This isn't something to be proud of.
That's a pat way to dismiss any ranking of countries for health outcomes.
If you want to come up with a way to produce a low rank for the US on some holistic indicator, you will not have a hard time doing it. Are we the "healthiest" country in the world? Certainly not! We don't even have mandatory military service.
The issue here is that we need to be clear on what lessons we're trying to draw from the rankings. People definitely want to use rankings like this in inappropriate ways. If you want to look at this and say "America has an obesity crisis", nobody credible will argue with you --- but you didn't need this ranking to do that anyways.
On the other hand, if you want to say "America has a crisis of unavailable health care", well, you're wrong. The statistics don't bear that out. We have other health services problems, like bankrupting the uninsured, but measured by effectiveness and outcome, we have a top tier system.
Is it better to have a nation with 2.5% diabetic population than 6.5% population, if it meant that the nation wouldn't have the best (but still very good) diabetic treatment outcome? Is that a good trade-off? Probably.
I replied, because often apologists for American healthcare (I'm not saying you are one) neglect to mention why we have a good treatment outcome for certain conditions.
See this is the problem. If you're making a list of "most diabetic countries", sure, stick the US at the top of the list and start thinking about public policy to reduce diabetes and obesity. But don't blindly try to use that ranking to make policy decisions about how we provide health care, which you imply by saying people are "apologizing" for US care, because making doctors and hospitals more accessible won't make people eat better.
It does not help at all that we have overseas military commitments at a scale no other industrial country would match. The suicide rate for veterans is wildly higher than for civilians.
Not counting the Navy, the US has at least double the per-capita rate of deployed troops. But that's misleading too, because most of New Zealand's deployments aren't hostile; a US soldier is far more likely to see combat than an NZ soldier.
None of what you said is either backed by facts or is actually worth remembering if you're trying to fix the problem.
I always read your replies to threads about health care in the US and I'm always left with two thoughts: "what does that even mean and how does it further the conversation?"
If you bothered to actually follow the link to the data (http://sites.nationalacademies.org/DBASSE/CPOP/DBASSE_080393), you'd see that none of what you said is accurate. The US is either at the end or, sometimes, in the middle of the rankings for everything. The Violence graph is particularly interesting.
It would be helpful if you could be clearer about which of those points "isn't backed by the facts" and which are "not worth considering", assuming those are disjoint sets.
In a top-level comment, the HN participant who kindly submitted the L.A. Times article that opens the thread here notes with regret that the New York Times report
on the same report provides more detail. The lede paragraph shows the importance of cultural and lifestyle factors rather than health-care-as-such in the mortality and morbidity outcomes:
"Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States."
Drug addiction in particular is a severe problem in the United States to a degree not seen in (for example) east Asia. The stark historical memory of the Opium Wars imposing Western drug-pushing on east Asian populations makes many countries on the other side of the Pacific Rim very wary of letting young people start drug use. Illicit drugs were all but unknown in the childhood experience of my wife under Taiwan's former military dictatorship. Growing up free of harmful psychoactive substances allows young people clear heads to learn a lot (including learning other languages for international understanding) and to grow up to promote social improvements, such as the steady democratization and upgrades in provision of health care in Taiwan during my adult life.
So let's be clear what the report tells us: health outcomes in the United States often fare poorly compared to the health outcomes in other countries approximately as rich. But the challenges to health in the United States sometimes differ in ways that reflect long-standing differences in United States culture that still need to be nudged in healthier directions.
AFTER EDIT: There has been some hand-waving (without specific deep links) about OECD health statistics in this thread. In fact, the United States does not fare as badly in comparison to other OECD countries
>The study listed nine health areas in which Americans came in below average: infant mortality and low birth weight, injuries and homicides, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease and disability.
I hope people don't think this is some condemnation of the US health care system. No matter how good your health care system is you're not going to be able to correct for serious lifestyle problems.
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[ 4.2 ms ] story [ 122 ms ] threadhttp://www.nytimes.com/2013/01/10/health/americans-under-50-...
It provides a little more detail.
[1] http://www.oecd.org/statistics/
0: http://super-economy.blogspot.com/2010/12/amazing-truth-abou...
And can you elaborate on why you think the post is wrong?
And can you elaborate on why you think the post is wrong?
Meanwhile, in response to your
Why do you think my worldview would be based on a single blog post?
I am wondering why you have submitted that link so often in previous Hacker News discussions of international comparisons among countries. (This most recent time is far from the first time you have submitted the link.) That link is the only external source you have submitted here. What do you think makes that a better post to consider for the issues under discussion in this immediate thread than some of the links shared on health issues in other subthreads here? What does that link actually have to do with health at all?
In the US, premature births occur at a much higher rate than other country and account for a large portion of the higher infant mortality rate. Those stats also don't tell you that if you have a premature baby, it's most likely to survive if treated in the US.
[1] http://en.wikipedia.org/wiki/Infant_mortality#Measuring_IMR
As for the other measures, how you count is important. Without seeing the actual data, it's hard to say exactly how relevant it is.
Pretty much what you'd expect for a system that doesn't emphasize accessible prenatal care.
Prenatal care has a minimal impact on premature births.
I picked access to prenatal care because it's one of the easiest ones to improve, it has a positive impact on a variety of metrics, and it should be desirable in itself to anyone who isn't a sociopath.
To further your point about statistics not telling you the whole story. I often see statistics that suggest you are more likely to be shot in the US than another country. This suggests that living in the US is a highly dangerous thing and that we all fear being shot on a daily basis. But if you look at the numbers it's generally not as dangerous as it sounds since you are more likely to shoot yourself than be shot by another person. The reason being is that suicide deaths by firearms are often much higher than homicides. The same for the statement I keep seeing that you having a gun in your house increases the likelihood you'll be shot. It's because you're more likely to shoot yourself with it than be shot by someone else.
Statistics can be presented in different ways to support different agendas. You have to be willing to look at the raw numbers objectively and consider how they are tabulated to get any meaning out of them.
Ty Cobb must have sucked at baseball because over his entire career he failed to get a base hit about 65% of the time at bat.
Gun use emerged as a factor: Americans were seven times more likely to die in a homicide and 20 times more likely to die in a shooting than their peers. In all, two-thirds of the mortality disadvantage for American men was attributable to people under the age of 50 -- and slightly over half of that resulted from injuries...
However, why is this article interesting to the Hacker News crowd?
But what to fix?
Much like hunger in the third world: it's a political problem.
Practical solutions have long since been developed and proved in other places. The problems persist where they do, because there's no political will to actually implement the solutions in those places.
So because X number of people get X-Rays that will never be paid for, providers have to try to find some amount they can charge those who do pay, to cover the difference. And the trick with that, is that insurance companies know damn well what X-Rays should cost and have the bargaining power to squeeze out much of the padding in the cost of an X-Ray. [1]
Which means those costs are eating into profits in a big way and has healthcare providers struggling to make the math work out. Particularly for those that service poorer areas, where fewer well-ensured patients can offset the cost of uninsured patients.
And when you don't have a lot of slack in your budget, it's pretty difficult to add beds and professionals to increase your ability to supply healthcare.
[1] Which is another perverse incentive for the hospitals to use new machines/drugs/methods when old ones will do just fine. Firstly, they're incentivized because their profit is largely function of the percent of raw cost the insurance companies allow for profit. So an X-Ray++ brings in more profit than a bog-standard X-Ray for the same amount of professional time.
Secondly, because newer tools are by definition not yet commoditized, they can squeeze more 'buffer' into those prices, until the insurance companies can sort out what it 'should' be and more hospitals get in on tool X and begin essentially competing with one another, by accepting lower rates.
While I agree it's a political problem in general, there's apparently a lot that can be hacked. Starting with lowering the cost of diagnostics and improving the information flow... There were a couple of interesting companies interviewed on Mendelspod (http://mendelspod.com/) - if you're interested in what can be hacked, give it a go.
There are also projects like http://nhshackday.com/
The point being is that fraud is a significant problem, but it's not easily solvable.
Oil subsidies mean people drive everywhere rather than cycling or walking.
It is an interesting question as to where to draw the line between personal responsibility and governmental responsibility. Of course most people in the US can afford to buy quality food, if they really wanted to, and some Americans are doing well. But Americans clearly aren't doing well at keeping up their health, and gov policy is making obesity worse. I saw some data point recently that suggested we may have passed an inflection point (for the better), hopefully it turns out to be true in the long run.
I'd go so far to say irresponsible to publish without disclaimers since these kinds of studies are so easy to regurgitate and buy into about the "state of the USA".
A glaring example - how can you even consider Japan a "peer" nation to the USA when comparing health?
Ethnicity has been shown, again and again, to have a gigantic impact on life expectancy - so a more compelling study may be USA Japanese with Japanese parents vs. Japanese in Japan.
But then again what about RICH Japanese in USA vs. RICH Japanese in Japan?
Or broken out by Japenese that follow different diets?
Or Japanese that smoke?
Or any of the other "studies" that try to identify individualized trends.
If we're trying to glean anything from this data beyond pageviews for newspapers then segment & compare the data along actually comparable lines - class, ethnicity, and regional lines.
Defending the USA's health system by saying "well, it has a stark class divide which pre-ordains that a large proportion of its population will get inadequate health care compared to other countries" is only valuable in that it tells us that to improve health outcomes, we've got to break down our class system.
News Flash: The U.S. isn't a welfare state. To benefit from everything this country has to offer, you need to pay for it. Yes, it would be better if that didn't apply to healthcare, but there needs to be some method of exclusion when demand is high and supply is low. Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)
what i mean is, well, great rhetoric, but you know, facts, man. facts.
At least we get treatment not dependent on the quantity of money we have.
I have no health insurance right now. If I got sick in Canada, I would absolutely visit my doctor, get a prescription and diagnosis, and be on my way. In the US, I have to pray I don't have a severe disease and try using over the counter meds because I can't afford upwards of $800 doctors visits if they perform any tests. It is around $150 just to walk in the door.
If you have something more complicated, like, say, requiring stitches, or even basic lab testing (urinalysis?), it all adds up on top of all of that. I'd imagine if you went to the doctor and he/she ordered a small battery of tests, you'd run up well over $800 fairly quickly.
Yes if you throw alot of money, you get state of art facilities and top doctors, but are you getting the return on investment if the healthcare system is lagging behind the "welfare states".
http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_(Attorney_Ge...
And, of course, for people who can't afford the inflated prices we've got here... the waiting time is infinite.
> And yet people from around the world fly here every day to have critical surgeries performed by the world's top doctors in state of the art facilities.
People fly to many first-world countries for medical care, including "Canada and Europe". Yes, if people have vast sums of money, they can receive excellent medical treatment in the US (as they could in many countries).
However, that's not the problem though, is it. The problem is that in general, most Americans fall behind in health compared to other first-world nations.
> but there needs to be some method of exclusion when demand is high and supply is low
Are you arguing that the state of health of the majority of the country is irrelevant as long as high-income earners can receive the best medical care?
People also used to (maybe still do) fly to Australia for cardiac surgery.
The US may be able to pull in doctors from around the world with salaries that are high (correlating to high healthcare costs), but the regular individuals access to such doctors is limited: if I, talking to my insurance provider in Washington, said I wanted to go to the East Coast and have Dr Oz do my cardiac surgery (leaving aside any, and indeed valid, controversy over him - I was just looking for a notable/famous surgeon), I'm fairly certain they'd balk (and I'm fairly certain because I've worked on software systems that determine such things for insurance providers).
Citation sorely needed. This claim is regularly trot around, but nobody has been able to point to data that would suggest that this is anything but extreme outlier behavior.
As a Canadian who lives in the US it's often shocking how different the perception of the Canadian health care system is between the US and Canada. Canadians by and large are quite satisfied with the system, while even reasonably liberal Americans I've met seem to believe it's some kind of waitlist-filled hellhole.
I've had more than one American express incredulity when I pointed out going to the US for major medical procedures isn't really a thing in Canada, where they thought it was widespread and relatively common.
By my own observation, there are a few isolated cases of this happening (mostly among the extremely wealthy), and is not at all widespread.
> "but there needs to be some method of exclusion when demand is high and supply is low."
The supply of medical capacity is not fixed or subject to a real physical limitation (like, say, rare earth metals). In Canada the response to constricted supply has been expanding the supply, as well as reducing per-use costs to make this possible. The supply is not infinite, but is high enough that people who need it, get it, and at a cost affordable to them (amortized across the entire population).
[edit] It's worth mentioning that, due to the economic incentive of single-payer health care, Canada invests a tremendous amount of money in preventative care and screening, which serves to dramatically reduce demand for the most expensive, most supply-constrained treatments. In fact I have a friend who works for the Canadian government right now doing computational screening for early cancer detection. It's interesting stuff, saves lives, and saves money, but requires a dramatic economic incentive to build out that simply doesn't exist in privatized care.
> "Would you rather wait 2 months just to see a specialist and another 2 months for treatment like patients in nationalized healthcare systems frequently do? (I'm looking at you, Canada and Europe)"
Citation, again, sorely needed. I grew up in Canada and have never waited 2 months to see a specialist, nor 2 months for treatment. The longest I've waited for a specialist was a few days. I've also (unfortunately) been to both Canadian ERs and American ERs, and the wait times are not substantially different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).
There are some exceptions, but generally things work well.
So I waited for 6 months behind a number of people including those who had similar non-critical injuries but were diagnosed earlier and those who had severe knee injuries requiring reconstruction or replacement. Rationing was done on a need basis rather than my ability to pay. Some people may talk about how terrible this is, and to be honest I probably could have afforded the surgery in a "private" system. Then again, when I was much younger and needed my first knee surgery I would have been hosed in a private system. And no, I wouldn't have been covered under my parent's policy in a private system.
Furthermore, when I have required urgent care, I have received it immediately. The longest I have waited is a few hours in the emergency room. Close friends who have dealt with much more serious life-threatening diseases have started receiving treatment/surgery within a few days or even the same day.
So yes, I experienced the terrible gulag that are Canadian medical wait lists and it really wasn't that bad. The wait lists are based on triaging, rather than wealth, and having wait times based on medical decisions made by professionals rather than economic incentives seems a much more humane system to me. I understand that some will call this "unfair" but that just means our definition of fair is different.
First, the exorbitant rate of medical inflation in our "market" healthcare system is a fiscal menace not only to the public sector, but to the private sector as well.
Secondly, the deteriorating health of the American workforce is an increasing threat to global competitiveness. An overweight employee pool with high prevalence of unmanaged diabetes is not an attractive one for global capital.
Expanding access, controlling costs and emphasizing preventive care are things we need to get better at out of naked self-interest. Saudi sheiks who want to fly in for a quadruple bypass may continue to do so, but if we lose them to somewhere that bows and scrapes to the mega-rich more than we do, good riddance.
I would really prefer not to have to do this. Do you have a suggestion for how I could avoid that wait? I live in the U.S. and those timeframes don't seem particularly high compared to what I'm used to.
What's that about wait times in nationalized healthcare countries again? I'm sure he'd have been much more quickly served in Vancouver or Toronto or Manchester.
This is so misinformed it's borderline laughable (if it wasn't thrown out there by someone who is a member of the HN community and, I'd assume, an intelligent peer.)
I have been treated in Argentina for urgent and non-urgent issues and never, ever, had to wait 2 months for anything. When I was referred to a specialist (best of her branch of medicine in a city of almost a million inhabitants) I got an appointment the following week and started treatment within a month. Whenever I needed something, like an X-ray or bloodwork, I could either get it free of charge at the local hospitals or just pay for it (incredibly, a CT Scan with the same machines they use in the US costs 1/6 the price in Argentina. How's that for free market economy?) and get a result immediately.
So, all in all, this is complete bunk. People who have never experienced any other system are by definition the worst to make a comparison with the US system. I've used the Brazilian, the Argentinian, the British and the US system and by far my worst experience has always been in the US, even while paying through my nose to get the same care I'd get for free in either of the 'developing' nations. Heck, I've used the _private_ system in the UK and even if I paid the extra bit to be seen by a doctor (20' wait at the practice; Oh! The horrors of endless lines and dead panels!) I only had to pay ~£2.50 to get all the medicine he prescribed (that's the upper bound, after that everything else is free.)
So yeah, definitely the US is not a welfare state. If anything, it's the contrary: a profiteering system where healthcare is just secondary to profit.
I don't know if this would improve general health, but it sure would make me feel like I am getting more for what I pay.
>A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.
>I asked Robert Ohsfeldt about this, who responded that the adjustment factor was based on fatal injury rates relative to the average. Hence, the adjusted numbers shouldn’t be seen as hard numerical estimates of life expectancy, but rather as a way of understanding the true relative ranking of the various countries on life expectancy excluding fatal injuries.
* The US is thought by some economists to have an artificially high infant mortality because the US is more rigorous about reporting live births than other countries which might write up the same events as stillbirths.
* Outcomes in the US for chronic serious illnesses are at or near the top of the rankings.
* Life expectancy figures in the US are anchored down by suicides and, more importantly, traffic fatalities, which the US leads the world in. While that's not something we should be OK with, it's also a direct consequence of the vast land mass and wide population dispersal in the US.
[1] http://www.cdc.gov/nchs/data/databriefs/db23.pdf
The lede on stories about US infant mortality isn't that Sweden outdoes us. It's things like "the US ranks alongside Qatar and Croatia". Those are the assertions I think we need to be more careful about.
It would be really interesting to see data comparing the healthiest people in the US and other similarly developed countries.
The population has no impact when we're looking at per-capita statistics.
Canada and Australia have the highest immigration rates in the world, so their homogeneity is going down, yet statistics like these are not going up.
The point is that Sweden is a cherry-picked comparison.
Choose any other OECD country then. The results are the same.
This is because we have so many people with chronic serious illnesses that we know what to do with them better (at high costs). This isn't something to be proud of.
If you want to come up with a way to produce a low rank for the US on some holistic indicator, you will not have a hard time doing it. Are we the "healthiest" country in the world? Certainly not! We don't even have mandatory military service.
The issue here is that we need to be clear on what lessons we're trying to draw from the rankings. People definitely want to use rankings like this in inappropriate ways. If you want to look at this and say "America has an obesity crisis", nobody credible will argue with you --- but you didn't need this ranking to do that anyways.
On the other hand, if you want to say "America has a crisis of unavailable health care", well, you're wrong. The statistics don't bear that out. We have other health services problems, like bankrupting the uninsured, but measured by effectiveness and outcome, we have a top tier system.
I replied, because often apologists for American healthcare (I'm not saying you are one) neglect to mention why we have a good treatment outcome for certain conditions.
http://en.wikipedia.org/wiki/List_of_countries_by_number_of_...
I would be very surprised if countries like New Zealand and Australia do not have more deployed troops per capita than America does.
I always read your replies to threads about health care in the US and I'm always left with two thoughts: "what does that even mean and how does it further the conversation?"
If you bothered to actually follow the link to the data (http://sites.nationalacademies.org/DBASSE/CPOP/DBASSE_080393), you'd see that none of what you said is accurate. The US is either at the end or, sometimes, in the middle of the rankings for everything. The Violence graph is particularly interesting.
http://www.nytimes.com/2013/01/10/health/americans-under-50-...
on the same report provides more detail. The lede paragraph shows the importance of cultural and lifestyle factors rather than health-care-as-such in the mortality and morbidity outcomes:
"Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States."
Drug addiction in particular is a severe problem in the United States to a degree not seen in (for example) east Asia. The stark historical memory of the Opium Wars imposing Western drug-pushing on east Asian populations makes many countries on the other side of the Pacific Rim very wary of letting young people start drug use. Illicit drugs were all but unknown in the childhood experience of my wife under Taiwan's former military dictatorship. Growing up free of harmful psychoactive substances allows young people clear heads to learn a lot (including learning other languages for international understanding) and to grow up to promote social improvements, such as the steady democratization and upgrades in provision of health care in Taiwan during my adult life.
So let's be clear what the report tells us: health outcomes in the United States often fare poorly compared to the health outcomes in other countries approximately as rich. But the challenges to health in the United States sometimes differ in ways that reflect long-standing differences in United States culture that still need to be nudged in healthier directions.
AFTER EDIT: There has been some hand-waving (without specific deep links) about OECD health statistics in this thread. In fact, the United States does not fare as badly in comparison to other OECD countries
http://www.oecd-ilibrary.org/sites/factbook-2011-en/12/01/01...
as some of the statements in this thread have suggested. The decline in all-cause mortality at all age ranges during my lifetime in the United States
http://www.scientificamerican.com/article.cfm?id=longevity-w...
has been steady, so people in general in the United States are living longer, healthier lives than ever before in history.
Too much "low fat" stuff being shipped around as "healthy" alternatives, when they are filled with sugar, instead of healthy fat.
I hope people don't think this is some condemnation of the US health care system. No matter how good your health care system is you're not going to be able to correct for serious lifestyle problems.