I wholeheartedly agree that the oncologists deserve a lot of praise/gratitude for their work. That gratitude is precisely the reason why I disagree with the latter half of your statement. I think it is unfair to to suggest that they would have accepted a monetary loss. Nobody visits an oncology specialist because life is wonderful. Every patient is somebody's mother, brother or spouse and every patient is facing an uphill battle.
Doctors deserve a paycheck to feed their families and pay off medical school debt just like everyone else.
Of course they do. But if he'd only raised $30k, they'd have gone "Welp, not enough, guess you're just going to have to die"? I seriously doubt it. You're going to serve the patients you can serve and get the recompense you can - people without insurance are going to bring some losses, but you don't just let them die.
" people without insurance are going to bring some losses, but you don't just let them die."
Are you aware of the health insurance debate/disaster in the US? How long can doctors operate at a loss?
I must say that you are very fortunate if you do not know someone who has died of cancer and was unable to see/pay every specialist they could fit in to their final months days. People die of cancer all the time wishing they had the money to see the ______ oncology specialist.
I've actually worked with health insurance billing.
The way it works is that they bill ridiculously large amounts, which nobody without insurance can pay. They know this. The insurance companies negotiate it, other people pay what they can, and it all more or less works out in the end. I'd much, much prefer to see a single payer system.
Seeing every specialist is different than being in treatment with a doctor and having them cut you off because you can't pay. It's very rare I hear of a doctor going "well it's a shame you can't afford to pay for this surgery" - nearly always they do it, bill it, and accept the losses. Hospitals recover less than 20% from people without insurance.
Texas oncology is a private practice. The $50K most likely paid for all the non-labor costs of the treatment. The doctors were working for free; i.e. they weren't compensated for their time
It's basically up to the people involved, everything is so baroque and ad-hoc there's not much standardization besides with medicare/medicaid and even that makes my eyes water.
I have had two family friends pass away while being unable to afford follow up visits to a specialist in NYC. You mention that you have "worked with insurance billing" in the past tense, is it possible that things have changed?
Great story of compassion and triumph. So... How do we make it scale?
Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably wild have been helpful. Though maybe the co-pay would have been $50k.
Universal tax-payer funded insurance? The term "tax payer" is interesting because politicians and pundits forget that we're all tax payers in one form or another. Granted some pay more, some are net consumers of govt services. But tax payers mean us, and those with more earned income more than those with less. I think the main difference between taxes and donation is choice.
Single-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable. Not that putting profit seeking entities in charge has yielded the ideal result.
Making drug providers, healthcare providers and everyone else in that supply chain non-profit? Profit has enormous motivational powers. Not always for good. But it is pretty amazing what can be accomplished by organizations setup to create wealth.
Big Data? Sorry, I couldn't resist. Well, lets use that as a proxy for innovation. It would seem that greater opportunity for innovation would help. Lower barriers to trying new drugs, procedures, diet, treatments would allow for potentially lower cost solutions to be created.
Separating health care from your job? Of your insurer only needs you to be healthy until you find a new job, there's not much in incentive for long-term healthcare and preventative screenings to identify tumors and other problems before they become an expensive problem. Though that would seem to be an arguement in favor of a single payer system.
Sorry, I don't have an answer. Hopefully, great stories like the OP continue. But if we don't make it scale then we haven't really done all we possibly can do.
I don't begin to understand the US health system (I live in the UK with its National Health), but didn't Obama try bring in compulsory health insurance to counteract just this sort of thing and it was defeated?
Not defeated, it just hasn't rolled out fully yet. States are figuring out how to implement everything, and of course the partisan foes of his health plan stage votes in Congress to repeal it (which never pass) every month or so.
It gets worse. According to CBO estimates, the plan underestimated the costs of the original rollout severalfold. Republicans are gleefully attempting to guarantee failure by refusing to approve any additional funds for that purpose.
I designed and implemented portable electronic medical records for 5 regional exchanges. Hospitals, clinics, pharmacies, ambulances, permanent stays (nursing homes), insurers, labs, etc.
Coordination was tough, because everyone thinks they own the data (and loathe to share) and are often competitors.
It's all about the incentives. The only fix I can think of is single payer, which will compel everyone to play nicely together.
That said...
Simply having the state by state insurance comparison portals seems to be very effective for price competition, better than I could have predicted. So on balance, it looks like the impact of Obamacare / ACA will be really good, if not perfect.
The figure that I was comparing is the initial cost of setting up the exchanges in the first place. From memory it was estimated by the CBO at about 6 billion, but only 1 billion was allocated for it. That is several-fold, though only a drop in the bucket compared to the 10 year figures once it is rolled out.
I have heard some republican state governors are pushing exchange setup to the Feds as part of their "gum it up" strategy, which may be pushing setup costs up. That said, as strange as it is to say, 5 billion is a relatively small number for the US government or the US economy.
It was not actually defeated, but if a Republican wins the next election (which is possible) and the senate and house can achieve a Republican majority, it will almost definitely be repealed.
The next election, or the election after that, or the election after that... As soon as they can, even if it takes then twenty years, they'll stab it in the heart with jubilant rapture.
It's highly unlikely they would repeal it unless they had an alternative. No serious proposals have been forthcoming (party because the ACA was actually the conservative proposal in the 1990's...)
It would be political poison, especially given the rollout will have had a few years to cement by March 2017 (the earliest anything could be taken to floor). Hard to tell what public opinion will be like in 3.5 years, but I'd wager it will be net-positive on ACA.
Single-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable.
It seems odd to me that so many Americans seem pessimistic about their own government. I could understand if the attitude was, "We could make universal, socialized healthcare work. We could make it cheaper than Canada's. We could make it better than Sweden's. We just don't want to for ideological reasons."
But how can it be that the attitude is, "It would never work here?" You're the greatest empire in the history of civilization. What is this word "can't" and why is it in your vocabulary?
Puerto Rico, US Vigin Islands, American Samoa, CNMI, Guam, and most importantly Hawaii are all annexed territories of the United States. Not to mention California and most of the west really.
If you just thought it were Ireland, Wales And Scotland that have an often uneasy relationship with England, you'd be surprised to learn who else bows to the English Crown.
(And yes Scotland has an upcoming referendum in 2014 on the issue of independence from the UK.[1] This is widely believed to be a losing proposition.)
Commonwealth Realm
Antigua and Barbuda, Australia, Bahamas, Barbados, Belize, Canada, Grenada, Jamaica, New Zealand, Papua New Guinea, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Solomon Islands, Tuvalu
Crown dependencies:
Guernsey, Jersey, Isle of Man
British Overseas Territories:
Akrotiri and Dhekelia, Anguilla, Bermuda, British Antarctic Territory, British Indian Ocean Territory,
British Virgin Islands, Cayman Islands, Falkland Islands, Gibraltar, Montserrat, Pitcairn Islands,
Saint Helena, Ascension and Tristan da Cunha, South Georgia and the South Sandwich Islands,
Turks and Caicos Islands
"This is widely believed to be a losing proposition." - evidence? I don't know if you're a UK citizen or living in Scotland, but I'd love to explain some of the nuances of Scottish politics. They said, once upon a time, that the SNP would never have a majority leadership (due to the way that the electoral system was designed for the devolved parliament) in the Scottish parliament, but look what happened at the last Scottish general election.
Perhaps what the Scottish people don't like the idea of is the SNP becoming the governing party of Scotland. However, and this is frequently ignored by the unionist press in Scotland, the SNP would not necessarily be the ruling party. There would be a new general election to vote for a new Scottish government in an independent Scotland and that could be Labour, SNP, Tory, Democrat, Greens or whatever.
There is a huge amount of disinformation banded about by Cameron, Osborne and other unionist politicians about Scotland's capabilities.
As an aside, "bowing to the English Crown" - the BAT, South Georgia, BIOT don't actually have any native population, and Pitcairn only has a population of 60.
I find that Americans hold the attitude that the government is not the picture perfect example of efficiency except in the case of the military. Spoiler alert: we have a quasi-single-payer system for the military.
Part of the reason that the military is able to do a relatively good job providing healthcare is that they can do a lot of sensible cost-saving things that are illegal in most places. Like using nurse-practitioners instead of MDs where appropriate.
Nurse practitioners are used in many countries with great results. Why is using them illegal ? of course it's because of regulatory capture and the general power doctors hold, which is probably the biggest reason why healthcare is so expensive(and also not very good).
You see it in million places: The limited number of medical schools, The lack of nurse practitioners doing the simple routine jobs in most specialties(dental, family, colonoscopy, anesthsia. Many others could exist), The lack of automation and expert systems[4] and automated patient interview[3] tools, the fact that family practitioners could replace a lot of the specialists work at lower costs[1], Many medical jobs could be done with a lot less training[2], the lack of use of proven processes like checklists[5], etc.
All those changes could save a lot of money, and raise quality. We know what to do, But how do we implement it ?
[2]Because there's a brain drain in africa to the west, some countries have started a 3 year surgeon degree program. Doctors who finished this degree seem to have equivalent results to fully trained doctors in simple/medium complexity surgeries.
[3]Research showed doctors only ask about half of the questions needed in a typical visit. Automated interview systems could at least gather more complete data.
[4]There's research review showing that correct implementation of decision support/expert systems could improve results.
[5]Peter provonost showed that checklists could reduce infection rates in one procedure from 8/12 percent to zero.This was around 10 years ago. I think gawande showed similar results in other stuff. checklists are still not commonly used.
Number 3, absolutely. That's true in the UK too. In fact, if AI consulted the patient, it would catch a lot of things which doctors miss, simply by asking enough pertinent questions.
When I have challenged doctors about this, they tend to say "Ah, but you're focused on data, we focus on diagnosing the patient", which is basically gibberish.
Let's do it. I had this idea that each medical field could have a sort of Global Subject Expert AI online to make diagnoses, and the more people using it, the more sublime it would become in its assessments.
If you're interested in building something, I think an automated medical interview app, for use by consumers, focused on some subset seems more practical.
The lack of adoption of checklists has bugged me for a long time now. I actually haven't heard of them in regards to infection rates, but rather surgery mishaps (I think that was Gawande). It's really disappointing that something so simple, with such clearly positive results, has yet to become mainstream practice. We make our commercial pilots use them; I wish we would mandate that our surgeons used them, too.
Well, we do already spend more than the UK on providing health insurance (divided by total population), but we're just providing it to seniors and poor people.
The problem is the morass of laws we've accumulated around healthcare over the years for various reasons that now interact in complex ways that nobody foresaw. Like the law designed to make Medicare or Medicaid (I forget which) drugs cheaper that ended up making it illegal to give free birth control to college students.
We also have the laws from when people believed that competition increased costs and so tried to ban competition between hospitals. Or the committee that sets doctor's reimbursement rates for Medicare procedures based on the *$%@# labor theory of value. And the laws designed to prevent people from overcharging Medicare that means that everybody has to worry about those rates across the industry. Or the way that the makeup of that committee means that primary care physicians gets shafted.
And the fact that we allow so few schools to teach medicine means that they can charge an arm and a leg, which means that those poor shafted PCPs need the kickbacks they get for assigning specialist care in order to pay off their student loans and malpractice insurance.
And I could go on.
And now we have this system that's incomprehensibly complex. So Congress has no way of figuring how to fix it on their own. There are people who've spent years figuring out how all of this works, but that's their job and if the system was actually fixed their job would be gone and that understanding they spent years acquiring would be useless.
Which isn't to say that this is entirely hopeless. There have been some efforts at the hospital level like Kaiser Permanente's to ameliorate the perverse incentives in the system and capture some of the value unlocked by that. And there are some laws that could be changes or repealed (like the one against hospital competition) without really breaking anything. So I think that gradual reform might be possible, but it's going to be a long road that doesn't particularly involve the issues that people tend to talk about around healthcare.
In slightly less words and with slightly less accuracy, you're unwilling or unable to wipe the slate clean and start from scratch.
To an extent I wonder how much of that is due to lack of recent experience with starting from scratch. The United States hasn't had a revolution, a war on its territory, or a regime collapse in a long time.
Germany and Japan were rebuilt from the ground up after 1945, France is now on the fifth republic, Spain, Portugal, and Greece shed dictatorships in the 1970s, some of Eastern Bloc now qualify as first world and have undergone a major change in 1989-91...
Instead of a gradual reform, what about enabling a new medical system , bound to new relaxed laws and new people to control it, to exist side by side to the current system, that would focus on low cost healthcare ?
Maybe it would be "lower quality", but least it would offer choice for many , and be a great research lab for low cost healthcare.
Well, Americans don't really vote, they prefer the government stay far away (imagine someone in Wyoming viewing a Federal solution kind of like Brussels solving Greece's health care problem), moneyed interests/cartels have a lot of sway, and some groups don't like paying for other groups' healthcare.
Local solutions don't really work for medical care, in terms of the legalities and economic structure, you have to require everyone to participate.
In this case, size and diversity work against us, it's just a lot easier in a small homogenous Scandinavian country.
Anyway, we have Obamacare gradually being implemented, where all employers above a certain size are supposed to offer insurance, and everyone else is supposed to buy it (the 'mandate' which the Supreme Court says is really just a tax).
So, maybe a minimum level of health care will start to be universal. But in order to get it through they made sure everyone was well greased. If the doctors, the hospitals, the insurance companies, or the pharmaceutical companies had to tighten belts a notch that would have been enough to sink it. So, it's going to stay very expensive.
I really think that people don't appreciate this fully for a lot of problems that the US has which have been 'solved' in other countries -- usually smaller European ones. Mail delivery, rail transportation, healthcare, etc. The US has a very unique blend of very urban and very rural areas that makes it hard to scale lots of services easily to everybody.
To echo Raganwald, I too don't understand a blanket unwillingness to even seriously consider the single-payer model. Like you'd be a socialist or a communist for even considering having private doctors and hospitals paid by the government instead of the patient.
From what I understand, drugs are much cheaper in Canada. Almost all medical procedures are cheaper here. I met a couple from Texas who flew up here for something, and they said it was cheaper for them buy plane tickets, stay here in a hotel for two weeks, and all other travel expenses, and get the procedure done here than to do it at home (uninsured). They still saved thousands of dollars after all that. That's craziness.
Maybe there's no perfect system. But the United States spends the most on health care per citizen, and has the lowest percent of government support. [1] You should at least consider what others are successfully doing to get the costs down and increase the quality of care for the uninsured and poor.
It's because of "American Exceptionalism." Single payer health care was not invented in America, therefore it could not possibly work in America. Education is similar. There are always at least 20 countries ranked ahead of the USA in primary and secondary education. Yet none of the successful approaches used in those countries can even be experimented with in the USA, because they "would never work here." Things are just different here, you see.
Knowing this, if one really wanted to implement single payer care in America, it would be more likely to succeed if the program was marketed as something like "Super Patriot America Care, just like our boys get in the US Military!" rather than calling it single payer care, which is some Euro/Canada not-invented-here thing that can't possibly ever work, because of America.
The funny thing is that the "father" of socialized welfare is Bismark, and the German system is largely private, and that too works far better. It doesn't have to be single payer: Pretty much every model that has set out with the requirement of providing universal coverage, in a country with enough money to fund it decently, has ended up better.
What's even more bizarre is that we have a single-payer system that's wildly popular among the 48 million people it serves and has demonstrated an excellent ability to control costs. It's called Medicare. It's currently restricted to those over 65 and certain people with disabilities, but expanding it to cover everyone would be a relatively easy task, it seems to me, compared to the gyrations we're going through trying to fix the private insurance system.
It's not just that many Americans have been persuaded that a single-payer system works for the old and disabled, but for some reason isn't right for everyone else. Rather, many Americans have been brainwashed into simultaneously supporting Medicare and opposing a generalized single-payer system, with equal fervor, without noticing the contradiction.
(Yes, really. I saw a photo a year or two ago of a protester at a rally carrying a sign that said "NO SOCIALIZED MEDICINE / DON'T TOUCH OUR MEDICARE", or similar language.)
I still can't decide what's more embarrassing: That the US have a third-world health care system or that people act like it is a hard, unsolved issue to implement something better.
I can't understand how Americans, who have the least efficient, most expensive health care system in the world, are so quick to write off public healthcare. The idea that government healthcare is more wasteful than a private system is not supported by facts, but the theory is too hard to let go of.
Which is not to say there is a perfect solution. But just about any of the alternatives would be better than the US system.
America doesn't have a free market healthcare system. It is heavily regulated.
The fact of the matter is that we've somehow managed to end up with a set-up that has just the bad parts from both models. All the runaway costs of regulatory capture, and all of the gross inefficiency of entrenched bureaucracy.
Seriously, this is not an unsolved problem. The US spends more per capita than the rest of the world but has huge swaths of people denied basic care, and poor outcomes overall for an allegedly developed nation. There are a range of options available - look at any of the varied options successfully implemented by every other developed nation on Earth. Americans may choose to reject them based on ideological grounds, but it's ridiculous to approach this like a problem that has never been tackled. Governments exist to address precisely these problems that require collective action without profit motive.
One note on efficiency - something like 30% (yes yes, citation needed) of American health dollars go towards insurance administration. A family member of mine works in Canadian health care and had a recent arrival (a physician, IIRC) from the States ask where the "billing floor" was because an out-of-country patient needed some sort of paperwork done. Well, Canadian hospitals don't have floors dedicated to processing payment. There was a small office.
On a second note, having your healthcare connected to your employment situation seems like insanity - I can't fathom anything that would argue in favour of that, unless you're an employer looking for additional leverage over your serfs.
> having your healthcare connected to your employment situation seems like insanity
It really is, although I don't think people realize it until you say it out loud. Precisely when you can least afford paying for a medical emergency -- when you're unemployed and thus have no income -- is precisely when it's most expensive. How broken is that? It would be insane in any other industry to charge your customer significantly more for the exact same service, simply because they're using a different payment method. Not to mention the horrible situation that arises if you acquire a medical condition so debilitating -- which usually also means it's expensive -- that it prevents you from working.
It's great that people here helped him out and that a life was saved, but it's also sad that some US citizens - in this case a veteran - have to beg for healthcare.
This is truly a wonderful story. But it makes you wonder how many others in a similar situation weren't so fortunate.
I lived in the US for two years, and I never understood the aversion to government healthcare. The Canadian system is far from perfect, and I know there are failures. But it's still a lot better than soliciting for online charity on a case by case basis.
I'm impressed and humbled that it worked in this case. Just a little disturbed that it was necessary at all.
I am not sure this story is really about the need for socialized medicine. This is more about the need of specialist care and second opinions. If most doctors he saw determined that he most likely would not survive treatment, a socialized medical program may have very well denied payment for such treatments, and he would have had to resort to fundraising anyways.
Maybe if the system was flexible, nimble and could make judgement calls on the side of compassion, it might work, but this is difficult in both public or private sector institutions.
When I was obviously ill and in pain in class the other day (I have some ongoing health issues), I had one of my classmates tell me that Obamacare was going to "destroy the entire country" (exact words) because people like me having health insurance would make doctors become underpaid. I mentioned that my health insurance paid $40,000+ to a certain hospital lately, and he complained that it all went to the hospital, not the doctors.
Then he went on some rant about how all the Canadians have to come down here for health care, and that was why you never hear of Canadians having surgery up there. I mentioned I had a Canadian friend who had a 3 part bowel surgery done recently, with very reasonable waiting times, and that of my several dozen Canadian friends, all but one was satisfied with their system, and he was just like, well, that's anecdotal, the statistics don't bear that out. That's not true at all, but he wouldn't hear of it.
Even before my health problems started, I was pro-single payer. But people like my classmate are everywhere, and seem to think that health care SHOULD be expensive and hard to get. It's inordinately cruel.
I've lived here all my life, but I'm actually moving out of state next month partially because my state's refusing to accept federal funds to cover my demographic next year, and I can't live without the medication I'm on. (Plus going to college out of state is cheaper than going to college in state (!). And they wonder why they have such a brain drain problem...)
I have often wondered given the kind of cost involved in good health care in USA, along with college fees, why don't more Americans move to Europe for health care and education where it is probably free most of the time?
Don't most of those "free" public health care systems only apply to citizens? I recall a story about a foreigner in Germany having to pay for their care, even if the price was reduced. Non-emergency care in the UK, for example, requires legal residency, which may be hard to come by for someone too poor to afford health care in the US. France requires non-EU citizens to have insurance for care in France to get a visa, as I understand it.
So, it's not just as easy as "let's pack up and move to the EU so we can get free healthcare tomorrow." Otherwise, you can imagine that every time a non-insured American got sick, they could compare the cost of getting new insurance to the cost of a plane ticket, and the plane ticket would win, I'm sure. =)
Yes, of course. But then I am talking more about the whole life, not only in the case of emergency etc.. I mean for someone like me, from what I have read about American healthcare and education system, I will choose Europe any day over America. And even though, I really don't have that choice with my passport. But in the case of US citizens, the choice seems realtively easy.
Being a US citizen doesn't mean that you can just waltz into Europe. Like other commenters said, you usually need to be a citizen or at least some sort of permanent resident to take advantage of European healthcare. Obtaining such status usually takes years and is only possible for the young and highly employable.
Packing up and moving is simply not an option for those who cannot afford to pay for healthcare in the US in the first place, and oftentimes logistics like family, employment, and language would prevent that anyway.
Mostly because Americans are terrified of foreigners and have absolutely no concept that the rest of the world isn't just a figment of Hollywood's imagination.
I'm living in Budapest partly for low tuition - my wife is Hungarian, which makes it less random than it seems.
Also, very few people in America can understand that life outside the United States could possibly be fulfilling. Or that tuition in much of Europe is free - I tell friends and family and they just boggle. There is such a strong feeling in the States that we have everything better than anybody else in the world.
When we were talking about moving to Budapest last year, I was asked by the plumber, "But is there enough food there?" He honestly believed, apparently, that everyone else in the world is starving except for the well-known massive foreign aid we provide. (That's tongue-in-cheek; most foreign aid is money specifically earmarked for the purchase of American industrial output, so it's really a handout to American industry, not to foreigners - and it's a tiny fraction of our annual budget to start with, but many people in America think that's where a substantial portion of their taxes goes.)
I'd move in a heartbeat if they'd take me, but it's hard when you can't afford education and most countries want you to have a bachelor's at least. So I got to live without either college or health care for five years instead. :( Now I have nervous system problems, so I'm sure they'd want me even less...
While this is a great and heartbreaking story that makes me proud to be an active member of HN it's also a symptom of the totally broken US healthcare system.
From wikipedia:
The United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990. Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and disability. Together, such issues place the U.S. at the bottom of the list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country.
According to the World Health Organization (WHO), the United States spent more on health care per capita ($8,608), and more on health care as percentage of its GDP (17.9%), than any other nation in 2011. The Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most.
Damn lies and statistics - it's very difficult to compare countries on Infant Mortality because they have different definitions of alive.
From wikipedia:
The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[24] In Germany and Australia, requirements for live birth are even higher.[25][26]
"However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[34][35][dead link][36] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[36]"
Your argument, will perhaps partially correct, fails to properly explain the disparity in infant mortality (mostly due to unnecessary premature births) between the US and similar industrial countries.
Yes it doesn't explain it away, there are other problems too that aren't related to health care: More teenage pregnancies (higher likely hood of low birth weight), more single mother pregnancies, more obese pregnancies). These are underlying cultural issues that while related to healthcare are different.
In no way am I trying to blame the victim or excuse a bad system. I'm only pointing out that these comparisons are very hard to do correctly and can be misleading. We have an urge to compare so that we can make better decisions, but it can be tough to do this. From the stats originally posted it could be argued that we need to spend more money on the healthcare system, when in reality we just need to educate people to wait to have kids.
Researchers from the NCHS found that low birthweight
and short gestational age births—a leading cause of
infant death internationally were more common in the
United States than in Europe. Although outcomes for
these births were similar, they found that the U.S.
rate of low birthweight and short gestational age births
was double that of Finland and Sweden.29 After adjusting
for potential recording differences by excluding very
short gestational age births, they found that the U.S.
IMR would be 3.9 if the United States had the same rate
of low birthweight and short gestational age births as
Sweden.
https://www.fas.org/sgp/crs/misc/R41378.pdf
In addition, if you limit the data to single child births, eliminating twins and other multiple births, the US actually ranks number one for child mortality. Multiple child births are inherently more risky, as are births to women over the age of 30. Due to wealth, cultural, and lifestyle factors the number of multiple-child pregnancies in the US is much much higher than in other countries. More American women choose to have children later in life and sometimes this includes fertility drugs which results in more riskier twin pregnancies.
When you remove car accidents and suicides from the death rates, factors that are largely independent from the health care system, the US actually has the highest life expectancy in the world.
A good source of info on this is the work of Scott Atlas. This econtalk includes a good look at the statistical biases in the micro rankings that get so much undue attention in the media.
I am not sure that suicide rates are particularly independent of health care provision, especially suicides in the elderly, which is where there has been a massive increase.
Edit: It has been (correctly) pointed out downthread that I have helped hijacking a very personal post for political point scoring - which I think is fair. However we lack a decent history function in HN so I leave it here otherwise the thread will read strangely.
Thank you - as a Brit I read this too. I cycled through emotions - fear and sympathy for the diagnosis, hope as some of our best professionals consider new options, and then.
WTF describes it best.
Americas attitude toward health care is odd from our perspective - not mismatched socks odd but like a Collegue suddenly announcing that aliens are real, they look very talk and thin and one is living in his attic
That kind of odd
(I am glad that the OP has recovered, heartened by every success medicine has against this disease. Just ... It's odd how nearly this was a different story)
You understand we've done a lot since 2007, right?
EDIT: specifically, "survival rate" is just "how many people lived for 5 years after diagnosis". Thus, you detect a lot of slow growing prostate cancer and your survival rates go up, even though nothing has been done to reduce the incidence of cancer, or stop any more people from dying of cancer.
When you look at US cancer mortality rates they look pretty good, until you restrict the numbers to the under-65s, when suddenly the numbers look pretty average. This might be because poor americans don't get access to treatment until they're 65 and qualify for some aid.
Dan I am not challenging your statement I am just curious if you have seen any figures about the new outcomes. I did a quick look at the UK Cancer research page and it does not look like many of the statistics have been updated recently.
That being said it would be nice if the disparity in survival percentages on this side of the pond looked more like the stats from your side:
I'd like to add to this that the US recommended screening PSA screeening for prostate cancer, whereas there's no screening program in the UK because the medical evidence suggests it does more harm than good. A huge proportion of older men have prostate cancer (30% of men over 50, apparently) but in most of them even without treatment it never progresses to the point of affecting them in any way before they die of something unrelated.
Similarly, the US screened women for breast cancer and cervical cancer earlier and more frequently than the UK, which again does more harm than good but improves the 5-year survival stats.
The US Preventative Screening Task Force has since recommended that screening should basically fall in line with what the UK's doing, but that happened well after that article was published.
From those top tens for females and males, five out of ten are countries with populations less than 12 million each. It would be interesting to see the US statistics by state.
Smaller networks (small population of a country, or by state) could be a factor here.
Hi, I believe that's wrong. I don't know why there is conflict in the technical literature, but I believe the consensus is that US healthcare outcomes lag behind most industrialized nations, including the UK. See e.g.
Those data show that the USA ranks far below the UK on Years of Life Lost due to several cancers. I don't see how that's consistent with your claim. [Edit: actually, YLL is an incidence statistic, whereas parent's claim is that survival statistics are higher in the US, which the sources I've found agree with.]
The Telegraph is a right-leaning paper and is well known to be anti-NHS. Please; being economically laissez-faire as people are on HN are is not incompatible with supporting state provision of healthcare, along with the other things a state provides. It's sad to see libertarians / laissez-faire economics people bashing the NHS by quoting stories cherry-picked by right wing media sources. It's just not something we need disagree about.
I cannot believe that the #1 comment responding to his thanks is basically a political one to raise awareness of the "broken" U.S. healthcare system, so I'll respond in-kind.
What was broken in this case was described by his statement: "I had no medical insurance and the few benefits I had with the VA would take months of paperwork to get me in." You can blame that on Ted Kennedy, btw. He is the one that made health insurance an institution in the U.S. The best chance we have at good healthcare here has nothing to do with government or health insurance, it was to do with doctors that are willing to say F.U. to the system and provide healthcare directly to paitents without middlemen. So, that's the other side of the politics. Now back to what we really should be talking about...
I think it is wonderful that his cancer was treated and that people here helped. Cancer really fucking sucks. I hate Cancer with a deep passion that some of you out there understand. Others of you like to think of how great your resume looks and how you are going to land a fat house on the beach. I used to also.
So long as you're not poor, health care in the US is good. If you live in a major city and are diligent about who takes care of you, it is great.
I've had three MRIs. All were scheduled the same day they were prescribed. I've routinely scheduled appointments with renown specialists and waited less than 2 days to get in. My double hernia surgery was performed by the same guy who treats the Chicago Bears. My old chiropractor/kinesiologist used to be Andre Agassi's.
To clarify: "not poor" != "rich". At the time of these expenses, I was making a good salary, but nothing unattainable by HN definitions.
However, if you're on Medicaid... you. are. fucked.
Have you considered traveling abroad to get your surgery? For that kind of money, it seems it would have been cheaper to get the surgery in another country even after factoring in the cost of the trip.
34 k would pay for the original poster's trip to my country (Uruguay), the best treatment available, and he'd have money left over - heck, 34 k would probably pay the doctor's wages on that hospital for a year.
There are very dodgy and shady costs with US healthcare.
I have the very best healthcare available in my country (Hospital Británico). It costs U$ 150 per month. A kidney stone would probably run me in the hundreds of dollars. 3k would probably bankrupt me.
Some differences are that doctors in the U.S. are paid an order of magnitude more, and I've heard hospitals have legions of well-paid administrators doing paperwork for insurance companies, which will have legions of people doing paperwork on their side, and government doing its bit, and lawyers doing their thing. All that money is obviously not going directly into healthcare, it's basically bureaucracy friction. I suspect "real" healthcare costs, even factoring expensive U.S. doctors, would be shockingly cheap.
Tell me something: Suppose you go in to get your left kidney removed, but the doc removes the right one by accident. What are your options? Law suit? What would you expect to get in settlement?
I'd expect in most places you'd get damages, and most likely the costs for the ensuing transplant (after all, you were needing to remove the left kidney for a reason, so now you have no other option).
That's per hospital, and for a non-surgeon, a doctor on average works on 3 or 4 hospitals, so he would make about 140k per year (among the highest paid in my country).
Surgeons and anesthetists are on a class of their own, they make upwards of 60k per hospital.
woo! fellow kidney stone sufferer here. I had a 9mm stone i had to have busted up ~18 months ago (and a few 5mm ones i didnt). Ended up owing a few grand on it even with insurance. still paying it down (owe only like $400 on it now, thank God).
yes. health reform (and lots of others) is/are needed.
I think you are far worse off if you make too much to be on Medicaid, but don't get health insurance through work and can't afford it. Everyone I know on Medicaid can go pretty much anywhere they want to receive treatment. I know very few doctors that don't accept Medicaid. (Dentistry is the exception, for those who are covered, it can be difficult to find a dentist.) (This is in Missouri- it may vary depending on your state). Even if you don't have insurance, you can still get a great deal of medical care- you will just be billed exorbitant amounts of money.
On cancer outcomes, the US outranks many (most?) of the countries that beat it on life expectancy. And, as pointed out downthread, life expectancy is a dodgy stat; it's heavily weighted by infant mortality, which isn't uniformly measured, and by accidental and violent deaths which, while tragic and perhaps symptomatic of other US problems, don't implicate our health care system.
It would also be interesting to see the stats weighted to account for the much higher levels of obesity in the U.S., which has to bump heart disease and cancer deaths significantly.
You have to be careful about cancer statistics, because in many cases the US diagnoses early-stage cancers that would never get recorded in other countries. Some of those cancers never progress to the point of being life-threatening, making the survival stats misleading. Others do but because they're recorded earlier US patients are recorded as surviving for longe when in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries.
>" in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries."
That's hard to tell, you can also say that because those patient were treated earlier they have a longer life expectancy. But I am agreed, those stats have to be looked very carefully.
Gil Welch at Dartmouth is one of the experts in unnecessary medical screening and lead time bias. He's written numerous academic and media articles, especially regarding lung, breast, and prostate cancer screening. Also an amazing public speaker:
You can use a table like this to see that US life expectancy doesn't get much better if you calculate it at age 10 or 20 instead of at birth and US ranking is not much different (actually the US drops a few places): http://www.worldlifeexpectancy.com/your-life-expectancy-by-a...
For 'first world' countries with low infant mortality rate life expectancy at birth and at age 10 is nearly the same.
I know I must sound like a broken record, but life expectancy is a poor proxy for quality of healthcare. There are many factors which impact life expectancy which have nothing to do with healthcare. For example, if you correct for the number of car accidents (which is high in the US due to the number of cars on the road), the US comes out near the top in terms of life expectancy.
The other thing is that to say that the US ranks 50th in life expectancy is useless without showing numbers. From what I've seen, the #1 country and the #50 country difference by less than 3 years. So is the number 50 ranked country really that much worse than the #1 country.
I just copied the first paragraph from the Wikipedia article, which happpened to be about life expectancy which is often seen as a proxy for quality of healthcare. Fair or not.
Here are some other excerpts from the article:
- The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population.
- lack of health insurance causes roughly 48,000 unnecessary deaths every year in the United States
- In 2007, 62.1% of filers for bankruptcies claimed high medical expenses.
- A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.
These quotes are just from the first paragraph of the article... There are many more if you read it through.
For an outside observer it's blatantly obvious that you have a broken system, and it's inexlicable why you keep defending it.
You won't get any argument from me that the US healthcare system is broken (both the private and public systems).
However, using flimsy statistical arguememts to make the arguememt isn't helping anyone.
Btw, the 62% of bankruptcies stat is also misleading. Whether the person had $10 or $100k medical debt is included. It's not surprising that if someone went bankrupt due to a failed business they wouldn't pay their medical bills either. Thus for many of those 62%, medical expenses had nothing to do with their bankruptcies.
Nobody is turning this into a political issue. This IS a political issue. The only people who argue otherwise are Americans that selfishly support the current system in their country.
Well bully for them. If they want people to stop "politicizing" issues that are entirely the result of the political game they play, then maybe they should stop being so selfish when a story like this comes up and some poor American has to pass around a hat so he can continue to live.
The minor inconvenience of ruining some feel-good story for you is nothing compared to the blind eye you choose to turn in regards to everyone out there who has the exact same problems but doesn't have HN to turn to to fund their treatment. One is barely an issue, the other is a travesty that you can help to change.
Expect this to come up every time until it's no longer needed.
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[ 3.4 ms ] story [ 238 ms ] threadIf only all of humanity did this to each other.
Doctors deserve a paycheck to feed their families and pay off medical school debt just like everyone else.
Are you aware of the health insurance debate/disaster in the US? How long can doctors operate at a loss?
I must say that you are very fortunate if you do not know someone who has died of cancer and was unable to see/pay every specialist they could fit in to their final months days. People die of cancer all the time wishing they had the money to see the ______ oncology specialist.
The way it works is that they bill ridiculously large amounts, which nobody without insurance can pay. They know this. The insurance companies negotiate it, other people pay what they can, and it all more or less works out in the end. I'd much, much prefer to see a single payer system.
Seeing every specialist is different than being in treatment with a doctor and having them cut you off because you can't pay. It's very rare I hear of a doctor going "well it's a shame you can't afford to pay for this surgery" - nearly always they do it, bill it, and accept the losses. Hospitals recover less than 20% from people without insurance.
Is it mandatory insurance? Insurance doesn't make everything affordable, but it probably wild have been helpful. Though maybe the co-pay would have been $50k.
Universal tax-payer funded insurance? The term "tax payer" is interesting because politicians and pundits forget that we're all tax payers in one form or another. Granted some pay more, some are net consumers of govt services. But tax payers mean us, and those with more earned income more than those with less. I think the main difference between taxes and donation is choice.
Single-payer or government provided healthcare? Pretty sure that no one would identify the government as the picture perfect example of efficiency. Plus, putting elected officials or their appointees in charge of handing out goods and services doesnt seem to be sustainable. Not that putting profit seeking entities in charge has yielded the ideal result.
Making drug providers, healthcare providers and everyone else in that supply chain non-profit? Profit has enormous motivational powers. Not always for good. But it is pretty amazing what can be accomplished by organizations setup to create wealth.
Big Data? Sorry, I couldn't resist. Well, lets use that as a proxy for innovation. It would seem that greater opportunity for innovation would help. Lower barriers to trying new drugs, procedures, diet, treatments would allow for potentially lower cost solutions to be created.
Separating health care from your job? Of your insurer only needs you to be healthy until you find a new job, there's not much in incentive for long-term healthcare and preventative screenings to identify tumors and other problems before they become an expensive problem. Though that would seem to be an arguement in favor of a single payer system.
Sorry, I don't have an answer. Hopefully, great stories like the OP continue. But if we don't make it scale then we haven't really done all we possibly can do.
I could have told them that.
I designed and implemented portable electronic medical records for 5 regional exchanges. Hospitals, clinics, pharmacies, ambulances, permanent stays (nursing homes), insurers, labs, etc.
Coordination was tough, because everyone thinks they own the data (and loathe to share) and are often competitors.
It's all about the incentives. The only fix I can think of is single payer, which will compel everyone to play nicely together.
That said...
Simply having the state by state insurance comparison portals seems to be very effective for price competition, better than I could have predicted. So on balance, it looks like the impact of Obamacare / ACA will be really good, if not perfect.
As of February, it was about $130 billion off over 10 years (i.e. $1.3 trillion vs. $1.17 trillion). That is not 'severalfold'.
http://www.californiahealthline.org/articles/2013/2/6/cbo-up...
And insurance premiums on ACA exchanges are coming in 20% lower than expected:
http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPre...
I do agree Republicans believe this thing is going to fail and are trying hard to encourage that.
I can't easily find a citation for it right now though. But http://www.cbsnews.com/8301-250_162-57589988/smooth-on-time-... confirms that at this point the rollout is facing potential trouble and needs billions more.
I have heard some republican state governors are pushing exchange setup to the Feds as part of their "gum it up" strategy, which may be pushing setup costs up. That said, as strange as it is to say, 5 billion is a relatively small number for the US government or the US economy.
They're still attacking Roe vs. Wade, after all.
2. There is a theory that Roe vs Wade is such a good campaign issue that no one wants to actually "accomplish" any changes.
It would be political poison, especially given the rollout will have had a few years to cement by March 2017 (the earliest anything could be taken to floor). Hard to tell what public opinion will be like in 3.5 years, but I'd wager it will be net-positive on ACA.
It seems odd to me that so many Americans seem pessimistic about their own government. I could understand if the attitude was, "We could make universal, socialized healthcare work. We could make it cheaper than Canada's. We could make it better than Sweden's. We just don't want to for ideological reasons."
But how can it be that the attitude is, "It would never work here?" You're the greatest empire in the history of civilization. What is this word "can't" and why is it in your vocabulary?
Since the US doesn't annex territories for itself and keep them as colonies as part of some Commonwealth Realm.
Although the US could have if it tried, with the slightest flex of a myoblast, in the last great war. It still can.
Pretty sure that's what he/she meant.
Nope. Neve happens. (Cough >Hawai'i<, cough)
(And yes Scotland has an upcoming referendum in 2014 on the issue of independence from the UK.[1] This is widely believed to be a losing proposition.)
Commonwealth Realm Antigua and Barbuda, Australia, Bahamas, Barbados, Belize, Canada, Grenada, Jamaica, New Zealand, Papua New Guinea, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Solomon Islands, Tuvalu
Crown dependencies: Guernsey, Jersey, Isle of Man
British Overseas Territories: Akrotiri and Dhekelia, Anguilla, Bermuda, British Antarctic Territory, British Indian Ocean Territory, British Virgin Islands, Cayman Islands, Falkland Islands, Gibraltar, Montserrat, Pitcairn Islands, Saint Helena, Ascension and Tristan da Cunha, South Georgia and the South Sandwich Islands, Turks and Caicos Islands
[1]http://en.wikipedia.org/wiki/Scottish_independence_referendu...
Perhaps what the Scottish people don't like the idea of is the SNP becoming the governing party of Scotland. However, and this is frequently ignored by the unionist press in Scotland, the SNP would not necessarily be the ruling party. There would be a new general election to vote for a new Scottish government in an independent Scotland and that could be Labour, SNP, Tory, Democrat, Greens or whatever.
There is a huge amount of disinformation banded about by Cameron, Osborne and other unionist politicians about Scotland's capabilities.
You see it in million places: The limited number of medical schools, The lack of nurse practitioners doing the simple routine jobs in most specialties(dental, family, colonoscopy, anesthsia. Many others could exist), The lack of automation and expert systems[4] and automated patient interview[3] tools, the fact that family practitioners could replace a lot of the specialists work at lower costs[1], Many medical jobs could be done with a lot less training[2], the lack of use of proven processes like checklists[5], etc.
All those changes could save a lot of money, and raise quality. We know what to do, But how do we implement it ?
[1]http://www.rwjf.org/en/grants/grantees/project-echo.html
[2]Because there's a brain drain in africa to the west, some countries have started a 3 year surgeon degree program. Doctors who finished this degree seem to have equivalent results to fully trained doctors in simple/medium complexity surgeries.
[3]Research showed doctors only ask about half of the questions needed in a typical visit. Automated interview systems could at least gather more complete data.
[4]There's research review showing that correct implementation of decision support/expert systems could improve results.
[5]Peter provonost showed that checklists could reduce infection rates in one procedure from 8/12 percent to zero.This was around 10 years ago. I think gawande showed similar results in other stuff. checklists are still not commonly used.
When I have challenged doctors about this, they tend to say "Ah, but you're focused on data, we focus on diagnosing the patient", which is basically gibberish.
That web app can name any person you think of by asking 20 or so questions. Just imagine what you could do if you made that but for diseases.
The problem is the morass of laws we've accumulated around healthcare over the years for various reasons that now interact in complex ways that nobody foresaw. Like the law designed to make Medicare or Medicaid (I forget which) drugs cheaper that ended up making it illegal to give free birth control to college students.
We also have the laws from when people believed that competition increased costs and so tried to ban competition between hospitals. Or the committee that sets doctor's reimbursement rates for Medicare procedures based on the *$%@# labor theory of value. And the laws designed to prevent people from overcharging Medicare that means that everybody has to worry about those rates across the industry. Or the way that the makeup of that committee means that primary care physicians gets shafted.
And the fact that we allow so few schools to teach medicine means that they can charge an arm and a leg, which means that those poor shafted PCPs need the kickbacks they get for assigning specialist care in order to pay off their student loans and malpractice insurance.
And I could go on.
And now we have this system that's incomprehensibly complex. So Congress has no way of figuring how to fix it on their own. There are people who've spent years figuring out how all of this works, but that's their job and if the system was actually fixed their job would be gone and that understanding they spent years acquiring would be useless.
Which isn't to say that this is entirely hopeless. There have been some efforts at the hospital level like Kaiser Permanente's to ameliorate the perverse incentives in the system and capture some of the value unlocked by that. And there are some laws that could be changes or repealed (like the one against hospital competition) without really breaking anything. So I think that gradual reform might be possible, but it's going to be a long road that doesn't particularly involve the issues that people tend to talk about around healthcare.
To an extent I wonder how much of that is due to lack of recent experience with starting from scratch. The United States hasn't had a revolution, a war on its territory, or a regime collapse in a long time.
Maybe it would be "lower quality", but least it would offer choice for many , and be a great research lab for low cost healthcare.
Local solutions don't really work for medical care, in terms of the legalities and economic structure, you have to require everyone to participate.
In this case, size and diversity work against us, it's just a lot easier in a small homogenous Scandinavian country.
Anyway, we have Obamacare gradually being implemented, where all employers above a certain size are supposed to offer insurance, and everyone else is supposed to buy it (the 'mandate' which the Supreme Court says is really just a tax).
So, maybe a minimum level of health care will start to be universal. But in order to get it through they made sure everyone was well greased. If the doctors, the hospitals, the insurance companies, or the pharmaceutical companies had to tighten belts a notch that would have been enough to sink it. So, it's going to stay very expensive.
I really think that people don't appreciate this fully for a lot of problems that the US has which have been 'solved' in other countries -- usually smaller European ones. Mail delivery, rail transportation, healthcare, etc. The US has a very unique blend of very urban and very rural areas that makes it hard to scale lots of services easily to everybody.
From what I understand, drugs are much cheaper in Canada. Almost all medical procedures are cheaper here. I met a couple from Texas who flew up here for something, and they said it was cheaper for them buy plane tickets, stay here in a hotel for two weeks, and all other travel expenses, and get the procedure done here than to do it at home (uninsured). They still saved thousands of dollars after all that. That's craziness.
Maybe there's no perfect system. But the United States spends the most on health care per citizen, and has the lowest percent of government support. [1] You should at least consider what others are successfully doing to get the costs down and increase the quality of care for the uninsured and poor.
[1] http://en.wikipedia.org/wiki/Health_care_compared#Internatio...
Knowing this, if one really wanted to implement single payer care in America, it would be more likely to succeed if the program was marketed as something like "Super Patriot America Care, just like our boys get in the US Military!" rather than calling it single payer care, which is some Euro/Canada not-invented-here thing that can't possibly ever work, because of America.
It's not just that many Americans have been persuaded that a single-payer system works for the old and disabled, but for some reason isn't right for everyone else. Rather, many Americans have been brainwashed into simultaneously supporting Medicare and opposing a generalized single-payer system, with equal fervor, without noticing the contradiction.
(Yes, really. I saw a photo a year or two ago of a protester at a rally carrying a sign that said "NO SOCIALIZED MEDICINE / DON'T TOUCH OUR MEDICARE", or similar language.)
Which is not to say there is a perfect solution. But just about any of the alternatives would be better than the US system.
The fact of the matter is that we've somehow managed to end up with a set-up that has just the bad parts from both models. All the runaway costs of regulatory capture, and all of the gross inefficiency of entrenched bureaucracy.
One note on efficiency - something like 30% (yes yes, citation needed) of American health dollars go towards insurance administration. A family member of mine works in Canadian health care and had a recent arrival (a physician, IIRC) from the States ask where the "billing floor" was because an out-of-country patient needed some sort of paperwork done. Well, Canadian hospitals don't have floors dedicated to processing payment. There was a small office.
On a second note, having your healthcare connected to your employment situation seems like insanity - I can't fathom anything that would argue in favour of that, unless you're an employer looking for additional leverage over your serfs.
It really is, although I don't think people realize it until you say it out loud. Precisely when you can least afford paying for a medical emergency -- when you're unemployed and thus have no income -- is precisely when it's most expensive. How broken is that? It would be insane in any other industry to charge your customer significantly more for the exact same service, simply because they're using a different payment method. Not to mention the horrible situation that arises if you acquire a medical condition so debilitating -- which usually also means it's expensive -- that it prevents you from working.
We have a very long way to go.
I lived in the US for two years, and I never understood the aversion to government healthcare. The Canadian system is far from perfect, and I know there are failures. But it's still a lot better than soliciting for online charity on a case by case basis.
I'm impressed and humbled that it worked in this case. Just a little disturbed that it was necessary at all.
Maybe if the system was flexible, nimble and could make judgement calls on the side of compassion, it might work, but this is difficult in both public or private sector institutions.
Then he went on some rant about how all the Canadians have to come down here for health care, and that was why you never hear of Canadians having surgery up there. I mentioned I had a Canadian friend who had a 3 part bowel surgery done recently, with very reasonable waiting times, and that of my several dozen Canadian friends, all but one was satisfied with their system, and he was just like, well, that's anecdotal, the statistics don't bear that out. That's not true at all, but he wouldn't hear of it.
Even before my health problems started, I was pro-single payer. But people like my classmate are everywhere, and seem to think that health care SHOULD be expensive and hard to get. It's inordinately cruel.
I've lived here all my life, but I'm actually moving out of state next month partially because my state's refusing to accept federal funds to cover my demographic next year, and I can't live without the medication I'm on. (Plus going to college out of state is cheaper than going to college in state (!). And they wonder why they have such a brain drain problem...)
P.S.: I am from Pakistan.
So, it's not just as easy as "let's pack up and move to the EU so we can get free healthcare tomorrow." Otherwise, you can imagine that every time a non-insured American got sick, they could compare the cost of getting new insurance to the cost of a plane ticket, and the plane ticket would win, I'm sure. =)
Packing up and moving is simply not an option for those who cannot afford to pay for healthcare in the US in the first place, and oftentimes logistics like family, employment, and language would prevent that anyway.
I'm living in Budapest partly for low tuition - my wife is Hungarian, which makes it less random than it seems.
Also, very few people in America can understand that life outside the United States could possibly be fulfilling. Or that tuition in much of Europe is free - I tell friends and family and they just boggle. There is such a strong feeling in the States that we have everything better than anybody else in the world.
When we were talking about moving to Budapest last year, I was asked by the plumber, "But is there enough food there?" He honestly believed, apparently, that everyone else in the world is starving except for the well-known massive foreign aid we provide. (That's tongue-in-cheek; most foreign aid is money specifically earmarked for the purchase of American industrial output, so it's really a handout to American industry, not to foreigners - and it's a tiny fraction of our annual budget to start with, but many people in America think that's where a substantial portion of their taxes goes.)
From wikipedia:
The United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990. Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and disability. Together, such issues place the U.S. at the bottom of the list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country.
According to the World Health Organization (WHO), the United States spent more on health care per capita ($8,608), and more on health care as percentage of its GDP (17.9%), than any other nation in 2011. The Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most.
http://en.wikipedia.org/wiki/Health_care_in_the_United_State...
From wikipedia:
The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[24] In Germany and Australia, requirements for live birth are even higher.[25][26]
https://en.wikipedia.org/wiki/Infant_mortality
Not to say there aren't problems with the US healthcare system, but we need to stop these comparisons that are just not relevant.
"However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[34][35][dead link][36] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[36]"
Your argument, will perhaps partially correct, fails to properly explain the disparity in infant mortality (mostly due to unnecessary premature births) between the US and similar industrial countries.
In no way am I trying to blame the victim or excuse a bad system. I'm only pointing out that these comparisons are very hard to do correctly and can be misleading. We have an urge to compare so that we can make better decisions, but it can be tough to do this. From the stats originally posted it could be argued that we need to spend more money on the healthcare system, when in reality we just need to educate people to wait to have kids.
When you remove car accidents and suicides from the death rates, factors that are largely independent from the health care system, the US actually has the highest life expectancy in the world.
A good source of info on this is the work of Scott Atlas. This econtalk includes a good look at the statistical biases in the micro rankings that get so much undue attention in the media.
http://www.econtalk.org/archives/2012/07/scott_atlas_on.html
Thank you - as a Brit I read this too. I cycled through emotions - fear and sympathy for the diagnosis, hope as some of our best professionals consider new options, and then.
WTF describes it best.
Americas attitude toward health care is odd from our perspective - not mismatched socks odd but like a Collegue suddenly announcing that aliens are real, they look very talk and thin and one is living in his attic
That kind of odd
(I am glad that the OP has recovered, heartened by every success medicine has against this disease. Just ... It's odd how nearly this was a different story)
May you have a long and happy life.
http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-sur...
EDIT: specifically, "survival rate" is just "how many people lived for 5 years after diagnosis". Thus, you detect a lot of slow growing prostate cancer and your survival rates go up, even though nothing has been done to reduce the incidence of cancer, or stop any more people from dying of cancer.
When you look at US cancer mortality rates they look pretty good, until you restrict the numbers to the under-65s, when suddenly the numbers look pretty average. This might be because poor americans don't get access to treatment until they're 65 and qualify for some aid.
That being said it would be nice if the disparity in survival percentages on this side of the pond looked more like the stats from your side:
http://www.cancerresearchuk.org/cancer-info/cancerstats/surv...
http://www.nap.edu/openbook.php?record_id=13497&page=3
Similarly, the US screened women for breast cancer and cervical cancer earlier and more frequently than the UK, which again does more harm than good but improves the 5-year survival stats.
The US Preventative Screening Task Force has since recommended that screening should basically fall in line with what the UK's doing, but that happened well after that article was published.
Smaller networks (small population of a country, or by state) could be a factor here.
Could you find the original study?
(http://www.ncbi.nlm.nih.gov/pubmed/18639491)
http://politix.topix.com/homepage/7019-us-is-27th-in-the-wor...
and the paper from which the figure is taken
http://jama.jamanetwork.com/article.aspx?articleID=1710486
Those data show that the USA ranks far below the UK on Years of Life Lost due to several cancers. I don't see how that's consistent with your claim. [Edit: actually, YLL is an incidence statistic, whereas parent's claim is that survival statistics are higher in the US, which the sources I've found agree with.]
The Telegraph is a right-leaning paper and is well known to be anti-NHS. Please; being economically laissez-faire as people are on HN are is not incompatible with supporting state provision of healthcare, along with the other things a state provides. It's sad to see libertarians / laissez-faire economics people bashing the NHS by quoting stories cherry-picked by right wing media sources. It's just not something we need disagree about.
What was broken in this case was described by his statement: "I had no medical insurance and the few benefits I had with the VA would take months of paperwork to get me in." You can blame that on Ted Kennedy, btw. He is the one that made health insurance an institution in the U.S. The best chance we have at good healthcare here has nothing to do with government or health insurance, it was to do with doctors that are willing to say F.U. to the system and provide healthcare directly to paitents without middlemen. So, that's the other side of the politics. Now back to what we really should be talking about...
I think it is wonderful that his cancer was treated and that people here helped. Cancer really fucking sucks. I hate Cancer with a deep passion that some of you out there understand. Others of you like to think of how great your resume looks and how you are going to land a fat house on the beach. I used to also.
I've had three MRIs. All were scheduled the same day they were prescribed. I've routinely scheduled appointments with renown specialists and waited less than 2 days to get in. My double hernia surgery was performed by the same guy who treats the Chicago Bears. My old chiropractor/kinesiologist used to be Andre Agassi's.
To clarify: "not poor" != "rich". At the time of these expenses, I was making a good salary, but nothing unattainable by HN definitions.
However, if you're on Medicaid... you. are. fucked.
I had a kidney stone a few weeks ago. All told, the bills for dealing with that hit $34,000.
For a kidney stone.
That's not about being poor or not, that's highway robbery.
Double hernia surgery was a couple grand out of pocket.
Not all insurance is the same.$34k is robbery.
34 k would pay for the original poster's trip to my country (Uruguay), the best treatment available, and he'd have money left over - heck, 34 k would probably pay the doctor's wages on that hospital for a year.
There are very dodgy and shady costs with US healthcare.
I have the very best healthcare available in my country (Hospital Británico). It costs U$ 150 per month. A kidney stone would probably run me in the hundreds of dollars. 3k would probably bankrupt me.
http://www.hospitalbritanico.org.uy
Some differences are that doctors in the U.S. are paid an order of magnitude more, and I've heard hospitals have legions of well-paid administrators doing paperwork for insurance companies, which will have legions of people doing paperwork on their side, and government doing its bit, and lawyers doing their thing. All that money is obviously not going directly into healthcare, it's basically bureaucracy friction. I suspect "real" healthcare costs, even factoring expensive U.S. doctors, would be shockingly cheap.
Tell me something: Suppose you go in to get your left kidney removed, but the doc removes the right one by accident. What are your options? Law suit? What would you expect to get in settlement?
Surgeons and anesthetists are on a class of their own, they make upwards of 60k per hospital.
yes. health reform (and lots of others) is/are needed.
That's hard to tell, you can also say that because those patient were treated earlier they have a longer life expectancy. But I am agreed, those stats have to be looked very carefully.
http://en.wikipedia.org/wiki/Lead_time_bias
Gil Welch at Dartmouth is one of the experts in unnecessary medical screening and lead time bias. He's written numerous academic and media articles, especially regarding lung, breast, and prostate cancer screening. Also an amazing public speaker:
http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph
The other thing is that to say that the US ranks 50th in life expectancy is useless without showing numbers. From what I've seen, the #1 country and the #50 country difference by less than 3 years. So is the number 50 ranked country really that much worse than the #1 country.
Here are some other excerpts from the article:
- The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population.
- lack of health insurance causes roughly 48,000 unnecessary deaths every year in the United States
- In 2007, 62.1% of filers for bankruptcies claimed high medical expenses.
- A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.
These quotes are just from the first paragraph of the article... There are many more if you read it through.
For an outside observer it's blatantly obvious that you have a broken system, and it's inexlicable why you keep defending it.
However, using flimsy statistical arguememts to make the arguememt isn't helping anyone.
Btw, the 62% of bankruptcies stat is also misleading. Whether the person had $10 or $100k medical debt is included. It's not surprising that if someone went bankrupt due to a failed business they wouldn't pay their medical bills either. Thus for many of those 62%, medical expenses had nothing to do with their bankruptcies.
David Goldhill is the author of Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It
He advocates restricting the insurance system gradually and phasing out eventually, to increase accountability and vastly improve delivery standards.
His father was afflicted by a series of hospital infections that compounded his condition and eventually killed him.
When admitted in hospitals, he was thrice subjected to medical procedures that were meant for other people.
This Atlantic article is eminently readable.
How American Health Care Killed My Father
http://www.theatlantic.com/magazine/print/2009/09/how-americ...
http://www.youtube.com/watch?v=Y_7qCpiS_ZQ
http://www.youtube.com/watch?v=2A9y_FttOGE
http://www.youtube.com/watch?v=u0OAj9J_HW4
https://news.ycombinator.com/item?id=4430020
Well bully for them. If they want people to stop "politicizing" issues that are entirely the result of the political game they play, then maybe they should stop being so selfish when a story like this comes up and some poor American has to pass around a hat so he can continue to live.
The minor inconvenience of ruining some feel-good story for you is nothing compared to the blind eye you choose to turn in regards to everyone out there who has the exact same problems but doesn't have HN to turn to to fund their treatment. One is barely an issue, the other is a travesty that you can help to change.
Expect this to come up every time until it's no longer needed.