• Welcome to OGBoards 10.0, keep in mind that we will be making LOTS of changes to smooth out the experience here and make it as close as possible functionally to the old software, but feel free to drop suggestions or requests in the Tech Support subforum!

About that "World's Best Healthcare System" the U.S. is supposed to have...

Please post a refuting study from a more objective source, then.

perhaps this one is sufficiently objective, since it is in a peer-reviewed journal? This study focuses solely on outcomes, compares five English-speaking countries, and doesn't include any of the data about satisfaction or access to care.

http://content.healthaffairs.org/content/23/3/89.long

Shows the US being decidedly middle-of-the-road in this peer group on most outcomes. Best on a few, worst on a few, middling on several.

No reason to get touchy. OP posted a study and I am simply pointing out that this is from an advocacy group and has to be taken with a grain of salt. Nothing more.
 
Pointing out that the Commonwealth Fund isn't the most objective source is a legitimate addition to the discussion since it is the opening point to the thread. Sorry it doesn't meet your standards.
 
This thread seems like a lost cause but i'll chime in with my two cents:

-We are by far (and i mean in fucking light years) ahead of every other country in the world combined when it comes to the development of new drugs, devices and medical techniques (i.e. surgery). The list of significant innovations to come out of the US is simply staggering.
- However as pointed out by others the *delivery* of the innovation is a fairly inefficient, non-transparent and full of graft. Yet it is the graft and smarminess that in some ways helps fund all the shit mentioned in bullet one

So i don't think anyone would argue we have the best "system" in totality but if they are willing to pay for it (or find an employer or social program that will) the average American easily has better access to healthcare than just about anyone else on earth.
 
This thread seems like a lost cause but i'll chime in with my two cents:

-We are by far (and i mean in fucking light years) ahead of every other country in the world combined when it comes to the development of new drugs, devices and medical techniques (i.e. surgery). The list of significant innovations to come out of the US is simply staggering.
- However as pointed out by others the *delivery* of the innovation is a fairly inefficient, non-transparent and full of graft. Yet it is the graft and smarminess that in some ways helps fund all the shit mentioned in bullet one

So i don't think anyone would argue we have the best "system" in totality but if they are willing to pay for it (or find an employer or social program that will) the average American easily has better access to healthcare than just about anyone else on earth.
as a fellow commie lib i'm with BKF on this, I dont judge our health care system on the care provided to the top 20% (or whatever %). Where is the innovation in providing the top care to everyone, and not just those "willing"(able.) to pay for it at the market rate? I just dont believe that economic forces are completely responsible for Americas leadership in Medical innovation, I think that maxim is a scare tactic to ward off increased government intervention i.e. socialism in the healthcare business sector.
 
as a fellow commie lib i'm with BKF on this, I dont judge our health care system on the care provided to the top 20% (or whatever %). Where is the innovation in providing the top care to everyone, and not just those "willing"(able.) to pay for it at the market rate? I just dont believe that economic forces are completely responsible for Americas leadership in Medical innovation, I think that maxim is a scare tactic to ward off increased government intervention i.e. socialism in the healthcare business sector.

Agree with this first part somewhat. Medicare/medicaid are fairly disastrous yet you can still get decent care via these programs compared to a whole lot of places in the world. Again i'd argue the sheer breadth of *potential* access to innovative products and highly-trained providers far outstrips what is on the menu in the rest of the world.
Disagree strongly with second part. It's all about $$. Small start-ups and large multinationals all pour money into research because of the massive fucking pot of gold at the end of the US rainbow. No one ever got rich selling drugs in the UK or anywhere else.

Disclosure: I work in Pharma so can probably be dismissed as an industry shill.
 
Chinaski, what specifically is the pot of gold? The Top 20 or whatever percent? Medicare/medicaid money? 300M+ in the richest country in the world?

What is the conflict between innovation, efficiency, and breath of coverage and how to we address it?
 
Medical innovation is fueled by profits, but I dont believe that innovation would stop or even slow down that much if American health care were socialized for the most part, but of course that's just optimistic naive conjecture on my part
 
I don't think American health care would be "socialized" without the profits. Any "universal health care" system would likely provide more customers coming more frequently.
 
Chinaski, what specifically is the pot of gold? The Top 20 or whatever percent? Medicare/medicaid money? 300M+ in the richest country in the world?

What is the conflict between innovation, efficiency, and breath of coverage and how to we address it?

It's simply the willingness of payers (whether private or public) to pay fairly ridiculous prices for drugs, devices and healthcare. Whether $100k/year for oncology meds or $50k for a pacemaker or even when a hospital charges $8 for a single Tylenol. There is just so much opportunity in the US market for product developers and it dwarves what you can make in the rest of the world.

Question two is a whole dissertation on its own (and my doctorate is in chemistry, not Econ or public policy) - but to me the system isn't wildly broken. If you want good insurance, then get educated (which anyone can do if willing to work hard and make it a priority), get a good job and get covered. If you aren't interested in doing those things than you can get public ally subsidized healthcare that in aggregate isn't as a good (I.e. Medicaid), but is better than nothing. It definitely needs to be more efficient in the delivery of that care : no one doubts that. But I think there are multiple ways for people to get access to good care and multiple ways for people to get access to great care (if they want to pay a little more). I'm obviously speaking in massive generalizations, but I'd take our system over a heavily socialized system like UK or Canada or EU in a second. We can often choose our physicians, hospitals, drugs, products , etc. you just don't get that optionality anywhere else

As noted on another thread, I think Obama should have worked on energy instead of this....
 
It's simply the willingness of payers (whether private or public) to pay fairly ridiculous prices for drugs, devices and healthcare. Whether $100k/year for oncology meds or $50k for a pacemaker or even when a hospital charges $8 for a single Tylenol. There is just so much opportunity in the US market for product developers and it dwarves what you can make in the rest of the world.

Question two is a whole dissertation on its own (and my doctorate is in chemistry, not Econ or public policy) - but to me the system isn't wildly broken. If you want good insurance, then get educated (which anyone can do if willing to work hard and make it a priority), get a good job and get covered. If you aren't interested in doing those things than you can get public ally subsidized healthcare that in aggregate isn't as a good (I.e. Medicaid), but is better than nothing. It definitely needs to be more efficient in the delivery of that care : no one doubts that. But I think there are multiple ways for people to get access to good care and multiple ways for people to get access to great care (if they want to pay a little more). I'm obviously speaking in massive generalizations, but I'd take our system over a heavily socialized system like UK or Canada or EU in a second. We can often choose our physicians, hospitals, drugs, products , etc. you just don't get that optionality anywhere else

As noted on another thread, I think Obama should have worked on energy instead of this....


Why would you choose our system over the UK, Canada, or the EU, when studies clearly and consistently show that the citizens of those countries are healthier overall and more pleased with their healthcare systems than US citizens, while simultaneously paying massively less per capita for the system? People say this over and over and over again and it just doesn't make any sense to me.

The US system might be better in some circumstances, but the outcomes demonstrate that in the vast majority of circumstances most of the rest of the developed world performs better and cheaper.

I've heard others make the optionality claim before. Frankly, I think at best it's overstated and at worst it's total BS. Google "Can you choose your doctor in France?" (Hint: the answer is "Yes").
 
Agree with this first part somewhat. Medicare/medicaid are fairly disastrous yet you can still get decent care via these programs compared to a whole lot of places in the world. Again i'd argue the sheer breadth of *potential* access to innovative products and highly-trained providers far outstrips what is on the menu in the rest of the world.
Disagree strongly with second part. It's all about $$. Small start-ups and large multinationals all pour money into research because of the massive fucking pot of gold at the end of the US rainbow. No one ever got rich selling drugs in the UK or anywhere else.

Disclosure: I work in Pharma so can probably be dismissed as an industry shill.

Tell me again how Medicare is "disastrous"?
Seniors love it: http://www.nejm.org/doi/full/10.1056/NEJMp1107184
It's more efficient than private insurance: http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/ (which is not surprising, since we know that EU social insurance-type healthcare systems are vastly cheaper than the US private insurance system).
Administrative costs in Medicare are around 5%, vs. 17% in private insurance http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicare_Admin_Final_Publication.pdf (this is a pro-private insurance paper trying to make the case that consumers are somehow getting some added value from that 17%).

Do you have some facts that support your opinion that Medicare is a "disaster"? It's expensive, sure, but mainly because everything health related in America is outlandishly expensive, and the overall fee for service model that Medicare has to operate within is a nightmare for controlling cost.
 
I think surveys that measure "healthiness" are reporting on food more than health care. US food is crap compared to Europe in terms of quality. Many bad things banned there are allowed here due to special interest payoffs. Not to divert the thread, but it is not health care's fault we're a nation of fatties.
 
I think surveys that measure "healthiness" are reporting on food more than health care. US food is crap compared to Europe in terms of quality. Many bad things banned there are allowed here due to special interest payoffs. Not to divert the thread, but it is not health care's fault we're a nation of fatties.

*sigh*

For about the eleventy-billionth time, these statistics I'm talking about adjust for population demographics. Many of the worse health outcomes seen in America and cited in these studies have exactly 0 to do with obesity, anyway (for example, we have a much higher rate of death from respiratory diseases, despite having a significantly lower smoking rate than comparative countries).

I'm about to tap out of this thread. I have posted multiple links with real scientific data addressing the many advantages that Euro health systems have over the US system, both in terms of costs and outputs. The responses I get are people's individual opinions about "fatties" or non-responsive posts about how it's great to be rich and insured and have a rare cancer in America. Nobody has posted one single link to support these opinions, which causes me to wonder where the opinions are coming from. I used to have these exact same uninformed opinions about the American health care system until I took the trouble to learn something about it.
 
choosing your own provider would be pretty awesome/worthwhile if there was some way to accurately rate/compare providers that are local and in your network. i have a decent health plan and picking a doctor is worse than trying to find a new mechanic. honestly, i've received some of the most attention/time at the local walk-in clinics
 
The US system might be better in some circumstances, but the outcomes demonstrate that in the vast majority of circumstances most of the rest of the developed world performs better and cheaper.

I've heard others make the optionality claim before. Frankly, I think at best it's overstated and at worst it's total BS. Google "Can you choose your doctor in France?" (Hint: the answer is "Yes").

I've lived for extended period of times in both USA and Europe, and had major medical services performed in both. It's laughable to think that'd I'd prefer the US system, it's so grossly inferior to what I receive here in Austria as almost not even be comparable at all. I can't think of a single American I know that lives on the continent that doesn't comment on the enormous gap in quality and access.

I think most people would have their eyes dramatically opened by living abroad for a year or two and actually experiencing live under other systems. It makes you appreciate what we do well, and it makes what we do poorly glaringly obvious. Healthcare is one of those "things we do poorly".



*and yes, I chose my own doctor here. He's very good. And I don't have to wait at all when I need to see him - I simply e-mail his office and setup an appointment and I'm seen right on time. And if I need immediate care, I can walk into one of the "urgent care" type offices that are in every neighborhood and be seen within minutes.
 
Last edited:
choosing your own provider would be pretty awesome/worthwhile if there was some way to accurately rate/compare providers that are local and in your network. i have a decent health plan and picking a doctor is worse than trying to find a new mechanic. honestly, i've received some of the most attention/time at the local walk-in clinics

Exactly. Consumer choice is a great thing in an efficiently functioning market with few information discrepancies between market actors. Which is pretty much the opposite of the market for health services.
 
Things banned in Europe that are allowed here: Artificial coloring agents blue 1, blue 2, yellow 5, and yellow 6, Olestra/Olean, BHA and BHT, Azodicarbonamide, Arsenic, Synthetic hormones rBGH and rBST, Potassium bromate, Brominated vegetable oil (aka BVO), Ractopamine in meat, astaxanthin in farmed salmon, genetically engineered foods.
 
Medical innovation is fueled by profits, but I dont believe that innovation would stop or even slow down that much if American health care were socialized for the most part, but of course that's just optimistic naive conjecture on my part

That's the thing, though, innovation isn't really fueled by profits because the majority of the innovation in the biomedical field doesn't come from private industry. It comes from basic research labs/institutions that are, primarily, funded through public grants. This is where the innovative new therapies/drugs are discovered at a basic level and often translated to clinical work before Pharma is even willing to procure licensing rights or assignment (buying) of the patent. And on top of that, a large majority of clinical trials (especially early ones that demonstrate actual efficacy (the drug actually works in the intended way)) are funded through federal grants. The government does this because the benefit to society of new therapies/drugs (and the associated taxes) is worth the investment on their end. Pharma likes this system because they don't have to shell out large sums of money on developing new classes of drugs that may not even be viable as a therapy.

Don't get me wrong, Pharma companies dump billions and billions of dollars in R&D. It is just that the majority of that is devoted to currently PROVEN therapeutic routes (like teams of chemists devoting decades to identifying a single small molecule inhibitor for Disease X to no avail in manycases) not the innovative type of research that is required to push medicine forward. And quite frankly, the system works pretty well as designed. The idea that socialized medicine would impact that, though, is tough to support because I can't see a move to socialized medicine reducing public grant funding any lower than it currently is (in fact, one could even envision funding increasing). You want better innovation in medicine? Increase funding for basic scientific research. Consistent cutting of biomedical research funding is going to eliminate any "innovation edge" the US currently has. The longer funding stays down, the bigger the impact it will have on future medical developments.
 
Part of the reason American healthcare is so expensive is because we are paying for the R&D for the next breakthrough. Socialized medicine in other countries won't pay for it, so we do.
 
Back
Top