One thing that's surprised me about the US is the general slowness of most things. In India, you can get MRIs and CT Scans same day. Or you could the last time I was there. And it didn't cost very much in comparison.
My doctors have all been good (attested to by my parents who are surgeons themselves) but the healthcare system is wonky.
One thing I didn't expect is that the Indian system where you just drag your health records around paper copy yourself is superior to US EMR systems - which doctors seem to always have trouble with.
But now I have some friends in medicine and I always have them pull my records and keep a copy myself. It's usually a fax but it's better that way. Clearly electronic interop isn't working most of the time.
The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.
Most of Asia has same day or next day medical tests. In India you can order something like UberEats where in a technician comes home collects your blood samples and the results are emailed within the next 24 hours or so.
Medicine seems to be commoditzed in the east, easily accessible and cheap. West treats it like voodoo magic or rocket science that only a chosen few are capable of partaking in. There is always a long queue to get to your local voodoo practitioner.
I had some pain in my lungs and they gave me an xray in about 30 minutes here in Spain to confirm that i had pneumonia. I waited 45 min to see the doctor in the emergency room and then another 10min waiting for the doc to check the xrays.
Yeah you need to know the keywords in EU, "pain in chest", "seizures". After which the emergency treatment is quite good.
But for the majority, it isn't great. You go with pain in stomach and it happens to be cancer, you die waiting. I personally have seen so many of these and it's heartbreaking.
That is true, but it also varies from country to country. In Sweden I haven't been able to see a doctor in 1.5 years. In Germany, the waiting time is ridiculous, usually 1-3 months, but if you choose your doctors (Google Maps is the best catalogue for almost everything) - you get the results and 99% of it is covered by statutory insurance.
> The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.
In France I could have a blood test right now, without an appointment, and an X-ray by tomorrow morning (just checked).
But the ER is generally far too slow and some specialists have much too long waiting times.
> The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.
In Switzerland I get an MRI within 48 hours if my doctor orders it.
Mind you, healthcare is also very expensive comparatively but the quality is very high and coverage is extensive.
Condition is if "your doctor orders it" and how long does it take to get to that doctor if it isn't an emergency. I don't about Switzerland but it is quite bad in majority of EU countries.
And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.
The other part no one mentions is the utter cheating that goes on in statistics to show that the health care system is doing good. Things like counting the patients who were admitted but not counting the rest 90% who died just waiting for months.
> And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.
Because false negatives are a massive problem. People get biopsies or treatments for things that never needed it, which is ultimately worse for their health (on average) than catching the rare time it is something.
There is no stats to what you are speaking. General People not being able to get to doctor in months is a bigger problem than a rare false negative.
This also reduces burden on doctors. If the only thing your doctor does is prescribe antibiotics and orders scans. Why not do it yourself and get treated early.
> And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.
I hope you are aware that these also exist in many EU countries, private clinics aren't banned because of public healthcare, you can purchase private health insurance in many countries, I can't say all because I don't know the intricacies of every country's system since this is a national policy and each member-state is free to run their own systems.
Here in Sweden I have private health insurance through my employer, I cannot go directly to a clinic for imaging, etc. since it needs a referral from a doctor but it's quite simple and when I needed I had many choices of private clinics to do a MRI. If you don't have insurance you can definitely pay out of your own pocket, both for a private doctor as for exams.
I feel the seiss system really nails it. Health insurance is mandatory. If you can't afford even the basic level, the government pays for it. The basic level itself covers basically everything from emergency care, hospital stays and gp. The extras you can pay for are things like single rooms in hospitals or access to private clinics. Compared to the local salaries, the basic package is quite cheap - doubly so compared to the UK where National Insurance extracts a very hefty portion of your paycheck and this gets you the dire waiting times of nhs...
Maybe because the Swiss didn't let the magical hand of privatization solve it? The healthcare providers might be private but the laws and regulations and conditions under which they are run are very strict and very detailed. Perfect? Of course not, I could give examples heaps. But better that many? Very yes.
Now, is there here anybody from Spain to comment on their system? I've heard good stuff about it.
National insurance contributions have nothing to do with the NHS.
NI contributions determine your state pension (but because the money from NI just goes to treasury, NI is really just income tax with different name)
My last trip to the ER was in 2010. Probably because I had good health insurance, they saw me quickly (less than half an hour), cleaned me up, maybe glued a cut, and I was done.
I think the problem in the west is just demographics. More older people leads to high demand on the healthcare system and fewer working age people leads to less supply.
Blood test yes, MRI - no. In the Ukraine I can go to the M24 center, and yes, 24 means it is literally working 24/7/365. And I don't need doctor's referral to do it. In EU I had to wait 2 months and have doctors referral, and that was lucky window I caught by chance. Other people report waiting much longer.
To get to the specialist doctors is also hard in EU, compared to the Ukraine. Here I had to wait between 1 to 3 months to a lot of specialists. And if any mistake in the referral is made, then wait need to be repeated.
Example - I got a referral for the retinal diag. But to do it 15 mins before the test eye drops are administered (atropine) to dilate pupils. Apparently I have needed to have two referrals - one for the drops, and another for the diag itself, and I got only the second one (made by an eye doctor in the same clinic, so regular staff). So I have waited months, and was denied the procedure, then a spend a week on a phone and visiting clinics in person to sort this out. Then I got proper referral (haha, actually not even then, they simply caved and allowed me to do it with what I had) and had to wait a month again to do a simple check which would take me a hour at any arbitrary day in Ukraine.
Same. But in Croatia where things are a little bit... well... different. For instance, I don't need a prescription to buy (almost) any drug in the pharmacy. And I don't need a prescription or referral for any medical exams or blood tests; I can order them myself. Asia is like this, but Europe to the north and west of Croatia really isn't.
I believe that things in the UK and Germany might be a lot slower and much more restrictive.
Well some relatively common things are easy to get in Croatia (bloodwork and meds - GPs like to prescribe those to get rid of you), more serious like exams, treatments, surgeries are absolutely terrible with waiting lists which are years long. People are dying, and/or their condition worsens before they even see a specialist. This is common knowledge for many years now.
Private clinics are opening left and right with the same(!) doctors working in both public and private clinics. Also corruption is rampant allowing doctor's friends to jump lines and that also happens for money/favors. So if you're not rich enough to go to a private clinic your second best option is bribes/corruption/nepotism. And if you don't have the latter, you're frankly fucked.
I've lived in the US where my health insurance had like a $6000 deductible and a $1400/month price-tag. (And, by the way, I really didn't appreciate how American doctors would gatekeep drugs, restrict their availability, and add significantly to their cost.)
Here, you can walk into any private clinic in Croatia, and arrange for even a fairly complicated surgery, and it'll cost you way less than all that. Your annual medical expense bill won't even come close; a very sick person in Croatia, who does everything in private clinics, pays less (annually) than a perfectly healthy person in the US who never sees the inside of a doctor's office.
My wife just gave birth here at an "expensive" private clinic, with a private room of her own, and the total price was cheaper than a few months of medical insurance would have cost in the US.
Ultimately, private clinics are a damn good thing, because price transparency, price competition, and paying out-of-pocket -- they all serve to keep fees reasonable. If a Croatian clinic tried to charge $100 for an aspirin tablet or a bag of saline, there'd be riots with pitchforks and torches.
I'm not sure if we're talking here about the same things. You may say: "oh it's easy to get meds and it's cheap to do X, medical system is great" while being a medical tourist and/or having a far above average pay, I would accept that. It's great if you have the means. Just like it's great in USA if you're rich, right? But directly comparing two completely different systems and different orders of magnitude of purchasing power and taxes doesn't really paint a good picture of how it's here.
For an average citizen the system is terrible and getting worse by the day. The examples are too numerous to mention.
I'm also not sure if you think that I'm somehow against private clinics. I'm not. They of course won't compete on medications with public services as that's pointless. What I do find apalling is that doctors are working in both public and private clinics completely legally. Moreover, that practice makes the public services worse by removing the availability of the doctors and makes taxpayers being double charged for the same service.
There would be riots with pitchforks if most needed some non-basic ("take these pills") medical help. When you're young you probably don't need much. But as you get older you actually might need some procedure or a treatment. But by that time you are actually older, sicker, and there aren't too many of you to actually riot. And many jump the lines by having friends (of friends) working in hospitals. It's bleak and grim and I don't see it getting better.
I don't think you appreciate how much worse things are in the USA, even after adjusting for income and taxes. (Effective tax rates are very similar between the two countries, besides.)
Medical care isn't perfect in Croatia -- but it's not perfect anywhere, and at least in Croatia the poor can have many of their needs met by a pharmacist, without even needing to see a doctor; they'll never need to pay >$1000/month out of pocket for garbage "insurance" with a high deductible; they have the option of public care for certain procedures and treatments, and private clinics for others.
Yeah, there may be an element of corruption to it -- perhaps if you "know a guy" you'll get your appointment more quickly -- but this is small-time corruption on a human scale. In the US the corruption takes place on far vaster and more impenetrable scales, with lobbyists, regulatory capture, and I could go on...
And, yeah, some can't afford private care, and need to rely wholly on the public system in their old age. I dare say the public system in Croatia is still a damn sight better than Canada's, or the UK's. Maybe you can tell me which country has an ideal public system? Distant Japan's, perhaps?
As for public system doctors working in private clinics -- it's like that all over the world, as far as I can tell. The medical system in Hong Kong is very highly regarded, and it produces good outcomes, and I know from personal experience that doctors there also work both systems simultaneously. Public hospital in the morning, private office in the evening -- or public hospital on Mondays and private clinics the rest of the week.
In fact, the system in Hong Kong is very much like Croatia's, but Hong Kong's private clinics are roughly 5-10x more expensive, on average, for the same procedures!
All things considered, and in light of the alternatives, Croatia's is really a better system than almost any in the world, for rich and for poor.
"This is not just US but whole of the west seems to have the exact same attitude"
The slowness you describe has not been my experience in many European countries. It really depends on how the healthcare system is designed to work.
I was pretty surprised when I went to China and I could just go to a doctor's office without an appointment, stand in a queue, stick out my tongue, get a diagnosis within ten seconds, and be sent out with a handful of random colorful pills wrapped in paper. Yes, this was, in fact, a real doctor's office, and I did take the pills. I have no idea what they were or did, if anything at all.
I also did enjoy the phone-ordered house visits from nurses in Indonesia when I got Bali belly, although that is probably a result of low labor cost more than anything else. And the poop tests I received a few hours later weren't all that helpful. Oh, I have "amoebas," that's very useful, thanks.
All told, I'm happy I usually live in Western Europe. Relatively expensive, but high-quality, fast healthcare without the constant risk of going bankrupt when something unfortunate happens.
Out of the Western Europe, I lived in Sweden and Germany, and I have not been impressed with the health care so far. I hear it's different when you're having a heart attack, but if you "just" tore some knee ligaments, for example, getting good care in a timely manner is a struggle.
In Estonia all of our records (incl. Health) are digitized and online in a central system that both doctors and you can access. It works wonders. Every doctor I go to can see my entire medical history with a press of a button, and I don't have to deal with any of that. Likewise when they prescribe new things, I can see my prescriptions right there, and so forth. We're a 100% online nation now, and clearly when done well it's remarkably good.
Like a physical structure made of one large component is often the strongest and lightest, most rigid etc. But it's the most vulnerable to cracking or other failures.
Or any other attack. I remember we had such a centralized registration system. It was used to great effect by the German Nazis when they occupied our country. Of course, occupation by foreign aggressors is highly unlikely in Estonia. Unless history repeats itself as it has (in Estonia) dozens of times.
Do you want to advance your society and make life more convenient for the people or do you want to live in constant fear and create unnecessary complexities for the people? We put a lot of effort in creating secure systems, we audit them constantly, and we get a plethora of cyber attacks from Russians on a constant basis, but they haven't gotten through yet.
We believe in living the best life we can, through the means of making life as convenient as we can, and we're very happy our government thinks the same. I've lived abroad many times, in many countries, and every single time was miserable because of the unnecessary complexity every basic thing involved. I very much doubt that complexity was for security reasons, more like the incompetence of the government bureaucrats to create a cohesive system that interoperates with all the different parts.
I want my health system to be both resilient and efficient. Why? Because generally when unforeseen black-swan-type catastrophic events produce high demand in the health system, chances are other infrastructure is also affected by whatever that event was.
If the last pandemic has shown anything it is that if great minds come together and cast aside their corporations strategic or financial incentives for a moment, we can have the nice things — so for example tools that excell in multiple dimensions at once that many described as incompatible with each other: convenience, resilience, privacy, ...
If we want to move things forward, we should do our level best to not fall into the trap of false dichotomies. What is often framed as a fundamental dichotomy is usually just a tension that people with vested interests abuse to get a solution that suits them. That is not where real innovation or good engineering happens.
Well, they are engaged in constant low-level conflict with Russia, so their systems must be pretty hardened against hostile incursions already.
If there is one EU region where digital security must be taken as a life-and-death matter, it is the Baltics. In case of weakening of NATO, they are the foremost candidates for the next Special Military Operation.
> In case of weakening of NATO, they are the foremost candidates for the next Special Military Operation.
I guess the odds of Trump winning are much lower than a couple of months ago. And even if he wins, if he follows with his stupid plan of giving Ukraine to Putin, he will be criticized by all sides. So losing a Baltic state would be another bitter blow and he probably would want to avoid that as he wants to appear "strong".
Also, NATO is not just the USA. The remaining countries had no choice but to increase their military spending and will continue to support Ukraine until the last dime knowing that the fall of this country will just make Putin more aggressive. We can't just let this happen, with the next American administration or without.
It is not really just about Trump. It is quite obvious at least since Obama that US strategic interests are reorienting towards Southeast Asia, which is understandable as half of humanity lives there.
And even with a friendly administration, it can feasibly happen that there will be more crises unfolding at the same time than the US is capable of efficiently addressing. (Say, Ukraine and Israel and Taiwan.)
I wonder how much of a choice the other countries have. Being a European and observing European political patterns, I am very sure that Finland, Sweden, Denmark and most of the former Soviet satellites will continue to support Ukraine because they know what is at stake for them. The UK may as well, given that the dislike between England and Russia goes a long way back.
But there are influential people in Germany (and I am not talking about the AfD here, but about the industrial lobby) constantly pushing in the back rooms for reconciliation with Russia at any cost, because high energy costs have made a mess of the German economy, and I can see something like a repeat of the Munich betrayal of 1938 in the future. At this phase of the war, Putin would be open to such an agreement with Germany. Not even his wildest plans foresee a re-subjugation of the former GDR, so Germany risks "nothing" (well, a lot of goodwill east of the Oder, but that may be an acceptable tradeoff for the businesspeople).
And the more distant countries such as Spain or the Netherlands or Belgium aren't really that much interested in Eastern European affairs, all the verbal proclamations notwithstanding. Although NL has some unsettled business against Russia with regards to that shot down airliner.
While I can see populist parties pushing for an agreement with Russia, it would be a ridiculous move because it would completely split EU into two parts: Russia-lovers (countries that don't border Russia) and Russia-haters (countries that do border Russia).
I agree that it would be a ridiculous move that would split the EU, but people have done such things in the past anyway.
The French discarded all the credibility gained through their extremely bloody victory in WWI by not helping Czechoslovakia and Poland in 1938-9. Prior to that, France was admired and followed by a dozen countries in Central and Eastern Europe which sought to emulate it. Nowadays, meh. It has been almost 90 years since the moment of French weakness and the trust is still not repaired.
Putin himself started a major land war with barely 200 000 soldiers against the second largest country in Europe. Any serious military planner would say that it is not nearly enough to ensure victory, and many people including me in fact considered the whole thing a bluff just by looking at the inadequate numbers. Yet here we are, in precisely the sort of unwinnable war of attrition that is the result of such a bad decision. It may yet end Russia as a power, not directly through the force of arms, but through later destabilization.
People are experts on stupid decisions, especially if they feel in a Zugzwang. I am not sure what German social democrats are going to do if their labor unions start to seriously push them. The threat of losing important factory jobs is potentially very destabilizing for the established left wing of the German political spectrum.
Are there safeguards in place to prevent the wrong people looking up your data with the touch of a button though? I'm aware of Estonia's digital prowess but for me privacy is a top concern and I'm glad we're not so all-in here.
> In Estonia, health information is gathered to the Health Information System, where your prescriptions and medical records are accessible to the health care professionals that provide services to you. The Health Portal enables you to view your data in the Health Information System, submit additional information, and change your personal data. You may restrict your health data if you wish. In that case, health care professionals no longer have access to your health information and the quality of medical care may be impaired, especially in emergency situations.
We take privacy very seriously. We can also see exactly who looked at our data, as there is a log of every person or institute who has done so. A little more is written here: https://e-estonia.com/i-spy-with-my-little-eyeprivacy/
I understand where you are coming from. But for ME I have personally ever wondered why are people afraid of others knowing their medical history.
This I know is a very unpopular opinion, but for my specific case, I've got plenty of medical record that may be considered "shameful"? Got several colonoscopies, endoscopies, I lost a finger, I had a LIS (anal operation) , etc, etc, etc haha. Yet, I kind of don't really care if people knew about it.
Maybe I have never truly suffered discrimination (I'm what we call "whitexican" here in Mexico, so I'm privileged. And that's why I think like this.
In countries where healthcare can exclude preexisting conditions this can be a major problem.
And it's not just about shame. It's just about it being nobody's business. I'm not afraid of people knowing my history (though I imagine my mental health history may raise some eyebrows, I don't feel bad about it) but it's just none of anyone else's business and I would certainly be pissed if someone knew that I didn't confide in.
Australia checking in and agreeing, usually same day or even within a few hours for MRI, x-ray and ultrasound. Next day for CAT. Centralised records so each practitioner can see the full history.
Oh and blood tests done with max 30 minute wait and then results in 48h
Although as an American, I always struggle with blanket statements because we have wildly different standards for literally everything depending on where you are. I live in a major city that isn't LA or NYC or something like that. all of my medical records are digitized too. All my doctors can look at everything an urgent care, hospital, regular doctor did. But also my sister who lives in nowhere, USA has to deal with paper everything and long delays. The US is both 1st and 3rd world depending on what area you're talking about.
I doubt this. I don’t have experience in India, but I have had lots of medical care in Thailand. Twice now Thai hospitals have found things that my US doctor and US imaging/diagnostic clinics missed. I can get MRI & CT immediately in Thailand, in the same places the doctor works. In the US I have to go to a separate clinic and wait weeks or even months. Cost in Thailand, at the most expensive private hospital (Bumrungrad) typically 1/5 or less US prices.
I also had great experience at public hospital in Taiwan, just walked in and asked for a test. Price was less than 10% for the same procedure in US, with no waiting.
And don’t even start on cost of prescription meds. Americans get scammed.
* 8am arrive to the emergency room in a private hospital
* 8:10am get seen by an internist doctor and after initial review, tell the doctor that I would like to get an MRI.
8.20 get a doctor prescribed mri ans take it to the radiology department
8:40 get the MRI
9:30 Get the results of the MRI, and pay for the whole thing: No more than $1500 USD. Without insurance .
10:00am take mri to doctor and get appropriate prescription.
That was an amazing experience. We have these incredible technologies that could be used to detect illness waaaay before . Like, allow everyone to have an MRI every 6 months. Regardless of illnes, after.say you are 30.
Plenty of urgent care places in the US will give you an mri if you walk in. It’s just expensive because labor here is crazy expensive compared to Mexico.
I wish I could pre-select an "I don't care. I'm informed and choose an open docs policy" box once after writing a 1 h exam and call it quits. My genome is on the Internet. I bet nothing bad will come of it by the time I die.
Classic example of government overregulation fucking over the regular citizen.
I go to two hospitals and am dealing with a medical condition and it's a total nightmare. Each hospital uses the same backend but I have to go through a lengthy and convoluted process to let them share information with each other after every single appointment.
I'm getting really sick of this affecting my treatment in the name of "privacy." I have a medical condition, for god's sake. Privacy is completely irrelevant if my doctors cannot even efficiently communicate to treat me.
Every week I curse whoever it was that thought this would be a great idea. I'm sure it sounded great in their heads, as regulations tend to do for most bureaucrats.
I am a security engineer btw, I have worked on privacy and security featuresets for products that billions of people use every day. I am 100% confident that it is doing more harm than good in the medical-information-sharing space.
Can the median income Indian citizen get such service? Chances are no. This report is about the average case. Extremely rich Americans, just like extremely rich Indians can probably get faster service.
I find it hard to trust a report that puts Canada above Germany in any healthcare related ranking. In terms of access, quality, and coverage, there's absolutely no comparison.
The UK performs better (third place) than, for example, Germany (second last place). The UK's healthcare system is often heavily criticized as being on the brink of collapse - any explanation for this?
The actual report [1] says it took five domains into account: a) access to care,
b) care process, c) administrative efficiency, d) equity, and e) health outcomes. Read the linked summary.
To summarize the summary: from 10 investigated countries, 9 are in the same ballpark. The US is an extreme outlier, bad in almost anything and expensive to boot.
The NHS being in trouble is apparently orthogonal to these domains. It is just unable to cover its cost with the income it has. But NHS is a gem, don't let anybody tell you otherwise. It does a marvelous job with the money it has. The reports laud it for its smart and efficient administrative process, affordability (for the citizen) and to a lesser degree for availability and access. While by no means bad it can improve on the actual care process and the results (which costs money). The NHS seems to be doing a good job and works as intended. The administration, for once, is apparently not to blame. So, what are the things that make people say the NHS is on the brink of collapse in the first place?
The NHS manages demand by rationing with queues rather than prices. That seems not to be accounted for. You get great care once they get round to you, but people routinely wait months or years in pain for fairly routine treatments.
I don't really know what the answer is because eroding "free at the point of use" will also push a load of people out of healthcare.
> The NHS manages demand by rationing with queues rather than prices. That seems not to be accounted for. You get great care once they get round to you, but people routinely wait months or years in pain for fairly routine treatments.
For what it's worth (don't let the politicians tell you otherwise) the US is the exact same way.
Here, because it's all about profit and margins are so thin, there's no slack in the system. It takes literally months to book an appointment with my primary care doctor. If you aren't already "established" it might take even longer.
Tests for not-immediately-life-threatening things are the same way. You get the next available slot which could be weeks or months out.
There aren't free slots floating around because they want all the staff busy all the time.
And you might think "well can't you pay extra to get to the front of the line?" The answer is well... I can't. Maybe there's some income level that this is possible or secret handshake, but it's not accessible to middle class people.
The issue with the debate over "free at the point of use" is that it is often framed as two extremes: It's either free or we'll have the same as the US where people are pushed out of healthcare on price (ignoring the counter-examples of most other developed countries).
But in reality there is a vast continuum between "free" and prohibitively expensive. There is also of course the option that some categories get "free" care in any case (like prescriptions now, which in England are £9.90 in general but 0 for children and people on specific benefits).
"Free at the point of use" is totemic of the NHS and any suggestions of change are rejected as a matter of quasi-religion (which can be seen in a few comments here to some extent)
Are you living in the UK or just making baseless assumptions? For an ever-inceasing number of serious health issues, the NHS has been essentially non-functional for many years. I have friends with chronic conditions that are looking to emigrate becase they're dreading their health getting worse in a system that's doing nothing to help them.
"NHS would be great except for the bad politicians" is not a serious argument.
It's underfunded. I'm willing to bet that the countries they're thinking of moving to either spend more on healthcare as a proportion of GDP than the UK does or don't have healthcare that's free at the point of use (or both).
Throw in noisy unions, elections (despite the idea of a Conservative government actually privatising the NHS being absurd), and pay comparisons to other countries that don't account for inflation, locuming, and private work - and here we are.
Not to say it's the best and couldn't be better or anything, but I do think the discourse and perception is way out of proportion.
The UK's healthcare system isn't failing, it's being failed. There's been a constant cycle of defunding the NHS because it is bad and the NHS becoming worse from a lack of funding. The obvious end goal is full privatization once the system becomes defunct enough for that to be sold as a "tough but necessary" decision. There is also very blatant lobbying from US healthcare firms in the UK as they would seek to expand into the UK once they no longer have to compete with the NHS.
It's effectively self-imposed austerity, which has been demonstrated to produce worse outcomes than investing in public services instead. There's an obvious conflict of interest at play as politicians (in the UK especially thanks to its governmental system) rarely have to rely on these public services as they can easily afford private alternatives.
There's also the factor of Western corruption. In Germany for example the health minister during the early pandemic owned a significant stake in several pharmacies while at the same time pushing for and implementing a mask subsidy that created massive profits for pharmacies handing out masks at or below cost. These ties are often legal despite the obvious conflict of interest.
Those rankings are of course heavily influenced by the methodology and metrics chosen. Differences can be very small but obviously even a very small relative difference results in a higher or lower ranking. That's how rankings work.
For instance, in this case: "The U.K.’s health system is the top one for affordability... In the U.K., the National Health Service (NHS) provides free public health care, including hospital, physician, and mental health care"
This does not mean it is 'better' or that others are in fact unaffordable.
For instance, in France a visit to the GP costs 30 Euros but 28 are covered by social security and private cover. Arguably 2 euros make no difference vs. "free" but it's just that you can beat "free" when ranking on affordability.
That being said, I think anyone with experience with the UK and other European countries' healthcare systems will be surprised, shall we say, with this ranking overall...
The only explanation is that the "report" is obviously detached from reality and using massaged metrics to make political points. The NHS is as bad as it gets.
"More than 120,000 people in England died last year while on the NHS waiting list for hospital treatment, figures obtained by Labour appear to show. That would be a record high number of such deaths, and is double the 60,000 patients who died in 2017/18."
Everything is relative. Most people only use health care in their own countries and therefore can only compare to another time in their own country. So if it used to be better in the UK, it might feel really bad now. If it's always been meh in Germany, it probably feels ok there, since it's always been that way.
Also, populism. Healthcare is a major point in the UK elections. It's been a major talking point for the left that healthcare is awful now due to bad policy by the right. Something doesn't have to be objectively true for people to feel like it is true. Just like everyone always thinks crime is up even when it's down.
> It's been a major talking point [...] doesn't have to be objectively true for people to feel like it is true. Just like everyone always thinks crime is up even when it's down.
I'm sorry, but no. It's not just a talking point. As someone with family in both countries, as well as having parents that have worked in both medical systems: The NHS waiting lists are genuinely bad and this isn't all in peoples' heads.
It's not even a "left vs right" issue; no one thinks the system is working right now.
> It's not even a "left vs right" issue; no one thinks the system is working right now.
That's true but as always the difference between left vs right (populism) is not what is being said but what the proposed solution is. This goes for many things: healthcare, immigration, poverty, etc. The issues are hot button topics but the proposed or implied solutions vary drastically. Alas of course the left in countries like the UK and Germany have become very centrist and instead of proposing different solutions from the right often join the moderate conservatives in suggesting what the right says "but less". This results in aimless reformism, means testing and bureaucracy which further feeds into far right populism by demonstrating "the left" as incompetent.
The system is chronically underfunded (despite the massive amounts of tax revenue it already receives.) Doctors can make much more going private and the public doesn't really feel like paying more in taxes for doctors in the NHS. Plus the inherent waste that comes with every government bureaucracy with access to what feels like ~unlimited funds, with no incentive or competition to be efficient on costs. Vicious cycle.
What does the ranking look like if you compare percentiles?
Naively I would assume as a non-American that if you're in the top 20% by income in the US you end up much better off than the top 20% income Brit, for example.
Or is it just actually worse for everyone? It feels intuitively obvious that the average will be worse because, well, the average person is skint and the US is less socialist.
As someone in the UK with income in the top 1%, I have never bothered with private insurance because I genuinely don't feel I need it. I occasionally pay for private GP services, and I've paid for some private services for my son, but for the most part the NHS works. It has waiting times for non-essential things, and if you don't want that, you can pay for insurance that gets you seen faster and it costs a pittance. But if you need treatment, you get it. Overall, paying cash for healthcare here is also so much cheaper that for Americans, for elective procedures with short-ish recovery, flying to London can be a cost-effective option compared to US hospitals.
I'm sure that if you're rich enough, you have fantastic care available in the US, but from what I've seen of prices for pretty basic stuff, I'm not so convinced most of the top 20% in the US have healthcare I'd consider tolerable.
As someone in the same income range, and many friends in comparable spot, I have to say that NHS is sometimes ok.
Here's an NHS case.
Case 1. My friend's wife had her body going numb, like, completely senseless. They didn't have a private insurance back then. It was maddening hard to get past the GP. And then there were numerous tests, and queues, and... She had a viral brain infection that was, luckily, easy to fix. Could go horribly wrong should they wait for a couple more months.
The problem is that GPs are afraid to assign tests other than the most simple blood tests (unless it's an obviously broken bone).
Case 2. My wife fainted in the middle of a family dinner. It looked serious, and I recognized the sympthoms thanks to dr. ChatGPT. Our car was at service that day. I was trying to get an ambulance but calling all the publicly available NHS numbers but all we got were endless questioneers. We had to force the situation by taking a taxi right to the hospital door. She had an urgent surgery the same evening, quite serious.
Again, there's just TOO MUCH backpressure from NHS at the entrance. Once you get past these filters, it actually it decent.
OTOH, with my highest tier private insurance I had an MRI scans, kidney checks, blood tests all done within a week or two, mostly because of how I had to coordinate things between various private clinics. Not fast, sure, but acceptable.
On the other hand doctors on the US prescribe far too many tests. These tests are generally set to have a 5% false positive rate so if you prescribe 14 tests you’re more likely than not to get a false positive. From talking to doctors it seems extremely common for something like that to happen and it’s always a headache when it does.
As soon as you need treatment beyond standard GP/prescriptions, like checks/analyses or specialised consultation/treatment then private insurance comes very handy to get good care quickly.
Waiting times are not only for non-essential things. The only thing with no waiting time is A&E if you are in immediate danger of death.
The NHS is some "safety net" that does the bare minimum at this point, or no longer anything at all (eg. dentistry).
Interestingly, nowadays if you have a good job and private insurance in China you get better routine checks than in Europe/UK. Even Chinese hospitals are extremely thorough and quick compared to British ones (at least the main Chinese cities)
I have had extensive rounds of tests for various things with the NHS over the last several years, and never had a problem sufficient to feel private insurance, even as cheap as it is in the UK, to be worth it. I don't doubt it's worth it for some, but there's a reason - and while costs will stop some, costs does not explain nearly all of it, given how cheap it is - that only about 10% of the UK population has private insurance, even with the underfunding of the NHS in recent years (e.g. 20%-30% lower healthcare spend for capita PPP adjusted than comparable economies does have an effect).
There's an inflection point, sure, where you start spending enough privately that the insurance is worth it, but so many of these things are so cheap here anyway that the gap from between where it starts to pay off until you're ill enough to get reasonably fast treatment with the NHS is quite narrow.
Sometimes people think it is wider than it really is because people want and push for treatments that are not medically indicated. E.g. patients pushing for pointless MRIs is common enough that same-day MRIs is a huge industry here even though they only make an impact on outcomes for very specific symptoms.
Private care is still quite affordable on a good salary so I can understand that you feel that private insurance is not worth it, but you were also very lucky with your NHS experience.
For instance the UK have very bad outcomes for cancer because things tend to be caught late and treatment delayed thereafter. Frankly, for anything potentially serious or time-sensitive I would go straight private (and in fact the NHS tells you to do that when they ask you if you have private insurance).
The NHS has much bigger problems than funding. Even the new, left-wing government has indicated that they won't increase funding without reforms.
> The NHS has much bigger problems than funding. Even the new, left-wing government has indicated that they won't increase funding without reforms.
It's always very convenient to starve something of funding for years when you want to insist something needs to be reformed before you can spend as much as it costs to provide service at an adequate quality.
Reform or no reform, outcomes won't improve without increasing the funding, as no other system in a comparable country manages to deliver more at the NHS cost level.
The point is that throwing ever more money at a bottomless pit isn't a solution. Hence there must be changes, not just more money.
Another issue is that the NHS is a religion. It is blasphemous to suggest departing from free-of-charge delivery or private involvement (although that's already what we have). Even suggesting "reform" is badly received.
The reason is that private intervention is tricky. The US has a fully private healthcare system, and as you can see from this post, it's shit.
I'm from the US so excuse any oversimplifications, but over the past couple decades I've noticed a trend of US-ification in British politics. I would be careful with looking to greener pastures.
The thing is that right next to the UK is France, which I know.
The French system is based on a mandatory health insurance, now with mandatory private health insurance in addition to that.
GPs and most health professionals are private practices that set up shop like a, say, lawyer would and there is big private sector involvement up to hospital level.
I think there are many similar examples throughout the world.
This is partly why I find this focus on the US system in the UK puzzling. My best guess is that it is used as a scarecrow by those opposed to any changes to the NHS.
Also: an unironic 1%-er income in France is like literally the bottom of the barrel Bay Area salary. If you're at or above the median America is great, outside of some very high cost of living cities.
If you're a billionaire or close to it, the US healthcare system is fantastic, unless of course you're traveling in one of the "medical deserts" and have an acute emergency.
You'd still stuck with the built environment as it is, just as everybody else.
A billion is just three Manhattan skyscrapers, so it can't change a city. Depending on where you live, you might well experience the exhaust, dust and noise of these environments, no matter how luxurious your individual dwelling.
I think that's more a problem with being famous: the top of the Wikipedia list* as I write this is "Bernard Arnault & family", who I've never heard of and therefore couldn't spot in a lineup much less a crowd.
But I did double-take when walking past Russell T Davis (or a lookalike) in Sheffield a decade and a half ago, and Richard Osman in Cambridge train station some other time.
The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills.
In all cases treatment is required by law, regardless of payment.
>In all cases treatment is required by law, regardless of payment.
No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for free.
It's a patchwork, with a lot of holes for people to fall through:
* Hospitals must treat or stabilize regardless of payment, but only for emergencies - they just have to try to keep you from dying on the spot
* The ACA (or Medicaid) subsidizes insurance for the unemployed, if your household income for the calendar year is low enough
* Employers are required to offer coverage to their employees, provided they work more than 30 hours a week at that company and it has at least 50 full time employees (this extends to dependent children but not spouses or other dependents)
This is better than nothing, don't get me wrong, but it could be a lot better still. We have the technology.
> In all cases treatment is required by law, regardless of payment.
Screening for and stabilization of emergency medical conditions is required at all emergency departments by law, regardless of ability to pay, but that's much more limited than "in all cases, treatment is required by law, regardless of payment", and even then, hospitals skirt the rules.
Lately I can’t even get a doctor - both the specialist and primary care doctors are booked months in advance. And I have one of the best insurance coverages currently available. Remember how we laughed at Canadians and Brits waiting for months to see their free/cheap doctors? Well we’re at a point where we have to wait _and_ pay through the nose. And then they can’t really do anything or fuck you up even worse.
Not that I'm trying to make you feel worse about it: In the UK we pay less per capita in taxes toward healthcare than you do in the US (or at least did last I added up the numbers - Medicare and Medicaid alone added up to a higher per capita cost than the NHS), and if we do want private health insurance, which here is basically "queue skip insurance", it costs a fraction of in the US because they only need to provide the "extras" - you'll normally try your NHS GP first, call your insurer if you can't get an appointment, or ask them to refer you privately for things there are queues to get done on the NHS.
For a lot of elective procedures, the price is even low enough that it'd pay you to fly to the UK and stay in a hotel to get things done here if the recovery isn't too long.
> For a lot of elective procedures, the price is even low enough that it'd pay you to fly to the UK and stay in a hotel to get things done here if the recovery isn't too long.
But please don’t do this. Our system is better than the US but private is now starting to struggle along with the NHS wait times as more people use their private coverage where they wouldn’t have done before.
If you want it as cheap as possible, sure. The point was not that it's the cheapest option but that even a high cost country like the UK is still cheap enough to be viable destination.
But the UK does attract a significant amount of medical tourism, and has hospitals specifically targeting an international clientele who clearly considers it a good balance of cost and quality.
The US is so corrupt that I’m afraid any attempt at universal healthcare would make it even more expensive. Obamacare was basically a trillion dollar giveaway to Big Pharma and Big Healthcare. The only positive thing I can see in it for me personally is that it became possible to buy (extremely expensive) healthcare privately rather than through an employer, and you could not be denied due to pre-existing condition. Don’t get me wrong, that’s significant, but the insurance is now three times the price it was before Obamacare and the actual care is much worse. And both the cost and quality/availability seem to be trending in the wrong direction.
I guess what I wanted to say is, lucky you. Hold onto that NHS for dear life and resist any attempt to privatize it. It’s very much a one way street.
Obama himself has said to that Obamacare (well ACA) is like (to use my own analogy) a "patch" on a a system that can't just be reimplemented (most of it due to political reasons). It's not terrific but it's what was able to be done.
Whereas e.g. single payer was an unachievable pipe dream from where they were standing in 2008/09. And he'd rather have something a bit better rather than go for the excellent system and fail and be left with the bad system.
And why was it "an unachievable pipe dream"? As I remember it, the Democrats had control of both houses of Congress, as well as the White House, for about 2 years. They could have passed anything they wanted.
A others have replied, some Dems were quite red, a lot of politicians are more eager to preserve their jobs than burn political capital...
The excerpt from his book: https://archive.is/V5TVM . He also talks about "political capital" and whether it'd be more wise to spend them on e.g. recession recovery. Ctrl-F for "More than forty-three million Americans were now uninsured" to skip the introduction about how the system got to the way it got.
The senate is not Democratic. Senators represent states, not people. Unfortunately the house is very poor at representation as well since the number of seats has been frozen. Too many compromises with slave holders built into the foundation of our country to have anything approaching a functional system. Those compromises have been hampering democracy and progress ever since.
Perhaps you don't understand how voting works? When the difference between minority in favor (not passing) and majority in favor (passing) is one person, then yes, one person has such power.
Democracy doesn't mean that the minority gets to overrule the majority when they feel like it. In fact, it is quite the opposite.
Unfortunately that’s exactly what “democracy” in the US means. Without a super majority, any individual can hold up any legislation they want outside of budget reconciliation. It will be that way as long as the filibuster exists in its current form.
Matches my experience. As a self-employed person health insurance in the US costs more under ACA, and then many doctors, hospitals, and labs won’t accept the ACA coverage.
My parents in America have Medicare plus a private “advantage” add-on they can barely afford. Right now they are waiting — for months — to find out if a necessary surgery will get approved or not.
I live in Thailand now, where I can afford insurance and get top quality care with no waiting, referrals, or uncertainty, and costs at the best hospitals still a fraction of US prices.
In the UK you also pay insane taxes and your _median_ citizen in the UK has far less disposable income after all expenses including healthcare, according to OECD metrics. In software engineering specifically, I'd make a third of my current income in the UK.
I'd much rather make 3x as much in the US and still get free healthcare through my employer, with shorter waiting lists and better treatment outcomes than the NHS.
And we also have "skip the line" services here as well.
My family have worked as doctors both in the UK (NHS and private), and the US, and they vastly prefer the US system from an outcomes and efficiency perspective.
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Commonwealth Fund studies like the one in the article tend to be quite biased and pushing a very specific agenda.
But in reality, we have far better mortality rates (1) for serious diseases: 48% better outcomes for cancer, as an example.
When people with serious problems want treatment, they come to our system if they can afford it, because we actually do have better outcomes regardless of what these highly biased studies say.
Edit: People calling my argument a "strawman" should really try living in both systems for a year with a chronic, serious health condition.
They will very quickly find that the US system is far better than the NHS. We get seen more quickly, our doctors can afford to actually spend time on us, more effort goes into root-causing a problem, we have more treatment options, etc.
It's easy to theorycraft online and look at the "on paper" metrics from highly biased studies and come to the wrong conclusions.
> your software engineers make a third of what they make here
Is this topic for discussing health care systems or the SW engineering salary dick measuring Olympics? Because those are two different unrelated topics.
Which country pays its software engineers the most is not some yardstick for measuring national quality of life of its average citizens, and whether SW engineers get paid a lot is totally irelevant to the people who are not working or aspiring to be SW engineers.
I bet the disabled US vets, homeless people or McDonalds workers in the states also don't give a fuck that their SW engineers are the best paid in the world but would probably feel a bit cheated learning that despite living and paying taxes in the richest country in the world, their peers in poorer EU countries get much more benefits and better quality of life.
>I bet the disabled US vets, homeless people or McDonalds workers in the states
Those two groups share interesecting means by which their healthcare is provided. Surprise! Its the government. So when people have doubts about an implementation of "Universal Healthcare" you shouldn't be surprised when you can acknowledge that as you said " but would probably feel a bit cheated learning that despite living and paying taxes in the richest country in the world, their peers in poorer EU countries get much more benefits and better quality of life."
Irrelevent but homeless people don't really pay taxes in any meaningful sense.
> In the UK you also pay insane taxes and your software engineers make a third of what they make here. At my big tech, as an IC5 I was making more than our UK Directors.
How strange. When I moved from US to UK within a FAANG I took a fractional pay drop and got an RSU topper. After leaving and working as a UK employee in an international org I make more than a lot of US directors. Perhaps the difference comes from the value you brought to the company?
One thing that is objectively true though is that, outside of the whinging from software devs in the 1% that no one really cares about, the outcomes and efficiency of the US system sucks compared to every other western nation.
It's always fun how the strawmen appears instantly when you discuss this subject.
We pay marginally more in tax, sure. How that is relevant to healthcare, however, is a mystery, given we spend less tax money per capita on healthcare than the US does. It's not healthcare that is the reason our taxes are higher, but other services.
I'm sure doctors prefer the US system. That's unsurprising - the US system pays doctors vastly large amounts. It also costs patients vastly larger amounts. So speaking of bias...
> They will very quickly find that the US system is far better than the NHS. We get seen more quickly, our doctors can afford to actually spend time on us, more effort goes into root-causing a problem, we have more treatment options, etc.
Nothing stops you from choosing extra insurance in the UK too if you believe you need that level of cover.
The only reason you're comparing it to the NHS instead of an equivalently expensive UK private healthcare plan is that the NHS provides good enough universal coverage that most people don't feel the need for more.
But the US equivalent would be to compare it with Medicare and Medicaid.
Okay, and what about all the other people who aren't blessed enough to be SWEs? They should just rot and go into medical debt for the rest of their lives for daring to get sick?
The UK isn’t functioning well at the moment. Cancer treatments keep getting delayed and people are dying as a a result, to give one example. I don’t know which countries are doing a good job on health, but it’s not the UK.
Same. Forced to get insurance through state exchange, premiums over $1,000/mo for two people. Very hard to find a doctor that accepted the insurance. And that was in a major US city. Every test and procedure requires a referral to a specialist, and the game of “do you take this insurance?” repeats. Then you get referred to diagnostic labs with long wait times (sometimes months) and they want payment up front and may not accept your insurance.
That process seems worse in every respect compared to my experience in SE Asia, and the US does not have better outcomes to justify the much higher costs.
There are a ton of benefits to having continuity of care, but also access to care. Do any out-of-network providers have appointments available? If so, and you can't find one in-network, you may be able to get an out-of-network provider covered as in-network due to an inadequate network.
I've heard of people calling their insurance company and keeping them on the line while they call a handful of offices and get turned down for appointments to get this approved.
Same here - and I'm always left wondering what manner of trivial/cosmetic cases are taking up these bookings and leaving more urgent medical cases to wait.
It's disheartening but not surprising to see the US health system ranking last among peer nations. Despite paying so much, we still struggle with access and equity. It's high time we prioritize real healthcare reform that addresses cost and outcomes, not just politics. https://templatecalendar.com/
Yeah that's the funny part: in the US you should pay thousands of dollars for the basic exam / ambulance ride and many people don't have coverage while in entirety of europe is basically free, but the US gov is still paying 50% more in GDP than the other
Quality of care is shit. Doctors barely care about their patients. It’s all a racket. Most areas seem to have a local monopoly that takes over the local hospitals. Obamacare has done nothing to really change anything meaningfully.
Obamacare is a mixed bag, but I don't think I'd go back to a pre-obamacare era if I had a choice. So many people stayed at jobs for longer than ideal because they had pre-existing conditions that wouldn't be covered under a new insurance plan.
The consolidation of the last 20 years has been a real black mark on the system. It was supposed to improve outcomes by making all the records easily available in one system. Instead we've seen the independent doctors office largely go by the wayside and local competition decrease.
Not all outcomes are comparable or worse though. The outcomes most improved seem to be net worth of executives.
It's unfair to judge the EU piecewise but then judge the US as a whole. Either let us compare apples to apples by judging the whole EU against the US or let us judge individual European member states against individual US states.
The EU has no common health system at all. Calculating any kind of averages makes little sense. Within some countries I am personally familiar with there are significant differences in availability of health services between certain areas, rural vs urban, but also regionally. Legally the systems should be rather uniform within a country though. Many countries have a split between publicly financed and privately paid services. It's probably expected that privately paid services are used less in poorer regions.
With the US I am not really familiar. I'd expect commercially and legally it works the same over the whole country. In practice many services won't be offered somewhere in rural areals compared to metropolitan areas. So if you are unable to travel no treatment. And of course if you aren't well off, no expensive treatment.
The US has no common health system. There are a few systems that are common (Medicare) but that is only for the elderly. The rest of the system is all done on the state level. The rules vary amongst all the states.
> the rest of the system is all done on the state level
Ok. Didn't know that. But you are talking about public services aren't you? I would assume a rather small fraction of the huge US health expenses are publicly financed. The bigger part is completely private businesses, both service production and insurances for those who have one.
That's the opposite in most EU countries and UK. A large fraction is either produced publicly or if produced privately then paid for by a publicly organized health insurance.
I don't know the percentage so I don't know if it is a small fraction. The basic setup is:
Medicare - federal program for seniors
Medicaid - state program for poor people (there may be some sort of funding by the federal government, but it is run by the states)
Private insurance - this is paid by the individual and/or the company they work for
The laws/regulations regarding what is and isn't allowed with the private insurance is handled mostly by the states, not the federal government. The federal government has pushed for various rules (ACA/Obamacare) but there is a debate about the constitutionality of the federal government getting involved.
There are also specific programs within the governmental systems that focus on children (Insure Kids Now) and provide dental not just medical.
Within Medicare there are additional (supplemental) coverages that provides better benefits called Medigap.
I'm sure there are more programs than just Medicare and Medicaid, but those are the largest ones.
As an American, I'm probably heavily influenced about non-state-by-state discussion in the media and thus ignorant... (and work in tech and don't directly pay for health insurance...) but I don't think I'm aware of significant state-by-state differences in healthcare.
I know California generally has more regulations and has MediCal, but most insurance options I've encountered seem to be multi-state (regional, not necessarily country-wide though). Things like FSA/HSA are nearly the same across all States I think?
I'd assume quality of care varies more by region (likely with some correlation between quality and the to major options health insurance providers) than by state lines.
That all said, I'd be curious to see all 50 states in a healthcare quality ranking combined with the various "peer" (or EU) countries like you propose. I'd probably be surprised by the spread.
Medi-Cal is California's implementation of Medicaid, which along with CHIP is always administered by the individual states (though the federal government tries to apply some controls via funding).
That's the only big top-down state-by-state distinction that comes to mind, but there are a lot of small details. We have some models predicting medical outcomes and financials and state is always at or near the top of the SHAPs. Sometimes bigger than age or household income. (I don't study this or anything, just an incidental observation.)
The organizations that take doctors' licenses away when they misbehave are all state-level organizations (in California, it is called the Board of Medical Quality Assurance) and I can easily imagine that some states perform this function much better than other states.
Does the Bavarian power grid also routinely go down because they don't invest in it and at the same time also refuse to add interconnects with other regions?
Not sure, but I think the grid integration is international with significant connections to e.g. France, rather than federal states within DE having their own thing?
More that the stereotypes people have of Germany/USA are really of Bavaria/Texas (beef, guns, lederhosen), more (small c) conservative, and there are occasional mumbles and grumbles of independence but they don't have any substance to them.
At least, that's what it seems. My grasp of German means there's a game of telephone between reality and my understanding of Bavaria, and I've never even been to Texas so I'm judging them by what people say online.
The report compares countries, not states. What point are you trying to make by comparing US states with EU countries (and Canada, and Australia, and New Zealand)?
I tried that argument here recently when I talked about civil asset forfeiture and a bunch of people said I was horribly ignorant about civics and that the US is apparently not one country.
I agree, some individual states have free healthcare, free community college. It’s easy to fall out of these systems or be unaware of them, but they exist
I’m the last person to have an America boner, but there is room for objectivity
I’m a fan of Germany, Austria systems. An educated and healthy populace seems positive. I’m aware of the problems residents have with those systems, they have private options too. Public debt isn’t as high, and maximum tax between state and federal level is lower than maximum of California + Federal. So, seems better.
Ugh. This. Not just for healthcare though, for everything. Using small wealthy countries with populations smaller than our states as a comparison against our continent sized country is really not helping or proving anything.
> Using small wealthy countries with populations smaller than our states
I don't know which countries you're talking about. Sweden has a population of 10m, which would make it the 10th largest US state. Norway's 5.5m people would make it the 23rd largest.
Even if we go really small and rich, Luxembourg's population is 670k - that's more than Washington DC (not a state, I know), Vermont, and Wyoming.
The only really wealthy European country that's smaller than a US state is Iceland.
Did you read the article? (I recently posted something similar - it's probably posted often.)
It's proving that the US, which spends BY FAR the most on healthcare per capita, is getting a very poor return on our investment.
It's not really "helping" because the GOP is so opposed to healthcare reform - which would cut into their corporate profits, and they've somehow persuaded their supporters that Jesus hated healthcare but loved automatic weapons.
Because we are paying for the rest of the world. Allow prescription drug imports from abroad. Pharma companies will be forced to charge more in the rest of the world and less in US. Allow insurance plans based on medical tourism for expensive procedures. Some countries will say no, but a lot of countries will say yes for profit. Once you have a choice of a hip replacement in Mexico or India, hospitals in these countries will compete for safety, cost, pleasant aftercare. Let's stop being the suckers.
> Because we are paying for the rest of the world.
While I don't know if that covers all the expenses, I don't think people appreciate how much funding the US system is contributing to new med-tech development.
A previous client created some analytics software, they have EU regulatory approvals, but those are almost secondary, without FDA approval they would shutdown. All of their client, except for a few UK customer (who just bundle and resell in the US) all of their clients are in the US. For a lot of smaller medical companies, even in the EU, the US market is their number one source of revenue.
I might be wrong, but it's also my impression that if you do have the money, you'll get much more in-depth care and treatment in the US. And it's from this segment many companies find the funding to develop new technology that will only much much later trickle down to public healthcare systems else where in the world.
There is certainly an argument to be made that the US pays the R&D costs for the rest of the world. Most new drugs end up in public healthcare systems as if the pharmaceutical company is throwing an old product into the discount bin.
However some of these new drugs are so expensive that some countries are now refusing to allow certain new cancer drugs on the market. Simply because the exorbitant price compared to the questionable gains in quality of life doesn't make sense anymore.
> Because we are paying for the rest of the world. Allow prescription drug imports from abroad. Pharma companies will be forced to charge more in the rest of the world and less in US.
Oh, look, a new cartel that will take 6 months to set up and decades to investigate.
One thing that's surprised me about the US is the general slowness of most things. In India, you can get MRIs and CT Scans same day. Or you could the last time I was there. And it didn't cost very much in comparison.
My doctors have all been good (attested to by my parents who are surgeons themselves) but the healthcare system is wonky.
One thing I didn't expect is that the Indian system where you just drag your health records around paper copy yourself is superior to US EMR systems - which doctors seem to always have trouble with.
But now I have some friends in medicine and I always have them pull my records and keep a copy myself. It's usually a fax but it's better that way. Clearly electronic interop isn't working most of the time.
The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.
Most of Asia has same day or next day medical tests. In India you can order something like UberEats where in a technician comes home collects your blood samples and the results are emailed within the next 24 hours or so.
Medicine seems to be commoditzed in the east, easily accessible and cheap. West treats it like voodoo magic or rocket science that only a chosen few are capable of partaking in. There is always a long queue to get to your local voodoo practitioner.
I had some pain in my lungs and they gave me an xray in about 30 minutes here in Spain to confirm that i had pneumonia. I waited 45 min to see the doctor in the emergency room and then another 10min waiting for the doc to check the xrays.
Yeah you need to know the keywords in EU, "pain in chest", "seizures". After which the emergency treatment is quite good.
But for the majority, it isn't great. You go with pain in stomach and it happens to be cancer, you die waiting. I personally have seen so many of these and it's heartbreaking.
That is true, but it also varies from country to country. In Sweden I haven't been able to see a doctor in 1.5 years. In Germany, the waiting time is ridiculous, usually 1-3 months, but if you choose your doctors (Google Maps is the best catalogue for almost everything) - you get the results and 99% of it is covered by statutory insurance.
> The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.
In France I could have a blood test right now, without an appointment, and an X-ray by tomorrow morning (just checked).
But the ER is generally far too slow and some specialists have much too long waiting times.
> The general slowness extends to simple things like x-rays and blood tests too. This is not just US but whole of the west seems to have the exact same attitude.
In Switzerland I get an MRI within 48 hours if my doctor orders it.
Mind you, healthcare is also very expensive comparatively but the quality is very high and coverage is extensive.
Condition is if "your doctor orders it" and how long does it take to get to that doctor if it isn't an emergency. I don't about Switzerland but it is quite bad in majority of EU countries.
And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.
The other part no one mentions is the utter cheating that goes on in statistics to show that the health care system is doing good. Things like counting the patients who were admitted but not counting the rest 90% who died just waiting for months.
> And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.
Because false negatives are a massive problem. People get biopsies or treatments for things that never needed it, which is ultimately worse for their health (on average) than catching the rare time it is something.
There is no stats to what you are speaking. General People not being able to get to doctor in months is a bigger problem than a rare false negative.
This also reduces burden on doctors. If the only thing your doctor does is prescribe antibiotics and orders scans. Why not do it yourself and get treated early.
You can absolutely walk in an have an MRI made at any time.
It's just not paid for by your health insurance.
Apologies, I mixed up my terms, I meant false positive.
And no, you are wrong, overtreatment is a huge problem.
You can, but it's not necessarily a good idea.
https://www.newyorker.com/science/annals-of-medicine/will-a-...
https://doi.org/10.1016/j.jacr.2024.08.024
> And Why can't you just walk in to a clinic to get x-rays and tests done like it is in done elsewhere. Have clinics compete for price.
I hope you are aware that these also exist in many EU countries, private clinics aren't banned because of public healthcare, you can purchase private health insurance in many countries, I can't say all because I don't know the intricacies of every country's system since this is a national policy and each member-state is free to run their own systems.
Here in Sweden I have private health insurance through my employer, I cannot go directly to a clinic for imaging, etc. since it needs a referral from a doctor but it's quite simple and when I needed I had many choices of private clinics to do a MRI. If you don't have insurance you can definitely pay out of your own pocket, both for a private doctor as for exams.
I feel the seiss system really nails it. Health insurance is mandatory. If you can't afford even the basic level, the government pays for it. The basic level itself covers basically everything from emergency care, hospital stays and gp. The extras you can pay for are things like single rooms in hospitals or access to private clinics. Compared to the local salaries, the basic package is quite cheap - doubly so compared to the UK where National Insurance extracts a very hefty portion of your paycheck and this gets you the dire waiting times of nhs...
Maybe because the Swiss didn't let the magical hand of privatization solve it? The healthcare providers might be private but the laws and regulations and conditions under which they are run are very strict and very detailed. Perfect? Of course not, I could give examples heaps. But better that many? Very yes.
Now, is there here anybody from Spain to comment on their system? I've heard good stuff about it.
National insurance contributions have nothing to do with the NHS. NI contributions determine your state pension (but because the money from NI just goes to treasury, NI is really just income tax with different name)
Does it? It's also close to last in most categories in the linked study.
I had to visit the ER in Philippines.
In US we sit there for 5-7 hours and see a nurse practitioner.
In Philippines we were in an out in 2 hours and saw two doctors.
My last trip to the ER was in 2010. Probably because I had good health insurance, they saw me quickly (less than half an hour), cleaned me up, maybe glued a cut, and I was done.
This was in the US, just outside Washington, DC.
I think the problem in the west is just demographics. More older people leads to high demand on the healthcare system and fewer working age people leads to less supply.
China, SKorea, Japan.. all aging
And they all make their citicens work insanely long hours. So they are not sustainable either.
Got to keep that Necropolis warm
If you're willing to pay out of pocket (~100 euro or so) that service is available in western europe too.
Can you name a few services that do this for that price.
I live in Europe and if I take a blood test at 7 am I can usually check the results online by 1 pm.
Blood test yes, MRI - no. In the Ukraine I can go to the M24 center, and yes, 24 means it is literally working 24/7/365. And I don't need doctor's referral to do it. In EU I had to wait 2 months and have doctors referral, and that was lucky window I caught by chance. Other people report waiting much longer.
To get to the specialist doctors is also hard in EU, compared to the Ukraine. Here I had to wait between 1 to 3 months to a lot of specialists. And if any mistake in the referral is made, then wait need to be repeated.
Example - I got a referral for the retinal diag. But to do it 15 mins before the test eye drops are administered (atropine) to dilate pupils. Apparently I have needed to have two referrals - one for the drops, and another for the diag itself, and I got only the second one (made by an eye doctor in the same clinic, so regular staff). So I have waited months, and was denied the procedure, then a spend a week on a phone and visiting clinics in person to sort this out. Then I got proper referral (haha, actually not even then, they simply caved and allowed me to do it with what I had) and had to wait a month again to do a simple check which would take me a hour at any arbitrary day in Ukraine.
And in the middle of a full-scale war, in a country not exactly wealthy, no less.
Same. But in Croatia where things are a little bit... well... different. For instance, I don't need a prescription to buy (almost) any drug in the pharmacy. And I don't need a prescription or referral for any medical exams or blood tests; I can order them myself. Asia is like this, but Europe to the north and west of Croatia really isn't.
I believe that things in the UK and Germany might be a lot slower and much more restrictive.
Well some relatively common things are easy to get in Croatia (bloodwork and meds - GPs like to prescribe those to get rid of you), more serious like exams, treatments, surgeries are absolutely terrible with waiting lists which are years long. People are dying, and/or their condition worsens before they even see a specialist. This is common knowledge for many years now.
Private clinics are opening left and right with the same(!) doctors working in both public and private clinics. Also corruption is rampant allowing doctor's friends to jump lines and that also happens for money/favors. So if you're not rich enough to go to a private clinic your second best option is bribes/corruption/nepotism. And if you don't have the latter, you're frankly fucked.
I've lived in the US where my health insurance had like a $6000 deductible and a $1400/month price-tag. (And, by the way, I really didn't appreciate how American doctors would gatekeep drugs, restrict their availability, and add significantly to their cost.)
Here, you can walk into any private clinic in Croatia, and arrange for even a fairly complicated surgery, and it'll cost you way less than all that. Your annual medical expense bill won't even come close; a very sick person in Croatia, who does everything in private clinics, pays less (annually) than a perfectly healthy person in the US who never sees the inside of a doctor's office.
My wife just gave birth here at an "expensive" private clinic, with a private room of her own, and the total price was cheaper than a few months of medical insurance would have cost in the US.
Ultimately, private clinics are a damn good thing, because price transparency, price competition, and paying out-of-pocket -- they all serve to keep fees reasonable. If a Croatian clinic tried to charge $100 for an aspirin tablet or a bag of saline, there'd be riots with pitchforks and torches.
I'm not sure if we're talking here about the same things. You may say: "oh it's easy to get meds and it's cheap to do X, medical system is great" while being a medical tourist and/or having a far above average pay, I would accept that. It's great if you have the means. Just like it's great in USA if you're rich, right? But directly comparing two completely different systems and different orders of magnitude of purchasing power and taxes doesn't really paint a good picture of how it's here.
For an average citizen the system is terrible and getting worse by the day. The examples are too numerous to mention.
I'm also not sure if you think that I'm somehow against private clinics. I'm not. They of course won't compete on medications with public services as that's pointless. What I do find apalling is that doctors are working in both public and private clinics completely legally. Moreover, that practice makes the public services worse by removing the availability of the doctors and makes taxpayers being double charged for the same service.
There would be riots with pitchforks if most needed some non-basic ("take these pills") medical help. When you're young you probably don't need much. But as you get older you actually might need some procedure or a treatment. But by that time you are actually older, sicker, and there aren't too many of you to actually riot. And many jump the lines by having friends (of friends) working in hospitals. It's bleak and grim and I don't see it getting better.
I don't think you appreciate how much worse things are in the USA, even after adjusting for income and taxes. (Effective tax rates are very similar between the two countries, besides.)
Medical care isn't perfect in Croatia -- but it's not perfect anywhere, and at least in Croatia the poor can have many of their needs met by a pharmacist, without even needing to see a doctor; they'll never need to pay >$1000/month out of pocket for garbage "insurance" with a high deductible; they have the option of public care for certain procedures and treatments, and private clinics for others.
Yeah, there may be an element of corruption to it -- perhaps if you "know a guy" you'll get your appointment more quickly -- but this is small-time corruption on a human scale. In the US the corruption takes place on far vaster and more impenetrable scales, with lobbyists, regulatory capture, and I could go on...
And, yeah, some can't afford private care, and need to rely wholly on the public system in their old age. I dare say the public system in Croatia is still a damn sight better than Canada's, or the UK's. Maybe you can tell me which country has an ideal public system? Distant Japan's, perhaps?
As for public system doctors working in private clinics -- it's like that all over the world, as far as I can tell. The medical system in Hong Kong is very highly regarded, and it produces good outcomes, and I know from personal experience that doctors there also work both systems simultaneously. Public hospital in the morning, private office in the evening -- or public hospital on Mondays and private clinics the rest of the week.
In fact, the system in Hong Kong is very much like Croatia's, but Hong Kong's private clinics are roughly 5-10x more expensive, on average, for the same procedures!
All things considered, and in light of the alternatives, Croatia's is really a better system than almost any in the world, for rich and for poor.
"This is not just US but whole of the west seems to have the exact same attitude"
The slowness you describe has not been my experience in many European countries. It really depends on how the healthcare system is designed to work.
I was pretty surprised when I went to China and I could just go to a doctor's office without an appointment, stand in a queue, stick out my tongue, get a diagnosis within ten seconds, and be sent out with a handful of random colorful pills wrapped in paper. Yes, this was, in fact, a real doctor's office, and I did take the pills. I have no idea what they were or did, if anything at all.
I also did enjoy the phone-ordered house visits from nurses in Indonesia when I got Bali belly, although that is probably a result of low labor cost more than anything else. And the poop tests I received a few hours later weren't all that helpful. Oh, I have "amoebas," that's very useful, thanks.
All told, I'm happy I usually live in Western Europe. Relatively expensive, but high-quality, fast healthcare without the constant risk of going bankrupt when something unfortunate happens.
Out of the Western Europe, I lived in Sweden and Germany, and I have not been impressed with the health care so far. I hear it's different when you're having a heart attack, but if you "just" tore some knee ligaments, for example, getting good care in a timely manner is a struggle.
In Estonia all of our records (incl. Health) are digitized and online in a central system that both doctors and you can access. It works wonders. Every doctor I go to can see my entire medical history with a press of a button, and I don't have to deal with any of that. Likewise when they prescribe new things, I can see my prescriptions right there, and so forth. We're a 100% online nation now, and clearly when done well it's remarkably good.
Does one big digital system make a cyber attack more damaging?
In theory yes. But having accurate & complete information in the hands of nurses and doctors saves lives on a daily basis as well.
Estonia is frequently targeted by massive coordinated and sophisticated cyber attacks. So far it has proved very resilient and secure.
Efficiency and resiliency are usually orthogonal.
Like a physical structure made of one large component is often the strongest and lightest, most rigid etc. But it's the most vulnerable to cracking or other failures.
Or any other attack. I remember we had such a centralized registration system. It was used to great effect by the German Nazis when they occupied our country. Of course, occupation by foreign aggressors is highly unlikely in Estonia. Unless history repeats itself as it has (in Estonia) dozens of times.
Do you want to advance your society and make life more convenient for the people or do you want to live in constant fear and create unnecessary complexities for the people? We put a lot of effort in creating secure systems, we audit them constantly, and we get a plethora of cyber attacks from Russians on a constant basis, but they haven't gotten through yet.
We believe in living the best life we can, through the means of making life as convenient as we can, and we're very happy our government thinks the same. I've lived abroad many times, in many countries, and every single time was miserable because of the unnecessary complexity every basic thing involved. I very much doubt that complexity was for security reasons, more like the incompetence of the government bureaucrats to create a cohesive system that interoperates with all the different parts.
Why does this need to be framed as a ditochomy?
I want my health system to be both resilient and efficient. Why? Because generally when unforeseen black-swan-type catastrophic events produce high demand in the health system, chances are other infrastructure is also affected by whatever that event was.
If the last pandemic has shown anything it is that if great minds come together and cast aside their corporations strategic or financial incentives for a moment, we can have the nice things — so for example tools that excell in multiple dimensions at once that many described as incompatible with each other: convenience, resilience, privacy, ...
If we want to move things forward, we should do our level best to not fall into the trap of false dichotomies. What is often framed as a fundamental dichotomy is usually just a tension that people with vested interests abuse to get a solution that suits them. That is not where real innovation or good engineering happens.
Well, they are engaged in constant low-level conflict with Russia, so their systems must be pretty hardened against hostile incursions already.
If there is one EU region where digital security must be taken as a life-and-death matter, it is the Baltics. In case of weakening of NATO, they are the foremost candidates for the next Special Military Operation.
> In case of weakening of NATO, they are the foremost candidates for the next Special Military Operation.
I guess the odds of Trump winning are much lower than a couple of months ago. And even if he wins, if he follows with his stupid plan of giving Ukraine to Putin, he will be criticized by all sides. So losing a Baltic state would be another bitter blow and he probably would want to avoid that as he wants to appear "strong".
Also, NATO is not just the USA. The remaining countries had no choice but to increase their military spending and will continue to support Ukraine until the last dime knowing that the fall of this country will just make Putin more aggressive. We can't just let this happen, with the next American administration or without.
It is not really just about Trump. It is quite obvious at least since Obama that US strategic interests are reorienting towards Southeast Asia, which is understandable as half of humanity lives there.
And even with a friendly administration, it can feasibly happen that there will be more crises unfolding at the same time than the US is capable of efficiently addressing. (Say, Ukraine and Israel and Taiwan.)
I wonder how much of a choice the other countries have. Being a European and observing European political patterns, I am very sure that Finland, Sweden, Denmark and most of the former Soviet satellites will continue to support Ukraine because they know what is at stake for them. The UK may as well, given that the dislike between England and Russia goes a long way back.
But there are influential people in Germany (and I am not talking about the AfD here, but about the industrial lobby) constantly pushing in the back rooms for reconciliation with Russia at any cost, because high energy costs have made a mess of the German economy, and I can see something like a repeat of the Munich betrayal of 1938 in the future. At this phase of the war, Putin would be open to such an agreement with Germany. Not even his wildest plans foresee a re-subjugation of the former GDR, so Germany risks "nothing" (well, a lot of goodwill east of the Oder, but that may be an acceptable tradeoff for the businesspeople).
And the more distant countries such as Spain or the Netherlands or Belgium aren't really that much interested in Eastern European affairs, all the verbal proclamations notwithstanding. Although NL has some unsettled business against Russia with regards to that shot down airliner.
While I can see populist parties pushing for an agreement with Russia, it would be a ridiculous move because it would completely split EU into two parts: Russia-lovers (countries that don't border Russia) and Russia-haters (countries that do border Russia).
I agree that it would be a ridiculous move that would split the EU, but people have done such things in the past anyway.
The French discarded all the credibility gained through their extremely bloody victory in WWI by not helping Czechoslovakia and Poland in 1938-9. Prior to that, France was admired and followed by a dozen countries in Central and Eastern Europe which sought to emulate it. Nowadays, meh. It has been almost 90 years since the moment of French weakness and the trust is still not repaired.
Putin himself started a major land war with barely 200 000 soldiers against the second largest country in Europe. Any serious military planner would say that it is not nearly enough to ensure victory, and many people including me in fact considered the whole thing a bluff just by looking at the inadequate numbers. Yet here we are, in precisely the sort of unwinnable war of attrition that is the result of such a bad decision. It may yet end Russia as a power, not directly through the force of arms, but through later destabilization.
People are experts on stupid decisions, especially if they feel in a Zugzwang. I am not sure what German social democrats are going to do if their labor unions start to seriously push them. The threat of losing important factory jobs is potentially very destabilizing for the established left wing of the German political spectrum.
Are there safeguards in place to prevent the wrong people looking up your data with the touch of a button though? I'm aware of Estonia's digital prowess but for me privacy is a top concern and I'm glad we're not so all-in here.
In the FAQ section of our health portal (https://www.terviseportaal.ee/en/kontaktid-ja-kkk/) it states:
> In Estonia, health information is gathered to the Health Information System, where your prescriptions and medical records are accessible to the health care professionals that provide services to you. The Health Portal enables you to view your data in the Health Information System, submit additional information, and change your personal data. You may restrict your health data if you wish. In that case, health care professionals no longer have access to your health information and the quality of medical care may be impaired, especially in emergency situations.
We take privacy very seriously. We can also see exactly who looked at our data, as there is a log of every person or institute who has done so. A little more is written here: https://e-estonia.com/i-spy-with-my-little-eyeprivacy/
I understand where you are coming from. But for ME I have personally ever wondered why are people afraid of others knowing their medical history.
This I know is a very unpopular opinion, but for my specific case, I've got plenty of medical record that may be considered "shameful"? Got several colonoscopies, endoscopies, I lost a finger, I had a LIS (anal operation) , etc, etc, etc haha. Yet, I kind of don't really care if people knew about it.
Maybe I have never truly suffered discrimination (I'm what we call "whitexican" here in Mexico, so I'm privileged. And that's why I think like this.
In countries where healthcare can exclude preexisting conditions this can be a major problem.
And it's not just about shame. It's just about it being nobody's business. I'm not afraid of people knowing my history (though I imagine my mental health history may raise some eyebrows, I don't feel bad about it) but it's just none of anyone else's business and I would certainly be pissed if someone knew that I didn't confide in.
Australia checking in and agreeing, usually same day or even within a few hours for MRI, x-ray and ultrasound. Next day for CAT. Centralised records so each practitioner can see the full history.
Oh and blood tests done with max 30 minute wait and then results in 48h
Same and I'm American.
Although as an American, I always struggle with blanket statements because we have wildly different standards for literally everything depending on where you are. I live in a major city that isn't LA or NYC or something like that. all of my medical records are digitized too. All my doctors can look at everything an urgent care, hospital, regular doctor did. But also my sister who lives in nowhere, USA has to deal with paper everything and long delays. The US is both 1st and 3rd world depending on what area you're talking about.
MRI and CT scans done in India vs US will have vastly different quality.
Basically, for equal quality in india you'll always end up paying 2x-5x of what you'll pay in any developed nation.
This is the primary reason, if you are rich and want quality - you will overpay in india.
I doubt this. I don’t have experience in India, but I have had lots of medical care in Thailand. Twice now Thai hospitals have found things that my US doctor and US imaging/diagnostic clinics missed. I can get MRI & CT immediately in Thailand, in the same places the doctor works. In the US I have to go to a separate clinic and wait weeks or even months. Cost in Thailand, at the most expensive private hospital (Bumrungrad) typically 1/5 or less US prices.
I also had great experience at public hospital in Taiwan, just walked in and asked for a test. Price was less than 10% for the same procedure in US, with no waiting.
And don’t even start on cost of prescription meds. Americans get scammed.
In Mexico my experience was this:
* 8am arrive to the emergency room in a private hospital
* 8:10am get seen by an internist doctor and after initial review, tell the doctor that I would like to get an MRI.
8.20 get a doctor prescribed mri ans take it to the radiology department
8:40 get the MRI
9:30 Get the results of the MRI, and pay for the whole thing: No more than $1500 USD. Without insurance .
10:00am take mri to doctor and get appropriate prescription.
That was an amazing experience. We have these incredible technologies that could be used to detect illness waaaay before . Like, allow everyone to have an MRI every 6 months. Regardless of illnes, after.say you are 30.
Plenty of urgent care places in the US will give you an mri if you walk in. It’s just expensive because labor here is crazy expensive compared to Mexico.
Electronic interop, in my experience talking to my GP (not US), is tricky not because of technical challenges but very strict privacy implications.
I wish I could pre-select an "I don't care. I'm informed and choose an open docs policy" box once after writing a 1 h exam and call it quits. My genome is on the Internet. I bet nothing bad will come of it by the time I die.
There's safety in numbers.
Classic example of government overregulation fucking over the regular citizen.
I go to two hospitals and am dealing with a medical condition and it's a total nightmare. Each hospital uses the same backend but I have to go through a lengthy and convoluted process to let them share information with each other after every single appointment.
I'm getting really sick of this affecting my treatment in the name of "privacy." I have a medical condition, for god's sake. Privacy is completely irrelevant if my doctors cannot even efficiently communicate to treat me.
Every week I curse whoever it was that thought this would be a great idea. I'm sure it sounded great in their heads, as regulations tend to do for most bureaucrats.
I am a security engineer btw, I have worked on privacy and security featuresets for products that billions of people use every day. I am 100% confident that it is doing more harm than good in the medical-information-sharing space.
Can the median income Indian citizen get such service? Chances are no. This report is about the average case. Extremely rich Americans, just like extremely rich Indians can probably get faster service.
Electronic health records have dismal ergonomy, usually. They're profiled for billing performance instead of care performance.
This changed about 15 years ago. Prior to that you would often just go same visit to imaging or whatever.
> One thing that's surprised me about the US is the general slowness of most things.
... and there is Canada
But did you get to redeem?
[flagged]
Each society has its own good and bad, and you can't dismiss an achievement because something totally unrelated happens in the same country.
I find it hard to trust a report that puts Canada above Germany in any healthcare related ranking. In terms of access, quality, and coverage, there's absolutely no comparison.
The UK performs better (third place) than, for example, Germany (second last place). The UK's healthcare system is often heavily criticized as being on the brink of collapse - any explanation for this?
The actual report [1] says it took five domains into account: a) access to care, b) care process, c) administrative efficiency, d) equity, and e) health outcomes. Read the linked summary.
To summarize the summary: from 10 investigated countries, 9 are in the same ballpark. The US is an extreme outlier, bad in almost anything and expensive to boot.
The NHS being in trouble is apparently orthogonal to these domains. It is just unable to cover its cost with the income it has. But NHS is a gem, don't let anybody tell you otherwise. It does a marvelous job with the money it has. The reports laud it for its smart and efficient administrative process, affordability (for the citizen) and to a lesser degree for availability and access. While by no means bad it can improve on the actual care process and the results (which costs money). The NHS seems to be doing a good job and works as intended. The administration, for once, is apparently not to blame. So, what are the things that make people say the NHS is on the brink of collapse in the first place?
[1] https://www.commonwealthfund.org/publications/fund-reports/2...
The NHS manages demand by rationing with queues rather than prices. That seems not to be accounted for. You get great care once they get round to you, but people routinely wait months or years in pain for fairly routine treatments.
I don't really know what the answer is because eroding "free at the point of use" will also push a load of people out of healthcare.
> The NHS manages demand by rationing with queues rather than prices. That seems not to be accounted for. You get great care once they get round to you, but people routinely wait months or years in pain for fairly routine treatments.
For what it's worth (don't let the politicians tell you otherwise) the US is the exact same way.
Here, because it's all about profit and margins are so thin, there's no slack in the system. It takes literally months to book an appointment with my primary care doctor. If you aren't already "established" it might take even longer.
Tests for not-immediately-life-threatening things are the same way. You get the next available slot which could be weeks or months out.
There aren't free slots floating around because they want all the staff busy all the time.
And you might think "well can't you pay extra to get to the front of the line?" The answer is well... I can't. Maybe there's some income level that this is possible or secret handshake, but it's not accessible to middle class people.
The issue with the debate over "free at the point of use" is that it is often framed as two extremes: It's either free or we'll have the same as the US where people are pushed out of healthcare on price (ignoring the counter-examples of most other developed countries).
But in reality there is a vast continuum between "free" and prohibitively expensive. There is also of course the option that some categories get "free" care in any case (like prescriptions now, which in England are £9.90 in general but 0 for children and people on specific benefits).
"Free at the point of use" is totemic of the NHS and any suggestions of change are rejected as a matter of quasi-religion (which can be seen in a few comments here to some extent)
"It is just unable to cover its cost with the income it has"
Which is a problem that politicians intentionally create in order to show how bad the NHS is.
Are you living in the UK or just making baseless assumptions? For an ever-inceasing number of serious health issues, the NHS has been essentially non-functional for many years. I have friends with chronic conditions that are looking to emigrate becase they're dreading their health getting worse in a system that's doing nothing to help them.
"NHS would be great except for the bad politicians" is not a serious argument.
[1] https://www.independent.co.uk/news/uk/nhs-collapse-hospitals...
[2] https://edition.cnn.com/2023/01/23/uk/uk-nhs-crisis-falling-...
[3] https://www.instituteforgovernment.org.uk/comment/how-bad-nh...
It's underfunded. I'm willing to bet that the countries they're thinking of moving to either spend more on healthcare as a proportion of GDP than the UK does or don't have healthcare that's free at the point of use (or both).
NHS bashing is our national sport.
Throw in noisy unions, elections (despite the idea of a Conservative government actually privatising the NHS being absurd), and pay comparisons to other countries that don't account for inflation, locuming, and private work - and here we are.
Not to say it's the best and couldn't be better or anything, but I do think the discourse and perception is way out of proportion.
That makes me doubt the metrics..
The UK's healthcare system isn't failing, it's being failed. There's been a constant cycle of defunding the NHS because it is bad and the NHS becoming worse from a lack of funding. The obvious end goal is full privatization once the system becomes defunct enough for that to be sold as a "tough but necessary" decision. There is also very blatant lobbying from US healthcare firms in the UK as they would seek to expand into the UK once they no longer have to compete with the NHS.
It's effectively self-imposed austerity, which has been demonstrated to produce worse outcomes than investing in public services instead. There's an obvious conflict of interest at play as politicians (in the UK especially thanks to its governmental system) rarely have to rely on these public services as they can easily afford private alternatives.
There's also the factor of Western corruption. In Germany for example the health minister during the early pandemic owned a significant stake in several pharmacies while at the same time pushing for and implementing a mask subsidy that created massive profits for pharmacies handing out masks at or below cost. These ties are often legal despite the obvious conflict of interest.
Those rankings are of course heavily influenced by the methodology and metrics chosen. Differences can be very small but obviously even a very small relative difference results in a higher or lower ranking. That's how rankings work.
For instance, in this case: "The U.K.’s health system is the top one for affordability... In the U.K., the National Health Service (NHS) provides free public health care, including hospital, physician, and mental health care"
This does not mean it is 'better' or that others are in fact unaffordable.
For instance, in France a visit to the GP costs 30 Euros but 28 are covered by social security and private cover. Arguably 2 euros make no difference vs. "free" but it's just that you can beat "free" when ranking on affordability.
That being said, I think anyone with experience with the UK and other European countries' healthcare systems will be surprised, shall we say, with this ranking overall...
The only explanation is that the "report" is obviously detached from reality and using massaged metrics to make political points. The NHS is as bad as it gets.
"More than 120,000 people in England died last year while on the NHS waiting list for hospital treatment, figures obtained by Labour appear to show. That would be a record high number of such deaths, and is double the 60,000 patients who died in 2017/18."
https://www.theguardian.com/society/2023/aug/30/national-tra...
> "More than 120,000 people in England died last year while on the NHS waiting list for hospital treatment,
Still seems better than the situation in the US
30+ million Americans watched as someone they knew died because they couldn’t afford treatment (https://www.forbes.com/sites/niallmccarthy/2019/11/14/survey...)
> any explanation for this?
Everything is relative. Most people only use health care in their own countries and therefore can only compare to another time in their own country. So if it used to be better in the UK, it might feel really bad now. If it's always been meh in Germany, it probably feels ok there, since it's always been that way.
Also, populism. Healthcare is a major point in the UK elections. It's been a major talking point for the left that healthcare is awful now due to bad policy by the right. Something doesn't have to be objectively true for people to feel like it is true. Just like everyone always thinks crime is up even when it's down.
> It's been a major talking point [...] doesn't have to be objectively true for people to feel like it is true. Just like everyone always thinks crime is up even when it's down.
I'm sorry, but no. It's not just a talking point. As someone with family in both countries, as well as having parents that have worked in both medical systems: The NHS waiting lists are genuinely bad and this isn't all in peoples' heads.
It's not even a "left vs right" issue; no one thinks the system is working right now.
> It's not even a "left vs right" issue; no one thinks the system is working right now.
That's true but as always the difference between left vs right (populism) is not what is being said but what the proposed solution is. This goes for many things: healthcare, immigration, poverty, etc. The issues are hot button topics but the proposed or implied solutions vary drastically. Alas of course the left in countries like the UK and Germany have become very centrist and instead of proposing different solutions from the right often join the moderate conservatives in suggesting what the right says "but less". This results in aimless reformism, means testing and bureaucracy which further feeds into far right populism by demonstrating "the left" as incompetent.
The system is chronically underfunded (despite the massive amounts of tax revenue it already receives.) Doctors can make much more going private and the public doesn't really feel like paying more in taxes for doctors in the NHS. Plus the inherent waste that comes with every government bureaucracy with access to what feels like ~unlimited funds, with no incentive or competition to be efficient on costs. Vicious cycle.
https://www.bma.org.uk/bma-media-centre/staggering-cost-of-l...
What does the ranking look like if you compare percentiles?
Naively I would assume as a non-American that if you're in the top 20% by income in the US you end up much better off than the top 20% income Brit, for example.
Or is it just actually worse for everyone? It feels intuitively obvious that the average will be worse because, well, the average person is skint and the US is less socialist.
As someone in the UK with income in the top 1%, I have never bothered with private insurance because I genuinely don't feel I need it. I occasionally pay for private GP services, and I've paid for some private services for my son, but for the most part the NHS works. It has waiting times for non-essential things, and if you don't want that, you can pay for insurance that gets you seen faster and it costs a pittance. But if you need treatment, you get it. Overall, paying cash for healthcare here is also so much cheaper that for Americans, for elective procedures with short-ish recovery, flying to London can be a cost-effective option compared to US hospitals.
I'm sure that if you're rich enough, you have fantastic care available in the US, but from what I've seen of prices for pretty basic stuff, I'm not so convinced most of the top 20% in the US have healthcare I'd consider tolerable.
As someone in the same income range, and many friends in comparable spot, I have to say that NHS is sometimes ok.
Here's an NHS case.
Case 1. My friend's wife had her body going numb, like, completely senseless. They didn't have a private insurance back then. It was maddening hard to get past the GP. And then there were numerous tests, and queues, and... She had a viral brain infection that was, luckily, easy to fix. Could go horribly wrong should they wait for a couple more months.
The problem is that GPs are afraid to assign tests other than the most simple blood tests (unless it's an obviously broken bone).
Case 2. My wife fainted in the middle of a family dinner. It looked serious, and I recognized the sympthoms thanks to dr. ChatGPT. Our car was at service that day. I was trying to get an ambulance but calling all the publicly available NHS numbers but all we got were endless questioneers. We had to force the situation by taking a taxi right to the hospital door. She had an urgent surgery the same evening, quite serious.
Again, there's just TOO MUCH backpressure from NHS at the entrance. Once you get past these filters, it actually it decent.
OTOH, with my highest tier private insurance I had an MRI scans, kidney checks, blood tests all done within a week or two, mostly because of how I had to coordinate things between various private clinics. Not fast, sure, but acceptable.
On the other hand doctors on the US prescribe far too many tests. These tests are generally set to have a 5% false positive rate so if you prescribe 14 tests you’re more likely than not to get a false positive. From talking to doctors it seems extremely common for something like that to happen and it’s always a headache when it does.
How much do you pay for your private insurance?
Wasn't me, it's a corporate perk
As soon as you need treatment beyond standard GP/prescriptions, like checks/analyses or specialised consultation/treatment then private insurance comes very handy to get good care quickly.
Waiting times are not only for non-essential things. The only thing with no waiting time is A&E if you are in immediate danger of death.
The NHS is some "safety net" that does the bare minimum at this point, or no longer anything at all (eg. dentistry).
Interestingly, nowadays if you have a good job and private insurance in China you get better routine checks than in Europe/UK. Even Chinese hospitals are extremely thorough and quick compared to British ones (at least the main Chinese cities)
I have had extensive rounds of tests for various things with the NHS over the last several years, and never had a problem sufficient to feel private insurance, even as cheap as it is in the UK, to be worth it. I don't doubt it's worth it for some, but there's a reason - and while costs will stop some, costs does not explain nearly all of it, given how cheap it is - that only about 10% of the UK population has private insurance, even with the underfunding of the NHS in recent years (e.g. 20%-30% lower healthcare spend for capita PPP adjusted than comparable economies does have an effect).
There's an inflection point, sure, where you start spending enough privately that the insurance is worth it, but so many of these things are so cheap here anyway that the gap from between where it starts to pay off until you're ill enough to get reasonably fast treatment with the NHS is quite narrow.
Sometimes people think it is wider than it really is because people want and push for treatments that are not medically indicated. E.g. patients pushing for pointless MRIs is common enough that same-day MRIs is a huge industry here even though they only make an impact on outcomes for very specific symptoms.
Private care is still quite affordable on a good salary so I can understand that you feel that private insurance is not worth it, but you were also very lucky with your NHS experience.
For instance the UK have very bad outcomes for cancer because things tend to be caught late and treatment delayed thereafter. Frankly, for anything potentially serious or time-sensitive I would go straight private (and in fact the NHS tells you to do that when they ask you if you have private insurance).
The NHS has much bigger problems than funding. Even the new, left-wing government has indicated that they won't increase funding without reforms.
> The NHS has much bigger problems than funding. Even the new, left-wing government has indicated that they won't increase funding without reforms.
It's always very convenient to starve something of funding for years when you want to insist something needs to be reformed before you can spend as much as it costs to provide service at an adequate quality.
Reform or no reform, outcomes won't improve without increasing the funding, as no other system in a comparable country manages to deliver more at the NHS cost level.
The point is that throwing ever more money at a bottomless pit isn't a solution. Hence there must be changes, not just more money.
Another issue is that the NHS is a religion. It is blasphemous to suggest departing from free-of-charge delivery or private involvement (although that's already what we have). Even suggesting "reform" is badly received.
The reason is that private intervention is tricky. The US has a fully private healthcare system, and as you can see from this post, it's shit.
I'm from the US so excuse any oversimplifications, but over the past couple decades I've noticed a trend of US-ification in British politics. I would be careful with looking to greener pastures.
The thing is that right next to the UK is France, which I know.
The French system is based on a mandatory health insurance, now with mandatory private health insurance in addition to that.
GPs and most health professionals are private practices that set up shop like a, say, lawyer would and there is big private sector involvement up to hospital level.
I think there are many similar examples throughout the world.
This is partly why I find this focus on the US system in the UK puzzling. My best guess is that it is used as a scarecrow by those opposed to any changes to the NHS.
Also: an unironic 1%-er income in France is like literally the bottom of the barrel Bay Area salary. If you're at or above the median America is great, outside of some very high cost of living cities.
Really teachers and baristas and builders get paid more than 99% of people in France
Or are you just talking specific tech jobs.
According to this article (https://www.lemonde.fr/en/france/article/2022/06/03/france-h...), top 1% earner in France in 2021 was 7180€ monthly, so ~8000$.
And what is 8k/month in terms of US percentile?
Family income: 60 Individual: 75
https://dqydj.com/income-percentile-calculator/
Adding some numbers to this thread. 99th percentile yearly income is:
- USA: $819k (2021)
- UK: £187k = $247k (2024)
- FR: €111k = $123k (2023)
Yeah, I've always found the "meme" of the 1% kind of amusing.
The 95th percentile US taxpayer earns as much as the 99th percentile Brit. Huge, huge difference.
The the UK is quite "unequal pay" as far as Europe goes.
If you're a billionaire or close to it, the US healthcare system is fantastic, unless of course you're traveling in one of the "medical deserts" and have an acute emergency.
If you’re a billionaire EVERYTHING is fantastic.
You'd still stuck with the built environment as it is, just as everybody else.
A billion is just three Manhattan skyscrapers, so it can't change a city. Depending on where you live, you might well experience the exhaust, dust and noise of these environments, no matter how luxurious your individual dwelling.
Not necessarily: if you're famous, you might have a hard time going out in public.
I think that's more a problem with being famous: the top of the Wikipedia list* as I write this is "Bernard Arnault & family", who I've never heard of and therefore couldn't spot in a lineup much less a crowd.
But I did double-take when walking past Russell T Davis (or a lookalike) in Sheffield a decade and a half ago, and Richard Osman in Cambridge train station some other time.
* https://en.wikipedia.org/wiki/The_World's_Billionaires
That's why I said "if". Some billionaires are not well-known publicly, and then there's Elon Musk or Bill Gates.
Indeed, though I think he likes it that way, and that it's a choice.
There are 2781 billioners in the world (according to first search result).
I'm fairly sure most of those can go out for dinner or drinks and no one would know who they were.
Hire your own public and make them act normal when you’re around.
The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills.
In all cases treatment is required by law, regardless of payment.
>In all cases treatment is required by law, regardless of payment.
No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for free.
It's a patchwork, with a lot of holes for people to fall through:
* Hospitals must treat or stabilize regardless of payment, but only for emergencies - they just have to try to keep you from dying on the spot
* The ACA (or Medicaid) subsidizes insurance for the unemployed, if your household income for the calendar year is low enough
* Employers are required to offer coverage to their employees, provided they work more than 30 hours a week at that company and it has at least 50 full time employees (this extends to dependent children but not spouses or other dependents)
This is better than nothing, don't get me wrong, but it could be a lot better still. We have the technology.
> In all cases treatment is required by law, regardless of payment.
Screening for and stabilization of emergency medical conditions is required at all emergency departments by law, regardless of ability to pay, but that's much more limited than "in all cases, treatment is required by law, regardless of payment", and even then, hospitals skirt the rules.
Not true except for immediate emergency care.
Many employers do not provide coverage. They skirt the law by employing people part-time (Walmart, Amazon) or as gig workers.
Even if the law reads as you claim that doesn’t mean you can get care in the US.
Lately I can’t even get a doctor - both the specialist and primary care doctors are booked months in advance. And I have one of the best insurance coverages currently available. Remember how we laughed at Canadians and Brits waiting for months to see their free/cheap doctors? Well we’re at a point where we have to wait _and_ pay through the nose. And then they can’t really do anything or fuck you up even worse.
Not that I'm trying to make you feel worse about it: In the UK we pay less per capita in taxes toward healthcare than you do in the US (or at least did last I added up the numbers - Medicare and Medicaid alone added up to a higher per capita cost than the NHS), and if we do want private health insurance, which here is basically "queue skip insurance", it costs a fraction of in the US because they only need to provide the "extras" - you'll normally try your NHS GP first, call your insurer if you can't get an appointment, or ask them to refer you privately for things there are queues to get done on the NHS.
For a lot of elective procedures, the price is even low enough that it'd pay you to fly to the UK and stay in a hotel to get things done here if the recovery isn't too long.
> For a lot of elective procedures, the price is even low enough that it'd pay you to fly to the UK and stay in a hotel to get things done here if the recovery isn't too long.
But please don’t do this. Our system is better than the US but private is now starting to struggle along with the NHS wait times as more people use their private coverage where they wouldn’t have done before.
Flying to UK for cheap healthcare is a sick joke.
There are much better countries for medical tourism: Thailand, Malaysia, Greece...
If you want it as cheap as possible, sure. The point was not that it's the cheapest option but that even a high cost country like the UK is still cheap enough to be viable destination.
But the UK does attract a significant amount of medical tourism, and has hospitals specifically targeting an international clientele who clearly considers it a good balance of cost and quality.
The US is so corrupt that I’m afraid any attempt at universal healthcare would make it even more expensive. Obamacare was basically a trillion dollar giveaway to Big Pharma and Big Healthcare. The only positive thing I can see in it for me personally is that it became possible to buy (extremely expensive) healthcare privately rather than through an employer, and you could not be denied due to pre-existing condition. Don’t get me wrong, that’s significant, but the insurance is now three times the price it was before Obamacare and the actual care is much worse. And both the cost and quality/availability seem to be trending in the wrong direction.
I guess what I wanted to say is, lucky you. Hold onto that NHS for dear life and resist any attempt to privatize it. It’s very much a one way street.
Obama himself has said to that Obamacare (well ACA) is like (to use my own analogy) a "patch" on a a system that can't just be reimplemented (most of it due to political reasons). It's not terrific but it's what was able to be done.
Whereas e.g. single payer was an unachievable pipe dream from where they were standing in 2008/09. And he'd rather have something a bit better rather than go for the excellent system and fail and be left with the bad system.
And why was it "an unachievable pipe dream"? As I remember it, the Democrats had control of both houses of Congress, as well as the White House, for about 2 years. They could have passed anything they wanted.
You're remembering wrong. They had a super-majority for only about 6 months. After that Republicans could hold up legislation via filibustering.
https://en.wikipedia.org/wiki/2010_United_States_Senate_spec...
A others have replied, some Dems were quite red, a lot of politicians are more eager to preserve their jobs than burn political capital...
The excerpt from his book: https://archive.is/V5TVM . He also talks about "political capital" and whether it'd be more wise to spend them on e.g. recession recovery. Ctrl-F for "More than forty-three million Americans were now uninsured" to skip the introduction about how the system got to the way it got.
Because they’re owned by Big Pharma and Big Healthcare. Same as Republicans. Also because we'd much rather fund wars than solve such problems.
I was complaining about the state of discourse on HN the other day. Your comment is example number... I don't know what number, I've lost count.
Joe Lieberman sabotaged the public option.
If one person has such power you aren’t really in a democracy
The senate is not Democratic. Senators represent states, not people. Unfortunately the house is very poor at representation as well since the number of seats has been frozen. Too many compromises with slave holders built into the foundation of our country to have anything approaching a functional system. Those compromises have been hampering democracy and progress ever since.
Perhaps you don't understand how voting works? When the difference between minority in favor (not passing) and majority in favor (passing) is one person, then yes, one person has such power.
Democracy doesn't mean that the minority gets to overrule the majority when they feel like it. In fact, it is quite the opposite.
Unfortunately that’s exactly what “democracy” in the US means. Without a super majority, any individual can hold up any legislation they want outside of budget reconciliation. It will be that way as long as the filibuster exists in its current form.
Matches my experience. As a self-employed person health insurance in the US costs more under ACA, and then many doctors, hospitals, and labs won’t accept the ACA coverage.
My parents in America have Medicare plus a private “advantage” add-on they can barely afford. Right now they are waiting — for months — to find out if a necessary surgery will get approved or not.
I live in Thailand now, where I can afford insurance and get top quality care with no waiting, referrals, or uncertainty, and costs at the best hospitals still a fraction of US prices.
In the UK you also pay insane taxes and your _median_ citizen in the UK has far less disposable income after all expenses including healthcare, according to OECD metrics. In software engineering specifically, I'd make a third of my current income in the UK.
I'd much rather make 3x as much in the US and still get free healthcare through my employer, with shorter waiting lists and better treatment outcomes than the NHS.
And we also have "skip the line" services here as well.
My family have worked as doctors both in the UK (NHS and private), and the US, and they vastly prefer the US system from an outcomes and efficiency perspective.
---
Commonwealth Fund studies like the one in the article tend to be quite biased and pushing a very specific agenda.
But in reality, we have far better mortality rates (1) for serious diseases: 48% better outcomes for cancer, as an example.
When people with serious problems want treatment, they come to our system if they can afford it, because we actually do have better outcomes regardless of what these highly biased studies say.
1: https://www.politico.eu/article/cancer-europe-america-compar...
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Edit: People calling my argument a "strawman" should really try living in both systems for a year with a chronic, serious health condition.
They will very quickly find that the US system is far better than the NHS. We get seen more quickly, our doctors can afford to actually spend time on us, more effort goes into root-causing a problem, we have more treatment options, etc.
It's easy to theorycraft online and look at the "on paper" metrics from highly biased studies and come to the wrong conclusions.
> your software engineers make a third of what they make here
Is this topic for discussing health care systems or the SW engineering salary dick measuring Olympics? Because those are two different unrelated topics.
Which country pays its software engineers the most is not some yardstick for measuring national quality of life of its average citizens, and whether SW engineers get paid a lot is totally irelevant to the people who are not working or aspiring to be SW engineers.
I bet the disabled US vets, homeless people or McDonalds workers in the states also don't give a fuck that their SW engineers are the best paid in the world but would probably feel a bit cheated learning that despite living and paying taxes in the richest country in the world, their peers in poorer EU countries get much more benefits and better quality of life.
>I bet the disabled US vets, homeless people or McDonalds workers in the states
Those two groups share interesecting means by which their healthcare is provided. Surprise! Its the government. So when people have doubts about an implementation of "Universal Healthcare" you shouldn't be surprised when you can acknowledge that as you said " but would probably feel a bit cheated learning that despite living and paying taxes in the richest country in the world, their peers in poorer EU countries get much more benefits and better quality of life."
Irrelevent but homeless people don't really pay taxes in any meaningful sense.
> In the UK you also pay insane taxes and your software engineers make a third of what they make here. At my big tech, as an IC5 I was making more than our UK Directors.
How strange. When I moved from US to UK within a FAANG I took a fractional pay drop and got an RSU topper. After leaving and working as a UK employee in an international org I make more than a lot of US directors. Perhaps the difference comes from the value you brought to the company?
One thing that is objectively true though is that, outside of the whinging from software devs in the 1% that no one really cares about, the outcomes and efficiency of the US system sucks compared to every other western nation.
It's always fun how the strawmen appears instantly when you discuss this subject.
We pay marginally more in tax, sure. How that is relevant to healthcare, however, is a mystery, given we spend less tax money per capita on healthcare than the US does. It's not healthcare that is the reason our taxes are higher, but other services.
I'm sure doctors prefer the US system. That's unsurprising - the US system pays doctors vastly large amounts. It also costs patients vastly larger amounts. So speaking of bias...
> They will very quickly find that the US system is far better than the NHS. We get seen more quickly, our doctors can afford to actually spend time on us, more effort goes into root-causing a problem, we have more treatment options, etc.
Nothing stops you from choosing extra insurance in the UK too if you believe you need that level of cover.
The only reason you're comparing it to the NHS instead of an equivalently expensive UK private healthcare plan is that the NHS provides good enough universal coverage that most people don't feel the need for more.
But the US equivalent would be to compare it with Medicare and Medicaid.
Okay, and what about all the other people who aren't blessed enough to be SWEs? They should just rot and go into medical debt for the rest of their lives for daring to get sick?
You forgot to mention what country you are talking about. That seems to be American.
Difficulties to get an appointment is also common in at least some areas of the EU countries I am familiar with.
Indeed. My girlfriend is waiting for ADHD appointment in Sweden - 2 years and counting.
United States.
The UK isn’t functioning well at the moment. Cancer treatments keep getting delayed and people are dying as a a result, to give one example. I don’t know which countries are doing a good job on health, but it’s not the UK.
Same. Forced to get insurance through state exchange, premiums over $1,000/mo for two people. Very hard to find a doctor that accepted the insurance. And that was in a major US city. Every test and procedure requires a referral to a specialist, and the game of “do you take this insurance?” repeats. Then you get referred to diagnostic labs with long wait times (sometimes months) and they want payment up front and may not accept your insurance.
That process seems worse in every respect compared to my experience in SE Asia, and the US does not have better outcomes to justify the much higher costs.
There are a ton of benefits to having continuity of care, but also access to care. Do any out-of-network providers have appointments available? If so, and you can't find one in-network, you may be able to get an out-of-network provider covered as in-network due to an inadequate network.
I've heard of people calling their insurance company and keeping them on the line while they call a handful of offices and get turned down for appointments to get this approved.
Same here - and I'm always left wondering what manner of trivial/cosmetic cases are taking up these bookings and leaving more urgent medical cases to wait.
To be clear that's been true in the United States for the better part of two decades.
So Australia the #1 has the best outcome but is second to last in access to care?
Sounds like a lottery. If you win a place it's good otherwise not.
It's disheartening but not surprising to see the US health system ranking last among peer nations. Despite paying so much, we still struggle with access and equity. It's high time we prioritize real healthcare reform that addresses cost and outcomes, not just politics. https://templatecalendar.com/
Yeah that's the funny part: in the US you should pay thousands of dollars for the basic exam / ambulance ride and many people don't have coverage while in entirety of europe is basically free, but the US gov is still paying 50% more in GDP than the other
Quality of care is shit. Doctors barely care about their patients. It’s all a racket. Most areas seem to have a local monopoly that takes over the local hospitals. Obamacare has done nothing to really change anything meaningfully.
Obamacare is a mixed bag, but I don't think I'd go back to a pre-obamacare era if I had a choice. So many people stayed at jobs for longer than ideal because they had pre-existing conditions that wouldn't be covered under a new insurance plan.
The consolidation of the last 20 years has been a real black mark on the system. It was supposed to improve outcomes by making all the records easily available in one system. Instead we've seen the independent doctors office largely go by the wayside and local competition decrease.
Not all outcomes are comparable or worse though. The outcomes most improved seem to be net worth of executives.
So how do you get complex necessary medical care effectively in the United States?
If you aren’t rich you wait, or go to a country with affordable health care and pay out of pocket.
Effectively? You don't. Or just be rich.
It's unfair to judge the EU piecewise but then judge the US as a whole. Either let us compare apples to apples by judging the whole EU against the US or let us judge individual European member states against individual US states.
The EU has no common health system at all. Calculating any kind of averages makes little sense. Within some countries I am personally familiar with there are significant differences in availability of health services between certain areas, rural vs urban, but also regionally. Legally the systems should be rather uniform within a country though. Many countries have a split between publicly financed and privately paid services. It's probably expected that privately paid services are used less in poorer regions.
With the US I am not really familiar. I'd expect commercially and legally it works the same over the whole country. In practice many services won't be offered somewhere in rural areals compared to metropolitan areas. So if you are unable to travel no treatment. And of course if you aren't well off, no expensive treatment.
The US has no common health system. There are a few systems that are common (Medicare) but that is only for the elderly. The rest of the system is all done on the state level. The rules vary amongst all the states.
> the rest of the system is all done on the state level
Ok. Didn't know that. But you are talking about public services aren't you? I would assume a rather small fraction of the huge US health expenses are publicly financed. The bigger part is completely private businesses, both service production and insurances for those who have one.
That's the opposite in most EU countries and UK. A large fraction is either produced publicly or if produced privately then paid for by a publicly organized health insurance.
I don't know the percentage so I don't know if it is a small fraction. The basic setup is:
Medicare - federal program for seniors
Medicaid - state program for poor people (there may be some sort of funding by the federal government, but it is run by the states)
Private insurance - this is paid by the individual and/or the company they work for
The laws/regulations regarding what is and isn't allowed with the private insurance is handled mostly by the states, not the federal government. The federal government has pushed for various rules (ACA/Obamacare) but there is a debate about the constitutionality of the federal government getting involved.
There are also specific programs within the governmental systems that focus on children (Insure Kids Now) and provide dental not just medical.
Within Medicare there are additional (supplemental) coverages that provides better benefits called Medigap.
I'm sure there are more programs than just Medicare and Medicaid, but those are the largest ones.
As an American, I'm probably heavily influenced about non-state-by-state discussion in the media and thus ignorant... (and work in tech and don't directly pay for health insurance...) but I don't think I'm aware of significant state-by-state differences in healthcare.
I know California generally has more regulations and has MediCal, but most insurance options I've encountered seem to be multi-state (regional, not necessarily country-wide though). Things like FSA/HSA are nearly the same across all States I think?
I'd assume quality of care varies more by region (likely with some correlation between quality and the to major options health insurance providers) than by state lines.
That all said, I'd be curious to see all 50 states in a healthcare quality ranking combined with the various "peer" (or EU) countries like you propose. I'd probably be surprised by the spread.
Medi-Cal is California's implementation of Medicaid, which along with CHIP is always administered by the individual states (though the federal government tries to apply some controls via funding).
That's the only big top-down state-by-state distinction that comes to mind, but there are a lot of small details. We have some models predicting medical outcomes and financials and state is always at or near the top of the SHAPs. Sometimes bigger than age or household income. (I don't study this or anything, just an incidental observation.)
The organizations that take doctors' licenses away when they misbehave are all state-level organizations (in California, it is called the Board of Medical Quality Assurance) and I can easily imagine that some states perform this function much better than other states.
Why? Europe is a collection of sovereign nations, not a federation of states like the US?
Aha! But Germany is also a federation. So it's only fair to compare Alabama to Saarland. Oh, wait...
Well, Bavaria is famously the Texas of Germany…
Does the Bavarian power grid also routinely go down because they don't invest in it and at the same time also refuse to add interconnects with other regions?
Not sure, but I think the grid integration is international with significant connections to e.g. France, rather than federal states within DE having their own thing?
More that the stereotypes people have of Germany/USA are really of Bavaria/Texas (beef, guns, lederhosen), more (small c) conservative, and there are occasional mumbles and grumbles of independence but they don't have any substance to them.
At least, that's what it seems. My grasp of German means there's a game of telephone between reality and my understanding of Bavaria, and I've never even been to Texas so I'm judging them by what people say online.
The report compares countries, not states. What point are you trying to make by comparing US states with EU countries (and Canada, and Australia, and New Zealand)?
Why. The US is one country the EU is not.
I tried that argument here recently when I talked about civil asset forfeiture and a bunch of people said I was horribly ignorant about civics and that the US is apparently not one country.
Does each state compete for itself at the Olympic Games?
Unfair to the EU or the US? Because this plays to the US favor.
I don't think it will matter.
I agree, some individual states have free healthcare, free community college. It’s easy to fall out of these systems or be unaware of them, but they exist
I’m the last person to have an America boner, but there is room for objectivity
I’m a fan of Germany, Austria systems. An educated and healthy populace seems positive. I’m aware of the problems residents have with those systems, they have private options too. Public debt isn’t as high, and maximum tax between state and federal level is lower than maximum of California + Federal. So, seems better.
Ugh. This. Not just for healthcare though, for everything. Using small wealthy countries with populations smaller than our states as a comparison against our continent sized country is really not helping or proving anything.
> Using small wealthy countries with populations smaller than our states
I don't know which countries you're talking about. Sweden has a population of 10m, which would make it the 10th largest US state. Norway's 5.5m people would make it the 23rd largest.
Even if we go really small and rich, Luxembourg's population is 670k - that's more than Washington DC (not a state, I know), Vermont, and Wyoming.
The only really wealthy European country that's smaller than a US state is Iceland.
Does having a bigger country mean health care is more expensive? How come?
Did you read the article? (I recently posted something similar - it's probably posted often.)
It's proving that the US, which spends BY FAR the most on healthcare per capita, is getting a very poor return on our investment.
It's not really "helping" because the GOP is so opposed to healthcare reform - which would cut into their corporate profits, and they've somehow persuaded their supporters that Jesus hated healthcare but loved automatic weapons.
[dead]
I'm sure it has nothing to do with the almost ~100 vaccine doses children are being subjected here...
You're correct, it has nothing to do with that
Seriously, fuck off.
Because we are paying for the rest of the world. Allow prescription drug imports from abroad. Pharma companies will be forced to charge more in the rest of the world and less in US. Allow insurance plans based on medical tourism for expensive procedures. Some countries will say no, but a lot of countries will say yes for profit. Once you have a choice of a hip replacement in Mexico or India, hospitals in these countries will compete for safety, cost, pleasant aftercare. Let's stop being the suckers.
A huge portion of our healthcare goes to paying health insurance providers, high rates for pharmaceuticals, and hospitals.
There's a reason these industries in the US are some of the most profitable. They act as middle men and make massive profits.
Because everything else is communism according to many US citizens.
>Because we are paying for the rest of the world
Don't blame a domestic problem on the rest of the world
> Because we are paying for the rest of the world.
While I don't know if that covers all the expenses, I don't think people appreciate how much funding the US system is contributing to new med-tech development.
A previous client created some analytics software, they have EU regulatory approvals, but those are almost secondary, without FDA approval they would shutdown. All of their client, except for a few UK customer (who just bundle and resell in the US) all of their clients are in the US. For a lot of smaller medical companies, even in the EU, the US market is their number one source of revenue.
I might be wrong, but it's also my impression that if you do have the money, you'll get much more in-depth care and treatment in the US. And it's from this segment many companies find the funding to develop new technology that will only much much later trickle down to public healthcare systems else where in the world.
There is certainly an argument to be made that the US pays the R&D costs for the rest of the world. Most new drugs end up in public healthcare systems as if the pharmaceutical company is throwing an old product into the discount bin.
However some of these new drugs are so expensive that some countries are now refusing to allow certain new cancer drugs on the market. Simply because the exorbitant price compared to the questionable gains in quality of life doesn't make sense anymore.
>Once you have a choice of a hip replacement in Mexico or India
This is already being done actually.
> Because we are paying for the rest of the world. Allow prescription drug imports from abroad. Pharma companies will be forced to charge more in the rest of the world and less in US.
Oh, look, a new cartel that will take 6 months to set up and decades to investigate.
So is the EU. Most of it goes to stockholders.
The US is a completely different level.