by stzup7 on 11/20/16, 10:22 AM with 301 comments
by antirez on 11/20/16, 11:53 AM
by iraklism on 11/20/16, 11:59 AM
It highlights a core difference between one of the two most "advanced" places in the western world.
For us Europeans, we don't even think that free healthcare, free education ( university included ) , and free state support when things go wrong is a right.
It is a as essential as a core human function as breathing and blinking. We don't notice it, it's just there.
And most of us are more than happy to pay higher taxes in order for us ( or our fellow citizens ) to enjoy these.
Granted , our taxes could be better managed, institutions could be more efficient, and governments less corrupt. But until someone shows us - with long term data backing up these claims - that there is a better alternative , we will keep giggling .
by clouddrover on 11/20/16, 11:43 AM
http://kff.org/health-costs/issue-brief/snapshots-health-car...
And yet the US has lower life expectancy than those countries:
https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
by fiftypounds on 11/20/16, 12:01 PM
The total cost: 250 euro out-of-pocket The cost of one sonogram in the US: $1500 (before insurance)
Healthcare in the US is a byzantine protection racket and very potentially a means to mass surveilance beyond the scope of public health.
by kensai on 11/20/16, 11:43 AM
*even Ayn Rand allegedly made use of the "social benefits" when the shit hit the fan and it's perfectly alright (https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Secu...)
by cm2187 on 11/20/16, 11:57 AM
There is little evaluation of physicians so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go.
The system runs a massive financial deficit.
It is run in an administrative way which creates odds behaviors. For instance department allowances based on % of occupation of hospital beds, which lead them to keep people overnight unnecessarily to preserve their budgets.
The system is very liberal in term of allowing you to see specialists. That's great in certain ways. The UK suffers from the opposite, where generalists' job seem to be to prevent people from seeing a specialist. But it is also a paradise for hypochondriac patients who will do dozens of useless exams subsidised by the tax payer.
Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.
by grecy on 11/20/16, 12:12 PM
My brother broke his leg horribly a few years ago. Ambulance, helicopter, plane, 3 surgeries, a month in hospital, steel plates, etc. etc.
In Australia, you don't pay a cent out of pocket for that, it's all covered with taxes.
Similar story in Canada too. Even little stuff like I broke my nose - into hospital, xrays, time with dr to straighten, appointment a few days later to check, etc. All free.
The difference is simply that Health Care is run for profit in the USA. Someone wants to profit off your health (or lack thereof) so you must pay a lot of money to line their pockets. Some story for Higher education, incarceration, etc.
by madaxe_again on 11/20/16, 11:53 AM
I was staying in a remote house, miles from the nearest village, an hour from the nearest hospital. After about four days of continuous vomiting in 40 degree heat I caved and called a doctor, in the hope of getting a prescription for antiemetics over the phone. It's Sunday. I figure it's a long shot but can't hurt.
Well, I call and she says "sorry, can't give you a prescription over the phone - but the doctor will be with you in ten minutes". I was sat there expecting a call back when the doctor shows up at my house. Checks me over, says I need IV fluids pronto, do you want an ambulance for €20 or do you want to get yourself there.
Wife gives me a ride to the hospital an hour away. The place has recently undergone big budget cuts so they've mothballed a big chunk of it, and it looked a bit sad, but inside everything was new and clean, and I'm seen within a few minutes of arriving. By a consultant surgeon who was called in to arrive a few minutes before me. I'm given fluids, blood tests, a CT and an MRI, and about six hours later an functioning again, and they're saying I can stay or leave, my choice, and here's a folder of information for you to follow up on back home.
All of this cost less than €60, and I honestly felt like I had all of France mustered and rallied to my care.
I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!". I still got decent treatment, of course, but it was all with a grumbling, discontented overtone - and despite it being a new (15 yr) old hospital, unbelievable amounts of equipment didn't work. There was a diabetic guy on a sugar monitor/drip on my ward that kept crashing - so their solution was to have him wake up and reboot it every 20 minutes so he didn't die. They didn't have another one available.
It's just astonishing to see how two supposedly similar socialised healthcare systems can end up so very different in their output.
by gerty on 11/20/16, 12:16 PM
by kelvin0 on 11/20/16, 3:56 PM
by tim333 on 11/20/16, 1:46 PM
>"We must have universal healthcare...I'm a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses...
I know he flip flops all over the place but maybe if people lobbied, something could be done.
by raphaelj on 11/20/16, 11:39 AM
> an American might assume. I pay an annual income tax of
> about 23%.
How comes this number is that low? Tax revenue in France account for about 48% of the country's GDP[1].
I'm living in Belgium, and my payroll tax is already higher than these 23%.
--
[1] https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...
by logronoide on 11/20/16, 11:39 AM
by yodsanklai on 11/20/16, 12:16 PM
For one thing, some care are very expensive, like dental crowns and implants. In the article, the author says he had to pay 1300 euros for 47 days in the hospital. You're likely to pay more for one dental implant, unless you have a very good insurance in addition to the regular social security (most people don't).
If you have to go to the ER and if you don't have a life threatening condition, expect to wait many hours in an overcrowded waiting room. Moreover, to see some specialists (e.g. eye doctor), you may have to wait for months to get an appointment. The list goes on...
by YeGoblynQueenne on 11/20/16, 12:59 PM
I think it's along the lines of "Why should I pay for someone else's healthcare?".
I've heard similar arguments from British people (I'm rather more socialist in my outlook than average, for a UK resident, I fear) and I don't really have an answer to that. Why indeed?
I'm probably conditioned to answer this with a "duh, because they're your fellow citizens". But I guess that's not everyone's cup of tea.
by on_and_off on 11/20/16, 1:12 PM
This has not affected my personal finances and I only had to focus on getting better.
I would like to move to the USA but I have got to admit that it frightens me that this kind of issue would have costed me a lot and a serious health condition could bankrupt me.
This is not ok. It saddens me that USA have not been able to instore a sane health care system.
by bluejekyll on 11/20/16, 3:52 PM
This translates to higher costs because maintaining hospitals in low density areas raises the cost of care per capita. This is also a reason that inter-regional train service has never been a good option in the US.
There are regions where it works, but coming up with a one-size fits all solution is hard. The metropolitan regions of the US have always subsidized the rural parts. We people of the cities have always paid a fee on our phone bills that helps reduce the cost of phone service in rural areas, as an example. I actually dislike this, because I think it subsidizes sprawl.
I believe the ACA is a good step (personally I'd like to see Medicare offered as on option alongside all state insurance plans), but it does need fixes. Whatever the solution, it's going to look different from Europe and France in particular.
by fiatjaf on 11/20/16, 1:35 PM
So you don't pay any kind of VAT?
That also wouldn't mean anything, if the State is not taxing you so much, but it still has money to finance these things, it is obviously because it is taxing other people a lot more and using the money to treat your health.
I would not find it very good to have my needs fulfilled with stolen money, as you seems to be finding.
by hartator on 11/20/16, 5:09 PM
by fvdessen on 11/20/16, 12:07 PM
by djfm on 11/20/16, 3:41 PM
by amelius on 11/20/16, 2:55 PM
by smcl on 11/20/16, 11:35 AM
Also for some reason this reminded me of a BBC story I read a while back - where "Heavy Legs" is described as a medical condition that only exists in France: http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspon...
by partycoder on 11/20/16, 12:03 PM
But there is fishy stuff going on too...
1 liter sterile bag of saltwater for intervenous use in American hospitals is charged at over $300, not considering the cost of the procedure, which can total $500.
The pharmaceutical industry also does some sort of disservice to society by inflating prices so much.
Then, some money stays at the insurance companies instead of going to actually improving healthcare itself.
by pentae on 11/20/16, 12:24 PM
by CarolineW on 11/20/16, 11:31 AM
by coldcode on 11/20/16, 2:11 PM
by digi_owl on 11/20/16, 12:14 PM
by ThomPete on 11/20/16, 1:00 PM
Some random thoughts:
You can never spend enough on healthcare. There is always new machines, new technologies, new drugs, new treatment types, better educated doctors we could spend our money on if we wanted to. Furthermore we are treating people earlier and earlier and for more and more things. The old saying that if you are not sick it's just because we haven't found the right diagnosis for you seems to be true.
In effect whether you are in a private healthcare system or a universal one whether you pay double or your get taxed 100% there will never be enough money for healthcare.
Now depending on whether you have private healthcare or public healthcare the way you measure it is completely opposite. In a private healthcare system everything is a potential profit center. I.e. the more people who are sick the more money can you potentially make.
In a public universal healthcare system everything is a cost center. You have a budget and you have to deliver to a politically decided standard.
Both have pro's and cons. To give you an example.
It took me 3 weeks to get a time with my dermatologist in Denmark, when i finally got it it was the day before I moved to the US. The Danish dermatologist found one they considered troublesome, but they couldn't themselves do the biopsy and I had to get a time at a hospital to get it.
I decided to wait until I got to the US ignorant as I was I thought it was just a question of formalia. But no I had to wait a whole month for my insurance to work (that is a whole other discussion for another time)
When I finally got it though, I got a reference for a dermatologist same day and they did the biopsy, same day. Today I am at Sloan Memorial with one of the best dermatologist in the world getting checked every 3 months having a complete 3d scan of my body (in blue speedos and a white net) and hopefully we will be able to make sure that I am being managed properly.
What I am trying to say is that the level of expertise a private healthcare system allow for is more flexible than a public one because it allow for the allocation of resources. On the other hand if you look at those let fortunate than me, with worse healthcare plans etc they will get a less favorable treatment. I.e. the system isn't evenly distributed.
What the public healthcare system secures is that it's mostly evenly distributed but with less of a flexibility to build experts as there are budgets and a bigger need for priorities in any publicly funded system as it's a cost center.
So you have fundamentally two system where one covers only those with insurance but allow them to potentially pay their way to the latest treatments with the best doctors and the other where everyone gets treated but you don't have the same amount of experts and potential treatments.
Neither systems are really optimal. Do we want to have people die because they can't get healthcare coverage or because they can't get the necessary treatment because it doesn't exist in the country they live. I know it's more complicated than this of course but in broad strokes thats at least my perspective and this has lead me to the following observations.
1) Both systems are fundamentally financially unsustainable in the long run. Whether the system succumbs to it's own weight by costing the tax payer too much to pay for everyone while only delivering average treatments or whether it's impossible for the insurance companies to secure a large enough part of the population without leaving too many without proper coverage. Both just doesn't sound "right" (I know Germany, and Switcherland have some variations that sound more right but I am not sure they don't fall into the trap of either the cost center, or the insurance cost issues.)
2) One way to solve it is to ensure that people pay for all the normal encounters they have with the doctors (sore troth, hernia, back pain etc) but that you insure yourself against long term illness. In other word we should pay for normal things but no one should be going bankrupt because they can't pay for long term or serious illness.
3) By removing the insurance part from a lot of the normal encounters with the healthcare system and only putting it towards more serious conditions hopefully doctors will start to compete against each other rather than spend all their time fighting with the insurance companies.
4) I have a naive hope that technology could somehow limit the cost of many of the more complicated treatments. Over time hopefully many of the things that are wrong with us can be treated via gene-therapy hopefully not requiring too many people to do the actual treatments.
5) I think we have to come to terms with the fact that none of the systems really work and that all of them have solutions to problems in the other systems. That way perhaps we can start to break down healthcare into more discreet parts rather than the giant monster that it is today.
Thoughts?
by thro32 on 11/20/16, 11:43 AM
Public health care will just transfer more money from poor to corporations (like with education). You need to fix the leaks first, for example sponsor medical tourism to other countries, etc...
by angry-hacker on 11/20/16, 11:44 AM
by osti on 11/20/16, 12:54 PM
by saosebastiao on 11/20/16, 5:22 PM
To a conservative opponent, getting high quality care at a low out-of-pocket cost is a result of health care being a redistributive social good, and "social good" is just code word for "shirking individual responsibility". They look at this situation and this author like they do their proverbial welfare queen...a beneficiary of their taxes.
If we actually want to convince them, we have to prove to them that Single Payer is an objectively more efficient system than insurance. In other words, were the total incurred costs lower than they would be in a our system? Because for them, that's an argument that matters.
Unfortunately even I, a strong proponent of single payer, would find a cross country comparison here to be disingenuous. Because it doesn't matter how efficient the French are at administering health care. What matters is how efficiently we would be at administering it. And hands down, we suck at government administration. Whether it is infrastructure, military, health, or whatever...everything we do costs more and takes longer than other governments doing the same thing.
And this is the major reason why our politics suck IMO. We have one side of the table that is 100% more government because government is awesome, one side that is 100% less government because government sucks, and nobody is arguing that we should be making government more efficient. And so we never get nice things.