USA Healthcare is 19.5% of GDP. Canada + Australia + UK + (a few similar countries) average 10.5% of GDP.
The USA healthcare price gouges via run away prices. Healthcare corporations corrupting congress is the fuel that forces this on people (and breaks a free market).
I’m a Canadian, and I would never want to give up our single payer system.
That being said, Canada has a huge health care problem right now. Frequently they need to close emergency services in major (& minor) cities at night due to staff shortages. The wait times for basic diagnostics is on the order of months (not days or weeks). For example, a relative of mine has lost 90 pounds since the start of the year, complained of chest pains and couldn’t (still can’t) swallow. They just got a basic scan after 6 months of waiting to confirm a baseball sized tumour in their lungs.
For many years we ran with just the bare minimum of staffing and equipment to keep costs low, and now, due to a number of factors our system can’t keep up.
Waste is not good, but a little bit of extra capacity (and cost) isn’t a bad thing when it comes to emergency services.
Much of the current failures are due to conservative provincial governments (looking at you, Ontario...) purposely underfunding before and into the pandemic.
We are now reaping what they have sown.
This is a classic "underfund to prove the system doesn't work thus we must privatize it!" move.
It seems a bit strange to call out the Conservatives specifically. Ontario has been purposefully underfunding healthcare for decades upon decades, with most of the damage done decades ago. Peterson (Liberal) forced practitioners to operate under fixed rates defined by the province, which even lead to a doctors strike. Rae (NDP) eliminated 8,000 acute care beds. Harris (PC) eliminated another 6,000 beds.
Governments of the last 20 years have held the status quo, which leaves them equally culpable.
Conservatives hate that their money is taken away to fund poor people and take money away from their rich friends, and it brings them to defund healthcare, liberals hate that it creates a natural monopoly and their inability to see a functioning society work without private hospitals brings them to defund healthcare
There's no point pretending you know what people's motivations are. Conservatives I've read/heard seem to generally want similar outcomes, but disagree drastically on the methods.
How much do you estimate this is being underfunded, and do you believe proper funding for healthcare would push the percentage of GDP closer to the US number?
You're assuming the US healthcare system isn't equally underfunded. The US has massive doctors shortages (especially in rural areas), and that's not counting all the care the US just doesn't do because people instead just die since they can't afford to go to the hospital.
> You're assuming the US healthcare system isn't equally underfunded.
You don't have to assume. It costs twice as much as the most expensive health systems on earth, but delivers Afghanistan-level life expectancies. The problem isn't that we're spending too little.
If you are going to use life expectancy you should at least not use hyperbole to compare. It would be fair to claim the US spends the most on earth but only gets Polish levels of life expectancy.
Infant mortality (but that's also tricky because of differences in reporting between countries), cancer survival rates.
Life expectancy is a particularly bad metric to use to compare health care systems, because it's heavily influenced by (1) how much people drive, (2) how much violent crime there is, and (3) how much drug addiction the country has. None of those are health care metrics.
I don't believe there's any credible critic of American health care that premises their complaint on America delivering bad health care. We deliver pretty excellent health care, and we deliver it faster than a lot of countries with better health care outcomes. We are in many places in the US overprovisioned for care (by measurements like empty hospital beds, or overprescription of elective procedures). The chief complaint about American health care is how expensive it is, not how good it is.
That distinction is especially important because getting costs down may involve confronting the ways American care is better than it needs to be or should be. For instance: we do a lot more elective surgeries than countries with better outcomes, in part because we do them outpatient here, and they're inpatient (a much bigger deal) elsewhere. For example, my understanding is you're much more likely to get a hernia repaired (probably needlessly) here than in the UK.
I don't know, but almost everything is more complicated than people often make it out to be. Unless you'd like to spend 40+ hours/days/years researching it, you're probably better off trying to be more laid back.
It's being underfunded by at least 10-15%, which is a lot for a system expected to run as cost effectively as possible. I'm getting that number from the average of $5336 vs ON at $4800. 4800/5336 = ~89%
I don't think we should aspire to US levels of GDP share. That seems quite excessive.
I think the solutions to our issues are structural changes and adequate funding.
The NHS is still wildly popular so it's politically impossible to privatize from the outside in but it's becoming less popular as its effectiveness declines due to expanding mismanagement, underfunding and corruption when awarding contracts.
> The wait times for basic diagnostics is on the order of months (not days or weeks).
The crazy thing to me about this is, most Americans simply skip medical procedures, or tests due to cost.
So American wait times aren't lower because their hospitals are better, they just server a much smaller pool of people due to so many being priced out of being healthy.
And honestly, the longer you go without doctor visits, more expensive, complicated and involved the process is.
Good link there, but assuming I’m looking at the same section as you, it seems like the 1/3 figure is for skipping or delaying tests and treatments recommended by their doctors, which doesn’t really tell us how many people forego seeing a doctor altogether due to cost concerns.
Technically it was 1/3 had or had family members, which means the number is actually much better than 1/3 but I was being generous.
We don’t know how many people skip healthcare because a doctor is inconvenient (in the states or in other regimes) either. So it seemed the most appropriate comparison to make.
Well, I'm here in a major metro area of the US and it's 6 months or more for every doctor I try to see. Very difficult to get in to see anyone for anything.
What's that major metro area? I'm in San Francisco and I have family in Boulder and in both primary care is like one or two weeks. Dermatology was a week and a half for me. A few months ago I needed imagining for a foot thing and it took three days for ultrasound and one week for an MRI. I thought this was the norm on big urban centers.
Chicago. My actual GP schedules months out. An appointment with "any doctor in their practice" is within a week. An appointment at their affiliated urgent-care takes hours, usually less. The correct strategy is to get a GP affiliated with an urgent-care, schedule a checkup with the GP, and, meanwhile, just go to the urgent-care for everything; they'll send records over to your doctor if there's anything complicated.
Chicago, I can make a televisit appointment to my primary care doctor typically with 1 day lead times. In person is typically 2 so he can schlep down to his office. He is a single practitioner with part time office and IT help. He recommends going to the minute clinic a block away from my house for most things that I can recognize and only calling him for a yearly consult which is a review of blood tests and a discussion about my health or for something the clinic didn’t figure out.
This seems like a completely reasonable approach and I’m always surprised that it’s not the default.
Every "Family" doctor has stopped practicing or gone to a no insurance model that caters to wealthy people. You can only get "internal medicine" doctors for primary care.
I've seen waits ranging from 4 months to a year, depending on what your dealing with.
It's also impossible to get a 2nd opinion. The specialists all tend to belong to the same groups so you'll call a different doctor and eventually get shunted back to the exact same doctor you started out with. Where the the competition?
I live in a suburban area and I go to the doctor for completely random things for my kids because it’s so easy. I can get appointments to be seen within hours.
Midwest, large city; pediatrician is same day, Allergist same week, Developmental Pediatrics was 4 months, Pediatric Ophthalmology was a year, it really varies. I'm lucky to have all these specialities available, people drive 2 or 3 hours to use the Midwest Eye Institute.
>Frequently they need to close emergency services in major (& minor) cities at night due to staff shortages. The wait times for basic diagnostics is on the order of months (not days or weeks).
Part of this is COVID burnout. It wasn't this bad in 2019. Wife works in healthcare and sees the difference every day. Nurses crying etc.
For what it’s worth, this experience isn’t entirely uncommon in the US either. I live in a rural area that has a trauma center and a hospital because it is X distance from the next closest hospital and gets money from the state/county to exist. But that is all they are. Outside of diagnostic imaging and very basic healthcare, you are shipped off to either Portland, Seattle, or in some cases Idaho. Everything is backed up and it is largely due to a lack of personnel because people are just not joining the field. It is basically the inversion of your problem. We burn out everyone who works in a hospital specifically because of the pursuit of profit. They’re all understaffed and everyone works shifts that are unsafe due to their length to compensate. Hospitals are an incredibly stressful place to work and doctors and nurses have inherently difficult jobs. Yet they’re treated largely like disposable assets to be burned through. It is bad for patients and it is bad for the staff. But it is apparently good for business.
For many years Canada (and similar countries) have relied on cutting costs by importing health care professionals from other countries. That pipeline has now shrunk considerably, resulting in the exposure of the underlying problem.
But looking from another perspective - if healthcare is 20% of GDP, an awful amount of people are therefore paid directly due to this "waste".
Any improvement in efficiency would mean those people lose out on jobs. A new use for them must be found, or there will be massive unemployment (at least, short-medium term).
This is a peculiar perspective to see on HN. Isn't the entire business model of startups and YC based on ruthlessly "disrupting" industries using efficiency gains achieved through technology, causing the same sort of unemployment? Why should healthcare billing and administration be any different?
I'm mostly interested why the USA suddenly becomes pro-worker when it comes to this expensive and inefficient healthcare system they have. I swear you could be talking to the most hardline GOP guy who wouldn't spit on a trade unionist if they were on fire ... but if you mention, say, single-payer healthcare they'll start weeping for the all the workers in hospitals' billing departments and in health insurance companies who will lose their jobs.
I mean I don't want anyone suffering either (one would hope you'd have adequate social safety net to take care of these people until they find another job) but it's such a bizarre exemption to carve out
No, they're worried that single-payer would increase healthcare costs and/or decrease quality. They might be wrong, but that's not why they'd be worried.
I've heard that too, but I have heard on multiple occasions that this will cause a lot of people employed in the field to lose their (sometimes quite well paying) jobs working in billing.
Probably they mean most cities, look at the voting statistics in various somewhat recent elections. If you don't buy the left/right dem/repub mapping, you can look at the various stances of the actual local officials elected.
There's a large web of insurance companies, hardware and chemical companies, provider networks, and universities that benefit too greatly from the current inefficiencies to ever move away from private insurance. Hardware and chemical companies like LifeSys have contracts with insurance companies and provider networks that state the insurance will only pay for things if the tests or treatment are done with that supplier's tools and that the work will only be done if it's within the network.
For a theoretical based on what actually happened where I live, Hospital X is contractually obligated to use a specific kind of infusion pump from supplier Y and order blood tests from specific supplier Z in order to get Blue Cross Blue Shield coverage. Meanwhile the state university pushed out the other hospital in the city and heavily expanded the surviving hospital campus they sponsored to take on the increased capacity and introduce the services they were previously lacking compared to their now dead competitor. So Hospital X is just following the policy of University Network A. All of which is a common practice.
In many states the state university sponsored medical care networks are the or are close to being the biggest employers. The University Of Iowa medical network, the West Virginia University network, and University Of Pittsburgh Medical Center network all have taken over a majority of medical care functions in their states, leaving mostly specialists and those in mental health to independent practices. That exacerbates the issue of insurance and supplier contracts, because these small places that are competing with the university networks often don't bother with insurance unless it's government provided and just prefer patients pay up front instead. They lose too much time and money sorting through the myriad private insurance providers, plans, and coverage obligations without full time staff to handle that for them. Medical billing is a massive industry for a reason.
Now, if everyone wasn't chained to private insurance and juggling all of these providers, coverage limits, and contractual obligations the number of inefficiencies and thus the overall cost would decrease. We have historical examples of this even in the U.S., by comparing what happened between 1960 to 1975 and it's modern equivalent of 2005 to 2020. Healthcare costs were increasing rapidly, doctors were dwindling in number, and there weren't enough medical students for generalist fields in the 1960s just like the 2010s. The major difference is that while quality of care continued to increase through the 1960s and early 1970s, both the efficacy and quality of care has gone down since the 2000s. The several minor differences were that nationwide coverage was rarely available in the 1960s compared to the 2010s, that Medicare was spending more than it was receiving in the early 1970s thanks to how Medicare was funded in the 1960s, and that privatization of entire hospitals was uncommon and frowned upon in the 1960s because of the income impact it had on the doctors. The U.S. barely survived the 1960s medical crunch with enough government intervention, but it is dying under the weight of the 2010s medical crunch because the government can't easily intervene and is lobbied to maintain distance.
So the reason the lead figures in the American right are worried about single payer is because they won't make as much money. And they're very good at convincing people to vote against their own interests because they know those people don't care to look into complex systems too deeply. As a result many of the regular voters and workers are worried because someone told them a lie about where the money is actually being wasted and what the actual history is.
My current job depends on the current system being wasteful (healthcare insurance administration). But I'd much rather have to find a new job in a new industry than have the current healthcare system of the United States.
Yes, and we should also think of the blacksmiths and the elevator operators, milkmen and horse carriage drivers, who will unfortunately be out of a job if we make our society more efficient.
There was a quote by an opposition politician in Germany to the argument that Germany should buy the Eurofighter (which had huge cost overruns etc.) because it creates jobs. Loosely translated: "We can also build a pyramid for Helmut Kohl [chancellor at the time] if the goal is to create jobs".
The defence industry is treated like that in every country. Part of the reason why a country wants to retain some military industry domestically, is to ensure production capacity during a security crisis (kind of like for agriculture). It's not just "jobs", but "jobs" with that particular skillset.
For instance, Germany is producing the Leopard 2. They may export most of them during peacetime, but should they need to, they could start pumping out those tanks for the Bundeswehr instead. Furthermore, with the skills available domestically, it would take much less time to repurpose VW/BMW/Audi factories to also produce weapons.
Most want be unemployed they will just make a lot less. Doctors, Surgeons and administrators are barely breaking 6 figures in many socialized systems, and those come with far higher tax burdens typically.
Two economists are walking in a forest when they come across a pile of shit.
The first economist says to the other “I’ll pay you $100 to eat that pile of shit.” The second economist takes the $100 and eats the pile of shit.
They continue walking until they come across a second pile of shit. The second economist turns to the first and says “I’ll pay you $100 to eat that pile of shit.” The first economist takes the $100 and eats a pile of shit.
Walking a little more, the first economist looks at the second and says, "You know, I gave you $100 to eat shit, then you gave me back the same $100 to eat shit. I can't help but feel like we both just ate shit for nothing."
"That's not true," responded the second economist. "We increased the GDP by $200!"
Yup. For the (downvoting) peanut gallery: aka "political economy". Obama Admin's compromises wrt ACA reform vs jobs has been written about.
Another example of political economy is two different efforts to address climate crisis, with very different outcomes.
During the Obama Admin, the push was for carbon taxes. Wonks loved it. Logical, concise, moral. Complete nonstarter. Because carbon taxes has no built-in constituency that's willing to advocate and defend it.
Whereas in 2020, progressives pushed "green new deal" themed industrial policy and investment strategy. Made most everyone a benefactor. Millions of jobs. 100s of billions of dollars. Much better political economy.
Not sure why you're getting down voted so bad. It's a valid point.
I recognize that there is waste and inefficiency in the system, but I can guarantee that any effort to "streamline" or cut "waste" will inevitably hurt everyday people... Even outside of job cuts.
If keeping existing inefficiency protects jobs, perhaps introducing new inefficiency creates jobs? But that would mean that we should force people to do wasteful things in order to stimulate the economy!
Thankfully the economist bastiat solved this absurdity in 1850.
> we should force people to do wasteful things in order to stimulate the economy!
you laugh, but this is exactly what the US gov't does, esp. with military budget allocation. Why do you think all sorts of military products are split into different pieces for manufacturing, separated into different states? It certainly doesn't help efficiency.
I'm not saying that healthcare shouldn't be improved via efficiency increases - it needs improving! But let's not kumbaya and ignore the plight of those whose livelihood would be disrupted (and not of their own fault).
The USA healthcare price gouges via run away prices. Healthcare corporations corrupting congress is the fuel that forces this on people (and breaks a free market).