The US Medical System

Emory said:

Private health care is not good by any stretch of the mind, but universal health care is no better because it sacrifices quality and affordability. If it’s supplied to everyone then it’s not going to cover much other than the bare minimum and it’s going to require a lot of money. And of course we know where that funding is coming from.

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@Emory Instead of derailing the unpopular opinions thread, I thought I'd respond to this in a new thread, so you can have my full opinion on it. To disclose, I'm not entirely against private healthcare and could see how the system could objectively work, but the US is in a peculiar situation with its medical system that makes it grotesque.



In terms of Healthcare comparisons between my country and the US (Canada vs the US), it costs the average American 2-3 times as much as it does for me in my country so that a quarter of the population can be effectively enslaved to medical debt in exchange for a system that gives Americans a lower lifespan and higher infant mortality rate, just so they can watch 4.5 billion get sucked away and not distributed back into the medical system by insurance alone.

To add insult to injury, medical expenses account for around 28.5% of the US Government's federal budget, part of which is spent on medicare. Which means the US does have public healthcare, it's just a horribly malformed monstrosity that is choked to death by private interest groups who slit the throat of its taxpayers with medical debt. The US system also has a stunning rate of fatalities as a result of doctor error, and an opioid crisis that has largely stemmed from how laissez-faire American doctors are with throwing out prescriptions for pain killers.

And in case you thought you could find refuge in wait times, don't worry, depending on where you live, the United States is a complete fucking disaster there too.

Oh, and in terms of GDP spent on Healthcare, Canada ranks in at 10.6% of its total GDP (2016) in contrast to the United States' 17.2% as according to the OECD, so even by economic standards, Canada spends less to get at least as much if not in some cases more coverage and care than their US counterparts.

According to every reliable source of data available that doesn't have a conservative spin to it, the US medical system is a grotesque disaster spurred on by the out of control dominance of Insurance Companies. If Insurance Companies weren't in the picture, it's very possible that your private system would be an efficient machine, as hospitals would only really charge what they needed plus a little to make some money. And, by all rights, my country's medical system shouldn't be remotely comparable--we have far fewer people to tax spread over a greater range of physical space. Response times should destroy the efficacy of my system in contrast to yours, but it isn't that way. It isn't that way because the US medical system imploded a long time ago.

Now, that being said...

• The United States is still a leader in medical research across the globe.
• The United States pays its doctors better than Canada does.
• Canada does have longer waiting times for some procedures and surgeries as compared to the United States. I think the average waiting time now is 20 weeks for some surgeries. This is a problem that needs to be fixed.

A couple of things that need to be pointed out, though.

We're generally happy with our level of care, in spite of its flaws and deficiencies, and if you compare the US system to a more functional public healthcare system like the NHS in the UK, it is utterly eviscerated.

As a personal note, I've had to use my medical system several times. Sometimes for job-related injuries (I worked as a Security Guard at concerts and the like for a while) and sometimes for personal reasons (it turns I have Asthma, and lung damage). I've never seen the post-apocalyptic waiting times people talk about. I got in to see a specialist about my lungs in under 14 days and had the information back about it the next day. I've never had to pay more than 40 dollars on medication, when I've even had to pay for medication.

So, if the US spends so much on healthcare, why is it blatantly worse in several aspects?

Well, let's look at how money is spent.

In my public healthcare system, tax money is taken and spent on the system. Some of it is lost to bureaucratic inefficiency, but the majority of it reaches doctors, hospitals, and medical supplies.

In the United States' private healthcare system, the money taken in by insurance companies is spent on some of the most expensive lobbying in the United States, and cold hard cash payouts to shareholders and CEO's in the form of profit sharing. Because of the profit motive, every insurance company has literally every motivation to pay out as little as is humanly possible on actual healthcare, and would instead prefer to spend that on multimillion dollar bribes, company payouts, or simply keeping it as a profit at the end of the day.

"Well, you don't have to pay for insurance!"

You don't, but, have fun paying 16,000 dollars for a single surgery. Adam Ruins Everything summarizes this in a more entertaining way than I could, so, I'll just link it.

Aaand... That's about it, I guess.

tl;dr: "Private vs Public" is the wrong question in the US concerning the problems with US healthcare. It's how massively corrupt the healthcare system is because of insurance companies, and a government that is in bed with them because of lobbying. Cull the insurance networks and hospital fees would drop significantly, or, assimilate the insurance networks into a single payee healthcare system such as what the UK possesses. Either way would reasonably work.

Yeah I’m gonna come clean and say I was not prepared for an in depth discussion haha but seriously I appreciate you taking your time to write this, you’re either very passionate about this topic or have entirely too much free time (im getting a sense of the former). Anyhow, this was very informative cuz as a senior in high school who doesn’t even have health insurance I obviously don’t have the experience you do. I just got out of work so perhaps tomorrow I’ll be able to respond to some of your points, I just wanted to acknowledge it while it’s fresh.

On a side note when you said Adam Ruins Everything (yes I’ve heard of the show) I was really alarmed for a moment before I finished reading cuz my names Adam and I read it quickly and in my tired state I was quite confused.

Passionate. Figured I'd extend what I happen to know in the hopes of perhaps showing you something you didn't--or vice versa, if you happened to be as educated or more educated on the topic than I.

I am mid to far left on the political spectrum, just to put that out there. I am a Socialist--so I am naturally biased to public healthcare. So, to be fair...

• In terms of private research, reward-based systems that promote merit via results thrive, and the US is pretty good at this. (Seriously, y'all are a world leader at medical research.)
• Competition can and does drive prices down--and that includes common medicines whose ingredients are not patented. (Cold medicine, for example.)
• There are past examples in the US, in terms of its history, where its hospital costs used to be pretty low without any form of socialization, and it performed well then respective to its time period.

I just find that the idea of waiting times and the like being tied to public versus private tends to be a misconception. Because, well, being blunt: Whether you pay out of pocket, or whether you pay the taxman, you're gonna pay the same fees either way. The biggest difference is in quality of care over distributed population--the rich in the US get amazing healthcare, whereas the rich here either have to deal with the same waiting times or fly to the US to get expedited care. Meanwhile, the poor in the US barely make it by assuming they aren't doomed to medical debt, whereas here the poor get the same level of treatment as the rich do.

If your healthcare system sucks, and it's private, you have a chance to get good care if you got the money. If it's public? You're right screwed.

On the other hand, in the US, there are millions of people who don't get the same quality of treatment simply because they were born poor--something they had no choice in. Whereas here, it is considered a sacrosanct right that everyone deserves care--no matter their financial level.

The difference between public and private is ethics--individual choice versus collective good, not efficacy. In terms of efficacy, that has entirely to do with how corrupt the system is, and how capable the government (or other regulatory service) is at dealing with the corrruption.

Nilum said:

As a personal note, I've had to use my medical system several times. Sometimes for job-related injuries (I worked as a Security Guard at concerts and the like for a while) and sometimes for personal reasons (it turns I have Asthma, and lung damage). I've never seen the post-apocalyptic waiting times people talk about. I got in to see a specialist about my lungs in under 14 days and had the information back about it the next day. I've never had to pay more than 40 dollars on medication, when I've even had to pay for medication.

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I suspect this misconception stems from differences in perception/what side of the fence people are on. Like, I've personally also heard a lot of Canadians and people from the UK complain about the wait times to see doctors. But take me... I live in the US where the average wait time to see a neurologist is 2-3 MONTHS. A primary care physician can take on average a month to get established with a new one. Trying to see an ob-gyn when I got pregnant? I was getting told by almost everywhere that they couldn't get me in for 8-10 weeks (upon researching further, discovered this was kind of normal). Given that I was already 8 weeks pregnant, this would have meant I wouldn't have seen a doctor until I was already over 4 months pregnant. Was only a generic open women's clinic that could get me in sooner. Now understand that this experience is the NORM for me.

Now have me say 'we have ungodly wait times'. And have someone in England say 'we have ungodly wait times'. And both of us are going to assume the other means something VERY different because we both have a very different foundation of what we define as ungodly wait times

When we can have 3 month wait periods for a specialist, and hear other people say their wait times are outrageous, it's expected some people are going to assume post-apocalyptic levels of wait periods are in play in other countries, rather than just a difference in perception of what is defined as an ungodly wait period. I know when I was younger, I just always assumed theirs were worse than ours meaning they must have to wait a half a year or more to see a specialist!) when they would say things to me about their wait times being the downside of their free health insurance. Wasn't until I actually really learned that the average person in the UK or Canada defines a long wait time in the span of a few weeks, rather than months like we do here in the US.

It can also vary by region. Wait times in big cities are more likely to be higher than small towns. So someone's personal experience will be influenced by where they live and/or grew up. And they'll pass that experience on to others, which may not represent a country as a whole (which can further confuse peoples perceptions). You'll wind up with cases of "I HEARD THIS GUY IN CANADA HAD TO WAIT 4 MONTHS TO SEE A SPECIALIST" even though that was a specific circumstance, in a particularly bad region.

I'm personally of the mind that the US wait time is outrageous and far worse than Canada or the UK. And part of this is that there's two factors in play. You first is that you need to be able to afford care. For people without the money immediately on hand this can mean months (sometimes years) of saving up money, or trying to acquire insurance so they can see the doctor. THEN when they finally get to make an appointment, they have to get through the actual wait period to get into an office that in turn can tack on several more months if they need to see a specialist (longer if their insurance requires them to see a primary care physician to get a referral to a specialist before they can make an appointment with a specialist). For example, I didn't have any health insurance from the age of 18 to 24. If we calculate this preventing me from seeing a neurologist, my ACTUAL wait time was... 6 years, and then an additional month to see a primary care physician to get a referral written to see a neurologist, and then another 3 month wait from the time I called and scheduled an appointment, to the day the appointment actually was. Even if someone in Canada had to wait half a year (which is a deliberately unrealistically high estimate), they still would have gotten in 5 and a half years sooner than I did. And even when people HAVE insurance in the US, you can still wind up with high wait periods due to finances. Dashmiel has health insurance, but with a deductible of $4000 before it kicks in... if he needs to see a doctor he has to first save up the money to see the doctor before he can actually go see the doctor, further increasing his wait period as well. He only gets to jump straight to getting care, after he's already spent $4000. Most statistics don't take into account this element of wait periods. They only calculate the time between making an appointment, and getting into an office.

This is why I believe that even though Canada regularly ranks in as one of the worst countries when it comes to their direct wait periods to see doctors, people in the US regularly wind up waiting years (or never getting care at all before they die). I personally would take a consistently mediocre wait period for EVERYONE if it means EVERYONE gets to see a doctor in a reasonable period of time, rather than the US's approach of 'fortunate people have no wait time, but if you're poor? you're shit out of luck. Once you actually can afford to see a doctor, sign your name at the bottom of this list, and they might get to you eventually'.

Tiko said:

my ACTUAL wait time was... 6 years, and then an additional month to see a primary care physician to get a referral written to see a neurologist, and then another 3 month wait from the time I called and scheduled an appointment, to the day the appointment actually was

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Note to self 1) Never visit USA.
Note to self 2) Never EVER get sick/injured there.

Not that I need a doctor for anithing but dietary suplement advice, and sparring-related injurys/stitching/concusion/pinched nerves once or twice (havent been realy seriusly sick enogh to need a doctor for 7-so years, the ocasional cold/sore throat I treat myself), but I do need one for those fairly often, about once in 2-3 months (same time as the events take place). I assume those wuld also be on a wait-list? Damn.... *shudders*

...and to think, I remember once geting annoyed vhen I phoned my doctor, and she tells me she cant see me the same day, I have to wait until tomorow. I needed to get examined, fresh set of medical papers to prezent, as a part of job-aplication. Yes... this thread puts things in perspektive. I guess I didnt know how good I got it here. I think I'l show this thread to some of the ppl I know, who make a habit of bitching about things here, and help them get a perspektive too.

Never visiting the US because of our healthcare seems like a mild overreaction.

Sorry, "healthcare"? As in CARING for one's HEALTH? Thats not a word I'd use for that... "Modern Spanish Inkvizition" wuld be more accurate.

So... thanx but no thanx. You just enjoy yorselves over there. And... good luck.

How does healthcare, yes healthcare, have anything to do with your visiting the country?

Emory said:

How does healthcare, yes healthcare, have anything to do with your visiting the country?

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I'm sorry, vas that a real question, or a bad joke? I'd prefer it if I end up needing a doctor, I wuldnt be left on wait list until I die, before geting one.

If our healthcare is really a concern for you visiting that’s certainly your prerogative and I’m not offended at all. But I’ve never had to wait a significant amount of time and I dont even have health insurance. I’ve never had a life threatening condition but I’ve needed medical care before and it’s never been a problem for me.

I would note that anyone with the resources to be visiting foreign countries aren't likely to be in the denomination of US citizens struggling to get timely health care. And generally would return to their own country for ongoing care. Emergency care is a different matter from what I was talking about in my earlier post. In the US if you're experiencing a legitimate medical emergency, hospitals are required to provide immediate care whether you can afford it or not. IE if a tourist got hit by a bus they would get immediate care, and then likely return home for ongoing care once able.

And from what I understand of visiting foreign countries... Generally a tourist relies on what their own health care from their country covers while traveling abroad to pick up expenses accrued in other countries.

Tiko said:

In the US if you're experiencing a legitimate medical emergency, hospitals are required to provide immediate care whether you can afford it or not.

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I sure as hell fucking hope so. Stil, not eager to test that any time soon. Aniway, I'm glad its not as bad as that first post you maked it look like. Stil, it sounds like hell for you guys who actualy live there. My condolences.

Tiko said:

Now have me say 'we have ungodly wait times'. And have someone in England say 'we have ungodly wait times'. And both of us are going to assume the other means something VERY different because we both have a very different foundation of what we define as ungodly wait times

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If it means anything, I've heard that in the US, people get a lot of freedom to schedule their appointments with a doctor. Here, if you need to see a specialist or a doctor, it goes something like this...

1. Call the clinic, lab, or hospital.
2. They ask for your name. Sometimes, they might ask for your healthcard number to confirm your identity, often times they don't.
3. They tell you when they next have a spot available, and you go when they tell you to go, and you strive your damn best to not be late.
4. If you're late more than 15 minutes, your appointment is either bumped back behind everyone else scheduled in that day, or cancelled outright depending on how busy the service is.
5. If their scheduled time interferes with work or education, you inform your workplace/educational facility of such an appointment. If they ask for evidence, you give them the number to the clinic that is going to see you, and they basically remind the company/educational facility in question that healthcare is a right and they need to deal with it.
6. You go in. If you have an appointment, your ass is probably in the door within 15 minutes (unless it's an emergency service), you do exactly what the doctor tells you to do (small chat may or may not be included), and once you're done, you get the fuck out of the way so the next guy can get in on time.
7. If anything is on the up and up, they call you with your results. If everything is cool and stuff, you probably never see them again unless you're on a repeat visit list--such as a family doctor.

Also, we have public vaccine programs. All you need is your healthcard number, you walk into a place that offers the vaccine (pharmacies mostly), wait a few minutes, sign some paperwork, get vaccine, go home. Sometimes, you even get a cookie.

Regarding freedom to set appointments, definitely. How it generally works for us is if you call, they let you know when the next available slot is. If it doesn't work for you, you can ask what they have available after that one. Or you can ask when the next available slot they have that lands on a Tuesday is, etc.

Ok, thats a litle more reasonable I guess...

This is how scheduling vorks over here: 1) you call your doctor at a clinic, the nurse answers, you tell "I'l be coming in today".
2) nurse says ok (VERY rarely wil they say come tomorow, like hapened to me as I mentioned, if they are too busy that day), reminds you of the work hours, vhether morning or evening ones (most doctors work
morning/evening on a odd/even date basis) and that you shuldnt be there past them
3) you show up vhen you like, or even dont show up if you cant make it, you dont need to explain anithing if you arent there, you just call the next day and re-schedule, as long as its vith-in the work hours, you put your
medical card in a receptacle by the door, and wait. How long you wait depends on how many ppl in a the waiting room ahead of you, vith there cards below yours in the receptacle, ahead in the lineup. Usualy the
wait takes about 10-15 mins.
4) you get in, doctors does his/her thing, prescribes vhat is needed, you pick up the prescribed meds for free from the clinic's pharmacy, if you got health insurance, if not, you need to pay for meds, and you go home
5) if you need to see a specialist, they send you there the same day, and tell you to be back vith the findings as soon as you can.

@Natalija If you're concerned about medical issues in the US, get travel insurance. Usually costs between 25-80 dollars for a month to cover a temporary stay, and in exchange you will be covered in the event of an emergency--drugs, dental, whatever. They usually also cover preexisting conditions (eg: my asthma) and it's a single cost event type deal unless you travel often and need consistent insurance. It's not perfect, and I'd rather live in a world where it isn't necessary, but then I also deal with banks and I hate banks too, so... Just gotta deal with it sometimes.

@Tiko Yeah, see, that wouldn't work here. The whole point of waiting lists is that you want to make it as efficient as possible. Example: Say a typical appointment at McHealth Clinic takes 30 minutes. If nobody is available all Tuesday morning (8 AM to 12 PM), you've just lost out on eight possible appointments, which artificially inflates the waiting time. It would also mean that everyone would flood the weekend spots and artificially produce insane waiting times.

Gotta be efficient, yo. Health is not a game.

Assuming I had any vish to travel there, yes, I'd have to deal with it. Since I dont... no need to give myself a headache. I just mentioned it in the kontext of how shocked I was at vhat I read here. It seems that little things like "Hippocratic Oath" are completly forgoten over there. Doctors making ppl WAIT months for medical care... fuck a doctor like that, and fuck the goverment that lets that happen. Over here, that wuld be grounds for a violent civil revolt, in no time. Goverment wuld be forced to give in, or face emergency elections, and the oposition wil be thrilled at a chance of major propaganda weapon agenst the governing party (or coalition of partys).

We'r efficient enogh. But we also dont stick to rules like glue, flexibility is also a nice trait.

It's less the fault of the doctors and more the fault of the system they're trapped in. The government has made it effectively impossible for "out of network" hospitals to exist, and making it illegal not to have private insurance.

Government is in bed with Private Interest Groups. It's a nightmare. A multibillion dollar juggernaut nightmare that spews massive amounts of propaganda to fearmonger people into believing that everything is fine and everyone else lives in a nightmare world. Seriously, go ahead, watch this (it's only 2 minutes long). Breath in the multimillion dollar propaganda machine at work.

Nilum said:

Government is in bed with Private Interest Groups. It's a nightmare. A multibillion dollar juggernaut nightmare that spews massive amounts of propaganda to fearmonger people into believing that everything is fine and everyone else lives in a nightmare world.

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And thats why I am SO anti-globalist and anti-consolidationist, and frankly, anti-liberal, because they are the ones who propagate that. The same elites that are behind this migrant invasion of Europe. Its all part of the same, inter-conected problem. Corporate hegemony, cultural degeneration, and multi-kulti national suicide, all part of the same master plan of the NWO. Total control of the people, on evry level. And yes, people are fear-mongered, because they are in-capable of critical thinking anymore. Too much TV, too much reality-show crap, too much shallow bulshit to shorten atention spans.

Yeah, it's definitely not the doctors' fault. Like the reason the wait time for neurologists is so ridiculous is that it's a high demand field. Not enough neurologists for the number of patients that need to be seen.