Comment by lettergram | Hacker News Reader

Comment by lettergram | Hacker News Reader

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I’d love to see real stats on that. All I ever see is the statement that there’s this huge problem in the US. Yet, when I travel I see tons of people without teeth, starving in the street, etc. It’s anecdotal, but I cannot imagine these countries are equivalent.

I’ve even seen the claim healthcare is super good outside the United stares. Although it costs more, the US had a top notch system for medical care. They can see a doctor in minutes, get open heart surgery, and go home for <$8000 within a week, with a high chance of survival. The only requirement is insurance, which the vast majority of people have. It’s the insurance part that gets people upset, the health care is not.

Further, Longer life expectancy means little by itself doesn’t mean much. What if a group is predisposed to disease via their genetics? Is that country not counting deaths of children, are the mothers less likely to carry to term, etc? Even if you controlled for everything, you’d also need good records are kept (something I doubt on Cuba).

My point is a lot of time this data is so fuzzy, it’s meaningless. Give me 100 stats and I can mess with the weights until Spain is #1 or #50 easily in healthcare. There needs to be lots of care to make solid claims and I don’t think that was done here, I think they wanted viewership.

Maybe the Cubans and the Spaniards have some magic genes on them, but I think is more probably that you vision of those countries is distorted.

Personally, and this is my intuition talking, I think that the most important fact is primary care.

If you need open heart surgery you probably would be better (marginally) in the States than Cube (assuming you can afford it), but what really makes a difference is to get diagnosed in the early states of a illness or, for old people, constant follow up by a doctor.

Interesting, it seems that both Italy and Spain have primary care totally public, that means, the doctors work for the National Health System. It would be interesting to check if this the case for the other top countries in the list.

I agree, and would add „lifestyle“ to the relevant factors. Cuba has a lot more „communal“ life. Eating alone, as but one example, just doesn’t happen. Even something like watching TV is more of a group activity. Even if the cause of that is an inability to afford your own TV, chances are it could have an impact on psychological well-being.

Physical activity is also far higher. Again, this may be a result of relative poverty. But walking or taking public transport to work just happens to also be healthy.

Interestingly, these are factors somewhat shared across Cuba, Spain and Italy, even though there is no similar economic pressure in those countries.

On the other side of the divide, I live in Germany. We have universal insurance that is functionally equivalent to government-run healthcare (I, and everyone else, can visit a GP any time without paying). Yet outcomes here, and in Britain and Canada, are closer to the US.

Out of curiosity, are primary care German doctors employed directly by the state, or are they private business that invoice later to the public health budget?

They are independent businesses. Most people have public health insurance. These are still entities distinct from the general budget. You can chose between different insurances, which have some minor differences in terms of extra services they offer. Rates also differ, but only very slightly. It’s around 12% of income.

There are also private insurances. They offer flat rates (not indexed to income) and are attractive to high earners and some young people.

> They can see a doctor in minutes, get open heart surgery, and go home for <$8000 within a week, with a high chance of survival. The only requirement is insurance, which the vast majority of people have.

See, that's one of the problems I have with the American system right there. Why do you have to pay for life-saving surgery when you already have insurance? That's absurd.

>People die on the list to get treatment.

This doesn't appear to be any different in the US, though -- people die often in the US from either waiting to get enough money for copays or from having their treatment be rejected by their insurance enough times until they die.

It’s called a co-pay and it’s because you’re expected to pay a portion along with all treatment. This is to make sure you aren’t going when you don’t need it.

$8000 for lift saving treatment is nothing really. I can go to the doctor for $20 - $40. However, if I need open heart surgery, $8k is fair.

In Ireland, Canada, etc you have to wait months to get treatment. People die on the list to get treatment. That’s my issue with that setup. I agree the US healthcare can be improved. However, don’t let the propaganda fool you (that’s for political campaigns), it’s expensive and we all want to fix that, but it’s very effective.

I really doubt anybody needs to be discouraged from frivolous open heart surgery by co-pay.

Also: nobody does on any waiting lists in Ireland or Canada. Or, more accurately: There may sometimes be waits for elective procedures, and people may get hit by busses while on such a list. But there’s no causality. The only waiting lists where people die are for organ transplants, as in most any country.

> . This is to make sure you aren’t going when you don’t need it.

This just does not compute. If you have a health concern, YOU NEED TO GO TO THE DOCTORS.

Trying to scare people away from visiting a doctors until it is bad-enough that their fear for their health overpowers their fear for their wallet is just sadistic madness. Utter utter madness.

>However, if I need open heart surgery, $8k is fair.

No this doesn't seem fair to me at all. No one should have to pay so much out of their pocket for a life saving operation.

> However, if I need open heart surgery, $8k is fair.

A "one-off" treatment such as this is one thing, but the co-pay system really breaks down for the individual once you start talking chronic conditions that require regular treatments for life.

In that case your insurance company may start to see you as a liability and raise the co-pay until treatment is no longer econically viable for the patient.

>The only requirement is insurance, which the vast majority of people have.

However, the vast majority of people do not have access to $8000.

> They can see a doctor in minutes, get open heart surgery, and go home for <$8000 within a week, with a high chance of survival. The only requirement is insurance

This is the same in any developed country (i.e. you can see a doctor if you pay), except that in addition to that most non-US developed countries also have the safety net of cradle-to-grave government run health care system.

This means if you dont have $8000 you can also get heart surgery and dont die.

Ideally with free & universal healthcare, you dont even get to the stage where you need emergency surgery in the first place. i.e. you'll be diagnosed and treated ahead of time when its not an emergency yet.

I've used both public and private in the UK. The benefit for the private health care is you generally get to pick when & where your appointment is (vs public when you are often told when & where your appointment will be and you need to change your schedule to get there on time ... although you do have some leeway in picking your clinic), and the places you go to do it are generally nicer places to be (decor, surroundings etc). If you need something truly urgently, the public system will generally get you seen as quickly as private. If its not urgent, then the public system has longer waiting times (because the truly urgent cases are getting seen first). Typically the equipment & treatments available in public clinics/hospitals is as-good or even better than the private clinics, and all the surgeons and doctors often do both public and private work.

tl;dr - Money generally just buys you convenience and nicer waiting rooms in non-US countries. The level of care is about the same IME.

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