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Comment by acabal | Hacker News Reader

All good points, but the fact remains that at my income, it simply doesn't make financial sense for me to be insured. If I must declare bankruptcy in case of cataclysm, then the system just lost much more money than they would have were I paying an affordable (sliding?) amount per month over my lifespan.

Anyway, this isn't the place to get in a discussion about how to fix the system. But as it stands now, it's just a fact that my bank account is better served by not being insured, having minor procedures done in another country, and declaring bankruptcy in the event of a cataclysm. That's not what the system in the richest and most powerful country in the world should look like.

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Totally agree, for relatively healthy younger people willing to risk bankruptcy, it's a massively cheaper option. I'm merely saying that that kind of cost is nearly impossible to achieve, as reaching it would incur costs elsewhere. Distributing the cost doesn't make it less real.

You say it, but you don't back it up with evidence. How is it that the US already pays more money per person for health care but with measurably worse results (measured as life expectancy, infant mortality, etc).

How do they achieve what you call impossible?

Measurably worse results than where? It's measurably better than many places.

I say it because many many many other places subsidize healthcare at least as much as America does. And people don't seem to count the taxes they pay as part of the monthly cost.

edit: edited my top comment, sources are there. Canadians, famous for cheap healthcare, pay $324 per month per person for healthcare. The government covers $227 of that, which means $227 per person per month comes from taxes.

Measurably worse than the rest of the G8, according to your source (http://en.wikipedia.org/wiki/Health_care_in_Canada) at least on life expectancy, infant mortality, per capita expenditure, costs as % of GDP, and % of government revenue spent on health.

Not true.

We beat Japan on life expectancy, provided you restrict the comparison to people of Japanese descent. Japanese Americans live 84.5 years on average, Japanese only 82.6.

http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2...

http://www.google.com/publicdata?ds=wb-wdi&met=sp_dyn_le...

(Would love to see data doing similar comparisons to other G8 nations.)

That's funny, but I'm not sure it's true. Your first link seems to say (it's worded awkwardly) that Japanese women in the US have a 84.5 year life expectancy. This isn't quite as high as the 85.66 life expectancy Japanese women have in Japan (https://www.cia.gov/library/publications/the-world-factbook/...)

That's despite people of Asian descent in the US having higher income and education than the average, both of which are positively correlated with life expectancy.

Even if it is true, I'm not sure what the significance would be. I would be surprised if you couldn't pick out many subgroups in the US which do better in the US than in their places of origin, without it supporting an argument about the quality of the overall system.

Oops, I think I misread the article. I stand corrected.

Very true. To actually make the argument you are trying to make, you'd actually need to do a carefully controlled study. But most such studies (which include ethnicity, rural living, diet, etc as predictors) actually show no significant relationship between marginal changes in health care and health outcomes.

The US pays more money because it has more health care being provided, in many cases.

It just so happens that more health care doesn't necessarily translate to measurably better outcomes (e.g. cancer screening helps reduce mortality for some cancers but not others).

It also just so happens that it's very rare to study whether a particular care regimen actually improves overall outcomes as opposed to just the thing it's ostensibly aimed at treating. Continuing our cancer example, cancer screening helps reduce mortality from _cancer_ for almost all if not all cancers, but for some the increased mortality from operations and other cancer therapies cancels out the improvement.

That's not to mention the fact that people in the US prefer to get care even if they know it'll likely make them worse than not getting care. I'll dig up the reference for this; I don't have it offhand.

>The US pays more money because it has more health care being provided

Reference for this, too, please.

Reference for the last part there: http://www.ncbi.nlm.nih.gov/pubmed/16282212

The first claim above is pretty broad; coming up with a single reference to support it would be hard, and coming up with a wide range of references time-consuming.

But as examples:

http://www.ncbi.nlm.nih.gov/pubmed/2268793 (2.5x more coronary artery bypasses per capita in the US than in Canada in 1988; admittedly somewhat dated).

http://www.pillsforall.com/blog/cardiac-stents-are-used-twic...

I realize that's pretty weak support; I don't have anything better off the top of my head, unfortunately.

So we pay more money then other countries but don't get better outcomes? Could we save money and get the same outcomes? And since we get worse outcomes then they do, could we spend less and still get better outcomes?

How do you defined "more health care?"

> So we pay more money then other countries but > don't get better outcomes?

Yes, exactly.

> Could we save money and get the same outcomes?

That seems like an obvious corollary of the above... But yes, I think we could.

> And since we get worse outcomes then they do

Not necessarily worse; just not better. Measuring and comparing outcomes across different populations is hard enough that it's hard to say more than "our outcomes are not clearly better than theirs".

> could we spend less and still get better outcomes?

This question is based on a premise which doesn't seem to be true, so probably no.

> How do you defined "more health care?"

Number of procedures per capita per year for various procedures is a reasonable measurement (where procedures can be MRIs, surgeries of various sorts, etc, etc). Usually people focus on the expensive end of this, by the way; having more physical checkups won't necessarily blow up your healthcare costs the way that more invasive cancer surgeries will.

Your logic works both ways. If you say it's hard to measure then how do you know that get the same outcomes?

"Number of procedures per capita per year" is a horrible measure. It assumes that procedures done is a good proxy for overall health, which it isn't. Public health (clean food and water, trash pickup, promoting exercise and outside activities, cutting down on smoking, etc) is also important.

Here's a scenario. Country A and B are identical except that country A has pushed for potable water and B has not. As a result, 10% of the procedures in country B are from dysentery, cholera, and other water-borne diseases which are relatively cheap to treat (keep hydrated with a solution of salts and sugar). As a result, country B has more doctor visits per capita, and on average these costs are cheaper than in country A. Country B also has lower life-expectancy, more days sick per year, and other measurable outcomes.

By your definition, country B has the better health care system but I think most people would prefer the overall health of country A. Therefore your measurement is not so useful as an indicator of overall health outcomes.

> It assumes that procedures done is a good > proxy for overall health

My whole point is that it's not a good proxy for overall health. However it _is_ a good proxy for amount of money spent on the system. Which is how you can end up spending more but not getting better overall health.

Do read what I said again. You're arguing against a strawman.

Which

> declaring bankruptcy in the event of a cataclysm

Some procedures are not covered in your scenario depending on your state. Organ Transplants in Arizona etc.

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