What on earth
We get a lot more care, pay higher rates, and have worse outcomes.
That last bit is why people are pissed.
We get a lot more care, pay higher rates, and have worse outcomes.
That last bit is why people are pissed.
Life expectancy in general in the US could also be due to the amount of gun violence, as well. Nothing to do with the quality of healthcare.
The fact that Americans intuit that it’s not is a worrying sign of just how broken our system is
Any evidence for this?
I don’t think this is a broadly held belief, I think it’s the “eeehhrm actually…” contrarian belief that’s trying to discredit the consensus view that our healthcare system gets very poor results for the money. So it shows up in places like this exact HN thread.
The US government does not care that much about obesity, gun violence and all that jazz because it is not the one paying for the damages it does.
All these factors contribute to the comparatively poorer life expectancy of Americans, which is, I agree, only a surface metric.
The more important dynamic you’re pointing to is that private insurers don’t care because our insurance is tied to our employers and therefore is expected (by insurers) to churn every 4 years or so.
It literally makes zero sense for a private insurer to invest in an American’s healthcare results more than 3 or so years down the road.
Surprise surprise, we have best-in-class care for emergencies and complex acute cases, and absolutely atrocious management of early disease and lifestyle problems (which is when it’s most cost-effective to solve health problems).
One of the strongest levers we have to improve the “inputs” you’re describing is a better primary care system. America’s has been absolutely gutted over the last 20 years by interactions of various economic and regulatory dynamics including (notably) the anti-competitive vertical integration of pay-viders and pay-vider+PBMs like UnitedHealth Group.
It is absolutely not true there aren’t system-level changes we can make in healthcare and insurance to help address this.
Having access to doctors helps to manage disease.
Obesity is a disease.
In particular, having access to PCPs helps to manage obesity.
Our healthcare system yields poor access to healthcare.
In particular, it yields poor access to PCPs.
Ergo the obese population is in part an output of and not an external input into the design of our healthcare system.
Ergo changes to the healthcare system absolutely can — and in fact should have as a key goal to — yield changes to levels of obesity.
> “ Rearrange healthcare/government insurance models all you want; it can't fix that.”
This claim is false. The mental model of an obese population being exclusively an input into our healthcare system does not track with what we know about the relationship between healthcare and obesity.
But hey, it's not like the US is a democracy exactly given that public opinion generally doesn't translate into policy changes anymore.