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This will probably get buried but it's outrageous that you can be bankrupted by medical debt if you get sick in the US! In Europe this doesn't happen.
EDIT: thanks for the gold kind stranger
I'm really exhausted by what seems to be this interminable stuck-at-superficial-memes discussion about health care in the US. I've lived in the US, spent a few years in the UK and experienced NHS, found it surprisingly shitty even though I was looking forward to rubbing Americans' faces in it, and then I ended up back in the US and actually on Medicaid (by near accident! a story for another time though) and found the quality significantly higher.
My new EA cause area for improving health care in the US is to arrange to have everyone live in Europe for a few years so they can get past using it as a cudgel for trying to advocate for their ideology that will fix everything.
I suspect it would backfire horribly and important lessons wouldn't be learned because the irony is too thick, but I dunno I'd really enjoy hearing "whaaaat? I need to wait 3 weeks for a blood draw because the one phlebotomist for my area is on vacation?"
To be clear I'm not saying the UK health care system is an order of magnitude worse (or better) than the US one, just that there are tradeoffs that can be hard to appreciate until you experience them.
I run a cancer forum on reddit https://old.reddit.com/r/coloncancer In the 6+ years moderating the community, I have encountered exactly zero Americans being bankrupted or made destitute due to medical debt, or being denied treatments or long delays owing to unaffordability. Everyone gets good, timely, high-quality treatments regardless of socioeconomic status, including costly surgeries and the latest chemo even if there is low likelihood of the procedures working. High medical bills are either negotiated lower, covered by various insurance programs (like Medicaid), covered by charity care, etc. Medical debt can be easily discharged, unlike other types of debt.
Fascinating!
One thought: is the group of people that doesn't have insurance and therefore doesn't get annual physicals and therefore doesn't have their colon cancer detected before it's way too late (a) a real cohort and (b) very well represented here? That would be a case of people having worsened outcomes because of poor access to care, no?
From what I have read, Canadians who have above average risk factors, such as family history, seem to have the hardest time getting timely colonoscopies, which would detect the cancer sooner.
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Probably don't tell stories about their good treatment so we only hear from people with bad treatment or that have mental illness (i.e. half of Reddit).
So here's another +1.
I had a serious form of cancer about 10 years ago. My treatment was wonderful. My doctors were excellent. Treatment started very quickly after I first went to primary care doctor with a mysterious lump. Furthermore, my cheap insurance paid for most of it. There were no surprise bills. I was out less than 10k out of pocket. I am lucky to be living in a major city in the US.
My step-kid has been on Medicaid for most of his life and he has some kind of non-metastatic cancer that grows and regrows in his throat. It's fatal for some kids and I think it's Make A Wish eligible (not really sure what that is but it sounds grim). In his case he merely had to have throat surgery under general anaesthesia on a near-monthly basis when he was a toddler to keep cutting them out.
Fortunately as he aged they stopped regrowing so aggressively and now he only needs surgery about every 12-18 months.
The surgeon who sees him is some kind of leading expert in this surgery and he's seen at this hospital that I didn't even know could be so shiny and nice.
Anyway, we never once had to pay out of pocket to treat it while he was on Medicaid. Now that we're on a private insurer it's about 10-20% co-insurance, so it's a few grand out of pocket every time we take him in; seems like a great fucking deal all things considered.
The surgeon did make a... funny?... remark once when he was finally switched to a private insurer from Medicaid that now the reimbursement will be enough that he can celebrate after each surgery with a mid-range IPA instead of PBR. Not sure how much to read into that; given how health care reimbursements work I could imagine the dude has a garage full of exotic cars or he really could mean he all-in nets beer money on each surgery. They both seem equally possible. I do hope he has a lot of exotic cars though.
Wow, that sucks. I can't even imagine how stressful that would be. Having a good doctor makes a world of difference.
The system seems to rely upon the good nature of some doctors. There are lots of doctors working for not much (compared to the stress of the job and compared to something like a Google engineer). On the other hand, there are profit-maximizing doctors pulling down 7 figures who are probably responsible for a large percentage of the cost inflation.
It's tough to get rich seeing patients. But if you own an MRI machine or other diagnostic equipment you can really make bank. I'm pretty sure it's been shown that doctors prescribe more unnecessary tests when they are financially rewarded for doing so.
Owning a medical practice where you have your own MRI machine and write prescriptions to use it does sound like it would be pretty lucrative.
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In my experience most of the American expats who talk about how great the healthcare system is in other countries are almost always young people who don't have to deal with catastrophic problems or manage long-term conditions, and if they did wouldn't have had a comparable experience back in the US. I remember one former coworker who was living in France brag about how he went to the doctor for some minor ailment and was only charged ten dollars and got a prescription that only cost a few bucks. Well, that's pretty much how it works in the US if you have any kind of insurance at all that isn't an absolute bottom-feeder. I had cellulitis about a decade ago and that's pretty much how it was at urgent care, they gave me a bunch of prescriptions that were so inexpensive the OTC probiotic the doctor recommended was more expensive than all of them combined. For more serious ailments the usual story is that you go in and don't pay anything up front and then in a few months the insurance company sends you a bill that's more than you think you should pay based on your understanding of the policy but not enough that it causes any financial hardship or is worth complaining about. So like a few hundred dollars.
When it comes to medical bankruptcies, I practiced bankruptcy law for a while and they aren't what you think they are. While you occasionally see someone who was uninsured and now owes a hospital $60 grand or something, that's pretty rare. What's more common is that a relatively low-income person has insurance but an injury or illness keeps them out of work for an extended period and they're forced to borrow to pay for expenses. These people aren't likely to have short-term disability insurance, and long-term disability from Social Security doesn't kick in until after they've been out of work for a year (though they get paid from the date they stopped work), and takes a while to process. By the time they get their disability payments or are back to work they're so far in a hole that bankruptcy is the best option. They usually have a lot of unpaid medical bills that are included in the bankruptcy, but that's not the driving force.
Good points, you try to bring these up anywhere else like reddit or hacker news and get downvoted to oblivion.
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The medical system in the UK is unusually bad. I found the medical system in Germany, Austria and Italy each far superior to it (and at least the last one of the three has no case for better socioeconomics). The US one was also superior, but (at least in the incarnation that you get as a PhD student at a reasonably rich university) still inferior to the three continental European countries above. My one encounter with the Canadian medical system put it only slightly below the Europeans. It's not clear to me if it's something cultural, or a consequence of the specific implementation and incentives it produces (I have low-confidence information that Sweden, which has the most similar medical system to the UK out of the ones I sampled so far, is similarly bad), but nowhere else have I encountered the combination of doctors who were this aggressively unwilling or unable to bring their brains to the job and just stubbornly prescribe heavy-duty medication which at best did nothing and at worst had nasty side effects based on an autocomplete-tier diagnosis (or actually googling the symptoms right in front of me) and complete lack of any equipment to even do something like basic blood tests (you get a referral to a lab and have to get another appointment once the results are in before they look at them, and the hope is clearly that in the >=7 days it takes the problem will resolve itself one way or another).
I hear this all of the time but I can't reconcile this with my experience.
I took my sister to the doctor in Italy once, in the countryside, and the doctor was an obese stupid looking guy in a big dimly lit room with no computer or desk. He looked at my sister's really strange bite on her leg and seemed oblivious to the possibility that this insect bite could cause Lyme disease. Even though she told him (in fluent Italian) that she was concerned this was a tick bite and that she could get Lyme disease. He just gave her some of of cortisone injection and sent her on her way.
She got Lyme disease.
On the plus side it was free.
I dunno I'm sure there are some doctors like this everywhere but if there was a doctor in the US that was this incompetent and they charged $200 I feel like the community would deal with them.
It's so unbelievable I'm doubting whether this actually happened even though I was definitely there and sober.
(Your UK assessment seems very familiar)
On the plus side, we're probably less than 5 years away from really good multimodal medical diagnosis AI. Hopefully these tools will start being used more, checklist manifesto style, as a sanity check for any diagnosis.
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I don't know if this is accurate for Italy or not but this is something I've noticed in Sweden.
Primary care is becoming a low status speciality due to a combination of increased workload and an influx of poorly educated and wetted non-eu doctors working in that sector (non-eu doctors that are not in primary care seem decent enough). This means that going to the doctor has become a complete gamble and unless you know that your gp is competent you can expect to have to do their job for them.
However, If you for some reason end up in a hospital you'll receive excellent care by competent doctors.
The end result is that if you unwittingly go for a one-off primary care visit in Sweden and you uncritically accept what the doctor says then you're more likely than not to receive very poor care for non-emergency issues (where they can refer you to a hospital).
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In practice, I think that the way that the NHS squeezes doctors and nurses is a false economy. The result is staff shortages, the importation of less competent doctors and nurses from the third world, and the flight of talented trained medical staff for sunnier climes with better pay. It's of course, entirely typical of our politics - see immigration, housing, infrastructure. Saving pennies today to end up poorer than Poland by the end of the decade. The UK was once, I remind people, on track to be richer per capita than the United States.
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(I had a different reply here but I deleted it because I was triggered by stuff that resembled something that you weren't actually saying. Sorry.)
What metrics are there, out of curiosity? I've only really seen "outcomes" mentioned but in my surface view these are confounded by issues of affluence (e.g. more obesity, more driving everywhere). Also it seems like ass-covering and hostility-to-rationing drive up costs as well; a socialized medicine death panel could cheerfully say no that test is expensive and highly unlikely to find a problem so there's no rx for it end of story, but in the US an indicator that you could have a 0.01% chance of a horrific disease justifies the test so end of story.
So, interestingly, my current wealth insurance plan is one where I pay out of pocket for stuff and then apply for reimbursement. This puts me in a position to shop around before I get tests to find the lowest price out of an attempt to stay under the per-incident deductible and also generalized fear that I might be stuck with the whole bill.
It's really eye-opening! The variance between rates quoted for a test is sometimes an order of magnitude and I can't get anyone to tell me why.
I've listened to podcasts with doctors and they will complain about such and such imaging machines being shit and others being great and that's why they refer to so and so place only.
So. I dunno my prejudice is that these cheap tests produce crappy grainy images that your doctor hates but they just roll with it. But I could also totally understand if it's also because proper supply and demand forces are completely distorted and you really do overpay by 10x for the same stuff
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German healthcare is also great purely on paper. You pay a fortune in I-can't-believe-it's-not-taxes and what you get is somewhere between indifference, incompetence and bureaucratic nightmares. At least that's my experience with it.
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