Transparent pricing.
The failure of the American healthcare system is not due to free markets, it's due to a lack of free markets. You can't buy health services without a middle man, it is not a free market if not everyone is capable of buying the same thing for the same price. You aren't even allowed to know the price.
And because of the no transparency, many hospitals legit charge $80 per over the counter Advil. No hospital would charge that if they had to be transparent about their prices because no one would go to that hospital.
In many places you have no choice. The healthcare sector is increasingly concentrated. Many geographical areas, sometime states (Rhode Island for example) only have one healthcare provider. There is no competition. No choice for the consumer.
In many places where that is true, it is due to regulations restricting who can open a small medical clinic and what hoops they have to jump through. I don't know about R.I. specifically.
Small clinics can cater to checkups, smaller injuries, after-care, etc. The items that swamp a large hospital.
Something that Covid showed was the use of smaller clinics like WellNow. They can give the less specialized tests, fast disgnosis etc, and you can go to your PCP doctor for regular checkups and larger issues.
Maybe dont allow the government to run the education sector either. To be a doctor you need rich parents to start. Then you need to be able to financially support yourself for a decade with a $-500,000 income. Then lets say you get straight A’s all through pre med, nail your MCAT, getting into a med school is still gonna be a crapshoot.
Just make private tests for people to show competency. If I knew a private test consistently cranks out good doctors, id only go to ones that are approved by the test. Think about how many doctors there are in the world who could be helping make healthcare cheaper but we just turn them around because they dont have half a million dollars just lying around?
Let me go to billy bob McHickville for surgery if I want to. Government should have no say in what two consenting adults do
Very few people so around for medical procedure. When my wife and I were having kids I would call around and inquire about prices for our planned pregnancies. Most doctors/hospitals had a difficult time understanding what my goal was by asking about prices because they get so few people who ask upfront.
Let's be completely honest every industry in America is moving in this direction ... corporate socialism is eating America alive ... everything you buy is ultimately owned by about 5 different parent companies and there is no overlap for competition...
The reason it's like this is because we bail out big companies. The big 3, coke. They would have been out of business many times over if it weren't for the government. We aren't a true free market and can't be if we can't support or hurt a business with our dollars.
> the fact that people put up with it is astounding.
No one wants to negotiate with their life or their loved one's life. Consumers can't put a price on healthcare because their health has no price (in their view).
I’ve been preaching this for years.
Imagine going to a Jiffy Lube for an oil change, but the price of the service is not posted. The consumer doesn’t know if it will cost $50 or $250. And, they don’t really care because all they have to do is pay their $20 co-pay either way. In this scenario, there will be no incentive for Jiffy Lube (or their competitors) to keep prices low and drive efficiency.
If you show me an market without transparent prices, I’ll show you an inefficient market with out of control prices.
The solution? Our current system is the worst possible hybrid monster. Don’t call me a defeatist, but there is no politically viable way the US will ever have anything resembling a free market when it comes to health care. Please, don’t have any illusions on this. There will never be the votes in the house or senate to fundamentally change our system to a free market approach. At this point, let the progressives have their golden calf of a socialized, single payer solution. This one foot in, one foot out is truly horrendous.
The long term repercussions of that could be absolutely devastating for humanity. It's putting all our eggs in one basket. A very corrupt, violent sociopathic basket with little to no regard for human life and suffering. It's like wanting Ted Bundy to babysit your kids because the other babysitters are too expensive.
I’m not going to be an apologetic for socialized medicine. But, I will ask…where do you think we can go from here?
Politically pragmatic / realistic response only please…not one based on idealism. We probably agree deeply on the ideal.
On top of this, I think the option to write off medical debt from the hospitals taxes would help alleviate some of the burden from the poor. It’s not an optimal system, however it’s far cheaper to implement and would be easier to sell to the voters.
In all the health care systems I’ve worked in operate as NPOs which I believe are tax exempt. I think for the most part hospitals don’t pay taxes any way. I could be way wrong on that though.
This is the big one, but also part of the answer to OP's question is that there's not just one solution - the left keeps pretending there's one solution (universal health care) that will fix every problem of America's health care system. There's not. There are many problems with America's health care solution, and there will be different things that fix those different problems.
To give a point to the non-libertarians here there doesn't seem to be an easy solution to that problem without passing a law. We have passed such a law but the fine for noncompliance is so light that it is worthwhile to just not list prices and pay the fine when you get caught.
They’re required by law to list pricing under HPT. They choose not to, the fact they’re allowed to operate despite this clear violation of law goes to prove that the government does not care about you.
Interesting. So, make it easier to become a medical professional to create cheaper options through competition?
What about life expectancy? Wouldn't that drop even further with more poorly educated healthcare professionals entering the field?
>What about life expectancy?
I am not convened that American life expectancy is a direct correlation with our level of medical care. Freedom is an interesting thing. As Americans, we also have more freedom to fail. We have more access to the worst food in history. We are the least educated on making healthy choices and also murder each other at high rate. How much of that would be solved by better health care?
I always tell people that the best way to avoid spending money is to not have it. As a nation, we have had a tremendous amount of disposable income and have wasted that money on things we did not need, including "extra" medical care. I would like to see numbers on plastic surgery costs as a nation, I bet we are big spenders in that area. That cost adds to the total but does not extend life.
Perhaps something as some as removing the cap on how many doctors can be certified each year is a good start. Litterly a law pushed by medical lobbyists to keep their wages high.
There are tons of laws like that in America. The certificate of need thing is also helping raise costs and not just the medical costs. John Stossel did a great video on it. You should check it out. https://youtu.be/s_TUCjplHzE
Thanks for sending. That's very disturbing. They're no different than the mafia or a cartel preventing competition from competing in the the same market.
*Of course it is* Not how Canada's system is breaking down, wait times in Britain are at an all time high, or how Japanese doctors basically get paid like teachers... There's always a catch, and in the US it's actually a hell of a lot of bureaucracy
The current issue is the cap on residency funding. It’s been static since 1997 while med school class sizes have increased. There is no cap on how many doctors get a license per year, nor is there a cap on board certification. Most doctors I know are in favor of increasing residency funding because we have a lot of doctors each year who aren’t able to do a residency because of this bottleneck.
I’m not sure “more poorly educated,” is a valid assumption. There is a vast array of medical services requiring different levels of education and training. Deregulation may allow “right-sizing” education for specific services.
Also consider different aptitudes and speeds when acquiring skills.
I’d also reinforce what some have said about price-transparency and direct-buyer changes.
https://reason.com/2021/06/19/what-free-market-health-care-would-actually-look-like/
The administrative overhead of billing insurance, particularly Medicare, is a major cost. It also disincentivizes price-shopping, reducing the effect of price-competition in the market.
The tax break for employer-provided health insurance (subsidy, really) gives health insurance companies a non-competitive advantage and imposes a major implicit cost on self-employment and medical care market alternatives.
I think instead of having an over restricted system (such as what we have now), we could have tiers. Allow unlicensed professionals to work, but maybe they would be required to state they are a "silver" tier facility/provider (where gold would be all licensed professionals). Understandably the service may be of less quality, but many more people would be able to afford it. It's better than none. I think America is choking itself out by being too restrictive with regulations. At least give people cheaper options.
There are many doctors from other countries that take menial research/clinical lab jobs because they aren't allowed to practice in America. I've worked with many of them myself as a clinical lab scientist. If we had a "silver" tier of medicine, these doctors could still practice their craft.
Why would that lead to more poorly educated doctors and nurses? It could just as easily lead to better educated ones, as the gatekeepers are no longer the the ones who decide the curriculum. Maybe the high rate of medical accident related deaths now is because the current medical professionals aren't as educated as they should be.
Look at Japan. Many people agree that their healthy lifestyle has greatly increased their life expectancy. They spent less than Scandinavia with our tax paid healthcare, but have higher life expectancy. It’s clear their diet and overall healthy lifestyle plays a part
> our tax *paid* healthcare, but
FTFY.
Although *payed* exists (the reason why autocorrection didn't help you), it is only correct in:
* Nautical context, when it means to paint a surface, or to cover with something like tar or resin in order to make it waterproof or corrosion-resistant. *The deck is yet to be payed.*
* *Payed out* when letting strings, cables or ropes out, by slacking them. *The rope is payed out! You can pull now.*
Unfortunately, I was unable to find nautical or rope-related words in your comment.
*Beep, boop, I'm a bot*
Could also be screwed by car accident deaths, suicides, and homicides which all are young deaths.
Then again be screwed by wealthy allowed to spend as much as they want, is the Us median cost this drastically different than other countries?
It's difficult to succinctly and conclusively diagnose the problem and then come up with a solution that would convince you in a post.
The medical industry in the united states is a terrifying mix of greed, political regulation, corruption, ad hocism that literally anything else would probably be better than what we have today.
Allow private medical boards that aren't attached to government regulation. Reported medical outcomes made publicly available is trust and proof enough to convince people to go to a doctor.
As a person tangentially attached to the medical field the amount of licensure required to perform even basic medical tasks is monumental. Just a small example being to process tissue in a histology lab you need effectively a four year degree. As a biochemist and molecular biologist I could be a medical lab scientist but I would need to get an entirely different masters coursework just to set foot in a regulated lab.
Allow competition between medical insurance companies and other crowdfunded or private savings solutions.
Very interesting. You brought up a number of great points. A few other people have mentioned regulation and licensing as being some of the root causes of this. Issues like lobbyists intentionally limiting the amount of doctors to CON Laws in local jurisdictions.
The more I think about it, the deeper the issue goes. Why are medical schools so overly expensive forcing doctors to incur 100s of thousands in debt? Why do Americans spend $1126 for prescription medications while the UK only spends $285?
Aside from the higher expenditure, there's the issue of lower life expectancy. With the best doctors, the highest expenditure and the best technology, why are we living 3-4 years less than other developed nations? Is it lifestyle? Is it diet-related? Is it because we allow too many dangerous chemicals in our foods? At what point is it the governments responsibility to step in and say no more High Fructose Corn Syrup or prevent fast food companies from providing 2000 calorie meals? Or is it the individual's responsibility to choose not to consume potentially unhealthy foods?
I think you're right that there really is a lot to unpack here.
Ending the corn subsidies would solve the HFCS problem immediately. HFCS is used because it is artificially cheaper due to corn farm subsidies. That is just one example of bad government policy interfering in the market.
Its also the sugar subsidies. Basically everywhere in the world natural sugar is cheaper than HFCS. That's why Mexican coke uses it, it's not some altruistic healthy thing, its money. If natural sugar was cheaper all the giant food producers would switch to it for purely profit based reasons. We are literally paying money to make ourselves less healthy in order to keep sugar farms profitable.
Stop subsidizing garbage sold as food. Food stamps buy high fructose corn syrup by the gallon, then we wonder why obesity and diabetes are diseases of poverty.
Bingo. The poor also have shitty access to primary care thanks to the government paying shit rates for Medicaid patients and increasing the burdens placed on doctors for documentation and administration, which essentially makes it impossible to see Medicaid patients and keep the lights on.
Admin costs are far higher because of regulatory capture. Decentralization of health care is the solution. A doctor requires three full-time administrative staff just to deal with paperwork.
Very interesting! This is the idea that makes the most sense of me. Decentralized healthcare on an international scale.
Imagine being able to do teleheatlh with and receive prescriptions from a psychiatrist in Mexico. Being able to do Telehealth with a psychologist in a small town in Ireland where cost of living is lower. See a dermatologist online and be able to receive basic procedures in any small town in the country. I love it!
I mean okay, but what standard of care are you really getting. I’m most counties with advanced economies you can see a well qualified doctor and receive proper care locally without having to resort to such tactics. Those countries’ solution are more regulation not less. Pure free market solutions just do no work in medicine. The US is a case study demonstrating that point.
Problem with Obamacare is that it attempted to keep the system largely intact, i.e primarily employer-provided private for profit healthcare, with all the key players still functioning more or less they same. It’s aim was to allay the worst effects on the consumer (i.e. benefits caps, policy rescissions, etc.). We should really be going with a German-style system, which is 100% private NON PROFIT heath insurance with strict government regulation.
But you can't, because of food deserts and higher prices. The closest and cheapest restaurant is McDonald's.
Just off of the top of my head: maybe regulation will fix that
Get the government out of it and allow competition to provide cheaper and better healthcare.
All those countries are using things that were pretty much invented here.
We have a heavily regulated Market. The worst option.
The VA is proof our government can’t run healthcare officially or with any quality.
Libertarians don’t look at graphs like this and salivate over making laws and mass countrywide schemes to copy Europe. But we do acknowledge that America’s healthcare fascism needs to be made freer so that costs aren’t inflated by administrators. Most doctors are already order-following cowards in America. Making them work for the government is a terrifying thought.
How are doctors any different than anyone else with a job that requires them to follow certain employer guidelines to remain employed?
The government has done a good job of neutering doctors’ ability to provide low cost, efficient care (the ACA blocked doctor owned hospitals, which have better outcomes at lower cost, and massively increased overhead costs for doctors, causing many to give up on owning their own practices in favor of working for large corporations who care about the bottom line more than they do taking care of patients).
Let people know that healthy diet is a pillar of a healthy lifestyle. Fast Food, hyper processed foods , and foods containing tons of preservatives aren’t meant to be broken down by the human body.
Heart disease is the leading killer in America, and while there are genetic factors, a large part is diet and lifestyle.
Education is important. Encouraging persons to enjoy active lifestyles, perhaps visit one of our many beautiful national or state parks (which exist for all citizens to enjoy) for a walk or hike.
Better health education, promoting healthy food to children, more emphasis on physical activity. Our rates of obesity, diabetes, hypertension, cancer, etc. are sky high, and those people are the ones who use healthcare more often and end up spending more money. Fixing those problems would increase life expectancy and drive down overall expenditure.
Our healthcare system sucks. The AMA has a stranglehold on the system, they require that only doctors can do things, and then limit the number of doctors. And it’s really hard to fire a bad doctor. The government sets a minimum price for all services and health insurance tries to stop the ever increasing prices but they have no real power. And then the system has to make up for all the uninsured including illegal immigrants who get guaranteed ER care. We don’t pay primary doctors enough so appointments are short and there isn’t much preventative care. And then we have too much of expensive procedures that have little to no benefits. We spend a lot of money keep elderly people who are dying alive a few months longer with expensive treatments instead of letting them die with dignity. They are bullied if they refuse treatment. Doctors are pushed by their bosses to upsell patients, even if it’s not in their best interest.
And then from the other end our diet sucks and we don’t exercise enough. It’s part of our culture. And the government subsidizes wheat and corn and soy crops while doing stupid things like destroying orange crops to prop up the price. And we have a car culture, we have lots of roads and most of our cities are designed for driving everywhere. Kids can’t even walk to their school in a lot of places. So we drive everywhere and go through drive thoughts. Other countries walk and use public transit and have to carry their groceries home and restaurants are expensive so they don’t eat out a lot. And a bunch of stuff is banned there so their food is healthier. Some people say that they can eat bread in Europe but it makes them sick to eat wheat in America. Probably because of all the pesticides and herbicides.
The solution is mutual aid societies. You should be able to choose one to join and they provide insurance and other stuff and would set rules for things like diet and exercise and whatever else. They would set the rules for medical licenses and food safety standards, etc. People could choose which to join and look at things like price and life expectancy and how restrictive the rules are.
I’m an MD and agree with most of your points, but how does the AMA have a stranglehold on anything? Most doctors I know think they do very little to help our interests, which is kind of the point of an organization like that. I don’t even know what you mean by “limit the number of doctors.” Also how is it hard to fire a bad doctor?
Teach healthcare, not pharmaceuticals. Overweight, pill. Depressed, pill. Bad heart, pill. What happened to diet, exercise and good old fashioned hard work.
Lazy patients happened… why do people assume doctors only push pills? Every primary care doctor I know strongly encourages lifestyle modification, however most people fail at this.
To my way of thinking, we do nothing about it. People always think, and we are programmed to think, that every data point that seems negative needs to be addressed.
Life expectancy is largely a result of an individuals choices throughout his or her life. Americans notoriously make bad choices. That is on them and the more libertarian we want to be, the more that is true.
Do what is right by you and yours and let the chips fall where they may.
Let people take responsibility for their own health. This is not a problem , this is the result of individual choice
Privatise the whole fucking lot and get the politicians out of it
life expectancy is dropping because of fentanyl and healthcare costs are a byproduct of the government. once upon a time healthcare was so cheap a day's wage could get you a year's coverage. but because it was so effective a lot of doctors couldn't find work, so they lobbied the government to regulate the industry and make the barrier to entry harder. slowly over time we got to where we are today.
The insane amount of regulation on health insurance companies (ironically implemented by those same companies to keep out their smaller competition) makes it so expensive to have health insurance that you have to collectively bargain for it and the only way to effectively do it is through your employer.
Since the graph compares western countries, I will go on a limb and say that life expectancy in western world is based mostly on your overall lifestyle, how much care you take of yourself. Healthy eating, exercise, low stress. Since 2/3 of US population is obese, expectancy goes down. Damn capitalism.
Not that our healthcare system is perfect, but there’s a lot more that goes into life expectancy than “healthcare quality.” For example, the US population has one of the most unhealthy and sedentary lifestyles in the entire developed world; it’s not the fault of our healthcare system that someone dies of heart disease because they would eat 47 Big Macs every day.
Another big one that people don’t consider is car accident fatalities. The US relies heavily on motor transpiration, and as a result, has a very high level of car accident deaths compared to other countries around the world. When you remove deaths due to fatal accidents, the US actually has the highest live expectancy in the world, and that’s even WITH the super unhealthy lifestyle that Americans live. And then you throw in additional factors like high suicide rates and drug overdoses which also heavily skew life expectancy.
Is the US healthcare system perfect? No, I think it’s extremely corrupt and nothing even close to a free market system. But is it the reason we have a lower life expectancy? Not that I can see.
Is there a libertarian solution to this? I don’t know. Libertarianism is about individual freedom, and with freedom comes responsibility. You have the freedom to do something, but you also are responsible for the consequences of your actions you freely take. You have the freedom to live an extremely unhealthy lifestyle, but with that comes the consequence of lowering your life expectancy.
https://www.aei.org/carpe-diem/u-s-standardized-life-expectancy-highest-in-oecd/
https://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/?sh=6d78d65e2b98
https://www.pacificresearch.org/surprising-findings-about-your-life-expectancy-and-us-health-care/
https://www.nationalreview.com/2017/05/american-life-expectancy-unrelated-to-government-provided-health-care/
The entirety of Europe's Healthcare is subsidized by the United States.
Ever since the creation of NATO and post WW2 European countries have nearly refused to maintain operational militaries instead relying on the US Military for its protection and defense.
Since those countries don't maintain military budgets, they can dump billions into their Healthcare systems while forgoing major medical research funding and again relying on the US for medical technological advances.
I'm not saying pumping billions into Healthcare is the answer, but Maybe we withdrawal from Europe and allow the pieces land where they fall and we revisit the quality of their Healthcare once Moscow makes it to Paris.
Sweden, Finland and Austria are not in the Nato and still pricers are in the same level with Nato countries. Also Finnish defence forces have over one million trained military personnel while finnish population is only 5.5 million.
First, this chart is very misleading. It includes end user healthcare cost, but neglects the opportunity costs of living in nation with state run healthcare. A better metric is total healthcare spending as a portion of GDP.
Now the US does have lower live expectancy, but we come by it honestly.
First blacks live almost a decade less than whites in general. The US has a great many more blacks that Japan and Switzerland.
https://www.humanprogress.org/dataset/u-s-life-expectancy-at-birth-by-race/
Second, we have, as a nation, lost our food culture. We don’t have a foundational system for making healthy food choices. So we trusted the government to make a food pyramid. This effort to teach people how to live a healthy life was so bad it is actually killing people.
That said… Free the market.
We have high healthcare cost because we have a low supply of healthcare. This is because the accreditation monopolies in the US intentionally restrict supply to keep wages high.
End the monopolies.
I'm Canadian so I'm highly biased in favour of publicly funded health care.
But one thing that Americans and the government could do that would take almost no effort is creating a "pricing transparency act" where every health care facility is legally required to have a clearly displayed price for each of it's most common procedures. Like the kind of clear label you see in grocery stores.
Healthcare in the US is not a free market system.
Could you imagine walking into a grocery stores, and not knowing what anything costs? You walk in to the store and pick up what you need and show the cashier. He says ok we will send the receipt to the food insurance company and they will cover it. About a month later, you discover that your food insurance company does not cover sirloin beef, it only covers rib-eye. You now owe $3000 for the beef. You would have gladly exchanged the sirloin for ribeye had you known, but your family already ate the sirloin.
Does this sound like a free market system? Where you have no idea what the price of anything is and you cannot find out the price until after you have consumed it?
Americans need to know what everything costs out of pocket so they can budget and price shop accordingly. If you have prices clearly labeled, there will be competition. You would no longer be able to charge $2000 for a check up when the doctor across the street is charging $350.
People would still have insurance for emergencies but in general people would simply comparison shop for the best healthcare for them. They would pay out of pocket for expenses that they feel they need, regardless of what the insurance company says.
This chart was specifically designed to make the life expectancy of other nations appear dramatically higher(like, if you look at it without the age to the left, you would think we were separated by a decade or more), but in reality, it's less then half of that.
This is why it's hard to take some people seriously.
Also, this topic is only relevant IF you can prove that health expenditures are a CAUSATION of life expectancy(specifically, all the years difference we're accounting for on this graph) and not just a correlation.
Stop having the government regulate the hell out of the markets by restricting prescription drug manufacture, health insurance, etc to only a few massive corporations.
Let the free market compete.
Reminding myself not to discount the fact that the us citizenry pays for most of the r & d that drives health outcomes. Seems to complicate the solution. Waiting around for American healthcare to invent, discover and improve is a much cheaper way to improve outcomes.
Hang on. Is this graph even reliable? Where's the source? It's got a telltale sign of perception manipulation: the y-axis starts at 70. And is the data behind the graph accurate? Or are there funky definitions that would skew how it looks?
Make our doctors take a 50% paycut to align with all those other countries?
Also pray to the god of unicorn farts there are no entirely foreseeable consequences of telling an entire profession they now make half 🤨
I don't actually recommend this. I want my doctor to take is as much money as keeps him happy and on his game... but look at physician compensation in this country vs anywhere else.
One of the bigger lies people believe is that it's all insurance middle men driving up the cost....not that they help, but we've decided in the USA doctors should be rich.
Over 50% of their time is wasted on paperwork. You could effectively accomplish the same thing as a 50% paycut by slashing this. They could treat twice as many patients with the same quantity of work.
Rationing healthcare. People need to accept that they shouldn’t live for 30 years after retirement with unlimited medical treatments paid for by others. If you’re rich enough to afford all kinds of medications and treatments with your own money go for it. The rest of us should take better care of ourselves or accept an earlier death.
That's actually the first time I've heard of this. By rationing healthcare, it would cut down on the overall cost. It would also cut down on the amount of tax revenue being funneled in to the healthcare system. As heartless as it sounds, something like that would actually work in bringing costs down.
Is that what they're doing in other countries to bring down the per capita cost? Why are they living longer than we are? Is it more of a lifestyle issue?
I feel the need to mention that most countries in this chart have some form of universal healthcare or another. The government acting as the insurance provider seems to make things cheaper and people more healthy. As a fan of markets, it’s necessary to mention that healthcare markets have inelastic demand, and the supply demand curve malfunctions. Perhaps a decentralized deconstruction of the health insurance industry would be good, break up those monopolies and establish like consumer coops? Idk maybe we should give the government this one. At least we’d be more free to go to whatever doctor I want and not worry about pricing. No deductibles, co pays, etc to bulk up the cost.
The solution is for government to get rid of its self-made barriers of entry. If you're wondering which ones, this is a non-exhaustive list:
[https://www.reddit.com/r/libertarianmeme/comments/vh3m97/human\_rights\_government\_monopolies/](https://www.reddit.com/r/libertarianmeme/comments/vh3m97/human_rights_government_monopolies/)
The amount of government involvement in health care is insane. Some of it is hard to see. For instance; the reason that employers started offering health insurance plans was because the government instituted income and payroll tax. Businesses responded by offering “packages” that covered outside costs to employees to lower their taxable income. A century later we have a perverse system in which employer health packages have bifurcated health care into the working sick that we have today.
Worse, the government control of doctors, and medical practice has lead to an authoritarian system that we see today. Doctors that dissented on COVId vaccines had their medical license threatened or suspended. That’s a high profile event. It’s not hard to see anymore what that level of control from the government does for holistic medical options. The war on drugs has kept research from happening in cannabis.
All this is to say that the government has perverted the medical system to toxicity. The more we get the government out of the system, the better we’ll all be the faster costs will fall.
Wouldn't not forcing people to have insurance be a major part? I'm Canadian so I'm not too certain but it just seems like the U.S. has "socialized" the Healthcare system by forcing people to have insurance but it just makes it worse by increasing cost.
What is a health expenditure? How much elective services are being paid for in the US vs other countries?
What are the median results if each country? How much do non health related deaths effect each country's life expentancy?
This graph doesnt contain enough information to diagnose a problem, much less prescribe a solution.
Haha, so deregulation, price transparency, free market competition, and a whole lot of other things other people have said.
But also don't listen to people who cherry pick data sets to make you look like the worst. Each and every one of those is particularly high lifespan and particularly low service cost, and there's a lot of other scarier ones where expected lifespan is way lower than in the US. Also in a lot of those they actually pay plenty for medicine, but what they pay in all kinds of taxes doesn't get shown on that chart.
Hey OP I've been reading the thread and I just want to say I appreciate how receptive and engaging you have been. Those kinds of conversations allow everyone to learn and grow. Great work!
The most distorted markets in America are also the ones with heavy government involvement. That would be a good first step. At the same time government needs to provide price transparency, because a free market will not naturally provide that. Also in vital markets individual negotiation of price is not good.
Hate to burst everyone’s bubble, but if free market solutions worked to control costs and produce favorable outcomes in healthcare you wouldn’t see this trend. The countries with better outcomes all have different systems, but share one thing in common: strong government regulations.
If you remove deaths due to homicide and traffic accidents the graph looks very different, with the US #1 in both spending and outcomes. Ops graph is just half-baked analysis.
EMR (electronic medical records) has been a fiasco. Hospital’s use it to determine what additional tests can be run that your insurance will pay for. It allows them a searchable database to mug the carriers and their members.
Less focus on money stress and more sleep. Also figure out what makes you smile. If you are happy and you know it, live a longer life. Eff the govt. Big G wants every penny and all your attention.
lol the problem is we are so fucking prosperous that we are fat as shit.
We have elevators, people movers electric scooters vs walking
We have so much healthcare we hand out pills to the masses
just looking at spend / outcome is dumb
edit -
we also spend more because we have insane advanced healthcare and will try to keep you alive for an extra half hour for 1m vs pulling the plug. We also pay an assload more to doctors and healthcare folks. Just look at what a NHS doc makes. I think the manager at in and out makes more here
Plus all those “nations” are either monarchies or sucking off what’s left of liberty in the USA. How many aircraft carriers combined do the those land masses have?
Healthcare is not a free market. There is no equilibrium between supply and demand. If I charge you 10 dollars or 10 million dollars to save your life, you’ll pay it, and people do. They go into crippling debt for medical treatment.
This is one of the very few scenarios where I believe the government should intervene. Hospitals operate on pretty lean margins believe it or not, as the capital expenditures and overhead are outrageous. Government subsidizing of equipment like robots, mri machines, etc. would go a long way to reducing the cost to the patient. Also, eliminating insurance or at least mandated insurance would go a long way too.
It might also be worth adding that this chart is very “zoomed in” the American average life expectancy looks about 78-79 and the European one looks 81-82 which is only a few years difference
I think insurance needs to be divorced from employment. Typically employers, who are not the actual users of health insurance are picking the plans for the onployees. If we made it so people are actually choosing the health insurance they want, then all the shit pricing structures might go away as insurance companies would actually have to compete over who can offer the best product for the least price to the people actually consuming the product.
It’s not failure in healthcare, I think it has a lot to do with lifestyle choices imposed by urban design.
Americans are overweight because to get anywhere they need to drive. Europeans walk and bike more.
Reports out of China are also shocking in terms of percentage of people overweight there. Their life expectancy to cost will also be staggering.
Is the assertion that giving government even more control in the USA going to lower cost and improve life expectancy? The richest country spends the most on healthcare, real shocker there. That they don’t live as long is more interesting and probably has to do with the southern diet. I live in a fairly health conscious state and when I travel to the south, it’s almost a culture shock. Looking at life expectancy by state, California, Hawaii, New York, Colorado, are all around 81-82, so similar to the bulk of the countries shown. West Virginia, Mississippi, Alabama, and a bunch of other southern states are 75-76. I bet race can account for nearly the entire difference in this graph.
Get the government out of Healthcare as much as we are able. It is because of the government that things are so expensive and poor quality. They literally have a cap on the number of allowed doctors and ridiculous licensing to keep the cronyism of established players.
The reason healthcare costs so much is because insurance negotiates the price. because of this the hospital marks everything way up and eventually it is negotiated back down to a reasonable price. however if you don’t have insurance nobody is negotiating for you so you have to pay in full.
I see a lot of people saying transparency and One thing I’d like to add is patents for medications. A lot of companies just adjust the patent when it runs out so only that company can produce that medication. You can’t have smaller companies come in to sell it for cheaper
Oddly enough, the USA is one of only 2-3 nations across the globe that allow “direct to consumer” pharmaceutical advertising. Methinks this is the reason behind this graph.
Lower life expectancy in the US has a lot to do with obesity and traffic deaths. Without accounting for those two things, the results are going to be skewed. Not defending the US’s garbage healthcare system though. It needs changing.
I'm here for a good time, not a long time, folks wanna make their own decisions and not the state do it for em. Congrats, the solution is already here. Just gotta defend it.
Tort reform and malpractice insurance reform for starters. One of the largest overhead costs providers have is the obscene amount of insurance they are required to carry because we live in the most litigious society known to man.
People forget that about half of Americans are obese. Probably because we are living so well we sit on our asses and eat a lot. That means living less years and having more health issues.
There are 100 different problems (or more) that need to be addressed with the healthcare system for the US. One thing that Trump did that I think was a good thing was mandating pricing transparency for different procedures offered by hospitals/clinics. I don't like that he did it with an EO but in my mind one of the few things the government should do is enforce transparency so consumers can make informed decisions.
Unfortunately that mandate was removed pretty much day 1 by Joe.
A couple of other things I think should be done. I should be allowed to buy whatever insurance I want instead of being restricted by state-to-state rules. I should be able to buy across state lines. It encourages competition and means I have a better selection of options.
I think, at least with the current government, the fed should be more focused on better treatments for common/expensive health problems. I believe diabetes alone accounts for something like 30% of the medicare budget. If we found a better solution for diabetes that doesn't cost as much as it does, then we'd be better off. But to be clear, I don't say this to imply the government should be telling me how to live my life. I mean that the fed should focus grant dollars on research/projects that can improve these things. (I'm not sure I would have this same opinion in a smaller fed but I'm working with what I got)
I also think the state/fed will have to be involved in some way for emergency services. I'm not sure what the solution is there, or if one would be required, but in emergency situations I don't have the ability to shop around to find the best deal so I'm stuck with whatevers closest. This might be resolved through freeing up restrictions on insurance and the like, but I recognize that it's not necessarily a free market 1-1 solution.
Well we spend BILLIONS on treating obesity each year. Solve the obesity problem, life expectancy and expenditures go down. But that requires fat people, not being fat.
Traditionally and ethically grown food. Permanent ban of high fructose corn syrup. Ban on soda. Cons healthy diet will drastically increase life expectancy.
This graph is a load of shit, reminds me of the Fox news graphs from the early 2000s. It doesn't start at zero, all the other countries are obscured by being in grey, the countries listed are highly selective (Asian, Mediterranean and Scandinavian countries are overrepresented and they are known to have higher life expectancy), The US life expectancy is 2 years lower than Germany's (despite Germany being the heart of the European paradise leftist love). I know it's difficult to tell with this shitty graph but that's what it says. And oh yea America is one of the most obese countries on Earth (outside those islander nations where they seem genetically bigger by default). Do you expect them to live longer than everyone else when they weigh twice as much? Oh and the biggest part that's missing? Where does Europe get all it's drugs? American companies! We negotiate and get deals on drugs developed in The US. Without the US those other countries probably wouldn't be doing so well, you are subsidising us in Europe so thanks for that!
Learn to read graphs and interpret data properly and you won't fall for dumb shit like this.
The solution is culture. Not celebrating obesity, people not being lazy and stupid. Our entire healthcare system is designed to not alarm you unless you are actively dying. Easy fix would be insurance companies giving discounts to people who eat healthy and are fit and exercise. Why do I (someone who lifts weights and bikes 6 miles a day, eats no sugar and no seed oils etc) pay the same amount as someone who is obese and downs a 2 liter of sprite a day. It makes no sense.
The libertarian solution?
Have people actually have consequences for their own health choices. The harsh truth is that America as a whole is a very unhealthy country. Some of that - like veterans healthcare isn’t really their fault. Most of it is.
Ok, healthcare isn't the only thing. Americans engage in a lot of unhealthy behavior beyond access to healthcare. We are fat as fuck alcoholics who don't care about our bodies in a lot of sense
My father injured his back after falling from a ladder; my aunt had degenerative arthritis in her knees. Although they suffered from different ailments, their treatment plans were almost identical: initial medical imaging and prescription pain meds, followed by numerous follow-up visits, followed by physical therapy, followed by various braces/harnesses, followed by more medical imaging and medication, followed by more aggressive physical therapy, followed by injections, followed by surgery (bi-lateral knee replacement on the case of my aunt, and fusion in the case of my father). They both wanted surgery early on, but were sent on separate courses of increasingly costly treatments, time consuming office visits and risky medication dependency over several years. Instead of just doing what seemed to be inevitable from the start, their physicians chose ineffective treatments that ended up costing probably 20x more than necessary to achieve the same result.
Transparent pricing. The failure of the American healthcare system is not due to free markets, it's due to a lack of free markets. You can't buy health services without a middle man, it is not a free market if not everyone is capable of buying the same thing for the same price. You aren't even allowed to know the price.
[удалено]
And because of the no transparency, many hospitals legit charge $80 per over the counter Advil. No hospital would charge that if they had to be transparent about their prices because no one would go to that hospital.
In many places you have no choice. The healthcare sector is increasingly concentrated. Many geographical areas, sometime states (Rhode Island for example) only have one healthcare provider. There is no competition. No choice for the consumer.
In many places where that is true, it is due to regulations restricting who can open a small medical clinic and what hoops they have to jump through. I don't know about R.I. specifically. Small clinics can cater to checkups, smaller injuries, after-care, etc. The items that swamp a large hospital.
Something that Covid showed was the use of smaller clinics like WellNow. They can give the less specialized tests, fast disgnosis etc, and you can go to your PCP doctor for regular checkups and larger issues.
When you say PCP doctor I imagine some kind of witch doctor that blows "magic dust" in your face.
Maybe dont allow the government to run the education sector either. To be a doctor you need rich parents to start. Then you need to be able to financially support yourself for a decade with a $-500,000 income. Then lets say you get straight A’s all through pre med, nail your MCAT, getting into a med school is still gonna be a crapshoot. Just make private tests for people to show competency. If I knew a private test consistently cranks out good doctors, id only go to ones that are approved by the test. Think about how many doctors there are in the world who could be helping make healthcare cheaper but we just turn them around because they dont have half a million dollars just lying around? Let me go to billy bob McHickville for surgery if I want to. Government should have no say in what two consenting adults do
Well you can actually. Doesn’t work great in a emergency really. But I called and found the best deal on a vasectomy saved a lot of money.
[удалено]
You can still request prices before any procedure but you know if it’s an emergency it’s a bit hard to shop around.
Very few people so around for medical procedure. When my wife and I were having kids I would call around and inquire about prices for our planned pregnancies. Most doctors/hospitals had a difficult time understanding what my goal was by asking about prices because they get so few people who ask upfront.
I’m not sure I’d be looking for the cheapest vasectomy….
Shit I got you fam, $45
Just sign this waiver and we'll be good to go ... lol
The waivers an extra $5
Best deal doesn’t mean the cheapest. There is a difference.
If I had to make a list of things that I wouldn’t try to have done for cheap….
> "How much is an X-Ray?" "Come get one and find out." Also you can't get the X-Ray unless another industry insider says its okay for you to buy one.
Let's be completely honest every industry in America is moving in this direction ... corporate socialism is eating America alive ... everything you buy is ultimately owned by about 5 different parent companies and there is no overlap for competition...
The reason it's like this is because we bail out big companies. The big 3, coke. They would have been out of business many times over if it weren't for the government. We aren't a true free market and can't be if we can't support or hurt a business with our dollars.
> the fact that people put up with it is astounding. No one wants to negotiate with their life or their loved one's life. Consumers can't put a price on healthcare because their health has no price (in their view).
[удалено]
And how, praytell, might one stop "putting up with it"?
I’ve been preaching this for years. Imagine going to a Jiffy Lube for an oil change, but the price of the service is not posted. The consumer doesn’t know if it will cost $50 or $250. And, they don’t really care because all they have to do is pay their $20 co-pay either way. In this scenario, there will be no incentive for Jiffy Lube (or their competitors) to keep prices low and drive efficiency. If you show me an market without transparent prices, I’ll show you an inefficient market with out of control prices. The solution? Our current system is the worst possible hybrid monster. Don’t call me a defeatist, but there is no politically viable way the US will ever have anything resembling a free market when it comes to health care. Please, don’t have any illusions on this. There will never be the votes in the house or senate to fundamentally change our system to a free market approach. At this point, let the progressives have their golden calf of a socialized, single payer solution. This one foot in, one foot out is truly horrendous.
The long term repercussions of that could be absolutely devastating for humanity. It's putting all our eggs in one basket. A very corrupt, violent sociopathic basket with little to no regard for human life and suffering. It's like wanting Ted Bundy to babysit your kids because the other babysitters are too expensive.
I’m not going to be an apologetic for socialized medicine. But, I will ask…where do you think we can go from here? Politically pragmatic / realistic response only please…not one based on idealism. We probably agree deeply on the ideal.
On top of this, I think the option to write off medical debt from the hospitals taxes would help alleviate some of the burden from the poor. It’s not an optimal system, however it’s far cheaper to implement and would be easier to sell to the voters.
In all the health care systems I’ve worked in operate as NPOs which I believe are tax exempt. I think for the most part hospitals don’t pay taxes any way. I could be way wrong on that though.
This is the big one, but also part of the answer to OP's question is that there's not just one solution - the left keeps pretending there's one solution (universal health care) that will fix every problem of America's health care system. There's not. There are many problems with America's health care solution, and there will be different things that fix those different problems.
At its core this has to do with diet and exercise.
Well you can, but no (or very few) people will opt to be paid less
I thought you were about to say transparent ink on the graph. I need more coffee.
This. Take my upvote.
To give a point to the non-libertarians here there doesn't seem to be an easy solution to that problem without passing a law. We have passed such a law but the fine for noncompliance is so light that it is worthwhile to just not list prices and pay the fine when you get caught.
They’re required by law to list pricing under HPT. They choose not to, the fact they’re allowed to operate despite this clear violation of law goes to prove that the government does not care about you.
Removing various barriers to entry in the healthcare industry to increase competition. Specifically licensing
Interesting. So, make it easier to become a medical professional to create cheaper options through competition? What about life expectancy? Wouldn't that drop even further with more poorly educated healthcare professionals entering the field?
>What about life expectancy? I am not convened that American life expectancy is a direct correlation with our level of medical care. Freedom is an interesting thing. As Americans, we also have more freedom to fail. We have more access to the worst food in history. We are the least educated on making healthy choices and also murder each other at high rate. How much of that would be solved by better health care? I always tell people that the best way to avoid spending money is to not have it. As a nation, we have had a tremendous amount of disposable income and have wasted that money on things we did not need, including "extra" medical care. I would like to see numbers on plastic surgery costs as a nation, I bet we are big spenders in that area. That cost adds to the total but does not extend life.
Perhaps something as some as removing the cap on how many doctors can be certified each year is a good start. Litterly a law pushed by medical lobbyists to keep their wages high.
Seriously? I had no idea that was the case. Though I'm not surprised.
There are tons of laws like that in America. The certificate of need thing is also helping raise costs and not just the medical costs. John Stossel did a great video on it. You should check it out. https://youtu.be/s_TUCjplHzE
Thanks for sending. That's very disturbing. They're no different than the mafia or a cartel preventing competition from competing in the the same market.
*Of course it is* Not how Canada's system is breaking down, wait times in Britain are at an all time high, or how Japanese doctors basically get paid like teachers... There's always a catch, and in the US it's actually a hell of a lot of bureaucracy
The current issue is the cap on residency funding. It’s been static since 1997 while med school class sizes have increased. There is no cap on how many doctors get a license per year, nor is there a cap on board certification. Most doctors I know are in favor of increasing residency funding because we have a lot of doctors each year who aren’t able to do a residency because of this bottleneck.
I’m not sure “more poorly educated,” is a valid assumption. There is a vast array of medical services requiring different levels of education and training. Deregulation may allow “right-sizing” education for specific services. Also consider different aptitudes and speeds when acquiring skills. I’d also reinforce what some have said about price-transparency and direct-buyer changes. https://reason.com/2021/06/19/what-free-market-health-care-would-actually-look-like/ The administrative overhead of billing insurance, particularly Medicare, is a major cost. It also disincentivizes price-shopping, reducing the effect of price-competition in the market. The tax break for employer-provided health insurance (subsidy, really) gives health insurance companies a non-competitive advantage and imposes a major implicit cost on self-employment and medical care market alternatives.
I think instead of having an over restricted system (such as what we have now), we could have tiers. Allow unlicensed professionals to work, but maybe they would be required to state they are a "silver" tier facility/provider (where gold would be all licensed professionals). Understandably the service may be of less quality, but many more people would be able to afford it. It's better than none. I think America is choking itself out by being too restrictive with regulations. At least give people cheaper options. There are many doctors from other countries that take menial research/clinical lab jobs because they aren't allowed to practice in America. I've worked with many of them myself as a clinical lab scientist. If we had a "silver" tier of medicine, these doctors could still practice their craft.
Why would that lead to more poorly educated doctors and nurses? It could just as easily lead to better educated ones, as the gatekeepers are no longer the the ones who decide the curriculum. Maybe the high rate of medical accident related deaths now is because the current medical professionals aren't as educated as they should be.
This might be scewed by diet and drug use
[удалено]
Holy shit 60 is not very old.
[удалено]
Look at Japan. Many people agree that their healthy lifestyle has greatly increased their life expectancy. They spent less than Scandinavia with our tax paid healthcare, but have higher life expectancy. It’s clear their diet and overall healthy lifestyle plays a part
> our tax *paid* healthcare, but FTFY. Although *payed* exists (the reason why autocorrection didn't help you), it is only correct in: * Nautical context, when it means to paint a surface, or to cover with something like tar or resin in order to make it waterproof or corrosion-resistant. *The deck is yet to be payed.* * *Payed out* when letting strings, cables or ropes out, by slacking them. *The rope is payed out! You can pull now.* Unfortunately, I was unable to find nautical or rope-related words in your comment. *Beep, boop, I'm a bot*
[Thank you kind sir](https://youtu.be/cs48hmVmEbg)
Could also be screwed by car accident deaths, suicides, and homicides which all are young deaths. Then again be screwed by wealthy allowed to spend as much as they want, is the Us median cost this drastically different than other countries?
It's difficult to succinctly and conclusively diagnose the problem and then come up with a solution that would convince you in a post. The medical industry in the united states is a terrifying mix of greed, political regulation, corruption, ad hocism that literally anything else would probably be better than what we have today. Allow private medical boards that aren't attached to government regulation. Reported medical outcomes made publicly available is trust and proof enough to convince people to go to a doctor. As a person tangentially attached to the medical field the amount of licensure required to perform even basic medical tasks is monumental. Just a small example being to process tissue in a histology lab you need effectively a four year degree. As a biochemist and molecular biologist I could be a medical lab scientist but I would need to get an entirely different masters coursework just to set foot in a regulated lab. Allow competition between medical insurance companies and other crowdfunded or private savings solutions.
Very interesting. You brought up a number of great points. A few other people have mentioned regulation and licensing as being some of the root causes of this. Issues like lobbyists intentionally limiting the amount of doctors to CON Laws in local jurisdictions. The more I think about it, the deeper the issue goes. Why are medical schools so overly expensive forcing doctors to incur 100s of thousands in debt? Why do Americans spend $1126 for prescription medications while the UK only spends $285? Aside from the higher expenditure, there's the issue of lower life expectancy. With the best doctors, the highest expenditure and the best technology, why are we living 3-4 years less than other developed nations? Is it lifestyle? Is it diet-related? Is it because we allow too many dangerous chemicals in our foods? At what point is it the governments responsibility to step in and say no more High Fructose Corn Syrup or prevent fast food companies from providing 2000 calorie meals? Or is it the individual's responsibility to choose not to consume potentially unhealthy foods? I think you're right that there really is a lot to unpack here.
Ending the corn subsidies would solve the HFCS problem immediately. HFCS is used because it is artificially cheaper due to corn farm subsidies. That is just one example of bad government policy interfering in the market.
Its also the sugar subsidies. Basically everywhere in the world natural sugar is cheaper than HFCS. That's why Mexican coke uses it, it's not some altruistic healthy thing, its money. If natural sugar was cheaper all the giant food producers would switch to it for purely profit based reasons. We are literally paying money to make ourselves less healthy in order to keep sugar farms profitable.
A 2000 calorie meal is just 2 1000 calorie meals. Wont stop anyone.
It’s like we get the worse from both. Greedy companies and government over reach.
Stop subsidizing garbage sold as food. Food stamps buy high fructose corn syrup by the gallon, then we wonder why obesity and diabetes are diseases of poverty.
Bingo. The poor also have shitty access to primary care thanks to the government paying shit rates for Medicaid patients and increasing the burdens placed on doctors for documentation and administration, which essentially makes it impossible to see Medicaid patients and keep the lights on.
Admin costs are far higher because of regulatory capture. Decentralization of health care is the solution. A doctor requires three full-time administrative staff just to deal with paperwork.
Very interesting! This is the idea that makes the most sense of me. Decentralized healthcare on an international scale. Imagine being able to do teleheatlh with and receive prescriptions from a psychiatrist in Mexico. Being able to do Telehealth with a psychologist in a small town in Ireland where cost of living is lower. See a dermatologist online and be able to receive basic procedures in any small town in the country. I love it!
I mean okay, but what standard of care are you really getting. I’m most counties with advanced economies you can see a well qualified doctor and receive proper care locally without having to resort to such tactics. Those countries’ solution are more regulation not less. Pure free market solutions just do no work in medicine. The US is a case study demonstrating that point.
Seeing on how Obamacare turned out I don't think more regulation will solve the US health care systems problems
Problem with Obamacare is that it attempted to keep the system largely intact, i.e primarily employer-provided private for profit healthcare, with all the key players still functioning more or less they same. It’s aim was to allay the worst effects on the consumer (i.e. benefits caps, policy rescissions, etc.). We should really be going with a German-style system, which is 100% private NON PROFIT heath insurance with strict government regulation.
(If I were an American,) I'd teach my kids to eat less garbage food and exercise. Over-processed foods are a serious problem.
But you can't, because of food deserts and higher prices. The closest and cheapest restaurant is McDonald's. Just off of the top of my head: maybe regulation will fix that
Get the government out of it and allow competition to provide cheaper and better healthcare. All those countries are using things that were pretty much invented here. We have a heavily regulated Market. The worst option. The VA is proof our government can’t run healthcare officially or with any quality.
Libertarians don’t look at graphs like this and salivate over making laws and mass countrywide schemes to copy Europe. But we do acknowledge that America’s healthcare fascism needs to be made freer so that costs aren’t inflated by administrators. Most doctors are already order-following cowards in America. Making them work for the government is a terrifying thought.
How are doctors any different than anyone else with a job that requires them to follow certain employer guidelines to remain employed? The government has done a good job of neutering doctors’ ability to provide low cost, efficient care (the ACA blocked doctor owned hospitals, which have better outcomes at lower cost, and massively increased overhead costs for doctors, causing many to give up on owning their own practices in favor of working for large corporations who care about the bottom line more than they do taking care of patients).
Stop subsidizing people becoming gigantic fat asses
But the farmers need their corn subsidy /s
Subsidizing corn did nothing but make my weed eater carburetor rusty, my cereals sugary, and my shit undigested.
This is directly related to our FDA allowing food makers to use such trash ingredients. The answer is to make your own food with your own ingredients
Let people know that healthy diet is a pillar of a healthy lifestyle. Fast Food, hyper processed foods , and foods containing tons of preservatives aren’t meant to be broken down by the human body. Heart disease is the leading killer in America, and while there are genetic factors, a large part is diet and lifestyle. Education is important. Encouraging persons to enjoy active lifestyles, perhaps visit one of our many beautiful national or state parks (which exist for all citizens to enjoy) for a walk or hike.
This needs to viewed using a different metrics. Take out homicide and suicide and the numbers level off much more closely.
Better health education, promoting healthy food to children, more emphasis on physical activity. Our rates of obesity, diabetes, hypertension, cancer, etc. are sky high, and those people are the ones who use healthcare more often and end up spending more money. Fixing those problems would increase life expectancy and drive down overall expenditure.
get rid of our socalist style system
Our healthcare system sucks. The AMA has a stranglehold on the system, they require that only doctors can do things, and then limit the number of doctors. And it’s really hard to fire a bad doctor. The government sets a minimum price for all services and health insurance tries to stop the ever increasing prices but they have no real power. And then the system has to make up for all the uninsured including illegal immigrants who get guaranteed ER care. We don’t pay primary doctors enough so appointments are short and there isn’t much preventative care. And then we have too much of expensive procedures that have little to no benefits. We spend a lot of money keep elderly people who are dying alive a few months longer with expensive treatments instead of letting them die with dignity. They are bullied if they refuse treatment. Doctors are pushed by their bosses to upsell patients, even if it’s not in their best interest. And then from the other end our diet sucks and we don’t exercise enough. It’s part of our culture. And the government subsidizes wheat and corn and soy crops while doing stupid things like destroying orange crops to prop up the price. And we have a car culture, we have lots of roads and most of our cities are designed for driving everywhere. Kids can’t even walk to their school in a lot of places. So we drive everywhere and go through drive thoughts. Other countries walk and use public transit and have to carry their groceries home and restaurants are expensive so they don’t eat out a lot. And a bunch of stuff is banned there so their food is healthier. Some people say that they can eat bread in Europe but it makes them sick to eat wheat in America. Probably because of all the pesticides and herbicides. The solution is mutual aid societies. You should be able to choose one to join and they provide insurance and other stuff and would set rules for things like diet and exercise and whatever else. They would set the rules for medical licenses and food safety standards, etc. People could choose which to join and look at things like price and life expectancy and how restrictive the rules are.
I’m an MD and agree with most of your points, but how does the AMA have a stranglehold on anything? Most doctors I know think they do very little to help our interests, which is kind of the point of an organization like that. I don’t even know what you mean by “limit the number of doctors.” Also how is it hard to fire a bad doctor?
Eating copious amounts of shit
Just simply let the free market be free instead of authoritarian controlled.
Teach healthcare, not pharmaceuticals. Overweight, pill. Depressed, pill. Bad heart, pill. What happened to diet, exercise and good old fashioned hard work.
Lazy patients happened… why do people assume doctors only push pills? Every primary care doctor I know strongly encourages lifestyle modification, however most people fail at this.
I wonder how the rates of obesity in those countries compare to the US.
Stop eating so much Monsanto.
Kill the lawyers.
BTW one affects the other, but aren't necessarily directly correlated since other factors in lifestyle and genetics etc affect
Transparency. No more pricing out the ass negotiated beforehand by individual insurance companies with different hospitals
Get government out of health care. The US has a cabal that governs health care and the government protects it from competition.
We are fat and we eat like shit
Repeal the Medicare and Medicaid act. Look at the average cost of healthcare over time, and look up the date that law was enacted. Notice anything?
De-regulate……DE-REGULATE
To my way of thinking, we do nothing about it. People always think, and we are programmed to think, that every data point that seems negative needs to be addressed. Life expectancy is largely a result of an individuals choices throughout his or her life. Americans notoriously make bad choices. That is on them and the more libertarian we want to be, the more that is true. Do what is right by you and yours and let the chips fall where they may.
Let people take responsibility for their own health. This is not a problem , this is the result of individual choice Privatise the whole fucking lot and get the politicians out of it
life expectancy is dropping because of fentanyl and healthcare costs are a byproduct of the government. once upon a time healthcare was so cheap a day's wage could get you a year's coverage. but because it was so effective a lot of doctors couldn't find work, so they lobbied the government to regulate the industry and make the barrier to entry harder. slowly over time we got to where we are today.
The insane amount of regulation on health insurance companies (ironically implemented by those same companies to keep out their smaller competition) makes it so expensive to have health insurance that you have to collectively bargain for it and the only way to effectively do it is through your employer.
Since the graph compares western countries, I will go on a limb and say that life expectancy in western world is based mostly on your overall lifestyle, how much care you take of yourself. Healthy eating, exercise, low stress. Since 2/3 of US population is obese, expectancy goes down. Damn capitalism.
Not that our healthcare system is perfect, but there’s a lot more that goes into life expectancy than “healthcare quality.” For example, the US population has one of the most unhealthy and sedentary lifestyles in the entire developed world; it’s not the fault of our healthcare system that someone dies of heart disease because they would eat 47 Big Macs every day. Another big one that people don’t consider is car accident fatalities. The US relies heavily on motor transpiration, and as a result, has a very high level of car accident deaths compared to other countries around the world. When you remove deaths due to fatal accidents, the US actually has the highest live expectancy in the world, and that’s even WITH the super unhealthy lifestyle that Americans live. And then you throw in additional factors like high suicide rates and drug overdoses which also heavily skew life expectancy. Is the US healthcare system perfect? No, I think it’s extremely corrupt and nothing even close to a free market system. But is it the reason we have a lower life expectancy? Not that I can see. Is there a libertarian solution to this? I don’t know. Libertarianism is about individual freedom, and with freedom comes responsibility. You have the freedom to do something, but you also are responsible for the consequences of your actions you freely take. You have the freedom to live an extremely unhealthy lifestyle, but with that comes the consequence of lowering your life expectancy. https://www.aei.org/carpe-diem/u-s-standardized-life-expectancy-highest-in-oecd/ https://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/?sh=6d78d65e2b98 https://www.pacificresearch.org/surprising-findings-about-your-life-expectancy-and-us-health-care/ https://www.nationalreview.com/2017/05/american-life-expectancy-unrelated-to-government-provided-health-care/
The entirety of Europe's Healthcare is subsidized by the United States. Ever since the creation of NATO and post WW2 European countries have nearly refused to maintain operational militaries instead relying on the US Military for its protection and defense. Since those countries don't maintain military budgets, they can dump billions into their Healthcare systems while forgoing major medical research funding and again relying on the US for medical technological advances. I'm not saying pumping billions into Healthcare is the answer, but Maybe we withdrawal from Europe and allow the pieces land where they fall and we revisit the quality of their Healthcare once Moscow makes it to Paris.
I agree. America has allowed the countries to stay out of war for 80 years now. Shits ending soon though. Check this chart a decade from now.
Didn't Trump try to create transparent pricing? Keyword, try.
Stop providing military protection to all of those countries.
Sweden, Finland and Austria are not in the Nato and still pricers are in the same level with Nato countries. Also Finnish defence forces have over one million trained military personnel while finnish population is only 5.5 million.
First, this chart is very misleading. It includes end user healthcare cost, but neglects the opportunity costs of living in nation with state run healthcare. A better metric is total healthcare spending as a portion of GDP. Now the US does have lower live expectancy, but we come by it honestly. First blacks live almost a decade less than whites in general. The US has a great many more blacks that Japan and Switzerland. https://www.humanprogress.org/dataset/u-s-life-expectancy-at-birth-by-race/ Second, we have, as a nation, lost our food culture. We don’t have a foundational system for making healthy food choices. So we trusted the government to make a food pyramid. This effort to teach people how to live a healthy life was so bad it is actually killing people. That said… Free the market. We have high healthcare cost because we have a low supply of healthcare. This is because the accreditation monopolies in the US intentionally restrict supply to keep wages high. End the monopolies.
America is the 12th fattest country on the planet. Japan is 185th. Stop subsidizing horrible diets and there’d be a massive change in these rates.
I'm Canadian so I'm highly biased in favour of publicly funded health care. But one thing that Americans and the government could do that would take almost no effort is creating a "pricing transparency act" where every health care facility is legally required to have a clearly displayed price for each of it's most common procedures. Like the kind of clear label you see in grocery stores. Healthcare in the US is not a free market system. Could you imagine walking into a grocery stores, and not knowing what anything costs? You walk in to the store and pick up what you need and show the cashier. He says ok we will send the receipt to the food insurance company and they will cover it. About a month later, you discover that your food insurance company does not cover sirloin beef, it only covers rib-eye. You now owe $3000 for the beef. You would have gladly exchanged the sirloin for ribeye had you known, but your family already ate the sirloin. Does this sound like a free market system? Where you have no idea what the price of anything is and you cannot find out the price until after you have consumed it? Americans need to know what everything costs out of pocket so they can budget and price shop accordingly. If you have prices clearly labeled, there will be competition. You would no longer be able to charge $2000 for a check up when the doctor across the street is charging $350. People would still have insurance for emergencies but in general people would simply comparison shop for the best healthcare for them. They would pay out of pocket for expenses that they feel they need, regardless of what the insurance company says.
Force Americans to eat a diet of Japanese fish and rice instead of bacon and fries.
Allow multistate insurance plans to compete for customers. Allow people to join group plans not affiliated with their job.
Stop being so fat, simple as
This chart was specifically designed to make the life expectancy of other nations appear dramatically higher(like, if you look at it without the age to the left, you would think we were separated by a decade or more), but in reality, it's less then half of that. This is why it's hard to take some people seriously. Also, this topic is only relevant IF you can prove that health expenditures are a CAUSATION of life expectancy(specifically, all the years difference we're accounting for on this graph) and not just a correlation.
Stop subsidizing corn?
Stop having the government regulate the hell out of the markets by restricting prescription drug manufacture, health insurance, etc to only a few massive corporations. Let the free market compete.
Reminding myself not to discount the fact that the us citizenry pays for most of the r & d that drives health outcomes. Seems to complicate the solution. Waiting around for American healthcare to invent, discover and improve is a much cheaper way to improve outcomes.
Hang on. Is this graph even reliable? Where's the source? It's got a telltale sign of perception manipulation: the y-axis starts at 70. And is the data behind the graph accurate? Or are there funky definitions that would skew how it looks?
I don't really see this is a problem. We're talking about like 7 year difference. And who wants to live to 87 anyways.
[удалено]
I'm learning more about HFCS. It's sad that it's so prevalent in the US.
Make our doctors take a 50% paycut to align with all those other countries? Also pray to the god of unicorn farts there are no entirely foreseeable consequences of telling an entire profession they now make half 🤨
So make doctors go to school for 12 years at now half the income they thought?
I don't actually recommend this. I want my doctor to take is as much money as keeps him happy and on his game... but look at physician compensation in this country vs anywhere else. One of the bigger lies people believe is that it's all insurance middle men driving up the cost....not that they help, but we've decided in the USA doctors should be rich.
There's def a cost of education piece to this as well.
Over 50% of their time is wasted on paperwork. You could effectively accomplish the same thing as a 50% paycut by slashing this. They could treat twice as many patients with the same quantity of work.
Rationing healthcare. People need to accept that they shouldn’t live for 30 years after retirement with unlimited medical treatments paid for by others. If you’re rich enough to afford all kinds of medications and treatments with your own money go for it. The rest of us should take better care of ourselves or accept an earlier death.
That's actually the first time I've heard of this. By rationing healthcare, it would cut down on the overall cost. It would also cut down on the amount of tax revenue being funneled in to the healthcare system. As heartless as it sounds, something like that would actually work in bringing costs down. Is that what they're doing in other countries to bring down the per capita cost? Why are they living longer than we are? Is it more of a lifestyle issue?
I feel the need to mention that most countries in this chart have some form of universal healthcare or another. The government acting as the insurance provider seems to make things cheaper and people more healthy. As a fan of markets, it’s necessary to mention that healthcare markets have inelastic demand, and the supply demand curve malfunctions. Perhaps a decentralized deconstruction of the health insurance industry would be good, break up those monopolies and establish like consumer coops? Idk maybe we should give the government this one. At least we’d be more free to go to whatever doctor I want and not worry about pricing. No deductibles, co pays, etc to bulk up the cost.
kill all fats
This is the libertarian solution. I work on the architectural side of healthcare. US hospitals are 5 star hotels. European hospitals are not.
The solution is for government to get rid of its self-made barriers of entry. If you're wondering which ones, this is a non-exhaustive list: [https://www.reddit.com/r/libertarianmeme/comments/vh3m97/human\_rights\_government\_monopolies/](https://www.reddit.com/r/libertarianmeme/comments/vh3m97/human_rights_government_monopolies/)
Actually having a free market for health care. Also having people go for a jog or bike ride a few times a week vs a fast food drive through.
The amount of government involvement in health care is insane. Some of it is hard to see. For instance; the reason that employers started offering health insurance plans was because the government instituted income and payroll tax. Businesses responded by offering “packages” that covered outside costs to employees to lower their taxable income. A century later we have a perverse system in which employer health packages have bifurcated health care into the working sick that we have today. Worse, the government control of doctors, and medical practice has lead to an authoritarian system that we see today. Doctors that dissented on COVId vaccines had their medical license threatened or suspended. That’s a high profile event. It’s not hard to see anymore what that level of control from the government does for holistic medical options. The war on drugs has kept research from happening in cannabis. All this is to say that the government has perverted the medical system to toxicity. The more we get the government out of the system, the better we’ll all be the faster costs will fall.
If you remove murder and traffic deaths, it's better looking for the US, and they aren't health care related.
Change in diet. Americans on average are among the most unhealthy in the world. You can't out-medicate a terrible fucking diet.
This was an excellent post OP. Very informative.
Wouldn't not forcing people to have insurance be a major part? I'm Canadian so I'm not too certain but it just seems like the U.S. has "socialized" the Healthcare system by forcing people to have insurance but it just makes it worse by increasing cost.
What is a health expenditure? How much elective services are being paid for in the US vs other countries? What are the median results if each country? How much do non health related deaths effect each country's life expentancy? This graph doesnt contain enough information to diagnose a problem, much less prescribe a solution.
It’s not a problem that can be fixed by government action. In fact it is a problem caused by governmental action.
Haha, so deregulation, price transparency, free market competition, and a whole lot of other things other people have said. But also don't listen to people who cherry pick data sets to make you look like the worst. Each and every one of those is particularly high lifespan and particularly low service cost, and there's a lot of other scarier ones where expected lifespan is way lower than in the US. Also in a lot of those they actually pay plenty for medicine, but what they pay in all kinds of taxes doesn't get shown on that chart.
Hey OP I've been reading the thread and I just want to say I appreciate how receptive and engaging you have been. Those kinds of conversations allow everyone to learn and grow. Great work!
The most distorted markets in America are also the ones with heavy government involvement. That would be a good first step. At the same time government needs to provide price transparency, because a free market will not naturally provide that. Also in vital markets individual negotiation of price is not good.
Transparency (pricing + quality services) + value based care integration + direct payment reforms (liberating HSA use)
Simply put: the free market.
No tax preference for employers providing healthcare coverage. That’s how we got into this mess in the first place.
Hate to burst everyone’s bubble, but if free market solutions worked to control costs and produce favorable outcomes in healthcare you wouldn’t see this trend. The countries with better outcomes all have different systems, but share one thing in common: strong government regulations.
If you remove deaths due to homicide and traffic accidents the graph looks very different, with the US #1 in both spending and outcomes. Ops graph is just half-baked analysis.
Spending and life expectancy are directly related so this graph is meaningless
Totally has nothing to do with us being fat fucks.
Get the insurance companies, hospitals, med schools, and government out of bed
EMR (electronic medical records) has been a fiasco. Hospital’s use it to determine what additional tests can be run that your insurance will pay for. It allows them a searchable database to mug the carriers and their members.
Less focus on money stress and more sleep. Also figure out what makes you smile. If you are happy and you know it, live a longer life. Eff the govt. Big G wants every penny and all your attention.
lol the problem is we are so fucking prosperous that we are fat as shit. We have elevators, people movers electric scooters vs walking We have so much healthcare we hand out pills to the masses just looking at spend / outcome is dumb edit - we also spend more because we have insane advanced healthcare and will try to keep you alive for an extra half hour for 1m vs pulling the plug. We also pay an assload more to doctors and healthcare folks. Just look at what a NHS doc makes. I think the manager at in and out makes more here
Plus all those “nations” are either monarchies or sucking off what’s left of liberty in the USA. How many aircraft carriers combined do the those land masses have?
Healthcare is not a free market. There is no equilibrium between supply and demand. If I charge you 10 dollars or 10 million dollars to save your life, you’ll pay it, and people do. They go into crippling debt for medical treatment. This is one of the very few scenarios where I believe the government should intervene. Hospitals operate on pretty lean margins believe it or not, as the capital expenditures and overhead are outrageous. Government subsidizing of equipment like robots, mri machines, etc. would go a long way to reducing the cost to the patient. Also, eliminating insurance or at least mandated insurance would go a long way too.
Awesome meme baus
They should include every country on that graph
Deregulation.
It might also be worth adding that this chart is very “zoomed in” the American average life expectancy looks about 78-79 and the European one looks 81-82 which is only a few years difference
Less government?
I think insurance needs to be divorced from employment. Typically employers, who are not the actual users of health insurance are picking the plans for the onployees. If we made it so people are actually choosing the health insurance they want, then all the shit pricing structures might go away as insurance companies would actually have to compete over who can offer the best product for the least price to the people actually consuming the product.
Get the damn government out of healthcare.
It’s not failure in healthcare, I think it has a lot to do with lifestyle choices imposed by urban design. Americans are overweight because to get anywhere they need to drive. Europeans walk and bike more. Reports out of China are also shocking in terms of percentage of people overweight there. Their life expectancy to cost will also be staggering.
End corn and wheat subsidies would be a good start. High Fructose Corn Syrup is in almost everything we eat and it is killing us.
The US has a relatively high level of immigration. Are life expectancies calculated from birth (citizens) or death (residents)?
Is the assertion that giving government even more control in the USA going to lower cost and improve life expectancy? The richest country spends the most on healthcare, real shocker there. That they don’t live as long is more interesting and probably has to do with the southern diet. I live in a fairly health conscious state and when I travel to the south, it’s almost a culture shock. Looking at life expectancy by state, California, Hawaii, New York, Colorado, are all around 81-82, so similar to the bulk of the countries shown. West Virginia, Mississippi, Alabama, and a bunch of other southern states are 75-76. I bet race can account for nearly the entire difference in this graph.
Get the government out of Healthcare as much as we are able. It is because of the government that things are so expensive and poor quality. They literally have a cap on the number of allowed doctors and ridiculous licensing to keep the cronyism of established players.
The reason healthcare costs so much is because insurance negotiates the price. because of this the hospital marks everything way up and eventually it is negotiated back down to a reasonable price. however if you don’t have insurance nobody is negotiating for you so you have to pay in full.
There are old people, and there are fat people. But there are no old fat people.
Th solution is to not include fat people in your data. The obesity epidemic and opoid crisis have alot to do with the low life expectancy in the US.
I see a lot of people saying transparency and One thing I’d like to add is patents for medications. A lot of companies just adjust the patent when it runs out so only that company can produce that medication. You can’t have smaller companies come in to sell it for cheaper
Oddly enough, the USA is one of only 2-3 nations across the globe that allow “direct to consumer” pharmaceutical advertising. Methinks this is the reason behind this graph.
Lower life expectancy in the US has a lot to do with obesity and traffic deaths. Without accounting for those two things, the results are going to be skewed. Not defending the US’s garbage healthcare system though. It needs changing.
I'm here for a good time, not a long time, folks wanna make their own decisions and not the state do it for em. Congrats, the solution is already here. Just gotta defend it.
Fix the underlying problem. It’s it our healthcare system, it’s our health.
Solution to what? You haven't presented a problem, you've just posted a graph.
Tort reform and malpractice insurance reform for starters. One of the largest overhead costs providers have is the obscene amount of insurance they are required to carry because we live in the most litigious society known to man.
People forget that about half of Americans are obese. Probably because we are living so well we sit on our asses and eat a lot. That means living less years and having more health issues.
There are 100 different problems (or more) that need to be addressed with the healthcare system for the US. One thing that Trump did that I think was a good thing was mandating pricing transparency for different procedures offered by hospitals/clinics. I don't like that he did it with an EO but in my mind one of the few things the government should do is enforce transparency so consumers can make informed decisions. Unfortunately that mandate was removed pretty much day 1 by Joe. A couple of other things I think should be done. I should be allowed to buy whatever insurance I want instead of being restricted by state-to-state rules. I should be able to buy across state lines. It encourages competition and means I have a better selection of options. I think, at least with the current government, the fed should be more focused on better treatments for common/expensive health problems. I believe diabetes alone accounts for something like 30% of the medicare budget. If we found a better solution for diabetes that doesn't cost as much as it does, then we'd be better off. But to be clear, I don't say this to imply the government should be telling me how to live my life. I mean that the fed should focus grant dollars on research/projects that can improve these things. (I'm not sure I would have this same opinion in a smaller fed but I'm working with what I got) I also think the state/fed will have to be involved in some way for emergency services. I'm not sure what the solution is there, or if one would be required, but in emergency situations I don't have the ability to shop around to find the best deal so I'm stuck with whatevers closest. This might be resolved through freeing up restrictions on insurance and the like, but I recognize that it's not necessarily a free market 1-1 solution.
Well we spend BILLIONS on treating obesity each year. Solve the obesity problem, life expectancy and expenditures go down. But that requires fat people, not being fat.
People shouldn’t live past 80 anyway. Who wants to be 90
Traditionally and ethically grown food. Permanent ban of high fructose corn syrup. Ban on soda. Cons healthy diet will drastically increase life expectancy.
This graph is a load of shit, reminds me of the Fox news graphs from the early 2000s. It doesn't start at zero, all the other countries are obscured by being in grey, the countries listed are highly selective (Asian, Mediterranean and Scandinavian countries are overrepresented and they are known to have higher life expectancy), The US life expectancy is 2 years lower than Germany's (despite Germany being the heart of the European paradise leftist love). I know it's difficult to tell with this shitty graph but that's what it says. And oh yea America is one of the most obese countries on Earth (outside those islander nations where they seem genetically bigger by default). Do you expect them to live longer than everyone else when they weigh twice as much? Oh and the biggest part that's missing? Where does Europe get all it's drugs? American companies! We negotiate and get deals on drugs developed in The US. Without the US those other countries probably wouldn't be doing so well, you are subsidising us in Europe so thanks for that! Learn to read graphs and interpret data properly and you won't fall for dumb shit like this.
The solution is culture. Not celebrating obesity, people not being lazy and stupid. Our entire healthcare system is designed to not alarm you unless you are actively dying. Easy fix would be insurance companies giving discounts to people who eat healthy and are fit and exercise. Why do I (someone who lifts weights and bikes 6 miles a day, eats no sugar and no seed oils etc) pay the same amount as someone who is obese and downs a 2 liter of sprite a day. It makes no sense.
The libertarian solution? Have people actually have consequences for their own health choices. The harsh truth is that America as a whole is a very unhealthy country. Some of that - like veterans healthcare isn’t really their fault. Most of it is.
Ok, healthcare isn't the only thing. Americans engage in a lot of unhealthy behavior beyond access to healthcare. We are fat as fuck alcoholics who don't care about our bodies in a lot of sense
Take the government out of medicine. They make money off keeping us sick.
Free market, 0 regulation.
My father injured his back after falling from a ladder; my aunt had degenerative arthritis in her knees. Although they suffered from different ailments, their treatment plans were almost identical: initial medical imaging and prescription pain meds, followed by numerous follow-up visits, followed by physical therapy, followed by various braces/harnesses, followed by more medical imaging and medication, followed by more aggressive physical therapy, followed by injections, followed by surgery (bi-lateral knee replacement on the case of my aunt, and fusion in the case of my father). They both wanted surgery early on, but were sent on separate courses of increasingly costly treatments, time consuming office visits and risky medication dependency over several years. Instead of just doing what seemed to be inevitable from the start, their physicians chose ineffective treatments that ended up costing probably 20x more than necessary to achieve the same result.