Price transparency in medical care should have been a thing since the 80s when we deregulated telecomms and aviation. There should be price transparency and WYSIWYG billing, no hidden fees, or bait and switch, etc. No $50 tylenols and such shenanigans.
I’d take it a step further and mandate a single price for everybody. Let insurance cover whatever the actual is going to be for paying in cash and not some voodoo accounting that generates a cash price backwards from the maximum negotiated rates.
Insurance should be to cover unforeseen events. Baking in the cost of trivial things like a “fee flu shot” just acts as a way to obscure the true costs.
Let's take it one step further and everyone pays for health insurance out of their taxes according to their means, and the state handles all the billing, negotiation and pricing on their end - and the individual never has to care who's paying and how much. Socialized medicine already covers 40% of Americans between Medicare, Medicaid and the VA. Time to get it to 100%.
The Canada Health Act is a great model. The Feds mandate that the Provinces figure out how to provide everyone a minimum standard of care, and each Province administers a public health insurance program that covers everyone. This would map perfectly to the states.
I'm not sure I would want to go there. "People of means" already pay greater taxes which support government programs. If you think they are not paying enough, raise their taxes, but avoid double taxation.
In other words, I don't think just because I would pay $1000 for a broken arm means I would agree that Bezos should pay $100,000,000 for the same. It would make no sense. It would make sense to close his tax loopholes. Sure.
Sorry for the unintentionally charged and hence confusing language there. I just meant via progressive taxation. Something like the Ontario Health Premium [1] which ranges from $0 per year if your taxable income is $20,000 or less, to $900 per year if your taxable income is more than $200,600.
I agree and also do not want what you outlined! :)
I strongly suspect that a socialized medical program in the US would not actually cost individuals any more than they're paying now - it's just that the cost they're paying is hidden behind employer paid premiums. That's just a private tax.
> Medicare already is 1/3 of the federal budget and I can assure you someone making low 6 figures definitely pays more in tax than 3x $900.
Well the first step is redirecting all the premiums paid by employers on behalf of employees into the federal pot. That should net ~$5500 per taxpayer or an additional ~$1.8T per year. That will sort out the bulk of it with no additional cost visible to individuals.
That is not the plan put forth by Medicare for All advocates. There is a strong undertone of income redistribution in progressive proposals for single payer.
I would also expect that if the government was taking that money my health benefits would be at least as good as they are now. And I don't think that will be the case. When I was a kid there was a period where I was on California MediCal and I distinctly remember getting glasses with _super_ thick lenses because all MediCal would pay for was the cheapest frames and lenses.
> That is not the plan put forth by Medicare for All advocates.
I'm almost 100% confident it is. That money is currently being paid on behalf of individuals to insurers. Take the insurers away that money either goes to individuals and gets taxed, or gets sent directly to the feds. Either way it's a no-op.
> There is a strong undertone of income redistribution in progressive proposals for single payer.
Healthcare is the great equalizer. It's not insurance - everyone needs it and everyone will use it. There's not really a strong correlation between more spend and better outcomes past a certain point. Except in the rarest of cases you can't cure cancer with fat stacks. What offering healthcare does is give low income folks the opportunity to found companies without the fear of death. It dramatically reduces the burden on all businesses and especially small businesses by killing a massive cost center.
> I would also expect that if the government was taking that money my health benefits would be at least as good as they are now. And I don't think that will be the case.
Every healthcare system that ranks above America's is single payer or two-tier socialized. MediCal is set up to be punitive to the poors like all Medicaid programs. A Medicare system isn't. There's a reason not a single AARP member is advocating for eliminating Medicare. What getting everyone on the system does is it makes the political class beholden to the needs of the individuals.
I watched Donald Trump in front a group of older folks literally hug a flag and say he'd do whatever it took to keep the Democrats away from their Medicare. That doesn't sound like a system itching to be upturned does it?
Socialized medicine is no more a partisan issue in most countries than a socialized fire department or sidewalks.
By income redistribution I mean most progressive proposals aim to heavily tax high earners to fund healthcare for lower income individuals. That money would otherwise be used by those earners to buy their first home, build retirement wealth, etc. Ever heard of HENRYs?
> MediCal is set up to be punitive to the poors like all Medicaid programs. A Medicare system isn't.
Citation is needed here. A lot of good doctors in my area won't take Medicare patients because Medicare reimbursements are too low. We also know from European systems that because everything is triaged based on need that wait times end up being very long if you don't have a life threatening condition. You also need to consider that American doctors make substantially more than European ones. If you compare the pay of specialty doctors in the NHS to ones in the US the difference is something like 5x.
> What getting everyone on the system does is it makes the political class beholden to the needs of the individuals
That is your perspective, and I think it's a naive one. I think it would prevent reforms that drive efficiency. Think of what happens when anyone talks about making Medicare more efficient: they get attacked as anti-elderly and portrayed as wanting to cut benefits. Or the same for military spending. At least the free market (which healthcare is not right now, but it could be) is ruthless about creating efficiency.
> Socialized medicine is no more a partisan issue in most countries than a socialized fire department or sidewalks.
Funny that the UK argues about NHS funding a lot then.
> By income redistribution I mean most progressive proposals aim to heavily tax high earners to fund healthcare for lower income individuals.
As someone who would be on the giving end of that, I'm fine with it, honestly. I won't always be on top.
> We also know from European systems that because everything is triaged based on need that wait times end up being very long if you don't have a life threatening condition.
We don't know that at all. Triaging based on need is a feature, not a bug - and a super easy way to save a ton of money! All of these criticisms were made up by the marketing department at insurers to fleece Americans. That's not hyperbole, and don't take my word for it. Here's an interview with one of the Cigna guys admitting to doing it, and apologizing. [1]
"Here's the truth. Our industry PR and lobbying group, AHIP, supplied my colleagues and me with cherry-picked data and anecdotes to make people think Canadians wait endlessly for their care. It's a lie. And I'll always regret the disservice I did to folks on both sides of the border"
> You also need to consider that American doctors make substantially more than European ones. If you compare the pay of specialty doctors in the NHS to ones in the US the difference is something like 5x.
Ok, and they shouldn't. I'm sorry. It's not sustainable, it's not affordable. They're taking pay cuts. Nobody is entitled to a certain salary, standard or lifestyle in perpetuity no matter how unsustainable. BMWs for doctors while 10% of Americans are told to die or pick their favorite finger after an accent is unconscionable. America pays more than anyone else anyways, and would still after cuts, where would they go?
However, this is also simply not true for every system. Most similar countries socialize malpractice insurance which is a huge cost for US doctors. US OBGYNs pay up to $200,000 per year in malpractice insurance. In Canada, $40,000CAD. In the UK I think it's 0GBP handled by the CNST. That goes a long way to balancing out pay differentials.
In the US anesthesiologists make 400K USD median, in Canada 335K CAD median.
> Funny that the UK argues about NHS funding a lot then.
They argue about funding and prioritization and all sorts of stuff, sure, but it's not a partisan matter that the NHS should exist and be the status quo. The NHS was literally in the opening ceremonies of the 2012 olympics. 87% of British folks are proud of the NHS. [2]
Canada's Conservatives support single-payer medicine too.
> As someone who would be on the giving end of that, I'm fine with it, honestly. I won't always be on top.
And I and many others are not. You should recognize that this is a _political_ issue where there is no objectively better outcome. Higher taxation has long run drags on innovation and wealth building. The tradeoff is yes, we don't have universal healthcare. I'm okay with that if it means I have more job opportunities and ability to build my wealth.
> In the US anesthesiologists make 400K USD median, in Canada 335K CAD median
Just because the gap isn't 5x doesn't mean there still isn't a huge gap. $335K CAD is $235K USD. And Canada has comparable CoL to major US cities so you're losing real purchasing power there.
> That's not hyperbole, and don't take my word for it
Take a look for yourself at the data in Table 4 [1] sourced directly from each country's government reporting infrastructure and decide for yourself whether you would accept those wait times. I wouldn't accept a 2 month average wait time for something as simple as cataract removal, that's for sure. The quality of life loss in that time is immense.
> Ok, and they shouldn't. I'm sorry. It's not sustainable, it's not affordable. They're taking pay cuts.
Good luck passing any legislation over the lobbying of the AMA then. You're suggesting fundamentally untenable legislation that will never pass in the US. Aka bikeshedding. This is exactly the reason progressives can't get any legislation passed in Congress.
> And I and many others are not. You should recognize that this is a _political_ issue where there is no objectively better outcome
Luckily the rich are a minority and this is a majority rule system :)
There is 100% an objectively better outcome. Better care for more people, fewer people falling through the cracks is objectively better. There are objective rankings of healthcare system quality.
> Higher taxation has long run drags on innovation and wealth building.
And not dying if a small business owner gets sick has a long run boost to the economy. Individuals being able to take risks without fear of death and pestilence has a long run boost to the economy. A carpenter having all their fingers re-attached instead of just some of them has a long-run boost to the economy. Small and mid-size businesses not having to administer health plans is a boost to the economy.
> I'm okay with that if it means I have more job opportunities and ability to build my wealth.
You'll still have your chance lol.
> I wouldn't accept a 2 month average wait time for something as simple as cataract removal, that's for sure.
Cataracts develops slowly over a period of years. It's explicitly one of the lowest priority surgeries you can get for that reason. It took you 10 years to develop you don't need it out by Monday, late February is fine. (NOTE: In some provinces your data shows you can get it out in 2 days in Canada). It's nuts to think that you should be able to pay more to get your decades old cataract out by Monday so that someone who was in a car accident can get in line lol.
So yeah you absolutely would, and you wouldn't care at all.
Either way, America will almost certainly land on a two-tier system where you can still get your way.
> The quality of life loss in that time is immense. This is exactly the reason progressives can't get any legislation passed in Congress.
It's simply not. Sorry. Data and satisfaction surveys disagree, but also - only for the few who can afford to jump the queue. There's very few of those so they're not really represented in surveys.
> Good luck passing any legislation over the lobbying of the AMA then.
Single payer in Canada passed explicitly against the wishes of the entire North American medical establishment. "The organized medical establishment was not nearly so reticent and mounted a ferocious propaganda campaign fronted by the local College of Physicians and Surgeons with the support of the Canadian Medical Association (CMA), the AMA, the local economic elite and most of the media in the province." [1]
> Luckily the rich are a minority and this is a majority rule system
Hmm, is that why the Build Back Better Act got killed in part by House Democrats wanting a SALT cap repeal? "The rich" you're thinking of excludes a large percentage of high earners who live in high CoL areas but are not wealthy. I'll remind you 20% of California earns more than $162k [1]. That's a lot considering the win margin of the general election and most CA state propositions. Enough to tip elections.
> And not dying if a small business owner gets sick has a long run boost to the economy
"Small business owner dying because they got sick without insurance" just doesn't happen. This is a strawman.
> You'll still have your chance lol
Average house price in Frankfurt is 7200 euro/sqm [2]. Tell me again how you can pay for a 200sqm house (=1.4M euro) when European software engineers make less than half of what American engineers make and get taxed more? A new grad at Uber in Europe makes 87k EUR [3]. A new grad in the US at any big name tech company makes more in the range of $180-200k. So your pay is more than double and you get taxed less, meaning you build wealth in the range of 3x as quickly.
> Hmm, is that why the Build Back Better Act got killed in part by House Democrats wanting a SALT cap repeal?
This could not be less relevant, but yes, I do think this likely represented the majority position. I think as much as we grumble Manchin represents his people. By the way 70% of Americans support Medicare for All so I'm not really worried about the popularity of the position. [1]
> "Small business owner dying because they got sick without insurance" just doesn't happen. This is a strawman.
18,000 Americans die each year due to insufficient medical coverage. You willing to bet not a single one is a small business owner? [2]
> Average house price in Frankfurt is 7200 euro/sqm [2]. Tell me again how you can pay for a 200sqm house (=1.4M euro) when European software engineers make less than half of what American engineers make and get taxed more?
Speaking of straw men, this is all attributable to the fact the Germans manage to cover 100% of their population for $5,595 per capita, vs America's covering 40% via a socialized program and 60% via private cover for $11,000 per capita?
> A new grad in the US at any big name tech company makes more in the range of $180-200k. So your pay is more than double and you get taxed less, meaning you build wealth in the range of 3x as quickly.
This argument doesn't hold water. You won't get that salary, broadly speaking, unless you live in SF, NY or SEA. There, your cost of living is so high your net take-home pay may well be lower than the German engineer. Certainly not after you adjust for PPP. But of course this has nothing to do with healthcare.
At this point much of your argument has devolved into Gish gallop, so let's take a step back.
If private cover is so good - so clearly superior - would you advocate for eliminating Medicare and Medicaid? If not, why not? Why is socialized medicine the bees knees once you turn 65 but utterly unworkable if you're younger? Why do 75% of those covered by Medicare think the system is working very well - significantly more than those with private cover - and why would that not extend to everyone?
My argument is simple: Medicare for All entails higher taxes on high earners, which stunts wealth building and economic mobility, especially for high earners who grew up in poverty. This can be easily seen by comparing, for example, salaries of software engineers in Europe and the United States. Medicare and Medicaid are intended to take care of those that _can't work_, but Medicare for All is intended to take care of people that _choose not to work in a higher paying field they dislike_.
> private cover is so good
I would pay for a single payer option if everyone paid a flat fee for insurance that wasn't income based. I'm against the income redistribution part of Medicare for All, for aforementioned reasons.
> Why do 75% of those covered by Medicare think the system is working very well
Once again, polls are incredibly misleading and dependent on the wording used in the survey. You need only look at surveys of Obamacare vs. the ACA to see this effect.
You continually try to engage in asking the same questions by claiming to not understand all the statistics I've given you and I don't believe you're conversing in good faith anymore. Goodbye.
> My argument is simple: Medicare for All entails higher taxes on high earners, which stunts wealth building and economic mobility, especially for high earners who grew up in poverty.
This is an absolutely tiny fraction because most poor people can't afford the healthcare necessary to actually thrive in the economy. Ditto the education. What we need is equality of opportunity, and that requires social services.
> I'm against the income redistribution part of Medicare for All, for aforementioned reasons.
I'm completely uninterested in this. Unless tied to income it's a regressive tax that punishes the poor disproportionately along the axis of marginal utility of money.
> Once again, polls are incredibly misleading and dependent on the wording used in the survey. You need only look at surveys of Obamacare vs. the ACA to see this effect.
This is a different subject and so not relevant. Everyone knows what Medicare is. The only thing most right-wingers know about Obamacare is that Obama created Obamacare. Really it's more like Romneycare for All as it's essentially a Republican policy. There's not a single left-leaning thing about making every individual pay a private company for healthcare. You're not showing a skew in reality, just marketing.
I suspect Americans would feel differently if they knew that Obamacare single handedly dropped the rate of people dying from lack of cover by almost 50% per annum.
> You continually try to engage in asking the same questions by claiming to not understand all the statistics I've given you and I don't believe you're conversing in good faith anymore. Goodbye.
Respectfully disagree. I've successfully refuted every concrete point you've made up to and including whether "the left can pass such a bill" and whether you really need cataract surgery tomorrow.
I wish you the best. Medicare for all is coming. It's just a matter of time.
However, you have failed to answer my core question. Do you think that Medicare should be abolished? Should Medicaid? If so, why? And in what concrete ways do you think that would make America a better place? More efficient? And why is 65 the magic age at which "socialism" finally starts to make sense?
According to your profile, you're not even a U.S. citizen, how can you purport to understand anything in the U.S. when you don't vote here? When you repeatedly post in favor of one political slant as a foreign national that's no different from Russian troll farms getting paid 50 cents a post to spam politics online.
> I'm completely uninterested in this. Unless tied to income it's a regressive tax that punishes the poor disproportionately along the axis of marginal utility of money.
Nobody asked your opinion. I was simply stating mine.
> However, you have failed to answer my core question
I don't feel a need to prove to you I've answered anything. Like I said, you are conversing in bad faith.
> Medicare for all is coming
Is that why Democrats lost elections in swing states in 2021 by double digit shifts compared to 2020?
It shows you that the "rich" you're discounting wield substantial political influence. Manchin wasn't the only one that killed the bill, House democrats also said they'd kill the bill during the merging of Senate/House versions if there wasn't a SALT repeal.
> By the way 70% of Americans support Medicare for All so I'm not really worried about the popularity of the position
Do you know how these surveys work? They literally just ask people how much they support "Medicare for All". They don't present any concrete policy or implications of implementing M4A. That's why "Obamacare" got way less support than "Affordable Care Act" in polls. Please understand the stats you're quoting at the very least.
> 26,000 Americans die each year due to insufficient medical coverage. You willing to bet not a single one is a small business owner?
And hundreds of thousands of people die from benign illnesses like the common cold and the flu each year. What's your point? I bet we can find someone in Germany who died because of wait times too, that doesn't mean we can use that to generalize to everyone.
> Speaking of straw men, this is all attributable to the fact the Germans manage to cover 100% of their population for $5,595 per capita, vs America's covering 40% via a socialized program and 60% via private cover for $11,000 per capita?
This has no relation to the impact of universal healthcare's higher taxes on wealth building. It is a fact that it is harder for working professionals in Europe to build wealth compared to the US.
> This argument doesn't hold water
Cost of living is not so high in NY and SEA. You can rent a luxury apartment in SEA for less than $2000/mo, which is comparable to Frankfurt. Only SF is insane. And German cost of goods is around the same or more than US, so I don't know where you're going with your PPP idea. You need only look at the cost of electronics, gasoline, food, etc. to see they are about the same.
> But of course this has nothing to do with healthcare
Yes it does. Implementing M4A would require heavily taxing high earners. I'm giving you an example of how a high earner would be unable to build wealth under European-like taxation. But it seems like you are unable to understand the idea that high taxes unfairly penalize high earners who came from poor families. I.e. implementing M4A's taxes would penalize economic mobility. Perhaps you came from a family with wealth already.
> By income redistribution I mean most progressive proposals aim to heavily tax high earners to fund healthcare for lower income individuals. That money would otherwise be used by those earners to buy their first home, build retirement wealth, etc.
This is the most transparently selfish thing I've read in a while. Congratulations.
”Socialized medicine is no more a partisan issue in most countries than a socialized fire department or sidewalks.”
That’s a disingenuous statement since most countries have a mix of public and private care and many folks rely on private insurance and private care. Canada is one where private care is almost non-existent, but the UK, Switzerland, Australia have a significant private segment.
What Medicare for All suggests (and a few Democrats have said it explicitly) is that private insurance would disappear.
So Socialized medicine isn’t a partisan issue in most countries, but neither is private medicine.
A few years ago, in Canada, we were paying $4500 per person - and everyone was covered.
The US was paying $5K public per person and $5K private per person.
Meaning - the US is already paying more per capita in public healthcare spending, than Canada, and for that price in Canada - everyone is covered.
This kind of means, the US could literally give all of its citizens 'Canadian Quality Universal Coverage' and literally save a few dollars in public spending, and wipe out the need for private spending.
So 'cost' and 'profit' are different things.
The US HC system is a giant elephant of inefficiency.
This is not a small thing:
'Healthcare' is a 'Pillar of American Decline'. I don't mean that America is falling apart, but rather, it's having less influence in the world.
50 years ago, you went to the Hospital because you were hurt. Now - it's all about aging people who are elderly who see the doctor 20x a year and it's why costs have skyrocketed. It's also when people are the least productive and less likely to be working with good insurance.
HC is a disaster that makes the US a 'much less attractive place to live' for one's entire life, unless one is rich - whereas that was not the case before.
It really needs to be sorted out.
The Media Left, by highlighting Woke issues, instead of things like outrageous healthcare, has completely lost their minds. MSNBC was calling Elon Musk 'racist and misogynist' for his completely benign comments about this giant tax bill. Instead of looking at inequality issues through economic lenses, they're committed to throwing around gender and racial slander. The HC system is a soft, easy target because there are unlimited stories of people getting huge bills, unfair pricing. But you won't see to many stories, because "Sponsored by Phizer".
> 50 years ago, you went to the Hospital because you were hurt. Now - it's all about aging people who are elderly who see the doctor 20x a year and it's why costs have skyrocketed. It's also when people are the least productive and less likely to be working with good insurance.
Literally 100% of the elderly in the US are already covered by the socialized medicine you seem to be advocating for. It's not optional.
Anyone who's had extensive dealings with the VA would be glad to share why they are not interested in single payer. Making that switch will not remove the incompetence, poor staffing lack of care, lack of accountability, and so forth.
Some sane standards need to be drafted and then enforced, hard and fast, before we start mandating how healthcare is paid for.
And anyone who has dealt with socialized medicine in the OECD will tell you the exact opposite :) Wholesale reform is needed, and that can certainly be part of the package. However, parceling it out is a great way to achieve absolutely nothing as evidenced by the current morass.
Interesting to look at the population from your link. The United States appears to be doing the best (LPI 2020 ranked 18) out of all the countries with population over 100 million. After Japan (ranked 19) the next closest are China (54) and Indonesia (57). I'm not sure what relevance this might have, I just found it interesting. The CEO rankings show a much different picture.
If I had to guess, one is weighting access to care differently than the other. America's system is good but not top tier if you can get it. It's really bad if you can't.
> and the individual never has to care who's paying and how much
But then nobody cares about how much the government is paying, and you end up with more and more taxes and inflation.
Taxes are increasing. Government debt and inflation are skyrocketing. Can't we put an end to it?
Also the government can't even build passenger rail without wasting absurd amounts of money and having "unexpected delays" in all projects. Why should we trust it to manage everyone's healthcare?
Because every comparable country that has a government-run healthcare system has somehow ends up with it being ~twice as efficient. I get that there's theory that says a private healthcare system should be better at keeping costs under control, but it's not borne out by the evidence.
"~twice as efficient" is a stretch. They might cost half the price, but they are not necessarily twice as efficient.
Medical treatments and equipments in the US are the best in the world (discounting super small countries). Americans have the highest life expectancy in the world (discounting homicides and transit deaths). Americans can get treatments fast while people in Canada or the UK have to wait for months because the government is rationing treatments.
And we should consider other reasons that explain the costs besides "private system inefficiency": American companies carry the world on medical innovation (so other countries are benefitting from the Free-Rider Problem, and Americans are paying for it). American regulation requires doctors to spend several more years in training than at other countries (in other countries the medical school is usually merged with undergrad). And, finally, Americans just earn more than people in other countries. GDP per capita is 60k in the US, 40k in other developed countries.
> Medical treatments and equipments in the US are the best in the world (discounting super small countries).
Not really. They're fine. In line with OECD. And further, America has a number of blemishes such as among the highest maternal mortality and infant rate in the entire OECD. [1]
...the U.S. ranks 33 out of 36 Organization of Economic Cooperation and Development (OECD) nations. In 2018, while infant mortality reached an all-time low in the U.S., at 5.9 infant deaths per 1,000 live births, still more than 21,000 infants died. Compared to countries with a similar GDP, the U.S. infant mortality rate is much higher. France and the U.K., for example, have 3.8 deaths per 1,000 live births.
The only area the US really excels is in cancer 5-year survival rates - not because the mortality rate is lower, however, it's about the same as everywhere else. The US just biases towards earlier screenings that do not extend life or reduce mortality.
> Americans have the highest life expectancy in the world (discounting homicides and transit deaths).
Are you sure about that? It doesn't look like that on this chart. [2] Not to mention the US spends dramatically more to achieve that much lower life expectancy than anyone else does.
> Americans can get treatments fast while people in Canada or the UK have to wait for months because the government is rationing treatments.
This is a straight-up lie peddled by the US medical insurance industry. Here's an admission and an apology by a Cigna executive tasked with doing so. [3]
"Our industry PR and lobbying group, AHIP, supplied my colleagues and me with cherry-picked data and anecdotes to make people think Canadians wait endlessly for their care. It's a lie. And I'll always regret the disservice I did to folks on both sides of the border."
They pulled the same thing when Canada instituted single-payer healthcare in 1962. [4]
> American companies carry the world on medical innovation.
Not really. There are as many European as there are American medical companies in the top R&D spenders worldwide. That's before we factor in government expenditures worldwide.
> And, finally, Americans just earn more than people in other countries. GDP per capita is 60k in the US, 40k in other developed countries.
Now imagine what they could do with an extra $5K per person per year - the difference between what the US and Canadian medical systems cost per capita.
The infant mortality rate is based on extremely misleading statistics.
In the US, if a baby is born who can be saved but isn't, their death is reported in the neonatal mortality statistics. But in other countries it is more common for babies in these situations to be counted as miscarriages or stillbirths.
In the US, very low birth weight infants are considered to be alive (because, of course, they are), but in Canada, Germany, Australia, and other countries, a premature baby weighting less than 500g is considered to be already dead, even if it is breathing and has a heartbeat. So they don't have to add it to their infant mortality statistics when their healthcare system fails to save its life.
In fact, since the year 2000, of the 52 surviving babies who were born weighting less than 400g, 42 were born and saved in the US.
The 4th worst maternal mortality rate in the entire OECD too. That would be the mother dying during childbirth. [1] More than double Canada in 2018 and 10X New Zealand. [2] Without getting into your data re: infants (because I do not know enough to do so), I suspect this one's not as easy to hand-wave.
The results of the study carried out in [2] say:
The U.S. has a relative undersupply of maternity care providers, especially midwives, and lacks comprehensive postpartum supports.
American healthcare is acceptable if you can afford it and a death sentence if you can't.
What's really interesting is that 60% of people in general (including those already on it) say Medicare is working well for seniors - but when you drill down only to the people actually covered, that number jumps up to 75%. Same source. Seems like a marketing issue?
Unfortunately as one example Medicare Part D price negotiation has been blocked since 2003. When some drugs were moved to Part B, insurance companies were furious because it allowed price negotiation for those.
Despite this election season’s divisiveness, both major parties’ presidential candidates have embraced the idea of authorizing Medicare Part D to negotiate directly with drug companies to set prescription drug prices. The Medicare Modernization Act of 2003 (MMA), which established Medicare Part D, included a ban on such negotiation.
Apparently both sides of the aisle pander to voters with the idea they'll help with healthcare costs and then don't once safely elected to office.
The patient should pay the same, no matter who does it. Compensation of healthcare staff is an internal matter and frankly not relevant to the patient.
So should every healthcare provider organization throughout the country be required to charge the same price for a given procedure? Many US doctors still run solo practices, so there is no real difference between the company and the "staff". It seems reasonable that doctors with more experience and better skills should charge higher fees.
To read your sarcasm I'd have to know whether you have in fact gotten surgery by a more experienced doctor. It just depends on so many things. First, you can't be a surgeon for that long, you start losing your "pulso" like stillness of hand at around 50. Then there's the vibe the old doctor and the young doctor give you.
You must use your judgment to interpret it, but let me tell you a trope: the old doctor, sure, he's done this thousands of times, so it's no big deal for him. But he might be complacent, and plus he's been a surgeon for decades, these guys get worshipped by the rest of the hospital, it typically gets to their head. He might have long ago lost sight of needing to help people who lost sight, if he's not a virtuous guy he'll hustle you, 100%. And if he fucks up? 1 divided by 2000 is what percentage error rate, .05%? Assuming it's never happened before.
Whereas the young doctor is probably hungry for his first paycheck after a decade of getting into debt and memorizing stuff, his big chance to stop getting hazed, this won't be his first time really, he'll want to do an amazing job. He has no track record so if he screws up, it won't be automatic to get a second chance, it's high stakes, and he'll have that error hanging over him. He might be nervous though, so you have to keep that in mind. But much better hands, and he'll actually perform the surgery according to the original definition of "perfection" : he'll carry it out all the way through. Won't skip steps to save himself a couple of minutes at the expense of weeks of pain. He doesn't yet know what parts of the surgery he can get away with not doing, he just does the whole thing.
On the other hand, if the old doctor is humble and the young doctor is arrogant, it could be the other way around. You need to judge the vibe.
So the choice would be between glaucoma surgery according to the standard of care - or glaucoma surgery according to the standard of care.
Now we are getting somewhere! What if all this "choice" did nothing to improve patient outcomes or public health but entirely served to get more money out of your pocket?
