[seibelj]

A bit confusing because the hospitals in Boston have wings for foreigners with luxury accommodations, and people all over the world fly in to get top-tier procedures done. My son was born with complications and my insurance paid for all of it at such a top-tier Boston hospital (I am a Boston resident and US citizen). So maybe things aren’t so simple.

https://www.bostonmagazine.com/health/2015/11/24/boston-hosp...

[jpgvm]

The existence of very expensive private care in the US isn't counter to my point if anything it's an embodiment of it.

Furthermore it's probably much more expensive than you realize. Premium contributions and deductibles totaled 11.6% of median income in 2020, compared to 2% Medicare levy in Australia across the income spectrum.

The US system isn't defendable. You can say things like "Well I'm rich so it works for me" but you can't make assertions that it's good as a whole.

[seibelj]

I will assert that the US medical system has pros and cons, and I would advocate for significant structural reform.

But such reform has not occurred despite decades of trying, and that’s because the system is not without the pros, and the pros make it infeasible to reform it at this time.

Pretending that the system is completely useless and broken is ignoring basic facts - such as overwhelming majorities of Americans that like their primary care doctor and their current insurance.

So it’s difficult to make such clear statements when the facts disagree with the progressive shrieking.

Furthermore - https://www.spectator.co.uk/article/why-is-canada-euthanisin...

> When the family of a 35-year-old disabled man who resorted to euthanasia arrived at the care home where he lived, they encountered ‘urine on the floor… spots where there was feces on the floor… spots where your feet were just sticking. Like, if you stood at his bedside and when you went to walk away, your foot was literally stuck.’ According to the Canadian government, the assisted suicide law is about ‘prioritis[ing] the individual autonomy of Canadians’; one may wonder how much autonomy a disabled man lying in his own filth had in weighing death over life.

The world is very complex and nothing is black and white

[jpgvm]

That is part of the problem, you have taken something that can be measured objectively and instead politicised it. Not a uniquely American phenomenon but definitely practiced most commonly there.

The system is without pros but that doesn't matter because of the existence of lobbyists. The American political system assigns representation proportionally by wealth of interests, that is just how it is.

You can see it play out over and over again from tobacco, oil, healthcare etc. Preservation of outsized corporate profits at the expense of normal people is simply the norm in America and is ingrained in its political system.

It has nothing to do with the pros and cons of actual healthcare provided to people (or the cost at which that care is provided), simply that those that stand to lose from making the system more efficient are willing to spend anything and everything to prevent that from happening.

Unfortunately too much of the American population are happy to be duped into thinking the current system is good in some way AND that they should tie their political identity to it's preservation regardless of the facts.

It's a tragedy tbh but maybe one day logic and economics will win out. Spending this much of GDP on healthcare is just stupidly inefficient, especially when you still have so many simply not seeking care because of the financial ramifications of doing so - cheating the economy out of their productivity.

[frumper]

All doom and gloom. Having experienced some very good treatments and excellent outcomes for my daughter, I have a different opinion than "the system is without pros".

[matthewmacleod]

But such reform has not occurred despite decades of trying, and that’s because the system is not without the pros, and the pros make it infeasible to reform it at this time.

This seems like a faulty assertion. It’s possible that this system offers benefits to some subset of people. But you can’t really draw much of a conclusion simply from its continued existence.

If one of your “pro”s is “makes so much profit for insurance companies that they are willing to spend huge amounts of money to fight reform”… well, I can’t imagine that’s really what you mean by “pro”.

[forum_ghost]

Medicine, first and foremost, is a BUSINESS.

It is also a game of super-sub-specialization. The entire field. There essentially numerous subspecialties within each specialty.

Some surgeons do nothing but the same apnea surgery 5 times a day. Some oncologists do nothing but specific neuroendocrine cancers all day. Some diagnosticians are good for a specific area of their field - and utterly useless elsewhere, because they just couldn’t care less and want to work on what they find interesting. Just like anyone else.

If you want to see someone who actually knows what they are doing, sees the same exact issue you are having 10 times per day instead of once per decade, you WILL travel. Of course, you can always settle for the clueless doctor nearby who will do the bare minimum, or maybe even nothing.

Remember: patient outcomes are not part of the standard of care. There are no real incentives to do better than bare minimum, as a physician.

Sometimes the talent is in Switzerland. Sometimes Germany. Korea has some leading talents in niche areas.

It just so happens that the US pays the best, and just like engineers who can write their ticket that move to Bay Area, so do the physicians that move to the US.

Real life example: many neonatal surgeons only begin practising on their own, independently, in literally their late 30s, if not 40s. In training until then, whew. Slightly different than picking up a new JavaScript framework.

Would you seek to maximise your income if you had to study for 20 years after high school?

Neonatal surgery is often $1-2 million per surgery. There are only a handful of such centres. Only some of them operated on a specific condition more than 10 times.

The same really goes for anything else from diagnostic to operators. Even in the US, you’d often have to travel out of state if you want to get a proper opinion. Easier with imaging or biopsies because these can be mailed. Tons of people travel for surgeries. 250k Canadians every year travel to the US to get care they cannot get on time (or at all) at home. I’ve seen it all, even Saudis flying over for dental work.

Next time you see your doctor ask them who would they pick for their surgery: someone who does the procedure 100x per year, or someone who maybe does 1-2 cases per year. Then guess where the most super-specialized talent can maximise their income. Probably not the remote Australia with a population of ~10% of the US.

US simply has the best talent. If you can afford it.

As for Canada/NHS/Australia being better - that’s just laughable. Canada is actually dead last among top 10 richest countries, and happens to have the second highest drug prices after Switzerland. Also has as many beds per capita as Mexico. You’d be better off going literally anywhere else.

Mayo at Rochester has a larger diagnostic antibody library than anything in those three countries combined, and can arrive at your diagnosis within two days instead of two decades. Guess where your tertiary centre in Canada/Aus/Uk often mails your blood work and biopsies once they are at the end of the rope?

That’s right. USA.

[jpgvm]

Medicine isn't a business as far as a government is concerned.

It's a utility that exists to protect the investment in it's citizens such that their full productivity can be achieved.

It's in a country's best interest to achieve the highest possible standard of care for all citizens, not just those that can "afford it".

Treating medicine as a business only works for the very top of the totem pole and over time leads to increasing degradation of the labor force. i.e what you are seeing in America right now.

Nobody in Australia ever wonders if they should call an ambulance if they are injured or worried they could be very ill, they just pick up the phone and dial 000. They are guaranteed as citizens of Australia to have access to life saving care whenever and wherever in our borders. They do so with no fear that they will financially ruin themselves.

In Australia we would go as far to call this a basic human right.

[forum_ghost]

What you are writing about is aspirational utopian fantasy.

What I wrote is harsh reality informed by two decades of being elbow deep in bodily fluids.

You may not like it, but you aren’t getting the best physician just because you developed some far out ideas how the best talent in the world must fix your problems.

Guess what, physicians are free people too, even free to refuse any patient for any reason.

They just want top dollar, and move where the pay is best, that’s all.

You wouldn’t move for a 10x higher salary? You would deny everything that would bring to your family?

[jpgvm]

I don't see how it's fantasy if it already exists in my home country...?

[RGamma]

~Two decades of social atomisation and commercial brainwashing have left their traces...

[forum_ghost]

What exists in Australia is exactly what the US has: private payers that get preferential access, and then Medicare for the poor/everyone else. People avoiding appointments they cannot afford. Psi service refusing to take Medicare patients. Unavailable pharmaceuticals in Australia that one can easily access in the US. You even have US-style HMOs.

It’s just a US-lite system compared to Canada (which like Cuba outlaws private healthcare, but has a grey healthcare market because the public system is broke), and NHS(which is broke like Canada, but at least you can pay private).

1) Patients avoiding appointments due to costs, just like the US:

“Almost impossible to get bulk billed’: patients avoid seeing doctors due to out-of-pocket costs”

https://amp.theguardian.com/australia-news/2022/may/12/almos... Private healthcare is better in Australia:

2) Private healthcare where cash suddenly trumps virtue-signalling on the internet.

Paying cash money? Jump the queue! The poor can languish and die while on waitlists.

“Public patients requiring elective surgery for cancer, heart conditions and other serious health issues face longer waiting times than their privately insured counterparts in public hospitals, according to a new report. ”

https://thenewdaily.com.au/life/wellbeing/2017/12/06/private...

3) Refusal of public patients.

In some cases, physicians don’t even take any Medicare patients -at all-.

Let’s take a rather relevant specialty for this thread, psychiatry:

“Psychiatry costs in particular are prohibitive. One reader reported paying $300 for 20 minutes with a psychiatrist, while another said they paid $900 for the first session and $500 for subsequent sessions. Another reader said her one-hour psychiatry session cost $435, and the Medicare rebate “didn’t even cover half”. Another reader, Jamie, said she had paid $220 and received $76 back from Medicare, but that her initial appointment was $600.”

Congrats! You are paying American rates! Good job Australia!

https://amp.theguardian.com/australia-news/2021/apr/19/like-...

My goodness, isn’t this a huge surprise! Highly trained people want to get paid even in Australia, news at 11. Who could’ve guessed.

Money talks. It’s that simple. Why is that so hard to accept?

Engineers used to move to Bay Area to get the best possible salaries, but we should suppress doctors who even as much attempt to move overseas for bigger pay checks, lol?

[fzeroracer]

What you've mentioned is objectively wrong and has nothing to do with reality. The US is not leading in healthcare outcomes or anything of the sort. And even then, there's more to life than just strictly salary. Things like retirement benefits, socialized healthcare, safety nets etc all contribute to reasons why this occurs.

Also as a side note: US doesn't have a physician surplus: It has a physician shortage. By your logic, we should see no issue in finding physicians, doctors etc because they should all want to relocate to the US where the salary is the highest.

[forum_ghost]

Anyone who keeps talking about averages or statistical outcomes does not understand the first thing about medicine: there is no averages.

Because of deep sub-specialization you only have an agglomeration of outliers that are really good at what they do, and then the plankton, just like in every profession.

You can either have someone that knows exactly what he’s doing, or someone who rarely does it. A large part of medicine is guesswork, and you want someone who’s seen enough to be doing the guessing.

There is no shortage of physicians if you have the money. You can see the absolute best physician of your choice literally tomorrow if you have enough money to name a hospital wing. They’ll just see you while they eat their lunch, or come in an hour earlier.

The shortage you are talking about, is a shortage of competent, qualified saints willing to forego compensation after spending a decade in training to treat the poor.

If your expectation is that the top talent should for peanuts - do you really think there can be no shortages? You are literally asking for saints and miracles.

P.S. >there's more to life than just strictly salary. Things like retirement benefits, socialized healthcare, safety nets etc all contribute to reasons why this occurs.

$2-3 million/year solve all of the above. There is more to life, but 90% of every graduating class are there for money, nothing less.

[fzeroracer]

No, I'm talking about a very literal shortage of physicians in the US. Not a shortage of saints or whatever tangent you're going on. The US has a physician shortage. I will repeat under your argument there should be no physician shortage in the US because the US has among the highest salaries for physicians. This should not happen by the argument you keep repeating.

The fact that someone can see a physician tomorrow with enough money is irrelevant because with enough money they are no limited to the US. Experts are not located entirely within the US, hence why many millionaire/billionaires will travel for medical aid because other countries might have people with more expertise in XYZ.

The rest of your comment is completely irrelevant to the argument I'm making.

[FireBeyond]

> Remember: patient outcomes are not part of the standard of care.

LMAO, what? It's literally, and defined as the end product of an acceptable standard of care, and used to judge whether a standard of care was given to a patient.

> Probably not the remote Australia with a population of ~10% of the US.

Victor Chang (https://en.wikipedia.org/wiki/Victor_Chang) would have liked a word with you. Trained in the US. But still set up shop in Australia. Considered the world's leading heart transplant surgeon, with survival rates well into the 90%s.

> Guess where your tertiary centre in Canada/Aus/Uk often mails your blood work and biopsies once they are at the end of the rope? That’s right. USA.

Because of course you mention tertiary centres as if any of those three don't actually have primary research facilities. A tertiary hospital in Australia isn't mailing shit to the US for diagnostics. In the event that they can't figure it out, there's many many state of the art facilities available.

All of this reads like some weird xeophobic libertarian fever dream, and the notion of Canadian, Australian healthcare systems as some primitive backwater barely discovering modern medicine is laughably ignorant.

[pishpash]

What you are saying is that unless medicine is not a business anywhere, it will end up being a business everywhere.

[forum_ghost]

It’s always been a business.

Even in formerly communist countries bribes got you better access.

As soon as you can figure out how to prevent people trying to leverage every resource they have and try to outcompete others to avoid death, let us know. you might get a Nobel.