[robertlagrant]

Yep, agreed. Well thought through response.

What's your opinion on the following assertion: countries (such as mine) with socialised medicine make sure everyone has a certain standard of care, but that standard only goes so far. The US lets people pay for any possible treatment, and so people who would be put on palliative care in, say, the UK, would be bankrupted in the US by trying to beat cancer with expensive drugs.

It's phrased as an assertion, but it's really just something I've been thinking about. What do you think?

[Mezzie]

It's probably accurate, and of course there are issues with socialized medicine as well. I have an interesting POV because I actually had my first relapse while I was living in Canada - I wasn't allowed to stay due to my disability but I have some experience with both systems. The waiting is definitely a problem - I didn't get into a neuro before I had to leave the country 9 months later, but at the same time I never worried about paying for treatment and I went to the ER when I couldn't feel half my body/couldn't walk without being concerned.

It isn't just socialized healthcare, though. It's also things like the US not mandating time off - for instance, I haven't had my Ocreveus infusion because I literally can't afford to take the time off to go to the infusion center. And the US is also very binary: Either you work full time or you get nothing benefits wise. For those of us who could comfortably work ~25-30 hours a week this results in either us overworking ourselves to the detriment of our health or not working at all. I'd love to work and just have a little bit of help for when I have a bad week or month, but that doesn't happen here.

The other problem with the American healthcare system is that it siphons off wealth from those in their end of life. Good luck planning a good life for your children: The government will take everything you own for your nursing home. That also has major impacts in term of stability.

But of course in socialized healthcare you do need to decide what is and isn't worth treating in some way and when cuts are needed you end up in dark places like Canada is with MAiD.

It's hard to say. I'm inclined to believe there are benefits and drawbacks to each approach.

[robertlagrant]

Yeah, totally agree. The American system seems to have, despite its amazing innovations and advances, that we all benefit from sooner or later, the worst of both worlds: neither an efficient market-driven approach not a particularly socialised one either. And that's despite the US government spending more per head than I think any other country on healthcare.

The ties between government, big pharma, insurance companies and hospital systems must be so entrenched that it's very difficult to see a way out.

[Mezzie]

Yes.

Add that to America disintegrating into a low-trust society where one almost has to assume that any stranger one meets is out to scam you/get your money somehow and it results in a country where it's terrible to be vulnerable. Which is one of the ways we grow as people, thus leading to emotional stunting amongst the populace, which in turn makes us less resilient and willing to act (particularly since we can't cooperate anymore) and therefore in my opinion sow the seeds of our own destruction.

[dragonwriter]

> And that's despite the US government spending more per head than I think any other country on healthcare.

Far more per head — part of which is higher cost of labor and that healthcare is extraordinarily labor intensive. But, its also fairly high as a GDP share, for which excuses like that don’t work. The US just genuinely has a healthcare system that is ludicrously inefficient unless your goal is maximizing the wealth-based quality differential, in which case Mission Accomplished.

[robertlagrant]

I really think this cynical take on wealth needs to stop. This is far more likely explained by politics.

Or more precisely: efficiency is distorted by compassion. Which is then recovered by efficiency. Which is again modified by compassion. If your system is a bewildering mish-mash of cost increasing political interventions and cost reducing market innovations then it's never going to work. But lawmakers need something to do to stand out, and so do business people.

[dragonwriter]

> I really think this cynical take on wealth needs to stop. This is far more likely explained by politics.

The only mention of wealth was describing the effect. Yes, politics is a key part of how that effect is acheived. (Of course, advocacy by those with wealth is a key part of how the politics happens, and... well, the politics/wealth interactions here are basically a near-infinite chain. They aren’t competing explanations.)