[Aeolun]

I think it’s amazing that a solid system can be defunded like that until it just sorta crumbles under it’s own weight. There’s no immediate solution either.

If you build more hospitals, you need more staff, if you need more staff, you need to make it more attractive, but even if you do you need several years before the first doctors/nurses from the wave with renewed interest in the position finishes university.

And that’s only if there is any political will to do so.

[bpodgursky]

Healthcare across the entire west is crumbling, and not through defunding. It's driven by demographic shifts that nobody has a real plan to fix.

[nradov]

Ultimately the only viable plan is going to be severe care rationing. In most developed countries we have an aging population with an increasing incidence of chronic diseases and a shortage of physicians. Regardless of whether payments come from governments, employers, or individuals the reality is that we simply won't have the resources to care for everyone.

[HarryHirsch]

In Britain, citizens have a hard time getting basic dental care that they can afford: https://www.bloomberg.com/news/articles/2023-07-13/uk-dentis...

The demographic explanation simply does not hold water when routine healthcare is not available.

[DanBC]

Important to point out that dentistry in England does not follow the NHS model of "free at the point of delivery, available to all regardless of ability to pay" but follows an insurance model, with a bit of state provision for those who can't afford insurance.

And dentistry is why people in England are scared of changing the model for NHS healthcare, because we see that dentistry is fucking awful for huge numbers of people.

The problem with the NHS is not the model, it's the funding.

[themitigating]

But that's routine healthcare for one particular part of the body. Meaning it could be true for general health.

In the US dental is considered a seperate insurance for most. So there's a separation for whatever reason meaning using it to disprove the demographic theory for "regular" healthcare might be valid

[confidantlake]

At least in the US they could stop restricting the number of residency slots.

[nradov]

The number of residency slots isn't restricted. The problem is that almost all residency program funding comes from Medicare and hasn't increased much for many years.

https://savegme.org/

[alostpuppy]

This

[dangus]

Explain how Japan has the #2 best healthcare system in the world then.

(It’s universal with 70% of costs paid by the government)

[Danieru]

Strong planning and hard decisions. Japan over produces doctors. Japan forces a strict 30minute cap on doctor visits when billed by that insurance. Japan limits hospitals to be only owned by doctors, not corporations. Japan has no medical malpractice lawsuits. Japan makes everyone pay 30% of medical costs, UpTo a cap of about 1k dollars per month. There is no such thing as the "nice" health care insurance nearly every American programmer working at a FAANG gets. Japan makes seniors also pay a large deductable.

Japan put in place many strategic constraints on their system to achieve this result. Hard decisions most countries would revolt at, doctors unions would strict at, and westerns would call broken.

But at least the system does it's job and is not projected to collapse. You can win votes, or you can design a functional system. You cannot do both.

[dangus]

Almost everything you mentioned is basically a legislative signature away from being a reality in Western countries.

That’s why I questioned the idea that demographic issues are going to prevent the West from solving this problem. A little bit of political will and some signatures is all it takes.

[opportune]

I don’t like “exceptionalism” arguments in general, and I think “muh homogeneity” is bunk as well, but Japan has a very strong and unique culture that results in outcomes that the rest of the world would not see in the same conditions.

See for example Japan having very few public trash cans but also very low amounts of litter, or even very low wage workers taking pride in their jobs, or Japan having both extremely low unemployment and also low/no wage inflation for very long periods of time. Japanese business culture is one of seeing a duty to the public/consumer in a way that most other capitalist countries do not. They have a cultural aversion to screwing people over and ripping them off, and in working very many extra unbilled hours because it’s expected of them - they’d never have the same healthcare failure modes as in other countries

[dkh]

This. You see this effect to some extent in Switzerland as well. Switzerland, many seem to feel, is "similar enough" to the United States that the existence of its universal healthcare system "seems" like a goal should be similarly within our reach. But this is to discount cultural differences, among other things, and the mindset of the average Swiss is I think quite different than that of the average American.

Some time ago I read 2 different books on healthcare systems, both very detailed, the authors having compared in-depth the many styles of healthcare systems in existence in addition to having relocated for some time to some of the locations to get a personal look. And despite all the complexities involved in such comparisons, both came to the same very basic conclusion: Healthcare systems are a reflection of the mindset of the country's citizens; Americans won't get universal healthcare until the average American believes that other Americans deserve it.

[seanmcdirmid]

The Swiss are big into responsibility: you must buy health insurance because we don’t want to pay for your healthcare when you need it (and lots of other mandatory insurance, eg bike and gun insurance, things that hardly exist in the USA ). They will give subsidies to those that can’t afford premiums, but otherwise you must buy it or else you are being a burden to your neighbors. It isn’t about people “deserving” healthcare than it is forcing people to take responsibility. The market is made even by disallowing group plans; you aren’t allowed to get it as a benefit at work and must pay for your premiums with post tax money.

The USA is weird in comparison: you get immediate healthcare even if you can’t afford it, with everyone else just paying for those who can’t or don’t want insurance. If Americans don’t want universal healthcare because they don’t think some Americans don’t deserve healthcare, they are doing that really wrong.

[dkh]

Interestingly, despite the burden of uninsured/unpaid medical costs, many in America view universal health coverage as antithetical to "forcing people to take responsibility." Given how many people are provided insurance by having (or being married to someone who has) a full-time job (half the population), there are many who feel that not being covered means you don't have a proper job, and perhaps you should, and why should I pay into a system so that you can get coverage easier? This is, of course, completely absurd, but you'll have no trouble finding people who think this way.

In case you're wondering why having to foot the bill for all those uninsured hospital visits doesn't make the "taking responsibility" thing super obvious, it's because most people aren't aware of how much they are paying for it. Like many things here, uncompensated medical care is ultimately paid out of a combination of many different local, state, and federal sources. While we are all paying for it somehow, it is not obvious to an individual how many of their dollars went to it. Therefore, while unfortunate, many believe that an increase in monthly healthcare premiums (they know exactly how many of their dollars go to that) means they will be paying more overall, not the same or less, because they are either unclear on how much of their money is going to the uncompensated costs now, or they don't trust that their tax bills will actually decrease.

We're once again at a place where most Americans believe healthcare coverage should be guaranteed, but are miles apart on who they trust to actually handle it. [1]

[1] https://news.gallup.com/poll/468401/majority-say-gov-ensure-...

[dangus]

Exceptionalism is still a terrible argument.

These examples heavily downplay the public health, safety, and behavior progress the West has made. In the US, litter, graffiti[1], and smoking were all greatly reduced over the past half century. The male smoking rate in America is half of the male smoking rate in Japan.

I think the idea that the Japanese form of capitalism is more benevolent than the rest is also a bit rosy-eyed. Statistics on hours worked aren’t great for Japan. It’s arguably not a good thing that low wage workers are prioritizing work. You say that there’s an aversion to screwing people over but in the same sentence you’re saying that low wage workers are being exploited and convinced to work unbilled hours.

[1] Jusr do an image search for “New York Subway 80s”

[chaostheory]

The main problem is that senior retirees are beginning to out number working adults who fund the system. Only skilled legal immigration can stem the tide, but that is not politically popular even amongst liberals. The end result is an entitlement system that is no longer sustainable.

https://www.imf.org/en/Publications/fandd/issues/Series/Anal...

> And that’s only if there is any political will to do so.

More taxes can only do so much if that was what you were implying. Middle class families can barely support themselves now let alone subsidize the little income they have left. Case in point, in the US for a family to have the same economic power as families in the past; they must make $240,000 - $300,000 depending on the metro

[gruez]

>I think it’s amazing that a solid system can be defunded like that until it just sorta crumbles under it’s own weight

"defunded"? Maybe if you're comparing post pandemic budgets to pandemic budgets, but spending is still way up compared to pre-pandemic levels.

[1] https://flo.uri.sh/visualisation/12020081/embed?auto=1

[sefrost]

I want to add some extra data for other people. The UK has an aging population. Old people need more healthcare spending.

If we adjust the data for age and demographic changes, then we can see spending was reduced between 2010 and 2021.

https://www.nuffieldtrust.org.uk/news-item/the-past-present-...

[throwawaylinux]

It is pretty blatant dishonesty to call it defunded or reduced spending though, as much as some ideologues like to claim it is.

[DanBC]

The people doing the defunding say that it's defunding. They're proud of it. They wrote a manifesto saying they were going to do it, and then they did it.

It's pretty blatant dishonesty to say that healthcare hasn't been defunded, and then only focus on NHS provision of healthcare while ignoring public health, social care, nursing care, etc.

[throwawaylinux]

> The people doing the defunding say that it's defunding. They're proud of it. They wrote a manifesto saying they were going to do it, and then they did it.

Oh? Do what, fund the health system at almost record levels?

> It's pretty blatant dishonesty to say that healthcare hasn't been defunded, and then only focus on NHS provision of healthcare while ignoring public health, social care, nursing care, etc.

It would be if someone had done that. Incidentally, are you saying that NHS has not been defunded? You wouldn't be very popular with said ideologues either then.

[photonerd]

The NHS has been underfunded for about 40 years, but especially under Conservative government.

Blair’s Labour—for all their faults—at least stopped the bleeding, but there wasn’t enough political & popular support for significantly increased spending.

Then Cameron & his bs “austerity measures” cropped it

[throwawaylinux]

> Blair’s Labour—for all their faults—at least stopped the bleeding,

Stopped the figurative bleeding and started the literal...

But by stopped the bleeding, do you mean kept at levels comparable to those set by the previous conservative government? I.e., agreeing with the level of funding set by the conservative government.

I find it weird how governments are given a pass in that way. Setting funding from X to Y is a horrific crime, but leaving it at Y when you have the power to change it to X is somehow okay.

[glomph]

Labour under Blair significantly increased the spending on the NHS compared to the conservative government before them.

[throwawaylinux]

https://www.nuffieldtrust.org.uk/news-item/the-past-present-...

Looks like there has been no slashing going on, even adjusted for inflation and demographics. And the conservative governments after 2010 kept funding at about the same levels as the Labour governments set it at. Fancy that.

I wonder what governments have had to show for this massive 2x increase in adjusted healthcare spending. Vast improvements to the system, surely.

[photonerd]

Your own source shows that when adjusted for population size/etc the trend has been flat/slightly down.

Now add inflation, that it was underfunded in the first place, and that the charts used start right after a major recession & the beginning of Thatcher…

[rcxdude]

The increases over the time period in that graph are still less than inflation, making it a real-terms funding cut, especially relative to the growth in population.

[gruez]

Here's a chart that adjusts for inflation:

https://www.economist.com/img/b/400/436/90/media-assets/imag...

As you can see, it's below pandemic levels (as I previously said), but still way above pre-pandemic trends.