[jimbob45]

It's unfair to judge the EU piecewise but then judge the US as a whole. Either let us compare apples to apples by judging the whole EU against the US or let us judge individual European member states against individual US states.

[usr1106]

The EU has no common health system at all. Calculating any kind of averages makes little sense. Within some countries I am personally familiar with there are significant differences in availability of health services between certain areas, rural vs urban, but also regionally. Legally the systems should be rather uniform within a country though. Many countries have a split between publicly financed and privately paid services. It's probably expected that privately paid services are used less in poorer regions.

With the US I am not really familiar. I'd expect commercially and legally it works the same over the whole country. In practice many services won't be offered somewhere in rural areals compared to metropolitan areas. So if you are unable to travel no treatment. And of course if you aren't well off, no expensive treatment.

[ImJamal]

The US has no common health system. There are a few systems that are common (Medicare) but that is only for the elderly. The rest of the system is all done on the state level. The rules vary amongst all the states.

[usr1106]

> the rest of the system is all done on the state level

Ok. Didn't know that. But you are talking about public services aren't you? I would assume a rather small fraction of the huge US health expenses are publicly financed. The bigger part is completely private businesses, both service production and insurances for those who have one.

That's the opposite in most EU countries and UK. A large fraction is either produced publicly or if produced privately then paid for by a publicly organized health insurance.

[ImJamal]

I don't know the percentage so I don't know if it is a small fraction. The basic setup is:

Medicare - federal program for seniors

Medicaid - state program for poor people (there may be some sort of funding by the federal government, but it is run by the states)

Private insurance - this is paid by the individual and/or the company they work for

The laws/regulations regarding what is and isn't allowed with the private insurance is handled mostly by the states, not the federal government. The federal government has pushed for various rules (ACA/Obamacare) but there is a debate about the constitutionality of the federal government getting involved.

There are also specific programs within the governmental systems that focus on children (Insure Kids Now) and provide dental not just medical.

Within Medicare there are additional (supplemental) coverages that provides better benefits called Medigap.

I'm sure there are more programs than just Medicare and Medicaid, but those are the largest ones.

[c1sc0]

Why? Europe is a collection of sovereign nations, not a federation of states like the US?

[daanvd]

Aha! But Germany is also a federation. So it's only fair to compare Alabama to Saarland. Oh, wait...

[ben_w]

Well, Bavaria is famously the Texas of Germany…

[short_sells_poo]

Does the Bavarian power grid also routinely go down because they don't invest in it and at the same time also refuse to add interconnects with other regions?

[ben_w]

Not sure, but I think the grid integration is international with significant connections to e.g. France, rather than federal states within DE having their own thing?

More that the stereotypes people have of Germany/USA are really of Bavaria/Texas (beef, guns, lederhosen), more (small c) conservative, and there are occasional mumbles and grumbles of independence but they don't have any substance to them.

At least, that's what it seems. My grasp of German means there's a game of telephone between reality and my understanding of Bavaria, and I've never even been to Texas so I'm judging them by what people say online.

[gertlex]

As an American, I'm probably heavily influenced about non-state-by-state discussion in the media and thus ignorant... (and work in tech and don't directly pay for health insurance...) but I don't think I'm aware of significant state-by-state differences in healthcare.

I know California generally has more regulations and has MediCal, but most insurance options I've encountered seem to be multi-state (regional, not necessarily country-wide though). Things like FSA/HSA are nearly the same across all States I think?

I'd assume quality of care varies more by region (likely with some correlation between quality and the to major options health insurance providers) than by state lines.

That all said, I'd be curious to see all 50 states in a healthcare quality ranking combined with the various "peer" (or EU) countries like you propose. I'd probably be surprised by the spread.

[daemonologist]

Medi-Cal is California's implementation of Medicaid, which along with CHIP is always administered by the individual states (though the federal government tries to apply some controls via funding).

That's the only big top-down state-by-state distinction that comes to mind, but there are a lot of small details. We have some models predicting medical outcomes and financials and state is always at or near the top of the SHAPs. Sometimes bigger than age or household income. (I don't study this or anything, just an incidental observation.)

[hollerith]

The organizations that take doctors' licenses away when they misbehave are all state-level organizations (in California, it is called the Board of Medical Quality Assurance) and I can easily imagine that some states perform this function much better than other states.

[daanvd]

The report compares countries, not states. What point are you trying to make by comparing US states with EU countries (and Canada, and Australia, and New Zealand)?

[croes]

Why. The US is one country the EU is not.

[shiroiushi]

I tried that argument here recently when I talked about civil asset forfeiture and a bunch of people said I was horribly ignorant about civics and that the US is apparently not one country.

[croes]

Does each state compete for itself at the Olympic Games?

[yieldcrv]

I agree, some individual states have free healthcare, free community college. It’s easy to fall out of these systems or be unaware of them, but they exist

I’m the last person to have an America boner, but there is room for objectivity

I’m a fan of Germany, Austria systems. An educated and healthy populace seems positive. I’m aware of the problems residents have with those systems, they have private options too. Public debt isn’t as high, and maximum tax between state and federal level is lower than maximum of California + Federal. So, seems better.

[csomar]

Unfair to the EU or the US? Because this plays to the US favor.

[ahoef]

I don't think it will matter.

[kylehotchkiss]

Ugh. This. Not just for healthcare though, for everything. Using small wealthy countries with populations smaller than our states as a comparison against our continent sized country is really not helping or proving anything.

[crummy]

Does having a bigger country mean health care is more expensive? How come?

[triceratops]

> Using small wealthy countries with populations smaller than our states

I don't know which countries you're talking about. Sweden has a population of 10m, which would make it the 10th largest US state. Norway's 5.5m people would make it the 23rd largest.

Even if we go really small and rich, Luxembourg's population is 670k - that's more than Washington DC (not a state, I know), Vermont, and Wyoming.

The only really wealthy European country that's smaller than a US state is Iceland.

[hilux]

Did you read the article? (I recently posted something similar - it's probably posted often.)

It's proving that the US, which spends BY FAR the most on healthcare per capita, is getting a very poor return on our investment.

It's not really "helping" because the GOP is so opposed to healthcare reform - which would cut into their corporate profits, and they've somehow persuaded their supporters that Jesus hated healthcare but loved automatic weapons.