[wisty]

And the US also pays a TON of tax dollars to a broken, overregulated system.

IIRC if you look at the cost of Medicaide, Medicare, VA, and other federal and state spending it's the same as most other countries per capita or as a percent of GDP. The US taxpayer pays about as much as Canadians to fund their public system, then pays the same amount again for private cover since it's not universal.

No I'm not making a typo. Medicare, Medicaide, and the US system is such a rip off that per capita Americans are paying similar tax dollars to their joke of a public system.

But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.

[refurb]

Canadians don’t get the same care as Americans.

McKinsey did a nice analysis of what is driving US healthcare costs. It compares category spending to OECD then compared price and volume.

Turns out the US pays a bit more for drugs (relative to total spend), a little more for inpatient care and a TON more for outpatient care but half of the increase is volume, not price.

As someone who works in healthcare globally, the difference in US care is stark. Americans get much early and more access to new technology than other countries.

If your lymphoma has returned and you have a 20% of living more than a few years the best care is CAR-T with cure rates close to 60%.

Check out CAR-T rates in the US versus Europe, it’s almost 3x. The US started using it in 2014 and Singapore just started paying for last year (11 years later). Even in Europe adopt only ramped up in the last 5 years.

So yes prices are higher, but a big part is more aggressive care with more expensive treatment.

[wisty]

The US healthcare system just upsells on unnessessary crap. It's junk volume or at best it's heroic high tech solutions mostly making up for the fact that people stay away from hospitals until it's too late.

Life expectancy shows that while the US is the best place to have stage 4 cancer, it's probably not the best place overall. Most places do the 80/20 stuff better.

But yeah, you are right that the US does some stuff well. Just not efficiently.

[refurb]

US care is highly aligned with international guidelines. Saying "it's junk volume" just tells me you're not that close to the data.

Life expectancy doesn't measure quality of healthcare, there are far too many confounding variables like genetics, diet, accidental deaths, etc. No serious study of healthcare quality relies on it.

Look at 5-year cancer survival rates. The US is better (significantly better) in many of them than other countries. A big part of that is access to the latest technology.

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2...

[wisty]

Now do maternal death rate. Like I said, a good place to have cancer but they aren't good at stuff that matters.

The US leans aggressive on tests and heroic end of life care. I doubt you really disagree (except maybe on whether you think it's the right call). That is where the money is, since the insurance company can be forced to pay. It's kind of good for the rest of the world though if the US wants to pay (in both money and other issues) to be early adoptors.

Read "When doctors die", the US is the total opposite - everything goes to the big ticket aggressive (and yes, modern and cutting edge) treatment where it's hitting diminishing returns. https://pmc.ncbi.nlm.nih.gov/articles/PMC6179868/

[refurb]

> Now do maternal death rate

Sure!

https://archive.is/rMVJ0

Turns out the CDC changed the way it counts maternal deaths, while other countries didn't, so you're comparing different measures.

The old US measure was deaths that occurred during birth or shortly thereafter, now it's within six months and they added a check box only asking if the woman had been pregnant in the last year.

Not "this woman died because of poor maternal care", but rather "this woman who died had been pregnant in the last year".

This change immediately doubled the number. The data was wildly overestimating maternal deaths and in fact the CDC and many states are revising data collection to improve the number.

[dghlsakjg]

A good tell that someone is utterly full of shit on Canadian healthcare is that they generalize all of Canada.

“Canadian health care” is not a thing. Each province administers its own completely independent system.

Someone on PEI is in a healthcare system that has as much to do with Alberta’s healthcare system as it does their neighbours in Maine. As a result, anyone referencing Canadian healthcare is talking about a dozen or so unrelated systems that do things very differently. The closest it comes is that there are interprovincial billing systems so you don’t have to do the paperwork to get covered for an urgent visit out of province, and not all provinces are signed on.

You can safely dismiss anyone that has reduced that complexity, or is completely ignorant of it. It’s a great way to tell when a foreigner is spouting talking points they picked up from an unreliable source and did not do even a minimal fact check on. “Canadian health care” as it is talked about in the US media is frequently fiction for propaganda purposes.

Canadians almost always talk about problems within a province. What's happening in the Maritimes has nothing to do with BC.

The feds set a minimum standard for a province to qualify for federal funding, and that's about the limit of their influence.

No idea if the rest of his statement is poorly sourced propaganda as the first sentence.

[refurb]

You’re ignoring the fact that provinces can’t fund technology that the federal government hasn’t reviewed and negotiated a price for.

So yes there may be differences between provinces in terms of when they fund what restrictions are put on it, the overall trend across Canada is pretty consistent.

And as I said Canadians don’t get the same care as Americans so concluding the higher cost is entirely higher prices for the same thing is false.

[lostglass]

I lived in Ontario for 20 years then I lived in Seattle for the next 17, I assure you that the healthcare I receive and received is pretty much the same - except in Ontario it's way cheaper.

You're talking about cutting edge technologies available to the tiniest sliver of people - I'm not even able to get access to much of them with my private FAANG insurance - and drawing a false comparison.

[refurb]

Nope. I've not only lived in both countries, I work in healthcare so I'm very close to who gets access to what.

And it's not "the tiniest sliver of people", we're talking about disease like cancer. Check out the CAR-T rates in the US vs. Canada, the difference is stark. And CAR-T is standard of care in some types of lymphoma.

Hell, ask parents with autistic kids what kind of early intervention is available to them in Canada. I had a coworker who moved to the US so he'd have much better access for his kid at a time when it had a big impact.

Look at access to the cystic fibrosis therapy that effectively cures it (e.g. Orkambi). It was paid for by insurance (and Medicaid!) from the day it was launched and avaiable to everyone it could help. In Canada some provinces just started paying for it, but only kids, adults are shit outta luck.

And I don't know the details of your FAANG insurance, but my US insurance (typical corporate insurance) pays for all these new technologies.

Canada is great if you have a routine issue. If you need something specialized you're going to be treated with therapies that are a decade or more old. Hell, even the CBC wrote a whole story about 2 friends with breast cancer and the differences in treatment.

https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-...

"Then I found out that this other country — which I thought had a healthcare system that was so superior to the U.S. — doesn't test for the tumour marker that saved my life, and doesn't cover this drug that is responsible for pushing my cancer into remission after traditional chemotherapy failed to do that."

[nkrisc]

Most doctors and nurses are not overpaid.

Certain specialities probably are overpaid (orthopedics), but others like pediatricians or general practitioners usually aren’t.

And nurses!? From the nurses I know they are underpaid for what they deal with.

The ones making loads of many are willing to travel around the country and uproot their life once or more every year. Not exactly a lifestyle without its drawbacks.

[wisty]

Everyone is gonna say nurses are underpaid. It's a caring, female dominated profession, it's a motherlove sentiment. And they are not paid as well as doctors.

Yeah, most pink / blue collar workers in the US are badly underpaid, but IIRC ones in the health sector are some of the best off, relative to medium salaries.

Compare teachers and nurses. In most countries they make about the same AFAIK (and I'd say nurses do deserve more, telling a parent Billy did badly on a math test has got to be easier than explaining a bad medical test). But in the US it's about 75k vs 95k. There's a huge premium for working in health in the USA, EVEN in the underpaid blue collar end.

Doctors make out even better in the US, and the c suite in health can have salaries that are just insane.

[nkrisc]

I don’t dispute this, but I also don’t think it matters. An underpaid profession being paid more then a severely underpaid profession doesn’t make the former overpaid.

[Sohcahtoa82]

> US doctors are overpaid. US nurses are over paid.

Median pay for a Nurse Practitioner is $132K/yr [0]. I think that's reasonable.

Average pay for physicians ranges from $220-450K depending on specialty. [1]

Personally, I think doctors should be paid more than software engineers, so I think those numbers are all reasonable, especially when you consider what it takes just to enter the field. Nurses require a Master's degree. Physicians need a Bachelor's degree PLUS another 4 years of med school AND THEN a residency program that lasts 3-9 years depending on specialty before they finally earn their medical license.

IMO, the idea that nurses and doctors are overpaid is quite simply ludicrous.

[0] https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-...

[1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...

[sgerenser]

You might find those salaries reasonable, but they’re probably double what those same occupations pay in many other (first world) countries with lower healthcare costs. Maybe the trade off is worth it, but it’s not something that can be ignored when people complain about how much more expensive healthcare is in the U.S. compared to Europe (for example).

[Sohcahtoa82]

> but they’re probably double what those same occupations pay in many other (first world) countries with lower healthcare costs

You'll find that salaries across the board are lower in other countries. Software developers in Europe make half of what they do in the USA. In exchange, they get far better benefits.

Also, physician salary only makes up about 8% of total healthcare costs [0]. Cutting salaries in half wouldn't significantly lower our healthcare costs.

[0] https://www.medicaleconomics.com/view/physician-pay-makes-up...

[sgerenser]

No, certainly just cutting physician salaries wouldn’t make a big difference. But cutting salaries for everyone involved, including physicians, nurses, and administration would. I’m not saying we should do that, but just that people seem to ignore how much higher salaries are in the U.S. when they compare healthcare costs to other countries.

[master-lincoln]

That's what a government would be for. You vote neo-liberal, you get it... (I consider both the US democrats and republicans neo-liberal)

[bestouff]

I think only the US consider the US Democrats as leftists.

[opo]

This is a common claim, but it is a misleading simplification of US politics and European politics. (In simple terms, many of the economic positions taken by the Democratic Party would be considered centrist in Europe, but if you include positions that have been taken on immigration, identity politics, criminal justice, reproductive rights, etc. it would not.)

[refurb]

The Democratic Party spans from slightly right to ragging left that even European leftists look at with confusion.

[Symbiote]

What's the name of the far left grouping?

[natebc]

Only the rightists do and among them really only the loud redfaced ones.

[cucumber3732842]

>But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.

17% of GDP is healthcare. So between 1:10 and 2:10 people in this country are making more than they otherwise would (note I did not say wealthier) because the system is screwed up and hoovers up more of everyone else's wealth than it ought to.

Slavery was 12% and (while obviously geographic concentration of industry plays a lot into it) it took a war for them to take a haircut.

[uoaei]

Earnings represented by GDP are not distributed evenly across a given population. That 17% of extra earnings goes to relatively few people in the States (I'm putting this very mildly, the concentration in reality is insanely lopsided).

[cucumber3732842]

The US healthcare industry is ~10% of the workforce. More if you include people affected by the supply distortions thereof (all those techbros working for agentic penis pump startups).

The fact that that pie is not sliced evenly does not change the fact that is an integer multiple larger than it ought to be.

[pjc50]

Possibly reasonable point about labour supply ruined by an absurd analogy with slavery.

[nekusar]

Not at all.

Systemic inertia is unimaginably strong.

I easily see that changing the USA to be more socialist, especially in areas where game theory indicates its the best solution, will likely take a civil war.

That also aligns with Marx's writings, that the capitalists will not acquiesce without a fight, and a big fight at that.

The slavery and Civil War connection is a comparison of similar economic magnitudes.