In the US you also have situations where all that science means that effective treatments exist but they are entirely out of your reach because of insane healthcare costs.
I can't imagine having to watch a loved one slowly die knowing that you are surrounded by doctors who could save them if you only had the tens to hundreds of thousands of dollars they demand or if you'd been living in basically any other developed nation on Earth.
I’m certain that the US is in no way unique in that. Countries with universal public healthcare care systems do cost-benefit analysis all the time and access to the newest effective treatment options outside of the richest/most developed countries (or even in them) is far from guaranteed. e.g good luck buying latest cancer drugs from the US on an East European salary after your local healthcare system bureaucrats have rejected them because they are too expensive and/or are taking a year or two to decide of they are worth buying.
> or if you'd been living in basically any other developed nation on Earth.
That’s just beyond absurd, unless you think that only Switzerland and a handful of other rich countries are “developed”. Yes getting some minimum/acceptable level of care when you’re not rich might generally be easier. Getting access to latest or even experimental drugs (most of which are developed in the US)? Not so much..
This is partially true but for many things the price is different. In the US drugs are priced assuming that there are some number of rich people who can afford them. This often results in higher margin pricing which is more profitable even if the volume is lower and puts them out of reach of many. In countries with public health care, setting the price that high will typically result in near-zero sales, so the price gets set closet to the cost-benefit point to make profit in lower margins but higher volumes.
It doesn't always work like this. Some drugs are just too expensive to manufacture and the minimum profitable price is too high for the benefit in public health care. But often the bargaining and purchasing power of a public health care system can achieve lower prices for drugs and other tools.
That's because we subsidize the world by investing in a massive portion of the science and tech for producing medicines. Then when those costs are recouped via sales to our consumers the whole world laughs at us while ironically many of them would be up shits creek without the advancements they get to piggy back off of.
Healthcare and medicine needs overhauling but it's maddening watching these downstream foreign benefactors damn the golden goose they'd be fucked without.
I don't think it's necessarily true that we need to keep letting Americans needlessly die due to unaffordable healthcare in order to maintain our nation's lead in innovation. We should be able to continue to invest in medical science without continuing to fall behind other developed nations in actual health outcomes for patients. There are certainly many opportunities to drastically reduce the costs of healthcare without impacting the budgets for research.
Does the US actually fall behind other nations in health outcomes? The US has two big factors working against them: much more widespread obesity (and the level of morbid obesity) and the insurance bureaucracy. These two factors should negatively impact health statistics without the treatments being worse.
> Does the US actually fall behind other nations in health outcomes?
For the world's richest people you couldn't do better than to be a patient in America. For most Americans though, the US healthcare system is failing them. America does worse compared to other nations in some very basic measures like having a lower average life expectancy, a higher infant morality rate, more obesity and congestive heart failure and more hospital/pharmacy screw ups. A child or teenager in the US is less likely to live to adulthood compared to those in other developed countries. It's not any better when it comes to mental health either. The US is one of the worst nations when it comes to mental health outcomes and suicide and drug related deaths are higher in the US. Over thirty percent of the US population has been forced to put off getting the care they need due to the cost and preventative care is usually the first thing that people cut back on leading to bigger problems that could have been avoided entirely.
If you adjust by factors like obesity, state and drug use US is quite close or more or less on the same level as Western European countries.
Even if you don’t do that there is a higher variance in life expectancy between different US states than inside the EU. e.g. California is about on par with the Netherlands, Germany, Britain while Mississippi and West Virginia are slightly below Bulgaria (of course mainly because of drugs..). IMHO that kinds of makes generalized comparisons semi-meaningless.
"Yeah, but just unimportant people from flyover states. We have to divide our analysis of the United States: Over here in California - you now were the people we care about live - life is just as good as in these other fancy European countries we don't look down upon."
People who can't do basic math and skip prevention are responsible for their own shit outcome.
People in Portugal, where healthcare is "free", i.e. the government pays for it, frequently wait for years before being able to see a specialist due to long waitlists. The obvious outcome is that only poor people use the system and if you can you use private healthcare.
People in Czechia with single payer healthcare system with e.g. average wage of 2000 USD pay from 100 euros a month for health insurance (unemployed) to e.g. 500 euros (with 4000 USD salary) or more if you make more. You get the same shitty service (something like 20 years behid the US), you just pay a lot more if you make anything resembling a US salary.
There's no such thing as free healthcare. Can you make a single payer healthcare system that works better? Sure, it's just hard and even if everything is ideal you get maybe 50% discount. The main way to make healthcare cheaper is to drop coverage for diseases that are expensive to treat.
- 90% of Americans have health insurance - I would say it works for more than half (most) of Americans. Granted, not all health insurance is created equally.
- The obesity and congestive heart failure issues is a function of poor dietary choices most Americans make (choosing fast/process food over cooking/making healthy foods), and not a function of healthcare access
Clearly having health insurance isn't enough to make healthcare affordable or prevent patient outcomes from being worse for Americans than patients in other nations.
> The obesity and congestive heart failure issues is a function of poor dietary choices
I also suspect that obesity and congestive heart failure issues are heavily influenced by diet, although I think that "choices" might be misleading here and that being unable to afford basic and preventative healthcare likely does have a major impact in healthcare outcomes even when the problems come from obesity and heart failure.
It's certainly not as if people in other nations don't also enjoy ultra-processed foods or are any less fond of sugar, fat, and salt. They just often have better access to healthier foods, and more stringent regulations concerning what companies are and aren't allowed to put in foods, what they are allowed to advertise, and how they are sold.
There is a huge difference between the number of people in the US who have little to no access to healthy foods when compared to those in other developed nations. Sometimes it's physical access (food deserts) and sometimes it's a matter of costs, but I don't think there's anything inherent to Americans that forces them to make bad choices. I'm guessing that instead Americans tend to have less choice and fewer opportunities for healthy foods in the first place, while having unhealthy ultra-processed foods that would be banned in other countries readily available, easily affordable, and heavily advertised to them.
I call bs on the second part. It's not unhealthy food that makes you gain weight, it's how much food you have.
On top of that, the healthiest foods are among the cheapest foods you can buy. Milk, oatmeal, potatoes, rice, macaroni, chicken are all cheap compared to most foods you can get. This stuff is available almost everywhere.
>but I don't think there's anything inherent to Americans that forces them to make bad choices.
It's partly cultural. But this isn't a uniquely American problem. It's just worse in the US. 72% of Americans are obese or overweight.
On top of that there was a recent study that found that BMR has decreased in the last ~30 years. Among men it was even up to 7%. That's a big enough difference to take someone from barely overweight to obese over a lifetime. But this is only a single study so far.
> On top of that, the healthiest foods are among the cheapest foods you can buy.
The usual argument here calls out "bulk beans and rice" instead of potatoes and chicken, but in both cases you aren't going to find that in a gas station or convince store which for many Americans (some 40+ million) is the only place they can get groceries. If they're getting chicken it's not going to be whole and uncooked. It'll be sold in a plastic bag leaching PFAS into the food and be coated in high fructose corn syrup (most packaged lunch meats have sugar or HFCS added). Those kinds of places tend to have very little fresh fruit and veg as well.
If you're looking at cost per calorie unhealthy food will often win out as less costly, not just in terms of money but also time and effort. Someone who works two jobs and spends hours sitting on or walking to/from the bus isn't always going to have the energy or time to roast a chicken. It's easy to see why they'd choose what's fastest, highly satisfying, requires less preparation and clean up, and is inexpensive.
Not that I'm suggesting that the 72% of Americans who are obese/overweight have those kinds of problems... just that you'll find more Americans who are in that position than you'll find somewhere like the UK.
I found the study on the decrease in BMR. That's pretty wild and if true, I wouldn't be surprised if it was a factor in the obesity problem.
>If you're looking at cost per calorie unhealthy food will often win out as less costly
What you should be looking for is cost per gram of protein. That's the only macro nutrient you need large amounts of. Calories per gram of protein are important too - oatmeal and dried pasta are the cheapest protein/$, but their protein/kcal is too low.
I think it comes down to 'not caring enough' to try to get it under control. All the obfuscation and noise around nutrition ("healthy food") doesn't help either, but it's doable.
>I found the study on the decrease in BMR. That's pretty wild and if true, I wouldn't be surprised if it was a factor in the obesity problem.
It might even be the main part, at least for men. If your normal TDEE is 2136 kcal and you eat at maintenance, but then your BMR drops by 7.7% (165 kcal) then you'll gain weight until your TDEE is at 2136 kcal again. During this you would go from ~80 kg to ~95 kg taking you from 24.7 BMI to 29.3.
An argument against the study is that it could be due to different measuring techniques. On the other hand, we have found that the average temperature of humans is slowly decreasing, so maybe it's true.
It's not all roses. I'm sure that even the wealthy who get healthcare in the US do have to deal with things like over-treatment, a lack of regulations, excessive costs, etc. It doesn't seem to hurt their outcomes enough to offset the fact that they'll have far more options, greater access to the best avilable technology/treatments, and that they'll be treated like absolute royalty.
No. If you get something like cancer, at best you can expect Medicaid to be comparable to basic private health insurance, which can easily leave people with out of pocket costs they can't possibly afford.
Medicaid has a ton of other problems starting with eligibility, but even if you are eligible and you successfully jump through all the hoops to keep it (which are sometimes totally insane: https://youtube.com/watch?v=bVIsnOfNfCo), you still may not be able to get the services you need. Many doctors won't accept it and you can die just waiting for an appointment. Studies have shown there was effectively one psychiatrist for every 8,834 Medicaid beneficiaries and just one cardiologist for every 4,543 Medicaid beneficiaries. These doctors can't possibly see, let alone adequately treat and manage the care of, everyone who needs them.
The closest we get to free healthcare in the US is care in the emergency room which is only required to "stabilize" you. They'll try their best to keep you alive if you're actively dying, but then they push you out the door and send you a massive bill. They won't give you chemo or radiation to keep your cancer from spreading
> That's because we subsidize the world by investing in a massive portion of the science and tech for producing medicines.
Even if we assume that's the case - as in, normal margins would be insufficient to finance the research - that does not account for the medical treatments themselves.
This is such a rotten take. America, saviours of the world. It entirely discounts the contributions that other countries globally make. Countries in the European Union, Australasia, etc.
The US cost of healthcare is about 17% of GDP. In other first world nations it's about 11%. This isn't service delivery or value, it's underlying cost. Per capita healthcare costs over twice of what it does in the UK. Similar for Australia. Both those are socialised and have very active R&D communities.
The average life expectancy in the US is about 78. In other first world nations it's almost unilaterally closer to 84.
The US is ranked 69th globally in terms.of health system performance. The US is also ranked worse than the OECD38 average for death by preventable causes.
The biggest difference between those places I mention and the above is that the US views healthcare as a capitalist endeavour and tries to claim that competition will lower prices. Quite the opposite has occurred, and the system has become perverted. Intellectual property laws applied in this fashion ensure that you cannot have competition for health care since drugs are limited to a single supplier. You also don't get a choice in hospital care or doctors in most cases when you really look at how medical competition works.
In other places, the costs are socialised through taxation. Drugs are purchased through nationalised efforts where suppliers must either come to the table and negotiate prices properly or lose access to entire markets. It's funny how they can still be quite profitable even under this scenario, and yet the prices still be so significantly less by orders of magnitude than US pricing per patient/dose.
American exceptionalism ceases to be felt when you go spend time in other first world nations for any meaningful length of time. You realise it's reassurance of self rather than truth on basically all but defence technology spending.
> The average life expectancy in the US is about 78. In other first world nations it's almost unilaterally closer to 84.
It doesn’t help that (at least when it comes to healthcare) US is a dozen of different countries in a trench coat.
Life expectancy in richer states like California or New York is very close to that in Germany, the Netherlands, Britain etc. (and if adjusted for the massive disparity in drug related deaths they’d probably be closer to Italy, France or even Switzerland) while the poorest states are about on par with Eastern European countries where it’s barely above 75 years or so. So any average figure is semi meaningless.
> That's because we subsidize the world by investing in a massive portion of the science and tech for producing medicines.
How much of the money that flows into the US healthcare system really goes towards medical R&D, and how much is effectively wasted due to the inefficient bureaucracy and out-of-control litigation?
> How much of the money that flows into the US healthcare system really goes towards medical R&D, and how much is effectively wasted due to the inefficient bureaucracy and out-of-control litigation?
Literally tens of billions are wasted annually on advertising. The cost is pushed to the sick and hurting while doctors are bribed to overprescribe whatever drug people are being trained to "ask their doctor about". I'd worry about that way before I gave a thought to "out-of-control litigation". Especially considering how companies like Purdue Pharma and Philips Respironics can knowingly kill people with their drugs and medical devices, try to hide the fact they were doing it, yet face no meaningful consequences and not one person is put behind bars. If anything, I'd say America should be demanding more justice from the legal system not less.
if US government is paying for research, advancement and what not, why should the end result not be free for citizens? let them spend a trillion dollars on a new drug developed by bayer or whoever, why should the company then charge anything more than say a generic paracetemol?
All research done using any amount of money from the US government should be open and easily accessible to every American (with exceptions for national security), but that doesn't mean we should get the products resulting from it without cost.
If the government funded research that resulted in a more eco-friendly car I wouldn't expect to see one delivered to my driveway or that the car with the fancy new tech (which might be a lot more involved in terms of costs) should be priced the same as the old tech.
Healthcare should just be made accessible and affordable to everyone. It looks like the best way to do that is with publicly funded health systems.
>I wouldn't expect to see one delivered to my driveway or that the car with the fancy new tech (which might be a lot more involved in terms of costs) should be priced the same as the old tech.
we often pay a new user tax, or monopoly tax like the epipen thing. that should not be possible.
Well, if the US decided to not offer medicine on a realistic price point, other nations would do what the US did with Germany's Bayer, back when Anthrax was a concern: Cancel the patent on the only Anthrax medicine available due to "national security".
Don't blame the world for your Pharma executives needing a third private jet for their mistresses.
It's a tragedy of the commons. US lawmakers need to ban pharmaceutical companies from selling their drugs in the US at substantially higher prices than the drugs are sold elsewhere.
I can't imagine having to watch a loved one slowly die knowing that you are surrounded by doctors who could save them if you only had the tens to hundreds of thousands of dollars they demand or if you'd been living in basically any other developed nation on Earth.