There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
There is absolutely no reason for a medical equipment provider to bill more than the retail price of a piece of equipment, especially after insurance has already paid more than the full cost of the equipment on each installment.
There is absolutely no reason for a family to receive a bill of almost one million dollars because their baby was premature and was in the NICU (see @thepasinins on instagram).
There are too many layers in the system making a fortune off the public's back while adding little to no actual value.
I have a nephew training to be a doctor now. He's looking at $500k in student loan debt by the end. That's a major problem.
Some doctors will do 4 of those an hour, but most will do 6. And they'll try and find ways to bill additional codes above the consult.
Yeah, it basically all comes down to the bureaucratic nightmare that ultimately benefits the owners of all things medical. Prices have nothing to do with the value of the good or service and everything to do with the maximum amount of profit that can be extracted from a 3rd party.
One of the worst moves in the last 30 years was Clinton adding private insurance options onto Medicare. In the last 60 years was making medicaid a state run program rather than a national program (or just medicare all together). It's actually crazy that we have 53 different government healthcare options. 1 for every state, medicare, and the VA. It's even more crazy that the government doesn't simply directly employ doctors and medical equipment. It's so crazy inefficient to involve 3rd and 4th parties into something that should be direct care.
The US remains one of the only wealthy nations in the world without nationalized healthcare. And we pay through it through the nose.
Quote:
“…has produced one of the lowest ratios of medical school graduates, 8.6 for every 100,000 people. This is far lower than the OECD average of nearly 15 graduates per 100,000 people.”No doctor makes this much for a 15 minute conversation. A small portion of that money is going to the doctor. Much of it goes to all the other aspects of healthcare. The facility, other people involved in care, etc.
And no 15 minute visit costs 1000 dollars to the patient as well. That’s a pretty big exaggeration.
She was grandfathered under a form of medical insurance - I think older Blue Cross/Blue Shield - none can access now. At one point, the US did have better health care than we do at the moment. The fcking idiot boomers (including my parents) bought into the BS from Nixon, Reagan, etc. Hey - (good or bad) - let's stop allowing one to write off debt, but allow companies to do so, etc.
This country does have it's head up it's ass and a significant number blame everyone but themselves and how they vote.
We pay more (as a country) by a lot* and get significantly less for our medical coverage. Want to go self employed with a family of 3? Want a PPO? $4-6k/mo in California right now. Deductibles will be high.
Americans drive cars and most live in unwalkable places. These impart significant risks that the healthcare system, no matter how good, wouldn't impact.
Has anyone dug into this to identify whether they tried to account for built environment? Or food system?
The results are not all that different. The USA lags other rich nations, and even middle income nations like Costa Rica and Chile. https://www.oecd.org/en/publications/health-at-a-glance-2023...
About 41k people die on the road in the US per year. While this is very high, and worse than pretty much any other developed country, it’s not going to move the needle _that_ much.
40% of Americans are obese and 75% are overweight. This is largely outside of the control of the medical system, but has a significant impact on mortality and life expectancy.
The UK health care system is an absolute joke, it's a running joke among a lot of the population. It's not free for a start, the taxes the population have to pay are eye watering. You have to wait weeks, if not months for a specialist, hospital beds are few, there is no accountability for regular fuck ups (I've been on the bad end of a horrific one).
The US system from what I have seen so far is a dream. It's cheaper and the service is top notch.
For context I've moved from the Midlands in the UK to the Research Triangle in North Carolina.
If you take any kind of look at disparities in health outcomes, it becomes immediately apparent who is dragging down the mortality statistics. This is not something espresso-drinking researchers at WHO dreamed up to fight a culture war.
NHS services are free at the point of care. I worked in the NHS for a good few years. Never swiped anybody's credit card.
In the USA, calling an ambulance will set you back more than $1,000. No insurance? Better not give birth. You'll need 20 grand. Maybe 50 grand for a C-section.
The principal components in life expectancy difference between the US and the other OECDs are car accidents, homicides, and CVD. Obviously, accidents and homicides aren't a function of the health care system; they're a function of the atypical dependence the US has on cars and its wildly atypical availability of firearms. Though: it is worth noting that the OECD definition of "preventable deaths" includes vehicular accidents!
But even the CVD statistics are misleading in a comparison like this. CVD outcomes are heavily regionalized in the US. The New England states have CVD outcomes comparable to western Europe. But go to Mississippi and Alabama and we look like a developing country. There's a lot of stuff going into that difference, but the key thing here is that the structural design of the health system is the same in both regions.
There's a lot not to like about the US system of employer-paid health insurance. But these kinds of critiques are frustrating and a little unserious, and it annoys me that this article assumes its readers won't dig into the crosstabs and will just take the comparison on faith. That's disrespectful to readers.
This is a long-standing fact. It's difficult to interpret without concluding that something is badly wrong with US healthcare provision.
Plenty of people out there trying, though
When basic exams cost them easily US$100k, you know the system is broken.
Health system is a business model in the US, and people who are organ donor are literally being murdered to have their organs removed.
Don't trust my owners, you won't need much to find that out.
The ACA baseline plan has to cover a yearly checkup, basic screenings for things like blood pressure and cholesterol, and even more in depth screenings like colonoscopies or pap smears; all at 0 out of pocket cost.
Americans blame everyone but themselves. Americans who do not have high rates of obesity have similar mortality to western europe.
Take Massachusetts who has one of the lowest rates of obesity- similar to Japan.
Sadly this line of thinking makes people angry.
You can't have a healthy society if all policies are dictated by corporations.
There’s always talk of freedoms and being brave and being the best country in the world to live in, but very, very little effort of action to improve anything.
The French riot in the streets if a single day of their extremely generous (by US standards) leave is taken away. Meanwhile Americand can’t get off the couch to protest, or are afraid of their own government if they do.
It's hard not to see those downvotes as copium or cognitive dissonance given no arguments have been presented to the contrary.
24 million Americans are insured under ACA. The current president has issued several executive orders that undermine the provision of ACA insurance and increase its cost. Millions are dropping coverage as the increases kick in. (https://www.nytimes.com/2026/05/01/business/obamacare-enroll...)
The solution are not better Hospitals to deal with your diabetes or cancer after all your food has sugars it should not have like corn syrup because sugar is cheap. You have so much additives in your food for preservation. Meat is full of Hormones.
Antibiotics on your vegetables that destroy your microbiota. Genetically Modified to fill the fields with pesticides.
Now Americans are obese as they process the growth hormones from their meat and their microbiota dies from the antibiotics they eat in their vegetables and their meat.
Waiting until your children has autism or asthma or cancer is not the solution.
A quick search reveals the best ER wait times worldwide are in the US, Germany, and Switzerland, with most the rest of western Europe dead last along with Canada and Australia.
The average ER wait time in the US is 24 minutes. In France 2h21m. Italy 2h44m.
Everyone likes to say how great Canadian healthcare is, but talk to actual Canadians and the cracks start to show, you're waiting months for a CT scan, and most need employer-provided health insurance anyway to fill gaps in coverage.
I've been to the ER in my country because of abnormal stomach pain. Obviously I was triaged and had to wait hours because it was not considered life threatening. But in the end a doctor saw me for free. I think if I were in the USA and didn't have health insurance I would have just stayed home and avoided the risk of an expensive bill.
It's just a blatant lie.
I've experienced healthcare outside the US (in the UK) and it's on par with US healthcare in terms of wait times. Seeing a GP was same day with walk ins. When not busy, it was just a 5 minute wait.
Seeing a specialist can take time. I knew people that saw a 3 month wait to see a specialist in the UK. In the US, I just experienced a 3 year wait getting a specialist for my kid with autism. I had to go out of state to get the initial diagnosis, but to get local followup care I had to do that 3 year wait. After that, we were able to get a bunch of referrals to other issues.
What constrains wait time is how many doctors and specialists are working in a field. That has almost zero to do with the underlying payment system of a healthcare system.
1. way too many regulations and lobbies that prevent any relaxation by scaremongering
2. unions that artifically constrain labor supply. doctors lobby to keep number of doctors low and regulatory capture preventing forign doctors from entering workforce. Uk for example imports doctors from india.
both political parties have their own agenda to not disrupt above . democrats love regulation and unions. republicans love corporate profits from regulatory capture.
healthcare is exterme opposite of freemarket despite the veneer
But "suppliers" know that demand has bo choice but swallow the prices and services.
Kind of like "cable companies" oligopolies but worse (see southpark espisode).
Health care should not be for profit.
You’re right. The Swiss system is deeply privatized, down to compulsory private insurance [1]. It just isn’t as opaque and corrupt as the American one.
Part of the problem with the American system is everyone is cynical with respect to reform, and has a singular bogeyman they’re convinced explains all of the problem, with zero room for multiple causation.
You might want to check that. In Cuba's case, not really unless you focus on their export of medical services. But for the greater case it's totally free. And qualitatively better than what the US provides.
Once this issue is fixed, costs will decrease.
Insurance companies are another matter. A middle man only in increases costs.
The free market should be used for common procedures, to bring costs down and insurace should only be used for rare surgeries that won't result in decreased prices.
Canada on the other hand, we don't spend enough time talking about. There's a country that understands freedom.
Any given health provider has to deal with thousands of different insurers, and it's not uncommon for individual patients to have primary, secondary, tertiary, and even quaternary insurers the provider then has to deal with to get paid for a procedure.
To keep health care workers focused on providing health care, providers hire a bunch of administrative workers whose job is to offload the work of haggling with insurance onto cheaper workers, but because there's so many insurers, and patients have so many layers of insurance, you end up with something close to 10 administrators per doctor.
Alas, because there's so much money sloshing around in the system, and because the US government is so thoroughly corrupt with bribes from special interests, there's no movement to correct the problem. The system is unsustainable, though, so it will inevitably collapse in on itself at some point, causing a lot of misery and probably death before anything is fixed.
A thing that's always worth keeping in mind: retail clinical practice for non-geriatric adults is a very small fraction of all health care costs in the US, and end-of-life care is a very large fraction. Most of us only have exposure to the former, and we generalize from it, but that's not giving us an accurate picture.
Only problem is you can’t destroy the jobs program. Someone pointed out to me that the job market is propped up nearly by healthcare alone.
For someone without and particular skills, credentials, network, medical industry jobs provide one of the last few steps to a stable, middle class life that’s also accessible to working class. In other words, it’s one of the last vessels for any sort of social mobility.
Imagine the profit margins where you don't have to pay salaries to them.
Phone and front desk stuff is just administrative burden, scheduling the appointment and making a paper trail.
(to improve US healthcare, laws will need to change; when those laws change is a function of election outcomes and cadence; those election outcomes are a function of the electorate, who they vote for, and the rate of cohort turnover; think in systems)
This timeline seems wildly optimistic
The issue is not that Americans are insufficiently violent.
I agree but what is the alternative? Not buying health insurance? Moving to a different country? Please don't say voting (That has solved nothing.)
The number of Americans with no health insurance dropped by more than 4 million between 2020 and 2024.
So do something to get control.
Americans have been conned that they live in the greatest country and that nothing needs to improve. And now you say they have no control.
They are the workers. A six month general strike would literally change everything about the entire country, forever. They just lack the will.
Its all just talk.
I've been overweight in my life and I hate it. You know how I lost weight and kept if off? I ate healthier, I walk a lot (to the grocery store, for example). US grocery stores have all the same healthy foods as every other country. You can eat healthy at restaurants too, if you must.
It's just people don't. There's nothing inehrently bad about food in the US. We at eat too much and don't exericse (walk). Now, if you'll look at all the other countries joining us in this because it isn't a US thing anymore.
You've added all these extra explanations (corn syrup, antibiotics, growth hormones) but it really isn't that complicated. BTW, I'm sure if you ate konbini foods every day in Japan and didn't exercise enough you'd get fat, too. There's nothing different about that food than a lot of junk/fast food in the US, it's just the Japanese seem to walk a lot more and I don't know how many people only eat out of 7/11.
Except that sugar (or more often, corn syrup) is added to everything.
Just as a small example: most regular people don't have the time to bake their own bread or make their own spaghetti sauce from scratch, so they get both from the store. However, in the US, unlike most European countries (and probably the rest of the world), both have tons of added sugar and/or corn syrup. This is true for most foods in the US, and while it's certainly possible to eat healthy, it's a lot harder to do so here.
> and don't exericse (walk)
A big part of this, too, is that not only are most areas in the US not designed to be walking-accessible, but I daresay most are designed to be openly hostile to pedestrians. Added bonus: in the case where you do happen to live in a walking-friendly area, you still can't send your kids out to walk around, lest you invite visits from CPS.
That isn't to say people in the US can't be doing more than they are to get healthy, but arguing it's no more difficult to stay in shape in the US versus other parts of the world is at best self-delusion.
One of these is not like the other.
The saying is the US doesn’t have “health care” we have “sick care.” Preventing diseases? Not profitable. Giving people diseases then charging them for treatment? Profitable.
Fortunately the obesity epidemic has a cliff like tail end, as those people tend to eat themselves into an early grave and lack the resources to pay to prolong their participation in Planet Earth.
What inherently prevents you from cooking a tortilla or baking bread in the US vs Spain? Do frying pans and ovens work differently? Has the US outlawed paella?
Calories in > calories out.
The great news is that when you eat less, it brings down the relative costs of better food. Instead of pounds of low quality ground beef, 3 packs of Twinkies, and a case of beer; buy some higher quality organic chicken, or even better, some organic vegetables.
Though, in Ireland, for instance, the worst parts of the country for car dependency would be close to as bad as the US. Their life expectancy is a little lower than the national one, but it’s not dramatic, and certainly not as low as the US one. There’s something else going on.
I assure you that preventative medicine does exist, even in the USA. Moreover, healthcare interventions for people with "lifestyle" diseases such as obesity have been extremely effective in reducing mortality from downstream causes such cardiovascular disease (e.g. statins).
Diet and exercise are huge health variables that doctors don't really have the tools to do anything about.
Obesity can be prevented, can be treated, and its effects on health can be managed. We are actually living through something of a miracle in the treatment of lifestyle diseases. For example, the proportion of total deaths among adults with diabetes from vascular causes (heart disease) declined from 48% in 1988–94 to 34% in 2010–15 (https://sci-hub.st/10.1016/S0140-6736(18)30314-3).
The USA is not some kind of outlier with a uniquely unhealthy population. The problem is *very obviously* something to do with how healthcare is provided here.
Not just discussions with a patient, but advising the government, pushing for regulation on things related to obesity, working with schools, etc.
Arguably, the problem in the US isn't that these are outside the control of the medical system, but that most Americans believe they should be outside the control of the medical system.
In (some) other countries, your comment would be a real "WTF?"
[1] Throwing in questions like "Is there a firearm in your house?" and "Is there a swimming pool in your house" intermixed with "normal" medical questions.
Not sure about that. But each person tends to have something like a single sentinel flag. E.g.: does medicare negotiate drug prices? And if there's a change for the better, they won't believe it's anything but a short term grift until they read it back as "true" from at least 16 different threads over the course of, say, 9 consecutive years.
Given that their representatives currently use phrases like "medicare advantage" to mean "off traditional medicare and on private insurance," that caution seems warranted.
Do you have indications that those are worse where wait times happen to be higher, or so you just take it for granted that longer waits must mean worse net experience?
Worse is the distortion of incentives for healthcare providers. The giant leaky insurance tit is there to be sucked on, creating corruption at every level.
When you are billed for a procedure you have no idea how much you are going to get charged or what you could get billed for. There could be gigantic opaque charges for things you have never heard of. Ticketmaster could only dream of such a rip-off.
Not to mention blatant over-billing for unnecessary diagnostics, etc. Every year new kickback schemes are discovered.
Price transparency is a real problem. Overbilling is a real problem, so is overprescription. Important to keep in mind that those are on the provider side, not the payer.
California -'You're right, if we provide preventative care, we lower the significantly more expensive ER visits, save costs, and reduce ER wait times'
'more freeloading on the system'