Throwaway05
5d ago
elective surgeries for cheap
Doubt on this front, the Western standard is for when things go wrong, which is rare - but if you get something like a T&A done in your 20s in a major academic hospital in the U.S. and have a major complication, you will likely be fine. In Mexico? No dice.
Throwaway05
5d ago
Yeah you can absolutely get some things done faster by heading over to the U.S. but keep in mind that the times where it's really useful (ex: cancer workup, need a new knee) it will become cost prohibitive and unreliable very quickly.
I assume the reality of the situation is Canada is not as bad as some of the stories would make it seem but those stories are still quite alarming.
It's also worth noting that while US care is expensive EMTALA and others things ensure you will get care for most types of maladies even if you become bankrupt afterwards. Many countries don't ensure this this outside the affluent west.
Throwaway05
5d ago
They are better than the USA, which is the key benchmark. Canada is much more similar than Western Europe and also has historically out-performed the USA, although our healthcare system is getting fucked on pretty hard right now so idk how the stats match up post-COVID.
Don't fall for the propaganda here, the U.S. has worse outcomes on many metrics but a population that is more unhealthy and those worse metrics are driven by a social goal (you have the freedom to accept lifestyle diseases). When you get sick you are better off here than everywhere else in every way except the pay check. You'll get faster care if it's outpatient, and better across the board. You might have worse outcomes because you eat too many Big Macs but that is a public health and cultural problem instead of a medical care one. The expense is higher is really the only problem.
(And note well: those lifestyle disease worsen outcomes on everything, example diabetes fucks with wound healing and metabolic process of all kinds, obesity makes surgery impossible, etc.)
I'm torn on this, if the USA also captures most of the world's pharma profits than this is a net gain no? No idea how the math works out there though.
I don't know either but good thinking.
This is true but hilarious. Americans are violently against "taxes to pay for healthcare" but are completely fine with "employer subsidized insurance premiums that mean they get less cash in hand in exchange for access to healthcare" which is functionally just taxes but with more middlemen??!!?! And poor people I guess get less services versus single-payer, but then everyone subsidizes them anyway via higher medical bills to offset all the non-payments from the aforementioned poor people.
This manifests in all kinds of ways. Don't want to take vaccines and want to accept the bad outcomes? American individualism. Clearly dying grandma with 95% 30 day mortality rate? Spend EVERYTHING. Etc.
Are death panels real anywhere? I also feel like prices/medical bankruptcy (66% of all USA bankruptcy filings) are kind of analogous? If you can't afford chemo you sell everything you have until you run out of money to pay for it and die. Also you absolutely do have rationing, it's just in the form of prices versus bureaucratic limits. It can be debated which type of rationing is better, but the human demand for healthcare is infinite, supply never will be.
The usual way this shows up in real life is in other countries under spending on end of life care (which is super expensive and with where I am in my life now.....yes I'd want that for me) and delay of care. Canada is notorious for this. I need major hip or knee surgery in the US and I can get it within the week, but Canada though? Months. People also die from cancer and other diseases or have worse morbidity because it takes awhile to be seen and treated.
U.S. has a lot of profit motive and well payed people so they get to both care about patients and actually hustle when it's necessary and the system allows it because $$$.
Also, since I don't really get to talk about my favorite medical topic here but now is a perfect time - Trauma!
No better place in the world to get fucking shot (at least in a civilian context)!
Throwaway05
5d ago
Their are two problems with this line of thinking:
- Are those systems actually that good?
- Can we make that happen here?
The U.S. is fundamentally a different place than Western Europe - we spend a lot of money on illegal immigrants, have a maximal amount of cost disease, we are more unhealthy (and importantly as other countries catch up they look more like us), we subsidize the rest of the world's medical research (maybe not fair, but we are the wealthiest country and nobody else will pick up the slack if we go away), we are more independently minded (people don't want to be forced onto insurance or into making certain decisions), medical malpractice is a huge drain, we don't have death panels and rationing, you can get care fast if you can afford it, etc. etc.
Fundamentally our healthcare system doesn't resemble anyone else's in both bad and good ways (don't believe the reddit left - the best care is in the USA).
Even putting aside those things good luck changing our system to resemble other's once reality comes into play (for instance forcing people onto plans).
Throwaway05
5d ago
The whole situation is a mess, I like to think of healthcare economics like communism - yes you can absolutely up end the system and make it way better than what we have now, but when has that ever happened successfully?
The thing that probably gets the most complaints over in doctor land is that changes to the current medicaid structure is likely going to result in a further decline in safety net and rural hospitals. This trend has been ongoing for some time but loss of medicaid dollars will probably accelerate it greatly and people are expecting to see that with the current wave of budget cuts.
Two specific things off the top of my head that you'd have to watch for:
-It is very easy for the hospital to help you by signing you up for medicaid. Private insurance would likely find ways to block this. Hospitals rely heavily on this.
-Medicare and Medicaid are much lower overhead on the clinical side of things and less paperwork. Private insurance is a lot more work (although Medicare is trying to change that! Yay). Don't expect a reduction in medicaid to reduce bureaucratic costs and middleman costs.
A common pathway for something like this is:
-you nearly bleed out
-medical attention arrives
-in the meantime multiple organs are not getting enough blood and therefor oxygen
-this may include the brain
-you are taken to the hospital which keeps you alive
-but you are already dead OR
-while in the hospital swelling, tissue death, infection from all of the damaged areas causes problems leading to formal death later
tons of stuff like this can happen.
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