@Zach777 I'm not sure, but probably. Also coupled with the fact that you have less doctors per population because doctors get paid much less, so fewer people become one. Insurance is effectively an artificial monopoly in single payer, or a coalition monopoly in universal insurance. The result of either of those are price fixing without much pressure on quality. For which this is the result.

Obviously the american system is better in some ways but has its own issues (such as being wasteful in terms of cost, despite having good quality of outcomes).

In the end it is clear to me neither system works and therefore neither should be emulated. The solution in my eyes is co-op based insurance. It removes the greed-factor by making those insured the owners of the insurance company, and preserves the supply-demand pressures by allowing people to switch insurance if they dont like the quality.

@freemo I never heard that there were less doctors per capita in other countries due to lower pay.
Do you have a source I can look at?

@Zach777 its been years since i saw that statistic... I can try to dig it up again, no promises.

@freemo @Zach777 Laws in the US and insurance requirements push many doctors out of certain states and into others. I wouldn't be surprised if such effects occur country to country, let alone the effect of unions like the AMA have on artificial labor supply.

@anon00110

Yea local laws and other regulations and unions are going to change the dynamics for sure.

@Zach777

@Zach777 Seems at the very least that is no longer true. Canada has the exact same number of doctors per capita as the USA according to the world bank.

Looking a bit deeper though it seems the USA does have more nurses per capita. Since int he USA nurses generally do most of the leg work and doctors only review and sign off that might explain some of the indifference.

@torresjrjr promoting healthy lifestyle is important, but there is only so much healthcare can do in that regard. Most of that will have to come from how your parents raise you.

@freemo
Yep. But I wasn't refering to healthcare as much as govt's role in school, like this:
https://www.youtube.com/watch?v=NGa6BPj3Mcw

I wish I had this. I wasn't really pushed like this so I was left behind healthwise. You'd probably ~half all doctor's appointments in the UK, US, etc.

@torresjrjr @freemo
wonder how many of them died in Vietnam

@moth_ball While america has some issues and money is part of that, generally its not an issue in the USA either. If your poor and on welfare you get free health insurance. If you arent poor you can afford health insurance so if you dont have it (and thus may go bankrupt) that was a choice you made.

@freemo How much does the health insurance cost on average? From what I've heard the cycle of industry inflating prices and insurance being stupid expensive is a real thing.

@moth_ball Well average is a bit misleading.. Many people who get insurance in the USA get it to cover elective treatments too which foreign insurance doesnt cover and would need supplemental insurance to get.

But on average our insurance is 425$... what is more telling is the **minimal** cost for insurance. In other words, whats the cost for insurance that covers only medical necessities and none of the nice optional stuff. for that its int he range of 200$ - 300$ for middle class families with decent income.. the poorer you are the cheaper it can be as there are programs the subsidize insurance cost for low-income families. Below a certain income level it becomes free.

You're right, I should've said "typical". Is that amount for a month or a year?

Social services cover a lot of elective treatments as well, most notably the lion's share of all prescription drugs' costs (still gotta pay a part of a relatively very small part of it, this is probably why they cant pump prices forever). My shoulder surgery was also paid for, not to mention countless other things as I'm made out of spare parts apparently. My insurance is 200€ and change for a year and that includes home insurance and travel insurance too. For costs not subsidized by the social services, my insurance covers healthcare costs after 500€.

What comes off as weird to me is that rather than make the government pay for health costs, govt assists you in paying corporations for the pleasure. isn't that just extra steps?

Interesting to hear about all this. Thanks for your insight.

@moth_ball Those were monthly prices.. for comparison in the netherlands I was paying 200 euro a month.. european prices are certainly a bit cheaper, but not by the huge margins people usually claim.

Keep in mind there are other limitations in european healthcare.. you dont have access to certain medications (like adderall), and you do not have the guaranteed privacies you would in the USA (for example in most universal healthcare countries if you have a prescription for controlled substances it is tracked on a public list).

@freemo
>tracked on public lists
Patient data is confidential. The local FDA does make inquiries if you prescribe controlled substances too liberally, so that much is true. But that data is confidential on their end too, so calling it public isn't right either.

There are pretty good reasons they don't just give Adderall to every student who heard from his friend that it works wonders. This is a powerful stimulant and there are risks involved with it. If you're implying that controlling abusable substances is bad, I suggest coming to work in a hospital with me and you'll change your mind pretty quickly. On top of the individual we must also take care of the populace on a wider level. I think you might know something about opioids over there.

While I can't say much about insurance other than what I have, regulating healthcare and the industries associated with it is absolutely a must if we want to have a healthy populace. Healthcare (public at least) wants you to be healthy, and that's what decisions like this are based on. Recommendations are reevaluated all the time based on new findings, too.

We have a saying: "Private healthcare gives you what you want, public healthcare gives you what you need."

@moth_ball @freemo It’s rare here too. However, the problem is that our system is overregulated to the point it’s better described as corporatist rather than capitalist. The solution is deregulation where it’s possible.

@trinsec The claims i made are from the link not the graph.. the graph uses a different metric from a different source showing a similar but different pattern (with the graph showing usa and germany as the best performers)

@freemo How do you even interpret that site's data? It seems oddly incomplete to me in presentation.
For example the section 'Health Care Wait Times by Country 2021' seems to be missing a few crucial columns I have the idea. And I wonder why Singapore is left out in the middle section, and I also wonder if whoever made this page hated their readers so much that a lot of stuff is unformatted and hard to read.

@trinsec I spent some time looking for public data on it.. while I have plenty of private data to pull from public seems lacking. I literally provided the only 2 public sources I could find that compares USA to europe. If you have better sources that show specialist and elective wait times please feel free to share.

@bonifartius
100% agree with your stance

@LennyGandolphini It sounds to me like both universal healthcare and private healthcare sucks where your at, and I personally would agree with this as a general statement.

So why be all for tax-paid universal healthcare at all, why feel you have to choose one or the other? Why not consider or suggest alternative systems that are neither of these two but address the concerns of both?

@freemo there is plenty of space and interest for me to speak about alternative systems, but I for one care mostly about the universal coverage, as it is something that, altough with some problems, left none of my relatives without medical help (to reassure you my aunt received her surgery in time when she decided to move to a different hospital).
I mean, to me whatever system endorsed should prioritize giving everybody the best medical support, or at least not letting anybody die.
I like thinking about the japanese constitutional statement that any citizen is entitled to receive the healthcare services they desire, and that means that even uninsured people with no funds can still choose the best opportunity for their issues.
their main issue now is the ever increasing amount of people requiring medical aid for unnecessary reasons, and the agreed approach is to invest more on prevention policies rather than limiting access to uninsured people.

@LennyGandolphini It sounds like you are using universal coverage to mean something more specific than what you really mean.. Universal coverage implies everyone is forced, beyond their own choices, to have insurance, and typically what constitutes insurance is strictly defined or worse yet a specific insurance is forced upon them, usually by tax money...

But your anecdotes about family without coverage suggests to me you mean something else that doesnt equate, necessarily to universal coverage. Correct me if I'm wrong but what you really support is that everyone has access to coverage, should they want it (which is not universal coverage). That is, if you are too poor to afford it it should be free, if you can afford it good quality affordable coverage should be available to you.

If that is correct, then your almost fooling yourself, as you arent asking for universal coverage at all, and thus alternatives are very much an option so long as they accomplish that goal no?

@freemo @LennyGandolphini i kind of like swisscare.

@freemo @LennyGandolphini swisscare is basically mandatory insurance (obamacare) but it's only for a basic life-or-death package and if your income is too low to afford an option its subsidized by the state. any additional insurances are left to the market for individuals to purchase. at least that's how i understood it.

@icedquinn

To me that doesnt solve any of the problems we have with either a free-market system or universal healthcare.

The problems as i see it is universal healthcare takes away choice on multiple levels, both of if you pay for insurance, and which insurance you get, as well as the effects of that (such as selection of medications which wound up being bound to what insurance covers and thus certain medications wont be on the market if not covered), as well as quality of insurance and care which comes from being able to select different insurance, or none at all, if you dont feel you get value. Basically it lacks the competitiveness to bring quality.

Now the problem with free market is cost, there is a greed and profit angle that the owners of insurance companies want to make as much money as they can at the expense of others. Normally supply and demand strikes a balance in other areas but when it comes to health insurance demand is infinite because a dying person will pay anything to live in a healthy state for just a few more days. So with supply and demand equations broken you dont have a healthy free market.

Any solution need to address both of these concerns without compromise. The answer to this is simply in my mind.. freemarket, co-op only insurance with strong welfare to assist those too poor to buy into it with "healthcare stamps" similar to foodstamps one can spend on healthcare.

In a co-op system the owners of an insurance company are the people who have policies at that insurance company, and everyone is an equal owner. So the greed aspect is wholly eliminated. Any extra money the company makes goes right back into the policy owners pockets. So the issues with free-market are resolved. Since the system is free market based it also resolves the issue with universal healthcare, that is, there is selection pressure that ensures quality care is given as people can always switch to the insurance companies that provide the best quality of coverage, and has the best doctors within its network.

@LennyGandolphini

@freemo it could be a language issue XD.

but yeah that kinda sums it up.
I meant that the coverage should be expanded to everybody, as a requirement for whatever system you adopt.
And from my perspective I'm fine with the public "Universal coverage" because there would be no inequality in services and relatively good salaries, and they would be financed through taxation, but it doesn't happen so we are at an empasse with an underfunded public service which sorta works.

@LennyGandolphini Cant say i disagree.. I see no reason there needs to be equality of service so long as the system ensures everyone can afford all the options.. If i want less coverage and keep more of my money I should have that right. Why should I be forced to have coverage I dont want in some notion of equality.. Thats like forcing everyone to eat vanilla icecream and telling a diabetic they cant abstain just because its more "equal"

@freemo everybody is free to do as they please, the important is having access to that quality.

I mean sure you can keep your money to spend it somewhere else if you want, life is yours.
As long as you dont refuse to provide the funds that grant other people the same choice.

@LennyGandolphini Why would I have to provide the funds for other people? Unless you mean specifically poor people, in which case I agree and that would be through welfare on taxes... but dont expect me to fund people who can afford their own.

@freemo that was what I mean, welfare and taxes 😅 😂

@LennyGandolphini Ok thats fair then.. so then you dont really support universal healthcare at all, just any system where healthcare is an option for everyone (universal implies there is no option it is mandatory)

@freemo yeah.

As long as the people's right to healthcare is ensured I'm cool with that

@LennyGandolphini great... So by that logic my own suggestion for co-op healthcare with strong wefare is also on the table..

I'd argue my suggestion is far superior than universal healthcare as it addresses the problems I mentioned earlier. It also satisfies your priorities (which are also my own priorities)

@freemo yeah if it goes around and works for everybody it is good to me.

my problem usually with deregulation and reforms of healthcare policies is that in my personal national experience they tend towards an accumulation of funds in the private sector with no regards for other ppl.
After all, it is a sector that historically drives huge profits

@LennyGandolphini Remember my proposal was insurance be co-op.. this removes the "greed factor" (what you call accumulation of funds in the private sector).. the insurance poilicy owners are the company owners as well. so any and all profits made go right back to the policy holders.

@freemo splendid.
Also what is up with antisemitism on mastodon?
I mean I got a bunch of messed up stuff on my home.
I mean should I get used to "ironic" shitposting or it's just a small part of the whole ediverse?

@LennyGandolphini From QOTO users or in general?

QOTO will almost never be racist, we dont have much tolerance for that here. However in terms of the wider fediverse (all accounts you can interact with) there are quite a few racist people and servers. That said its easy to address.

So generally each server has its own rules. A few allow everything, and those are the places the racism breeds. The nice thing is here you can block servers not just people. Therefore blocking is far more effective than say, twitter... Just block the 20 or so servers that allow racism and you shouldnt ever come across it in your feed again. Or atleast, very rarely. In fact you could probably block the 5 biggest and eliminate 97% of it.

@freemo splendid and glad to hear that.
Each time I read those rants I get a little aneurysm and I have yet to adapt to this whole federal concept

@LennyGandolphini yea I hate them too, which is why i love the fediverse its so easy to filter out.. Let me know if you ever have any problems I can likely step you through a solution.

@freemo sure thanks buddy