Tuesday, August 10, 2021

health care

These two graphs really say it all:

 

A few years ago I got a freak knee infection that landed me in the hospital. The experience was so smooth, non-stressful, and NOT followed up by months of fighting insurance companies over insane charges I had no way of knowing or avoiding ahead of time, that I decided in that moment that we would stay in Australia long enough to get citizenship and thereby always have access to Australian medicare. Matt has twice needed an ambulance*, and we had a baby, and we've made countless same-day appointments for minor ailments, and each of those experiences has made my mind boggle at how well it works and how we ended up in this magical place almost by accident.

The pandemic has re-affirmed that many times over. Life has been basically normal since last July, the economy is healthy, and while certainly things are far from perfect, 600,000 lives in the USA alone would have been saved if they had achieved our death-per-capita rates, so I'm not complaining. More generally, of course there are problems, big problems in fact, with the system, but the gulf between the system here and the system I used to put up with in the US is so vast that there is no question whatsoever which is better. I wish so much that my friends and family could live with the same peace of mind. And that I could convince more Americans to come visit for a few months because that's how little time it would take for even the most stubborn among them to realize what they're missing out on.

4 comments:

David said...

It is truly terrible in the US. After living in the Australian system, do you think there is any low-hanging fruit for improving things in the USA? Or do we need to have a radical overhaul of the entire system in order to completely reset incentives and processes?

Vera said...

The difference between them is definitely a fundamental overhaul and I think that's the only hope for the US to get to the level of AU/NZ/Norway/etc, but I'm sure there is plenty of low-hanging fruit that would significantly improve things. Separating insurance from employment for one definite thing...

I'm definitely not an expert on health care at all; part of my point is actually that the difference is so massive that you don't have to know anything about it to judge which is better. It amazes me the extent to which many Americans insist on believing theirs is the greatest in the world. With additional sophistication you can tell a story about how it's bad but that changing it would compromise something even more valuable (pharmaceutical innovation e.g.) but it's so bad that it's implausible that there isn't room for massive improvement, or figuring out how to mostly protect those things while overhauling the rest, or something like that.

Henri said...

How was the performance measured? I'm from Denmark, not Sweden or Norway, but our healthcare systems are similar. My experience is that the US is much, much better, at least for those that have insurance. My Danish friends generally agree. So it was odd to see Norway at the top. I don't see Denmark on the list.

Vera said...

Performance is a composite measure that emphasizes average outcomes (at least that's what I gleaned from skimming the report a couple of weeks ago - there is much more detail at the link :) I agree, I'm sure the US is much better for rare/complex issues, which is why people go there for specialized treatment.

There are certainly downsides to the AU/NZ/Scandinavian/etc approaches, as I said. But as an average person I prefer it a million times over. If I have an emergency in the US I can't instantly teleport to Australia, but if I develop a rare cancer that needs treatment that isn't approved/covered/used in Australia, I can travel to the US for that. So selfishly I very much appreciate the complementarity of the US system, but I'm not so selfish that I wish the status quo on 325 million Americans.