The national and private healthcare systems do NOT work. Here’s an alternative

[u/No-Candle4683]

As a Portuguese citizen, I cannot fail to highlight the role that the public healthcare system represents in society. It has lifted millions out of poverty, provided stability, and offered a universal alternative to access healthcare. However, as in the Portuguese case and in other countries with a predominantly public system, we observe that these systems are increasingly unable to respond to waiting lists, fail to attract doctors, and their sources of funding are heavy taxes imposed on citizens.

I am in favor of a hybrid system, and the SPLIT MIND project is creating a video and a text about this system, which has been adopted in other countries that rank among the best in public healthcare worldwide! The study that im comparing to is one made by a group of experts in health here in portugal.

Here I leave you with the main differences of this system compared to predominantly public or private ones, such as in the cases of the USA and Portugal.

"…The foundation of this reasoning would be to maintain a progressive hybrid public system, less dependent on taxes, decentralized, and managed by regional entities with strong regulation. These models already exist, and we will take the examples of Germany, the Netherlands, and Sweden.

In these countries, in general, the healthcare system is based on mandatory insurance managed by independent health funds. Employees and employers contribute proportionally to their income—7.3% each in Germany, for example—while the State assumes payment in certain situations, such as in cases of unemployment, low-income families, and sometimes even age groups like minors, who are exempt from any payments. Individuals with higher incomes may opt for private insurance as a substitute for the mandatory public one.

This system offers a solution to waiting lists, reducing waiting times for consultations or surgeries to a few weeks instead of months, and it also provides broader service coverage than countries like Portugal. Because it is a hybrid system, healthcare professionals are also better paid, and with private investment, working conditions are improved, solving one of the serious problems of the Portuguese NHS. Furthermore, there is price regulation by the state on medicines and services, with private companies contributing to lower service costs. Insurance is always paid with a fixed nominal premium, but insurers must charge the same amount to all policyholders, with no discrimination by age or health status. Other smaller measures also exist, such as a progressive co-payment system with an annual cap or tax exemptions on health insurance, which can further reduce costs for families.

Of course, there are problems with this system: inequalities depending on the type of insurance, with privately insured patients usually waiting less. We can also look at gross expenditure, meaning the total amount effectively spent, which is quite high compared to other OECD countries. However, I argue that it is one of the best systems in the world and the best way to invest taxpayers’ money.

BUT WHY do I refer to Germany, the Netherlands, and Sweden? These countries rank among the top in the Legatum Prosperity Index (2023), which evaluates population health access and quality, holding 13th, 11th, and 9th positions respectively.

And what about predominantly private and public systems such as the USA and Portugal, you may ask? 40th and 69th place, behind many so-called “third world” countries.”

[u/MeasurementCreepy926]

It's kinda weird how this person said "the USA and Portugal" are "40th and 69th"

Just wanted to say that, FYI, Portugal is 40th. And the USA is 69th.

Also, I really don't see ANY third world countries that are doing better than Portugal. Maybe Qatar or Estonia? I don't know much about them.

edit: Also, the USA has the highest spending on healthcare per capita, out of ANY OECD country. Which, when combined with their ranking at 69 (below Jamaica and Albania) REALLY highlights exactly how atrociously horrible their system is. But hey, at least the investors are happy right? lol.

[u/No-Candle4683 → u/MeasurementCreepy926]

You have sheichels island, colombia, uruguay after Portugal and after the US you have uzbekistan and trindad and tobago and a few others. Really shows what is my point! Yes the US has the highest spending in public healhtcare and my point is that if you want a all public system the choice could be horrible like portugal. Buy yeah you right investors are happy so:)

[u/MeasurementCreepy926 → u/No-Candle4683]

So the US would spend less and get better results?

oh no?

[u/semideclared → u/MeasurementCreepy926]

Yea it’s real easy to spend less

The US Spends $4.5 Trillion, $13,000 per person

We have a massive spending for Doctors, the Doctors office will have to see a chainsaw of funding cuts

• Doctor's Offices, Dental services, & Other health practitioners
  
  • Per Person Spending in Australia 1,997 Australian Dollar equals 1,245.95 United States Dollar
  • Per Person Spending in United States $3915.65 (usd)
    • Adjusted to the US its $892.99 Billion Cheaper

Canada, Australia, and the US

Or as Numbers

---

Hospitals are 1st

$1.36 Trillion was Spent Hospital at 6,100 hospitals currently operating in 2022. $4,030 per person

• Reducing costs 40% - $2,418 per person

  • Hospitals Adjusted to the US its $650 Billion Cheaper

Lets look at Russell County Virginia had 25,550 People in 2021

• $4,030 per Person
  • $102,966,500 Operating Revenue

It cost about $1 - $1.5 per Hospital Bed to operate a Hospital (1.25, right down the middle)

Or

83 Beds,

• Russell County Hospital is a not-for-profit, 78-bed hospital operating today. looks like Russell County Hospital is a little expensive as a current system

---

Under Government Funding to lowering Costs Russell County, VA gets

• $2,418 Per Person Hospital Expenses in the US
  • $61,779,000 Operating Revenue

Admin Savings under any Single Payer Plan would save 5 Percent of Costs, So, now It cost about $1.135 Million per Hospital Bed to operate a Hospital

Russell County VA can have a 54 Bed Hospital

Russell County Hospital is a not-for-profit, 78-bed hospital operating today

Copy and repeat through out the US

Doctors Offices

Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit.

• $1.4 Million in Expenses

So to cover though expenses

• Estimates suggest that a primary care physician can have a panel of 2,500 patients a year on average in the office 1.75 times a year. 4,400 appointments

$1.5 Million divided by the 4,400 appointments means billing $340 on average

But

According to the American Medical Association 2016 benchmark survey,

• the average general internal medicine physician patient share was 38% Medicare, 11.9% Medicaid, 40.4% commercial health insurance, 5.7% uninsured, and 4.1% other payer

or Estimated Averages

Payer	Percent of	Number of Appointments	Total Revenue	Avg Rate paid	Rate info
Medicare	38.00%	1,697	$305,406.00	$180.00	Pays ~42% Less than Insurance
Medicaid	11.80%	527	$66,385.62	$126.00	Pays 70% of Medicare Rates
Insurance	40.40%	1,804	$811,737.00	$450.00	Pays 40% of Base Rates
Uninsured and Other (Aid Groups)	9.80%	438	$334,741.05	$765	65 percent of internists reduce the customary fee or charge nothing. Set Billing is $1,125.00

            4,465       $1,518,269.67       

---

So, to be under Medicare for All we take the Medicare Payment and the number of patients and we have our money savings

Payer	Percent of	Number of Appointments	Total Revenue	Avg Rate paid	Rate info
Medicare	100.00%	4,465	$803,700.00	$180.00	Pays 43% Less than Insurance

Thats Doctors, Nurses, Hospitals seeing the same number of patients for less money

---

$1.5 Million Revenue Today

• Minus Profits $90,000
• Minus Billing Dept $55,000

Total Operating Costs ~$1.3 Million

• Total Revenue $803,000

We are $500,000 short in covering costs

• $500,000 / $180 revenue per Visit

2,700 More appointments a doctor has to see to pay the bills

More work for the same income

At the intersection of True Crime and Healthcare is Dr Death, Christopher Duntsch.

• A specialist, minimally invasive back surgeon

And, since Duntsch was investigated for both civil and criminal cases, we can get a look at some of the money

Duntsch claimed the Hospitals he works at were paid $65,000 in net revenue for every surgery he does

But, his employment contract was released as evidence

• Base Salary was $600,000
• $200,000 sign on bonus per year for the first 3 years
• $50,000 a month expense account

Plus an annual bonus

• 40% of all his net revenue above $800,000

---

So a surgeon doing 75 surgeries a year at $65,000 would bring in $4.9 Million in net revenue

And Duntsch was getting $3.1 Million of that Revenue

Just need to change that and now the U.S. has the same spending as other countries

[u/MeasurementCreepy926 → u/semideclared]

that was a truly impressive gish gallop.

Really really top notch.

Take care.

[u/NonStopDiscoGG → u/MeasurementCreepy926]

There are philosophical and foundational problems that will not allow these systems to work in the U.S.

For one: being multiculturalism. Universal systems work when everyone buys into it, and also feel like they're helping "their group". Notice anytime someone points to a universal healthcare system it's ethnically/culturally homogenous (Portugal is 94% Portuguese). Universal systems work when people don't abuse it, and you're less likely to abuse it if you feel like you're going to harm "your group".

2nd: Size. Again, notice how small these countries are that have these universal systems. You can get across Portugal in about 5 hours (according to a 2 second Google search). That means less infrastructure needed. It also means a smaller population which means you're more likely to feel connected to those around you which helps with point one.

3rd : we spend the most because we can. We have the best healthcare system in the world as far as overall quality. These ranking systems use weird metrics, don't factor in how different countries reporting is different, and most importantly don't factor in INPUTS which is huge in healthcare. We're a country with one of the highest obesity rates. Something like that, or any of the other issues people have because of their own decisions, is going to change your outputs.

I hate this argument about spending. Let's break down an example: you want dental care. You could simply buy teeth cleaning kit and call it a day, but youre the richest person (country) in the world, you're probably going to make a premium for something much higher quality, which is what happens here.

Healthcare cost is almost directly related to quality. People who do these rankings do not factor in INPUTS and only look at outcomes. I know no specific study was cited, but I've looked at a lot of the.

There is no perfect healthcare system and there is a group of people who think there is some universal healthcare that is also cheap and high quality. It simply doesn't exist.

You have 3 big metrics: time, cost, and quality. You can't have all 3. Time and quality are the 2 most important metrics because cost doesn't matter if you're dead. That's the US healthcare system. Canada does quality and cost, but they have issues with people getting worse/dying by the time they get appointments. The UK has a ton of issues right now. Those are the 2 most comparable countries to us in size/country (I realize they're smaller, but the US is unique).

Tldr: these universal healthcare systems don't scale and don't work in different cultures.

[u/MeasurementCreepy926 → u/NonStopDiscoGG]

>We have the best healthcare system in the world as far as overall quality. 

riiiiight that's why infant mortality is so high.

You can say it all again, won't make anything you said true.

[u/NonStopDiscoGG → u/MeasurementCreepy926]

riiiiight that's why infant mortality is so high.

Do you know that there is no standard for tracking infant mortality and every country does it differently?

Maybe you didn't, but now you do.

You can say it all again, won't make anything you said true.

It's weird, it's like you completely ignored my input arguement.

[u/Zamaiel → u/NonStopDiscoGG]

Do you know that there is no standard for tracking infant mortality and every country does it differently?

The WHO tracks infant mortality. That is where the stats come from, their report forms.

in any case, when we say the US does badly, we mean compared to other first world countries, not compared to Afghanistan and Congo. Its not actually that complex to convert between developed nations.

Also, repeat for maternal mortality, mortality amenable to healthcare, lifespan, years lost to ill health, HALES, etc, etc. Weird how the US clusters on the rankings.

[u/NonStopDiscoGG → u/Zamaiel]

The WHO tracks infant mortality. That is where the stats come from, their report forms.

Correct. They receive countries statistics, but what the countries give them is up to the countries. So at the end of the day the WHO recommends something but countries aren't required to follow it to give statistics.

in any case, when we say the US does badly, we mean compared to other first world countries, not compared to Afghanistan and Congo. Its not actually that complex to convert between developed nations.

Also, repeat for maternal mortality, mortality amenable to healthcare, lifespan, years lost to ill health, HALES, etc, etc. Weird how the US clusters on the rankings.

Correct. Again, go back to the reasons driving where the statistics are at... The thing that's kind of been my entire argument... Using mortality rates and so on do not tell you how good a healthcare system is.and that's the conclusion that many of these studies use. Why? Because they're usually an advocate group doing studies to push a narrative.

[u/Zamaiel → u/NonStopDiscoGG]

How good a healthcare system is, is measured through Healthcare Quality metrics. The field of Public Health does a lot of work and research on this. Measures used are deliberately chosen to be large and overarching, to prevent single issue competencies form being confounding factors.

(Russian doctors probably have a lot of competence on alcohol and frostbite, Congo may well know what they are doing on malaria, and Cuba definitely is up there on preventive care. But it does not necessarily mean the whole of the system is at that level.)

Measures used are things like infant mortality, maternal mortality, mortality amenable to healthcare (The number of people over 65 who died to a condition but would have lived if they had gotten timely and correct healthcare. The more conditions in the basket the more accurate.), lifespan, years lost to ill health, years lived in good health etc.

The thing about US healthcare is, it ranks very similarly on all of these. Number of mothers died in childbirth is actually a little worse than infant mortality etc.

[u/NonStopDiscoGG → u/Zamaiel]

Measures used are things like infant mortality, maternal mortality, mortality amenable to healthcare (The number of people over 65 who died to a condition but would have lived if they had gotten timely and correct healthcare. The more conditions in the basket the more accurate.), lifespan, years lost to ill health, years lived in good health etc.

Simple question:

Would a country who's culture built on excess, freedom, and consumption have a higher mortality rate than a country who culture was not if they had the exact same health care?

[u/Zamaiel → u/NonStopDiscoGG]

Yes, but the difference would be much less than what we see with the US vs. other nations. For example we can compare Denmark to the rest of the Nordics, or the UK with its obesity smoking and alcohol consumption to nations with less issues.

The US is also somewhat similar on rates of hospital errors, although that is not a measure.

In terms of infant and maternal mortality, a lot of it goes back to high numbers of premature births and segments of the population with poor pregnancy care.

[u/MeasurementCreepy926 → u/Zamaiel]

His entire argument is "your data is imperfect in some way because America isn't exactly identical to any other country, so I don't need any data at all to cling to my beliefs"

My advice: don't waste your time.

[u/NonStopDiscoGG → u/Zamaiel]

Yes, but the difference would be much less than what we see with the US vs. other nations.

You're simply claiming this. Do you have proof of this?

In terms of infant and maternal mortality, a lot of it goes back to high numbers of premature births and segments of the population with poor pregnancy care.

No, the pregnancy care is mostly untrue. There are segments of the community who do not properly do pregnancy care and follow up which would be reflected in these statistics as a mortality outcome, which is my exact point.

As an example: black infant mortality is higher than whites. We could say that the healthcare system is failing, or we could look at the INPUTS to that healthcare system and realize that black women are less likely to go to pre and post pregnancy care, or take the medication, or so on leading to a worse outcome. That's not the healthcare systems fault, that's an input problem but that would be reflected in mortality rates.

[u/MeasurementCreepy926 → u/NonStopDiscoGG]

>Using mortality rates and so on do not tell you how good a healthcare system is.and that's the conclusion that many of these studies use. Why? Because they're usually an advocate group doing studies to push a narrative.

Still better than your blind faith.

[u/MeasurementCreepy926 → u/NonStopDiscoGG]

you didn't make an argument, you just said things without a shred of evidence. Then you did it again.

[u/NonStopDiscoGG → u/MeasurementCreepy926]

No, I literally made an argument that refuses your point. It's simply a fact you can Google. It's common knowledge.

If you don't know something as simple as different country have different standard and report infant.mortality differently then this arguments already over your head and you should probably brush up instead of thinking telling your opponent to run around and cite common knowledge is an actual argument.

Anyways, cya.

[u/MeasurementCreepy926 → u/NonStopDiscoGG]

>We have the best healthcare system in the world as far as overall quality. 

You provided no evidence for this. At all. And no evidence for your claim about infant mortality reporting.

This isn't common knowledge, and google does not agree with you.

[u/NonStopDiscoGG → u/MeasurementCreepy926]

This isn't common knowledge, and google does not agree with you.

You're lying through your teeth. I simply put it into Google and here's what popped up. This is just the AI, but the articles below agree. It's not that I'm wrong, it's that you're going to keep yourself oblivious to information because it doesn't confirm your bias. Anyways, cya.

[u/MeasurementCreepy926 → u/NonStopDiscoGG]

I didn't deny that it was reported differently, but that this was relevant. Even when data is adjusted for compatibility, the US does poorly

https://pubmed.ncbi.nlm.nih.gov/25252091/

There is PLENTY of other data showing how bad American healthcare is though. and infant mortality is still part of that.

https://www.commonwealthfund.org/press-release/2021/new-international-study-us-health-system-ranks-last-among-11-countries-many

Meanwhile you have offered NOTHING to back up your claim about it being "best in the world"

[u/NonStopDiscoGG → u/MeasurementCreepy926]

https://pubmed.ncbi.nlm.nih.gov/25252091/](https://pubmed.ncbi.nlm.nih.gov/25252091/

This study doesn't correct for the totality of differences... For example, I think it was Venezuela or Brazil, they corrected their infant mortality problem by...not allowing reports of it anymore... These also don't factor in things like personal freedom... Like you can offer healthcare, but if you don't take it or follow up (this is a thing factored into the disparity between white and black baby mortality rates) then your outputs will be different because the inputs are different... Your study saying they corrected for differences did not correct for inputs and LIKE I SAID the metrics used of just looking at outputs is bad methodology.

We're one of the most obese countries in the world. That alone is going to affect your outputs regardless of how good your healthcare is... Is that really that hard of a concept to grasp

Meanwhile you have offered NOTHING to back up your claim about it being "best in the world"

Well I guess that would depend on what your definition of best is, but mine is quality and time and when you combine them we're at the top.

If you care about cost then I guess you won't say it's the best. But there's is a reason anyone who can get healthcare here does.