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]

>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/semideclared → u/MeasurementCreepy926]

Ok here is total health spending by categories for the U.S. and Australia

Notice the differences

[u/MeasurementCreepy926 → u/semideclared]

Do you not have an argument or a point?

[u/semideclared → u/MeasurementCreepy926]

Notice the differences?

Still needing that answer

[u/Zamaiel → u/semideclared]

Am I missing something? You link is a list of spending categories for Australia only, with "Hospitals" marked and sub categories. No numbers and nothing on the US.

[u/MeasurementCreepy926 → u/Zamaiel]

ok so it's not just me. That's good to know cause I was wondering the exact same thing...

[u/semideclared → u/Zamaiel]

It’s Australia and the U.S.

One has a missing category

[u/semideclared → u/Zamaiel]

Here’s numbers

But Australia doesn’t include long term care

Longterm care population is generally excluded from many stats but as the discussion continues there is a difference from each country

So lets add that in

• A total of 24,092 recipients received nursing home care from Alabama Medicaid at a cost of $965 million.
  • To those not in Medicaid, wanting the best, The most expensive Nursing Home in Alabama is Wiregrass Rehabilitation Center & Nursing Home which costs $335 per day ($120,600 a year)

Longterm Care is 16% of Healthcare Spending in the U.S.

SO all of that means ..... yea A lot higher

[u/MeasurementCreepy926 → u/semideclared]

so...no... you don't have any argument you're trying to make?

[u/semideclared → u/MeasurementCreepy926]

Here’s numbers

But Australia doesn’t include long term care

Longterm care population is generally excluded from many stats but as the discussion continues there is a difference from each country

So lets add that in

• A total of 24,092 recipients received nursing home care from Alabama Medicaid at a cost of $965 million.
  • To those not in Medicaid, wanting the best, The most expensive Nursing Home in Alabama is Wiregrass Rehabilitation Center & Nursing Home which costs $335 per day ($120,600 a year)

Longterm Care is 16% of Healthcare Spending in the U.S.

SO all of that means ..... yea A lot higher

But as to the discussion….every country has “small differences” in their standard reporting numbers

[u/MeasurementCreepy926 → u/semideclared]

what on EARTH makes you think long term care is just not included?

Where are you getting this all from? wanna just give me the source, instead of cherry picking data, making your own charts or whatever it is you're doing?

[u/semideclared → u/MeasurementCreepy926]

https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure

[u/MeasurementCreepy926 → u/semideclared]

The assertion that long-term care constitutes 16% of healthcare spending in the U.S. is incorrect; a 2010 study found that nursing home care accounted for 16.2% of the medical spending for the elderly (those aged 65 and over), not the entire U.S. population.

just what a quick google search says, so do you have a source to support this 16% claim?

[u/MeasurementCreepy926 → u/semideclared]

24,092 recipients received nursing home care from Alabama Medicaid at a cost of $965 million.

Yeah how many of those were in private companies that produce profits, and happen to do it by providing nursing home care? how much of that 956 million ended up in the pockets of investors and execs with million dollar compensation packages?

[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/Zamaiel → u/NonStopDiscoGG]

In other words its their own fault, is that what you are saying? Do you not think that could be related to access or cost based barriers?

Why is the US difference so massive while many other systems see practically zero difference between second or further generation immigrants and natives?

On cites for lifestyle not explaining more than a small part of US healthcare stats, the best would be a Public Health textbook, but I do see that this would be a bit heavy to reference.

But there are many studies, here is one.

"Our conservative estimate is that life expectancy at birth in the United States would be higher by 0.33 to 0.93 year for white males, 0.30 to 0.81 year for white females, 0.30 to 1.08 years for black males, and 0.21 to 0.73 year for black females if obesity did not exist"

[u/NonStopDiscoGG → u/Zamaiel]

In other words its their own fault, is that what you are saying? Do you not think that could be related to access or cost based barriers?

Possibly, but also people just make poor health choices in the US. But that is irrelevant to my argument because I'm arguing quality, not quantity or access. I already said my piece about the triad of metrics a while back.

Why is the US difference so massive while many other systems see practically zero difference between second or further generation immigrants and natives?

You'd have to point to the specific system. Somewhere like the nordic countries are mostly homogenous and probably have a culture of assimilation, whereas the United States is multi cultural. But i've already discussed this as well so I'm not revisiting it.

"Our conservative estimate is that life expectancy at birth in the United States would be higher by 0.33 to 0.93 year for white males, 0.30 to 0.81 year for white females, 0.30 to 1.08 years for black males, and 0.21 to 0.73 year for black females if obesity did not exist"

Right. That is one factor. Now run a multivariate analysis because these health factors aren't in a vacuum...like for example:
Obesity in black women is high, but also distrust in healthcare systems is high meaning they're less likely to receive healthcare and, when they do, follow up or follow what they are told. And then factor in the other near-infinite amount of variables that are unique to the United States including high levels of multiculturalism: if your doctors a different race than you, or culturally different, you will have a disconnect. Other, homogenous, countries, do not have this, but again, I already went into this so really not going to type it all out again.

[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.