Links - 10th May 2020 (2) (US Healthcare)

James Romanow's answer to According to Bernie Sanders, all Canadian citizens are guaranteed healthcare, and if they come out of a hospital, they don't get a bill. Is this true? - Quora - "There needs to be a special space on Quora for Americans to ask about Canadian (and other country’s) healthcare system.  So, despite what your boyfriend/newscaster/father says about Canadian healthcare you need to know a couple of things...
There is Triage in Emergency rooms, and generally throughout the system. If I show up with a cut, and it’s a busy place I may wait a while to get stitched. On the other hand on a sunday morning with four people ahead of us, my elderly father was admitted and in a bed inside of a minute. I had to do the paperwork for him while he was being treated.
Hip and knee replacements are usually done quickly but as the population ages there have been surgery backlogs. Stents etc. get done right away.
In short the system could stand improvement. A Swedish doctor told me he considered the French medical system the world’s best. I’ve heard French men and women complain about their system. Bitching about healthcare is pretty normal worldwide. So yes you can find Canadians who complain...
Life expectancy in Canada is about 4 years longer than the USA (Canada’s ranking is 7, US’s ranking is 34.)...
Infant mortality in Canada is 54 per 10,000 births. In the US it is 58 per 10,000  We get all this without getting billed when we exit the hospital!"

Jose on Twitter - "but I like having a choice"
-your employer chooses your health plan.
- your insurance chooses your healthcare provider
-insurer chooses what prescriptions will get covered
-insurer chooses the doctors
Tell me again what choice you made in all that. Literally the worst argument"
Not to mention your insurer chooses whether to pay you back

Why The US Has Better Cancer Survival Rates Than The Rest Of The World - "The United States has better survival statistics compared to most other countries. Whether this is simply because of better cancer treatment is arguable. A missed cancer diagnosis is a common lawsuit in America. The defendants typically settle for unlimited economic loss and also pain and suffering. That is a huge incentive for American doctors to overtest for cancer. Of course that leads to earlier diagnosis and a significant time bias in studies comparing healthcare systems... Very expensive cancer treatments such as the new immunotherapies for cancer are more widely available in America than in countries with national healthcare where there are restrictions based on cost/benefit and budget caps.The larger question is whether a society can afford to spend what America spends to get low single digit improvement in cure rates and and to prolong survival by a few months especially at the end of life.Treatments that cost $200,000 per year are used to extend average life expectancy by 3–4 months in stage 4 cancers. Of course it’s worth it for the minority of patients who are put into long term remission. But it doesn’t help the others."
This might explain why a Lancet article, correcting for age, finds the US has poorer outcomes than Western European countries

Utah cuts healthcare costs by flying employees to Mexico for prescriptions - "A health insurer in Utah is seeking to reduce prescription drug costs by flying state employees to Mexico, where they can collect medications at a fraction of the US cost.The year-old programme involves about 10 state employees. The cost savings are so large that the insurance program can pay for each patient’s flight, give them a $500-per-trip bonus and still save tens of thousands of dollars. One participant, Ann Lovell, a 62-year-old teacher, said she had saved as much as $2,400 by travelling from Salt Lake City to San Diego and then crossing the border, in order to refill a prescription for arthritis medication... Four states, including Florida, are looking at Trump administration proposals to allow states to import drugs from Canada... Support for cross-border prescription drug purchasing, or “pharmaceutical tourism”, is a rare instance where political ideologies meet."

Uninsured Get Pushed from Hospitals Faster - "Folks who aren't covered by private insurance are much more likely to get booted out of the hospital early, a new study finds.Uninsured patients were also more than twice as likely to be transferred to another hospital and 66% more likely to be discharged outright, compared with people with private insurance"
Of course, even before this, some Americans insist their system is fine since you are guaranteed emergency room treatment regardless of ability to pay (ignoring the fact that relying on emergency room treatment is not a viable healthcare strategy)

Bills from out-of-network doctors rising at in-network hospitals - "In the U.S., physicians in an insurer’s network have agreed to accept a set amount from the insurer as payment in full for their services. Out-of-network physicians, however, are not constrained by any in-network agreements and can seek additional payment from patients, a practice known as out-of-network balance billing.At many hospitals in an insurer’s network, some of the physicians may still be out-of-network, particularly for specialties like anesthesiology. This can lead to balance billing surprises even when patients make a point to seek care at an in-network hospital... “In an emergency, a patient is often unable to choose the emergency department, the physicians or the ambulance service,” Steinbrook, author of an editorial accompanying the study, said by email. “And, a patient may seek routine in-network care at an inpatient hospital or outpatient facility, only to later find out that in-network physicians were not available to care for them.”"

This is the real reason most Americans file for bankruptcy - "66.5 percent of all bankruptcies were tied to medical issues —either because of high costs for care or time out of work. An estimated 530,000 families turn to bankruptcy each year because of medical issues and bills, the research found.Other reasons include unaffordable mortgages or foreclosure, at 45 percent; followed by spending or living beyond one’s means, 44.4 percent; providing help to friends or relatives, 28.4 percent; student loans, 25.4 percent; or divorce or separation, 24.4 percent.
It is notable that spending or living beyond one's means is so high and speaks to the American culture of instant gratification and consumerism (i.e. no, it's not just because of "capitalism" and "exploitation" that you're spending more than you can afford)

Why the U.S. Health-Care System Is So Bad - The Atlantic - "According to the Commonwealth Fund, which regularly ranks the health systems of a handful of developed countries, the best countries for health care are the United Kingdom, the Netherlands, and Australia. The lowest performer? The United States, even though it spends the most. “And this is consistent across 20 years”...
1. A lack of insurance coverage
2. Administrative inefficiency
3. Underperforming primary care...
Together, these reasons help explain why U.S. life expectancy has, for the first time since the 1960s, recently gone down for two years in a row."
Gandhi said “The true measure of any society can be found in how it treats its most vulnerable members.” It seems those who think US healthcare is the best option out there think “The true measure of any healthcare system can be found in how it treats its richest patients"
An American tried to dismiss this by claiming that access was what pulled down the US's rankings. Yet, the US has middling results for care process, is second last for administrative efficiency and is last for health care outcomes. In the end he conceded defeat by telling a Brit challenging US healthcare to go such on the NHS

A World of Wellness— Medical Tourism is on the Rise - "The community of Los Algodones, Mexico, 10 miles from Yuma, AZ, bills itself as “Molar City” with more dentists per capita than anywhere in the world. Drawn by its 350 dental clinics and 150 optical clinics, an estimated 6,000 U.S. citizens cross the border each day from November to March seeking dental and vision care that can cost two-thirds less than it does back home. In December the town even throws a party with food, drink, and live music to welcome its annual influx... even if insurance covers treatment, high deductible and co-pay requirements can make U.S. treatment cost prohibitive. A good rule of thumb, claims Woodman, is the $6,000 rule. “If your specialist quotes you a price of $6,000 or more for treatment, chances are good that one or more foreign countries can offer you the same procedure and quality for less, even including your travel and lodging expenses.”Businesses who self-insure their employees’ health care plans are beginning to realize the value of encouraging out-of-country care. Three years ago, in Antigua, Guatemala, I met four vacationing families working for the same Colorado business whose employer annually covered their Guatemalan vacation and medical costs for dental and medical checkups because it was less expensive than offering an insurance plan. Beyond cost, international medical facilities actively market an improved patient experience. Amenities like low nurse-to-patient ratios; deluxe hospital suites; boutique recuperation resorts; airport and in-town limo transportation and concierge services to make all arrangements during a medical stay are often included as part of the care. For less invasive treatment, the facility’s concierge or a specialized medical tourism travel agent can assist with logistics should you decide to combine treatment with vacation... The American Journal of Medicine estimates that 1.4 million Americans sought international health care in 2017. The number is expected to increase 25 percent annually, driven by a maturing population and increasing medical costs... International medical facilities marketing to U.S. patients are often staffed by physicians and other health professionals trained in the U.S."
Strange how US healthcare is superior, yet so many Americans go abroad for treatment

20 leading economists just signed a letter arguing Medicare for All would generate massive savings for American families - "Dr. Gerald Friedman, a professor at the University of Massachussetts Amherst, told Business Insider that the best argument for a universal healthcare system is its potential ability to rein in the skyrocketing costs of healthcare."There's been too much loose talk that Medicare for All is unaffordable," Friedman said. "What's really unaffordable is the current system. We spend about twice the average for affluent countries in the OECD on healthcare""
Naturally, there were people dismissing them as not real economists, frauds, an advocacy group etc

New poll shows Canadians overwhelmingly support public health care - "A new poll conducted by the Toronto-based Nanos Research points to overwhelming support — 86.2 percent — for strengthening public health care rather than expanding for-profit services... Canada’s government just released a report titled “Healthy Canadians — A Federal Report on Comparable Health Indicators 2008.” Its findings almost identically mirror the CHC polling results. In that report, a leading indicator points to the fact that “Most Canadians (85.2 percent) aged 15 years and older reported being ‘very satisfied’ or ‘somewhat satisfied’ with the way overall health care services were provided, unchanged from 2005.”"
If it were really that bad, why would Canadians support it so much?
That said a two tier system really makes sense to ease the load and offer choice

Most Americans Still Rate Their Healthcare Quite Positively
Medicaid/Medicare are rated as having better coverage than private insurance by 9% and 79% of people covered by Medicaid/Medicare say it is excellent or good (only 6% behind the rating for private insurance). So much for the claim that Medicare sucks and is worse than private insurance
One idiot American claimed that 79% of people covered by Medicaid/Medicare saying it was excellent or good said it was terrible. I said if so, that meant 70% of people on private insurance saying coverage was excellent or good meant private insurance coverage was even more awful