It seems that the “advanced countries” that have the quality national health care schemes that you admire, Mr. Reed, are countries for whose defense the American taxpayer has been paying the lion’s share of through, 例如., NATO. It is much easier for a government to fund first rate socialized medicine, long vacations, and “public amenities” when it’s not paying for its own defense on its own Euro, Yen, Won, Canadian dollar, or what have you.

Certainly there is no perfect health care system in the world and I would submit that crony capitalism has ruined the one in the US. If there were truly market forces in play with insurance of catastrophic events, our system might have some semblance of economic rationality and would likely perform much better. Japan seems to have it right by making physicians the major stakeholders in the medical service industry. When businessmen in the US saw how much money there was in health care, they just had to get some of it and so we now have a system which everyone tries to game and might occasionally give the patient a good outcome after the various players milk as much money out as is possible. There are many complicated schemes proposed for saving money and improving quality, many of which cost a lot and are of unproven benefit. My suggestion, which could be implemented tomorrow at virtually no cost is to limit hospital executive salaries to no more than twice that of a GS-15. Hospitals get 80-90% of their money from Medicare and Medicaid, so they have been socialized for a long time. Since they already are quasi government institutions, we should no longer pay the CEO’s and myriad VPs millions.

Complete socialization in the US is generally a bad idea. The analogy of the MVA is all too real. Even the military system which was given good reviews in Fred’s article is not what it used to be–they are kicking out many retirees to the Tricare system in order to keep costs down.

确实。 美国的医疗保健状况非常糟糕，没人来过这里。

Hell NATO should have been gone long ago for it was little more than a scam for the military/industrial trade, and for that matter still is for we always need an enemy, thus we squander our money for the benefit of the few at the expense of the many always looking for another bogyman to keep the scam going..!!!

美国的医疗保健可以说是世界上最好的。过去 30 年，从心脏病到关节置换，医疗保健领域取得了惊人的进步。患者来自世界各地，在我们的医院接受治疗。绝大多数的进步
医疗保健服务领域的巨大利润来自于医院、医生和制药公司所寻求的巨额利润。
医疗保健的大部分费用是由于允许世界各地的任何人免费入院而产生的。没有人因为欠钱而被拒之门外
除非你考虑少数营利性医院。我们的医院甚至不允许
在不违反联邦法律的情况下跟踪他们如何在非公民身上花钱。
尽管我们在医疗保健上的支出确实比世界其他国家多，但在很大程度上，这些钱花在拯救生命和治疗疾病上是值得的。除了让家人身体健康之外，还有什么更好的理由花钱呢？为什么我们从来没有听说过政府在律师费上花费太多？我敢打赌，如果我们将法律行业国有化，除了律师之外，没有人会介意。

I always wondered what happened to the true concept of “mutual insurance” – where the policy owners own the insurance company and therefore earn dividends from its gains. It is in the interests of the policy owners to stay healthy to maximize their own profits.

Are those around any more – or all gone, except in name?

Also, maybe we need to have caps on compensation via tort reform.

和平：

Fred, American medicine’s Iron Pyramid has been successfully blocking any sort of national health scheme since May 1943, when its Council on Medical Service and Public Relations started promoting group health insurance to its Big Business allies.

Think “10 thousand, 10 million, and 10 trillion”. Ten thousand modern factories that haven’t been built in America, 10 million good jobs lost, and 10 trillion dollars in extraordinary enrichment of group health insurers, medical practitioners, hospitals, medical equipment makers, and Big Pharma over the past half-century, ever since Medicare kick-started medical super-inflation, which only group health insurance beneficiaries could keep up with.

U.S. medical care was cheaper and better before the federal govt. started to subsidise it in the 1960s. A relative was in the hospital recently. In the next room was an elderly Haitian getting his second pacemaker. Wonder who pays for that? Undoubtedly artificially increased demand raises prices.

US subsidizes healthcare in other nations.

Americans pay high prices for drugs, but these same drug companies sell the drugs real cheap to other nations.

Also, other nations let old people die. In the US, they are kept alive as long as possible.

But with growing Diversity in Canada and EU, things will break down.

Btw, many people support socialized medicine not necessarily due to results but ideology as they were drummed in schools from young age that it is eeeeevil to privatize medicine.
Even Canadians who don’t like their healthcare system will support socialized medicine cuz they’ve been indoctrinated to virtue-signal that way.

Another thing. Aren’t food, clothing, and housing more essential than medicine for human survival? Then, why are people allowed to make profit off that stuff?
We let free markets take care of food, clothes, and housing. And we provide socialism for those who can’t afford those things.
Well, the same thing should be done with medicine. Try to handle the problem with markets as much as possible, and then offer socialized basic medicine for those who can’t afford doctors.

The main problem of American health is fattiness. Look at Michael Moore. Fatsos like that cost us dearly. And then you got tons of Negroes shooting one another or using drugs. And white deplorables are also into big drugs.

We have the system we have (an abomination) because our politicians are for sale. I doesn’t help that dumb ass Americans believe single payer is Communism.

我同意。
The myth the NATO was there to defend rather than loot Europe needs to die.

有一些以宗教为基础的相互保险运作。 他们明确地被排除在奥巴马医改的购买要求之外。

The “payment for defense” by the yankee imperium is a red herring, since, absent the yankee power structure fomenting wars for European countries to participate in and create the refugees which are causing problems there, there would be no need for such expenditures, which are a total waste of money and divert funds from health care.

如果其他国家让老年人死去，为什么所有其他西方国家的预期寿命都比美国帝国高。与此同时，最新的数据实际上显示，帝国的人口在下降，而其他地方的人口则在持续增加，其中包括加拿大，加拿大的预期寿命比边境以南地区长了几年。难怪如此高的数字支持加拿大制度，如文章中引用的91%。作为双重公民，医疗保险（这是加拿大制度的名称）的存在是我在家庭义务结束后搬到这里的一个关键原因。我可以证明这个系统比狗咬狗的洋基公司系统要优越得多。医疗系统的失败是洋基系统的普遍失败之一。

Hey Bill,

不知道-谢谢！

和平：

“如果其他国家让老年人死去，为什么所有其他西方国家的预期寿命都比洋基帝国高。”

Other nations don’t have gun violence, lots of negroes killing negroes, and etc.

Also, other nations aren’t as fatty as the US.

Even if a nation does little to keep old people alive, life expectancy will be high if people eat right, walk than always use car, drink red wine, and don’t shoot each other like Negroes.

US medicine spends more to keep old folks alive, but there are too many fatties who die young from gluttony. And too many Negroes killing one another.

Freddie, you and your pal are nuts…..letting a couple of Beaners cut on your ticker to save a few bucks. Maybe you could find a couple of Haitians to work on it with an exacto knive for a couple hundred dollars. If you stopped devouring murdered pigs, your arteries wouldn’t resemble a clogged sink trap, and you wouldn’t need to murder more pigs to harvest valves for installation into your diseased sclerotic blood pumpers. Fact: there was almost no incidence of heart disease in Asia…until they adopted the poisonous westernized diet of fat, dead animals, and lots of sugar.

Fred makes some good points, however he’s off the mark by suggesting that comparisons be made with military health care.

First, the average health profile for military personnel (not damaged physically or mentally by combat/deployment) is far better than that of the general civilian population that includes elderly, substance addicted, fatbodies (although obesity has piggybacked itself into the military to some extent with “diversity” and women) and others who couldn’t survive an induction physical or boot camp.

Second, Fred conveniently neglected to mention VA health care as a possible comparison metric, which by no means is a simple no paperwork, just git ‘r’ done high quality proposition.

Third, military doctors pretty much get to skip residency/internship requirements of civilian doctors who attend medical school without the benefit of an ROTC scholarship to boot. Military doctors don’t have student loan debt in other words, much like foreign trained doctors who come here to run their Medicare/Medicaid scams.

I was working on Capitol Hill when ClintonCare was being considered and there were comparisons, mostly to the U.K. and Canadian systems. The U.K. was generally held out as the worst, with long waits for elective surgery and some procedures simply not done past a certain age. Canada’s system got a better review. Cross-national comparisons are difficult, since the health status of the population differs among countries. The U.S. does seem to pay quite a lot for results that aren’t much better, or actually worse, than other countries. I have limited experience with the U.K. and French systems, which I have found to be relatively good. France does have universal medical coverage (Securité Sociale), but the reimbursement is low and most French people who can afford it buy private insurance (穆图埃勒). But the French system is showing strain under the influx of migrants who are low income and qualify for free unlimited care (couverture maladie universel) and who have some fairly exotic diseases. I had a language student whose sister was a medical doctor studying tropical diseases–she planned to practice in Paris–there was that much demand for those services.

Importing tens of millions of destitute third-worlders will have a deleterious effect on any nation’s health-care system. Meanwhile the USA offers top-notch care to those who can afford it, or who are employed by large organizations such as corporations, institutions, government etc. They include good insurance coverage as part of their compensation packages. If you’re in the individual market, or employed by small business, you may be out of luck.

Yes, a Canadian, French, or UK-like system would’ve been a huge improvement. But of course the greedy doctors, hospitals, and insurance companies will never let it happen. Also, the pharmaceuticals: the highest prices I’ve seen were in the US and Switzerland.

Call it “regulatory capture”, or crony capitalism, or whatever – the essence is clear: the government is acting in the interests of the big business (and against its population) to the extent unseen in the ‘developed’ world…

” . . . [G]ood insurance coverage as part of their compensation packages”. Kyle, you’ve hit on probably the #1 reason why American health care debate goes instantly wobbly. Group health insurance enrollees 错 believe the cost of their insurance is an alternate wage or salary. It’s not taxed as a wage or salary. Plus, how can it be compensation for work if the $200 an hour executive enrolled in a single plan costs the employer $7,000 a year, while the $20 an hour janitor with contractually qualifying dependents is enrolled in a so-called family plan at $17,000 a year?

You almost can’t blame the medically insured for not wanting the lid blown off an astounding scheme that’s misguided at least, if not downright iniquitous.

You are aware that the German healthcare system, first in the world, was created and maintained for over 60 years, through two crushing losses in two world wars, before NATO ever paid a nickel for that country’s “defense,” right?

The doctor doesn’t order a PET scan, three MRIs, and a DNA analysis of your grandmother’s dog to run up the bill.

It is true that some of these elaborate machines, having been purchased, must be used (to pay for them). There is also the ever present shadow of the trial lawyer looming over the doctor. Much of medicine is defensive.

Enormous amounts of money are spent trying to “save” or prolong the life of people near the end, even of the indigent, and those costs are eaten by the hospitals.

Much of the high cost of our medical system is rooted in our legal system.

A couple of months ago there was a report that 45,000+ Canadians had, or chose, to seek care outside the country (most in the US) because of unavailability or waiting times for treatment.

Funny you should say that. It has been said, for many years, that the best healthcare in Canada is in the US. Those who can afford it, come south. People have come from the UK, France, Germany and Italy as well, although not as many as from Canada as we aren’t quite as handy to the eastern side of the Atlantic pond.

弗雷德，退伍军人管理局在做简单的拆线手术时，没有让你失明吗？

It seems that the “advanced countries” that have the quality national health care schemes that you admire, Mr. Reed, are countries for whose defense the American taxpayer has been paying the lion’s share of through, e.g., NATO.

Canada, France, UK, all spend, on healthcare, less than half for capita than the US. It’s not clear to me how the robbery of the US taxpayer by the military-industrial complex (which I agree, is happening) can serve as a justification for robbing the same US taxpayer by the healthcare industry too…

Upper class living in Mexico is affordable on a US middle-class income. Upper class medical care systems in Mexico are superior to middle-class medical care systems in the US.

Simple facts can be instructive when selective chauvinism does not blind. Pretty much the story of human existence, right there.

Canada, France, UK, all spend, on healthcare, less than half for capita than the US. It’s not clear to me how the robbery of the US taxpayer by the military-industrial complex (which I agree, is happening) can serve as a justification for robbing the same US taxpayer by the healthcare industry too…

No attempt is made to “justify” it. The rich, in the majority, exist by means of the military-industrial complex. All other economic factors are irrelevant to them. Thus, the mind-control exerted by the rich-owned MSM emphasizes the absolute need for astronomical costs paid by the working citizen, to maintain an enormous military machine that benefits whom? the rich.

Junk food industry + poor eating habit due to immature/impulsive culture + rise of shamelessness & fatso-ness + crazy blacks doing violence are the real drag on American Health.

If the US were to ban junk food, life expectancy will go up by 10 yrs.

It’s been said Cuba has pretty good health.
This has little to do with healthcare.

It’s that (1) Cuba is a police state that keeps blacks under control and without guns (2) Cubans most subsist on rice and beans that are more healthy than ice cream, sodapop, cookies, and too much beer (3) walk a lot than relying on cars.

The main emphasis should be on American HABITS than HEALTHCARE.

It’s like US spends lots on education, but some segments of the population learn little because their habits and attitudes(or habittudes) are so rotten.It’s not always about money or organization. It is about the intangible factor of habits.

大多是荒谬的分析。来自英格兰和类似地方的民意调查询问了那些从未了解过其他医疗保健系统的人。当然，他们会表示批准他们拥有的唯一医疗保健系统以及他们熟悉的唯一类型。正是政府的影响和干预使得美国的医疗保健如此昂贵。为什么富有的加拿大人来到美国接受严肃、严格的治疗？或者从墨西哥来美国？您的评论仅在极其普遍的意义上是相对的，是该主题的表面知识。你对这个主题的了解与你对进化论和遗传学的了解一样深，其深度可以用一两毫米来测量。听说过表观遗传学吗？我以为不是。

>Group health insurance enrollees wrongly believe the cost of their insurance is an alternate wage or salary. It’s not taxed as a wage or salary.

One essential step in restoration of free market in medical services in he U.S. would be to end the tax preference for medical services, as described above.

Only when the consumer of the services has knowledge of the cost can there be any hope of containing costs. Medical services provided by an employer (or “insurance” to pay for such expenses) should be taxed at the same rate as any other form of compensation.

The present system dates to WWII, and was an “end run ” around wage and price controls by Henry J.Kaiser to recruit the best workers for his shipyards.

It needs to disappear, and the sooner the better.

美国的孕产妇/婴儿死亡率位居世界第 30 位，尽管其医疗保健支出（占 GDP 的百分比）比排名第二的发达国家高出近 50%。预期寿命排在世界第 50 位，并且实际上正在下降（按绝对值计算）。如果你问我的话，那是一个相当糟糕的投资回报率。

毫无疑问，对于百万富翁来说，美国的医疗保健是世界上最好的。对于其余的，则没有那么多。

Fact, you can’t murder a pig or any other damn animal for that matter.

The life expectancy has more to do with life style than any measure of quality of health care in the USA. Whether you are shot in Chicago at age 17, are involved in an automobile accident results in your demise, or you over dose on narcotics when you are dead there is nothing the health industry
will do for you.
As for maternal/infant mortality rates, this is more related to social services provided along with life styles of the mothers, than health care per se.
Go into the best hospitals in the US, or any community hospital and you will find the people who have just got off the plane from Syria or Ghana getting the exact same care as your coddled millionaire.

我认为我们可以确定，当弗雷德和他不忠的犹太妻子需要进行严重的医疗手术时，他们将前往北方。

如果我没记错的话，弗雷德在美国做过眼科手术。

Do some google research to confirm that health care in the USA costs more than twice as much as similar developed nations, yet is rated below average.

The health care racketeers love to speak about free markets, but fought off attempts to require public pricing. It is very difficult to obtain prices from hospitals, even by customers. They bill and you must pay. The #1 reason for bankruptcy in the USA is medical costs!

So require any provider who accepts Medicare/Medicaid (which is nearly all of them) to post their prices on-line. That is free market, but Congress can’t seem to get this simple idea enacted. If you need a hip replacement, you should be able to go on-line and shop for one.

On the other hand, Congress should help. Once a hospital reports an illegal alien or any foreigner to the US government, it can then bill Homeland security for care at the Medicaid rate. (It’s a simple fact that people without a valid SSN are not here legally, and they can simply check e-verify to find out) This will compensate hospitals and lower costs for all, while ensuring Homeland Security arrives on discharge to deport these foreigners, some who cost them over a million dollars. Perhaps this will cause the US government to bill foreign nations for this care, like from their aid budgets. Right now, the Border Patrol drops off injured illegals at hospitals for free care and never returns.

if you are uninsured, your prices can go from 10x to 100x as much as it would cost insurance companies.

single payer system can’t get here fast enough.

Oh yes, aunty ! Defence from the enemies the US creates – defence for the wars it starts or encourages, & defence which profits the US defence industries. Oh yes, those naughty socialistic, Japanese, Europeans etc !
Oh…& pity the poor US taxpayer who is the ultimate loser…(excluding all those dead, displaced victims of “defence” in various shitholes here & there)

Preventative medicine — it’s a great idea, but where’s the profit ? And, god help us, if the government dare suggest, let alone DO something, it’s SCREAMS of the Nanny State time.
I pity US business: health care is an overhead which reduces it’s profitability. BUT – it can never countenance a universal medical coverage for ideological reasons: the government, collective action, can NEVER (outside of the military) EVER be allowed to be considered a valid answer to national issues.
Universal – basic – health coverage is not HARD. A small tax on ALL incomes (say 1.5%) should cover the basics. The rich can further insure themselves for speedier service, face lifts & breast/penis enlargements.
And perhaps (oh, god no !) governments might encourage (not dictate) healthier living….
The current US health system has little to do with capitalism & a lot to do with old fashioned rentier economics…. Sure, find fault with universal coverage, but don’t kid yourself that you are defending “capitalism”.

Just one more reason why the US & the West generally need to take a cold hard look at immigration policy.

How many Mexican nationals seek to have their healthcare in the U.S. ?

How many U.S. nationals seek to have their healthcare in Mexico?

These numbers (or reasonable estimates of them) could be found with some research. The results of this research would say something useful about revealed preference, and which system delivers reliably better results. (Much more useful than one anecdote about cardiac surgery in Guadalajara.)

The U.S. system is inflated primarily because the EMTALA law requirements that all-comers to a hospital E.R. must receive care regardless of ability to pay. This law is used by hospitals to justify inflation of charges overall to cover losses, and therein lies an enormous opportunity for arbitrage.

Any article on U.S. Healthcare inflation that does not include “EMTALA” and “chargemaster” is missing the problem.

” . . .[G]reedy doctors, hospitals, and insurance companies . . .”. Yup, Mao, true. If I can generalize from my own observations of our medical associations and local medical societies, medicine is among the cruelest of our professions. Hippocrates warned of intrinsic vulnerabilities in the doctor-patient relationship. America’s “exceptionalist” response seems to be to turn over the national checkbook to Big Medicine and tell ’em to use their best judgment. (My hunch is that sulfa and penicillin, plus the successful public health measures of the early 20th century gave the America Medical Association way too much unwarranted prestige and political influence.)

With health insurance costs approaching the cost of wages and salaries, we may be nearing some crisis that’s sufficiently ripe for the President and key Congressional leaders to act. How in the world we’ll politically account for the gratuitous deaths of maybe a half-million folks, the needless suffering of many more, and the bankruptcy and impoverishment of millions as a result of health care costs is beyond me. I think there’d be good justice in seeing the medical establishment taken down a few pegs, but I’m not sure how many opinion leaders and decision-makers feel that way.

Yes – it’s about habits inculcated by parents within the context of general culture. And just look at that culture ! Parent takes their eyes off kid for a second…well god help them ! A child alone, unsupervised in the degenerate stew that passes for culture now…?
You could weep tears of blood, much good that would do.

我不支持北约，但老实说吧。 在美国统治欧洲之前，他们离持续的战争不远了。

When ‘Obamacare’ was being debated in the US House, Rep. John Dingell (MI) introduced a 19 page long single-payer bill, but Nana Pelosi killed that bill in the committee, so the 2,100 page long ACA bill would be the only one passed.

At 2,100 pages long, the Obamacare bill must have so much pork in it that when its squeezed, bacon fat drips out.

There should be a technical term – argumentum ad uxorem – for this rhetorical technique. It is also frequently deployed against John Derbyshire.

根据联合国和中央情报局的数据，共产主义地狱般的古巴的预期寿命与美国相同。即使在制裁之后。卡斯特罗式的共产主义医疗保健将比现行制度更好。事情就是这样糟糕。

“Ever hear of epigenetics?”

Ever heard about the bureaucratic waste and exorbitant salaries of the health insurance CEOs in the US? How these waste and salaries are financed? – The US healthcare system is a racket. This racket includes taxation without representation (the fines for non-enrollement in the racketeering “health insurance” schema). Or as you wrote, “It is government influence and intervention that makes American healthcare so expensive.” Correct. It is the 美国政府被保险公司收购 这使得美国的医疗保健过于昂贵。
For instance, citizens of South Korea are not interested in getting healthcare in the US; moreover, people from other countries travel to get medical care in South Korea: https://www.medicalavenuekorea.com/en/south-korea-is-the-new-destination-for-health-tourism/
这是旧数据（2011），对于美国功能失调体系的天真的捍卫者（不直接牟利）来说应该具有教育意义（重新支出）：
“National health insurance in South Korea is currently a single-payer program (that is both publicly and privately financed) that pays for privately provided health care. Universal coverage was achieved in 1989. As a result, the household share of total national health spending fell from 87.8 percent to 54.6 percent during the three decades, and the out-of-pocket share dropped from 87.2 percent to 38.0 percent. Although covered services have gradually expanded, benefits remain relatively low, and public funding is limited, leaving beneficiaries with relatively high copayments. Coupled with the fact that [韩国]政府管理支付给提供商的费用表, the health care share of gross domestic product was a low 6.3 percent in 2007.”
“South Korea has a universal national healthcare system operated by both the Health Insurance Review and Assessment Service (HIRA) and the National Health Insurance Service (NHIS). 国民健康保险制度覆盖率超过97%，谁支付溢价并拥有 接触任何医生或医疗机构的权利. The remaining 3 percent of the population is covered by a Medical Aid Program for the poor.”

“如果其他国家让老年人死去，为什么所有其他西方国家的预期寿命都比洋基帝国高。”

其他国家让不健康的人死去，而不是给他们提供他们无力承担的手术，以便让他们坐在椅子上或躺在床上还能再呼吸几年。

这是将更长的预期寿命归因于医疗保健质量的问题之一：其他国家的人们具有更长的预期寿命，因为他们过着更好的生活方式，这使他们能够首先避免需要医疗保健。

Note: In last week’s column I made disparaging remarks about the accuracy of the AR15, and was taken to task by many readers. I should have said what I meant by accuracy, and I guess it isn’t what most people mean. In my days at Soldier of Fortune, we got into exotic stuff, such as sniper rifles, and it probably distorted my ideas of things. Google on “sniper rifles,” and you will find virtually nothing in .223. At Parris Island we fired .762 at 500 meters. And I don’t pretend to understand the photo with the “smoke disk,” which I can’t figure out.

Fred: The reason that “sniper rifles” are not in .223 (5.56 in military parlance) is not because the .223 lacks sufficient accuracy, but because it delivers inadequate energy at ranges between 600 and 1,000 yards.

Accuracy-wise, the AR-15 has ruled the 600-yard line in Service Rifle competition at the National Matches for about two decades now. Match-grade ARs are used for Designated Marksmen in the Army, whose job is to engage out to 500-600 yards. Snipers, who are expected to score hits between 600 and 1,000 are issued .30 cal weapons.

The contemporary AR is “not your father’s” Vietnam-era rifle. It’s highly accurate off the shelf and can easily be modified to outshoot a good bolt-action rifle.

弗雷德：

I appreciate your naivete. You seem to regard the American health care system as a failure because it provides poor care at exorbitant prices, and is out-of-reach to millions of citizens. However, the American health care system is #1 in the world in maximizing profits for pharmaceutical companies, medical device makers, doctors, for-profit hospitals as well as insurance companies. In other words, as a business, American health care companies do an excellent job of using health care problems to extort money out of ordinary Americans. They are without peers in the world.

Healthcare reform in America means, how can we steal more money from these filthy plebes? They must have some economic blood left somewhere. So it makes perfect sense that discussion of Europe or Asia is verboten, the last thing the MSM and the lobbyists want is Americans waking up to the fact that their health care system is simply a financial scam to skim even more money off the backs of workers. Pay us, or your kid dies from a preventable illness, that is the business of compassion.

Thank God for all the diversity, because if we weren’t able to pit this group against that one, the peasants might revolt over their conditions.

你以为你只是用一些关于社会主义经济问题的直白的撒切尔式智慧打动了我们，不是吗？你所做的一切，尽管是无意的，只是给我们提供了另一个例子，说明美式裙带资本主义所固有的无情的贪婪。军工联合体并不关心谁为国防买单；他们只关心谁为国防买单。只是它得到报酬。外国援助只不过是为国务委员会创造一个利润丰厚的市场的平台。美国风格的裙带资本主义依赖于这种间接的支付方式，因此那些最终买单的人根本不知道账单有多高，因此无法拒绝。美国的医疗保健利用保险公司来制定方针并掩盖我们医疗保健的高得离谱的成本，而这些保险公司花费大量资金游说政府阻止开发更好的解决方案。因此，我们得到的是奥巴马医改，而不是一个真正可行的系统。美国风格的裙带资本主义将成本社会化，将利润私有化。这是所有可能的系统中最糟糕的一个，如果游戏不是被金融和政治精英操纵的话，它很容易在思想市场上被击败。这就是为什么每个国家都拥有比美国更具成本效益的医疗保健系统

fred reed wrote:
” It is telling that in the debate over Obamacare, few looked at systems in other countries to see how well what worked. The reason seems to have been a mixture of the classic American arrogance and lack of interest in anything beyond the borders.”

=============

wrong…the reason “america” never looked abroad to compare is because our politicians did not look abroad to compare, and the reason the politicians did not look abroad to compare is because our media did not force them to do so. And why did the media not do so? Because the media is funded by ads bought by corporations, and some of those corps make big bucks extorting the public for healthcare, dummy.

Fred, you are like some sort of cargo cult analyst. Like a WW2 era tribesman who sees airplanes land with cargo, and you cannot understand more than one layer deep.

In other nations the leading societal institutions are forced to cater to the will of the people. American institutions do not have to do so. When you ask me why that is so, you will have begun your journey of discovery, grasshopper. But I aint gonna hold my breath.

are you talking about using their wife against them in the comments section?

there is a difference. derb hates china and “chicoms” 🙂 and he is married to a chinese. that 1980s trip with our spies to china did a number on derb 🙂

fred’s wife have nothing to do with this article. at least in the same sense as the above. dixie is using whatever he thinks hurts the most to attack fred. now, that is just fuck up.

I can never understand why people need to get personal in comments, especially when it is completely unrelated.

同意。

I once had a procedure done in the Philippines for the equivalent of USD 60. In the US at the time it would have been no less than 1500, and I’m not exaggerating a bit.

Also, I got the appointment in a few days there whereas in the US it would have taken weeks to schedule.

The service was top notch, and I was treated with a degree of respect by real humans (be assured, it was mutual) unheard of in the Land of de Fwee.

I swear that the bedside manner learned by the consistently incompetent and hostile medical professional bureaucratoids in ‘Merka must be taught by prison warden or military “intelligence” (tsk, tsk) interrogation burnouts.

Fred, you are like some sort of cargo cult analyst. Like a WW2 era tribesman who sees airplanes land with cargo, and you cannot understand more than one layer deep.

And doesn’t even want to. Smashed illusions of greatness and all of that. Rough stuff.

I’m convinced that he writes that way despite his imaginary and snobbish claims of high “IQ” not only because that’s the best he has, but because it resonates with his intended audience, the “tough talkin” yet insecure Trump or Hillary luvvin ‘Merkin booboisie, who’re on the fast plane to nowhere and always will be.

可悲的东西。

However, the American health care system is #1 in the world in maximizing profits for pharmaceutical companies, medical device makers, doctors, for-profit hospitals as well as insurance companies. In other words, as a business, American health care companies do an excellent job of using health care problems to extort money out of ordinary Americans. They are without peers in the world

also please keep in mind that most of the lucre extorted from everyday Americans reeling from some medical catastrophe is done so at the very end of people’s lives, and as such, we must never underestimate the importance of proscribing (with jail time!) any attempt on some misguided people’s parts, to allow for what some lunatics call ‘humanitarian euthanasia’.

If a ninety year old man or woman is suffering some excruciating and terminal affliction, Free Introduction is the time when the ‘ching, ching’ really kicks in! Assorted surgeons and specialists and myriad hospital personnel and devices and expensive hospital equipment can all be brought to bear at astronomical profits! This is the time in a person’s life when the medical establishment really gets their$. It’s a God damn gold mine!! It’s the Mega-payout at the casino!

So, the next time you hear some misguided, namby-pamby do-gooder, talking about ‘oh, oh’ some new drug or something, that allows for terminally ill people at the twilight of their lives, to check out with dignity on their own terms, just remember that they are effectively robbing hospital administrators and surgeons and anesthesiologists and pharmaceutical corporations and the entire AMA- untold billions upon billions of dollars of extorted lucre, that can be used to purchase entire villas on the Italian Mediterranean for a single hospital administrator!

These euthanasia people are dangerous! And they must be stopped. Thank God that the ‘Jesus people’ are there to make sure everyone knows that God **wants** those people to suffer at the end of their lives. If He didn’t, He would let them check out. So it’s not for those people themselves or their relatives to decide when it’s time to go. It’s for the hospitals and politicians and the Jesus people to decide. We’re talking about trillions of dollars that are at stake here. Do we want such decisions to be made by the people who’re actually on the gurney? Or the AMA?

我是法国人，住在法国。我的祖母在 94 岁时脑中风。她的大脑几乎不再起作用（她无法移动，无法说话，甚至无法识别人们的面孔）。法国的公共医疗保健系统让她活了四年，直到她的心脏停止跳动，也就是她 98 岁生日的前几天。

我的妻子刚刚因流感和严重的哮喘住院了六天，因为巴黎地区目前正处于污染高峰。她出现呼吸困难，因此给医疗紧急服务中心（SAMU）打电话，大约十分钟后，三名消防员出现了。他们把她送往医院。她住的是单人间，有彩电。六天后，当她出院时，我们没有支付任何费用，甚至没有支付电视租金（通常我必须支付）。我为我们两个人提供了补充健康保险。我每月花费 234 欧元（按今天的汇率计算为 247 美元）。我不知道如果我没有健康保险我会支付什么（如果有的话）。

我认为自己是一个保守派。但这里的普遍共识是，既然人们为警察、武装部队、公共教育、公共卫生等缴税，那么他们就没有理由为公共卫生第二次付费，而他们为公共教育则无需支付任何费用或他们从警察和武装部队那里获得的（相对）安全。

不过，这个系统并不完美，如果你去任何一家法国医院，你都会看到很多第三世界的“游客”，他们是用法国纳税人的费用来接受治疗的。他们的政府应该支付费用，但他们很少这样做。法国社会凝聚力的普遍衰退也已显现出来，“少数族裔”威胁甚至殴打医务人员的事件时有发生。

确实，美国拥有一流的手术设施，但仅限于那些负担得起的人。

至于美国为欧洲的国防付费……你们美国人为什么不停止付费并撤军呢？但这是一个反问句，因为每个人都知道答案是：因为美国政客不想这样做。

除了你的第一句话之外，你的评论非常好。

Judging by auntie’s past comments, I’d say she was doing what you say she did in sentence two, but I could be wrong .

As for an example of the high costs (of really low quality… if people only knew…Fwed should…) care in the US see my comment #57.

Bingo! Right here:

When businessmen in the US saw how much money there was in health care, they just had to get some of it

而另一个：

we now have a system which everyone tries to game the system

还有另一个。

..and might occasionally give the patient a good outcome

This next idea may need to be reconsidered because these cats typically are very low class power-hungry junior mafia wannabees and are completely worthless so they need to be given a cardboard box (to live in) and a boot out the door. Same with the insurance racket mugwumps. :

My suggestion, which could be implemented tomorrow at virtually no cost is to limit hospital executive salaries to no more than twice that of a GS-15.

当您病重时，您会搬到韩国吗？

消除限制保险公司仅在特定州提供保单的障碍，或消除各州对保险附带条件的各种且不一致的要求，将对增强竞争和降低成本大有帮助。奥巴马医改最大的问题是对任何患有既往疾病的人进行强制承保。

至于医疗保健首席执行官。我同意。整个美国商界都有这种心态——都是短期思维。担任首席执行官足够长的时间，让大量的股票期权奖励归属，公司回购股票以提高股价，以及资产负债表会计的阴谋保证了首席执行官的大笔发薪日。谁关心公司 10 或 15 年后会是什么样子。下个季度的业绩才是最重要的。因此，为了生存并提高估值（和股票期权价值），并购是必经之路。

根据数字的计算方式，2015 年首席执行官的薪酬比普通工人或工厂车间工人高出 220 至 415 倍。 1968 年这一比例为 30 至 41 倍。这就是所谓的精英（寡头）治国方式。

也许特朗普会停止一些这种胡言乱语，即精英主义者变得更加富有，而富人和“勉强过日子”之间的差距继续扩大。如果他停止完全不受控制的移民，这将帮助一些人，因为移民的人缺乏技能，没有受过教育，不具备典型的美国职业道德，而且智力发展水平（即智商）基本上很低。因此，更多的人陷入贫困或仅仅处于勉强维持生计的水平，而寡头们则扩大了他们的财富。

Oooh! Exquisite! All of it. Good insights, well expressed!

It’s for the hospitals and politicians and the Jesus people to decide.

Speaking of “Jesus” people, the medical “ethicists” also cash in by “pontificating,” (or should I say “rabbificating”) on the “sanctity” of life while their fellow bureaucrats-in-crime get paid insanely for snuffing the lives of other millions with every wicked means the subhuman mind can conceive.

Speaking of the AMA, all one can do when examining it’s history is to shake one’s head in disgust.

“Flexner was John D. Rockefeller’s “stool pigeon” in setting up the takeover of the entire medical school industry by Carnegie Foundation, which was a Rockefeller Foundation subsidiary at that time…….When you say “Carnegie Foundation”, you’re talking about something that has no substance. It’s entirely under the domination of the Rockefellers. ……………..He (Abraham Flexner) did “The Flexner Report”, and this changed the medical schools of the United States from homeopathic, naturopathic medicine, to allopathic medicine — which was a German school of medicine which depended on the heavy use of drugs, radical surgery, and long hospital stays. That’s what we’ve got today, allopathic medicine.”

-Eustace Mullins.
http://www.whale.to/b/flexner_report.html

You think it’s any better today?

“As head of the AMA (and editor of the Journal of the American Medical Association from 1924-1949), [Morris Fishbein] decided which drugs could be sold to the public based only how much advertising money he could extort from drug manufacturers, whom he required to place expensive ads in the JAMA. There were no drug-testing agencies, only Fishbein. It was irrelevant if the drugs worked.”

http://rense.com/general19/enemy.htm

I have friends who tell me that in medical school attempts were made to encourage (guilt trip) them into joining the patriotic sounding AMA. No doubt true.

If you really want to see how an efficient medical system world, look no further than that benevolent, highly efficient, family run dictatorship called Singapore.

https://en.wikipedia.org/wiki/Healthcare_in_Singapore

It is not the “kindest” healthcare system in the world but it is the system that is most likely to not eventually bankrupt the country that supplies itas its people live longer and longer.

Singapore of course also has probably the strictest border controls on the planet so its system might be be presently be duplicatable elsewhere except in a places like Japan or Korea with similarly tight border controls.

消除限制保险公司仅在特定州提供保单的障碍，或消除各州对保险附带条件的各种且不一致的要求，将大大有助于增强竞争和降低成本。

我意识到我的提议对大多数人来说似乎令人难以容忍，但您想降低医疗保健费用吗？

删除保险公司 和 所有 other money grubbing “businessmen” from the health care equation and I bet we’d all be pleasantly surprised at how costs and prices drop.

I wanted to get a simple blood test for ferritin, stored iron…In every other country, I would just take a small sample of my blood and mail it to a lab, for maybe $25. In the USA, that is illegal. I had to go to a GP and convince her to order the test. Total cost at least $300….

“Remove insurance companies and all other money grubbing “businessmen” from the health care equation and I bet we’d all be pleasantly surprised at how costs and prices drop.”

Homo Americanus will never see it. Too busy being masturbated by the invisible hand of Adam Smith.

Speaking of “Jesus” people, the medical “ethicists” also cash in by “pontificating,” (or should I say “rabbificating”) on the “sanctity” of life while their fellow bureaucrats-in-crime get paid insanely for snuffing the lives of other millions with every wicked means the subhuman mind can conceive.

I always want to be clear that when I speak such of “Jesus people’, I’m never referring to the typical Christians, whom are the best people in the world. Rather, I’m talking about the uber-corrupt 领导， for whom no amount of suffering is ever sufficient to satisfy their twisted and profane version of scripture- as long there’s shekels to be sucked. The Pope, being the perfect case in point, as he goes around calling people who tell the truth on the Internet ‘shit eaters’, because they’re overturning Satan’s Temple of Lies and a century of fake news from the war-mongering lie-machine controlled Kosher media.

These so-called Christians that form the corrupt core of official Christian leadership- demand that destitute women be denied birth control, that terminally ill patients be forced to suffer as long as there’s lucre to be slurped, and also love, love, love wars that slaughter millions of innocents, and get real and good Christians in Syria and elsewhere crucified and their daughters enslaved to sub-human orcs.

But so long as the leadership is awash in shekels, there’s no amount of suffering or misery or horrors that the little people can’t endure for the greater glory and exultation of the Christian leaders. The Pope being the most execrable of them all.

It’s a terrible shame that good people are cynically used by immoral charlatans and scoundrels by invoking and twisting the words of the Christ to mean the opposite of His intent, which was all about love and compassion and peace. But the Pope and the other “Christian” leaders have turned His words into war mongering and hatred and lust for Mammon’s damnation.

And it is Mammon that the American medical establishment (and the Vatican) worships, make no mistake about it.

The U.S. system is inflated primarily because the EMTALA law requirements that all-comers to a hospital E.R. must receive care regardless of ability to pay.

You hit the nail on the head regarding the inflationary medical cost effects of EMTALA.

In addition, federal government laws require that hospitals and doctors be reimbursed the least amount possible for their medical services rendered to Medicaid and Medicare patients.

The difference between phony government medical pricing and real medical cost is passed on to young and insured middle class people.

Then there’s the numerous illegal aliens that receive free ER medical services, all thanks to the perfidy of Obama and his democrat mafia.

确实如此。

The American medical and pharmaceutical industries are little more than extortion rackets.

I’ll give a couple examples. A bag of Saline costs about $2.00, but if a ambulance gives you a saline drip – the cost of that Saline bag is $800.00.

Take the pill called Sensipar, it runs over $100 a pill. It’s so expensive that medicare part D won’t cover it. In India you can find the same medicine albeit under a different name for $3 a pill. This goes on across the board.

Take Scorpion antivenom, you can get a vial in Mexico for a $100. The same vial in the U.S. costs patients $30.000.

Epipens which cost around a $150 in Europe or Asia, cost over a $1000.00 in the U.S.

Daraprim which goes for between $35,000 and $110,000.00 has been synthesized by two Australian teenagers for $3 and change.

Do you know that by law hospitals are required to post the cost of procedures but they don’t, why is that? So they charge the patient according to to their insurance or income level. It’s flat out illegal and the doctors and administrators should be in jail for the practice.

If I go to private surgery clinic as opposed to using a hospital’s surgery ward for outpatient surgery, the cost is 1/10th that of the hospital’s facility. MRI’s clinics are like wise.

Drive by doctoring. In our hospitals its quite fashionable for doctors to come by for about 30 seconds if that and then charge the patient for a consult that didn’t happen. If you look at a breakdown of your hospital stay you’ll see a lot of it. Usually it’s a quick way for a doctor to make a fast $300-500.

If I go to a privately run surgery clinic for outpatient surgery vs having the same procedure done in a hospital the cost differential is astounding.

卫生保健。
One of those all important entities the Americans NEVER get to vote on.

消除限制保险公司仅在特定州提供保单的障碍，或消除各州对保险附带条件的各种且不一致的要求，将大大有助于增强竞争和降低成本。奥巴马医改最大的问题是对任何患有既往疾病的人进行强制承保。

This is just unsubstantiated wishful thinking based on economic theory that says competition always makes things better. Well, competition in financial services didn’t make things better it just made more people cut more corners leading to our junk bond meltdown in the 80s, the dot com boom and bust of the 90s and the housing bubble of the 00s.

更多的竞争可能意味着更多的保险骗局，人们将一生都投入到他们认为可靠的计划中，却发现当他们真正需要时却没有真正的保险。

We have the system we have because of WWII and wage controls that were used during the war to hold down costs and keep employees in their place. The only thing the companies could provide in the way of increases was to increase the benefit packages. It just caught on and continued after the war because health care was cheap then and it wasn’t very costly. I imagine the corporate execs could probably exaggerate its costs to the employees and pay out far less in wages at bargaining time.

And we’re not good at looting, Or (honest question) are we?

“Universal – basic – health coverage is not HARD. A small tax on ALL incomes (say 1.5%) should cover the basics. The rich can further insure themselves for speedier service, face lifts & breast/penis enlargements.”

是的，如果它只涵盖基础知识的话。

但美国人认为必不可少的东西远远超出了基础知识。

美国人对基本权利的观念非常被宠坏和溺爱。欧洲和加拿大也一样。

If single payer system only focused on basic healthcare and essential needs, it’d be doable. But too many Americans get too fat and unhealthy and then go to doctors to demand all kinds of drugs and service and etc.

Consider all the Americans on this or that medication. Now, I’m not gonna be Tom Cruise about this and denounce all drugs. But drugs should only be used as last resort. For many Americans, it is the first resort, and they want more and more.
而且这个东西真的很贵。

如果没有这些药物和其他东西，过去的人们如何应对？他们在社区、教堂、家庭、亲戚和文化中找到了意义。对于许多美国人来说，这一切都已不复存在。他们只是接受了垃圾文化、享乐主义、青年崇拜等等。当青春过去时，他们像《伊索寓言》里的蚱蜢一样感到空虚，然后转向毒品。有些人转向使用冰毒等不良药物。有些人转向大型制药公司提供的专业索玛，应该称为 Harma。

This is why Single Payer system won’t work. Too many Americans became accustomed to getting too much from the system.
对于许多需要索玛、索玛、索玛的美国人来说，基本护理已经不够了。

Michael Moore is perfect posterboy for what is wrong with America. He is a fatty fatass fatkins who can’t control his fatbody appetite. A fat tubaroon like him will have all sorts of health problems, but of course, his ilk want the STATE to take care of it.
Lardsass mother******.

US subsidizes healthcare in other nations.

Americans pay high prices for drugs, but these same drug companies sell the drugs real cheap to other nations.

You got that right! My Viagra costs $20 per pill at my local CVS pharmacy. It’s $2 per pill for generic Viagra from my on-line Canadian pharmacy; but why do the packages come postage stamped from India?

Those nations haven’t added 70,000,000 gov’t dependent Mexicans with Type II Diabetes, in 25 years, to their populations.

I’m thinking removing 30,000,000 bloodsucking illegals from the US and ending the annual admission of 1.5 million legal, broke immigrants will have a an effect on US medical care even more dramatic than the elimination of big business.

Here. After suffering 5 cases of pneumonia since 1968 to 1977 with the last one giving me nasty complications in form of rheumatism I degree, chorea and the whole bunch of other complication losing control of some of my faculties by the age of 11, I was diagnosed and sent to Soviet hospital at one city. Spent there 2 months. No use. Was transferred to another hospital other republic other city, spent another 2 months there. Greatly improved. Then I was sent into children hospital sanatorium for 3 months where kids also studied to avoid missing a year at school. Hence. in 1979-1980 I spent 7 months at hospital with intensive care and lots of medicines. Continued later treatments at home for another 2 years and was completely healthy by 1982. Considering severity of my case , I was shown to medical students as a rare very severe case… It cost my family nothing at all and the country got healthy kid. That’s socialism for you.

Complete BS. Good luck to you if you end up in a French ER or are not connected to the inside functioning of the French system. It is VASTLY inferior though much better than Mexico. Much much much better. I won’t go into unnecessary details. Suffice to say that I practiced in both the French and the American health care systems as a physician. I would never get treated in a French hospital unless I knew the physicians in charge. It would never occur to me to got to Cuba or Puerto Rico as just random examples. YES you can be lucky. But you just need one bad experience to die. In Mexico or anywhere else where care is subpar. Very very subpar. After all anybody is free to choose where they want care. As a patient who happens to be physician only the US will do. Did I mention that this would NEVER include a VA hospital ( talk about subpar). Why not try Haiti and give us your experience?

Thanks for the clarification, not that I even began to suspect that you meant true Christians. I was raised in a supposedly Christian environment and I must say, I have never met one that acted Christ like, including me own self. None I’ve ever met even came close.

If a Martian who never heard of Christianity were told what it was and asked to observe people and pick out the Christians by the things they say and do, it’d be a while before he could find one.

It’s as apparent as it is humorous to read the letters of Paul and the effort he expended trying to shepherd the herd. No sooner was Christ tacked to the cross, but the “Christians” apparently but not surprisingly started going astray, just like their Jewish ( if Josephus is credible )predecessors.

What disgusts me the most is the overwhelming support of the clergy for the State’s wars.

If Democritus were alive now, and should but see the superstition of our age, our [269]religious madness, as [270]Meteran calls it, Religiosam insaniam, so many professed Christians, yet so few imitators of Christ; so much talk of religion, so much science, so little conscience; so much knowledge, so many preachers, so little practice; such variety of sects, such have and hold of all sides, [271]—obvia signis Signa, &c., such absurd and ridiculous traditions and ceremonies:

-Robert Burton, THE ANATOMY OF MELANCHOLY, first published in 1621 (Project Gutenberg’s version):
http://www.gutenberg.org/files/10800/10800-h/10800-h.htm

My local newspaper reported in detail on a woman who was being treated with Herceptin at a cost of $32,000 per treatment—每三周. That’s more than a half-million a year. That astounding cost diminishes wages and shareholder’s equity, and among an untold number of American companies profits become losses because of the burden of group health insurance premiums. We’re just not getting the true skinny on how America’s aggrandizing medical establishment is and has been wrecking the economic prospects for ourselves and our loved ones.

Cost of Herceptin treatment in the UK? About 15% of this woman’s treatment.

We have the system we have because of WWII and wage controls that were used during the war to hold down costs and keep employees in their place.

I suspect that part of the benefit of subduing Germany and Japan was to have another relatively cheap labor pool to tap into which would have a similar effect . Plenty of manufacturing jobs could be shipped overseas if the American worker got a little too uppity.

Interesting note: Toyota motors was producing only a few vehicles per week and was about to go bankrupt when the Korean war started. All of a sudden it was mass producing trucks under contract to the US military and eventually came to be the number 1 vehicle manufacturer in de world by number of units sold.

Gm was the world leader, I believe but now is number 3 after VW.

You ain’t no physician.

Socialized medicine in places like Germany, Japan, Canada, Australia amount to a corporate subsidy, transferring employee medical costs from a business to the taxpayer. Eventually, a single payer system (simplified Medicare) providing basic military style medical to the entire population will be installed here in the USA….maybe even by Der Trumpster in his second term. Those insisting on coverage for the fancier treatments (organ transplants, exotic drug therapies, long term nursing care facility, drug and alcohol rehab, psychiatric disorders, etc ) could buy a suitable supplemental plan at their own expense. In this way, medical could be reduced from 18% of GDP to maybe 12% of GDP, and the burden shifted from businesses to the taxpayer. Too sensible?

“Are u moving to South Korea when you become seriously ill?’
Are the US citizens allowed only to wave flags and chant “USA, USA?”

I like U.S. healthcare. I like the quality and the price I pay. Not sure what y’all are talking about.

The United States is much bigger than other First World countrieand richer than all but about three small ones. Still there could be a small element in the idea that other countries lower percentage expenditure on defence was good for their health expenditure and outcomes – if you could be bothered to do the figuring based on fact snd careful calculation. However….. that doesn’t explain why US healthcare is such an outlandish proportion of GDP for very poor average results.

Another sally from the same fortress might suggest that other countries are free riders on American pharmaceutical companies’ inventions which cost patients and health insurers much more in the US than in other countries. Maybe but deduct huge advertising expenses only incurred in the US and the bias of American and all purely commercial pharmaceutical research towards drugs which will be taken for a long time rather than cures.

You are correct. Cost him previously sharp eyesight in one eye. I use VA Healthcare in New England, self-touted as the best. I’ve had good luck with them and true enough, no paperwork. They did a carpal-tunnel surgery that couldn’t be beat and their foot-guy was a surgeon who reconstructed the feet of Humvee guys that rolled over IEDs, an incident they found was very hard on the feet. My feet were wrecked in crummy flight deck boots and years up and down the ladders of carriers, many a day, dozens. These guys know bones, I tell ya.

Eyes, not so much maybe, for Fred anyway, although I get my eye care exams there too. Not sure there’s a Model at VA that applies to civilians without you simply declare the country to be on Medicare, all current payments to insurance now a tax to the Feds. The insurance companies are a powerful lot. Not sure how you cut them out without a coup…

sodapop, cookies, and too much beer

Hey! Keep the sweets, lay off my beer! Ha!
And my cigarettes, red meat, motorcycles, scotch, broads, cigars. I got bored with the skydiving on my own, but that’s not a healthcare issue. No chute, no you. There are others, but none that change the general picture..

There are a number of religion based mutual insurance operation. They specifically were excluded from the Obamacare requirement of buying .

Healthcare sharing ministries are not mutual insurance companies. In fact, they’re not even insurance. That’s why they needed an exemption in the ACA — so that their members do not pay the penalty for not having insurance.

Members pay a fee to access the ministry. If they get sick, they submit the bills to the ministry, which divides it up into pieces and asks other members to pay part of the bill. You literally write a check to a stranger and mail it directly to him. The obligation is religious and not contractual, so you could just decide to skip out on mailing the check. The only thing they can do is to kick you out.

A mutual insurance company would include all the costs in the premium. You never have to write a check to a stranger. Instead, you pay the insurance company, which is contractually obligated to pay the stranger. If the insurance company refuses to pay, it would be sued.

Yes, Fred can get a bit funny on evolution but your accusations of superficiality would be better based if you didn’t try to make a point out of Canadians who can afford it coming to the US for critical medical treatment. That the the US has the best of many important activities and institutional functions – including universities and weapons production amongst others – is totally irrelevant to the case against the whole health care system in the US judged by cost and by outcomes.

I always wondered what happened to the true concept of “mutual insurance” – where the policy owners own the insurance company and therefore earn dividends from its gains. It is in the interests of the policy owners to stay healthy to maximize their own profits.

Are those around any more – or all gone, except in name?

Mutual insurance used to be much more common than it is now. Most of the Blue Cross & Blue Shield companies used to be mutuals. However, many of them have demutualized and switched to being for-profit companies.

The incentive really isn’t that strong because these companies are very large. If you save the company $100,000 by not getting Hepatitis C, that $100,000 gets split among the million members, and you end up with 10 cents.

The nonprofit Blue Crosses are not significantly cheaper than the for-profit Blue Crosses. The reason is that the for-profit companies do a better job of cutting costs. The CEO has stock options, so he has an incentive to cut the fat. A nonprofit CEO has a much harder time doing this.

It’s the same reason that GEICO is taking market share from State Farm. Because State Farm is a mutual, it ought to have a cost advantage, since it doesn’t have to make a profit and GEICO does. However, State Farm squanders its entire cost advantage by using an agent-based structure. GEICO cuts out the fat with its direct sales structure, so it can underprice State Farm and still make a nice profit.

Agree, more or less, which means $1 trillion 每年 in walking-around money to buy stuff, or build factories, plus America gets to join the ranks of grown-up countries with good health care stats, and a medical establishment that doesn’t use its specialized skills and unique authority to politically word-whip a whole nation to get what it wants.

I’m not sure an American Medicare for All plan means giving up much of anything, or having to “settle”. If my memory’s okay, the European standard for new drug approval was “better than existing pharmacopoeia” while the American bar was merely “better than placebo”, which pretty much means a license for Big Pharma to print money with me-too products. Likewise, I expect we’ll find numerous dubious treatment regimes that exist solely because the money is available to pay for them.

I keep seeing the US compared to other “developed” countries, but given the demographics of the US these days, that’s not really an accurate comparison. We are more like Brazil than Europe.

我记得米尔顿·弗里德曼（Milton Friedman）在与一位斯堪的纳维亚教授交谈时说过，他说斯堪的纳维亚半岛没有贫困。弗里德曼说，有趣的是，在美国的斯堪的纳维亚人中，我们也没有贫困。种族和文化很重要。

我有 Medi-Share，这是一个基于基督教的项目。 我今年62岁，身体健康。 通过 Obamacare，我的保费是 725 美元，免赔额为 7500 美元。 通过 Medi-share 是 220 美元，免赔额为 10,000 美元。

Medi-share 不包括自我造成的负面结果。 由鸡奸引起的疾病不在承保范围内。 醉酒出事或抢劫便利店被枪杀，你的成本是别人的问题。

Not sure where all this “first rate” national healthcare is hanging out. 5 year survival rate for cancer in the US=66%, in Canada and the UK= 44%…Also, UK NH has few dentists, has advised people to pull their own teeth….

Eventually, a single payer system (simplified Medicare) providing basic military style medical to the entire population will be installed here in the USA….

There’s nary a chance of that. The rich own the country (or, more correctly, share it with Israel), and there will never be “health-care” in the US that does not make at least as much money for the rich as does the current system — if “system” it be.

America is corrupt throughout, in all government and all financial “institutions”. America as we knew it is over and done. Perhaps revolution will one day restore a few elements of America, briefly. Without substantial reduction in population — 50% at least — there will never be any “getting better” for any but the 1%.

Updated stats, UK 5 year cancer survival rate–50%, US–70%+

“Not sure there’s a Model at VA that applies to civilians without you simply declare the country to be on Medicare, all current payments to insurance now a tax to the Feds. The insurance companies are a powerful lot. Not sure how you cut them out without a coup…”

Thank you for very clear explanation. The overwhelming majority of the US citizenry would pay taxes to have a decent single payer system. These taxes will be significantly lower than the current racketeering fees charged by the parasitoids of US insurance companies. These companies want to continue their fat living on the body of the US citizenry whatever the cost for the society.

嘿workforlivn，

That actually sounds pretty cool – they enforce you to live responsibly. What about stuff like diabetes from eating too much sugar and not exercising or stuff like cancer from smoking – is that ‘self-inflicted’?

非常感谢！

和平：

Hmmm – very good points to think about – much thanks for the details!

I remember speaking to my boss about this topic and saying to him that I don’t think either a private or public solution will solve our problems. The fact is – apart from a minority of us – we live horrendously unhealthy lives. Any medical system will suffer under the burden of such wide-spread negligence.

I know a pathologist who trains other pathologists in one of the top universities in Chicago. His assessment is that he will be shocked if we don’t see regulations concerning sugar within the next two decades because of the evidence of how bad it is – and it is in practically everything. As far as he is concerned, he has no problems calling it poison.

https://www.youtube.com/watch?v=B56Gpf1f5_A

和平：

There does seem to be a potential category between “better thab placebo” and “better than existing product” – like “better for some patients”.

和仅供参考：

https://www.mskcc.org/experience/become-patient/international-patients/private-translation-services

我会定期与这些家伙打交道（上帝保佑他们）。 不是没有人去加纳照顾……

With all this being said, good to know healthcare is free in iSrael for Israeli Jews as I understand it lol. At least, our tax dollars are providing that kind of service for someone in the world even if it’s not us LOL.

As a citizen of a country with (nominally) free universal healthcare, I was really disappointed about the American healthcare system when I was trying to understand it. I thought one could not invent more confusing and anti-people system than that. Crony capitalism at its essence. But after some consideration, I though it might be not so terrible as it sounds.

First, the majority of Americans are ensured, so they will very unlikely face the high prices listed above. Only 10% of Americans are uninsured (http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/). The poor who cannot afford insurance could use Medicaid (thanks to condemned Obama!).

Second, the average spending on healthcare rarely goes above 10% of a family budget
https://www.creditloan.com/blog/how-the-average-us-consumer-spends-their-paycheck/
https://www.valuepenguin.com/average-household-budget
Here more detailed: http://www.bls.gov/cex/

So it is not that unaffordable. While in other countries people pay higher taxes, in the USA people pay directly and usually the very same amount of money. So either you pay 10% more on taxes or 10% on the insurance.

The elderly are covered by Medicare.

But after all, this discussion is in fact pointless. After Americans have elected Trump and the GOP, it is futile to expect they’ll ever consider a reform and not to say nationalization. The Right have always been against the state involvement into healthcare. Americans have chosen their fate and this very site agitated for Trump very hard. So after you made your choice it’s silly to whine that you had chosen the wrong guy.

And the insurance lobby will never allow it, either, they even managed to ruin not one politician. that:http://truecostofhealthcare.net/conclusion/

Guess that for the US Congress, Israel is thoroughly socialist:
“Health care in Israel is 普遍 and participation in a medical insurance plan is compulsory. All Israeli citizens are entitled to basic health care as a fundamental right. The Israeli healthcare system is based on the National Health Insurance Law of 1995, which mandates all citizens resident in the country to join one of four official health insurance organizations which are run as 非营利组织, and are prohibited by law from denying any Israeli citizen membership.” https://en.wikipedia.org/wiki/Health_care_in_Israel

不是没有人去加纳照顾……

您故意将讨论引向荒谬，以使您变得愚蠢。 没有人将美国与非洲相提并论，顺便说一下，非洲只有博茨瓦纳和突尼斯拥有真正的免费HC。 您正在谈论的事情甚至都不会让您费心检查。

But let us compare the USA with other major English-speaking countries (AU, CA, IR, NZ, UK) or the top world countries from G7 or EU-15. How many of them go to the USA for a treatment? I’m not speaking about the millionaires who can easily spend hundreds of thousands of dollars on their health, but about an average person with an average income. How many, average British, Irishmen, Frenchmen, Germans, Italians, Spaniards, Japanese, Canadians, etc. goes to the USA for a treatment? Why would a French bus driver go to the USA, if he can get his treatment at home with little or no cost?

Let’s leave emotions and crunch numbers. The USA pay only 16% ($600bn) of the federal budget on the military and 27% ($1,000bn) on Medicare & Health. Total health expenditures of the nation: $3,000bn. Given that $1,000bn are already covered by the federal budget, you need another $2,000bn in the budget. Even if the state would spend zero on the army, it would be $1,400bn short.
https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/
http://www.cdc.gov/nchs/fastats/health-expenditures.htm
If the state spend 50% less on the military then the required sum would be $1,700bn or $5,300 per capita. Sure you could get that money from the top 1% and the corporations but how can you get at them if the state itself is controlled by those oligarchs and their lobby is the most powerful? Moreover, you have elected one of the oligarchs as your president. Reap what you have sown.

确实。 美国的医疗保健状况非常糟糕，没人来过这里。

人们根本不了解美国的医疗体系。 他们不考虑这一点。 他们来到美国过着更好的生活和更高的工资，他们不认为生病后会发生什么。 许多人认为免费医疗服务是发达国家的既定条件，他们只是认为美国是一样的。 但必须注意的是，当今大多数美国移民是来自第三世界国家的人民，对他们而言，美国医疗保健所具有的所有缺点是他们所能获得的最好的。 但是对于第一世界国家的人民来说，那一定不是那么令人印象深刻。 欧洲不再是移民到美国的主要来源。 的确，为什么现在德国人或瑞典人会移民到美国？ 80,000年，在2014万移民中，只有1欧洲人来到美国（我想大多数是来自较贫穷的东欧国家）。 因此，唯一可以说美国最好的方法就是与第三世界进行比较。 美国一定跌了这么低。

“But after some consideration, I though it might be not so terrible as it sounds.”

You have missed an important point of the article: the exorbitant cost of healthcare is the primary cause of bankruptcies in the US. Moreover, the huge numbers of people in their prime years cannot afford comprehensive screening and/or seeing a specialist and thus they are less protected than the poorest citizens that enjoy Medicare and can go to any specialist and receive any procedures and any surgeries. As for the middle class citizens, you should better learn about the deductibles that the hardworking Americans have to pay to the insurance-racket sharks. Meanwhile, the med. doctors are loaded with bureaucratic trash and their work is compromised by the same insurance-racket sharks.
Overall, it is as terrible as it sounds.

也许你所说的这些美国人值得我们熟知的营利性保险结构。双方本质上都是腐败的，并且只为了狭隘的自私利益而行事。要实现改变需要某种形式的震动。

什么是 可以 更好地工作并有利于普通人是与医生甚至医院进行低水平、例行就诊的直接安排。所有门诊工作都将由消费者直接支付，他只会为“大件”如手术或昂贵的药物或测试购买保险。我相信一次基本的看医生费用在 150-250 美元之间：对大多数人来说并非不可能，而且可能会激励人们更好地照顾自己。这不是一个新想法，但如何探索可能性？

下次您去看医生时，询问他任何手术的实际费用是多少。 （他很可能不知道）。告诉他你正在货比三家并计划选择成本最低的提供商。中间商（保险）自动消除。如果数百万人这样做，系统将在短时间内降低成本。

如果民主党人像关注妖魔化他人一样关注这种激进主义，他们实际上可能会取得真正的进展。

Well Fred, first you pose the dilemna:

Almost all advanced countries, if not all, have national medical care. It is telling that in the debate over Obamacare, few looked at systems in other countries to see how well what worked. The reason seems to have been a mixture of the classic American arrogance and lack of interest in anything beyond the borders.

And then you answer it:

I tell you, boys and girls, America is a collection of self-interested interests concerned with maximizing profits and nothing else.

It is and always has been about the money and who was going to get to line their pockets! And as for amerika being the most corrupt of advanced countries I don’t know if that is true and I doubt you do either. But it is definitely corrupt. The last 8 years under odumbass and the presidential election prove that beyond a doubt, and it isn’t just the government, but the lying LSM presstitutes and their fake news, the criminal democratic party, and corporate amerika which have raped this country in the race for profits.

也许你所说的这些美国人值得我们熟知的营利性保险结构。

We’ve never had free competition in the medical industry. It has always been regulated by the states and outsiders (any other state) were kept out. Trump wants to change that so insurance companies can compete for business in multiple states. I expect that competition will be promoted in other areas too.

没有任何解决方案是完美的，但它会比“obdumbass护理”和我们之前的护理更好。

更有效且对普通民众有利的方法是直接与医生甚至医院进行低级别的常规就诊。

Forbe’s Magazine has offered this type of program to their employees for years. Not sure if it survived odumbass care, but it was a good program and controlled costs.

美国的孕产妇/婴儿死亡率位居世界第 30 位

这是一个虚假的统计数据，没有考虑到美国在拯救早产儿方面比其他国家做得更多，包括宫内手术，这就是为什么我们的死亡率更高。

这些都是在将我们的教育系统与其他国家进行比较时使用的虚假统计数据。如果你只计算我们的白人学生，我们和任何其他先进国家一样。如果你在亚裔学生中做广告，我们会做得更好。是黑人和拉丁裔拉低了这一数字。

In is hanging out under the “Statistical Lies” column. See my other comments in the thread.

why are people allowed to make profit off that stuff?

I personally know a number of doctors, and none of them are poor. But it is the insurance companies, big pharma and our criminal government that are driving up healthcare costs.

The real cost of health care is the huge advances in medical care that has afforded every great benefits. Knee replacements, heart stents, angioplasty, and wonderful drugs that cure otherwise fatals diseases cost huge amounts, but I doubt anyone would say it wasn’t worth it.
Every other country benefits from the improvement in health care developed in the USA.
Just like funding the trip to the moon, health care is a great project that the USA has funded with the benefit going to the rest of the world.

Knee replacements, heart stents, angioplasty, and wonderful drugs […] he improvement in health care developed in the USA.

All the techniques you mentioned were developed in Europe. ‘Wonderful drugs’ are mostly (conceptually) developed by public-sector research institutions.

All the techniques you mentioned were developed in Europe.

Please explain; that’s not the impression I got.

I just looked it up.
https://en.wikipedia.org/wiki/Themistocles_Gluck
https://en.wikipedia.org/wiki/Andreas_Gruentzig

The angioplasty was first developed in the USA and later advanced by some of the European nations but the vast majority of the development was funded and advanced by US companies and hospitals. Knee replacement as a “routine” procedure was developed here in the US and later exported to the other countries for the “one payer” system.
One payer, i.e. government, system suppresses innovation and places health care in the hands of the politicians in Washington who subsequently use health care to entice votes.

Nah. In reality, it’s the opposite: what suppresses innovation is the profit motive. Fundamental science is not a money-making enterprise, which is why a vast majority of scientific and ground-breaking technological advances have been produced by the public sector. Computing, the internet, space exploration, nuclear power, NIH, GPS navigation, you name it.

The private sector is good at mass-producing and selling identical items (cheap junk, mostly), but that’s about it…

The NIH is a money losing proposition and is not in the forefront of bringing new drugs and treatments to the public. Computers were developed by IBM and other for profit companies. Nuclear power is developed by private power companies, GPS was initially a military project but was made available to the public through private enterprise.

Look, I’d like to see NATO reined in or disbanded, and at the least I’d like to see US & NATO stop stirring up conflict in Ukraine and elsewhere.

But it’s willfully naïve to suggest that European countries wouldn’t need to spend substantial money for defense if the US government weren’t causing / exacerbating such problems.

Would it be wise to leave your countries defenseless against China, Russia, Iran in perpetuity? Because you “just know” that they’d never forcibly take your land and resources, or subjugate your people, if they knew they could easily do so?

We (USA) have spent and borrowed far too much for the military-industrial complex and unnecessary non-defensive wars. European countries have pathetic inadequate militaries and refuse to spend what is needed for mere defense and deterrence. Two extremes. Both should be avoided.

这就是菲德尔·卡斯特罗出国拯救自己的生命而不是坚持古巴医疗保健的原因吗？

You seem to have some anger issues with regard to Christians — a very numerous and diverse group. Leave it to the hate-everything-traditional millenial faggots to employ derogatory snark such as “the Jesus people”, please — you’re better than that.

But fair is fair: you make an excellent point about doctors, hospitals, and pharmaceutical companies unnecessarily milking the American taxpayer and insurance ratepayer for VAST sums at the very end of elderly people’s lives.

Other than allowing truly voluntary euthanasia / assisted suicide — a policy which poses its own grave risks, such relatives or government physicians pressuring an ailing, frightened, depressed old person — what do you suggest?

I’d be happy if the US government would withdraw our troops from Europe and bring them home. The troops can be posted on the Mexican border, where they will actually have a useful and Constitutional function.

Enjoy Sharia — we’re going to be too busy fighting off the Mexican colonization of our once-beautiful country to help your pathetic and cowardly asses.

YES! Any doctor or physician’s assistant whose practice or hospital receives more than 50% of its revenues from any taxpayer-funded source — Medicare, Medicaid, Veterans Administration, state government, county government — should have his income severely limited below what those crooks are getting now.

Twice the max for a Grade 15, Step 10, would be just fine — and still plenty of money (that works out to more than $300,000 – 310,000 in most major cities in the US).

Doctors should stay out of the AMA just like any sensible, freedom-loving lawyer should stay out of the ABA. These are disloyal, untrustworthy, unduly greedy institutions with members who often look down on the rest of us whom they are supposedly “serving” and “representing” and “treating.”

YES. But how about doing BOTH?

Deport illegal aliens, stop all taxpayer subsidies to non-citizens (including legal permanent residents), stop requiring hospitals to treat illegal aliens for any reason, secure the borders with troops, AND cut big biz and big pharma out of the loop.

I know many Christians here in the USA who strive and work hard to live life as true Christians, honestly and peaceably and charitably.

I also know many church-going Christians who oppose our government’s cruel and utterly unnecessary non-defensive wars.

But I’ll grant you that they are very likely not the majority of self-professed Christians.

Who has a better track record, though, when it comes to non-defensive violence, intimidation, dishonesty, and cheating — Muslims? Jews? Christians are not uniquely or even especially hypocritical from what I have observed, just fallen humans and way short of the standards we say we admire.

Well, you ain’t no grammarian, but he may well be a physician 😉

If we weren’t paying for alien peoples — especially illegal aliens and people who aren’t even citizens yet (legal permanent residents) — and disproportionately hostile, reckless, and frankly stupid people (african-“Americans”), many of us wouldn’t object to something like that.

感谢。

How about comparing the health outcomes and patterns of white Americans to those in Europe? There are obviously plenty of willfully reckless white Americans, as measured by morbid obesity, diabetes, gout rates, premature disability and death from smoking, etc., but substantially less bad lifestyles and outcomes (on balance) than African-“americans” and Mexicans.

(Same for the incidence of violent crime, gun crime, and many other measures on which “the USA” is supposedly so much worse than European countries.)

Hi Talha, just did a cursory perusal of Medi-Share’s website, and they seem to say that an extra fee of $80 per month applies to people who are overweight, or have too high a BMI, or have diabetes.

Didn’t inquire about other conditions that are often largely self-inflicted and (for most people) readily avoidable through sensible diet and lifestyle, such as gout.

I wonder how costly, and how practical, it would be to require members to undergo an annual or even twice-a-year test that would reveal recent smoking, such as (maybe) a test for level of carbon monoxide or other toxins in the blood.

Taking a different tack as Christmas approaches, I will wish you the peace and love of God and urge us all — certainly including me — to better follow the example of Jesus.

Agreed on all counts. Important to include “high-fructose corn syrup” in all its permutations as part of “sugar.”

On balance, it was an easy decision to side with the guy who might take action to slow or reverse the Third World colonization of my country, even if I don’t agree with him on all major issues.

Moreover, with our large African population — which is by far even more reckless and irresponsible in their unhealthy lifestyles than white Americans — any system of universal taxpayer-funded healthcare will be less affordable/realistic than it might be in countries that do not bear such a heavy burden. The same appears to be true, on average (albeit to a somewhat lesser extent) of our large and rapidly growing Mexican population.

All of us, of whatever background, need to live healthier rather than continue expecting doctors and drugs to mitigate the predictable results of our self-abuse. That is true under any system of healthcare.

You make some good points, including the observation that relatively few white Europeans immigrate here any more.

However, with persistent dangerously-low fertility rates among white Europeans in Europe, the fact is that there simply aren’t as many Europeans in existence who could immigrate ANYwhere. They have lost all common sense, appreciation for the beauty and rewards of raising children, and their will to survive.

We aren’t that far behind them on the road to subjugation or extinction, but some of us are trying and fighting. We would welcome white European immigrants in any numbers they can muster. (Just drop the self-hatred and compulsion to surrender everything to non-white immigrants. Yes, my German and German-American friends, I’m especially talking to you.)

Our med system is deeply flawed, alright.

But we shouldn’t ignore or downplay the enormous portion of the “need” for medical care that is caused by Americans’ reckless & stupid voluntary choices: smoking, over-eating, massive consumption of sugar and corn syrup, (which causes millions of unnecessary cases of diabetes and gout that are readily avoidable for most people through sensible diet and lifestyle), refusal to walk or bike or swim or otherwise exercise even a little bit, etc.

As for people allegedly being unable to afford deductibles, how much are these same people blowing every month on television, tobacco, marijuana, alcohol, etc.? Often many thousands of dollars each year, even in lower-income households.

When one factors out self-inflicted avoidable health problems and the cost of those same vices & luxuries, how many people are behaving like rational adults and still can’t afford insurance premiums or deductibles? Too many, but not nearly as many as you’re making out.

No system of healthcare will be affordable and sustainable over the long term the way that so many Americans are behaving like idiots and then expecting doctors and drugs to mitigate or reverse the damage.

The first electronic computer was designed by Alan Turing to break the Enigma code and was funded by the British military. The US government was probably funding a lot of computer development you never saw. When I worked at Hughes, the US was spending a lot of money through grants to companies like Intel and Vitesse (gallium arsenic) in its radiation hardening and very high speed integrated circuits programs.

The Manhattan project paid for the first nuclear reactors at Hanford Washington for the main purpose of creating plutonium for the atomic bomb. NIH does conduct basic research that nobody else will fund.

The first electronic computer

But was that a computer in the modern sense of the word?

The US gov’t, certainly, provided funding for all kinds of things.

嗨，RC，

It definitely sounds very interesting to me. Right now, it’s a tough thing for me to give it a go since one of my kids has Type1 diabetes and it costs a lot for the monthly medications so it is just too risky. However, it sounds pretty good for a normally healthy and responsible family. And (like anything) the more people that sign up, the better services they will be able to provide at better cost.

Taking a different tack as Christmas approaches…to better follow the example of Jesus.

Very seriously appreciated! That’s what I’m talking about!
“Then, We sent after them, Our Messengers. And We sent Jesus, the ­ son of Mary, and bestowed on him the Gospel. And We ordained in the hearts of those who followed him, compassion and mercy…” 57:27

May God preserve you and your family in this season and throughout the year.

All of us, of whatever background, need to live healthier rather than continue expecting doctors and drugs to mitigate the predictable results of our self-abuse. That is true under any system of healthcare.

But health is not all about the choice. While I myself do not drink and do not smoke, eat healthy and I’ve always been slim and hence I’m supposedly healthier than many, still I have some health issues I dare not to name as that’s a personal matter, some of that may have been indeed my fault but most things obviously not, and I fear to think how I could deal with those my health issues let I happen to live in the USA. Even the corrupt and outdated Russian healthcare system looks more reliable and friendly. There is a less chance I will be left untreated because I have no money or the right insurance. Of course, I won’t be left dying in America in an extreme situation but I might have been billed with an immense sum I would have to pay my whole life. In Russia they won’t bill me. Though I must admit I have not been long to Russian doctors as I do not need their help right now, but I hope in my distant future they will help me. Though some my elderly relatives have not had an excellent experience with Russian doctors, who often cannot make a right diagnose and hence cannot help, but overall I know many examples of good doctors as well. But all in all it’s nothing about money as in America, I never need to worry about that. In America you have to think about money first and only then about your health.

The US gov’t, certainly, provided funding for all kinds of things.

I don’t think this is even controversial. It’s a known fact: all fundamental research and conceptually new technology is either financed or directly done by the state. Then it’s passed to the private sector for commercialization. Socialization of costs, privatization of profits, the usual.

By some strange twist America is not very friendly for European people. You either must be a relative of a US citizen or have a very in-demand profession (like IT) and a sealed contract to get a visa. No Ellis Island for average working European people no more. But at the same time it is easier to get to America for poor uneducated culturally alien Third Worlders who are flooding America by frightening numbers.

And that very unfriendly and confusing healthcare system does not make America more attractive for Europeans, either. Not only I, living in a country by no means with the best healthcare, see it confusing and repulsive, but a German, who might want to flee the refugee crisis of the Vaterland, will see it confusing and repulsive for sure, after he’s got very accustomed to his native, state of the art, healthcare system.

As for the middle class citizens, you should better learn about the deductibles that the hardworking Americans have to pay to the insurance-racket sharks.

Yes, I studied that and know these things (at least in theory). For example, you pay $500/mo premiums ($6,000/year) but then you may have pay out of pocket from $5000 up to $10,000 and only if you reach that sum you may have got reimbursement from the already paid by you $6,000, but even that not so simple because you anyway always have to copay or co-share. That’s a clear racket, I agree. I better save $16,000 a year and after 10 or 20 years I will have a lot of money to cover any expenses if bad things happen.

Overall, it is as terrible as it sounds.

I hope I’ll survive it if I ever happen to live in the USA. That’s all I worry about. You all seem to have survived.

美国！ 美国！ 美国！ 美国！ 好的我明白了。

I’m not a flag waiver Alfred, but fake statistics are no better than fake news. Just as with the phony unemployment numbers published by our criminal government, and the crime numbers, you have to look at what is behind the data. Medical care in the US is as good as or better than any other Western country when you compare apples to apples.

就像我说的那样，美国是如此糟糕，没人愿意在这里。 如果不是某个特定的群体，那么“人民”在美国A的这里就不会有1/10的问题了……

嘿鲍里斯，

But health is not all about the choice.

Of course not. But I think the point RC (and I) would make is that – that is exactly what a medical system is supposed to be there for. For those things that are out of our control; like my son has Type1 diabetes, which just comes about on its own or childhood leukemia. If that’s all we had to worry about, it would be much more manageable, but our system is being crushed under the weight of people’s poor habits. For instance, my boss used to eat a pint of ice cream everyday before the doctor told him he tested positive for diabetes. At that he point he made a 180 with his life, but many people don’t – they just expect the medicines to do their work for them.

Like my pathologist acquaintance stated; one can of soda a day and you basically have a 50/50 chance of getting diabetes. How many people do that – it’s fairly common.

和平：

I better save $16,000 a year and after 10 or 20 years I will have a lot of money to cover any expenses if bad things happen.

Won’t be enough. The problem is the huge and ridiculous mark-ups on any medical bill. Surviving cancer can easily produce medical bill over 1 milllion dollars even though the insurance may only pay 150,000 of that.

Don’t we love Fred’s “research”? If Canadians are so gung-ho about their medicine, why did the NYT run their article in Jan 2000 about them going south because their hospitals were full, with waiting lists out to five years for some procedures? Why is it that waiting times in Scandinavian doctor offices are STILL out 2-4 weeks after 45 years? Why is it that Fred doesn’t also report how the French government with their socialized care is also going broke?

Fred is haggard enough to remember as I do how much seeing a doctor or a visit to the emergency room cost in this country in the 60s. I had to get glass cleaned out of me and stitched up in a half dozen places from going through a windshield. The emergency room cost was $40 cash–my dad had no insurance. I was able to pay that with only a month’s profit from the paper route I was running. My father was able to cover a doctor’s visit out of pocket in 1968 on a teacher’s salary. No insurance. A year later I was back in the emergency room from another bike accident, and I was able to pay that off in two months on a minimum wage job. No insurance.

Fred, you dead-head, accounting for the dramatic rise in medical costs imposed by lobbying needs to enter your argument, among a great many other factors.

当我在'Nam 的时候我带着M-16。真是一坨屎，没有之一。我渴望使用 AK-47，但我的部队不让我们使用它们。我捕获了一个 RPD，结果是一样的，将其交还。一个 75 发圆鼓，比猪 M-60 轻约 16 磅。当你带着像 XNUMX 这样的垃圾出去巡逻时，那种感觉真恶心。

It is a good thing to motivate people to be healthy through money. But my point is not about that. The problem is that in America you always must think about money even of you have a serious health issue. Before going to the hospital I must think: 1) Have I got an insurance? What if I could not afford it and now have none? 2) Have I paid all the required premiums? 3) Have I got a required sum right now to pay the deductible? What if I have not? Will I be able to pay the bill in the future? 4) What hospitals can I attend? 5) What conditions are covered by my plan? What if my current conditions is not covered, because when I bought my plan I did not expect it to occur? E.g. a sudden acute tooth pain, and you have not bought a dental plan. Etc.

But in countries like Russia you never think about money. Do not understand me wrong, Russia has no way a perfect healthcare, in many ways it is faulty and ineffective. It has been reformed several times during the past 25 years, still the best solution has not been yet found. You must not expect miracles from it. But everybody can rely up on it. Everybody, whether with a job or not, with money or not, has a universal insurance.

Once I had an acute unexpected illness. I had no job at that moment hence I did not pay my medical insurance tax (your Russian employer must deduct around 5% from your wage, where it goes to the universal healthcare fund). But when the illness seemed to be more serious than I thought I did not think for a minute, I just called, they came, they drove me to the hospital, where they were giving me antibiotics for a couple of days. I might remain there for legally required 21 days, but I left when I felt I did not need their help any more. I have never been billed. I never thought that the more I lay, the more I would pay.

I can cite similar cases of the people I know. They got some acute unexpected health issue, they called, then were sent to the hospital, operated or treated, lay in the hospital for 21 days or more and never ever thought if they could afford it. Of course, Russian hospitals are not ideal. For example, the food there is not of a best quality, usually. It is expected that your friends or relatives bring you your own food whatever you want and hospitals do not bother themselves with food preparation. Often you must buy additional medication, but usually it is affordable. Other than that you owe nothing. And remember I’m speaking about Russia, a relatively poor country that has just recovered from one of the worst crises in its history. I cannot imagine how good must be the situation in Germany or Sweden or whatever First World country other than the USA. Never they ever think about money. It is their government who have to think about money, not people. Only in America your money first, your health second. No pay, no way.

The problem is the huge and ridiculous mark-ups on any medical bill. Surviving cancer can easily produce medical bill over 1 milllion dollars even though the insurance may only pay 150,000 of that.

But there are limits you must pay, aren’t they? And no lifetime or yearly limits either, the ACA prohibits that.
http://obamacarefacts.com/health-insurance/out-of-pocket-maximum/
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

I thought you were talking about not having any insurance and just accumulating money in an account for your later medical needs. If you never have any significant bills you would be better off. However one major health scare and you would be wiped out. If you have a spouse, do you want to leave your spouse destitute – unless you cash in on that .357 policy?

感谢您的后续评论……可能超出了我应得的。

就纯粹的质量而言，我同意美国拥有世界上最好的医疗保健系统之一。但为什么（正如其他人指出的那样）一袋 2 美元的盐水溶液会让患者（或其保险公司）花费 800 美元？如今阑尾切除术甚至不需要过夜，为什么平均费用为 33,000 美元？如果几乎每个平均收入或以下的人都被排除在系统之外，那么就无法将其与任何具有全民覆盖的地方进行“同类”比较。

我是加拿大人，我当然不会对我们的医疗保健系统大喊大叫，因为它一团糟。成本（对政府来说，从而间接对我们加拿大人来说）已经失控，因为利润动机仍然存在，营利性公司仍然供应我们的药品、手术工具和设备、诊断设备等。

我不知道可持续的全民医疗保健模式是否可能，但我们当然还没有尝试在加拿大找到一种模式。

I don’t have an answer for the high costs Alfred, but I suspect much of it is caused by government meddling in the market. I know the costs here are high and we subsidize the lower costs in other countries like your Canada.

I am hoping the market remedies and cross state competition that Trump puts together when he gets rid of odumbass care will help with some of those costs.

It costs almost a billion dollars to bring a new drug to market because of the federal regulations and after it is brought to market, practicing doctors often find the drugs have uses outside of their prescribed use, but the drug companies cannot legally promote those uses without going through a entire set of new drug trials. That kind of regulation doesn’t help. Many useful drugs are not allowed to be sold because they have too high a mortality rate, but if you are terminal and have a 70% chance of living an additional 6 years with a drug that has a 30% chance of not helping you at or reducing your life to only 3 additional years which choice would you make? I’m sure most people would want the drug. The government won’t allow that drug on the market so the reality is, you would have no choice at all.

turtle, I’ve publicly offered several times to debate the question of whether group health insurance ought to exist at all. I’ve also offered to speak to the trustees and administrators at my local Podunk Tech, where I’m an insider-observer, on how group health insurance is destructive of Western values. No takers. One-third the board is made up of medical doctors, a medical insurer is a big underwriter of Podunk Tech sports, etc. You get the picture.

The big expansion of group health insurance occurred after WWII-era wage and price controls were lifted. So what is group health insurance? Try politically motivated compulsory charity for wage and salary earners, made respectable because so many people believe it to be compensation. I suspect historians will one day make much of the social psychology and behavioral consequences of insured folks who believed they worked for the total cost of their group health insurance enrollment when it was obvious they were employer-subsidized to the tune of 67%, 75% (a common figure), 90%, and, much rarer these days, 100%.

I agree that insurance is not a very good solution. It should be simply a public service, like the police, libraries, courts, defense, public education, firefighting service, etc. Like the NHS in the UK.

What it definitely should NOT be, is a for-profit business. It’s not something we 消耗.

You can decide whether it’s worth to you to pay $800 for the latest iPhone or $100 for a cheap Android. But if you need an appendectomy – there is no choice. It’s a matter of life and death, you are not calculating the cost/benefit analysis here. The market model doesn’t work, and instead it turns into ‘your wallet or your life’ – a simple robbery.

Mao, agree. BTW-I’m somewhat of a reluctant convert to some sort of a national health scheme. What finally won me over was seeing how America’s Big Medicine routinely used extortionate means to squelch debate, inflict some truly rotten ideas on the public, and not give a damn about the consequences. Our doctors and drug company people are wonderful folks, but they’re political “runaways” who hold enormous, undue political influence. We’ll get some American-style Medicare for All scheme, and probably fairly soon, but it’ll be a political 不可抗力 deal, which is too bad.

I was rather answering to your second sentence. But you seem to be right, the prices are too high, it might not be farsighted and reasonable to save.

I’ve just checked plans at https://www.healthcare.gov/see-plans/ and found out that after all there are many reasonable plans. If you work, you can afford them. If you are poor, you can ask for discounts from the government. I just hope the GOP will not abolish those discounts and out-of-pocket limits. The insurance lobby seems to be very eager to abolish the ACA altogether with the GOP.