We’ve been very fortunate to always live in areas with access to great medical care. That said, I waited 9 months for a new patient appointment with a dermatologist last year. I could have gotten in sooner if I had something suspicious and now that I’m an “established patient” it shouldn’t be that long but that still seemed crazy long.
I agree that where you live can make a big impact. I’ve heard horrible wait stories from friends in other parts of the country. And some friends in New England have had all their providers move to a private pay/concierge medicine model only.
IMO, having health care as a for profit model is at odds with providing for the common good.
I think the mixture probably works best. There is not a lot of evidence suggesting that pure private pay is more effective, though it can be great for the top tier. Public insurance or public provision can provide better health outcomes at lower cost for the middle tier and especially for the bottom tier compared to the US.
On the other hand, adding a private insurance overlay for the top tier probably enables continued political support from the top of the income distribution who likely have outsized political power.
The flip side of having a private insurance system is that US consumers and companies pay, directly and indirectly, for almost all of the cost of drug development for world pharma and biotech. The other countries typically end up paying a lot less for the same drugs, sometimes getting them a bit later. This is in part because purchasing through hundreds of private insurance companies means that they have little bargaining leverage (and until enactment during the Biden administration, the US Congress blocked Medicare from negotiating like other countries for purchasing drugs). When the US actually changes, either drug development activity will be reduced, we will change the rules for regulating much more targeted drugs so that development costs are lower, or other countries will actually have to pay more for new drugs.
Yep. Other first world countries need to step up, looking at EU, UK, and Japan.
#1 is sadly the most likely scenario. For #2 we haven’t see so far lower development costs for the targeted drugs we do have. #3…why would these countries change their current behaviors? There would have to be reasons for them to do that, not sure reduced drug development would incent this change.
My sense was that the testing requirements (clinical trials) could be designed to be significantly less expensive for targeted drugs if the testing was better tuned to the targeting, but I could be wrong about that. Revising the testing requirements would of course require a rethinking of how we do things, which would be pretty hard politically (and probably new testing requirements would open up new possibilities for lawsuits).
I know a Canadian and American married couple who lived in the US for decades, but chose to move to Canada for retirement, after observing their parents’ experiences with medical and assisted living care in each country.
Even stuff like COVID-19 rapid antigen tests are far more expensive in the US than in the EU. As in $8+ in the US versus under 0.50€ in the EU (and they also can get combo COVID-19+flu+RSV tests for under 3€).
But is not obvious why this is the case, or if it is related to how insurance works.
I am not at all familiar with the UK system. The private sector in Canada is small and varies among provinces. Diagnostic imaging is a common private sector service because wait times for it in the public sector can be extreme, even if you have symptoms.
I wonder what their experiences will be with assisted dying, where the Canadian law (and rapid growth in the number of deaths) seems to be a hotly debated issue. That is of course one way to keep medical costs under control.
We have known two people in the last couple of years who have requested Assisted Death (I know it is called something better or at least more euphemistic) in Canada. The first one was an esteemed doctor who knew that his systems were going and that it wasn’t going to be pretty. The second was a mother of a friend who recalled her husband having stayed on in a near vegetative state for years and decided, given that the end was near, to terminate. I think the family in the second situation was very understanding. In the first situation, it felt a little abrupt (he didn’t talk to anyone about the decision until he’d made it) but it was also probably a good thing.
I’d be in favor of something like that (for elderly folks who are close to death) here. ShawWife and I have joked that we would like to drive off a cliff like Thelma and Louise when we feel it is time to go.
However, the use of assisted death as an option for people who need but don’t qualify for disability services of psychiatric treatment seems morally questionable at best.
Competition level in Silicon Valley has been decreasing. Sutter has been buying up lots of smaller providers. For many, the main choices are between Sutter and Kaiser (Stanford is expensive and not in-network in most insurance plans), and costs (total, including what employers pay for employer-sponsored plans) of non-Kaiser insurance plans appear to be based on Sutter costs (which are significantly higher than Kaiser costs, not that Kaiser is that cheap).
Pharmacies have also become more concentrated and less competitive.
When it comes to generic maintenance drugs available from multiple manufacturers, we stick with tried and trusted. Not all formulations are created equal (even though they are supposed to work as well as the brand name). Pharmacies, in our experience, usually get a generic by a particular manufacturer and stick with it. So a refill will not be a mystery pill.
I chose this pharmacy because they are close to me (no car), deliver for free (I tip the deliverer of course), and I don’t have to go through a ridiculous phone tree to get to talk to someone. What with all my medical issues during the past couple of years, it’s worth tolerating less than ideal open hours especially since the pandemic and possibly a slightly higher cost (but usually not, and that includes nonprescription stuff). They have an old-fashioned scale with a slot for a coin but it’s free. It looks something like this:
Medical Assistance in Dying (MAiD) is not limited to terminally ill patients. People who feel that their “quality of life” is bad can request it. The Quebec health minister recently boasted that since MAiD was introduced the province has saved over C$100,000,000 in health care costs. He later retracted that statement.
While I can see how talking about cost savings of this program can lead to some ethical questions, I really wish the US would legalize assisted suicide in all states. I think in general we focus so much on prolonging life instead of helping alleviate suffering.
