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Which Country Has the World’s Best Health Care? by Ezekiel J. Emanuel

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  • Quite interesting.
  • The absence of universal coverage, combined with high deductibles and copays, made it less likely for people with symptoms to seek medical help, thus endangering them and the rest of us.

    This is packed with more than many people acknowledge. High deductibles and high copays render "coverage" useless to many people with health insurance. There is a difference between universal coverage and universal care, something that some ACA supporters seem hesitant to admit.

    On the flip side, absent universal care, many people do fail to seek out medical help thus endangering "the rest of us." Universal means universal; diseases do not discriminate by citizenship. A fact that many Republicans and some Democrats can't seem to deal with.

    As to the different systems...
    See https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html

    They all make tradeoffs between three objectives: (quality of) health, cost, and equity (fairness). Sort of like the engineering tradeoff: you get to choose two: cheap, fast, good.

    Quality of health care: how good are the outcomes (mortality rates, life expectancies, etc.)?

    Equity: do you try to achieve similar outcomes regardless of what makes economic sense? In the interest of helping everyone equally, do you allocate 10% of health expenditures to the last year of life, or do you allocate resources to where they are more effective? (This is not the best example of equity; socioeconomic factors are better, but harder to give as terse examples).

    FWIW here's what the book's author, Emanuel, wrote a quarter century ago about end-of-life cost savings being somewhat illusory:
    https://www.nejm.org/doi/full/10.1056/NEJM199402243300806

    No matter what choices are made, health care is a limited resource. Controlling the number of elective or non-critical procedures via queues is one way to address this fact. Allocating on the ability to pay is another, with the absence of universal care being the extreme case.

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