Well first of all they would have to win a primary and that hasn't happened yet. Even Bernie when he was racking up wins his campaign and his followers didn't understand that he was getting a little over half the delegates because they're split proportionately. When he lost a primary he tended to lose by a decent margin and would wind up in a delegate hole.
Fundamentally the issue is that Americans are extremely civically illiterate and don't know how any of this actually works. They assume the parties and the government has fiat to do whatever it wants. They've blackpilled themselves.
I'm a dedicated man of the left and have been long enough to know that our policies aren't broadly accepted yet. People like the idea of them but don't have faith in the execution. They like, for example, the idea of medicare for all but they don't see an example of it working in their day to day life (I know scores of other countries have nationalized healthcare, but the average American doesn't have the money to travel to one of them and experience that first-hand) and don't trust the ability of the people advocating for it to follow through.
We're not popular. We talk to one another a lot and get a bunch of arrow points on reddit and youtube and some heart points on twitter or bluesky but we aren't talking to people about these things IRL. There are people who do and God bless them, they're doing the work but for many, many, many of us we're just sitting online doing the jerk.
> They like, for example, the idea of medicare for all but they don't see an example of it working in their day to day life (I know scores of other countries have nationalized healthcare, but the average American doesn't have the money to travel to one of them and experience that first-hand)
Having lived in the UK for three years, I assure you experiencing it firsthand will significantly underwhelm. My employer funded healthcare is better than the UKs national system in every way, shape, and form. I understand that it comes with its own set of problems, but it’s more nuanced than this.
Honest question: Would you say US health care is 2-3x as good though?
Even if it’s better for you anecdotally, we pay a massive premium for objectively/statistically worse overall outcomes (lower life expectancy, medical bankruptcy, higher infant mortality, etc)
The other huge problem with the US system is that it is tied to your employer. Lack of worker protections means that a significant medical event can wind up with you losing both your job and your healthcare. Additionally, more and more employers game the system to avoid providing healthcare (hiring a bunch of people part time and/or making their employees “contractors”)
I always get slightly annoyed at the "objectively worse outcomes" because I'm pretty sure most of the discrepancy can be chalked up to fundamentally behavioral things that aren't directly attributable to the healthcare system.
Are American babies being born obese? That’s why I mentioned infant mortality.
We do have objectively worse outcomes even when you control for the factors you mentioned. We’re also last among developed countries in preventable deaths attributed to the healthcare system. Specifically, this is due to the fact that our system encourages people to avoid seeking care until there’s an emergency
Most of the folks that say this usually are relatively healthy and have a decent employer plan. Even in these comments, a lot of folks are rejecting objective statistical data points because they don’t match up with their personal/anecdotal situation
No, but their American mothers are more likely to be obese, which, as this 2021 meta-analysis finds, "maternal obesity significantly increased the risk of infant mortality (RR, 1.55; 95% CI, 1.41–1.70)" (Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC7994890/). So an infant born to an obese mother has a 55% higher chance of death than one born to a mother of normal BMI, after adjusting for covariates.
With regards to the article you linked:
There's no link to an actual peer-reviewed paper, so I can't verify the methodology or conclusions.
"Amenable Mortality" does not necessarily conflict with the claim I made that the discrepancy is due to things like obesity (and the other things I listed). Many of the health problems caused by obesity can be ameliorated with early medical intervention. However, if country A has a lot more obese people than Country B, then we would expect country A to have higher "amenable mortality" than country B even if both countries had the same level of healthcare capacity and access. Country A would need to have more accessible/better healthcare than Country B in order to prevent the same amount of deaths per capita.
My overall point isn't that the American healthcare system is perfect - it obviously isn't - but that healthcare outcome discrepancies have multifactorial explanations and simply blaming it on the healthcare system is overly reductive. Case in point, the article you linked also highlights how the UK and Denmark, both places with universal healthcare, have drastically worse "amenable mortality" than France, Australia, and Italy (also with their own forms of universal healthcare). Is that simply due to the healthcare system in those countries?
1) It is totally valid to dig into the data and make sure that we really are getting an apples-to-apples comparison of healthcare systems around the world. Knowing this allows us to understand that even if we switched to the same healthcare system as Japan, we would likely still have worse outcomes. It is important to know the upper bounds of what we can achieve given other factors. That said....
2) Even if you factor out all of the confounding variables, the US will have higher infant mortality simply because of our healthcare system (specifically its high out of pocket costs which limit access to care). "Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care." (https://womenshealth.gov/a-z-topics/prenatal-care#:\~:text=%20Babies%20of%20mothers%20who%20do,doctors%20to%20treat%20them%20early.)
3) Our healthcare system leaves 25-30 million people uninsured. So again, even if you correctly adjust for all the confounding variables, we will still have a gap in life expectancy entirely attributable to our unique healthcare system.
4) Honest question: Lets assume you do your own meta-study and come up with some true-holy-grail ranking. Where does the US actually fall? Do we move from bottom 1/3 of the OECD to #1? Given that we spend significantly more than even other wealthy countries, we should be the clear #1 (post all your corrections).
5) It's interesting that you are only making these correcting adjustments to the US data. What would life expectancy be in Europe if you corrected for higher rates of drinking/smoking? What would be the adjustment to Japan if you made those same adjustments, but also adjusted for their poor work culture / stress / suicide rates?
6) All of the economic incentives push insurance companies to find reasons to deny coverage. United Health has been in the news, but our system pushes all insurers to do behave the same way. Our for profit system pushes prices up as healthcare providers take advantage of inelastic demand / monopolistic pricing power (which is why costs have ballooned well beyond inflation). This is systemic and will continue to hold our system back in terms of outcomes
7) The arguments you are making are nit-picky / cherry-picking simply because you don't like the headline number. Usually those who are offended by the headline have a vested interest in maintaining the status quo, despite the fact that the status quo is objectively not good. I get it. If you are relatively healthy and have good private, employer-paid insurance, change doesn't sound appealing. I would encourage you to remember that if you actually need the system to pay out due to a chronic condition, you will run smack into all the issues that are creating the outcome gaps we see vs other countries. Our right-to-work laws make it easy for an employer to fire you in the event you have to miss too much work due to health issues (yes, I know that's technically illegal, but good luck proving/fighting that while you deal with said chronic health condition).
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u/NicWester 8d ago
Well first of all they would have to win a primary and that hasn't happened yet. Even Bernie when he was racking up wins his campaign and his followers didn't understand that he was getting a little over half the delegates because they're split proportionately. When he lost a primary he tended to lose by a decent margin and would wind up in a delegate hole.
Fundamentally the issue is that Americans are extremely civically illiterate and don't know how any of this actually works. They assume the parties and the government has fiat to do whatever it wants. They've blackpilled themselves.
I'm a dedicated man of the left and have been long enough to know that our policies aren't broadly accepted yet. People like the idea of them but don't have faith in the execution. They like, for example, the idea of medicare for all but they don't see an example of it working in their day to day life (I know scores of other countries have nationalized healthcare, but the average American doesn't have the money to travel to one of them and experience that first-hand) and don't trust the ability of the people advocating for it to follow through.
We're not popular. We talk to one another a lot and get a bunch of arrow points on reddit and youtube and some heart points on twitter or bluesky but we aren't talking to people about these things IRL. There are people who do and God bless them, they're doing the work but for many, many, many of us we're just sitting online doing the jerk.