# The U.S. lacking UHC **URL:** \ **Category:** Factual Questions\ **Created:** [June 29, 2012, 1:47am UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652 "2012-06-29T01:47:22Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [June 29, 2012, 7:14pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/21 "2012-06-29T19:14:01Z")
> [@Novelty\_Bobble](#): > > They do indeed, horrendously complex to account for all contributing variables to those but I’ve yet to see a convincing argument that the US system gives better outcomes for less money. Surely if you were certain your system is better you would be screaming the fact from the top of the roof? > > Ultimately those arguing against healthcare like to shy away from the inconvenient successes of pretty much every other civilised nation and boil it down to ideological roots. > Fine, I understand that and would have more respect for people if they admitted other systems were better but felt the US way was a better ideological fit for them. That is defendable at least but in the real world ideology is not an FDA approved treatment for diabetes or cancer. And yet if you look at life expectancy of individual states, you will see, for instance, that CA has a life expectancy higher than many European countries with UHC. Now why is that? It could be as simple as the fact that we have a lot of Hispanics, and for some reason that we don’t understand, Hispanics have a higher life expectancy than whites. And, of course, blacks have a lower life expectancy than whites, and CA has few blacks as percent of its population than most states in the South and East. Is CA’s health care system better than Norway’s since we have a longer life expectancy? ---
**Author:** ![Ulfreida](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ulfreida/32/8014_2.png) [@Ulfreida](https://boards.straightdope.com/u/Ulfreida)\ **Post date:** [June 29, 2012, 7:27pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/22 "2012-06-29T19:27:20Z")
Simple wealth would account for some of the better health stats from California: it is considerably wealthier than almost any other state. UHC aside, I’d say the biggest reason for the poor health outcomes in the US is income inequality. The vast wealth of the US is extremely unfairly distributed, compared to other developed economies. It isn’t just health care per se. Not only that, but much like the health care issue, most Americans are not merely ignorant but positively mal-informed about income inequality in their country. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [June 29, 2012, 7:36pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/23 "2012-06-29T19:36:35Z")
The Snidely Whiplash in me wants to say that of course all first world countries have UHC, because that would be one of the major determinants in whether a country is first-world or not. A citizen of a first world country, whatever their socioeconomic status, should not have to wait until their thirties and have a Medical Makeover reality show pay for the surgery to get a significant cleft palate deformity corrected. The major difference I think is that the USA is rather unique in being one of the first countries to experience a popular revolution against hereditary/monarchic rule, and doubly unique in not allowing that revolution to deteriorate into chaos and a replacement dictatorship. (like France, Russia, Iran, etc. ) As a result, while other countries, especially first world, have governments usually evolved from their autocratic roots, the USA is stuck in the “every person is their own master” mindset. WHile this has been beneficial in many respects, yieldng the greatest country on earth (IMHO as a foreigner) there is a downside. Ideally, the system should have evolved like, say, Canada, where the states each were forced to follow the lead of best, and like Romneycare, each state implements their own health system. THey’ve done it for public education centuries ago. Why this has not happened for health care? Debate material… UHC is not paadise, but the simplicity boggles the mind - one billing agency, one list of approved procedures and how to get approval for them, one fee schedule, one medical ID card. Things that have happened in Canada - no “extra billing”, i.e. a doctor cannot charge the patient over and above the fee schedule, nor do the same work outside the system if they want to bill inside the system too. Timing is regulated - you can’t bill for 30 “full medical exams” in one hour. ---
**Author:** ![njtt](https://avatars.discourse-cdn.com/v4/letter/n/ecd19e/32.png) [@njtt](https://boards.straightdope.com/u/njtt)\ **Post date:** [June 29, 2012, 7:52pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/24 "2012-06-29T19:52:28Z")
> [@etv78](#): > > Yeah, the notion that CUBA has UHC made my head hurt! Why would it surprise you to find that a Communist country should have UHC? Do you not know what Communism is? I think you will find that the USSR and all the Soviet bloc countries had UHC back when they were Communist (and most still do). Those US opponents of UHC who call it “socialized medicine” are not wrong to do so. (What is wrong, is their implicit assumption that socialized necessarily means bad. An assumption that would not go unchallenged anywhere but in America.) I find it much more surprising that (according to the map) China and Vietnam do _not_ have UHC. (But, of course, China has not really been a Communist country for a long time now, and Vietnam is very poor.) What is surprising about [Cuban health care](http://en.wikipedia.org/wiki/Healthcare_in_Cuba) is not that is universally available (and for free), but that [its quality is almost as good as that as US health care](http://www.photius.com/rankings/healthranks.html) (although I think that is after you average the level of US care for the insured and the uninsured), with longer life expectancies, and it is provided for a tiny fraction of the cost. Cuba even gets wealthy [health care tourists](http://en.wikipedia.org/wiki/Healthcare_in_Cuba#Health_tourism_and_pharmaceutics), mostly rich people from second or third world countries (but also some from some wealthy countries, including the USA) who cannot, however much they pay, buy the same levels of medical care and expertise in their own countries, but who know that they can buy it in Cuba more cheaply than they could in the USA or even Europe. > [@Shosy](#): > > I’m not sure about other countries, let alone most, but it helps that medical school is essentially free, but at the same time you’re required to essentially work for the state and opening a private practice before 10 years is quite curtailed. What country or countries are you talking about? Anyway, this has little to do with my point about the efficiency of UHC systems in comparison to the American system. American doctors may, on the whole, make a bit more money than those in most other countries, but that is not a particularly significant contributory factor toward the excessive cost of American health care, and doctors everywhere make a good living. Also, I don’t think many, if any, countries forbid new doctors from going into private practice (maybe Cuba, I don’t know); it is just that (in UHC systems where the provider doctors do, in effect, work for the state, which is by no means all of them) there is not much of a market for basic levels of medical skill outside the system when everybody can get access to those for free (or they have already paid the insurance premium for them). Once a doctor has acquired sufficient special expertise, experience, and reputation for people to want to specifically see him (or her), then it makes sense for them to go into private practice and sell their premium-level skills and services to those who can afford to pay, and many do. ---
**Author:** ![njtt](https://avatars.discourse-cdn.com/v4/letter/n/ecd19e/32.png) [@njtt](https://boards.straightdope.com/u/njtt)\ **Post date:** [June 29, 2012, 7:57pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/25 "2012-06-29T19:57:50Z")
> [@John\_Mace](#): > > Is CA’s health care system better than Norway’s since we have a longer life expectancy? I think you know the answer to that is a resounding “No,” but thanks for the obfuscation. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [June 29, 2012, 7:58pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/26 "2012-06-29T19:58:07Z")
> [@Ulfreida](#): > > Simple wealth would account for some of the better health stats from California: it is considerably wealthier than almost any other state. How are you measuring wealth, and how does CA stack up per that measure? And how does that metric influence health? > [@njtt](#): > > I think you know the answer to that is a resounding “No,” but thanks for the obfuscation. No, I don’t know the answer. If you think it’s “no” then prove it. ---
**Author:** ![Ulfreida](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ulfreida/32/8014_2.png) [@Ulfreida](https://boards.straightdope.com/u/Ulfreida)\ **Post date:** [June 29, 2012, 8:18pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/27 "2012-06-29T20:18:56Z")
> [@John\_Mace](#): > > How are you measuring wealth, and how does CA stack up per that measure? And how does that metric influence health? > No, I don’t know the answer. If you think it’s “no” then prove it. Well, just sorta scuffling around on the net I managed to find a stat that California was #12 in per capita income (as of 2010 – could have fallen, not likely it went up). It was about 106% of average. I am only guessing how that would affect health outcomes – for example, larger tax base might lead to more state, county, and city programs aimed at improving the health of the poor. Just a better safety net. CA also tends toward the liberal so there might not be as effective conservative resistance to helping the poor via government aid as in some other states. But these are guesses. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [June 29, 2012, 8:50pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/28 "2012-06-29T20:50:59Z")
> [@John\_Mace](#): > > Is CA’s health care system better than Norway’s since we have a longer life expectancy? I’d suggest a good test of how good a system is would be how well it works across its full reach. If you cherry-pick California then you’ll have compare it to a similar area within another country. And then so the same with the worst performing areas as well. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [June 29, 2012, 10:30pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/29 "2012-06-29T22:30:08Z")
> [@Novelty\_Bobble](#): > > I’d suggest a good test of how good a system is would be how well it works across its full reach. > If you cherry-pick California then you’ll have compare it to a similar area within another country. And then so the same with the worst performing areas as well. I didn’t “cherry pick” CA. There are lots of states with high average lifespans. But we don’t have a national health system in the US, so there is no compelling reason to compare the whole of the US with countries which do, especially since the US is so much larger than the other Western Democracies. In fact, CA all by itself is a large administrative unit as compared to your typical European country. ---
**Author:** ![Qin\_Shi\_Huangdi](https://avatars.discourse-cdn.com/v4/letter/q/f04885/32.png) [@Qin\_Shi\_Huangdi](https://boards.straightdope.com/u/Qin_Shi_Huangdi)\ **Post date:** [June 29, 2012, 11:00pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/30 "2012-06-29T23:00:41Z")
I’m surprised the Chinese, the North Koreans, the Vietnamese, and Laostians don’t have UHC-even if its crappy I thought they’d have nominal UHC for ideological reasons. BTW what’s the cost of the UHCs in Iraq and Afghanistan? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [June 29, 2012, 11:41pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/31 "2012-06-29T23:41:44Z")
> [@Qin\_Shi\_Huangdi](#): > > I’m surprised the Chinese, the North Koreans, the Vietnamese, and Laostians don’t have UHC-even if its crappy I thought they’d have nominal UHC for ideological reasons. BTW what’s the cost of the UHCs in Iraq and Afghanistan? My amateur understanding is that China used to have it, then got rid of it, and is now trying to institute a UHC program again. In part because w/o a UHC system (or an elderly age pension) most Chinese save most of their incomes rather than spend them for fear of old age or disease. North Korean can’t even afford corn, let alone healthcare. At least not for anyone but the ruling elite. The Vietnamese are looking into UHC. Not sure about the Laotians. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [June 29, 2012, 11:43pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/32 "2012-06-29T23:43:14Z")
> [@John\_Mace](#): > > I didn’t “cherry pick” CA. There are lots of states with high average lifespans. But we don’t have a national health system in the US, so there is no compelling reason to compare the whole of the US with countries which do, especially since the US is so much larger than the other Western Democracies. In fact, CA all by itself is a large administrative unit as compared to your typical European country. Unless you are able to compare yourself against other systems what compels you to think of your system as good or bad? wouldn’t you want to know? What metrics would it take to convince you that the US approach to healthcare is worse than a UHC system. %coverage? cost per head? overall life expectancy? variance of life expectancy? ---
**Author:** ![Candyman74](https://avatars.discourse-cdn.com/v4/letter/c/ad7895/32.png) [@Candyman74](https://boards.straightdope.com/u/Candyman74)\ **Post date:** [June 30, 2012, 12:21am UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/33 "2012-06-30T00:21:01Z")
> [@John\_Mace](#): > > In fact, CA all by itself is a large administrative unit as compared to your typical European country. What do you consider a typical European country? California may be the most populous US state, but that’s half the size of Germany, France, UK etc. certainly not “large” compared to them. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [June 30, 2012, 1:47am UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/34 "2012-06-30T01:47:11Z")
> [@MrDibble](#): > > Have legislation for UHC in the pipeline, I guess. At least that’s the case with us. Not sure why the US situation technically doesn’t scan as attempting UHC. Wiki has a lot of politics. I’ll point out there are many other “First World” nations that don’t have UHC: Iran, Phillipines Thailand Oman Turkey The definition of “First World” being (at least according to the wiki map) as being part of the Allies during the Cold War: > **[First World](https://en.wikipedia.org/wiki/First_World)** > > The concept of the First World was originally one of the "Three Worlds" formed by the global political landscape of the Cold War, as it grouped together those countries that were aligned with the Western Bloc of the United States. This grouping was directly opposed to the Second World, which similarly grouped together those countries that were aligned with the Eastern Bloc of the Soviet Union. However, after the Cold War ended with the dissolution of the Soviet Union in 1991, the definition large... If we accept a wiki map for one thing then we have to accept a wiki map for another- pending updates. ---
**Author:** ![Mr.Duality](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mr.duality/32/4098_2.png) [@Mr.Duality](https://boards.straightdope.com/u/Mr.Duality)\ **Post date:** [June 30, 2012, 2:27am UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/35 "2012-06-30T02:27:21Z")
> [@DrDeth](#): > > Wiki has a lot of politics. > > I’ll point out there are many other “First World” nations that don’t have UHC: > Iran, > Phillipines > Thailand > Oman > Turkey > > The definition of “First World” being (at least according to the wiki map) as being part of the Allies during the Cold War: > [First World - Wikipedia](http://en.wikipedia.org/wiki/First_World) > > If we accept a wiki map for one thing then we have to accept a wiki map for another- pending updates. Neither Thailand nor the Philippines is 1st world. Your definition of “First World” is ridiculous. In the Phils the legal minimum daily wage is about US$4 and many employed people don’t even get _that._ ---
**Author:** ![Dr.Drake](https://avatars.discourse-cdn.com/v4/letter/d/ad7895/32.png) [@Dr.Drake](https://boards.straightdope.com/u/Dr.Drake)\ **Post date:** [June 30, 2012, 2:31am UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/36 "2012-06-30T02:31:50Z")
> [@Mr.Duality](#): > > Neither Thailand nor the Philippines is 1st world. Your definition of “First World” is ridiculous. > > In the Phils the legal minimum daily wage is about US$4 and many employed people don’t even get _that._ Yes, according to that map, Sweden is a third-world country, and the article itself makes clear that the map represents an older usage of the term, not the contemporary economic / standard-of-living definition. ---
**Author:** ![fumster](https://avatars.discourse-cdn.com/v4/letter/f/e9c0ed/32.png) [@fumster](https://boards.straightdope.com/u/fumster)\ **Post date:** [June 30, 2012, 4:13am UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/37 "2012-06-30T04:13:31Z")
> [@John\_Mace](#): > > I didn’t “cherry pick” CA. There are lots of states with high average lifespans. But we don’t have a national health system in the US, so there is no compelling reason to compare the whole of the US with countries which do, especially since the US is so much larger than the other Western Democracies. In fact, CA all by itself is a large administrative unit as compared to your typical European country. I’m trying to figure out the logic here. We pick the most populous and arguably the most liberal state in the US to show that healthcare is better done at the local level following conservative ideology. Yeah, that makes sense. I’m sure that Mississippi and Alabama, being more conservative and smaller than California must be even better. Norway sucks, Mississippi rules! ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [June 30, 2012, 7:49am UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/38 "2012-06-30T07:49:16Z")
> [@Mr.Duality](#): > > Neither Thailand nor the Philippines is 1st world. Your definition of “First World” is ridiculous. It’s not\* my\* definition. It’s wikipedias. And, if we’re using one wiki map to prove one thing, we should accept another in the same debate. Now certainly, there are other meanings of the term “First World” but none of the others are agreed upon by consensus. ---
**Author:** ![ruadh](https://avatars.discourse-cdn.com/v4/letter/r/d2c977/32.png) [@ruadh](https://boards.straightdope.com/u/ruadh)\ **Post date:** [June 30, 2012, 8:42am UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/39 "2012-06-30T08:42:58Z")
Ireland (south) does not have universal health care at the primary level. For an ordinary GP visit - and we have a gatekeeper system, so you pretty much have to go to your GP for a referral to get specialist care - the patient pays out of pocket unless their income is low enough to qualify them for a medical card. How low is “low enough”? Well, I’m on a trainee’s wage at the moment, which is minimum wage, and I don’t qualify for a medical card. I make too much money. The cost of that GP visit is determined by the GP; the state refuses to regulate it. Mine is one of the cheaper ones - she charges €55 per visit (or about 17.5% of my net weekly wages). This is just the visit itself; prescriptions are on top of that (the state only pays if you spend above €120 per month) and bear in mind Irish medicines are vastly overpriced compared to much of the rest of Europe. “Extras” like blood tests cost another €25 or so. A trip to the emergency room is €100 without a GP referral. Unsurprisingly, there is both anecdotal and research evidence to show that people in this part of Ireland are far less likely to seek medical care when they need to than people from the North who are covered by the NHS. We’ve had discussions about this here before and there are some (mostly American) Dopers who insist that yes, Ireland **does** have universal health care simply because hospital stays are mostly covered. But nobody here seems to think we have universal care - in fact, one of the current coalition government’s campaign promises was to introduce it (we’re still waiting) - and the idea that you have it in a country where a significant segment of the population is priced out of even basic visits to their doctor renders the whole concept meaningless. So, short answer to the OP, “no”. ---
**Author:** ![An\_Gadai](https://avatars.discourse-cdn.com/v4/letter/a/d6d6ee/32.png) [@An\_Gadai](https://boards.straightdope.com/u/An_Gadai)\ **Post date:** [June 30, 2012, 12:18pm UTC](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652/40 "2012-06-30T12:18:30Z")
> [@ruadh](#): > > Ireland (south) does not have universal health care at the primary level. For an ordinary GP visit - and we have a gatekeeper system, so you pretty much have to go to your GP for a referral to get specialist care - the patient pays out of pocket unless their income is low enough to qualify them for a medical card. How low is “low enough”? Well, I’m on a trainee’s wage at the moment, which is minimum wage, and I don’t qualify for a medical card. I make too much money. > > The cost of that GP visit is determined by the GP; the state refuses to regulate it. Mine is one of the cheaper ones - she charges €55 per visit (or about 17.5% of my net weekly wages). This is just the visit itself; prescriptions are on top of that (the state only pays if you spend above €120 per month) and bear in mind Irish medicines are vastly overpriced compared to much of the rest of Europe. “Extras” like blood tests cost another €25 or so. A trip to the emergency room is €100 without a GP referral. > > Unsurprisingly, there is both anecdotal and research evidence to show that people in this part of Ireland are far less likely to seek medical care when they need to than people from the North who are covered by the NHS. > > We’ve had discussions about this here before and there are some (mostly American) Dopers who insist that yes, Ireland **does** have universal health care simply because hospital stays are mostly covered. But nobody here seems to think we have universal care - in fact, one of the current coalition government’s campaign promises was to introduce it (we’re still waiting) - and the idea that you have it in a country where a significant segment of the population is priced out of even basic visits to their doctor renders the whole concept meaningless. > > So, short answer to the OP, “no”. A very good post. It’s a consistent black mark against the republic that we don’t have a better, more inclusive health system. [Previous page](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652.md?page=1) [Next page](https://boards.straightdope.com/t/the-u-s-lacking-uhc/626652.md?page=3)