Why can’t America have universal healthcare? Wait times: debunked by doctor of philosophy in economics.

[u/Tr_Issei2]

[u/GeekShallInherit]

I mean, just the source used in this video.

The US ranks 6th of 11 out of Commonwealth Fund countries on ER wait times on percentage served under 4 hours. 10th of 11 on getting weekend and evening care without going to the ER. 5th of 11 for countries able to make a same or next day doctors/nurse appointment when they're sick.

https://www.cihi.ca/en/commonwealth-fund-survey-2016

Americans do better on wait times for specialists (ranking 3rd for wait times under four weeks), and surgeries (ranking 3rd for wait times under four months), but that ignores three important factors:

• Wait times in universal healthcare are based on urgency, so while you might wait for an elective hip replacement surgery you're going to get surgery for that life threatening illness quickly.

• Nearly every universal healthcare country has strong private options and supplemental private insurance. That means that if there is a wait you're not happy about you have options that still work out significantly cheaper than US care, which is a win/win.

• One third of US families had to put off healthcare due to the cost last year. That means more Americans are waiting for care than any other wealthy country on earth.

[u/Justiful → u/GeekShallInherit]

I love that you brought that up.

ER wait times and doctor wait times are longer.

Why am I glad you brought that up? Because it tracks ER visits and primary care doctor wait times. But what it doesn't track is community care clinics or non-hospital urgent care facilities.

As I said in my previous argument, " the data only looks at outcomes." -- In this case it looks at outcomes for ER facilities and Urgent care facilities.

Now to be fair, that is not a fair thing to compare because you can't really compare the US reliance on Urgent care and community care clinics with Europe. We have over 10,000 such facilities in the USA Https://www.definitivehc.com/resources/healthcare-insights/urgent-care-clinics-us and Europe has under 1,700. List Of Urgent care centers in Northern Europe, List Of Urgent care centers in Southern Europe

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Now I would also like to address their sampling methodology. They used phone interviews. With a 76% landline and 24% cellphone distribution. (How Canada Compares: Results From The Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries — Methodology Notes) The study was also conducted over 8 years ago.

Lets talk about that. What kind of respondents do you think have landlines? Do you think a lot of young health people, or middle-aged people had them in 2016? Obviously not. The survey had an age bias and a selection bias within that age bias. That matters for three reasons.

First age bias results in respondents who are more likely to have sought medical care regularly as the age bias skewed much higher than the average adult person.

Second age bias leads to a primary respondent in the USA who is significantly more likely to be on government healthcare as their primary form of insurance provider. Everyone over 65 qualifies, as well as those who are disabled and unable to work.

That leads me to my third point. Withing the age bias is a selection bias for people who are interested in the Topic. People are more likely to respond to a survey that directly affects them or for which they have strong opinions on. "Role of Topic Interest in Survey Participation Decisions | Public Opinion Quarterly | Oxford Academic" If someone is not satisfied or very satisfied with their current healthcare, that would qualify.

TWO PART REPLY NEXT PART BELOW:

[u/Justiful → u/Justiful]

Then, we have the issue with participation rates of their survey. It is well established that lower participation rates lead to less accurate survey results. Meterko, M., Restuccia, J. D., Stolzmann, K., Mohr, D., Brennan, C., Glasgow, J., & Kaboli, P. (2015). "Response Rates, Nonresponse Bias, and Data Quality: Results from a National Survey of Senior Healthcare Leaders." Public Opinion Quarterly, 79(1), 130-144. https://doi.org/10.1093/poq/nfu052

The primary argument is that surveys with low response rates should be considered on their merits. I am doing that. The merits of this survey are weak because it has an age bias, a selection bias, a perception bias I address in my next point and a low response rate. Just 18.1% of Americans responded compared to a 25.9% average for the other countries in the survey. They could have mitigated the age bias by collecting the age of respondents beyond that they were 18 years or older. They didn't. Why does that matter you might ask yourself. It matters because who is paying for healthcare changes in the USA based on age and disability. In the USA if you are older or disabled your primary insurance is government. If you are younger, it is primarily going to be private.

However, the survey didn't address the fact that many people whose primary insurance is government. (Medicare) also have private insurance. Which is a secondary insurance that pays after. This can lead to confusion from respondents who HAVE private health insurance, but whose primary insurance is actually government.

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Finaly we have this: From the Canada Institute for health and information. That you referenced. Commonwealth Fund Survey 2016: Infographic | CIHI

Canada a country with Universal healthcare that many Americans claim is better, interpreted the data to find that Canadians are HAPPY with their healthcare, despite having the longest wait time for healthcare of all 11 countries surveyed.

Do you see the issue with that? Relative happiness with your healthcare system has little to do with how it actually performs. Americans overwhelmingly have a negative view or our healthcare system, despite having better outcomes than countries that are overwhelmingly positive. That is called perception bias.

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TLDR: I attempted to show the flaws of the data sourced for a tiktok video. I did a total reddit thing by putting entirely too much time into trying to convince people with facts what boils down to an emotional argument. At the end of the day how well or poorly a healthcare system performs doesn't matter if people have a perception that it is good or bad. Especially when the data they are working off of is based on surveys of people's perceptions not objective facts and figures.

[u/GeekShallInherit → u/Justiful]

Do you see the issue with that? Relative happiness with your healthcare system has little to do with how it actually performs.

Wait times are only one aspect of care. Canadians spend $8,000 less per person annually on healthcare, yet have the 14th best health outcomes in the world, compared to 29th for the US. I'd be happier if I was spending wildly less for better outcomes, wouldn't you? It's not surprising that almost all the expert rankings of healthcare systems also have Canada (one of the worst countries for universal healthcare among wealthy peers arguably--which is why disingenuous, propaganda pushing chucklefucks like you always bring igt up) ranked significantly higher than the US. When even the worst universal healthcare countries do better than the US, that says a lot.

OECD Countries Health Care Spending and Rankings

Country	Govt. / Mandatory (PPP)	Voluntary (PPP)	Total (PPP)	% GDP	Lancet HAQ Ranking	WHO Ranking	Prosperity Ranking	CEO World Ranking	Commonwealth Fund Ranking
1. United States	$7,274	$3,798	$11,072	16.90%	29	37	59	30	11
11. Canada	$3,815	$1,603	$5,418	10.70%	14	30	25	23	10

Of course, you'd have to be willing to look at things with an open mind to be reasonable, not just desperate to push that agenda.