• Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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What do you think about the Dutch health care system? info here:

Mike O'Connor

In my post, I mention how hard it is for those of us who read only in the english language to acquire sufficient insight into the health care systems of the non-english speaking world to have an informed opinion. I have no opinion about how the dutch system operates. I would be reluctant to base an opinion on a single document, especially if I have no other insight into the landscape of that world.

As I ponder this, I think back to how utopian the portrayal of Soviet, Communist Chinese, and even Cuban health care systems have been, and how completely discordant the propaganda was with the reality in each of those instances. A free press is not sufficient to have the necessary window into such systems. An ability to critically and independently evaluate the information they disseminate is crucial to understanding the reality of what is happening. If your only source of information is the system itself, you are at their mercy for information. You might have suspicions, but you won't have facts. You'll be able to speculate, but you won't have the necessary context for an informed opinion. In evaluating various sources, it is incredibly helpful to both be in the business and to know people who have worked in these places: it's otherwise difficult or impossible for outsiders to form calibrated opinions.

Similarly, I would not condemn any system on the basis of one unfavorable report, or even a collection of them, while I was otherwise uncalibrated about such a system. So, for example, if my only source of information about either the US or Cuban health care system was a recent 'documentary' about them, I would be reluctant to use it, and the publicity associated with it, as the basis for an opinion. Importantly, you need to read the details of these reports, not just the summaries that are published in the lay press. One recent ranking of health care systems rated the US quite poorly - primarily because it is not a nationalized system (and the murder rate here is high).

Such stuff (reports of bad events) can provoke you to wonder what is indeed going on. The BBC article about the recent problems in Japan is sufficient to make me wonder. I am too ignorant of their system to have an informed opinion or criticize.

Medical Tourism

Portugal is a booming market as well.

Ronald Cray

Most of the industrialized nations with national healthcare have higher life expectancies, lower infant mortality rates and lower obesity than the U.S. Not propaganda, fact. If our healthcare system is so much better than their nationalized systems, why is that?

Mike O'Connor

The short answer is that I don't know, and frankly, neither does anyone else.

1. Obesity. The rest of the world seems to be catching up. Why is there an epidemic of obesity in the USA? There is a massive literature that confronts this question, with many invoking greed, avarice, unchecked desire. Others allege that food is cheap, the US is wealthy, and its citizens are increasingly sedentary. There is little or no evidence that health care can prevent or reduce obesity (unless you count gastric bypass).
2. Infant mortality. Ditto. We know much less about this than most health care experts would like us to believe. A few interesting references:

3. Life expectancy. The citizens of wealthy countries have longer life expectancies. Why? Well, no one knows. Citizens of countries with private health care or a patchwork of health care (e.g. Switzerland, USA) have life expectancies comparable to those of countries with completely socialized health care. Socialized medicine may provide outstanding care to the poor, but does not seem to dramatically improve life expectancy. Be clear: even if socialized health care did nothing to improve life expectancy, that alone would not constitute strong evidence against it (it still offers a lot of apparent social good). Life expectancy, like all of the other examples you chose, is more tied to the overall wealth of a society than the nature of its health care system.

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