Public Health vs USA Health

I will try not to be tiresome! Here is a brief clear excellent article pointing out the key differences between USA and the most of the rest of the world:

The complex differences in how health care is done all spring from a very simple difference in organizing philosophies. Read the article and let’s talk!

david fb
(long term survivor of everything under the sun from [as Grandma urged me] "Sheer damn cussedness with a smile)


We can easily list a few differences–

Lack of universal health care. Many uninsured.

Over concentration of medical professionals in cities leaving many rural communities with inadequate care or no services nearby.

Closing rural hospitals.

Racism. Whites still get better care, more access, more likely to be paying patient, more likely to afford needed care and medicines. Better treated by the medical community.

What is the solution to this problem?

Your list is excellent, but also highly illustrative in that European doctors are emphatic in telling me that it is not that USA lacks “universal health care” but that the “health care” we use as a model, even if made universally available, would fail from lacking provision of the far more socially focused different older and tradition called "Public Health".

Public Health begins with suppression of epidemics, clean water, sewers (all know of and written about thousands of years ago at the dawn of urban civilization), basic regulation insuring the safety of the food supply (often starting with milk production and supply to infants and children, and then expanding to non-adulteration of foods and safety of perishables such as meats. The USA is now creaky with regard to those but still competent. It is the final layer of modern Public Health where we are a disaster – easily accessible very local public health clinics that take care of the 90% or so of all health issues that are readily treated, and the use of that setting to keep track of problems and potential epidemics and that CRUCIALLY provide the education of the public as to, well, everything that matters.

The USA does not have that. We once did sort of when most factories had clinics, but even that is now almost absent, The most luxurious expansion of Obamacare would fail to make much difference unless we first provide that crucial layer. I jumped on the article about Public Health in Portugal because Portugal is so good at that level.

david fb


I agree. Better delivery of health services would be a major plus. More local clinics would be a step in the right direction.

We know that many of the homeless have mental health issues and many end up in prisons–again with little or no care. We can do better.

Ditto better drug treatment programs. With adequate capacity.

And better prenatal care would save us many problems with childbirth.

These kinds of care are well worth the investment. But where do we get the funds. And do we have sufficent training for staff to fill those positions.

Send more money!!!

1 Like

I was going to post this article, but it was impossible for me not to be snarky. So, good job.

Really and truly stopping the skim of the insurance and “Healthcare” corporations, combined with the actual savings from having “grassroots” early intervention health care, by all evidence, would save more than enough money to fund a sensible public health system.

We once upon a time (late 19th century) were leaders in the world in public health, but then the AMA decided maintaining the wealth and status of its membership was too important to allow that…

david fb


Right on. Ordinary healthcare should be funded at the individual or family level just like food is. Insurance is to transfer risk that the individual or family cannot deal with, not for known recurrent things like getting your teeth cleaned or your annual checkup. Putting insurance as the middleman just increases the cost, the bureaucracy, and nothing good comes from it.

This transfer originated from good intentions, companies offering “benefits” instead of higher take home pay. The outcome was the most expensive healthcare in the Universe with zero benefits to the public. The Healthcare Industrial Complex LOVES IT!!! The Military Industrial Complex Eisenhower worried about is peanuts by comparison.

At the philosophical level, it was one more move to transfer responsibility away from the individual to the machine.

The Captain


Now, are you talking about a publicly funded system of providing medical care…or what you’ve itemized as public health such as was responsible for the successes in disease prevention in the 1800s?

See, Denny’s right in a way. Allowing the insurance industry to control the funding and delivery of medical care the way it has/does (as opposed to taxpayer funded) almost promotes an unequal provision of care…skim and waste aside…that in itself is a barrier that doesn’t exist for Denny and others enjoying a publicly funded, universally accessible system of medical care.

Thing is, when looking closely at Europe or other developed countries and how they finance medical care, you’ll see that they’re all as different from each other as they are from the USA. The really big difference that I’ve experienced as a whole, though, is that there’s a greater feeling of “collectivism” than here in the US. Less of an “us” (The Insured) and “them” (The Uninsured). There are the healthy and the sick. Now, I doubt this is anything to do with being European but rather that other governments are aware that, left to its own devices, its citizenry would be equally self interested as USians in a) how much they paid for their potential, personal medical needs and b) how much they consumed at time of service. So those choices are removed.

Given the discussions we have on Medicare Advantage plans vs trad Medicare, how likely is it that USians would willingly vote for the option that appears to take away their choice in favour of a system of direct/indirect taxation and a nationally based insurance scheme that’s then shared equally with “them” (the Uninsured/those who haven’t contributed/ don’t “believe” in publicly funded services)

This is without even considering how preventable * disease * actually is…even when it’s a preventable disease (spoiler alert: not all expensive-to-treat diseases are preventable)


Insurance is only needed with free market healthcare. Socialized medicine already enjoys the benefit of the law large numbers to distribute risk to all taxpayers.

With a mix of private and socialized medicine plus insurance you have the perfect recipe for waste. You can have private and socialized medicine side by side if you keep them separate. It worked rather well in Venezuela until Chavez screwed it up like everything else he screwed up.

The Captain


One of my nieces is married to a man from Turkey. Although he is a US citizen now, he returns to Turkey for all his major medical or dental care.

1 Like


When healthcare is required to be funded and paid by each individual or family, there is no free market for healthcare.

I am arguing for community clinic centered taxpayer supported Public Health as found throughout most of the developed world and done particularly well in Portugal, but very evident as well in other countries BECAUSE

  1. evidence shows it is the most cost effective way to provide GOOD basic healthcare to most people in most circumstances.
  2. Healthcare is something best NOT left to each individual because health is

a) inherently a HERD phenomenon, others affect me both for good and for ill
b) complicated and most people simply do not know enough to make good decisions for themselves
c) can be provided in a manner the does NOT block options to opt out and do whatever expensive, clever, mad, individual thing a given individual wishes to do by going to an expensive clinic, a coven of witches, or whatever so long as they are carrying and spreading disease…

A lot of my opinions have been formed by having had the most gold platinum and diamond studded health insurance on the planet and seeing it fail me, by being deeply involved in fighting off murderous idiocies during the early years of the AIDS epidemic, and by experiencing excellent compassionate health care in Spain and Mexico provided at extremely low cost.

My MAIN POINT is that most USAians (like the good people populating this excellent Board) are simply ignorant of how an effective compassionate system is organized, paid for, and operates from a completely different pov as to what is possible and how it can be done.

david fb


I’d say not really.

The UK’s NHS (as it was founded…not what it’s descended into) would be a good example to use. Free at time of service, based on need rather than ability to pay, to be used mindfully and the good of the majority (probably not exactly the wording but the general principle) Not, however, everything you want, when you want it etc., so there has always been a private adjunct. The sort of thing that’d make for a bit of covert queue jumping, more convenience (you wait to avoid paying…or pay to avoid waiting), access services that aren’t provided by the NHS etc (cosmetic surgery, liposuction etc). Since the NHS takes care of the serious stuff, these optional add on plans are fairly cheap.


Explain why not.

The Captain

1 Like

Primarily because no one stands equally in the marketplace…either financially or medically. Additionally, as mentioned just a bit upstream, whether you (generic “you”) get sick and how that sickness might be managed is far more dependent on others in the herd/marketplace than most anyone is ever aware of.


Whilst this may be true…the cheapest way to provide medical care, that is…it may not be particularly acceptable across all cultures and all socio economic groups. Depending on what you mean by basic care, that is.

In addition to having been a patient, provider etc within both the UK (first 35 years) and US subsequently, I have friends who’re resident and working in medical systems in other European countries. None of them utilise/work in community clinics but have set ups remarkably similar to the US at primary care level…but for funding, that is.

The same applies to food. Why is food not socialized as well? Why is food an individual responsibility? Why is not EVERYTHING socialized?

It has been tried in many ways from the authoritarian Soviet Union to free kibbutzim and some societies in the US and they all failed.

The Captain


It is not affordable for anyone but the wealthiest. When people are sick, they will pay whatever it costs to get well again. So, they go broke every time they get something they can’t treat themselves.


Free does not mean affordable. Free means no price fixing by government or any other entity such as cartels and monopolies.

Not affordable means that there is something wrong with the system that allows providers to charge extravagant rates. Probably something like cartels that have not been broken up by trust busters. Standard Oil was broken up. Ma Bell was broken up. The Healthcare Industrial Complex needs to be broken up.

The Captain


The definition of the US healthcare system.