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Comment by janekm | Hacker News Reader

I think the article could have benefited from some info on the efforts the Shenzhen government has been making on addressing the concerns raised, including setting up the Hong Kong University Hospital in Shenzhen branch and the giant "Qianhai Shenzhen-Hong Kong Modern Service Industry Cooperation Zone", a free trade area in Shenzhen with corporate law based on Hong Kong's and very attractive tax benefits.

Whether that's enough to assuage Hong Kong'ers cynicism is a different matter, of course ;)

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A thing about healthcare in China: while it is expensive on average, some serious interventions can be up to 20 times cheaper (cancer surgeries, complex fractures and soft tissue trauma, etc.) Emergency medicine is priced predatory though, in bigger cities, appendicitis can cost you $15k+.

I myself don't understand American obsession with healthcare, they are free to go anywhere in the world, and it will be cheaper for you than back home.

I don’t have numbers handy, but IIRC a startling number of Americans have never left the country. It’s prohibitively expensive and simply out of reach for many (most?) people.

Flying domestic in the US is crazy expensive when compared with budget airlines in Europe, where (if you look out for it) you can get a flight from London to Rome for £40.

International from/to the US is pretty much the same as everyone else in the world pays. This is based on my experience paying for and flying to 32 countries, many more than once.

My understanding about why Amercians don't fly international is the same as the UK used to be - not many even have a passport, and even less have an interest in cultures other than their own. For these last two comments I have no data, only hearsay.

>Flying domestic in the US is crazy expensive when compared with budget airlines in Europe, where (if you look out for it) you can get a flight from London to Rome for £40.

Its $60 for EWR-ATL and I didn't even look hard. $260 EWR-SFO and that's a 5 hour flight.

And KEWR-KATL is 650 nm direct and EGLL-LIRF is slightly over 780 nm. People forget how big the US is. Some states can really be considered separate countries by european standards.

Here's a map to illustrate the point.

https://www.reddit.com/r/MapPorn/comments/8fscnh/european_st...

I don't think it's necessarily that we have less interest in cultures besides our own, it's more that we usually plan vacations around wanting to see something, like a national monument, or do something, like party at Mardi Gras. Combine that mindset with the fact that the USA is so big, and there isn't much of a reason to ever leave the country because you'll never be able to see everything it has to offer, plus you don't have to pay to fly across the ocean. And yeah, I personally don't know anyone with a passport, it seems pretty rare here. I think one reason might be because of our neighboring countries. Until a couple of years ago, Canada didn't require a passport or visa when crossing our border, and Mexican border towns have been viewed as unsafe for as long as I can remember, so people didn't really go to Mexico except by cruise ships.

It was more than 10 years ago that all changed. Not only that, US immigration officers even had personal discretion to let us in without proof of citizenship at all, and I'm pretty sure it was the same going North. Sucks how things are now, it just seems unnecessary to me.

>people didn't really go to Mexico except by cruise ships.

Cancun has always been a popular destination.

Note that it costs $145 to get a U.S. passport now

Amortized that's only $14.50/year, and renewals cost less.

When you can travel freely in an area basically the size of continental Europe without a passport, having one is not generally seen as a baseline requirement for being a regular person. This is a major change in mentality from many places where countries are smaller and crossing them not a rare event.

There might be a minor distinction to be made between having a no interest in other cultures and having £1500 lying around to fly to London.

> There might be a minor distinction to be made between having a no interest in other cultures and having £1500 lying around to fly to London.

1500? Easily doable for 500/600 return with some planning.

I get those values when searching MIA-London in Google flights, doable with other cities as well

San Francisco to London can easily run $2000 coach. That said, you're absolutely right! It's always possible to find a way to get around for much less than typical full price, and you are very correct to note this.

However, is it perhaps possible that the precise numbers might not be particularly relevant to the point? It's still at least an order of magnitude more than the cheap flight, for two major destination cities about as far apart and Detroit and Dallas.

Trying randomly for Detroit to Dallas vs Detroit to London on Oct 1 it was £51 vs £133 single. The London routing involved changing in Reykjavik though.

For anyone curious how that ~$170 USD fare is possible, it's WOW airlines and doesn't even include an overhead bin. It's great that WOW exists as an option, but it's hardly standard.

For example, from St. Louis, the cheapest round trip is in the ~$900 USD range.

The lack of overhead bins makes me go WOW.

If you live on the east coast you can get a discount flight to London for only $200 round trip. When these sales come up a group of my friends grabs tickets and go together, it's become a tradition.

You don't need a passport (as a European) to travel within the EU either.

That used to be true but countries started checking again since the latest refugee crisis. Austria / Italy. Austria / Germany you definitely get checked if you travel by train and sometimes car.

I think that discounts the vast area, number of landmarks and tourist attractions, and multitude of different sub-cultures inside the US itself. When you can drive somewhere new and interesting in a few hours, and don't need any paperwork or currency exchange and don't have to worry about the language, that's much more appealing than expensive and time-consuming overseas flights.

All of that save the language is true for the EU as well.

Domestic flights in the US are relatively cheap if you're flying between two international airports. Cheap, as in less than $120.

> My understanding about why Amercians don't fly international is the same as the UK used to be - not many even have a passport, and even less have an interest in cultures other than their own.

There's a much simpler reason: the US is unbelievably large compared to European countries. The US equivalent to a London-Rome trip would be Washington, DC-Miami. Another example I give is that I used to live in Urbana-Champaign, which is "near" Chicago, which is roughly commensurate to saying that Paris is "near" Brussels.

And of course, the sheer size of the US also includes a massive diversity of climates and environments. The Florida Keys, North Carolina's Outer Banks, the Great Lakes, badlands in the Dakotas, Yellowstone, the Shenandoah Valley, Maine wilderness, Utah's canyons, Nevada's salt flats, San Diego--all of these places are completely different from one another. Not to mention we have our own Caribbean islands (US Virgin Islands, Puerto Rico), subarctic wilderness (northern Alaska), and Pacific paradises (Hawaii, American Samoa, Guam, Northern Marianas).

In Europe, distances are much shorter, and they have a different taxation regime. This I think is the bulk of the issue.

> It’s prohibitively expensive

I understand they may think it is, but it's not. And certainly cheaper than having to pay for healthcare back in America for any serious intervention.

There are a lot of Americans who never set foot outside their own state.

That's simply not true. Most americans have traveled outside of their own state. Like 90% of americans. And the 10% who haven't are mostly young children.

The best estimate I can find for that is around 10%, which is also about the same percentage of people who have never left the UK.

How is it startling? Some people don't care to leave the country? So what if it's not their thing? Not everyone cares to travel and even if you do, there is a million places to travel within the US, you'll never get bored, there is always something new to see. Why does it bother you that people enjoy doing different things than you in their free time?

It's not cost prohibited, discount airlines like Norwegian Air and Air Lingus run non-stop flights from the East coast to Europe for $100-$300. Flights to the Caribbean are not more expensive than domestic flights.

Cost prohibitive is relative.

Flying anywhere is cost prohibitive for a lot of families in the US. Buying 4 or 5 airline tickets gets expensive fast, even on low-cost airlines. The median family vacation in the US is probably a car trip to a destination within 4-5 hours of where the family lives.

This isn't as relevant for people without families, but many of them tend to be early in their career, so money and vacation time are bigger constraints.

Not buying it.

Median family income in households with children in the US is ~$80,000/year, mean is ~$100,500/year[1]. That's enough to afford $1,000 in airline tickets if you wanted to. Millions of people fly to kid-centric destinations like Orlando, Florida a year, and Orlando is incredibly cheap to fly to. It also amazes me how many people bring children on cruises and they even have kid centric cruises. The cost to fly is also at a historic low.[2][3] I see routes I took 10 years ago not increase in price since then.

Most people I know are not "travel people" and wouldn't take a "travel vacation" if it was free, so they are not buying airline tickets. Just cuz they aren't buying airline tickets doesn't mean that can't afford them if they wanted to.

My point was, if you're going to get onto an airplane it doesn't have to cost you significantly more to travel to a foreign country. Also traveling abroad isn't exactly something one "should" do, some people just don't want to.

[1] https://www.census.gov/data/tables/time-series/demo/income-p...

[2] https://www.cntraveler.com/story/average-domestic-airfares-n...

[3] https://sfgate.com/chris-mcginnis/article/Hawaii-South-Afric...

> Some people don't care to leave the country? So what if it's not their thing?

It leads to an uneducated populace, ignorant of other cultures and with a very limited perspective of world affairs.

People's understanding of the world becomes limited to what you hear from the state department and the news media.

Makes it easy to drop bombs on people a world away if you never bothered to get to know the people or places you're destroying.

Oh, c'mon...

You can learn about foreign affairs and become educated without visiting other counties, it's not a requirement. You'll learn more in books than you'll learn drinking a margarita in Cancun resort.

Visiting other countries doesn't, by definition, lead to learning about foreign affairs and becoming educated of other cultures. I studied abroad and some of my fellow study abroad students didn't develop any understanding of foreign affairs or enlightenment about culture.

No place that has been bombed lately are where tourists will travel to.

> It’s prohibitively expensive and simply out of reach for many (most?) people.

No it isn't. It's just that we have a huge country stretching from the western pacific ( guam, hawaii, etc ) to the arctic (alaska ) to the caribbean ( puerto rico ). We have a variety of cultures, regions, natural wonders and peoples than any country in the world.

Most americans can afford to travel overseas. But we have so many options within the US and its more convenient. Traveling from NYC to hawaii is far more impressive than traveling from NYC to London. And we have the grand canyon, mount denali, yosemite, yellowstone, florida, mount rushmore, new orleans, texas, chicago, endless list of places to visit. Most people, not just americans ) would explore their own nation first and then see the rest of the world.

It's generally europeans who brag about traveling and yet they mostly travel between tiny european countries. What's so impressive about someone in luxembourg traveling to france, germany and belgium in an afternoon? It isn't that impressive. But they could claim to have traveled to 3 countries even though those countries are pretty much the same as luxembourg.

To put this into perspective, the distance from moscow to berlin is 1100 miles. The distance from NYC to LA is 2700 miles. We just have a lot more land, lot more culture, lot more places to visit.

"We just have a lot more land, lot more culture"

LOL. You know the difference between America and yoghurt, right?

Sure do. And I know we have a lot more diverse culture than say sweden or spain or any european country.

Maine to NYC to new orleans to texas to california to the midwest to las vegas and throw in puerto rico, alaska and hawaii.

Feel free to show me another country that can match the diversity of peoples, cultures and land that the US has. LOL. Show me another country with the grand canyon, rocky mountains, yosemite, yellow stone park, etc.

I love people who laugh at american culture and yet watch our movies, tv shows, listen to our music, etc. So thumb your nose at us while listening to rock n roll, jazz, hip hop, techno, etc and watching game of thrones, friends, southpark, etc.

I gave an honest answer to why americans don't travel to foreign countries as much. It's because the US is the size of a continent. We have a lot of things to see here. We can literally travel thousands of miles and still be in the same country. In europe, you can drive through 3 countries in an hour.

Health insurance in China is often flipped compared to how it works in the rest of the world, and definitely America. Instead of having a deductible, you have a benefit cap ($100k for the policy I got working for Microsoft). So the routine stuff winds up being very cheap to free, and the catastrophic stuff will bankrupt you. Well, not really, since Chinese hospitals will ask you to prepay your treatment, so bankruptcy isn’t an option.

This is how the USA was pre-ACA (but without the prepay requirement). The benefit caps were called lifetime maximums and were generally much higher dollar amounts. Still, they were low enough to bankrupt the average family if someone had a major catastrophe.

But that person would be alive. Also certain assets are protected in bankruptcy. https://money.howstuffworks.com/personal-finance/debt-manage...

The cost of any serious surgery needs to be weighed against the quality of the work and I would never go for the cheapest guy in some foreign country to cut me open.

Frontline, I think, once found that, while there are very good doctors all over the world, when you walk into any hospital in the USA, at least, odds are the doctor in front of you is very good but the odds of that happening in other parts of the world is far lower.

> odds are the doctor in front of you is very good but the odds of that happening in other parts of the world is far lower.

No, there is also a large bellcurve in terms of treatment outcomes back in the US between choosing the best in one's field and going to any hospital. That's not unique to international medicine at all.

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