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Comment by Someone1234 | Hacker News Reader

I moved from the EU to the US...

Toddler had a seizure (first and last ever). Called 911. $1300 for a 1.5 mile (per Google Maps) ambulance ride to the hospital plus a $300 bill just towards "medical care" for the ride (none actually given).

Then $800 for the ER, and a seperate $400 bill for the doctor (who sent us home after telling us to come back if more occurred but otherwise give child's tylenol and go see the child's pediatrician on Monday).

Did I mention that both the ambulance company and the hospital have a local monopoly? There's no price competition, no choice to be made, nor could there be in a medical emergency.

The problem with all of these is: If it happened again, I'm genuinely going to think "is this an emergency enough to justify a $2K medical bill?" That shouldn't be how medical treatment is decided.

The whole "capitalism will solve it" thing just isn't working. I cannot shop around for medical care, I cannot see prices, and insurance is $1300/month for essentially no benefit (except to turn prices from bonkers to incredibly high).

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Nowhere near as close - I had what I thought was food poisoning and went to the ER. Deeply aware of US ER fees and was already questioning my choice. I go there and was made to wait 30 minutes in excruciating pain. But it got better and I felt good enough that I decided to leave - specifically because I’m scared of the costs. I informed them and left. Did not see the doctor or anyone. Except the nurse who took my weight and height. Got a bill for $1000. Literally for stepping into the ER.

It’a no coincidence that US has such high opioid addiction and homelessness. Even in third world countries these people would have gotten treatment that didn’t bankrupt them.

one reason ERs are so expensive is they are required to provide medical services for people who can't pay. so you are paying a subsidized price. also those fees are negotiable if you are patient and can spend a bunch of time on the phone.

How can a private business be required to perform a public service at its own cost? If the service is public, the public should pay for it; if it's not, each pays his own.

Consider this: a public service is financed by taxes that are proportional to one's income. The way it works now, both a minimum wage worker and Jeff Bezos are asked to pay $1k to walk into a ER, to "subsidize" what is effectively a public service.

In the US you pay just as much as us in the EU from your taxes towards healthcare as well. You are being double dipped for the privilege of having portions of the population not able to afford actual care.

Possibly, on average. Some pay (vastly) more, some less.

I don't see the double-dipping in the math though. EU has populations of people who aren't contributing in taxes much or at all.

We’re talking about total sum per head. Not average.

So saying some people pay less and some more is ignoring the fact that you are actually as a whole paying much more.

It’s arrogantly individualistic to assume that “others might pay more therefore I should continue to support this horrid system”

You're putting words in my mouth, complete with quotation marks. I never said anything about what anyone should do. I didn't even say that on the whole people in the USA pay less.

In the EU, people pay a varying amount (overall a greater fraction of their income) in taxes. In the US, people pay a varying amount (overall a greater fraction of their income) in healthcare. I think these are widely accepted facts.

The US healthcare system has endless problems, I was only commenting on the "double-dipping" part of my parent comment, not writing an essay.

The 'Double dipping' is referring to the average US citizen having to contribute just as much as western europeans from taxes towards healthcare, and then on top of that having to spend just as much privately from personal or employers insurance, and cash. US healthcare costs are about double that of other nations and tax contributions at the same level.

Are you saying that taxes in the US don't vary by income?

I think I misunderstood your original comment. I heard "paying for one's own expenses plus for those who can't afford it" (which is same in the US and the EU), where it seems you mean "paying from taxes plus out of pocket".

My uninformed impression is that in the US one does not pay proportionately the same amount of taxes towards healthcare (maybe you have citations to the contrary?).

I would (only from experience and anecdotes) guess that you're right about it costing double, however.

> My uninformed impression is that in the US one does not pay proportionately the same amount of taxes towards healthcare (maybe you have citations to the contrary?).

Each and every report of US healthcare costs and funding. I'll just grab from the wikipedia article [0] for now.

> Public spending accounts for between 45% and 56.1% of U.S. health care spending.

And one of the pretty handy graphs [1]

Worth noting that this is with a lot of people unable to afford treatment.

[0] https://en.wikipedia.org/wiki/Health_care_finance_in_the_Uni...

[1] https://upload.wikimedia.org/wikipedia/commons/thumb/f/f7/OE...

Edit: Has to be coupled with public spending in other nations to be complete. There is another article related to the graph [2] with another easy to understand graph [3]

[2] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

[3] https://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/OE...

Your citations seem roughly in line with what I said and expected: Americans pay double overall, with a similar dollar amount of public healthcare.

Proportionately speaking, that means Americans are not taxed the same (higher incomes). Interestingly, based on what I'm seeing re: incomes, the /total/ healthcare expenditure is, as a proportion of income, the same between the US and western Europe.

Overall this seems quite unsurprising: healthcare is expensive, the US pays more and the government spreads it around less. Worth noting that health and lifestyle in the US is also "worse" (more cultural than healthcare related).

>people who can't pay

How does it work? Do you need to apply somewhere that and get certified for "cannot pay" status? Do you need to do it before the bill? What if you can pay 1000$ but cannot pay 2500$? What if you can pay but after paying it your life standards lower significantly? What if you have some money and you were about to go to college but an appendix happened and now you cannot affor college?

You just don't pay. They send a bill, you ignore it.

That's about it.

You're imagining this to be more friendly than it is -- "can't pay for emergency medical care" in the US is a euphemism for "got a bill from the hospital, couldn't pay it, so the hospital sold the debt to a collections agency and wrote the account off as a loss", not a reference to a forgiveness program.

Since the hospital takes a loss in those cases (and has to, since they have to treat everyone), everyone else's cost of care goes up to subsidize the loss.

> You're imagining this to be more friendly than it is -- "can't pay for emergency medical care" in the US is a euphemism for "got a bill from the hospital, couldn't pay it, so the hospital sold the debt to a collections agency and wrote the account off as a loss", not a reference to a forgiveness program.

As someone who's family has been in that situation before, not it is not. We had a $35,000 bill forgiven entirely because we couldn't afford it. The process was certainly stressful, distressing, and we shouldn't have a system where it happened in the first place. That doesn't change the fact that the end result was forgiveness.

You can typically try to work out a deal with the billing department which might be a payment plan, cash payment in exchange for a discount (easier to get if you have bad or no insurance), or a combination of both. But once they send it to collections, good luck.

You can negotiate with collections too. If they bought the debt for 5 cents on the dollar (typical) and you make it clear they can accept 50 cents on the dollar or call you for the next 7 years because you just don't care, they may accept.

If the patient is a destitute homeless person they literally cannot pay. The bill can get sent to collections, but it's not like they have an address to collect from, or a good credit score to ruin, so it's uncollectable.

With that theory, the prices would be just as high in countries with mandatory and regulated medical insurance, yet they aren't.

This is a bit of a feedback loop - jack up prices to cover those who can't pay, now more people with bad/no insurance can't afford to pay, rinse and repeat. And it's not just ER prices, the whole medical industry in the US is overpriced - even offices whose patients all have good insurance will still charge large amounts, and of course drug makers still raise prices well after recouping R&D.

This is empirically the least efficient way in the world to systematically handle medical services and payment for them.

The theory is that if the people that couldn’t pay also got lower level services in the first place they wouldn’t be straining the ER rooms.

This is especially a problem in SF with the homeless population. They obviously have no normal healthcare, but the hospital I went to was inundated with them (my own 5 day stay there was billed at over $80k; no surgery).

You know that ERs also provide service to the poor in the civilized world, right? And we don't bankrupt the poor for the privilege of living.

"subsidized price" for heath care is the most horrible and obnoxious shit yet.

That would buy you 5 days of ICU stay in most of the third world countries :)

You can call your doctor's triage line if they have one and they can usually diagnose food poisoning over the phone and call in a prescription if you need one. Otherwise there is urgent care which is cheaper than the ER.

Similar story. Came from Europe to US to go to college. Got a terrible strep throat. Went to the nearest emergency room. Waited for almost an hour. Saw some intern for 10 minutes who prescribed me a codeine pill and later charged me $400. That was in early 2000s money. The funny thing is I already had insurance through the university, but this doctor wasn't "in-network" apparently.

Even if there wasn't a monopoly I can only imagine the insurance company advising clients to use specific hand signals to indicate which network they belong to so the ambulance driver knows where to drive if you're incapacitated and can't speak. "Raise and wiggle three fingers for Blue Cross Blue Shield, and two for Anthem". Or maybe have everyone get tattoos on their arms with their insurance network details.

How did an intern prescribe something to you? That should not be possible. Also, codeine isn't a treatment for strep. They should have given you antibiotics after diagnosing a throat swab.

I was in pain and I guess after checking that my throat wasn't going to close completely he gave me something for the "pain".

> How did an intern prescribe something to you?

He seemed young enough to be intern. I didn't specifically check his age or credentials.

Perhaps a young doctor. :-) They should have advised against you leaving until they did a throat culture. It's rare, but strep can develop into a life threatening condition.

This does not make sense on several levels:

1) strep throat is not an appropriate use of the ER.

2) codeine is not a course of treatment for strep or any other communicable disease. A course of antibiotics is mandatory.

3) strep infection cannot be diagnosed at first sight. Culturing is required.

1) I had no idea what it was, I was just thinking my throat was going to close. They never did a culture. I was sent out in 10-15 minutes after I was seen.

2) I was expecting some antibiotics. But because I said I was in pain they gave me a "pain" pill I guess and sent me on my way.

3) For sure. I was expecting them to do some better diagnostics. Certainly after charging $400 (in early 2000's money, I would probably be more now).

Well my family moved to Germany and this was our experience with German healthcare:

1. Mom goes to doctor because of shoulder pain

2. Doctor prescribes "health spa" (wtf?) to see if the pain will go away. Apparently "spa time" is a common default prescription because the healthcare system is overrun with people that come in with sniffles and aches that go away in a few days?

3. Spa Time does nothing (as predicted); doctor orders xrays

4. Process/analysis/??? is taking forever; in the meantime we have moved back to USA

5. US doctor correctly diagnoses problem same day as initial visit and orders specialized PT that actually helps

> because the healthcare system is overrun with people that come in with sniffles and aches that go away in a few days

I have a family member who's working in ER in a public hospital in France, she told us that there's a lot of people who come in for nothing, often abusing the free ambulance service. And apparently whenever it's raining there's less people coming in, all things being equal.

I'd wager that you just went to an 'allgemeinarzt'... they're doctors for general illnesses, which usually go away within a few days. practically just to get an AU so you can get a few days of paid leave[1].

If you're having an actual issue, you'd have to go to a specialized doctor or a hospital which has the equipment to actually diagnose your issue... such as an xray machine in your case. diagnosis is done right after taking the image, so you'd have had a similar experience if you went to an actual clinic

[1] according to the Finanzamt (german IRS) the average worker takes an additional 12 days of paid leave like that... additional to the normal 20-30 days.

The problem is, there's no price caps on anything, so these profit seeking monopolistic predatory hospitals can charge whatever they want. Medical emergencies are the number 1 cause of bankrupcy in the US. The US spends 19% of GDP on medical with worse service and outcomes. this is more than twice the Euro average.

In the US, you need to be very careful with medical care. You should never ever go to a hospital unless you're absolutely sure that your life is in danger, and even then, you should research your condition first.

Also, don't have kids. The medical insurance premiums in the US are extremely high, if your employer isn't paying for it.

> Medical emergencies are the number 1 cause of bankrupcy in the US.

Nit:

Medical expenses are the top cause, not medical emergencies. Not that this is much better.

What about the 60% of Americans who have health insurance through their employers? The median American spends about $3,000 a year on premiums + out of pocket expenses: https://www.commonwealthfund.org/publications/issue-briefs/2.... That's less than what most would pay in mandatory social insurance taxes in Europe.

> That's less than what most would pay in mandatory social insurance taxes in Europe.

Yeah, it might be. But you also pay that in the US, to the same degree.

Why is it so common to think that US citizens don't pay taxes towards healthcare? They do, and just as much as western europeans. The europeans just don't have to pay those extra $3k. US healthcare costs twice as much per person as healthcare in other western nations.

Same here.. $1300/mo for family of 4. 10k deductible. Another $2k/year for dental.

And then it barely seems to cover any normal stuff.. physical therapy for son, still get $1k bill. Dental work for kids, another $1k.

And you are totally right all it does is make you think "is my kid really doing that bad that I should take him in?". Fuck having to get down to that mentality... I hate it, but it's the reality of the situation I'm in.

If someone is lurking outside our house, we don't think to ourselves.. "Hmm, should I call the police? I don't see a gun, he probably isn't too dangerous.. I'll just wait it out". No, you freakin call the police when you need it and don't have to worry about going bankrupt because of it.

Really sick of this backwards ass country we live in with regards to healthcare. I can afford it.. sort of.. but I have no idea how people below my income deal with day to day medical stuff. It's horrifying.

it's very naive to think that Europeans don't pay for their healthcare. Germans make monthly payments for insurance, etc. Are they that much lower than 1300 a month?

according to posters here, basic insurance is 800 dollars a month. Average net disposable income in Germany is 34K.3 a year http://www.oecdbetterlifeindex.org/countries/germany/

In the US, it's roughly 45K. So, Germans pay less for insurance, but not that much less, considering it as a % of disposable income. And this is for the basic public option. Many Germans pay for private insurance.

They are much lower, think in the 100 to 150 range. And that's without company discounts if you have a job. On top of that, there is a fixed limited amount you have to pay yourself per year if you actually use it, and everything else is covered.

naive calculation from an estimated 8% effective rate[0] says a german family making 60,000 would pay 400/month. Additionally however, no deductibles.

[0] https://www.npr.org/templates/story/story.php?storyId=919714...

Does that include the employer contribution?

But they get much better healthcare for that though.

In Germany you make your monthly payments and if you ever need anything, it is very cheap or free. In the US you make the same payments and still pay thousands whenever you need care.

So what is being paid for in the US? In the German system you pay your money, you get your healthcare, in the US system you pay your money so you get the pleasure of being less over-charged when you need your healthcare?

> In the US you make the same payments and still pay thousands whenever you need care.

That's an exaggeration. You make it sound like a definite whenever you go to the doctor here. That's far from accurate. It can happen, and way too often does, though.

in Germany after tax disposable income is lower than in the US and prices for things are generally the same or higher.

They have Google where I live so we can find out.

https://www.howtogermany.com/pages/healthinsurance.html#gkv

The public opinion which covers you and non working dependants is a reasonable 720 euros or aprox 800 usd or aprox 15% of wages whichever is less.

720 euros a month as a % of after tax income is higher in Germany than 1300 in the US ? also, not clear what that public option covers exactly and how many people buy additional private insurance because public option is inadequate? https://www.handelsblatt.com/today/politics/handelsblatt-exp...

720 euros or 15% whichever is less. As I type I'm paying 38% of my income before taxes in health care related expenses. I'd take the German option in a second.

“If someone is lurking outside our house, we don't think to ourselves.. "Hmm, should I call the police? I don't see a gun, he probably isn't too dangerous.. I'll just wait it out".”

I’d actually just grab my gun and wait it out, assuming I wasn’t already carrying it.

In the US, you only call the cops if someone is likely going to die anyway, and you want a better chance of it not being you or one of your friends.

The current training regimes generally do not emphasize de-escalation. Adrenaline-fueled escalations end up killing people that have not committed capital crimes, and likely never would.

There is, of course, also the possibility that the cops don't show up in a timely fashion, or don't do anything to help you when they do arrive, or even turn their investigation onto you, and that is not independent of cultural background or apparent skin color.

There are reasons for owning and carrying guns in the US beyond hoplophilia.

I agree with your points, however, many Americans do indeed have to think twice about calling the police in that situation and all probably should. Should you call the police because there's someone outside the house and risk them arresting or shooting you? That's a real question for many Americans. Healthcare isn't the only thing that's broken in this backwards ass country, that's for sure.

The US system is worse than "capitalism will solve it." It combines everything that is bad about socialized medicine (regulatory red tape, bureaucratic overhead, slowed advancement, state-enforced moribund monopolies) with everything that is bad about privatized medicine (predatory pricing behavior, regressive cost burden, non-universal coverage).

It's a remarkably bad system, a kind of "pessimum" solution that benefits only insurance companies as far as I can tell. I've also heard that it's run as a kind of jobs program that's designed to employ massive numbers of middle-tier management, clerical, and bureaucratic types.

The US has a lot of these worst possible outcome systems. We seem to like to take all the worst ideas from the left and combine them with all the worst ideas from the right. Another example of the worst ideas of both sides is zoning and urban planning in California.

Yet people blame Obamacare for the prices you just mentioned :).

That . after the smiley is making me go bonkers, lol.

State granted monopolies aren't capitalism. What the US has is literally the worst of capitalism and socialism mixed together in some sort of corrupt, inept, admin heavy hybrid system. It's like pick a team already, but you can't do both; create healthy markets through regulations, or get rid of the markets, but right now the regulations just create incredibly unhealthy markets.

> The whole "capitalism will solve it" thing just isn't working. I cannot shop around for medical care, I cannot see prices, and insurance is $1300/month for essentially no benefit (except to turn prices from bonkers to incredibly high).

Considering that, for the services you mentioned, in the US it is often a government itself sending the rhetorical you those bills, I think it is a bit more complicated than merely blaming capitalism.

Edit: does someone mind telling me why I am wrong?

You're certainly correct it's more complicated than that, so the downvotes aren't due to being wrong. shrug

Healthcare in the US is neither free market nor socialized. It's an absurd mess of both worlds combined into a singular nightmare.

It's essentially the worst of both worlds. Just enough socialism for a selected class of businesses to capture the profits of necessary services. Made worse by the fact that sometimes those "businesses" include local governments.

I didn't downvote you since legitimate opinions shouldn't be downvoted but the reason I think you're wrong is that US is a particularly chronic case of the government serving the needs of capitalism above and beyond the population at large.

It's like saying don't blame Catholicism, blame the Vatican. One is a direct expression of the other.

> I didn't downvote you since legitimate opinions shouldn't be downvoted but the reason I think you're wrong is that US is a particularly chronic case of the government serving the needs of capitalism above and beyond the population at large.

I think it's more a problem of local governments often acting as quasi-capitalist entities themselves. If charging people $1000 for a ride in a fire department ambulance reduces property taxes, why not?

> It's like saying don't blame Catholicism, blame the Vatican. One is a direct expression of the other.

Eh, I don't think that is accurate because the Vatican is Catholicism, not merely an expression of it.

Also, my point was that you can't blame one idea or entity for the state of health care in the US. There are a number of sociological factors that need to be addressed, including but not limited to extreme capitalist beliefs, belief in "rugged individualism", moralism, and xenophobia.

You’re not wrong. However, given the facts that most of the people on HN are from the Bay Area and that Socialism is the soup du jour, the down votes shouldn’t be surprising.

About 10% of HN users are in the Bay Area.

Perceptions of ideological bias on HN are in the eye of the beholder. Opposite ideologues see opposite bias, I assure you.

I think what we've got in the US cannot be described as capitalism either. The market is way too regulated to be a well functioning market. I think we've just got the right mix of capitalism, regulation and complexity for the average consumer to be confused to get the perfect crony capitalism. The US health Care system is a Rube Goldberg machine made out of grifters.

Edit: of course there are great people working in health care, but they get ground to pieces by the grifting machine.

FWIW, according to this list[0], U.S. median household income is about $10k/year higher than Germany.

[0]: https://en.wikipedia.org/wiki/Median_income#Gross_median_hou...

I agree that is outrageous. The problem is that people think it is capitalism. When there is no price transparency, there is no capitalism, period.

Hopefully the US is on the way to government healthcare, but for now it would be great to just achieve price transparency so people can shop around.

Without price there is no competition. Without competition there is no capitalism.

Our current system is completely fueled by legalized price gouging. It's insane how much the medical industry is allowed to exploit these regulations.

No true capitalism.

is this a reference to : https://en.wikipedia.org/wiki/No_true_Scotsman ?

"When there is no price transparency, there is no capitalism, period."

Capitalists are perfectly fine with lack of price transparency or other tricks as long as it makes them money. They don't like competition.

What you are talking about is functioning markets.

There's a lot of equivocation in the term "capitalists". Using the term to mean "people who want to take the capitalist system and turn it into a non-capitalist system that permanently writes their own benefit into it" is, well, I'll go with "not the path to clear thinking about the problem". I'm not comfortable calling it wrong, I mean, such people exist and in quantity, but it's definitely asking for muddled thinking on the topic to call someone deliberately tearing a system apart a name that implies them to be an advocate of that system.

Look at the health system. There are a lot of capitalists who make a lot of money on their capital and don't seem very interested in change because most changes will cost profits. But from a market point of view the system is inefficient and lacks transparency .

Capitalists can mean ideological believers in capitalism, or it can mean those who own capital. The former may be interested in efficient markets; the latter generally only want to maximize returns.

that's why I want a clear distinction between the two. A lot of the second type of capitalist disguise themselves as the first type.

Theories about efficient market/exchange is _liberalism_. Capitalism is an ideology about who own the means of production: in this case, the person who own the capital. When the state OR a "commune" owns the mean of production, this is communism. But you can definitively have a "free market communism", except WTO will probably disagree on whether product issued by a state controlled industry really respect its rules.

You can also the two, like in the nordic countries (or germany) where employee actually have voting power about the strtegic orientation of the company (actually i think employees are considered "owning" 30% of the issued shares or something like that). From a (weird) point of view, this is 70% capitalism, 30% communism.

Both will eventually merge into the same thing, so I struggle to see a real difference.

In a free market, the assumption is that everyone is a rational actor that will work in their own self-interest. People that want to maximize returns are behaving as you'd expect; someone not wanting to maximize profit in a free market would be considered an irrational actor.

Which, well, there lies the problem. For a lot of markets, maximizing profit comes at a very human cost. For healthcare the profit incentive is to have as many barriers to avoid paying individuals as possible because their profiteering is orthogonal to your well-being in most cases.

This is also why many markets can be considered short-sighted because it's easier to make returns now than it is to gamble on long term growth, which results in smash-and-grab style of corporate takeovers.

Ultimately even if we did have price transparency for healthcare all of the issues would still remain. It just can't work as a free market and going further in that direction is just pouring salt on a rotting wound.

No, they do not merge into the same thing. If you already have capital it is to your advantage to create a system where nobody new can compete with those who do - lest someone who doesn't have capital comes along and undercuts you.

Yes, and that was my point. Staunch supporters of capitalism often own capital. A great example is home ownership, which people use as an investment platform. Using your home as an investment platform means you have an interest in maintaining the value of your investment, which leads to things like NIMBYism or voting against measures that might help the city, but devalue your property.

The only way you could possibly maintain free market capitalism is by, ironically, putting in rules preventing people from using the free market in their own rational self interest. Which is why I believe healthcare can't be fixed by making it free-er, simply because the rational self-interest of insurance companies is against that of the insured.

Kenneth Arrow did a great analysis on efficient markets and the US healthcare industry. Basically it doesn't work the way it works in most free markets because of information asymmetry (he got the Nobel for it). Even if you had price transparency, you aren't in a position to decide what treatment to buy because you're not the doctor and don't have the necessary knowledge to make that decision. The whole process is misaligned because the recipient is not knowledgable enough to make the decision, the decision maker (doctor) is not the payor, and the actual payor (insurance) is often neither of those. Efficient markets require certain preconditions to be met to work. It's true in many situations but there are some well known edge cases.

I would welcome a link to the analysis you point if you wish, but this is very reductive.

There are a million markets with information asymmetry and work just fine, and there are plenty of examples of cash-pay systems that work reasonably well for healthcare.

I disagree with OP that the problem is price transparency, but the healthcare market in the us is intervened in ways that prevent the classic workings of a market.

I think you are right but I still think two steps would make the system much saner:

- Price transparency

- One price for the same service. The practice of charging $500 to the insurance but $10000 to the uninsured needs to stop. Maybe it's fine to vary by a few percent but there is no other market where the same product costs 20x more depending on who pays. If the excuse is that this is to compensate for non payers then let's pay for this from a separate pot.

None of this addresses the point- even if you have price transparency and one price for the same service, you are not educated enough to select services you need. Doubly so if an emergency happens.

There are plenty of situations where you know what you need and you could shop for prices if it was possible to get any reliable prices. At a minimum transparency would make it obvious to the public how crazy the pricing practices are.

I agree about emergency situations.

If I go for routine bloodwork do I know exactly what bloodwork to order for, or the codes to request? Do I know when to discern between MRI, Xray, or ultrasound diagnostic? I find this hard to believe.

Often your doctor tells you what tests they want and then you go to some center where they perform the tests. It's pretty predictable in many cases.

"Often your doctor tells you what tests they want"

This is the exact point- you do not have the education to shop because you don't even know what you need to be shopping for.

> "is this an emergency enough to justify a $2K medical bill?"

Yep, that's how you think about medical problems as an American. Get used to it.

not being able to see prices ahead of time is probably the biggest problem... but it also stinks that with or without insurance, you appear to pay about the same total cost.

> The whole "capitalism will solve it" thing just isn't working.

There's no capitalism in US health care system - you alluded to it yourself with lack of price transparency example. The key issue is medical cartel with AMA at the core who lobby hard to restrict supply of physicians as well as narrow scope of practice for everybody else. As a result you have people having to go through a gatekeeping 500k-a-year dermatologist to get a prescription for $250 creams which you can buy over the counter in the UK for 10 pounds.

Nobody really talks about medical cartel in politics because doctors are popular with average Joe - unlike insurance and drug companies.

> There's no capitalism in US health care system - you alluded to it yourself with lack of price transparency example.

This is true.

> The key issue is medical cartel with AMA at the core,

The AMA has basically zero power over any of the issues you describe.

> AMA lobbies hard to restrict supply of physicians as well as narrow scope of practice for everybody else.

No, the number of physicians is limited by the number of residency programs, which is determined by how much funding there is. Residency programs are not self-sustaining, so they're funded by Medicare.

> As a result you have people having to go through a gatekeeping 500k-a-year dermatologist

Most physicians take home a lot less than you'd think. The gross salary is misleading, because physicians also have high licensing, insurance, equipment, and continuing education costs. The gross pay does not take these expenses into account, and furthermore, these expenses are typically not tax-deductible for most physicians.

It varies heavily by region and specialty, but the average (not top - average) physician in a city like New York or San Francisco actually has a lower take-home pay than a mid-level FAANG engineer[0] in either city.

[0] e.g. an L4 engineer at Google.

"It varies heavily by region and specialty, but the average (not top - average) physician in a city like New York or San Francisco actually has a lower take-home pay than a mid-level FAANG engineer in either city. "

That's a pretty high bar though.

> That's a pretty high bar though.

Depends on what your reference point is. I think most people on HN would be surprised to learn that their doctor likely makes less take-home pay than the second-lowest level of engineer - L4, "SWE III" - at Google.

“Capitalism will solve it” is not at fault here. What you’re describing is crony capitalism. It sounds as if your local politicians are not doing a great job at creating TRUE competition along with a TRUE free market. In other words your local monopoly should not even exist it should be broken up.

I’m of the opinion that is how we should assess medical treatment, by cost. People get a ton of unnecessary treatment. Depending where you live $2k for a hospital trip via an ambulance may also be fair. Think about how many people saw your son, drove you, the bed he took. In SF a bed in a hotel is $400 - $500. That’s just a bed, not anything else.

Your take home salary in the U.S. is typically 80% after tax (effective tax rate). In the EU it’s closer to 50% (or less). It’s much more expensive in the EU just not all at one time. That’s perception.

I do think we should have competition though and open pricing. Can’t decide to do something or not unless pricing is clear.

Also if you are upset about medicinal costs be upset at the medical schools. They limit the number of doctors intentionally to inflate salaries.

You're wrong.

Can you please stop posting unsubstantive comments to Hacker News? If someone is wrong, it's great to provide correct information in a factual way. If you can't or don't want to do that, it's fine to post nothing.

https://news.ycombinator.com/newsguidelines.html

>In the EU it’s closer to 50% (or less) It’s much more expensive in the EU just not all at one time

Not really, procedures and the drugs themselves are much cheaper as they are usually negotiated on a national level. Personnel salaries are also not that high. If everything is cheaper you cannot argue that the total cost is higher.

The personal salaries is really messed up because of they are barely graduating more doctors now than the 90’s that’s an intentional inflation of salaries.

Comparing a hospital stay with a pricy hotel stay is deceptive. The 2 types of services are by no means related. It's an utterly meaningless comparison.

Having seen a seizure I would definitely call an ambulance if my kid had one for the first time.

Since you picked SF let's talk about that. You may take home 80% but then you pay state income tax, sales tax, real estate taxes etc.

In SF you are more apt to be paying 40% than 20 in total.

Then your premiums for health insurance for a family. The average family pays 5,714 in premiums not including actual health care costs.

Then you have to consider the situation of those who are less fortunate. In Europe it's a slide down a slope. Here it's a drop off a cliff.

US government spending is 38% (2018) resulting in a net tax rate of you guessed it 38%.

UK government with it’s well known free public healthcare and similar culture spends an excessive 38.5% (2018).

PS: Government debt has the net effect of increasing the cost of government spending over time, which somewhat underestimates these figures.

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