Comment by HSO | Hacker News Reader

Comment by HSO | Hacker News Reader

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> The 40h a day week and modern-day work contracts come as a direct evolution of medieval servitude, with little modification.

Well, in Europe it is more the estate system and urban manufactures, I think, that have influenced the culture of work. In the US, you have something much worse even. I found this recent article eye-opening for me:

[1] M. Desmond. In order to understand the brutality of american capitalism, you have to start on the plantation. New York Times Magazine, Aug 18 2019.

web: https://www.nytimes.com/interactive/2019/08/14/magazine/slav...

> a desperate need for people to continuously prove the need for their own role, as automation and informatization eat away more an more jobs.

While I agree with this (go @AndrewYang! ;), I don't think it is the only (or even the biggest) factor. It is the long shadow of WWII and the resulting demographic imbalance coupled with a self-serving but fundamentally wrong narrative around "economic growth". This has led to what some have called "the big institutional lie" where throughout society you have institutions that rely on promises of advancement or necessity to lure the fresh blood but that can not keep these promises to all of them. It's basically a pyramid scheme. Peter Turchin pointed to this as a contributing factor to polarization as the educated "elite" of such countries/societies must increasingly fight among itself for the increasingly rare places or resources (relatively speaking). → revolutionary potential

>"the big institutional lie”

The big lie is all the lavish promises people made to their future selves. Expensive medical treatments (Medicare), retirement funds (social security/pension payments), expensive infrastructure (constant access to clean water/electricity/gas/sewage/etc).

Maybe the biggest lie is pretending to be able to predict the future. All those aforementioned promises require future resources, population, growth, technological advances, all of which are just guesses as to what will be available in the future.

> Expensive medical treatments

Again. Universal healthcare solved that in Europe.

It is expensive, but it's a shared cost that benefits everybody.

> Maybe the biggest lie is pretending to be able to predict the future

Maybe, but back then they didn't have the means to care for more than a few days at a time, to think about the future.

If they could have done it, they would have done it.

I guess my comment was specific to the US, but pay in the medical field is vastly lower in Europe than in the US. Regardless, Europe is still subject to the biggest factor, which are demographic changes and they will have an impact on the availability of future benefits. I would say these past 20 years and maybe next 10 will have been the peak, and then there will be visible cuts in services or quality of services due to lack of people (and/or taxes) to service the debt.

It's not by any means solved in Europe. // Swede

Compared to the system in the US it is. How did one researcher put it? "Every healthcare system has its flaws, but the US somehow manages to have all of them."

Compared to the US it is. Obviously there are going to be ongoing problems in any large undertaking, but Sweden pays half the cost for healthcare per capita. A 50% discount for equal quality care. Americans like myself are getting absolutely screwed in terms of the cost of healthcare.

Well, you're right!

It's not entirely solved yet, we still have to die sometimes...

> Universal healthcare solved that in Europe.

As a person which lives in Russia and Germany, I'm really interested in what you mean by solved?

Universal healthcare in Russia is a total mess. Universal healthcare (edit: in Germany) have a lot of problems too, of which the most significant is underpayment, low salaries, and such a lack of personnel, that CDU people did really suggest to use conscription to draw the free workforce.

The very flaw of positive rights is that you can't guarantee them, since they cost money. If you have no money, your positive rights end there. Yet people still believe that one could guarantee such rights.

I am Russian, and Russia is a total mess, full stop. To address positive rights - societies don't just "run out" of money. As has been repeated a million times, a country with a sovereign currency is not run like a household budget. And the "right to clean water" is rather useful in making sure we don't have outbreaks of the plague and other fun stuff

> First, societies don't just run out of money.

Social programs do. Price goes up due to natural reasons, budget goes down due to natural reasons, your government can't provide a service anymore.

The most common example is social security, the pension system. Demography changed, age of retirement goes up, payments go down, and you can't do anything about it.

Sure, the governments try to deflate the price, but there are no miracles, and artificial price deflation causes deficit, for example a deficit of medical personnel or scarcity of a service.

Money is a proxy for power. That power comes from the ability to trust the government issuing the money and the people the government represents (i.e. the country). You can claim the right to clean water all you want, but unless you fund infrastructure development, and have access to aquifers or fresh water lakes, it doesn't matter how much money a government issues. Similarly, if a country isn't producing enough children to support the elderly, it doesn't quite matter if they've been promised nursing homes.

See Zimbabwe and Venezuela.

To address positive rights - societies don't just "run out" of money. As has been repeated a million times, a country with a sovereign currency is not run like a household budget.

Sure, a country with a sovereign currency can create as much currency as they wish. They can never "run out" of money, literally. Practically, though, creating more currency doesn't result in more products being made and services being performed. Most countries are aiming for their currency to hold its real value relatively steady in accord with its nominal value, and you cannot do that if you create more money whenever you "run out" of it. So yes, countries cannot "run out" of money literally, but practically they can and do.

My favorite subject.

First, I'm not sure if you're aware, but the price of a procedure in the US is not necessarily related to its cost. There's been several news articles showing the same procedure can cost 100x more in one hospital vs the other in the same city. Hospitals literally pull prices out their ass and justify it by saying "no one pays that price". Then they bludgeon people with these completely fictitious numbers when insurance doesn't play ball.

What you're also failing to realize is the US does have a universal health care system, it's just really shitty and inefficient: its called the emergency room. Doctors can't just leave people to die if they can't pay.

Stories from the great US paid healthcare system:

When my wife had to get her gall bladder removed. The hospital charged us $25k for 1 hour use of the surgery room, and $20k for 1 hour use of the recovery room. It took insurance almost a year to resolve, and in the meantime both sides kept bothering us. Hospital told us not to worry though because things usually get resolved once both sides start threatening eachother with lawsuits. I asked what happens if insurance still doesn't pay it, and they said that the hospital usually writes it off. Sounds GREAT!

The above was on top of ~10k other general hospital bills, plus 3.6k anesthesiologist, 25k surgeon, and a couple k in post operation followup. Total charged price for one of the most common operations in the country: about 85k. Completely sustainable.

In another instance, we needed something done that we thought wasn't covered by insurance. When trying to figure out what the price would be, it took several weeks worth of phone calls, and tens of hours on the phone to figure out with our local hospital what it would cost. Then when we got there, someone said it didn't include something. But it was OK because insurance covered the whole thing for various reasons. We said OK. They were wrong though, insurance still didn't cover it. This is important because medical places usually have an "insurance price" and a "cash price", and we got screwed out of the cash price by going through insurance.

We also had a close friend deliver her own baby in a hospital hallway and get charged $30k for the delivery.

My sister was charged $1.2k for the removal of a cotton ball from her ear while waiting in a line.

My brother had a $5k ambulance ride.

I always think twice before interacting with the healthcare system in the US.

Do you have any idea how absolutely crazy these numbers sound over here in Europe?

The legal maximum out of pocket cost for a calendar year for in network providers (providers who agree to a price with your insurance company) is $13.5k. You should budget at least that much for a childbirth in the US (in case of complications such as C sections and other common issues after birth), if you can manage to plan your child being born between ~May to Oct, as you can then likely have all your expenses be in one year, otherwise another year's out of pocket maximum will come into play.

Could you elaborate how anything of this is relevant to what I wrote?

The point was that you can't guarantee positive rights, since positive rights require some commitment.

>Stories from the great US paid healthcare system

Did I said it is great? Why you emphasize "paid" when any healthcare system is paid?

Your services are flawed in a typical American way, i.e. overregulated crony mess where all the burden lies on an avg Joe since he has no leverage on a political system while lobbyists do.

I bet my head that if you implement a universal healthcare, you would end up in a mess like that which Russia have, rather than something more decent.

I had a friend who had an appendix removed, the bill was $80K, similar to what you quoted. He didn't have insurance, however, so he haggled on the bill. Eventually they settled and accepted $8K, or 10% of the sticker price, for the procedure. I don't know how insurance companies settle these things behind the scenes, but I imagine many are overpaying and we're all paying the cost through higher insurance prices.

Insurance companies have zero incentive for real procedure prices to ever be listed; they provide 'value' both in terms of their negotiation services and in terms of pointing to how expensive getting anything done is.

However the true result is presented to wall street: If the insurance company is making more than a very meager profit we're getting screwed out of what should be universal affordable care.

It means that in Europe universal healthcare is almost a solved problem, according to WHO (World Health Organization) 6 out of the first 10 and 16 out of the first 20 highest ranked healthcare systems are in Europe.

source: https://www.who.int/healthinfo/paper30.pdf

>20 highest ranked healthcare systems are in Europe.

It's not a rank, it's a (bad) efficiency metric, which says that Ukrainian and Kazakhstan HC is "more efficient" than Russian, and that Chilean HC is "more efficient" than that of Denmark.

If you assume this metric shows what's better, it's safe to assume that this metric is garbage. To lazy to dive into the methodology, they weight the date using avg schooling years and other vague staff, but the results rendering this paper totally unsound.

Comparing different countries using a single "performance" metric is nearly always garbage, since all sorts of important nuances are being omitted.

> It's not a rank, it's a (bad) efficiency metric, which says that Ukrainian and Kazakhstan HC is "more efficient" than Russian, and that Chilean HC is "more efficient" than that of Denmark.

They are, according to the World health Organization.

Ukrainian healthcare system is more efficient than Russian because you don't have remote regions that have very little or no chances of being reached in case of emergency.

Chile and Denmark are basically at the same level, it shouldn't be a surprise that many South American countries rank at the same level of some western countries.

If you look at the ranking created by other entities, it's more or less the same, even though they used different metrics.

You will always find mostly European countries in the top 20s.

Italy and France really are among the best in the World when it's about healthcare.

USA really is shitty, even though they have the highest spending per capita.

The methodology is well explained, there's an entire chapter explaining it, they are not 'Comparing different countries using a single "performance"', your rebuttal is rebutted.

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