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Comment by etaty | Hacker News Reader

Just for fun, same sentence on health care.

> I'm so happy about this. Private health care insure are the scum of the earth. They're totally antithetical to a free society that values human life. They often lobby for minimum health care coverage in law (effectively requiring by law a certain percentage of citizens to be marked as clients). Any profit they skim off the top is money that should be spent on research and education. Next up should be criminalizing charging huge quantities for basic health care by private hospitals and the usurious fees on drugs.

I'd wager $1 in their pockets costs society easily 10X that.

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We detached this subthread from https://news.ycombinator.com/item?id=20955522.

Yes, I'm also in favor of socialized medicine for basically exactly these reasons. Shocker, I know. The system works!

I grew up in socialized medicine, and you get sick, you go to the hospital, they treat you and you leave. There's no step 4. Why Americans continue to willingly subject themselves to these torturous systems is beyond me. It's all in y'alls control.

Because they've been sold lies for years and most of them can't really believe everything they know about such an important aspect of their life is bull.

> Why Americans continue to willingly subject themselves to these torturous systems is beyond me. It's all in y'alls control.

https://www.goodreads.com/work/quotes/2911271-america-and-am...

Because when people talk about how terrible healthcare is here, it's usually people who don't have or can't afford good insurance. And by good, I mean covers most everything and doesn't have a huge out of pocket.

If you have good health insurance, the healthcare in the US is absolutely top tier.

Many people that complain are getting a plan with a huge deductible either because they are being cheap or can't afford better. But I think in a lot of cases it's the former. People just don't prioritize health care. Many would rather trade in their 2 year old car for a brand new one.

Even people with good health insurance find all the paperwork a pain in the ass. I'd far rather have decent, not luxury healthcare and no damn paperwork, when I'm sick I am not interested in dealing with administrative nonsense. The entire health insurance industry is parasitical.

I have never had much paperwork besides a few signatures. And we have had some extensive procedures.

“I’d rather 10 guilty men go free than 1 innocent man behind bars” -some American dude

> Why Americans continue to willingly subject themselves to these torturous systems

They've been told socialized medicine is evil communist plot to steal their hard earned money. Many Americans have not been outside of the states and have no concept of what life in other countries might be like. There's a good percentage of Americans that are completely ignorant of how the rest of the world does things, and also dismiss this as inferior. They've been told their entire life that the US is the greatest country, so, why would we do it any other way?

All of the people I know who are strongly opposed to government run healthcare are veterans. They are people who have spent 4-20 years of their life with government run healthcare.

One guy I knew went to the doctor complaining about blood in his poop. Was prescribed pepto bismal. Went back a few months later. Same thing. Went back a few months later, same thing. This pattern repeated for a little bit over a year. Eventually, he got a colonoscopy. Stage 4 colon cancer. He passed away a few months later.

A friend of mine went to the doctor with a fucked up ankle. Swollen to the size of a grapefruit. They wrapped it and gave him 800mg Motrin. Week later, same thing. Repeat x4. During the last trip, the doctor was giving him the scrip for another bottle of Motrin, when another (higher ranked) doctor recognized him and ordered the junior doctor to do an x ray. The junior doctor protested but did it anyway because it's the military. Fractured ankle. By this point it was mostly healed, so too late to put a cast on it. Fortunately it hadn't healed wrong, so it didn't need to be rebroken.

Vet communities are full of stories like this. And veterans, people who have had government healthcare for years to decades, are the population group most opposed to government run healthcare.

This doesn't necessarily mean government run healthcare is bad; the military is disfunctional in many ways. But your assertion that opposition to government run healthcare is based in ignorance is absolutely, completely false.

> But your assertion that opposition to government run healthcare is based in ignorance is absolutely, completely false.

Socialized medicine is in no way equivalent to the VA system or the issues of the DoD and VA. So if you're using that as an example to disprove ignorance, to me that just proves how ignorant people are. Pointing to the VA as an argument against universal socialized medicine is such an absurd take that I'm not sure how to respond.

If anything, your comment proves my point. Americans are completely ignorant on the basics of the topic to the point where they compare a poorly designed military system as some kind of argument against socialized medicine. The incentives of the VA are so radically different from any national healthcare system. I appreciate the debate.

Can you elaborate on why Tricare and the VA aren't government run healthcare? I define government run healthcare as healthcare that is run by the government.

The fact that it's poorly run is actually the point. Few Americans want to replace their experience at the doctor's office with the experience from the government run Post Office or DMV. The point is that many Americans have relatively little faith in the government to design a good system, and association with government run systems correlates strongly with lack of faith in the government to operate smoothly.

Note that my position, not that it really ought to matter, is as a proponent of universal basic income. Cut everybody in the country a check for $1500 a month, keep the ACA requirements that everyone buys health insurance and that insurance companies can't reject coverage on preexisting conditions, and let the market solve the problem. The problem is that healthcare is too expensive, not that it's bad. The government, for everything it sucks at, is really good at sending a check every month.

> Can you elaborate on why Tricare and the VA aren't government run healthcare

They are in the technical sense that the US govt "runs it". They are not socialized medicine as every Western country has implemented. They hardly have the scale, participation or political pull.

> I define government run healthcare as healthcare that is run by the government.

This is a bit naive, because the VA and DoD have a strong vested interests in short term solutions to keep soldiers going and back on the field. Also, many of the VA's problems stem from the fact that only a small % of Americans actually use the VA and care about its performance. So politically, it's hardly something that anyone focuses on, despite many promises to the contrary.

> experience from the government run Post Office

The post office is actually really efficient and is an example of a very well run government service. They're on par with any private company, easily, in both price and service. If anything, cuts to the post office have hurt it more than any operational problems or mismanagement.

> The point is that many Americans have relatively little faith in the government to design a good system

This is because many Americans actively vote against their best interest and elect politicians whose sole purpose is to hamstring the government from doing anything effectively. It's the classic conservative self fulfilling prophecy: cripple the government, point to the fact that the "government doesn't work", then privatize and reap the rewards. It's just a political game to make rich voters richer.

There is a step 4: pay exorbitant tax rates.

When you remove all private insurance payments for health the US still spends more than other countries. The US government pays huge amounts for healthcare for lousy outcomes.

The problem is that the government is paying for healthcare in the first place.

The private payment seems to be very expensive for not great outcomes.

Can you describe some aspect of US healthcare that you think is good?

I live in a European country with a public health care system. The lowest tax bracket is ~34% and the highest ~44%.

However due to a minimum below which no taxes are paid and other features, the effective rax rate for a $35k salary is ~15%. For a $90k salary it’s about 32%. A median salary is about $70k.

This is excluding pension (the employer pays that on top to a pension fund).

Public services are pretty good and not expensive for me, they are even cheaper for people in lower income levels. (Putting a kid in kindergarten is about $100-200/month for example)

If you take everything into account, I suspect it’s the US system is a much worse deal for everyone except the top 5-10%.

Is there a story of poor people getting bankrupted by taxes anywhere in the world that has socialized healthcare?

Different systems have different problems. In Canada, some people die due to wait times for treatable conditions, or are forced to wait so long that their condition worsens to be beyond repair and they are permanently debilitated. Over 50k people leave Canada per year to get their healthcare in the United States instead.

The trope that wait times are materially worse in single-payer systems is precisely that: a trope. You do not have to dig hard to find examples of wait-times measured in months to get diagnostic procedures scheduled, and where I live — the San Francisco Bay Area — the wait time for an initial consultation with, e.g., a dermatologist has been about the same, for as long as I've lived here. I know doctors who work in hospitals who've had to wait months for a breast cancer scan.

A thing that sucks in both systems can not legitimately be used to argue against only one of them.

That's because California is a terribly run state, and one third of your population is on Medi-Cal. You literally have the same problems as Canada.

Here's me in Washington where I had a severely injured wrist after a car accident, was advised to get PT immediately...

... and had no PT within the county with a <10 week wait time.

I guess we're close to Canada though, so maybe it's contagious?

People wait 6 months or more in Canada.

O...kay?

So, how about all of the not-California parts of the US that have the same kinds of problems (which is, last I checked, more or less "all of them")?

Because, the thing is, only one of my examples was, you know, from California.

That has to be weighed against both the wait times in the US and the amount of people who do not even try to go to the doctor to check out potential treatable conditions. Sure, the wait may (haven't verified) be longer, but I've never heard "can't afford to go to the doctor to check it out" / "don't call an ambulance, I don't have an insurance" from people outside of the US.

So sure, the amount of patients is pretty much guaranteed to be higher once they can afford the care. If you optimise only for wait times, then the obvious solution is to have no doctors and 0 wait time.

Ambulance rides are not socialized in Canada, and people skip going to the doctor for all sorts of reason. Stubborness is not an exclusively American trait.

Yes they are they’re just not free, it’s capped to discourage unnecessary use.

Maybe if you have really great insurance in the US wait times aren't that bad, but the vast majority do not have great insurance, and wait times can still be many months to get in to see a specialist. Generally speaking critical care in Canada is not something you have to wait for. Cancer treatment and surgery, it's when you need it. Wait times for some things may be longer: Hip replacement big the issue isn't acute, for example.

Whether or no wait time varies greatly, the overall quality of care can be assessed in terms of patient outcomes life expectancy which are generally very similar while spending significantly less money. In fact many countries with socialized healthcare actually surpass the US on some factors like infant mortality, in part because the US has a higher poverty rate and those in poverty have less access to healthcare.

> In Canada, some people die due to wait times for treatable conditions

Do you think this doesn't happen in the US?

If you're about to say "but in the US we can pay for healthcare", well that's true everywhere. Anyone with enough money can pay for healthcare.

In Canada, conditions covered by the socialized plans are illegal to be treated by private practice. More than 50k people leave Canada every year to get treatment in the US to either avoid wait times or the government refuses to pay for the procedures.

> More than 50k people leave Canada every year to get treatment

Yes, like I said, anybody who can afford it can travel to get healthcare elsewhere.

Travelling from US to UK and paying 150% of the English tariff price for health care turns out to often be cheaper than getting care in the US, even if you include the travel costs.

[citation needed]

The information is readily available - you could have taken 5 seconds and searched for it yourself instead of leaving a sarcastic unconstructive comment.

https://www.fraserinstitute.org/studies/waiting-your-turn-wa...

The site you link to mentions nothing about deaths nor about people going to the United States for treatment, including in the linked PDFs. Perhaps you could have tried to address the claims made instead of leaving a sarcastic unconstructive comment.

Don't forget that the US's rapid access to all the healthcare the patient wants leads to huge amounts of harm in the form of over-testing, over-diagnosis, and over-treatment.

Are you actually arguing that people wanting too much healthcare is a bad thing?

Yes. It's not just me, it's doctors too.

Take 1000 men over 50 and give them PSA screening for prostate cancer for about 11 years.

Take 1000 different men over 50 and don't give them PSA screening for prostate cancer for about 11 years.

For the group without screening about 7 die from prostate cancer. But for the group who do have screening we see the same number of deaths. The screening hasn't prevented deaths from prostate cancer.

The group without screening didn't have any false alarms and didn't have any needless biopsies. 160 men in the group with screening had false alarms and unnecessary biopsies. 20 men in the screening group had treatment (which can include incontinence and impotence) for non-progressive prostate cancer.

https://www.harding-center.mpg.de/en/fact-boxes/early-detect...

Over-testing leads to over-diagnosis which leads to over treatment, and harm is caused at each step.

Margaret McCartney or Gerd Giggerenzer talk about this.

It absolutely can be. The reason you don’t get colonoscopies until you’re in you’re 40s isn’t because they’re not fun. It’s because the risk of a false positive times the negative consequences thereof outweighs the benefit of you finding something early. People are wierd gooey lumps of random stuff. Scan anyone and you’ll find something out of place. The vast majority is irrelevant until some break even point where it’s not. Hence the recommendations and guidelines.

Just like you could have picked a credible source instead of a libertarian think tank. You are surely aware that the burden of proof for an assertion is on the proponent, not the disputant.

https://en.wikipedia.org/wiki/Fraser_Institute

No, but there are stories of brain drain and capital flight as the wealthy move themselves and other businesses elsewhere to avoid exhorbitant taxes.

Yeah sure.

I once worked in the US and in Canada (Connecticut) in the same year.

My tax rate was lower in Canada for the same salary.

I paid 45% of my income in taxes last year alone.

For comparison in my income bracket:

Ontario income tax rate: 12.16% Canada federal tax rate: 26% Employment Insurance and Social Security are deducted seperately and made up the rest of my deductions.

Connecticut state income tax rate: 5.50% US federal tax: 22%

Unless social security rates are worse than Canada, I don't see how your situation is possible.

Incorrect. Americans spend twice as much for healthcare as other first world countries.

So he's incorrect because you think if we socialize medicine what we spend now will go down?

He’s incorrect because he has misquoted the evidence. Canada’s wait time data is restricted to medically necessary but non-emergent procedures. It is inaccurate to say that millions of people are dying while waiting for treatment. The average wait time for a cancer patient to be seen is 3 weeks. Average. Remember, not everyone with cancer is dying.

I appreciate the value of debate, but i ask that you please do your homework before you start citing the evidence

The US government already spends at least 10k per capita on healthcare - without even having a socialized medecine. More than double that of Canada at 4.8k per capita.

The United States is not a free market healthcare system - it's literally the worst parts of both capitalist and socialized systems with none of the benefits of either.

Also: I am Canadian, I spent nearly 50% of my earned income last year on just taxes. I also live in the most expensive city in the country. 90% of my medical expenses I've had in the past 10 years came from private practices that I paid out of pocket with a smidgen of private insurance that cushioned the blow a bit. The Canadian system is nowhere near as great as ignorant Americans like to believe.

I grew up in Canada, have family there I visit regularly and live in America. The tax rate in California top marginal is higher than Ontario and yet one includes healthcare. You don’t think you can spent 50% of your marginal income on taxes in California? I think with the state taxes no longer deductible it’s closer to 55%. I’ve only ever had great interactions with OHIP.

You couldn't pay me to step foot in California.

Trust me with the amount I make they could.

Ok you have to pay tax but the cost is usually far less than the US system.

I prefer not to have beaureaucrats decide how I spend my money.

I've had a relative with a treatable condition wait so long for a surgery that her condition worsened and it couldn't be fixed and now she is permanently physically disabled.

They do the best they can with the budget they're given.

Private hospitals and health insurance are still allowed. Here in Canada, every public hospital still has a billing department for the uninsured & those with private insurance (foreigners, etc.) (I wonder if you can opt to pay to "skip the queue" here?)

What you're talking (skipping the queue) about is a two-tiered system, which I would be in-favor of but it is taboo to even bring it up in Canada (or at least, that has been my experience).

I'm in the UK and we have private and the NHS along side which kind of works. The NHS can be a bit rubbish in terms of long waits and the like.

This argument is long, long past its expiration date.

While the US by some measurements has a lower overall tax rate than other developed countries [1], the difference between us and, say, Canada, who enjoy high quality socialized health care, is far from "exorbitant".

There's a very reasonable argument for considering all of the consequences of our systematically broken health care system as a "tax" -- it amounts to a massive financial and quality-of-life burden for most Americans.

Health care in the United States is more expensive than in other developed countries for identical procedures [2]. Medical costs are the worst kind of lottery, where an overnight visit for tonsillitis can get you a nice little $100,000 bill [8]. Do you not consider that a tax? Why not?

Medical bills account for 60% of bankruptcies in the US [3]. High medical costs are literally causing people to commit suicide [4] or to die of entirely preventable causes [5] while others just forego care entirely [9]. For those people who do jump through the hoops to get private medical insurance, there are entire bureaucracies dedicated to denying claims [6]. There are so many perverse incentives involved that some doctors are taking it into their own hands to try to lower medication costs, and pharmaceutical companies are responding by tripling the costs of the medication [7].

Meanwhile tons and tons of Americans stay in jobs they don't like just to maintain their employer-sponsored health insurance [10], strangling their wages and preventing positions from being opened up to more enthusiastic employees.

These things are all taxes. They are taxes on American society, impacting all of us. Anybody that's opposed to socialized health care "because muh taxes" is defending this system, this embarrassing, broken, corrupt system that endangers and kills countless people every year and acts as a massive multi-faceted anchor on our economy.

[1]: https://www.taxpolicycenter.org/briefing-book/how-do-us-taxe...

[2]: https://www.washingtonpost.com/news/wonk/wp/2013/03/15/why-a...

[3]: http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bill...

[4]: https://www.reddit.com/r/news/comments/co21rt/elderly_couple... -- linking to Reddit here because there are a lot of comments there worth reading.

[5]: https://www.snopes.com/fact-check/shane-patrick-boyle-died-a...

[6]: https://splinternews.com/a-glimpse-into-the-bureaucratic-hel...

[7]: https://arstechnica.com/science/2018/04/doctors-tried-to-low...

[8]: https://www.reddit.com/r/WTF/comments/ngngy/merry_fucking_ch...

[9]: https://www.fool.com/investing/2017/06/09/sick-of-high-healt...

[10]: https://www.theguardian.com/commentisfree/2017/nov/13/fear-o...

There's a choice component to health. Sure, you can lose the genetic or environmental lottery and just be unhealthy.

Or you can choose to be unhealthy. Smoking, drinking, drugs, poor diet, lack of exercise. These are by far the biggest contributors to healthcare cost and they cost absolutely nothing to prevent. Many people just don't take responsibility for their health, and many others in the US don't like the idea of subsidizing other people's healthcare for preventable or self-inflicted health complications.

edit: I actually do have access to one of the best single payer systems in the world due to dual citizenship. Single-payer is far from the perfect silver bullet everyone likes to sell it as.

I think what you're getting at is that in the US, people have a financial incentive to be healthier due to the cost of health care.

How is that working out? Does the average American eat healthier, do more exercise, consumer fewer drinks, or do fewer drugs?

I actually don't think it's working out. People in general are awful at risk assessment. But, Americans like their choice, even if it means the majority of them will make poor ones.

It's also a downward spiral. The more people are responsible for their own well being, the more they're opposed to "handouts". So those who do take of themselves and do responsibly manage risks I've noticed are the ones more opposed to socialized medicine.

Hm, this is a good point. US provably has the greatest incentive to live healthy due to having the provably highest health care costs. That is a rational and reasonable argument. Yet you get downvoted for it which is interesting. I think you make a good point though.

> many others in the US don't like the idea of subsidizing other people's healthcare for preventable or self-inflicted health complications.

Who cares really?

It costs a bit more to care for people in dollars and cents, but it fosters a better society, which everyone benefits from.

Another case of people wanting to be freeriders.

Apparently enough people care enough. Otherwise this wouldn't be such a contentious debate topic.

Right but it reduces your cost as well, which is why it's so strange. It's cutting off your nose to spite the face.

It doesn't seem to be working. U.S. has obesity epidemic and shorter life expectancy than most countries with socialized healthcare.

This system throws caring-but-unlucky people under the bus.

And even people who really care about their health still have to endure this absolutely bizarre implementation (how can you have an efficient market where prices are secrets or fiction?)

In the USA there are plenty of perfectly normal, educated people, taking care of themselves, eating right, jogging every morning and doing the "right thing" entire life who get literally financially destroyed, savings wiped out, and go bankrupt because of "complicated" illness that is perfectly solvable but "costs a lot" due to the state of medicine in this country.

Why "educated" people in this country still keep voting in the same crooks (dems & reps) is beyond me.

This election cycle is going to be the same thing - this crook or that crook. Pick one that will do less damage. There is no difference anymore. This two party system BS has to go.

But there is a solution to that. Anything that can be easily identified as being the result of someone's own choices they are on the hook for and/or can get insurance for. Yes, these things would have to be enumerated, with some things debated and others refined, but insurance companies didn't seem to have any trouble enumerating what they will or will not cover and this isn't any different. Most if not all of the issues with implementing a system like this will be things that have been done before.

How expensive is health care in the US? IE, in my country dentistry is fully private, and it costs about 100 USD for a teeth cleaning. How much is that in America?

Just a cleaning without x-rays? About $100-300.

Dental isn't really indicative of "how expensive health care is" though. Lots of U.S. dental and vision "insurance" plans are really just mandatory subscription plans since their bills are pretty consistent, and anything that might cost more gets you a referral to a hospital.

It's when you visit a hospital (voluntarily or via emergency ambulance) that you'll start getting the $1,000 - $100,000 bills that'll kill ya.

> It's when you visit a hospital (voluntarily or via emergency ambulance) that you'll start getting the $1,000 - $100,000 bills that'll kill ya.

As a kid I had a 2 day hospital stay for an appendectomy that cost about $1000.

An appendectomy now runs around $100,000. An airlift to the emergency room will also cost around $75,000.

This is a common childhood ailment and is not related to living the so-called sinful lifestyle that people like to bring up as justification for high medical costs.

Dental isn't really indicative of "how expensive health care is" though.

I'm in good health so I don't have much personal data - dentistry is about the only fully privatized healthcare I access.

I would wager just a cleaning without x-rays would rarely exceed $100.

I live in a very expensive California city and it's about $160 for a cleaning with x-rays. And it's not a discount dental shop.

I live in a more affordable US city and go to a small dentistry, I paid $80 cash for my last cleaning and x-rays.

My typical doctors visit costs me $40 out of pocket. My wife, who sees more specialists and physical therapists because of her scoliosis ends up paying about $250/mo in premiums. I have the 'premium' insurance that my employer offers, which means that I'd pay no premiums for inpatient hospital care. My family health plan costs about $240 per bi-weekly paycheck or $6,240 per year. My employer pays a little over $600 per bi-weekly paycheck for my health insurance or $15,600 per year. Even with that and my employer-sponsored long-term disability insurance, I'm sure I'd still probably be permanently bankrupted if I got a disease like cancer.

My wife and I needed prophylactic rabies vaccinations after a bit of an adventure involving a bat in a guest house. Had that happened when we didn't have health insurance it would have cost $38,000 out-of-pocket. Blood-based medicines are expensive everywhere in the world, but I personally think it's completely immoral that we would even entertain a system which would completely sink someone financially over something like that.

OK so you're paying $15600+$6240=$21,840 a year for health insurance. That is a common rate in the US for family coverage.

You also pay $40 for a $100 teeth cleaning, so you're on the Bronze plan that has a 60% coverage and 40% copay. That's the most common plan.

You mention bankruptcy due to cancer. That is true. If you undergo cancer treatment the billed costs can run over $1 million. And you'll have that 40% bronze plan copay. This bankrupts everyone. Those not bankrupted had plans with 10 or 20% copays because they were of the elite class.

Some consider this affordable and reasonable. I don't, and I think you agree.

You mention your rabies vaccine costing $38,000 in the US and this is true. Did you know the rabies vaccine, without insurance, runs around $400 a dose in most of the world? With a 5 shot sequence that comes to about $2,000.

Dentistry is private with some insurance options in the US, and I (in the suburbs of a large city in the Midwest) would have paid about $100 for a teeth cleaning had my dental insurance not paid for it. (My dental insurance is about $25 a month and covers most of major oral surgery if needed. My root canal cost about $350 with insurance recently)

Once in the US, I was quoted $200 for busting a cyst that had developed on my finger due to small cut/infection (this service in my European country is offered for nearly free in any pharmacy).

Instead I went to a Walgreens, bought a pin, a lighter, some ethanol, and a band-aid for like $5, and did it myself...

For each chemo session, our hospital is currently charging around $25k. A complete breast cancer treatment, including surgery and reconstruction, is $500k or so.

This is through insurance. Cash payment is negotiable and possibly much less, but that’s negotiated case per case.

My relative had $1.2 million in "treatment" for lung cancer that made her horrifically ill and miserable in her last months. The 20% copay with great insurance was $240,000, annihilating her modest estate. The "treatment" didn't extend her life, but did make her last moments filled with misery and horror, as the overwhelming majority of so-called "cancer" treatments do. Interestingly she was averse to treatment because she had seen how useless and painful treatment had been to certain previous friends and family. Thus she got the oncologist's solemn assurance that treatments had massively improved and hers would almost certainly be effective and extend her life. Neither of these claims were true and the oncologist knew it.

It's far worse than treatment with leeches. Far far far worse. It's inhumane, oncologist merchants of death are aware they are causing suffering for their own financial gain, and most oncologists have committed severe crimes against humanity by simply practicing their vocation. Oncology for the most part is on par with being a Nazi SS soldier torturing and killing people, only much worse. It's a sadistic enterprise of pseudoscience which harms innocent people for profit. Those that promote it are vile evil people who should be permanently locked away from decent human beings.

> it costs about 100 USD for a teeth cleaning

It's about the same for me in the US, where we also don't have insurance for dentistry in general.

Getting a couple stitches on a Sunday on the other hand last ran me a bit over $7500.

I got stitched at a private clinic for about 1/10th that here. I'm in NZ so salaries are a bit lower but cost of living a bit higher.

$7500 seems well out of whack. What kind of gold were the stitches made of!? Surely it could be done for cheaper than that.

I just realised I am in a private prison.

They key difference is that health care clients want their services.

But while the exact rationale doesn't hold, there are inherent problems on competition and freedom of choice on health care that kinda break capitalism. There is also the rationale that one does want minimum health care coverage in a society, and a market is not able to provide that.

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