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Comment by TheSpiceIsLife | Hacker News Reader

Why aren’t US citizens queuing up to emigrate?

At this stage, it seems like the US is the “land of the free”, whereby “freedom” is defined as the ability to freely exploit everyone.

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Emigration is hard, and emigrating somewhere remotely decent is even harder (because everyone wants to do the same thing as you). I’d also wager that the people who truly need to leave have the least means to do so. Getting into Canada or Western Europe requires at least a college degree, and probably being in a sought-after field. And by that point, you’re probably doing okay in America (for now). I mean, I live comfortably, although even good insurance and a high salary isn’t a guarantee that you’ll be okay. I’ve thought of moving, but the difficulty (logistically and psychology) and the fact that I really am comfortable make it unrealistic at the moment.

I agree, though, the masses are exploited (us included), and it’s troubling.

most are still stuck in the loyalty type mentality buffered by things like patriotism and national anthems and flags for any event with >5 people and a TV camera.

50 years ago people had the same loyalty towards their companies, and look where that got US manufacturing workers. nowadays you'd be nuts to expect to stick with a company for 10 years. get yours and get out: others be damned.

so it shall be with citizenship. as more and more citizens have more and more power to up and leave, or work outside the confines of the US without too much hassle, questions such as "what on earth are we still doing here?" will be asked, at first in whispers (as they are now), later in louder volumes.

where things go from there, anyone knows.

Last time I went to the ER I got an itemized bill in a week for $300 or so.

All medical imaging I've had done has had pricing given up front showing what they where going to bill the insurance company and what the insurance company was going to pay and what I'd have to pay.

My non-emergency visits have a $40 copay up front.

Only the nightmare cases get talked about.

Which metrics do you measure, optimize for your web services? P90 & P99?

Why would health care be any different?

Conjecture is silly when there's good data to be had.

The number one cause of bankruptcy in the United States:

> "medical expenses"[0]

The average amount charged for an ER visit in the United States:

> between 2008 and 2017, the average price of hospital ER visits rose 135 percent, from $393 to $924[1]

The cost of an ambulance ride in the United States:

> $164/mile[2]

And make sure to compound the monetary cost with the cost of people avoiding medical care out of fear and unknowns surrounding the actual monetary cost.

[0] take your pick of any study done by anyone

[1] https://www.beckershospitalreview.com/finance/average-cost-o...

[2] https://www.consumerreports.org/consumerist/164-per-mile-sur...

ER visits at 924 are still far below the stories in this thread of 4-5 digit $ visits for simple issues.

The OOP is still averaging under 300, again, not the horror stories in this thread.

Problems exist, but it seems that only a small % of providers are horribly abusing the system.

(of course a small % across over 300 million people is still a lot of harm!)

USD 900 for an ER visit is a horror story too. Where does someone without savings get that kind of money from? At least it seems difficult for many: https://money.cnn.com/2018/05/22/pf/emergency-expenses-house...

I don't live in the US and I'm not American so perhaps I'm missing some information.

It needs to be fixed, but a $900 average that includes $200 charges for a $25 "medical boot" and charges for a $30 bandaid sounds like it may be not too hard to reduce costs across the entire board.

If the average ER visit was 5K of unknown miscellaneous charges than that would indicate nationwide maliciousness on the part of nearly all hospitals. If only a small # of hospitals are engaging in that level of unfair billing, then they can possibly be investigated one by one.

It is the same thing as "we have thousands servers that are crashing at random multiple times a day" versus "we have a bunch of servers that are low on RAM, and a couple servers that crash 5 times a day."

Neither scenario is good to be in, but it is possible to get a hand on the latter scenario, while in the first scenario a "burn it all down and rewrite" fix might be appropriate.

For one, probably because these stories are the exception? I know a bunch of people will probably tell me I'm wrong and I might be (haven't used the US health system in a 3 or 4 years since I moved out) but for most people their insurance just covers it (or medicade if they're old).

Otherwise most people don't want to leave their friends and family

Note: not defending the horrible system. Only suggesting that most people using their company provided insurance probably don't run into these issues.

Company provided insurance, only cost us $5k to have a healthy pregnancy followed by a healthy baby, with no special circumstances. This was the usual “negotiated” cost. Why not print $2mil for a yearly wellness check while you’re at it, and then give a generous 1.9mil discount? The whole system is absolutely positively bonkers. How much of my premium is going to professional negotiators for insurance, and how much of my hospital costs are going to professional negotiators for hospitals?

Not much. Your premium is going towards paying for the $1M NICU cases where it takes extreme interventions and the $1M/month hemophilia patients. Even a population of a small state like Iowa can have problems distributing costs like that.

https://www.desmoinesregister.com/story/news/health/2017/05/...

I think distributing the costs is entirely reasonable; warranted, even. That is, after all, why insurance works at all. Distributing the cost by inflating receipts is, no matter how altruistic or “necessary” you may think it to be, a fraud.

I'm a lifelong patient. I currently have great coverage.

I don't know how it's possible, but our healthcare system has been getting worse every year. Even simple stuff like refilling scripts has become Kafka Meets Keystone Kops. The insurer has interjected itself into every single transaction, second guessing everything, adding ever more hoops to jump thru.

It's a wonder that we even bother with doctors any more, since the insurers apparently know better than my doctors.

Things are so bad, I wouldn't even know where to start if anyone wanted to fix things.

Better to just start over.

Because most of these stories are extremes. All my friends' pregnancies and major surgeries came with some hefty "residual" bills, but all got negotiated down or tossed. If you stand up to them they'll back off. About 80-90% of America has insurance that is "ok" and will keep you from going bankrupt. It's not as bad overall (big picture) as the anecdotes portray. Don't forget there are 340 million people in the USA (1% is still 3.4 million people, plenty of room there for stories to arise). It still really sucks and we need price controls and public option for insurance though. Also fear of the unknown, leaving your family behind, other countries in general don't like Americans unless you bring a few million dollars with you, other countries seem to have a very high barrier to foreigners working there, etc get in the way.

At least what we know is that currently the flow of migration is reversed with a lot of European countries. Many countries like all the northern countries, Netherlands, Switzerland, or even Spain have more Americans moving than their own citizen settling in the US.

Seriously thinking about it.

I am also a British citizen, so I'm at least waiting to see how this whole Brexit thing shakes out.

Australia has the largest British ex pat population: https://en.wikipedia.org/wiki/British_diaspora#Institute_for...

If you're considering somewhere in the EU other than Britain or Ireland, you should probably aim to be registered as resident before 31 October.

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