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Comment by dcolkitt | Hacker News Reader

Your hypothesis does not hold up to the data. The unemployed in Canada experience the same penalty in life satisfaction as the unemployed in the United States:

> On average, the unemployed experience lower life satisfaction than the employed by about 0.3 standard deviations in Canada and the United States, by 0.32 standard deviations in the United Kingdom and by 0.47 standard deviations in Germany.[1]

Your claims relies on the assumption that unemployment in Canada is more tolerable than unemployment in the US. Yet large-scale surveys do not reflect that for the average jobseeker.

Therefore we can conclude that higher unemployment in Canada vis-a-vis the US is almost certainly driven by a lower supply of jobs, rather than as you posit a lower demand for employment. The same also holds true for the major Western European economies surveyed.

[1] https://www150.statcan.gc.ca/n1/pub/11f0019m/11f0019m2018408...

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> Your hypothesis does not hold up to the data.

Your data is not relevant to the hypothesis. The surveys were conducted in different time-frames (Canada: 2009-2014, USA 2005-2010), which I shouldn't need to tell anyone why that dataset is not useful for rigorous comparison, but I will anyway: one surveys people who were just recently hit by a recession and tracks them throughout the economy's recovery; while the other surveys people who recently experienced massive economic growth (exuberance) and tracks them throughout their economy crashing. Both, Canda's and the USA's, economies were intertwined during the 2007-2009 financial crisis, and this should be accounted for -- but it isn't.

Furthermore, the data DOES hold up to the GP's assertion: that as the unemployment rate goes up, the gap in life satisfaction between employed and unemployed approaches zero (chart 2). That is, 20% nationwide unemployment, unemployed and employed Canadians have the same life satisfaction (chart 1).

Lastly, this is social sciences. We cannot conclude anything from the data without experimentation. At best, this data is observational reason to pursue deeper inquiry, at worst it's idealogical fodder to drive other people's agends by lying with statistics. Everyone does it. Statistics don't really mean anything on their own, and lay-people give them too much weight!

Not to mention that people's personal moods do not necessarily reflect the quality of their material position.

Your comment seems unnecessarily dismissive and misses the point.

The parent argues that Americans disproportionately boast about their unemployment figures compared to Canadians despite US unemployment carrying an exponentially greater risk of causing financial ruin due to medical expenses.

You dismissed his comment outright by citing that self-reported stress levels of unemployed Canadians and Americans are about the same, although this is at best tangentially related.

I'm guessing your data is comparing satisfaction of employed (nationality) to unemployed (same nationality).

If so, all it says is that unemployment sucks and fails to really compare across borders. I've seen some stuff that indicates American parents are some of the most stressed out and dissatisfied parents on the planet due to our lack of family-friendly policies, including but not limited to our sucky healthcare policies.

Health care is not tied to employment in Canada, for one.

Heath insurance is a benefit offered by some US employers as an alternative form of compensation. Employers get discounted rates because of how many customers they bring to the insurer and they pocket some of those savings while passing the rest on to the employees.

You can get health insurance without having a job. It's expensive, but it's not like it's cheap through employers. Just cheaper.

Health care - at least, treatment for life-threatening emergencies - is a right protected by the Emergency Medical Treatment and Active Labor Act in the US.

You can't get treatment for life-threatening "conditions". You can only get treatment for life-threatening "emergencies". You got a tumor? Good fucking luck. You got a seizure because of your tumor? Come on in and we'll make sure to send you an absurd bill later.

Yep. And I don't see it being fixed in the US, because the anti-single-payer crowd erroneously believes that US healthcare exists under a "free market". In truth, the budget per capita for healthcare in the states is actually _higher_ than in Canada. So Americans pay more for a lot less.

It turns out a few turn-your-head-and-coughs in your 30s is a way better deal than waiting for it to become a trip to the ER in your 50s.

From a profit standpoint, the health industry (providers, not payers) have every incentive to delay care for chronic conditions until they can't get away with not doing it. Once a patient is sick enough, more resources and justification tends to be thrown against the insurers to pressure them to pay up, no matter the cost. One might recall Michael Moore's infamous protests for a dramatic example of this.

I know multiple poor people that had their cancers cured without cost to themselves, no "emergency" required. The reality isn't as bleak as you are making it.

The US has the highest cancer survival rate in the world, which would not be possible if poorer populations were not having their cancers proactively treated.

On the one hand, good for them and it would be nice if you elucidated whatever you know about how they pulled this off.

On the other hand, it's basically dismissive of a very real problem here. I read a lot about homelessness. I've seen far too many people indicate they are homeless in part because they have cancer and it's ruining them financially.

America is hardly some utopia where we take wonderful care of all our people, regardless of ability to pay.

General surgeon in the South here. What I've seen is that uninsured individuals will prolong going to the doctor for symptoms because of cost and that sometimes costs them their lives because of the advanced presentation of their disease. On the other hand, once you get diagnosed with cancer in South Carolina, you automatically qualify for Medicaid so that you receive some treatment.

This way, you die with treatment and our system does not seem cruel. Even advanced, expensive chemotherapy is paid for, sometimes exceeding hundreds of thousands of dollars.

The Affordable Care Act provides subsidies for health insurance based on income, not assets. If you're diagnosed with cancer and lose your job (because chemo is tough), and have assets, pay the Cobra until next sign up period. Sell all assets and invest to make about $20-$30k a year. Your premiums will be low and you'll have access to quality care. Move near large academic institutions because they do medicaid / bad insurance care. This way you minimally touch assets.

Rich people hate the Affordable Care Act because they don't get subsidies on premiums, which are about $3500 / month for a family now, and they have to pay 4.8% Medicare tax on all income over $250k . So, in essence, someone that makes $1m a year pays $78k/year in health care costs.

Lastly, I take care of a Pizza Hut delivery person who gets his insurance through the Affordable Care Act and only pays $40 / month for it, because of the subsidies.

Thank you.

Just for clarity's sake:

Medicare is a health insurance program for all citizens of U.S. whereas Medicaid is health coverage for low income group and people with disabilities.

Medicare is federal-supported program and Medicaid is a joint program by the state and the federal government. As such the eligibility and coverage for Medicaid vary from state to state.

https://www.differencebetween.com/difference-between-medicar...

> The US has the highest cancer survival rate in the world

The US isn’t bad in that respect, but according to Wikipedia, this statement isn’t even true for the subset of countries on their list: https://en.m.wikipedia.org/wiki/List_of_countries_by_quality...

That only looks at three cancers. The oncology literature tracks survival rates across all cancer incidence, in which the US consistently comes out on top. Only a few other countries, such as Switzerland, are close.

It is attributable almost entirely to more aggressive (and expensive) diagnostics combined with many new cancer therapies being available in the US years before they trickle down to the rest of the world.

> The US has the highest cancer survival rate in the world

No it doesn't.

But even if it was true (and it isn't) you should also specify which type of cancer.

No country gets every type of cancer better than any other.

For example if we consider stomach cancer, South Korea is on top with 57.90% survival rate, USA is 30 points lower at 29.10%

> which would not be possible if poorer populations were not having their cancers proactively treated

It wouldn't also be possible if rich people couldn't get the same treatments other countries have developed by traveling abroad or having them for cheap in Mexico, Bolivia, Venezuela.

But to put it in another way: take breast cancer, where USA leads the charts with 88.87% survival rate.

According to the sources "About 1 in 8 U.S. women (about 12%) will develop invasive breast cancer over the course of her lifetime."

In Italy, where I come from, we measure breast cancer as patients over 100,000 women, not in %.

"Breast cancer is the leading tumor among women in Italy ... The incidence per age group was estimated to exceed 100 new cases every 100,000 women ≥ 40 years of age"

100 over 100,000 is one in a thousands or 0,1%, which is 120 times better than U.S. 12%.

It means that every 120 women that develop breast cancer in USA there is only one Italian woman in the same condition.

That's what really an universal health care system make possible: to not develop the diseases.

You are cherrypicking, and conflating incidence (demographics) with survival rates (medical outcomes). The survival rate across all cancers in the US is around 70%. In the UK (since I work there and have the number handy), it is around 55%, which is a significant improvement for the UK in recent years.

Cancer incidence rates are primarily the product of genetics and environment, which is why it varies across countries. It has little to do with access to healthcare. Stanford hospital has given state-of-the-art treatment for both liver and stomach cancer for free to poor members of my family.

> Cancer incidence rates are primarily the product of genetics and environment

I'm sorry, but that's not how it works.

For example only 1 in 4 breast cancers are attributed globally to risk factors (i.e genetics or environment)? [1]

Since you're bringing it up, I know a things or two about cancer, my father worked in health care, in pulmonary oncology, my mother worked in health care too, in infective diseases, most of my family is tied to Italian public health care, my aunts and uncles worked for it, our family best friends worked there, one of their children and one of my best friends is now a geneticist and is researching rare disease (some types of cancers among the others).

If it was simply about environment and genetics, looking at the numbers, one would assume that in Africa or India they have a very resilient genetic pool and the best environment in the World and in USA they've got some serious problem [2] [3].

Of course that's not the entire story, in those places people don't develop cancer because they die for many other (curable) diseases before cancer gets them.

So what makes survival rates so high in the US?

Well, this Forbes article [4] explains it quite well: overtreating.

But at what price? (not talking about raw monetary value here)

Cancer insurgence is tightly related to aging [5], I've brought up the example of Italy because it's the second oldest population in the World on average after Japan.

And we know that the best cure for cancer is (still) avoiding it.

We have a system here that tries to prevent cancer: women are called in for regular check ups for a number of diseases (including breast cancer), men are checked regularly for prostatic cancer when they are 40 or older and its for free.

Companies, by law, have to send their employees to regular check ups every five years.

I have high blood pressure, I have to attend mandatory check ups every year, because I am more at risk than the others.

It's all paid by the Company.

Would you prefer to develop breast cancer and have a 90% chance of survival or not develop it at all?

Breast cancer is by far the most common type of cancer for women [6] and it has high levels of survival rates in all the western World [7].

What's particularly controversial about the way US counts average survival rates is that they also count breast cancer in situ, which is not a try cancer, but it's used to inflate breast cancer statistics [8]

One statistics is particularly interesting, despite the fact that since the 90s sales of cigarettes per adult per day dropped dramatically and are among the lowest in the west [9] the share of cancer deaths attributed to tobacco is still pretty (alarmingly) high [10].

What's really important in cancer prevention and cure is that globally the chances of going back to an average life expectancy is rising, not only the survival rate after 5 years. In Italy 25% of cancer patients can expect to go back to a normal life, I haven't found the numbers relative to USA.

[1] https://ourworldindata.org/grapher/share-of-cancer-deaths-at...

[2] https://ourworldindata.org/grapher/share-of-population-with-...

[3] https://ourworldindata.org/grapher/cancer-death-rates?tab=ma...

[4] https://www.forbes.com/sites/quora/2017/06/13/why-the-us-has...

[5] https://ourworldindata.org/grapher/share-of-population-with-...

[6] https://ourworldindata.org/grapher/share-of-population-with-...

[7] https://ourworldindata.org/grapher/five-year-survival-rates-...

[8] https://en.wikipedia.org/wiki/List_of_cancer_mortality_rates...

[9] https://ourworldindata.org/grapher/sales-of-cigarettes-per-a...

[10] https://ourworldindata.org/grapher/share-of-cancer-deaths-at...

I was trying to find a word that covered "illness" and "injury", but you're right. I've edited my post with the fix.

Try getting healthcare in the US without health insurance, and try affording health insurance when you don't have good enough work. Yeah... thought so.

You edited your post to add a line about emergency healthcare being a legal obligation of hospitals - we both know that emergency healthcare (i.e. "I am literally dying right this second") is not the total of necessary healthcare for many people. I invite you to try surviving very long as a diabetic when the only treatment option is to go to A&E when you are literally dying.

I understand your point but you’re also attempting to portray that low income folks have no chance at obtaining health insurance. Thankfully Medicare and Medicaid coverage gives health insurance to millions of people. 63 million to be exact were enrolled through some form of Medicaid in October 2019 (Center for Medicare, 2019)[1]. Another 10 million or so people are eligible for Medicare (prior to age 65) due to a disability.

[1] https://www.medicaid.gov/medicaid/program-information/medica...

The problem is there's a gap between having low enough income (and being able to jump through enough hoops) to qualify for Medicaid and having a good enough job to be able to afford adequate health insurance to receive healthcare in anything but an emergency.

> Try getting healthcare in the US without health insurance, and try affording health insurance when you don't have good enough work.

I'm not offering an opinion here. I just think the distinction between health care and insurance is important.

The original post I was responding to implies to some that you need a job to receive treatment. It also conversely implies that having a job means you can get treatment. I've actually talked to people outside the US who think that because of how our discussions are often worded.

> You edited your post to add a line about emergency healthcare being a legal obligation of hospitals

I'm sorry. I often think of things to add to my post right after submitting. I was editing it before I saw your response.

> we both know that emergency healthcare (i.e. "I am literally dying right this second") is not the total of necessary healthcare for many people.

I agree, which is why I specified that the right only extends to life-threatening emergencies.

If you're not offering an opinion through the kind of hair-splitting that elides the immediate and generally permanently life-wrecking consequences of not having health insurance, then that hair-splitting serves very little purpose. On the other hand, if your opinion is that the status quo is acceptable, it allows you to rhetorically minimize those consequences because, hey, at least they're not dead, even if the best way out of that debt can seem to be suicide[0].

If you believe that, you've bilged a test of basic humanity. If you don't, perhaps re-think what drives your well-actuallies in the future?

[0] - https://www.cbsnews.com/news/elderly-couple-found-dead-in-ap...

I gave a reason for my "splitting hairs" and you conveniently ignored it.

Stop projecting opinions that are not mine onto my post. I believe the health care and insurance industries in the US is broken and does not adequately serve a huge portion of citizens with low incomes. I have never suggested the current system is okay.

If your opinion is reliant on misinformation, you should reevaluate it. Otherwise, you should not be concerned with someone like me "splitting hairs".

Emergency care means they stabilize you so you won’t die right away and then kick you out. Many of the things that you will die from will never even qualify for it, e.g. treatment for cancer. You need money, insurance, or real charity to get care for that.

In the US, the distinction between having health insurance and being able to receive necessary healthcare is not a huge distinction. Fairly sure you know this.

I would consider a distinction between financial ruin and death to be fairly significant. That doesn't mean I think a system that so frequently results in financial ruin is acceptable.

My intention is not to say "you're just broke, you're not dead". Quite the opposite. My intention is to say that health care access is not limited by whether you have a job - it's whether you have money. Plenty of people have money but no job and even more have jobs but no money.

Emergency healthcare prevents some causes of death - generally, those which can be fixed in an ER and allow the person to continue living a mostly normal life after. Take the example of a diabetic person, or a suicidally depressed person, as counter-examples which cannot be fixed in an A&E environment and will lead to death.

Health insurance is a benefit offered by some employers to some employees. And the data clearly shows that the drop in employment has not resulted in a corresponding rise in health insurance coverage, which just adds further evidence to the argument that our current low unemployment rate really just means that we’ve traded high unemployment for high underemployment.

I take care of a lot of people who work for Fortune 500 companies that have Medicaid. My taxes, therefore, subsidize these companies' profits. Moreover, when I was in private practice, I accepted sub market fees for my services when I took care of them. This is the reason why I am a hospital employee. I get paid regardless of whether the hospital gets paid.

Thanks. Edited my post to say "some US employers".

> Employers get discounted rates because of how many customers

That's hilarious.

I mean, you are correct that employers bundle employees together. But without massive government intervention during and after WWII, the industry would have been wildly different, and the way the trend began was highly historically contingent:

https://en.wikipedia.org/wiki/Stabilization_Act_of_1942

Econ 101 is insufficient for understanding the world.

I do not want to spread misinformation. If that statement was incorrect, could you let me know how to correct it?

It is mainly that economic factors regarding employment insurance bundling are side effects of having employment-based insurance, not the cause.

It is very useful to look at other countries - we have lots of natural experiments in health care markets. If bundling were determinative of market structure, you'd see the same pattern elsewhere.

Lots of medium sized (and larger) companies self insure and pay an outside company for administration rather than insurance (insurance companies often offer this type of service).

You care completely mis-citing / mis-reading that study. It specifically is an attempt to measure the non-material effects of unemployment on persona well-being and happiness.

"Emotionally tolerable" is a very different thing from "financially risky". Indeed, people should be willing to tolerate temporary dissatisfaction to achieve a better long term outcome in ways that they are not willing to tolerate complete financial ruin and the potential loss of major assets that will decrease their long term outcomes.

Financial stress explains upwards of 30% of the cross-sectional variance of life satisfaction.[1] If the hypothesis is that the US unemployed are significantly more financially stressed than the Canadian unemployed, then that would almost assuredly be reflected in differing life satisfaction scores.

[1] http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.536...

Again, you are conflating two different things, financial risk and financial stress.

You are also citing a study that looks at the financial stress levels of employed mental health professionals and then trying to use that to reason about the economic choices made by unemployed people.

This is not how you use data responsibly. You can't just use a 30% correlation in an unrelated dataset to justify conflating two different measures without actually doing statistical analysis to show that that there is reason to believe that that correlation not only exists in a different population, but also isn't washed out by an a other factors.

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