Norwegian asks students in poor healthcare countries like USA to return | Hacker News Reader

Norwegian asks students in poor healthcare countries like USA to return

complex.com

72 pointsNicoJuicy56 comments

"NTNU strongly recommends that all NTNU students who are outside Norway return home. This applies especially if you are staying in a country with poorly developed health services and infrastructure and/or collective infrastructure, for example the USA."

In one way, it is stating the obvious, since HN submissions about the US health care have been aplenty; in another way, this seems to be a genuine show of care for the students stuck in the US; in yet another, political shots have been fired, and USA starts being perceived as the third world country that it is with regard to its public health care services. (Unless you happen to be rich, which you likely don't.)

They're not just concerned about health care, they're concerned about the whole infrastructure in the US. They just formulated the wording a bit strange. Collective infrastructure for instance is probably "public transportation" since "kollektivtransport" in Norwegian is public transportation.

I'm not taking any sides here but personally I know where I'd like to be if I become sick. I might actually be already, I've started to have chest pains and slime balls and a slight fever last few days.

As much as I love public transport, universal lack of it accompanied by having nearly 1 car per person on average during pandemic is good.

These are students, they don't have cars.. At least not here maybe they buy one when they get to the US :)

Maybe a lesson learned from all of this is that being rich can't buy you herd immunity, and the health of millions of uninsured people will affect your life. And when overwhelmed hospitals are triaging in the moment based on who has the highest chance of survival, it's unclear that a credit score is going to factor in to the decision.

Do you know who I am?! I'm J Paul Getty.... Age? 80. (hypothetical I know he died in 70s...).

And you?

I'm 40 with two kids.. Wife's a homemaker, I'm sole breadwinner.

Dr... 2nd one is stronger, and has young kids to watch for...move him to top of list...

Getty: But I'm J. Paul Getty.

Dr: Sorry, your chances are less of survival, you're more of a strain on the system, it's just survival of the fittest, kind of like how capitalism works, you get it right?

Someone on Reddit largely debunked this as a (possibly intentionally) bad translation, leading to the 32k upvote thread on /r/worldnews being removed:

Original comment, copy pasted below: https://old.reddit.com/r/worldnews/comments/fj61zf/norwegian...

=====

FAKE NEWS!

They are talking about "collective infrastructure" which is a poor translation of the norwegian term "kollektivtransport" or "kollektiv infrastruktur".

The Norwegian original makes it abundantly clear, as they mention an example of: "where it could be difficult to get to the airport without your own car".

> I tråd med rådet fra UD vil jeg som rektor sterkt anbefale alle NTNU-studenter som befinner seg utenfor Norge om å reise hjem. Det gjelder spesielt hvis du oppholder deg i et land med dårlig utbygd helsevesen. Det gjelder også for land med dårlig kollektiv infrastruktur som for eksempel USA der det kan være vanskelig å komme seg til flyplass hvis du ikke har bil. Det samme gjelder hvis du ikke har helseforsikring.

Proper translation would be:

> In accordance with the advice from the UD, I as a principal strongly urge every NTNU-student that is outside Norway to come home. This especially applies if you are in a country with poorly developed health care. It also applies for countries with poor public transport, like for example the US where it can be difficult to get to an airport without your own car. The same applies if you do not have health insurance.

I tried to translalte word by word, rather than getting the grammar correctly, hence the strange wording.

Cancer death survival rates (US vs. Norway)[1]:

Prostate (97% vs 86%)

Breast (89% vs 86%)

Cervix (63% vs 71%)

Rectum (64% vs 65%)

Colon (65% vs 62%)

Leukemia (51% vs 53%)

[1]https://ourworldindata.org/cancer

These rates are tricky to evaluate because they depend a lot on screening philosophy (i.e. (a) in one country, a non-aggressive cancer is never detected and never counted. In another, it is detected and counted as "survival". (b) some lethal forms of cancer have fairly constant distribution of survival time, so if you detect them earlier, you can take credit for higher survival rates without actually having altered the course of the cancer in any way).

Rich people are skewing the data favorably. The average does not tell the full story.

https://qz.com/1519229/the-annual-cancer-rate-report-shows-t...

Actually your data shows that both rich and poor saw a significant decrease in cancer deaths, the wealthy just saw a bigger decrease.

You could probably say the same about any random country. Not sure what your point is.

Do those stats count all detections where the patient died, or all deaths where the cause of death was determined to be cancer? I can imagine in the USA someone who can’t afford treatment might end up committing suicide, thereby artificially lowering the cancer rate and the deaths from cancer statistic.

Remembering that different countries have different definitions for, say, infant mortality (eg: difference of opinion as to what counts as a live birth, meaning that some countries report lower infant mortality but higher perinatal mortality)

I read the comment as referring to how the infrastructure is set up, not the care itself.

For me this covers how payments and insurance are organized.

Most people who are used to free healthcare aren't ready for the type of bills that come from an accidental visit to a US hospital.

I’d be curious to see for each country the average stage at which a persons cancer was detected, and the average personal financial impact for treatment.

Cancer death survival rates are universally 0%

ಠoಠ

You're within the statistical margin of error.

Don't forget the bill

Actually, the US is probably the best country for COVID-19 treatment due to the number of ventilators per capita. 52 ventilators per 100k residents. Italy has only 5 per 100k. Not sure what Norway has.

https://medium.com/handwaving-freakoutery/predicting-america...

Like that's good to hear. That's an order magnitude more, but still pandemic could easily overwhelm what is available.

I know it is politically correct nowadays to diss US healthcare system. But in the current pandemic, it is more about government preparedness. If you let an exponentially infectious pandemic run wild without any curtailing mechanism, no matter how sophisticated the healthcare system is, it is bound to get overwhelmed.

I absolutely can't stand the notion that describing or warning against the very real, awful scenario many Americans face with their healthcare is first and foremost a "diss", as opposed to something that must be said loudly and often until the problem is eliminated. This is human suffering we're talking about.

Many in the US have no healthcare insurance, or watered-down plans, recently permitted by GOP.

My point is no matter whether you have insurance or not, if hospitals are overloaded, you will not be treated. Just look at situation in Italy.

Italy here. I agree with your point. Luckily despite the rumors of war like triage we're still treating everybody because we increased capacity. There is a little slow down in new cases today. Still a race between setting up new capacity and hospitalizing people.

Until it all runs out, I'd rather start with a situation where I have health insurances versus a situation where I don't.

In other words, I'd rather try to escape the encroaching fire in a Toyota than a Yugo.

It is good to have insurance. I have one. But when I was trying to reach a doctor during the weekend because I had bad cough and was very worried, I couldn’t get through. The line was overloaded. At that time it hit me that, in case of emergency, different set of rules apply. Having insurance becomes almost irrelevant.

Corona has swamped a lot things.

I’m not sure it’s accurate to say/imply that “many” have short-term plans, which is what were reauthorized. Those plans make sense for some but certainly not many.they Are edge case solutions. There are, as you say, many with no health insurance.

You're right that it's about government preparedness, but how do we expect a government that's all about protecting the profits of the insurance industry to have the best interests of the citizens in mind?

We're in the midst of a crisis and we still can't imagine giving away tests / vaccines for free. Even though economically it would be the best course of action, we're so opposed to anything that even slightly resembles a handout here. Even when those handouts have drastically positive effects on the economy.

The USA needs to end the whole "crabs in a bucket" mentality, or we'll wind up wondering why this is happening again just a few years from now.

What people miss is this: You don't want to be sick in America, or abroad generally. It could turn out very very expensive. There are travel insurances, but they have limits. In rare circumstances, this can happen in every country.

Critical Care Beds Per Capita

8 vs 34.7

https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co...

https://link.springer.com/article/10.1007/s00134-012-2627-8

Well the other angle is the US public just doesn't give a damn about anyone else in general.

There is absolutely no change in behavior here.

In weeks if they were stacking bodies for lack of storage space, I am still not sure people here would change their behavior, everyone feels special/priviledged and not affected until it suddenly hits them.

This is an inflammatory headline for no reason. The USA does not have “poor healthcare”, it has expensive healthcare.

A true poor healthcare nation would be somewhere where no amount of money could buy you any effective treatment.

We cannot allow people to think that shitty but cheap and freely available healthcare somehow qualifies as a nation with “good healthcare”.

> The USA does not have “poor healthcare”, it has expensive healthcare.

So... it does not have healthcare for the poor? That's not good healthcare, is it?

> We cannot allow people to think that shitty but cheap and freely available healthcare somehow qualifies as a nation with “good healthcare”.

For some people, it is a choice between shitty healthcare, vs no healthcare.

So... it does not have healthcare for the poor?

Sure it does, it has either Medicaid (almost zero out of pocket) or heavily subsidized (up to 100%) marketplace plans.

Do Norwegian students have access to Medicaid? If they have travel insurance, would they be covered, or will an exclusion kick in?

In many socialised healthcare countries, tourists will get treated for free or cheaply (although you should always have insurance: and you really really want to avoid many facilities in poor countries because they often lack funds to give decent care).

So if you are just above “poor” what happens then?

Well to his point the headline doesn’t say “poor healthcare system” it says poor healthcare.

Medicare. The US public health care system as a % of GDP is probably 75% of the size of Norway's total healthcare spending...and the US has a private health care system subsidising that worth 3x Norway's total spending as % of GDP.

There is a lot of confused thinking on this topic.

Re: The USA does not have “poor healthcare”, it has expensive healthcare.

It has both. We pay a lot and get less for it on average than other nations. It's done a few things better, like allowing newer cancer treatments, but that's an exception.

I would say it does a lot better than just cancer treatments. However, cost and accessibility is probably the biggest problem. Health care is also just one those things that don't follow a normal supply and demand graph.

Like in the extreme if you need a certain drug or procedure to survive you will pay whatever you can. You're basically held hostage. Like take a look the costs for the latest hepatitis C treatments. It's basically extortion in my opinion.

Technology and R&D are always creating new treatments, but the new ones are rarely cheap, as is true with any new technology. The first desktop laser printers cost almost as much as a car, for example. It's good to have new options, but those options do have a price.

If you are well-to-do, you have a lot more options in the US than other countries, which tend to subsidize the lower end with the higher end.

Healthcare that is not accessible without falling into debt and/or prison is poor healthcare, period.

To a sick person, it doesn't matter if they can't get themselves treated because the infrastructure doesn't exist or because the infrastructure exists but is out of their reach; they're dead either way in the long run.

And in the particular case of an epidemic, having a significant part of the population without good access to the healthcare system is likely to create worse outcomes for EVERYONE.

> A true poor healthcare nation would be somewhere where no amount of money could buy you any effective treatment.

That's precisely the worry here! If we don't keep COVID-19 spread low enough to stay within hospital capacity, no amount of money will be able to buy you treatment. Non-critical surgeries are already being postponed everywhere, even surgeries for earlier-stage cancers [1] – no matter how much you're willing to pay. Granted, not the normal case, but I'd consider ability to respond to pandemics part of the quality of a nation's healthcare system.

[1] https://www.nytimes.com/2020/03/14/us/coronavirus-covid-surg...

Hate to break it to you but even with COVID-19 people will still have to go to doctors and hospitals for other things completely unrelated to coronavirus.

Yea if you have coronavirus it may be hard to get treatment specifically for that but if you break an arm or crack a skull you can still go in for an X-Ray and cast.

If it's something that requires a hospital, it's very likely that you won't be able to. You'll be triaged in a tent outside the hospital. If it's something your family physician can do in his/her office, you might be ok there.

Show me where that has happened and I’ll believe it. As far as I know, broken arms are still being mended.

Italy.

Has the US ever been in the top 10 or 20 countries ranked for best healtcare? Every time I see a ranking it's around #30...with Norway far ahead.

I am certain that healtcare costs factor in to ranking. Being overly expensive makes it bad.

For example, the "poor" American system has the most ICU beds per capita than any other country. It might be cost a lot to stay in one, but that's probably they we have so many.

No true Scotsman?

How about changing the measure of “no amount of money” because there will always be some amount of money sufficient to get you the healthcare you need — in some cases that will mean flying you out to a different country, in others it means flying a medical team and equipment to you.

When a simple drug like insulin costs $1000/vial versus the $10 everywhere else, and simply setting a broken leg can set you back $30k where everywhere else that procedure costs $300, it’s clear that there are certain levels of “having money” that are insufficient to afford health care. There’s a huge problem of accessibility hidden behind employer provided health insurance.

There's a whole range:

- Free and good (Scandinavia, France, and many other EU countries)

- Cheap and good (South Korea)

- Expensive and good (US)

- Expensive and bad

The US doesn't rank that high out of those options to be honest.

EDIT: Actually, I think it makes sense to make a distinction between healthcare system and hospital. The US has a very poor healthcare system, while it might have good hospitals.

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