Comment by jjav | Hacker News Reader

Comment by jjav | Hacker News Reader

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> it's the health care that's so expensive

Doctors earn well but not particularly different from FAANG-style software salaries.

I don't know how good these numbers are but here's some: https://blog.nomadhealth.com/complete-list-of-average-doctor...

For example emergency medicine doctor is listed at 366K average (~$162/hr). So when I've had to go to the emergency room and end up seeing the doctor for about 20 minutes, that's about $54 worth of doctor-time (as an order-of-magnitude approximation, ignoring fully-loaded employee costs since I don't have that number).

And yet the bill that arrives is on the order of ~$6000. Sure there's also nurse salary to pay for my visit and other legitimate overhead that's part of the actual "care".

So from that bill I got, over $5000 are inefficiencies and non-care-providing rentiers inflating the cost. Nearly all the bill goes to entities other than the actual medical care providers! So no, it's the the actual doctor+nurse salaries that makes the USA health care so exceptionally expensive.

> Doctors earn well but not particularly different from FAANG-style software salaries.

Yes, but ALL doctors earn that much ALL the time, whereas the FAANG salaries you read are the lucky/skilled top 5% of the industry and only during a once-in-a-generation share price boom where stock grants exceed salaries.

And yes, doctor/nurse salaries are a big part of US healthcare excess cost (as is over-prescription, obesity,insurance profits, insurance admin overhead)

No man, this is HN where everyone makes $300k/yr cash comp 6 months out of school. You didn't know?

I think your 5% number is right on point. There are almost 4 million software developers in the US. Company-specific numbers are hard to come by, but estimating, Facebook only has a few thousand developers - Goldman Sachs has approximately 9000 and several sources say FB has "less." Netflix has less than 9,000 employees total and I think it's unlikely a huge percentage of those are developers. Google has less than 30k (and that's assuming 100% of R&D and Ops groups are engineers). Microsoft has about 40k. Even adding a bit to each of these estimates, you're looking at maybe 110,000 developers at FAANG companies themselves. Let's double that to account for other companies (mostly finance) that will pay comparably - it's certainly less. That's about 5.5%.

And you touch on stock price which I think is super important. This isn't cash compensation. It's massive stock grants which are subject to losses. If some black swan event happens and one of the FAANGs goes out of business there are going to be a lot of bankrupt principal and staff engineers. Doctors don't have that problem because their $500k is W2 cash compensation.

The median software engineer salary is somewhere around $100-110k. Half the developers in the US don't even make six figures.

For the emergency room bills most of it is paying for other people who didn't pay. It's kind of socialized medicine.

That would suggest only something on the order of one in every 50 emergency room visits actually pay. I don't have the numbers to confirm or refute that, but that ratio seems highly unlikely.

Or take a general family medicine doctor visit. 242K average salary = ~$116/hr. On a typical appointment I'll see him 15 minutes or $29 of doctor-time. Yet the bill is $450.

It is more a billing negotiation tactic between your health insurance company and the medical facility that you are seeing.

The insurance company negotiates the bill to a rate of $x for in network $y for out of network. So no they are not expecting you to pay that $6000.

I got a bill from my therapist for $430 for a 30min appointment, insurance paid $186 with zero copay, it just had to go through the magical cost-reducing power of an insurance company.

This system is wierd.

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