Every time I go to the doctor I wish I could take myself to the vet instead.
When it was our cat's time too, I was struck by his end of life experience versus that of a human. Whereas a human could have exhausted their life savings on futile treatment or end of life hospice care, Denver cat went quietly into that good night on his favorite blanket surrounded by his loved ones.
I'm currently in need of some very common medical treatment, but the maze of providers I need to go through in order to get a referral just ain't worth it. Versus, if I were a cat or dog, I could simply go to the area university veterinary hospital and likely get my answer same day.
Pieter Hintjens (of ZeroMQ and AMQP fame) chose this option when diagnosed with terminal cancer, and wrote about it extensively at [1] and [2].
I suspect there is an order of magnitude in the difference in level of care that goes into the average person vs dog. I mean, for one, it is very common to hear things like - "well, you have to remember, their lifespan is short. They only have a year or so left to live." This just isn't a discussion that is had with people.
Except doctors. Doctors refuse life extending treatments at a much higher rate than general population of patients.
Find a 4-5 story parking garage and stand up on the edge. That part of your brain that kicks in and tells you to get back down to safety will also tell you to pour every cent you have in to buying a few more weeks.
This can change when there is no "back to normal" available. When your quality of life is shot and you know that tomorrow won't be better than today.
In a suicidal person who jumps off that building we consider this a tragedy because there's usually no physical reason that those feelings couldn't have passed, why their life couldn't have been normal again.
But in someone with a terminal condition and a body that's just done... and especially if they're well informed about the realities of their medical condition... yes, there can be things you care about more than throwing every cent you have into extending the pain.
But I think there's truth to both points, and every single case will be different.
I believe the only blocker to allowing euthanasia in the developed world is a potential for abuse.
Part of this could be that pets are limited in their ability to communicate details of their feelings to humans, making it harder for humans to tell the difference between a pet that is acting off because of something that they will recover from without a trip to the vet and one that is acting that way because of something that is serious and is going to go downhill fast if you don't take them to a vet soon.
This leads to vets first going to the vet for a given illness later into that illness than a human with a similar illness would have went to the doctor, hence a greater chance of it being too late.
With my cat (and this would likely be the case with any of my cats...) we took a reasoned look at the medical options and the quality of life choices. It wasn’t exactly cheap, but we basically bought him a year of life. If it had been a human family member, we would have gone through exactly the same decision, IE: do you want to keep fighting and do you want to go through this procedure or not?
I plan to go back if I ever need a major medical procedure.
I've always opted to be treated locally when needed - but I also pay for an emergency evacuation service that puts my butt on a jet back to the states if things go pear shaped.
And yes, dental care is all over the map— it feels very much like what I imagine US healthcare to be, with co-pays and mystery charges and having to log into my insurance company's online portal to do stuff. The NDP made a bunch of noise in the last election about a national dental plan, though even that effort would only have covered family incomes up to CAD$90k [1], so it wasn't anything like the universal no-questions coverage we have for core healthcare.
1: https://www.cbc.ca/news/politics/ndp-dental-plan-fact-check-...
Do people in the States not pay for pet insurance?
We sure did go for it in Toronto. Vets seem to charge by the pound (wait, sorry, kilogram, immigrant…). Large dogs seem to come with large medical bills, and we were strongly advised by friends and family to go for pet insurance.
Now, I am not actually sure that pet insurance, versus setting up a dedicated savings account that we sock money into, was the best idea. If anything, we went for it because I am from the States, and I assume any non-trivial medical issue will be cripplingly expensive.
For me, the cost of routine care, spay/neuter, and a certain amount of unforseen expenses should be part of what you plan for when you get a pet. Beyond that, it's a judgment call as to whether the cost of some treatment is worth it. I know people who have spent thousands of dollars treating cancer in an old dog, and others who have euthanized younger pets who developed expensive but in theory treatable health problems. I don't think either approach is wrong, it's up to the owner.
Funny enough, dental insurance in the US is very straight forward. I have always gotten quotes up front with very clearly explained charges. The way it has worked is dentist talks over with me what they want done, billing person runs the numbers and gives me paper with estimates, and if I agree I pay whatever balance I owe on the way out.
Amazingly straight forward, kind of like how everything else should work...
FWIW Eye doctors and insurance on glasses works just as well.
An example of my frustration with dental: I went to my usual dentist for a checkup, but then he referred me to a specialist. The specialist appointment wasn't going to be for a month, but then they call suddenly and have a cancellation the next day. I end up having to pay full price for the specialist appointment because my insurance doesn't like that I had two "assessment" appointments back to back.
On another occasion, I was quoted a procedure, and my decision for when I wanted to have it done was driven entirely by which insurance-year it was going to fall under, rather than by my convenience or how urgent it was, or anything else.
I know these are fundamentally "insurance issues" and I suppose better supplemental insurance could make them go away, but at the end of the day, just like with Americans, my insurance is chosen by my employer and I have basically no control over it.
It's uncommon here in Norway, unheard of in fact as far as I am concerned. I have a checkup once a year that includes a really thorough cleaning procedure and x-rays. That costs about 120 USD. If I need a filling that will probably add about 100 USD at the most and the two crowns (milled ceramic done on site, on demand) that I have cost about 500 USD each so over the last thirty years I have spent about 6000 USD on dentistry, so an average of 200 USD per year.
They can, but they vary. I'm a citizen of both countries and there's one allergy medicine I take where the generic price in the US is the same as the name brand price in Canada. The name brand in the US is 7x higher than the name brand in Canada.
I had to get an MRI from a vet hospital in the past. It was still over a thousand bucks, and in the range of quotes I'd gotten for human MRIs before.
I wonder what similar stitches in an urgent care vs a primary care office vs an ER for a human would cost.
You'll hear medical professionals claim imaging is expensive because the machines are expensive. Which just says to me that medical professionals aren't accountants.
Consider a dental w-ray machine. $15-30k. That's the cost of Prius used as a Taxi. You don't pay a couple dollars for a 15 minute Taxi cab ride.
An MRI machine, I forget how much those cost. But whatever, lets compare one with a modern passenger airliner. Cost is about equivalent on a 'per passenger' basis. And an airliner requires highly trained professionals to keep it running.
A new MRI costs ~3 million, has an operational life of 10 years, performs 5000 scans per year, for a total 50,000 people trips.
The people operating the MRI machine are probably payed more than anyone working on the airplane and take vastly more time per passenger.
You seem to be off by a factor of 5 or 10.
https://info.blockimaging.com/bid/92623/MRI-Machine-Cost-and...
https://www.pasadenanow.com/main/lab-in-emerging-biomedical-...
Here is a link for a 7 million suite to house one of the machines https://www.dignityhealth.org/sacramento/about-us/press-cent...
While costs for these machines are going down, even more expensive 7 and 10 Tesla machines are starting to be installed, going up to $14 million
Anyway, your estimate seems to be way off, basing it on a 6 year old puff piece for a cutting edge model that was deployed in a lab. The cost for a typical new MRI is more like $500k.
If you ask "How much does a car cost?" The answer is not "Here are some articles about people buying Lamborghinis that cost $250,000".
Most people are using a middle of the road 1.5 T machine.
If your point is that MRIs less than 3T exist, I agree. If your point is that cheaper MRI exist, I agree. If your point is that nobody has spent 3 mil on a CT, then I disagree. A link showing the price of used machines 10-15 years old isn’t going to change that.
[0] https://www.careerexplorer.com/careers/magnetic-resonance-im...
I agree that it is a very strange comparison between MRI and a plane, I was just chiming in on the capital and employment cost for each could be comparable on a per trip basis, not that MRI prices are where they should be.
In my personal opinion, a major problem with US healthcare is a race to the top, where the newest and best care is sought irrespective of the price. A judgement call needs to made somewhere on cost/marginal benefit, and post-procedure reimbursement debates is the worst way to do it. CT machines can cost between 250K and 14 million, as I mentioned in a sibling post. Similarly, MRI costs can range from $170-$5,500 [1]. In the current system, almost nobody is incentivized to keep costs down. Doctors and insured patients want the best care, as costs are externalized to the insurance pool. Insurance companies want to maximize costs, because their profit margin is limited by a % of spending.
https://turquoise.health/service_offerings?q=MRI&location=90...
My dog had MRIs and ultrasound recently. Each event was $700-$900 a pop.
I take my dog for routine full checkup that includes MRI and Ultrasound whenever I travel to south america. They use the same machine brand as in the US, with same diagnostics. I pay $50-$85 over there for the same tests.
Vets over in SA (not business owners) make about $500-$1000 USD per month.
It would seem the huge cost is not from the machine. Its the labor. I think these are the 2 key differences:
a) Based on my understanding, getting licensed in this SA country is a nonissue. There is in fact an oversupply of vets because its easy to practice.
b) The price for the vet studies is on the 2k-5k year for a private U. Compare with US Colleges.
Regarding quality: Our vet in SA diagnosed my dog after seeing the US diagnostic test reports , over whatsapp. She was correct on her diagnosis from the start. It took 4 different US vets, 3 separate facilities, 4 days of hospital bills ($5000) to arrive at the same conclusion that I got from a whatsapp.
It is not the machine problem. It is a captive market with huge costs related to labor.
Re: the large patient, yikes!
The bores are really small: 55mm or so is not uncommon, so a mouse would fit, but nothing much bigger. Other animals are usually scanned on a machine meant for humans (sometimes even the exact same ones, very early in the morning or late at night).
The $2000 place is associated with a local hospital chain that is well regarded. I guess that is how they could negotiate $2000 for an MRI with insurance and the other place (that I went to) was only able to negotiate $500.
Honestly, the price for health care in the US is all funny money. I've gotten a single shot, of a very common drug, that was billed at $20k, knocked down to $10k with the "insurance discount", so my 10% co-pay ended up $1000, with insurance!
I had a surgery that was billied at $250k where the "discount" was over $150k. That $250k price is clearly not real.
The highest medical bill I've ever paid is £8.50. Of course I pay National Insurance to cover the costs of the healthcare system. But as far as I can tell that's no more expensive than what people in the US pay despite their insurance having not nearly the same coverage.
They have insurance. And if they don't, they declare bankruptcy. It's not permanent. It's a seven-year ding on your credit rating.
I am genuinely interested.
And please don't take any of this as a defense of the current abominable US system. I lost my dad to complications of untreated diabetes because he didn't have health insurance. What I'm saying is that people who should declare bankruptcy often don't, because they think bankruptcy will ruin their life. It won't. It protects you from predatory lenders and gives you a fresh start.
Isn't the issue that health insurance often doesn't cover everything. And that it's very difficult to get health insurance at all if you have pre-existing or chronic conditions (exactly the people who need it the most).
I have never declared bankruptcy and there isn't really a situation that I can foresee where I will need to.
You spend more time with your dog than most people, and I certainly care about him more than any person who is not in my immediate family.
The vet always guilts me into some sort of stupid test. Usually I walk out of there $300 lighter.
Seems pretty similar to the vet. But that's just an office visit. The expensive stuff is at a hospital when the CYA care shows up.
Which is why they spend 5 minutes on you, 90 minutes after your scheduled appointment time.
Some of the bills that I've run into have still managed to approach the cost of routine visits at some specialists when billed to my HSA.
In the countryside people tend to have a more utilitarian view of animals and would simply get a new one rather than wasting money keeping a sick animal alive.
I'm not.
What I’m getting at is that for most animals the owner can be compensated for accidental death easily. (How much is a head of cattle at auction?)
Not that this explains all the discrepancy, but it may explain a non trivial percentage.
Here's some FDA guidance on how to translate doses from animals to humans: https://www.fda.gov/media/72309/download
I generally agree with your sentiment - regulation and insurance overhead are big costs. I do think some people should be able to do the basics at home if they wanted. Basic sutures are a pretty good example, you could even save that $150 that you mentioned.
See the reviews on this product page: https://www.amazon.com/InstaMorph-Moldable-Plastic-6-oz/dp/B...
The service needs to be available in some form at least for folks like me that have an essential tremour or otherwise are limited in fine motor skills.
This also contributes to the amount of emergency room treatments that could have been trivially handled with earlier intervention. A boil that has gone septic is a very serious medical condition, but nearly all boils can be trivially resolved with a short regimen of antibiotics.
A sterile suture kit is about $2 as well.
If you cannot afford US dental care, and you are not super poor, get a 1 way ticket via Kiwi.com to a more “eastern” European Union country like Croatia or Poland. If you use scripts from GitHub or are very good at searching you can get such tickets for $200-$250. You can find extremely excellent dentists with great qualifications and reviews in countries like that, and many have amazing reviews and are super cheap.
A lot of people from EU countries, that do not have “socialized dental care” go to countries like that a couple times a year to get dental care.
> If you use scripts from GitHub or are very good at searching you can get such tickets for $200-$250.
This is the average cost, per tooth, of the work I had done here 2 years ago, in the US, at a dentist where I paid cash.
> You can find extremely excellent dentists with great qualifications and reviews in countries like that, and many have amazing reviews and are super cheap.
I’m wondering how cheap they have to be in order to make it cheaper to fly to europe. How much would be an extraction or a filling replacement?
When I lived in the US, I had an individual plan through Costco (Delta Dental) that was quite a good deal. It was a Dental HMO plan, though. Really, the only thing I noticed that it did not cover was implants. However, Costco only offers it in a handful of states: https://www.costco.com/dental-insurance-services.html
Alternatively, you can get an individual dental plan through Delta Dental Plan in any state here: https://www1.deltadentalins.com/individuals.html
In both cases above, if you get the Dental HMO, it has no annual or lifetime maximum dollar limits, no waiting periods, or pre-existing condition clauses.
Anyways, I used my American dental insurance to get cleanings, X-Rays, and fillings. I go to Europe a couple times a year at minimum anyways, so I use that to my advantage by getting more advanced dental care there.
Dental implants, especially Swiss implants, can be 8 times cheaper than what some dentists charge in the US. A Swiss implant, when all said and done, costs about $1000 USD in the more eastern EU countries.
You may want to check out this website: https://www.whatclinic.com/dentists/worldwide
I would stick to European Union countries, as the quality of materials is very high. There is some website like the link I posted above, that has implant success rates posted, by dentist. I just do not remember the website's name. Anyways, you take your time and do extensive research before you choose your dentist.
Anyways, I have a very rare immune-mediated disease affecting my autonomic nervous system, which affects salivation, so my teeth are totally jacked up, even though they look really nice. I also have type 1 diabetes, and it makes my teeth naturally more prone to infections. So, cost-wise, I am screwed when it comes to dental care. I know somebody with the rare disease I have, that has about 20 implants in her mouth.
But, if your teeth are really jacked up, and especially if you need implants (of course it is better than dentures), it is way cheaper to go to European Union countries. This is even for 1 implant. If you may need thousands of dollars in dental care, you may be better off going to the European Union to get that care.