Related post from a very harsh doctor who really has lost hope in American healthcare. In the comments he mentions essentially collapse as the only way out he sees.
I was lucky that I had a good insurance plan, but still, trying to navigate the system when I wasn't unable to was the absolute worst experience.
Which medical system recommends that? And why?
My jurisdiction stopped paying for those because they don't have any evidence of net benefit. It makes more sense to target exams based on your risk of having issues.
https://www.ncbi.nlm.nih.gov/books/NBK82767/
Medicine is often uncertain & going looking for problems can end up being a good way to create new problems where there weren’t any before.
If you propose a universal program to catch diseases early then you need to demonstrate two things: 1) there are people with these diseases that are currently not being picked up and 2) the false positive rate & harm caused is less than the existing harm being caused by missed opportunities to treat real issues.
By way of example, many health services have abandoned screening programs for prostate cancer via PSA tests - the harm done was judged to outweigh any observed benefits. Even in those places that are still screening there will be an age cutoff as, below a given age, the costs are thought to outweigh any possible benefits.
Here's the thing though, it's pretty obvious that early, regular screening and health checkups with a focus on improving health are a net positive. You go to the doctor, do some blood work, a couple x-rays, and they tell you areas where you could be healthier.
Any reasonable person would agree with that. You can come up with arguments for why I'm wrong, and try to put the burden of proof on me, and by doing that you make it such a hassle to try to improve things that I just give up.
This is why nothing gets done in North America anymore. There's always a reason not to change things, not to try anything new. That's how you end up with a stagnant society, crumbling healthcare system, outdated infrastructure, school shootings, global warming, housing crisis, etc.
I don't know mate, I'm sure you have good intentions but it's hard for me to find a net positive outcome of your position.
Is that a worthwhile use of their time? Do we see a net improvement in health outcomes if we do this? Healthcare is littered with treatments that were thought to be helpful but turned out to have negative outcomes.
If you want to introduce something new it really is on you to demonstrate that it represents an improvement to the status quo, because what a “reasonable person” thinks very often turns out to be completely false & ends up doing actual harm.
From my perspective, that's exactly the point of these basic preventative labs - how do you even know what you might be at risk for if you haven't established a baseline? As we saw on the thread about cancer earlier today - early detection has had a greater impact than new treatments.
I had a doctor who was willing to do basic blood tests and he helped me create a plan of sorts about what I needed in the way of long-term awareness, nutrition, etc. And then he retired. Since then, the doctors that I have spoken with have had an attitude in line with yours, IE: call me when you are sick. But that's a core problem with our health care system - the emphasis is entirely on treating symptoms of the disease rather than on prevention. And this to my thinking is why men in particular are statistically low users of health care - because they give up on playing the game.
were you not around for the obamacare debate? i was, and it was made perfectly clear that a majority in the house and senate + the presidency, all in theory working toward the same thing, couldn't really change anything.
without legal intervention, who's iterating and innovating process? and to what end?
If Canada could do it that way, why not US?
“In Canada waiting times have reached an all-time high, with a median delay of half a year between referral and treatment.”
I’ll pass, thanks.
Keep killing those kids
[0] https://www.statista.com/statistics/1240400/maternal-mortali...
https://www.commonwealthfund.org/publications/fund-reports/2....
Humanity is very bad about pre-emptively identifying risks and avoiding them - witness our response to global warming, both world wars, falls of empires, carcinogens, peak oil, the housing crisis, the health care crisis, and so on. Problem is that until a crisis is actually upon people, it's not urgent, which means that everybody has an incentive to focus their attention on things that actually are urgent. A fair number of people may not even agree that a crisis is imminent, or what to do about it, or they may have vested interests in the old system and resist any new change.
People have been manipulated into supporting these bad actors through media. Wanting affordable healthcare is "socialism". Single payer healthcare will kill your grandma with "death panels". The fact is that in most metrics socialised healthcare is fucking the absolute shit out of the US system, which somehow manages to kill twice as many pregnant women as Canada[0]. At this point the only thing that might change the minds of these people is to feel the consequences of their actions.
[0] https://www.reuters.com/article/us-health-pregnancy-idUSKCN0...
He had to visit a hospital recently, while he never disclosed to me what his medical condition was, at the end he mentioned that his hospital bill was almost $1500... "Only to find out I'm also allergic to penicillin" and that "if I would have taken an ambulance it would have doubled the bill"
That is a kind of "loaded". Joe Average with a crap job, or no job, is not so lucky.
I also have kids and, like most people on HN, have “good” health insurance that comes with a tech job.
But get one family member that needs to see a cardiologist or neurologist every few months and you’re hitting your $6,500 deductible every April.
Do I understand right that this means you might have to pay up to $500 for medical problems?
That seems huge to me, it's higher than what one pays "out of their pocket" here for a childbirth for example and I don't think you can expect a regular person to spend this unexpectedly, that's about a third of the average wage (in Belgium).
I expect to pay at least $200 anytime I receive healthcare, even just for a 5 minute consultation with the doctor. Childbirth is minimum $4k to $6k, assuming vaginal and hospital stay is 2 nights. If C section and 3 nights, then add $2k to $3k. If using epidural, add $3k more. For both of our kids, we reached annual out of pocket maximum of $5k to $7k in the calendar year, for regular, non complicated vaginal births.
Deductible: What you pay before insurance company starts paying. Usually at least $2k, but varies anywhere from $0 to $10k. Could even be as high as the out of pocket maximum.
Out of pocket maximum: The maximum you pay in any calendar year for healthcare. After that, all responsibility falls on insurance company. Legal maximum for 2023 is $9,100 for individuals and $18,200 for families. Usually this is $5k per individual and $10k per family, give or take a few thousand.
The higher the deductible and out of pocket maximum, the lower the insurance premium (like any other insurance).
Insurance premiums are $400 to $1,200 per month per person from age 0 to 64, give it take a few hundred. That means for a family of 4, health insurance will be ~ $400 per month for each kid, and $500 to $900 per month for each parent. So roughly $24k to $36k per year in insurance premiums, plus out of pocket maximum is ~$10k, which means $30k to $45k per year will pay for a family’s (of 4) healthcare in a calendar year.
If receiving health insurance via employer, the employer will usually pay 70% of the insurance premiums. Sometimes more. If not receiving health insurance from employer, and you are lower income, then you can get tax credits (government subsidy). This lower income is usually $100k per year and below, the lower the income, the higher the tax credit.
Age 65+, the federal government starts paying for your hospital emergency healthcare, but you may or may not need to pay for medicines and outpatient (non hospital) healthcare depending on your income/wealth.
https://www.zorgwijzer.nl/zorgvergelijker/english
The lowest deductible on that page is ~$400.
That said, I'm shocked that the average wage in Belgium is only $1500. That sounds very low, do you not have any workers protections for wages?
Well I never lived in the Netherlands and I am not planning on doing so, so their healthcare system isn't really something I have ever had any reason to study. This system strikes me as very different from ours and the costs I see on this page are far higher than those in Belgium, France or Germany. This deductible system also does not exist in these countries.
Average wage in Belgium after tax is 19 000€ from what I can see, so about 1600€ per month, however various sources give different numbers and another number I can find gives 2250€ as median wage. The difference might be that 1600€ per month takes into account the whole population including people who aren't working while the median is calculated on the people who do have a salary, I'm not sure though.
It's not especially low either way when one doesn't have to pay "$30k to $45k per year [...] for a family’s (of 4) healthcare in a calendar year" (according to sibling comment). School and education in general is mostly free as well, which also helps I guess. A family of four in reasonably good health should expect to spend a few hundred euros per year on healthcare here.
It doesn't sound like you know the plight of others very well.
Like almost every professional career from software engineering to law, medicine, engineering, finance, etc. pays 2-4x the same roles outside the US, and usually includes great health insurance.
Whereas almost all public insurance in Europe, etc. doesn't cover preventative screening, so you better hope any disease you get starts with clear symptoms.