I’ll never be an astronaut | Hacker News Reader

I’ll never be an astronaut

shaunoconnell.com

205 pointsweird_science105 comments

My father had an undiagnosed bicuspid aortic valve. He collapsed while swimming when he was in his early 60’s, thankfully in the shallow end of the pool. He was pulled out unresponsive by lifeguards, brought to a hospital, and thank God woke up. A few weeks later and at a better hospital than our local one, he has a porcine valve installed. That lasted about 20 years. Thanks to his preference to avoid doctors during COVID, a few medical issues occurred simultaneously and the worst ended up happening - endocarditis, or an infection of the heart around this replaced valve. He almost died a second time last year from this, but he survived emergency open heart surgery that replaced the valve and cut away a section of infected aorta.

Until this year he would always swears that he was the unluckiest person. Now he’s 82 and still alive after all this and he feels lucky.

Go to your doctors regularly, get screened, and don’t put off procedures until they’re an emergency.

Saved by lifeguards, doctors and nurses, inventors of medical apparatus, heart surgeons, but a deity gets the thanks. SMH.

The people you listed don't get to decide who they will be able to save. It is up to unpredictable factors beyond anyone's control most of the time. To put it another way, do they get the blame when they don't save someone? Of course not, because nobody really controls those outcomes.

Unpredictable factors? If they didn't provide care to the patient, the patient would die. He lived because they came into work and tended to him.

You forgot to list the pig that was sacrificed to supply the first valve, the EMS teams, the ambulance manufacturers, the saline suppliers, the autoclaves, the blood donors, the vasopressors, the fungus that may have excreted antibiotics, and much more of the technical as well as flesh and blood and bone supply chain that goes into saving a person.

When on a religious trip to Israel, his cardiologist placed a written prayer in the Western Wall during one of the scariest periods for my father.

Thanks for listing more. I think it'd be better to summarise it all by thanking science.

I'm glad the cardiologist has developed a way to manage the suffering we all go through in this hard life, but his delusions about some deity reading a piece of paper he stuck in the wall had nothing to do with your father's recovery.

Where's your scientific evidence it didn't help? You've run experiments and collected data?

This kind of base anti-theism is counterproductive and ultimately meaningless.

The burden of proof is on the person asserting that this magic happened.

On the contrary, it's counterproductive to be such a horrible human being that you disregard the efforts of the people who saved the life of your father. My calling that out and trying to shame that horrible behaviour is very meaningful. If I'm successful, the world will be improved.

Regardless of where the burden of proof lies, telling someone who nearly lost a parent this year that they are a horrible human being for expressing their gratitude in a way you disapprove of isn't going to convince anyone of anything. And I don't think that you will make the world any better by being mean to other people.

True. My bad.

The amount of religion-hate and mocking that goes on HN is baffling.

Medical evidence doesn't support screening for that type of congenital heart defect unless the patient has some specific symptoms or risk factors.

https://www.healthcare.gov/preventive-care-adults/

There is no reliable evidence that going for regular doctor visits improves outcomes for healthy adults. Obviously if someone has a known heart condition then their doctors may recommend more frequent follow-up care but for the rest of us the old recommendation to get an annual physical exam no longer applies.

https://time.com/5095920/annual-physical-exam/

What a great write up. Hope that Shaun will have his surgery soon.

I underwent mitral valve surgery this summer due to mitral insufficiency. Fortunately the surgeon was able to repair my heart valve using a Physioring. This means that I will not need life long warfarin treatment, only 3 months post surgery (which is soon up).

When I woke up after the surgery my first thought was "I can no longer feel my heart beat". Before due to the insufficiency my heart worked hard and I could mostly feel every heart beat even at rest.

Now that its been a few months I'm feeling so much better than before the surgery - like I've been given my life and a future back.

Without the surgery I would have developed heart failure and died in a few years time. Now I have good odds at making it to retirement age and hopefully even more. Certainly a humbling thought.

If you read this Shaun - you will eventually feel better than before the surgery!

I (29) had my aortic valve replaced (On-X mechanical) and an aortic graft done literally 8 weeks ago. The full procedure is called a Bentall[1]. It's pretty wild.

The mechanical valve was the best option for me as an active young person because it should last my whole life. Tissue values wear out in about ~15 years from what I've read. Sometimes closer to 10 if you are an active person. The warfarin and INR management is a little bit of a bummer, but I was provided with an INR testing device free of charge, which was rad.

I also wrote a blog post[2] about some of my experiences, although I've yet to write anything about the time post-op.

  [1]: https://en.wikipedia.org/wiki/Bentall_procedure
  [2]: https://finn.lesueur.nz/posts/a-heart-murmur/

Can you hear the ticking now? Is it annoying?

Yeah, absolutely! I hear it whenever the space I'm in is relatively quiet. I also hear it a lot while wearing earbuds and listening to something, especially while walking. I presume it will be quite loud when I get back to running, but perhaps it'll be covered up by the sounds of my suffering.

As for the annoying: nah. It never bothered me, although I've been told that some people find it hard to get used to. Apparently, I made a groan of realisation in ICU post-surgery when my partner described the high pitch metallic clock/watch ticking noise to my parents to help them identify it. My partner pretends to be annoyed by it, but she doesn't _really_ mind.

Hello, fellow On-X owner!

I understand the bummer that warfarin can be. I have two pieces of advice.

1. Don’t diet the dose, dose the diet. In other words, don’t try to adjust what and how you eat to fit the mg of warfarin you are taking every week.

2. I believe a large percentage of what you hear regarding warfarin is ridiculously overblown and I almost never place limits on what I do because of some fear of a bleeding event (within reason, of course.)

Thanks for the message! It's always nice to hear from others in the same position.

Re sport: I'm not too concerned about it, honestly. I do a lot of backcountry adventuring, rock climbing and pack rafting and I'm not about to stop because of an elevated increase bleed risk. I won't push it right to the edge, but I'll keep enjoying life.

Re diet: I agree! Drastically altering my diet isn't something I particularly want to do. I'm quite happy to adjust my dose as necessary.

You’re already doing much better than I was when I went through it. Best of luck to you!

Runs in my wife’s family. Most of them refuse to get scanned. The taint of “pre-existing conditions” haunts many, and there’s really not much to be done about it. I just carry a lot of life insurance on her and we live our lives.

Meanwhile, I’m a land whale that’s been CT scanned and been told by a frequent NYT contributing cardiologist “I have no explanation for how a man your size has such a healthy heart.”

Genetics, yo.

Riveting writing. I have a family member who collapsed from sudden cardiac failure, from a non diagnosed heart syndrome she had since birth - she luckily was at the hospital when it happened.

This and aneurysms make me value the small things in life - you could fall down and die any minute.

I hope the sound of the valve will fade away!

I think an aortic aneurysm is what took out John Ritter.

He was in terrific shape, and just dropped dead.

I know someone else that was also in great shape (AT through-hiker), and died of a brain aneurysm. They found him dead in his RV, in Vermont.

We all have today, and right now, is the only guarantee.

I also know folks that have very bad quality of life, yet somehow, manage to have a great attitude.

Grant Imahara from Mythbusters is another one. 49 and in ostensibly great health, taken out by an aneurism. Life is short, at best, but for many of us it will fall shorter even still.

Ultimately we're all made of meat, and sometimes the meat goes bad.

I think strictly speaking it was an aortic dissection that killed John Ritter, not an aneurysm. Aneurysms grow slowly, and like a balloon, the wall thickness goes down as the vessel circumference increases. So then it can suddenly leak. The aneurysm is chronic (though often asymptomatic), the leak is usually sudden and catastrophic. An aortic dissection is a sudden tear in a usually non-aneurysmal aorta, if the leak goes all the way through it's usually immediately lethal, but often the pressure of blood "dissects" (separates) the inner and outer walls of the aorta, leading to all sorts of weird symptoms, which is why it is often misdiagnosed (A vascular surgeon was once reported to have said about aortic dissection that the "the standard of care is to miss the diagnosis", because it so often mimics other conditions, both benign and dangerous. )

As I recall it, Ritter didn't drop dead but generally, absent any preexisting context, aortic disection is a tricky differential diagnosis and so in his case they chased the wrong dx for a few hours until the window for intervening had closed.

Got diagnosed this year with mitral valve prolapse. It won't be an issue medically for some time, but it is definitely sobering to feel the heart beating so strongly.

> The surgeon told me I was too young to have a bioprosthetic valve – from a pig or a cow – as these don’t last like metal ones do, and other surgical options, even though they wouldn’t need warfarin for ever were not recommended for me, as a relatively young patient.

I had my pulmonary valve replaced when I was 13 with a porcine (pig) valve. True, they don’t last forever, but they can last a good two decades before you need to exchange one out. My cardiologist, as far as I know, plans to use another one for my next surgery.

I have had a synthetic (metal/plastic) aortic heart valve for decades. The differences in anatomic valves and the designs do matter, day to day. My organic was replaced at 2 with a near-experimental synthetic, then at 9 with a Bjork-Shiley design (blood thinner from then on) then again at 32 with an Onyx design.

My heart is now considered too damaged to get a more modern version, even if there was a big improvement (unlikely). The flow control and stress testing that has been done on synthetics make them far superior to organics, among other features like the multi-leaf design that makes blood thinners a formality via FDA blanket process rules for synthetic approval.

I'm really surprised that anyone recommends organics for aortas or even chooses to have them. To continue the rather opulent lifestyles that celebrities/politicians might maintain, there may be a narcissistic belief they can stave off the inevitable growing handful of pills they need to take every day to soldier on. Good luck to each and every one.

It is related to age. If your immune system is on the decline as it generally is as we age it doesn't do as much damage to the bioprosthetic valves and they last much longer. The controversy revolves around just what that age is. When my surgery was done I was in that gray zone 59. The first surgeon I spoke with was adamant about using the mechanical valve. The next surgeon I spoke with was more like I can see arguments both ways.

I am fairly active. I chose the bio because I knew I would have trouble regulating the thinners. The tissue is chemically treated in the newer valves to increase their life span (maybe). When I get this valve replaced they can insert the new valve within the old using TAVR which doesn't require them to open your chest. If my valve last long enough I figure they will have new better ones using carbon synthetics.[1]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9967268/

This person's adoration of the NHS, the mismanagement of which is possibly actively killing them, is somewhat amazing.

That said, there are great cardiac surgery hospitals on the continent that take private payers. He could get patched up near immediately for a small fraction of the price cited in the article.

I was going to write him specific information but his "contact" page doesn't have an email address.

I have a congenital condition called Transposition of the Great Arteries (TGA), and just recently in had to have a 4th open heart surgery, this time to replace a valve. I was lucky enough to get a tissue valve rather than a mechanical one, so I don't have to deal with blood thinners the rest of my life, but the downside is that they wear out anywhere between 5-20 years, depending on your lifestyle and other health conditions, which means I could be facing anywhere from 2 (if they last 20 years) to 11 (if they last 5 years) more surgeries, assuming I last another 60 years. The upside is that future valves can be inserted via catheter, assuming no unexpected narrowing of the arteries. That is a one-day, maybe overnight procedure, with a week or less of recovery, rather than the ordeals that a fully open-heart one brings.

I honestly think the hardest part is worrying about how much my spouse worries.

Hopefully Shaun gets his surgery, and recovers well (took me about 2.5 months to get back to relative norma0lness).

This post is inspiring me to take care of my health better than my current life style.

Personally I’d rather be a scientist doing a stint in Antarctica than be any kind of astronaut, although I know there is no use for a software engineer over there.

I think this person is in IT: https://brr.fyi

May not be a software engineer, but they have an interesting job.

There are computers and electronics systems in Antartica, so they obviously need technicians/engineers to maintain those, I know someone who has been there for some months doing that. It's not software development but you might apply if you know some sysadmin/technician things.

The Cambridge based British Antarctic Survey group hire sysadmins which don’t look particular senior however the pay sucks which could be an issue for those with mortgages etc. £25k or something if I remember correctly.

25k?! That’s only slightly above minimum wage, isn’t it? That has to be the worst-paid sysadmin job in the UK, surely.

My first tech job at 19 was sysadmin in Exeter for £13k lol, as a first line technician. Pretty sure the only reason I got that job was I didn’t care about salaries so just said what I was earning at an electronics store.

£25k is definitely low though.

The most I've ever made in my life was $28k. I'd probably be perfectly happy with 25k to be honest, at least until real self driving cars exist, that's pretty much the one expensive luxury thing I want besides a few vacations.

Your priorities are messed up. A self driving car for what, so you don’t have to drive back and forth between your $25k job?

> Your priorities are messed up.

They could be from a country with a lost CoL so $28k is a huge deal, they could be living the life they want doing a job they love, etc... Just so happens some future tech is interesting enough that they wish they could afford that too. Not everyone is in tech for the FAANG bucks!

Although if GP wishes they could earn more I assume any account holder on HN is technical enough to find a remote job paying more than that if they wanted.

I'm in the US, where the CoL is pretty high, but I'm also very clumsy and really don't have any business being on the road, which is probably my #1 career weakness by far, entry level embedded systems is often very onsite heavy.

I'm super clumsy and really shouldn't be on the road at all. Before I moved I spent hours on the bus every day, here I can mostly only do remote since the bus is so limited.

Full self driving would complete change everything. I could look at jobs I've never even thought about, because of the need for transportation.

Universities always pay the professional-ish help poorly.

You want to be a janitor or a deputy Vice Provost or something to work at a college.

Well yeah, it's a government job so it's probably going to suck money-wise; the guy I know ended up losing money I believe because he had to buy a lot of snow clothes and paid travel expenses on his own account.

Moreover, I believe he had a really bad time there because the population in the base was mostly military and they treated him like shit in the most military bootcamp style with physical aggressions and such. So, he ended up not completing the whole term. (This probably will depend on the country of course).

It’s a research institute so I don’t think it’s directly a government role, more like a university. I see adverts at Oxford University for sysadmins at around £45-65k so it’s on the low side for what I consider comparable jobs, but my thinking might be flawed

It's pretty bad considering Oxford prices.

(Source: I am an Oxford resident.)

Agreed, although most companies in Oxford never really matched living costs either (well, housing costs) - Oxford Uni pay staff comparably to other companies in the area (like Elsevier or Oxford Computer Consultants). Let alone the low salaries in academia there...

This person’s blog pops up every once in a while in HN but might be a good inspiration [1].

[1] https://brr.fyi/

It depends what you do.

If you do embedded software/embedded hardware (microcontrollers, FPGA, kernel dev kinda stuff), you'd probably have a spot with the experiment operators. Maintaining the experiments generally requires a decent bit of low level software and hardware experience even if you aren't necessarily sitting down and coding every day.

And if you are good with interpreting/processing data you may also still be able to land a seat with the experiment operators since they do that as well.

Or if you have Ops/DevOps, SysAdmin, or DB Admin experience, you likely could secure a slot in IT.

You likely wouldn't get the job the first time around but if you keep submitting applications, eventually you are likely to secure a job down on the ice.

https://icecube.wisc.edu/jobs/ doesn't have anything right now but they used to have a bunch of sysadmin/sre positions ("do you know ethernet cabling and python" kind of thing - they used to recruit at pycon US.) So there are definitely opportunities...

I feel like astronaut is only a good idea if you really enjoy long airplane rides.

My oldest son was born with a similar condition. First murmurs at birth, then aortic stenosis diagnosis at 1 month, severity still unknown due to the heart immaturity, and the urgent operation at 2 months old to try fix it. A balloon was inserted into his aortic valve by a catheter from his groin and expanded to dilate the valve. It was a terrifying experience, but one that worked great for us. He may have to have a replacement one day, but for now he is healthy and off any medication. We have yearly checkups.

I am told replacement surgeries can be done via catheter, sparing the much larger risk in have the chest cracked open.

A huge thank you to SNS, the portuguese NHS. All this was done free of charges. It gets a bad rep from some things that don’t work well, but I only have good things to say.

A year later I was preparing our 1 year old party and had a call from a friend which had a baby born with a much severe heart condition. He didn’t survive the required operation and I really felt for him. It messed me up. We had been in the same spot but I had been very lucky. Still am.

My father had a rheumatic fever in his teens. This triggered calcification of his aortic valve that eventually led to aortic stenosis. It was diagnosed two weeks before my wedding, in a different country. My parents missed the wedding but my father's done very well after the emergency valve replacement. Pay attention to small signals, and get checked out regularly. He was running risks that weren't necessary!

> If you’re standing outside a cardiothoracic operating theatre, you have a better chance than the majority who will be miles away living their lives.

Most of the time you don't, but sometimes you get lucky. When Neil Clarke had his "widowmaker" heart attack he was at a conference down the street from a hospital[0]. In another case, an new father suffered an aortic dissection walking in the front door of Brigham and Women's Hospital[1].

[0] http://neil-clarke.com/the-day-it-nearly-ended/ [1] https://bwhpublicationsarchives.org/DisplayBulletin.aspx?art...

A previous boss of mine had a heart attack while finishing a 5K turkey trot. He happened to be nearby multiple emergency and medical personal who started administering CPR immediately. He survived and still runs.

https://archive.ph/Yc4gU

Bob Odenkirk was also very lucky that through a set of unusual circumstances, there was an AED available when he had a heart attack on set:

> Rosa Estrada — we were very lucky that this woman was nearby because she knew how to do CPR properly, and she had the AED [defibrillator] in her car, and she only had it in her car because she was returning it to somebody who she borrowed [it from]. It was a total crazy coincidence that she had put it in her car, and I guess she'd had tried to return it, but the friend wasn't home. Otherwise she wouldn't have had it either. And so it's only because of that circumstance that it was in the trunk of her car. And I'm sure that helped me immensely. I mean, the CPR is number one, but the fact is, I didn't get a heart rate for 18 minutes after this started, and that's a long time.

https://www.npr.org/2022/07/25/1112731181/better-call-saul-b...

I wonder if it makes sense in this day and age to have AEDs as part of first aid kit? There is an issue that people require adequate training to use one properly. Maybe, we could subsidize AED for people that have taken advanced CPR class

Without looking at the statistics, I wonder how many lives can be saved if there are enough people trained to use AED and provide CPR considering in a lot of areas it can be a while before ambulance shows up

AEDs are present in a lot of public-space first aid supplied these days: supermarkets, shopping centres, etc. When you turn them on, an automated voice guides you through every step. They're not idiot-proof, but they're pretty close.

Don't quote me on this, but I think AEDs are quite pricy (I think in the range of 10-20k USD). They could totally be on an emergency kit if you or your organization has billionaires but otherwise are better utilized in common places.

When I worked as a lifeguard in high school (2003-2006) at the high school indoor pool we had an AED that hung in a box attached to the wall.

If I recall, I think we practiced with a dummy one during lifeguard training, but they are more ore less automated and a voice walks you through the process. I think most people would be able to use one successfully, without any prior training.

I don't understand how the author can praise NHS for providing this expensive surgery free of charge, whilst simultaneously noting the hundreds/thousands of patients who die while on the surgery waiting list.

Not to be morbid, but every time a patient dies before this surgery, the NHS saves £50-100,000. So is it really a successful system if the only way to make the budget work is letting folks die? Why on earth would the author not be gleefully prepared to pump a little bit, or a lot, of his private funds into this system in order to improve on his chances of survival?

Are you advocating for increasing the NHS budget, or replacing it with privatized health care?

Probably for privatised health care - once it's down to money it's the individual's fault for not being able to afford to live and no longer a failing of the system. Thus goes the libertarian concept of personal responsibility.

And yet this is a terrible plan because purposely killing people is actually terrible for the economy and any money saved will be drowned by the amount of money lost, especially since the money saved will go directly into the pockets of the people who own the privatized healthcare companies and not back into the pockets of the people.

Libertarians aren't actually that great at looking at the big picture.

You guys are tilting at windmills here. I didn't advocate for anything except common sense. Unless you value money more than lives, this system is clearly shite, but the author doesn't acknowledge that, probably due to politics.

The budget is part of the system. If you assume unlimited resources, then every system will work flawlessly.

It’s only common sense to present the pros and cons of policy. You don’t seem to even think it’s worth your time to take an actual stab at estimating the cost of death, and so it’s only common sense to think you haven’t thought your way through this at all. You’re still arguing this is a budgetary concern without acknowledging the fact that your policy may actually result in a worse budgetary concern.

You know what’s also common sense? That death isn’t a good thing. More death = worse society. Bad society = no money.

You still haven't answered whether you're advocating for improving or starving the NHS. Although if you're intent on shitting on the NHS as if it's intrinsically bad (regardless of budget), I would strongly suspect you are advocating for more private health care, and vote conservative.

Feel free to elaborate on what your common sense dictates as a solution.

The budget is also part of the insurance system. The problem is that you seem to think that resources should be expected (or demanded) to become infinite once healthcare is managed by the state. Insurance companies have turning you down for care as a priority.

They don't, you have mis-read the section:

> If hip, hernia and cataract waiting lists had a similar mortality rate then tens of thousands would die before they got their op.

For these other types of operations there can be very long waiting lists, but these are not conditions from which people die suddenly without warning.

The NHS has its problems, but I, for one, am glad that if I get a life-threatening condition I will be treated according to my need without having to bankrupt myself in the process. Additionally, I'm glad the insurance companies don't drive the pricing of quite cost effective drugs and treatments until they are out of range of the uninsured, even though they could easily be priced affordably.

He gave sufficient numbers to do the math on how many people die while waiting for their turn. It is thousands in this case.

Regarding the NHS you are falling victim to the binary choice fallacy. It is not a strict choice between NHS’s model and the American hyper privatized healthcare. Where I’m writing this, Taiwan, there is a first-class healthcare system that has national single-payer insurance for all residents (only $27/mo!!), and generally no waiting list and patients can normally see any specialist they wish with walk-in appointments during usual working hours.

You can have your cake and eat it too.

Also, almost anyone who wishes can, at any time, fly to a country that has affordable and efficient healthcare and be a customer.

I have friends (Americans) who have had procedures recently in South Korea, Turkiye, and Germany. Sometimes it's just easier and faster, and isn't that expensive even if you don't use insurance.

That's why I'm in Taiwan right now :)

I'm honestly surprised there is not an entire class of insurance programs for people who happen to live in a jurisdiction that has basically said "we would rather you die on a wait list than allow private healthcare" (e.g. British Columbia in Canada[1]). That insurance would cover healthcare abroad, maybe constrained to certain geographies and conditions. Unlike travel insurance it would assume that your care abroad is necessary due to a lack of services in your home jurisdiction.

Perhaps the actuarial data is hard to collect, but I suspect it would be a booming business as most countries with socialised system seem to be heading towards a total decline, if not outright collapse.

---

[1] https://nationalpost.com/news/canada/b-c-upholds-ban-on-priv...

> It is not a strict choice between NHS’s model and the American hyper privatized healthcare.

You'd be amazed by how few people in the UK understand this.

Same goes for the US.

Interesting that you framed it this way and not the other way around.

I don't understand. "The other way around" compared to what?

> Taiwan, there is a first-class healthcare system that has national single-payer insurance for all residents (only $27/mo!!)

How?

At 27 USD/month/person, are you sure you're not failing to account for taxes and other government funding for healthcare?

Don't get me wrong. Healthcare could be better and cheaper. We could train more doctors to lower wages :)

But healthcare and care in general is a hard place to increase productivity. New treatments and drugs help, but anything advanced usually have to involve humans.

Secret to Taiwan’s healthcare: slave labor of the doctors.

Doctors seem to get by just fine. They are paid a living wage like any professional, and take on little to no debt from medical school (one of the top schools is $4000/yr in tuition).

Yes I said it was nationalized healthcare. But Taiwan’s tax burden isn’t oppressive either. Tax brackets are pretty similar to the US.

They start by not paying the insane wages the rest of the first world has normalized. There is no reason a typical doctor should be expecting half a million $$ in total compensation.

They also cut out a lot of middlemen. No private insurance. Doctors offices are also pharmacies. No domestic pharma industry abusing the paten system to extract rents from medications. Etc.

> Yes I said it was nationalized healthcare. But Taiwan’s tax burden isn’t oppressive either.

Yes, but let's be clear: It's not 27 USD / month per capita.

I live in Denmark with public heathcare, it's not horrible, but wait times for non-critical things are longer than it was in the US (with a great insurance). Not that it's been a huge issue for me.

In any case, I'm pretty sure our healthcare system is more than 27 USD/month per capita :D

A random search for healthcare expenditure puts the number around 650 USD/month per capita (probably you can find a different number and make it larger/smaller, so I'd take this as a ballpark figure).

You can read about Taiwan's system here: https://www.commonwealthfund.org/international-health-policy...

I had the same surgery done in the good old US of A and I only had to wait 3 months to schedule surgery in the SF Bay area. How bout that for service;) Knocking the NHS is getting really tiresome. The US with it's private insurance is already making people wait and also not providing optimal outcomes while still being overly expensive. The fact is either system can work - but we as a society have not prioritized the necessary training in volume to make these highly technical jobs available at scale.

[1] 28K new doctors are minted in the US each year. [2] Predicted shortfall of doctors up 124K by 2034

[1] https://www.google.com/search?q=how+many+doctors+graduate+ea...

[2] https://www.aamc.org/news/aging-patients-and-doctors-drive-n...

The only way to make the budget work, for all of medicine worldwide, is to let people die (!)

There's a marginal dollar cost on saving one extra life, versus not saving it. It's not that we're out of people to save, it's just not in the budget to save the next one. The one more.

You can contribute using generosity.

No one wants to believe this. But it is absolutely true: there is no healthcare system that can save everyone forever.

The growing assortment of treatments to combat issues that arise naturally through aging gave rise to the expectation that we can live longer. Technically, that’s true, but the collective cost of care starts to go exponential. At some point, we must acknowledge that we will go bankrupt trying to save everyone.

I wish there was a way for people to check out before they become such a burden on society. Until then, we had better make peace with the reality that “death panels” are choosing for us, because we as a civilization can’t afford for everyone to live their longest possible life.

I see no logical reason for this to be true, certainly not in any absolute sense.

You can't see that a situation will come up, every day, where you have to make a choice between spending millions to keep someone alive for another year, or spending those millions on cheaper and more effective interventions for 100 children?

Here's the logic. Budgeting doesn't suddenly disappear and resources don't suddenly become infinite when healthcare moves from insurance companies to government. People who bash the NHS as a concept are people who prefer insurers to budget their healthcare instead of civil servants. Insurers are also death panels.

It's not that simple, though. You can't set a budget and let everyone die once you reach your limit.

Healthcare often uses "quality-adjusted life years", where the value of a medical intervention is judged by the amount and quality of the life years gained by doing the intervention. Once you set a value on a life year, it becomes a simple calculation whether the treatment is worth it. $5000 operation to save a newborn baby? Obviously worth it. $10M so a 90-year-old can live three more months? Yeah, not going to happen.

The best part is that you can apply a similar principle to other things. For example, at a certain point you gain more quality-adjusted life year per $ if you spend it on non-healthcare things, such as safer roads, better education, preventing homelessness, and fighting crime.

I agree it's not that simple, and finding better interventions in term of quality-adjusted life years seems really good!

I'm not sure though how much elasticity there is in people's willingness to contribute more in response to more effective medical interventions. Setting a value on a life-year makes sense when choosing intervention, but individuals looking at their taxes or charitable contributions don't have a step-change reaction where they're happy to give without limits to the $X QALY opportunity until it becomes $X+1

I do think you have that budget in a very real sense, and I'm not sure I know exactly how sensitive it is to the effectiveness of the interventions, especially as you expand out. I'd argue that the current price of a life year still seems relatively cheap, but the healthcare system does not often complain from being inundated with too much funding.

    > $5000 operation to save a
    > newborn baby? Obviously
    > worth it.

Obviously? A 10 year old, sure, because you've sunk a lot of money into education etc. for that individual already.

But while any given newborn has a lifetime of tax paying ahead of them, they're also easy to replace.

If you made this an auction I'd bet you'd get at least two couples willing to produce newborns within a year for $2500 each.

The NHS may save that much money, but the US government currently estimate the life of the average person to be worth $10 million (btw this figure was created in the ‘80s so keep inflation in mind). So how much is the UK losing here? It’s a net negative to let people die.

I don't know where that number comes from but I'm assuming it's a contribution to GDP over a lifetime or something. Seems high, but whatever.

The people dying of aortic stenosis have already completed a large percent of their lifetime contributions and may even be into the net negative territory (when you're retired and society has to take care of you).

> The people dying of aortic stenosis have already completed a large percent of their lifetime contributions

I was sure you’d be wrong here, as congenital stenosis is a thing. You were right - shows what you learn working in a centre when congenital disease is a specialty.

Average age of death is in 70s.

https://www.nature.com/articles/s41598-017-15316-6

And how much do you estimate the cost of their early death to be? Their children who mourn and become bitter at the government and their society for not providing life saving surgeries to their parents while the rich preserve their fossilized parents… how much money will you advocate we should spend on propaganda to manage their vulnerable mental state? How much less money do enemies of the state need to spend in order to bring those people over to their cause and betray your government? And when terrorist attacks become worse, how much money will you advocate wasting on an increased police state?

If anything, the $10 million + inflation is an understatement. There’s no end to the potential monetary value of increased quality of life, and there’s no end to the monetary loss of decreased quality of life.

> So is it really a successful system if the only way to make the budget work is letting folks die?

The NHS doesn't get to make that decision. The problem is that it has seen literally a decade of budget cuts, despite a rapidly aging population. Compared to countries like France and Germany, the UK has far fewer doctors and nurses per capita.

The Tories are intentionally trying to make the NHS fail by essentially strangling it as they really want to privatize it. As the decades before have shown, the NHS can operate perfectly well when it is supplied with a proper budget.

> Not to be morbid, but every time a patient dies before this surgery, the NHS saves £50-100,000.

Your looking at this too narrowly. There is a point when the NHS saves money by having patients die - this is true in every other health system too. But having a young tax payer die loses them money in terms of future tax take. One can do the equation and it would be something like healthcare cost versus tax take multiplied by years of life left paying tax.

https://www.myhsn.co.uk/top-tip/how-much-does-the-nhs-cost

> the only way to make the budget work is letting folks die?

"The budget" isn't a constant. It's something that politicians have control over.

If you live in the UK you have to be positive about the NHS. As soon as the NHS becomes broadly unpopular it will be replaced with a U.S. like system.

The fact is the Tory party has been kneecapping the NHS for nearly a decade now - austerity measures to underfund it, and brexit which cut off a lot of talent.

The current state is purely a result of politics - and likely lobbying efforts to change the UK system to a more profitable one.

Good luck with the surgery and your recovery.

Don't love all the negative attitude about the NHS in the comments. Yes, could be better. Still, amazing progress over time. This un-constructive pessimism really doesn't serve much purpose IMO.

Heartfelt (no pun intended) get-well wishes to the author. May he be able to send many more excellent write-ups.

From the title I expected a humorous reference to the "Potential" gag poster (https://despair.com/products/potential), probably because the chances of anyone becoming an astronaut are very slim.

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