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Comment by throwme0827349 | Hacker News Reader

This is fine as a high level economic discussion, but I think it misses the point of the complaints from actually US consumers: when I consume healthcare as an individual I am paying with a blank check, and I am therefore likely to be tricked into consuming more health care than I would otherwise choose to afford, perhaps to a ruinous degree.

I think ordinary consumers care much less about whether their country spends a nominal share of GDP on the heath sector, than about whether they will be unexpectedly bankrupt by consuming health services, and this is why people are actually mad.

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> The claim that US health care prices are inexplicably high was never well-evidenced

I can provide anecdotal evidence that prices inexplicably high. A primary care physician will charge anywhere between $200-$500 for a visit. If you have good insurance, you don’t pay out of pocket. In the same city, I once had to go to a PCP who would only work without insurance. I had to wait a lot because of how many people were lined up in front of the office, but I paid $50 for the visit. I’m already paying 4-10x in a comprable market for the same services.

When I was abroad, I had to visit a doctor’s office for food poisoning. I paid 200 in the local currency. I could have gone to a hospital and they would charged me 500 in the local currency. But what’s important to know is that the median monthly wages in the country were 25000 in the local currency. So all in all, you’d pay a smaller portion of your wages for a simple checkup.

And that tbh is why people are actually mad.

I recently had skin cancer surgery. I was offered a 20% discount to self pay. Because of my deductible I would have paid more if I used insurance than if I just paid. We are now to the point where it's not cost effective to use our private insurance for cancer surgery. How anyone is defending this system is crazy to me.

My wife had a kidney transplant. Two of her medicines cost hundreds each per month with insurance, but without insurance are under one hundred each for three months.

Agreed. I have trouble squaring an argument like that with my own personal experience. (I also did not read the article, but I get the gist from the comments, for whatever that's worth.)

To take two ER-related examples:

• In the USA, I had some brief, sharp chest pain and my general practitioners office refused to set an appointment without be going to the ER. I was quite certain it was not a heart attack, but I complied. I was briefly triaged and not admitted. I believe the bill (with very good insurance) was more than 2000 USD.

• In Germany, my wife had an eye injury that required a trip to the ER. She was triaged, saw several doctors, including a specialist. She fortunately did not need treatment, but was required to check with another specialist within a few days to check how things were healing. There was no cost for this beyond our public insurance.

I can cite dozens of other examples where medicines were free/cheap, tests or specialists were covered by default, elective procedures were dramatically cheaper, etc. And this doesn't even include several fights with US insurance companies over tests that were recommended by a doctor.

Is the system here perfect? Certainly not, FAR from it. But it is a big reason why I'm not interested in moving back to the US.

Is a primary care physician what we would call a family doctor or general practitioner (GP) in the UK? In Norway an employed adult will pay about 240 NOK (about 22 USD) to visit their family doctor (allmennlege). I'm not sure what the rules are for the unemployed but I'm sure they pay less, children (under 18s), full time students, and pregnant women pay nothing. Median income is about 55 kNOK/month.

I don't normally have to wait unless I turn up at the surgery without an appointment. If the previous appointments run over I sometimes have to wait but rarely ore than half an hour.

Yes a PCP is what family doctors or GPS are elsewhere.

I started and sold a company in the industry, and agree that macro level analysis misses this. In the us healthcare as a “product” has an AWFUL customer experience. On so many levels. And the worse it gets the more people want to “burn it all down”, despite the fact that it might not be as dire as we think when we do the high level analysis. Whether or not that’s a good thing is up for debate.

The outsize portion of gdp that healthcare takes up is why it is likely to bankrupt you in this country, although it isnt the reason for the lack of transparency.

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