I got dysentery so you don’t have to
eukaryotewritesblog.com
eukaryotewritesblog.com
Edit: since https://news.ycombinator.com/item?id=41911099 was the first submission of the article, I'm going to merge the comments thither and re-up that one. But only the on topic comments. There is way too much dross in this thread—perhaps a fresh start will make for a healthier discussion.
(Sorry, l1n — not your fault at all, and I'm sorry we don't have karma sharing implemented yet.)
or the fecal-oral route
You mean when it hits the fan
While I agree its cool to see progress. If I get sick in the US and need medical attention, just fly me back to Europe. Id rather not go bankrupt.
One isn’t better than the other. There are trade offs. Your preference appears to be financial.
Especially with emergency care it’s quite fast. Back in August my son fell off the monkey bars and his elbow exploded. Ambulance in 7 mins. Hospital triage in 5 mins. Doctor 5 mins after. X-ray took 5 mins. Waited 7 mins. Diagnosis and sent to Children’s hospital one town over. More x-rays, surgery prep, surgery with two paediatric orthopaedic surgeons, four steel pins inserted, post-op, sleep, and he was home by 7am. Three more checkups with the main surgeon followed over the months.
Cost us $8 in parking. Never even saw a bill. I would never, ever, trade this for the American approach. I need to know that every kid on that playground gets this exact same level of care.
I don’t mean talk in vague assertions about how you have read some other specific yet unrelated anecdotes about childbirth costing $125,000 or something. I mean how much would your son’s specific situation cost you in a comparable area of America for a family of comparable income?
The reason I ask is because the general approach should not be argued against with anecdotes. You commonly hear of wait time issues in universal healthcare countries. You commonly hear about cost of care issues in America. Generally speaking there is an obvious trade off.
And just like wait times and cost are preferences, your preference is equal care for children. In America that does not happen. That is part of the trade off.
I am not implying that all things are equal. I am unhappy with the health insurance cartels that drive up cost in America making the lower middle class suffer. I am unhappy with the inconsistent care availability from region to region across the country.
But I also resist the implication that American healthcare always bankrupts a person and that free / low cost care is a simple decision.
That's the fun thing about the US system. The only way to find out how much it costs is to wait for the bill. So while your question is a fair one, logically speaking, it's unanswerable in practice.
At the very least one guaranteed difference is that you would NOT not get a bill.
Then, a common scenario is a health insurance setup that covers 100% of the cost beyond a threshold, while the individual is responsible for the cost below that threshold.
My threshold is $6k for example. In the above scenario with the elbow, I estimate that the total cost would be around $100-200k. So I would end up paying the full $6k, and the insurance would take care of the rest.
The other common scenario is one where the threshold is much lower (e.g. $200) but the insurance covers e.g. 90% of the total cost. I find that option more risky, because I know the total costs can be staggeringly high, and 10% of a staggering number is usually also a staggering number :-)
There is also the question of how well you really understand the terms of your insurance policy, which can be extremely complex.
What gets me about the insurance billing is that besides being complex for me, it is also complex for the insurance company - people on the other side are just people, after all, not some infallible super-intelligent aliens. And the failures that come out of that are kind of hard to believe for people used to nationalized health care; my favorite example was a $15k bill I received months after a surgery that I called back to get more details, upon which the agent said something like "oh that's coded wrong" and after a few keyboard taps I owed $500. What if I had paid the original amount without asking? How many people do not ask? And the cynical question, how often do the "coding errors" happen the other way?
It still cost 3 or 4 thousand dollars. So it's not necessarily those six figure costs that are tough to deal with but even routine hospital care that gets very expensive in the US. I'm fortunate that we can afford that cost. But for a lot of people even making the payments on that would be a hardship. We didn't even know it would cost that much even though we had called our insurance to try to figure it out. Nobody can tell you how much it will cost until you incur the cost which is absurd. And the hospital "price lists" are beyond useless.
It shouldn't cost anything to birth a child in a hospital setting like a birth center in any civilized country, and we shouldn't have to deal with billing issues and insurance companies in the insane first 12 weeks of a child's life when we're sleep deprived and just dealing with actual medical issues and adjustment. We've spent collectively hours on the phone with insurance for this and various other charges. The "private payer" "employer provided" system constantly produces bad experiences and outcomes for everyone. Every insurance provider I've had over the past 5 years is a company that constantly screws up and that I can't fire, unlike my car insurance.
The American healthcare system doesn't bankrupt us right away, but it does so slowly by bleeding us for costs we shouldn't have to pay and by robbing us of time right when we need it most.
My family paid exactly $0 for this experience, with good US insurance.
People paying thousands of dollars with insurance have chosen to purchase cheaper insurance premiums, and then bear higher costs when there’s an expensive event.
This is a fine choice to make. It does not mean the US healthcare system is especially expensive for middle class people.
Like many parts of the US economic system, the US healthcare system isn’t very good for poor people. But don’t go thinking it performs poorly for the upper half of the income distribution.
It's prioritized as per need, for example elective/preventative operations or procedures will be delayed if there is a new higher level emergency, this makes practical sense given the nature of healthcare and I have never had a problem with that.
It's slightly off topic though, my comment was off the cuff but it's a reality.
> Your preference appears to be financial.
Well regardless of financial accessibility if you can justify why in the US the markup of pharmaceuticals is so extraordinarily high for everything vs the rest of the world ?
https://pmc.ncbi.nlm.nih.gov/articles/PMC9914690/figure/heal...
I would be VERY nervous to be in the US without fully comp insurance.
We do a lot of the (very expensive) drug discovery and testing.
They charge more in the US because they can, because of people who gleefully accept it and defend it by saying "we do a lot of expensive drug discovery and testing"
Drug development essentially results in the creation of very expensive intellectual property. A wide variety of drugs are easy and cheap to manufacture [1].
The cost to develop a drug can range from $314 million to $2.8 billion [2]. Fewer than 8% of drugs make it through the development and trial process [3]. It's super expensive and risky.
Other countries do not have to respect US drug IP and can produce these drugs for near zero cost. They benefit from the expensive drug discovery and vetting that the US pharmaceutical industry perform and the US FDA requires, but they don't have to pay for any of it.
When countries do pay for US drug IP, they do a lot of strong arm bargaining. If this happened in the US, many of the drugs, especially for rarer illnesses, wouldn't be developed in the first place.
[1] Gene therapies, monoclonal antibodies, viral vectors, and other types of treatments not so much.
Where are the costs, and what would it take to break tyem down?
For example if the costs are in screening molecular candidates, that could be done in a lab on a computer in India or Vietnam just as easily as in New Jersey. If its clinical trials, Europe is cheap and Asia cheaper still, both with high quality medical staff. Etc.
Any commenters understand where the major costs are?
The market can do this right now. The US has a lot of the talent and expertise, though.
> If its clinical trials, Europe is cheap and Asia cheaper still, both with high quality medical staff. Etc.
While the FDA has accepted foreign drug trials as long as they are held to FDA standards, they still prefer to have trials conducted in the US that represent a US population. And no matter the case, it's still extremely expensive to meet these requirements.
On the other hand, when I've gone to that clinic with urgent issues, they see me the same day.
I gather it is much the same in systems with decent healthcare systems; just much, much, much less likely to bankrupt you just for being sick.
Hell, I recently had to find a new dentist because the one I had been going to for years suddenly had 4-6 month lead time if I needed to reschedule a routine cleaning.
ER visits are an all night endeavor.
Even though this does make sense if you think about it as a tiered support system. If my finger joints don't come back up, my general practitioner can see that, poke at the fingers a bit and decide if guided physio makes sense - no need for more expertise. If there are subtle breaks in the joint requiring attention - more expertise is needed.
I’ve waited far longer in US hospitals and paid hundreds of dollars AFTER insurance.
But if you're on the US, just go to Mexico (or maybe some central american country or Brazil)
Besides I was completely blown up in the US on my motorcycle with fractures all over and in the ICU for days and I paid a grand total of $2k. I think it was pretty cool honestly.
There was some therapy afterwards that cost a little more but overall I’m back to normal except for a few thousand. Since I make hundreds of thousands more this feels like a good deal.
My wife paid a grand total of £0
The very _idea_ we would need to pay money for such medical treatment is bizarre.
If you divide the NHS budget for 2024 (192 billion) by the UK population (67 million) you’ll find it works out to just under 3000 pounds per person just for 2024.
Assuming your wife’s visit was this year your family paid about 3x what the poster you are responding to did.
I’m also working from the assumption most posters here are in high tax brackets; I understand tech jobs in Europe pay much worse than the US so that may not be true.
Probably not a bad idea to get travel insurance if vacationing in the US. The other way around you may want some sort of additional insurance if traveling from the US to Europe.
The poster is referring to cost at the point of care - which under the UK's NHS model is £0. The "£3000" per year should really be viewed as the cost of an insurance policy (in fact, NHS funding comes from a progressive tax called National Insurance - at least in theory). This "£3,000" on average then compares to the average cost per person of a health insurance policy in the US of around $7,700 [0] - plus of course in the USA you generally have point-of-care costs too.
Additionally tax by its nature in the UK is progressive and the income distribution is fairly heavy-tailed, so it's not really a cost of "just under £3,000pp" - the average citizen pays far less than that, and even most high earners will pay less. For example someone on £100,000 (top 1-2% of salaries in UK) will pay just over £4,000 in NI [1] - but NI funds more than just the NHS and also funds social care and state benefits.
Of course in the UK some people choose to supplement NHS care with some form of private insurance - either paid for privately (uncommon) or provided as an in-kind benefit through an employer (still not ubiquitous but recently more common). Private care is typically used for things like skipping waiting lists for certain treatments or access to alternative care not offered by the NHS.
These private policies tend to have a lot less coverage than the NHS, so I would say aren't directly comparable to the NHS - nor are they generally totally adequate as standalone insurance policy so aren't comparable to an insurance policy in the US either.
The model is just very different in the UK and the US, and it's hard to compare them directly. However, what is inarguable is that the NHS provides very good value for money, especially when compared with other G7 nations [2] - on average less than half of the expenditure per capita of the US.
[0]: https://www.william-russell.com/blog/health-insurance-usa-co...
[1]: https://www.which.co.uk/money/tax/tax-calculators/national-i...
[2]: https://www.oecd.org/en/data/indicators/health-spending.html
It's interesting to me that you think about it as free.
Which parts of America?
I mean, the US has lots of areas where the water is contaminated with carcinogens and other toxins and pollutants. The oil pipeline spills alone are already a handful, and then there's mining slurry, and industry dumping their waste where they really shouldn't etc. etc.