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Comment by Dedime | Hacker News Reader

Admittedly I didn't dive much into this to get the full context, but it's saddening to me that a legendary game designer had a GoFundMe. I was hoping achieving that level of status in a traditionally well-paid industry would leave one well off, financially.

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The games industry is not traditionally well paid, unfortunately.

This. It's consistently lower-paying than the rest of the software industry.

It's such an erractic industry in terms of compensation. You can found a studio, make some acclaimed darlings, and still end up shuttering and being no better off than your average joe. Then there's being a "software engineer in games" where you're a cog in a wheel fixing bugs in the yearly Sportball game that gets compensated 200k and you live very well despite never truly "impacting" the industry the same way. 200k isn't mindblowing for a software engineer, but it's well beyond "average joe" range at that point.

I'm that cog. Or at least, was. Situations like this make me thing a lot about the state of the industry and where I lie in life.

You contributed to a popular game that lots of people enjoyed? Rest easy with this, friend.

Video games are an art form, the downside is they pay like one too.

Yep, unfortunately that's a big part of the reason I left for a more traditional tech role. The same skills are extremely valuable at any company writing performance critical software.

Cancer and US Medical Care has a tendency to drain any savings you have. Also, it was sudden so it’s not like she was ready to retire at all.

I'm wondering if she actually got the fundraiser money, considering how quickly this moved - the last update implied it would have to go to her funeral, and I hope it pays for the bills or helps her family.

Some funds were used to cover treatments. She has arrangements with her family, and this fundraiser helps.

Not just legendary game designer, but co-founder of a game studio and publisher (Interplay).

I was hoping one wouldn't need to be well off to get treatment for an illness, but that's the US for you.

The video game industry is not a well paying one, even for programmers

The United States is the wealthiest nation on the planet according to Forbes, richer than the subsequent three nations combined.

It’s a tragedy that our own citizens are not the direct be beneficiaries of that wealth.

I think a lot about the scene in Star Trek IV when McCoy is in a hospital and says “what is this the dark ages?”

Gofundme is like a kafkaesque tragic absurdity that - hopefully - will be looked at as an indictment of the inequitable K shaped economy we’ve built, and hopefully fixed in the future.

As a lucky European, I have US labeled as “richest third world country”.

> The United States is the wealthiest nation on the planet according to Forbes, richer than the subsequent three nations combined.

This framing by Forbes (any many others really) is insidious because it doesn't take into account the population number and how unevenly wealth is spread.

For instance, Switzerland is not a huge economy - around the 20th in the world, but its citizens enjoy an extremely high quality of life because both income inequality and incomes overall are significantly better that in the US.

Population size is usually included in those calculations. It’s typically GDP per capita.

But I couldn’t agree more that the inequality and social safety net (or lack thereof) make the numbers deeply disconnected from QoL. Which I believe is the whole point.

> It’s typically GDP per capita.

If so, then the US is ~7th, or 5th among nations numbering in the millions. Still very high, just not at the top.

Considering the James Van Der Beek of Dawson's Creek fame is having to hold a fundraising auction of his memorabilia to fund his cancer treatment, cancer is expensive in the US.

Cancer is expensive everywhere, the difference is who pays for it.

actually a difference is also how many players along the supply chain siphon money out of the process. the more greed is allowed and acted on for the treatment, the more expensive it gets. introduce layers of insurances, hedgefonds, pension funds, lobbyism, ... it adds up to riddiculous amounts far beyond the original R&D/infrastructure/treatment costs.

And those are just the downsides of a market-based system. There are also upsides of single-payer systems, like monopsony buying power.

And also downsides, e.g. many treatments just aren't available, and many others would never have had their discovery funded without the market-based system existing.

Governments can (and do) directly fund medical research including drug discovery. This is in part because governments of even just middling competence have an incentive to keep their workforce (which also includes their military) healthy.

Nobody is advocating for eliminating a market-based system. My country (Australia) has both single-payer and a market-based private healthcare system.

You can imagine how that system, like most, is actually getting its medical advancements from the US.

This… is a think that people believe, but it’s not as simple as that. Most basic research is universities, all over the place. Many drugs are developed in Europe. A lot of medical machinery is developed and made in Europe (Siemens, Philips and Roche are huge in this space). Like most things, med tech is fairly globalised.

And let's not forget that a substantial amount of medical research performed in the USA is not market-based but rather publicly funded through the NIH.

And performed by researchers that received free education in their home country before moving to the US because they hope for a better career there...

That's not an "and" - the NIH is funded by businesses in the US.

Most of that is funded by the NIH and not by the local systems. Spending money is easy.

> This… is a think that people believe, but it’s not as simple as that.

This is a thing people believe because pharmaceutical companies keep repeating it. And to be fair, they're not entirely wrong in that getting a drug/treatment from the lab to the pharmacy is incredibly expensive because most drugs don't work and clinical trials are super expensive.

It does seem to me that a better system would be to split out the research/development and manufacturing of pharmaceuticals into the lab development (scientists), the clinical trials (should be government funded) and the manufacturing (this could easily be done via contract).

> It does seem to me that a better system would be to split out the research/development and manufacturing of pharmaceuticals into the lab development (scientists), the clinical trials (should be government funded) and the manufacturing (this could easily be done via contract).

The market is there to risk money in the world of imperfect information trying to predict what would be good to pursue. That is one of the hardest parts of the process, but it's not even made your list.

Exactly. This was entirely deliberate as I (personally) believe that market signals are profoundly useless in healthcare. Like, there's no free market in life or death, nobody will quibble over cash when they're in pain so I'm not sure how a market is supposed to work.

Fundamentally, the incentives of society and private companies are misaligned with respect to healthcare. Society wants a cheap, simple treatment that basically works forever (like sterilising vaccines). However, because of how the patent system works, companies want a treatment that is recurring, and can easily be patented multiple times.

Because of this, so much money goes into lifestyle treatments for the rich world, and not enough into re-using things that can't be patented. I think this is a giant waste of resources, hence my suggestions above.

Which the US had a situation exactly like that until very recently: development labs, often at Universities, with scientists paid for by grants (some private, but the majority being public, government grants), with clinical trials overseen by government agencies like the National Institute for Health (NIH), and winning research eventually being tech transferred for cheap to Pharmaceutical companies to manufacture, distribute, and market.

The companies have the biggest PR arms, so took the most credit for a system that had been balanced on a lot of government funding in the earlier, riskier stages. Eventually the marketing got so unbalanced people didn't realize how much the system was more complex than the marketing and voted for people that decided it was a "free market" idea to smash the government funding for the hard parts of science.

> Which the US had a situation exactly like that until very recently: development labs, often at Universities, with scientists paid for by grants (some private, but the majority being public, government grants), with clinical trials overseen by government agencies like the National Institute for Health (NIH), and winning research eventually being tech transferred for cheap to Pharmaceutical companies to manufacture, distribute, and market.

Yeah, this isn't a particularly new idea. Like, most of the risk in pharma is on testing, and there's so much waste in spinning up plants for drugs that may not even succeed in Phase III. So I'd like to split that out.

This is a comforting lie Americans tell themselves to justify being ripped off.

You pay double the OECD average, and more per person for healthcare than the Swiss - and that's only counting the publicly funded parts!

This implies the US is subsidizing the world's healthcare system and sacrificing it's own citizens for the benefit of every non-American.

You're ok with that?

I'm okay with implying that, yes. More than implying it.

This doesn't make any sense. If you make a thing, the price you set for selling that thing in a country has little to do with where you happen to be living when you made that thing.

Sorry, I don't know how your example maps on to what I was saying.

This is either intentional bad faith trolling or you are not aware of the per capita spending on healthcare in the US.

https://www.healthsystemtracker.org/chart-collection/health-...

You don't think cancer is an expensive disease to treat? You don't think it involves a lot of inputs?

It's a lot more expensive in the US. Three years of ribociclib is US$100k here in Argentina, which dwarfs the usual costs of things like chemotherapy, radiation therapy, and surgical resection. (All of which is normally paid for either by a health plan or by the public hospital system.) In the US, if you have to go through all of that, I think the cost is going to be at least an order of magnitude higher.

How'd the theme song to that show go again?

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