Richard Lynch, an awesome PHP community guy and former colleague needs our help
richardlynch.blogspot.com
richardlynch.blogspot.com
Also, just yesterday DHH posted this: "Top income tax rate for California residents is 51.6%. Top for Danish residents is 51.7%. (Kicking at $500k+ vs $70K+, though)."
Which puts things in perspective.
Isn't it, though? If you replace "insurance" with "appropriate medical care" that does in fact sound like what we're talking about.
This individual was a programmer, who based on his blog only quit his job once he was physically unable to perform the duties required - and yet, is clearly unable to cover all his medical expenses.
The system is broken. Anyone who says different is either delusional or selling something.
You can also save money for emergencies and not live in debt beyond your means your whole life as too many Americans do. Sometimes bad luck strikes and you'll need to ask for help from friends, family, and the community and there's no shame in that.
If you get sick and can't work, is the health care system supposed to pay your mortgage too?
The American system is based on choice, and Americans will not give up that choice no matter how many discussions are had calling the system broken. It is not a broken system in which a person with appropriate means choses risk over safety.
If we were talking about people without the means to pay for insurance then this would be an entirely different discussion.
Any guesses what a family policy with a $10,000 (?!) deductible goes for in Maine? $1,400. Say what? That's if you don't get insurance through your employer, which is becoming more rare everyday as insurance negotiations for employers gets stupid expensive everyday too. That's approaching 30% of my annual salary, and we'd have to pay up to $10,000 before anything kicks in.
Oh, and routine medical visits aren't covered either, so that just encourages you to not see a doctor unless you really need to. Who honestly wants to drop $200 annually to have someone with 5 years of med school tell you you're fine, but could lose a little weight.
The system is broken. If you're covered by insurance you have no right to speak to any of this. If you live in a state where individual policy pools are cost effective, you have no right to speak to any of this.
The state of the matter is that the rest of the world has figured this out. And while there will always be challenges figuring out when $84,000 for open heart surgery on a 90 year old man is warranted, we can do better than right now.
TLDR; Health care that's twice as expensive and general health that's not even in the top 25 in the world anymore. And no, people go to Thailand for really expensive experimental surgeries (done by American doctors, granted), these days.
http://www.webmd.com/health-insurance/insurance-plans/health...
The miserable irony of this is that then the government winds up making a deal with FOR PROFIT insurance companies. Companies which would be failing their investors if they weren't wringing every cent out of the policy holders to pad their own pockets and generate wealth off the suffering of others.
My personal opinion is that the ACA is a stepping stone to a single payer or something close to it in the USA. Meanwhile it is absolutely the worst of both government spending and private corporations. Now we just have to wait a whole other oscillation of the liberal-conservative pendulum, which tends to take 10-20 years.
I grew up in Houston, where people from around the world go when they want to be treated for cancer at M.D. Anderson Cancer Center. It's not cheap, but the best doctors in the world head there because they can make the most money.
Single-payer healthcare is worse than the Affordable Care Act.
[1] https://www.healthcare.gov/how-does-the-health-care-law-prot...
The reality is that there are many more nuanced single-payer healthcare systems in the world than the one where the government tells you who gets to live and who gets to die. In the U.K. for example, there are still for-profit health care insurers and if you're wealthy enough you can buy their policy and have quadruple by-pass surgery when your 75.
I'm not going to pretend we don't live in a capitalist world and that at some point rich people are going to live better than poor people. That would a fool's dream. But to argue pure Smith-style market economics will help keep people healthy is a joke.
Even worse than that, while you laud the MDA Cancer Center in Houston now, wait 20 years and the cost of operating it will have sent it out of the country. In a globalized world you are competing with everyone, and while the USA has been sleeping the rest of the world has been getting very good at what we believe makes us special.
If I had to pick between the UK's system, where price controls help pay for healthcare for those who can't afford it, and the Affordable Care Act, where wealthy people pay for healthcare for those who can't afford it, I'd choose the Affordable Care Act.
Price controls have such a terrible track record that we should prove why healthcare is different from the failures we've seen in housing, food and gas before trying again. Price controls give us less of what we desired so much in the first place.
I'm not sure how much you know about the UK system, but it doesn't use "price controls". Its funded by National Insurance Contributions [1], which are a form of payroll tax. The more you earn, the more you pay. People on low incomes pay nothing but still receive health care.
Except that most doctors already make plenty and that most doctors are in fact also strongly motivated by the desire to help and treat people. That's why they became doctors, and the latter desire helps them achieve becoming better doctors much more than a desire for money.
I'm not saying they're not motivated by money. Just that "the best doctors" are probably driven by a couple of other motivations too.
Even more important is pointing out that medicine is already not a perfect capitalist economy. Insurance companies negotiate crazy deals with hospitals and doctors to avoid paying out, and the hospitals and docs are driven to post prices as high as humanly possible because the insurers are so ruthless in undercutting every single expense. What would Ayn Rand have made of a world where generic Advil in a hospital setting cost 1000% of what the drug store is charging? That's not a Smith economy. That's a gross perversion of free economics.
That's the snake eating it's tail on the other end of price control. $25 per pill for pain killers [1]? It's a joke.
[1] http://www.healthcarefinancenews.com/blog/why-aspirin-taken-...
To "make the most money" is not necessarily a motivation for "the best doctors in the world".
It doesn't even necessarily get you "the best doctors money can buy".
In lots of countries, if you get too sick to work, the government will assist you in paying for housing. In lots of countries, they'll do it if you're just unemployed, too.
There's no righteousness to the fend-for-yourself ideals of the USA. It doesn't have to work that way. You can choose, as a society, to sacrifice extreme wealth for greater equality. It doesn't make those countries better, but nor does it make them worse.
The widespread and persistent belief in the USA that whatever the USA does is the best way, and all other countries are dumber and weaker, is one of the most distasteful things about living here as an immigrant. It doesn't have to work this way. The American way is not automatically the best one.
Where I'm from, if you get sick and can't work, we won't let people waste away on the streets, yes.
This despite the fact that any honest reading of our medical outcomes shows that America gets very average medical care, and that we pay about twice per capita what the best care in the world costs.
I mean, I know there's a lot of propaganda out there, and I know there are a lot of sociopaths who are eager to believe it... but I'd think you'd keep your dishonest pro-status-quo, anti-efficiency nonsense out of a thread like this one. Especially since your post implies an utterly nonsensical (and clearly grossly uninformed) dichotomy that the only options are pure state control or the status quo, when any informed survey of developed nations would show many other models, some of which would work well in the US.
Sadly, progress is stalled and we all suffer because there are obstructionist assholes like you, willing to ignorantly pretend that the status quo is the best in the world.
You won't find much sympathy for the middle class who choose a nicer house in a more expensive city, a newer car, or a bigger family instead of safety and security for the future.
Sure especially bad circumstances happen, and then you have the government, friends, and family to fall back on... and maybe some of these public services could be improved, but a significant positive change certainly has happened with the ACA.
Progress isn't necessarily taking choice away from the population, because ultimately health care will cost the same whether you can choose your coverage or the government chooses it for you... if there are inefficiencies and cost problems, don't think that forcing everyone to have the same health coverage will fix them... there are plenty of other problems.
If you can't handle an opposing viewpoint without becoming extremely upset and resorting to petty insults, you are part of the broken political system that has led to many of the problems we face, not me.
But hey, as far as you're concerned, that's okay; he should've lived out of his car or something to be able to afford it.
The average cymo treatment is about $75,000 a hit. So, you know anyone who is prepared for that? The top 1% are, of course. But the rest of us? Those who don't have insurance are fucked. Those that do are ok until they get a bill for services not covered by their insurance. And god help you if you want a non-standard treatment. Then it's ALL on you. And then the house is up for sale. Then the cars. Then you are applying for medicare disability. Only to be dined because you made too much money last year.
This happens all the time. My hope is that Obamacare deals this. But I have my doubts.
Tell you what.. get cancer then come back and comment. I bet you change your mind. ;) No offense of course. Just don't come to my county hospital for care.. my property taxes are high enough. ;)
http://www.pnhp.org/facts/what-is-single-payer
Under plans like H-R 676, 95% of people are expected to pay less overall for healthcare. So, no, you are not paying for 'that $75k', you are paying for much less.
They are HUGE. I work in the field (writing software). Every insurance company has it's own forms and payments requirements. So do governments, local, state and federal. Not to mention reporting requirements. Throw in other insurances such as schools, the VA (and TriCare), Medicare, Medicare Disability (they are different by the way) and Medicaid - and the hundreds of other sources I've missed. This all equals to a administrative nightmare. A cluster-fuck. A huge expense the hospitals and doctors have to deal with. And you'd think moving to electronic medical systems would fix this.
And this is one of the big reasons healtcare.gov failed the first time out.
A large segment of the United States falls in this category. In 2012, over 47 million non-elderly Americans were underinsured for health care: http://kff.org/uninsured/fact-sheet/key-facts-about-the-unin...
Also in the report: "The majority of the uninsured are in low-income working families. Reflecting the more limited availability of public coverage, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic Whites."
Uh, do you have anything to back that up, apart from the standard assumption that "US is #1 at everything!"?
And even if you had 10/10 top hospitals globally, overall average quality is a better metric than handpicked best-of-class examples.
If you're talking about average medical conditions and the average outcomes... maybe not, but those statistics are usually about the medical systems as a whole which is much more difficult to compare in a country without universal health care.
Again, do you have anything to back this up? My question isn't about there not being good hospitals in the US, but rather the assumption that the best ones in the world must be American.
Also, I think you definitely mean "and" rather than "or" in that sentence. If you have a difficult medical problem and no money, then your best hospital is going to be one that will treat you rather than turn you away for having no money.
And how about all those people that can't work, because they're sick, or disabled, or mentally ill, or too young, or too old, or they just need 3 months think time to get their head in the right place.
Too bad for those people, they're going to die.
But that IS what we are talking about here. Millions of americans do a hard days work and can't afford insurance. You know where they get their care now? At the country (public) hospital emergency room. Don't believe me? Go and have a look. Most of the people waiting in the waiting room are not emergencies. Their waiting for standard care. And they got no place else to go.
And this impacts us all. As in property taxes going up to pay for the public hospitals. Oh wait.. don't tell me - we don't need public hospitals either right? I mean you got yours... fuck the rest right? Until you get sick and facing cymo treatments that cost $75,000 a pop. And your insurance company only covers 75% of the bill.
Then you're complaining "where's my medicare disability?"
Are they really? Citation?
Wrong, there's still a large part of the population who will end up dying of what we call "natural causes" such as Heart attacks and stuff like that. These are very inexpensive, because you don't see them coming, usually. So, no, not everyone on Earth dies from Cancer.
Oh nice, they should put that on the brochure.
[0] https://en.wikipedia.org/wiki/Diseases_of_poverty#Cardiovasc...
So, yeah, you might be lucky enough to unexpectedly drop dead before some other scourge takes you
However if you don't happen to fortune into a sudden unexpected death, your body will inevitably decay to the point that you will become a large financial and emotional burden on someone. (Or die homeless and friendless). But we can't take care of those people, cuz socialism! They should have had the common courtesy to just hurry up and die.
I'm not arguing probabilities here, I'm arguing deductive reasoning. You are a decaying meatsack. So am I. At some point something very bad will happen to that decaying meatsack. Such an event will be absurdly expensive to treat. Since I think we'd all agree that for pretty much anyone it makes sense to have health insurance, the obvious next step is: just give everyone health insurance and take it out of tax, and simplify these things 1000 fold. (Not to mention that a single payer would have WAY more leverage, and thusly could negotiate way lower prices. And that's not a hypothetical.. that's how it works in pretty much every country that isn't the US).
His/her argument is, AFAICT: "Because insurance companies can profit, that shows that less than a majority of people die after a prolonged, expensive illness.
Therefore the earlier statement that "it is 100% certain you will have a long, expensive illness at some point in life" is not true.
Plenty of people die of sudden stroke or heart attack in their 70s after a relatively healthy life up to that point.
The lowest hanging fruit, biggest bang for the buck, best ROI, the most logical common sense way to control US healthcare costs is to switch to single payer with universal coverage.
Sure, do all the other kabuki, like quality of care, healthcare insurance exchanges, price transparency, generics, whatever. Because better is better. But know that you're weeding the flower beds while the house is burning down.
They wouldn't have that ability in a European like country sponsored insurance since everything would be covered.
http://www.washingtonpost.com/blogs/wonkblog/post/why-an-mri...
You may be thinking "OK, the system is not great but I'm fine because I've got a good insurance", but that's not true. Even with a good insurance you're getting ripped off before of the cost before insurance of healthcare.
You say that now, but I guarantee you the moment you get diagnosed you change your mind. Especially considering so many terminal illnesses can in fact be cured with (very expensive) treatments.
Also, what about all the non-terminal illnessess? What happens if you break your leg? Or get stabbed? Or get in a car accident? Or any of the millions of other things that can happen?
By definition, they aren't terminal illness then. In any case, in the US (or many other countries), those treatments are unavailable or will literally make someone homeless (and preclude them ever getting insurance again). There's also the question of if it's worth it - will the end result provide proper quality of life or not.
Breaking a leg is a specious analogy as it is neither terminal nor permanent; but if something worse did happen and it would permanently affect my quality of life, yes, I'd still feel the same.
Universal healthcare exists (and works, with various degrees of success) in most countries that are otherwise very similiar to the US in terms of culture, form of government, and in some cases have worse corruption and bureocracy.
As in many things with democracy and social security, there would be inefficiencies, abuses and problems, the real issue is, in my opinion, if the people would be better off in the end, all things considered.
That doesn't mean the new system is inherently wrong.
The data, comparative experiences, and commons sense, disagrees with you.
Single payer is easier to audit. Because it's more simple.
Healthcare Fraud: Auditing and Detection Guide [2012] http://www.amazon.com/Healthcare-Fraud-Auditing-Detection-Gu...
Healthcare Fraud: Auditing and Detection Guide [2007] http://www.amazon.com/Healthcare-Fraud-Auditing-Detection-Gu...
And before you say "tort reform", single payer and universal coverage largely eliminates need for malpractice insurance. Again, because we have existence proofs (every country that has single payer) that discerning people can use to inform their opinions.
Centralized economic solutions work better for some things. Free market soluctions work for other types of things.
The USSR was a dictatorship where everything was managed by the State. This is not what it is being proposed.
Further, most transactions are private or semi private, meaning not conducted via an open market. The amount one business unit (or agency) charges another for goods and services may be informed by a market price, but not necessarily.
I could also say that 2 and 2 not always is 4. Please give concrete examples.
Prisoners Dilema type problems. Concrete example: Cigarette advertising bans. (I'll clarify that this is better for the companies involved on a competition between company basis and "better" for the public in the form of a shrinking tobacco market)
More to the point a real concrete example is healthcare costs. Per person they are cheaper in comparable countries to the US such as UK, Australia, Canada all countries with public healthcare systems (this is including the tax money spent). I would also point out that if you are going to argue that health outcomes are better in the US than those other systems (Maybe that's true, I couldn't say) you are missing the key point of what these non free market systems can be good at (that is capturing externalities, like in this instance bankruptcy or inability to afford service).
And yes the US Government involvement and regulation in the Healthcare industry in the US destroyed it too. Up till 1960s and invention of Government intervention into US healthcare system, the healthcare in the US was cheap, affordable and the US kept #1 spot for longevity in the world. After medicare, medicaid and all the other Government involvement and regulation in healthcare in the US (i.e. 10% of GDP in the US goes to healthcare) we have #50 in longevity and nobody can afford it. Blaming capitalism for that just shows your ignorance.
Healthcare was cheaper before cigarettes were heavily regulated or after?
Which is it?
Or perhaps you're arguing that corporate profits are more important than people?
And no, Government regulation isn't more important than people.
Secondly you grossly misrepresent what I say with the first few sentences of your reply which makes me worry about whether you paused to give any thought to what I said or just decided to be argumentative and pick out random words you disliked. Nonetheless I'll go through your points.
>You claim cigarate bans helped tobacco industry?
No I claimed ADVERTISING bans on cigarettes helped the companies by reducing expenses related to competition between cigarette companies. I also claimed that outside of the industry it had other positive effects. However you will have noticed the quotes around "better" in ' "better" for the public' because I felt I should qualify that a non smoker generally costs the health system more by living longer.
> CFC helped grow corporations?
I'm sorry, perhaps I shouldn't have assumed you knew what CFCs are and why they are relevant to the conversation. CFC are a widely useful range of chemical compounds that were used in a great many products, they also deplete the ozone layer. The regulation of CFCs which phased out their use is an example where government intervention was required and the free market solution of localized profits failed. I have no data on whether it helped grow corporations, it is however known that the requlations reduced the amount of CFCs in the atmosphere which led to the shrinking of the hole in the ozone layer.
>Because if all you are saying is that regulation is destroying industries, well that's actually my point.
You're the one that's taken the hardline position of saying that centralized solutions never work better than pure free market and as I reject your reframing of better to be only industry, I am pointing out that centralized/regulated solutions do work better in some cases. Even if I didn't reject your definition of industrial production as the basis for better, wartime america with centralized planing on production was a 'better' idea than the free market system it had before it, being much more productive.
>And yes the...
It may have been cheap and affordable but that doesn't mean everyone was getting it, in fact that's the reason the government stepped in. So sure the system got screwed up by regulation, because it was the wrong regulation, they should have gone whole hog on the nationilization like the other countries and then the US would have a better system. (And by better I mean has a positive effect on the the most peoples lives, not maximises the money spent on basic healthcare, or the total wealth of the "healthcare industry")
I'm sure I've persuaded you that your original statement about the free market system always being the best system is an untenable position. If you still disagree could you explain to me how a system without regulation deals with atomic weapons. (Now a flippant question because I really would believe it to be absurd to hold to the unregulated premise at this point (I hope you realise I'm poking fun at the premise not you)) Do they always go to the highest bidder cash wise or do they only sell them if there's a sales contract not to blow up the seller... and whatever court the breach of contract trial would be held in?
You give concrete examples of decentralized (unregulated) markets working better than open (regulated) markets.
I could also say that 2 and 2 not always is 4.
I don't doubt it.
And then I take corporations competition every day over Government regulation.
You've got all the bad parts of centralized bureaucracy without any of the good bits.
(edit: also, it's hard to tell how many layers of sarcasm your post has, but economists generally agree on centralising certain aspects of healthcare. Insurance is a fairly well studied topic in general.
The reason people bring it up is because it's just straight up propaganda preventing them from thinking. Single payer is inarguably more effective, efficient, and cheaper. Also, "I'm against a public system because it's corrupt"? But this private system is a-ok, no corruption at all! FFS.
You can't, and should not, ever; spoke about corruption on a media were a south american/african could read you. US got corruption? We got it worst! Much much much worst. Worst in a level were the King of Soccer (Pelé) can say on national television that the money that would be stealed during the construction of the stadiums for the world cup would came back as tourists money.
And, beside that... we have universal health care. (It's not fancy nor without big lines of people or up to 5 hours waiting to a doctor but it exists, and works. Specially for serious illnes like cancer, HIV or Hepatitis).
What am I missing?
Why does this gentlemen have to loose his house to get medical treatment if healthcare is affordable?
But single-payer it is not.
(edit: Medicaid is very limited in recurring residential care and support, so this potentially be a contributing factor).
I'm not aware of anyone, from any political background, who thinks the US system is anything above "pretty crappy". I've heard some people express positive sentiments regarding small parts of the system -- the quality of certain types of care, for example -- but never for the system as a whole.
The primary disagreements I'm aware of concern how to fix the current worst-of-both-worlds system. Do we put it entirely in government hands? Do we enact more regulations to try to force down costs? Do we remove or relax regulations that appear to drive up costs? How do we create transparency in pricing? How do we respond to innovative groups like Qliance? How should we balance the role of government, individuals, families, employers, and charity in health care?
Do not mistake disagreement on how to answer those questions as support for the current system.
Don't get me wrong he acknowledged it wasn't great, but there is more than sufficient doubt and confusion amongst most Americans with regards to what the actual problem is an how to fix it to prevent any kind of attempt and changing things.
Just last month my pregnant fiancée was very ill with an infection and she was examined straight away at A&E, bypassing the 3 hour waiting time. It's for cases like here that the 3 hour wait is in place. There was no cost to me for any of that, perhaps except national insurance which is very small payments out of my pay packet each month a d the £7 for the course of anti-biotics
The real problem is how do we adequately reward doctors who spend such a massive amount of effort and time not just in school but in work? The NYS cannot do this, there are targets like "15 mins per patient on ward rounds". Each doctor needs to spend 10 years in the NHS before private practice. How is a system like this sustainable with a massive budget deficit to boot and government that would like to see its end?
In 2013 my son received treatment from NHS Scotland for a very serious eye infection and, later on, a nasty shoulder injury - in both cases the care was fantastic and even though I have private health insurance I never thought about using it.
I know lots of people have problems with the NHS (a few years back my wife got some care that was less than "caring" - but that seemed to be a staff problem) but generally the experiences of our family has been excellent.
Your moaning about having a 3 hour wait for non urgent cases, when in other countries you'd have to pay a fortune for such treatment.
And who cares how they talk to you, as long as you end up getting the treatment you need that's all that matters.
I care, many people care. When you're feeling like shit, you don't want to be made to feel worse. It's simple.
I don't mind a 3 hour wait. The 3 hour wait just shows how thin doctors are spread. Lets face it, a 3 hour wait for any sick person in an uncomfortable chair is NOT going to do them any good.
http://www.nhs.uk/chq/Pages/941.aspx?CategoryID=68&SubCatego...
Which sounds a bit bureaucratic but it does also mean you get free prescriptions for 12 months after the birth.
Of course, in Scotland, Wales and Northern Ireland there are no prescription charges...
We had to go to A and E with our daughter a couple of weeks ago. We were seen before I even had time to park my car after dropping off the wife and baby! The doctor and nurse were both very supportive and were happy to see us even reassuring us that we were absolutely right to come in even though no treatment was required in the end.
Around 10 years ago I had months of physio on the NHS and a series of consultant appointments. I was very happy with the service.
Yes, the NHS is struggling like all public services, but the media seem keen to trash the NHS and force us into privacy to keep the (mainly conservative) MP's happy and help their friends get the big contracts. It makes mistakes and isn't perfect but in general I've had good experiences.
I've also had surgery and a lengthy hospital stay in California. An excellent standard of service but at a massive cost (fortunately fully paid by my travel insurance).
I'd prefer the service as it is in the UK where everyone is equal insurance or not even if the quality is not quite as high as places where the end user is paying for the service.
The pre-op preparation was really impressive, the operation itself was astonishingly quick and well-performed (I was not expecting her to be conscious and talking 2 hours after having a non-trivial part of her body replaced), the post-operative care was pretty decent but certainly not terrible, and the physiotherapy support and general aftercare was good to great. They provided the equipment she'd need to get about the house and keep up her normal life whilst she was recovering, and in general, the whole experience was good to excellent.
In my experience, the right wing perspective is more like "some of the best health care procedures, embedded in a payment/distribution/insurance system that sucks". One of the biggest fears is that the few things American healthcare does well will be sacrificed, and the things that are wrong with the system won't actually be fixed, the costs will just be shuffled around and hidden a bit better.
I was discussing health care reform with one fellow who was under the mistaken impression that outcomes in the US were significantly better. After I explained that people in countries with socialized medicine get care that's just as good as ours, he asked me, "OK, but then why do we need to change anything?" He really thought that the current system, if not great, was still perfectly fine. I've seen that a lot.
There is, no doubt, a wide spectrum of beliefs. But don't underestimate the number of people who think the system is pretty good overall. Really, just look at the total lack of any credible alternative reform put forth by the right wing. They talk big, but they don't seem to come up with anything beyond "leave it alone". They're stuck in kind of a tough position, because they've been advocating government non-interference and free-market solutions for so long, yet they're not in a place where it's acceptable to say that poor people should die in the streets from treatable conditions, even though that's what a free market solution gives you. As a result, there's a huge incentive to convince people that the way things are right now is just fine.
Also, I have no doubt that you've talked to people with strange ideas, but your conception of what conservatives advocate (or fail to advocate) is very far from my conception of what conservatives advocate. Your statements make me think you know someone like one of my friends, but you're missing the whole rest of the spectrum of conservative/libertarian/capitalist thoughts, memes, and ideas.
We need to educate the youth to start thinking about life holistically and not just in terms of vacations and latest toys.
Just to answer the question above, the US provides SSDI insurance as part of the social security program to cover people with disabilities who cannot work. And many (most?) professionals also have additional long term disability insurance to cover the difference between SSDI and what their normal living expenses are.
He had to pay $11k out of the total $55k bill, rest was paid by insurance. ($7000 for a CT scan? $4500 worth of Anesthesia? I'd be surprised if one still doesn't think these are artificially inflated prices)
I'm not sure how much would he be charged if this whole insurance thing was not there - may be ~$11k?
(Just for the curious: In India, that operation in the best of hospitals would have cost him may be around $1600 without insurance. With insurance, he'd save most of even that. )
In fact the US would look cheaper for the majority of the population. Which is comparing against a low bar.
I don't think you could classify that as a working system.
They are not. As I said, this was the cost in the best of hospitals. In government hospitals, poor people get medical care for a fraction of it. Of course, the health care system is still not good, but I'm convinced that a US like system of insurance is not a solution either. Canada and some other countries have it much better.
>In fact the US would look cheaper for the majority of the population.
No, it's not. Had this system been working, millions of Americans wouldn't go outside USA to get basic treatment (many of them go to India). Something is fundamentally wrong here ([1], [2], [3], [4]).
[1] 7.5 Million US residents travel abroad for care each year: http://www.cdc.gov/features/medicaltourism/
[2] Medical Bills Are the Biggest Cause of US Bankruptcies: Study : http://www.cnbc.com/id/100840148
[3] Why U.S. Health Care Is Obscenely Expensive, In 12 Charts : http://www.huffingtonpost.com/2013/10/03/health-care-costs-_...
[4] 'Medical tourism' draws Americans to India : http://communities.washingtontimes.com/neighborhood/traveler...
It's not 7.5 million US residents per year, it's 750,000.
And this:
"The nonpartisan Fraser Institute reported that 46,159 Canadians sought medical treatment outside of Canada in 2011, as wait times increased 104 percent — more than double — compared with statistics from 1993."
Calculated upwards, that would be 404,000 or so on a population equal basis with the US. A lot of Canadians are seeking treatment abroad too.
You should clarify your comment by mentioning what state and city you live in, how much you earn a year, and how many multiples that is of the average income in India, and in your state.
Healthcare in India is operated by the states; there is no national program. Care is not consistent. [0]
In India, can doctors provide food? I'm serious. 42% of Indian children are malnourished [1] - a frighteningly higher rate than the average malnourishment rate of sub-Saharan African countries.
This is but one figure representing India's overall healthcare system (or lack thereof), and unhealthy populace.
[0]: https://en.wikipedia.org/wiki/Health_in_India
[1]: https://en.wikipedia.org/wiki/Healthcare_in_India#Health_iss...
Despite the diplomatic meltdown between Fiji and the western world, Australia and NZ continued to offer healthcare to Fijians. It was a decision by the Fijian government to start sending people to India instead. [1]
Also, Fiji has very large ethnic ties with India. [2] The country has a history of deep social and religious divisions as a result. [3]
I don't think there's any suggestion or indication that it's actually preferable to have surgery or treatment in India rather than Australia or NZ.
As an Australian, I'm sorry that Fijians can't come here anymore under their healthcare program.
[0]: https://en.wikipedia.org/wiki/2006_Fijian_coup_d%27%C3%A9tat...
[1]: http://www.fiji.gov.fj/Media-Center/Press-Releases/FIJI-LOOK...
[2]: https://en.wikipedia.org/wiki/Indians_in_Fiji
[3]: https://en.wikipedia.org/wiki/Indians_in_Fiji#Religious_and_...
Australia and New Zealand only deny medical visas for people in the Fiji government and military (and their family).
I do not understand the countries that don´t have this, it is just logical that if you pay when you are healthy you must be 100% covered when you are sick (without excuses or having to justify anything). The most strange thing is that what I pay for my health insurance is less of what I heard it is pay in USA (I pay 70 USD per month) but the difference is big: I live assured that whatever happens I'll be covered, no disease will make me lose my house.
The problem is not about beeing a developing country or not, it is about political decisions that obligate insurances to do what they must do.
No system is without its problems. I'm just glad in the US it's not about quality or quantity of care, just funding.
http://breastcancer.answers.com/medications/the-cost-of-neup...
The cost of the drugs was just picked up by the medical system instead of my pocketbook.
I have seen this argument before; American health care is expensive because everybody else is a slacker who can't pay. It's obviously false. US pharma companies aren't subsidizing Canadian drugs, the Canadian government is. That Canadian drug prices are lower is more a function of the broken US medical system than anything else.
... However ...
I got diagnosed with Cancer (lymphoma) in 2008. I was xrayed, CT scanned, blood tested and ultrasound guidance biopsied so fast that my head spun. From initial lump discovery to the onset of chemo was only a couple of weeks. Quality of care was first rate, and it's been 5 years. My experience with Canadian health care for a life threatening condition was extremely good.
I should also note that the cost of my medication was a significant $100k+ figure, not including chemo drugs, and this was all covered to an out of pocket of under $1k.
I was a working as a contractor, and didn't have any private medical insurance of any kind.
Needless to say, looking at the cost of treatment, and the ruinous effect it would have had on my (and my wife's) finances, I am very glad I live in Canada.
Imagine not getting treated for cancer for 3 years after being diagnosed.
My momma, 55, otherwise ridiculously healthy, has terminal brain cancer among other things. She was diagnosed five days before her 55th birthday (10/25) this year -- [seemingly] out of the blue.
While her and my father have insurance (through United Health Group), there's no smooth sailing because her treatments are so "specialized".
I, at 22, cleaned out my savings and checking just to make sure that her treatments will be paid for, and additionally hire a wicked-awesome in-home PCA to make sure that she's living comfortably when I'm not able to be there.
I won't get into the logistics of why my father / her husband won't pay for things.
Never been so proud to eat Ramen Noodles.
Edit: you guys make me tear up. Thanks for the support and kind words.
That's one of the most powerful statements I have heard in a long time - I'm sure she's proud of you. Good on you.
Plan for the worst, hope for the best.
A great doctor bought us three good years - far longer than anyone expected.
I always say, if I can give anyone one piece of advice it's "Don't wait!". There's no telling how long any of us have left.
Fortunately for me, the people at Mayo Clinic are amazing and gave treatment they knew we couldn't even start to dream to pay for. Not everyone is so lucky.
Ended up dropping the whole thing though. And lawyer said it was slam dunk malpractice, but reality bites and it's amazing what hospitals can do.
Paraphrasing from a a recent movie "Every one should live by a code...glad to know that yours is Family."
Your efforts are truly amazing. I hope one day in the face of such challenges I could be half the person you are now.
I'm not sure why your first instinct is to think that he should rely on his country rather than on his family and friends.
That's awfully sad, albeit not as sad as the fact that it was successful.
He's not saying Obama or Bush or Clinton or Bush or $foo, he's saying the government.
If Richard and his family would not have to care about the money, this thread could be about nothing else beside him and his achievements.
That's the thing though. It has only become a right or entitlement in the places that provide it. I'd wager people would feel the exact same way if their government provided housing when compared to countries that don't provide housing.
No doubt entitlement priorities vary based on the development level of the country, the culture, and so on ad infinitum. There is hardly a social safety net in China for example, the population is heavily expected to handle its own savings. Most likely their population will gradually demand more entitlements, looking to copy what others have done.
There are obviously all sorts of arguments that focus on bankruptcy, high costs, the burden of being without a job, and so on when it comes to healthcare - that sound far more reasonable than other entitlement arguments (eg should everyone be given a free yacht).
America of course does provide free and or heavily subsidized housing (not free house ownership mind you), in every state in the union in fact (along with federal programs). Mostly it's a matter of what you qualify for, and where (varying based on what's available in your location, and what your income is, etc). I don't think all entitlements are created equal in terms of demand or import; the population of a country is going to regard some as far more important than others.
This is why in France we have universal healthcare, that goes beyond legal residents but also benefits illegals (with AME, Aide Médicale d'État).
1) Larger risk pools are better. Let's say you have your ten closest family members and friends, and they're willing to spend an arbitrary amount to save your life. Despite that, a diagnosis like brain cancer or a severe heart attack with complications is likely to bankrupt all of them. Make it hundreds of millions of people, and the bumps are smoothed out to oblivion.
2) Lots of people are embedded in communities that have fewer resources available than other communities. You're damning them to die--or, in this case, die in a significantly less dignified way without proper palliative treatment--just because their friends and family happen to be poorer.
3) What about the people who don't have many family members or friends? Do we just want to condemn them to suffer, merely because they thrive with only a few friends instead of many?
Private insurance helps with these problems. Some people, however, aren't willing, knowledgeable, or rich enough to purchase health insurance. Even if you hold them in contempt and think that they deserve to die because of their lack of insurance, as a society we don't like that. So we can either (a) provide everyone with public health insurance/care or (b) require everyone to purchase insurance. Some countries go with (a), some with (b), most a mixture of the two.
It's best that whatever country we're in, we look at the countries that have had the best results in health outcomes and copy them as best we can in new local contexts.
Does that make sense?
reddit.com/r/igotout
Guys (and gals) of HN, let see if our little community can get to together to help Richard enjoy his last days (and maybe provide a bit for his family if we do really well).
Most of us can miss $20, and Richard and his family need it more than must of us do..
It takes seconds and you won't even miss the 3 lattes it could buy you.
During the year we worked together, Rich was probably the #1 driving force in PHP support worldwide. This was a time when PHP was still gaining traction and it really needed champions like Rich. He answered thousands of questions, posted sample code, responded to emails from strangers, and basically wouldn't leave his desk night day until he'd helped everyone that came to him (often wrapping up at 2 or 3 am).
Rich is also a huge supporter of local music and when I knew him, he was as much a driving force in the Chicago music scene as he was in the PHP scene. He happily fronted the $$$ to bands to cover the costs of recording and touring with zero expectation of getting paid back and even bought a van to loan out to bands that wanted to go on tour.
Needless to say I kicked in some cash. I'm glad to see he's getting some support here. He truly deserves it.
I'm completely broke (dealing with my own circumstance, but it's got nothing on his) but I still kicked in $20AUD -- I'd rather it help Rich as a thanks, no matter how little.
You're right, Rich truly does deserve it.
Sigh Someday the govt & banks will catch up with the 21st century.
If someone can put a little extra in the bin on my behalf, I'll look for a chance to pay it forward. Thanks
Then he passed away.
His kids didn't lose their house. His kids didn't lose their opportunity to go to college.
Not to too bad for pretty small city in the middle of nowhere in Mexico.
I wonder how one of the richest nations on earth, with the biggest army, can't provide for the healthcare of its citizens when much poorer nations (mexico, uruguay, etc.) can.
A matter of priorities I guess...
Given America is by far the world's largest economy, and possesses a fairly complex sociocultural system (significant diversity in most every respect, many competing large interests), I'm not sure why anybody would think transitioning to a soft-Socialism or "modern welfare state" model would be fast or easy.
EDIT: I live in Chicago and believe Rich does as well. Looking to help.
He mentioned that he suffered a seizure and that led him to be taken into the ER. Does he mention any other previous symptoms that might have led up to it? In general, what symptoms do exist for this sort of thing?
Good video: http://www.novottftherapy.com/patients-about.php?ID=3
It applies an alternating electrical field to the brain to prevent cellular replication. It must be worn for 18 hours/day for several months to see 'better' outcomes. I scare-quoted 'better' since the therapy improves a 0% survival rate at 36-months to a 10% survival rate, which is obviously an improvement, but just highlights how awful glios are.
Paper which led to FDA approval: http://www.virtualtrials.com/pdf/Stupp_NovoTTF.pdf
Can someone explain to me why is he asking for donations? Doesn't the insurances cover with these expenses in USA?
"insurance" doesn't cover catastrophic stuff (there is some) but also covers everyday things like checkups. (The analogy is car insurance covering oil changes and tire rotations.) You'll pay a deductible (eg $30), the insurance company will pay the health provider, you'll get half a rain forest full of numbers in the mail, none of which reflect who actually paid what to whom. (There are extra negotiated charges and discounts between various parties.) The health care providers try to make their numbers as large as possible.
"Insurance" companies won't make money if they pay out, so they have all sorts of limits. For example there may be annual or lifetime limits which are trivial to hit in cases like this.
The various estimates are that around 70% of bankruptcies are due to medical bills and that 75% of those are people who had insurance. Example story http://www.cnbc.com/id/100840148
This was my experience just trying to get some blood tests http://www.rogerbinns.com/blog/gplus/the-first-rule-of-the-a...
Insurance companies are like ISPs. You're fine until your usage pattern significantly exceeds the average.
At that point, the insurer will do any and everything in their power to drop your coverage and/or hasten your demise by denying or delaying treatment.
On a related note, this is why some of the people who are unable to keep their misleadingly cheap plans post-ACA should actually be happy. They would simply have been dropped anyway - when they actually needed that coverage.
Sorry, but I cannot understand how a high skilled worker in a high income country has to beg for money because medical problems.
It's pretty messed up.
>Aren't any insurance provider covering these kind of things?"
On paper, yes. In reality, no. I'm not aware of any sources of data on which, if any insurers are better in this regard. The insurers obviously have no reason to divulge this and the folks who experience are likely dead or dying.
>"If so, why anyone would take a insurance that doesn't?"
As the other comment points out, most people receive insurance through their employers, limiting their options. It's possible to self-insure, but prohibitively expensive for many people.
Even among those who are well-paid. The costs are high enough that it's quite common for married couples, particularly those who have or plan to have children, who could otherwise live on one income to maintain a one job "for the benefits".
Finally, there's an incredible amount of misinformation about how these things work in practice and about legislation like the Affordable Care Act aka "Obamacare" which aims to address some of the worst parts of it.
>"Sorry, but I cannot understand how a high skilled worker in a high income country has to beg for money because medical problems."
Medical care in general and cancer treatment in particular is atrociously expensive. Paying out of pocket you'd be looking at several thousand per month for drugs, thousands per day for hospitalization and tens of thousands for major surgery.
Even with insurance the co-pays and deductibles (amount the insured is required to pay) can range up to a significant percentage of those costs.
Unless you're fabulously wealthy, a terminal illness generally means living exactly as long as your insurance and/or the generosity of others allows.
He would be in the wealthiest 1% of the entire world population, yet needs donations. What does that mean for the billions of others?
We've got no idea what Richard earned, but saying "six figures" can make it sound fabulously wealthy. $999,999 is six figures. So is $100,000. $100k in suburban Chicago raising a family is quite possible, but likely isn't going to leave a whole lot of room for savings. He may have had moderate savings that were wiped out in 2008. He may have had savings and needed to drain those to pay for another medical situation in his family earlier. We just don't know the details.
1%? Hardly. Someone earning $100k might be in the top 10% - http://www.financialsamurai.com/how-much-money-do-the-top-in... - still obviously towards the top, but the phrase "1%" has other "occupy" connotations that simply don'y apply to Richard.
I said top 1% of the world, not US. Someone earning $100,000 is probably in the top 0.1% actually.
But yeah, the rest of your comment is fair. I wasn't being judgemental about his request for donations; Merely pointing out how disturbing it is that despite his relative wealth, he needed help. This isn't a jab at him, but at the state of the world we live in.
Some plans have maximum out-of-pocket costs per year... say $20k, some have no maximum. Some plans have maximum benefit... so the insurance company will only pay up to a certain amount... say $1M
These are just some of the choices, your history and where you live affect how much each of these costs. People choose their level of coverage and it's cost (or their employer does)
There are some cases of insurance companies trying to screw people out of what they are rightfully owed, but there are lots of cases where the coverage just isn't adequate for the issue and the bills are still very expensive.
Can anyone confirm that this is his twitter? https://twitter.com/LynchRichard
We can send Dogecoins via Twitter.
In fact, if HN really wanted to make a dent, maybe 'mining for Richard' would be a worthy campaign given the mining power likely at the community's disposal.
I am Not in good $ituation now but as someone who had similar problems in the past(medical bills and no money) I do feel it.
Life sometimes sucks but we can make it a little better.
Donate if you feel like it is ok to donate even small amounts.
(Please consider emailing me. I am not trying to derail this discussion. It is just that I have spent years talking about this and I am usually pilloried. It is very frustrating.)
I can be reached at: reportemp@gmail.com
I think the atheist would say you won't know then, either.
If that's not worthy of denigration, take it up with Jesus himself, who said pretty much the same thing.
"When you pray, you are not to be like the hypocrites; for they love to stand and pray in the synagogues and on the street corners so that they may be seen by men. Truly I say to you, they have their reward in full. But you, when you pray, go into your inner room, close your door and pray to your Father who is in secret, and your Father who sees what is done in secret will reward you…"
Matthew 6:5-6
There's just so much assumption and ill will in this subthread. Get a grip, people.
Maybe you should get out more. Or perhaps just be even a little more generous in your assumptions. Many people do believe in... well, lots of things they pray to. You don't have to; I don't either. But that doesn't mean everyone else's motives are somehow always shallow and selfish.
Sorry, but your comment is a whole lot worse than his.
Wonderful argument good sir!!!
Straight from his thanks page at the very top.
Who is trying to do that?
Furthermore, there are many, many threats to longterm survival, not just mysticism.
Mysticism prevents us from dealing with those other threats rationally, and that makes it #1 on the list of mental bugs to fix.
You. Stop it.
PHP is the first language that I ever learnt and it has had a great influence on my life. Thank you for everything you've done Richard. Please spend the rest of your days peacefully.
https://www.barona.com/about/community-relations/donation-ap...
http://www.themillcasino.com/about/donationsform.cfm
And maybe there are other sites that sponsor charitable organisations.
The button was a little hard to see for me on the site (particularly on mobile).
The URL that the button sent me to (I forget whether Paypal makes this useless or not, but I'm hoping it works):
https://www.paypal.com/us/cgi-bin/webscr?cmd=_flow&SESSION=Q...
My grand father got diagnosed with cancer recently and my mother got cluster headaches. We are in France so everything is mostly taken care of and I couldn't imagine what it would have been otherwise.
FWIW it's retirement homes that broke family around here.
I am really glad this made to the front page of HN, it is great to see people helping him and his family out.
Richard, thanks for your contributions.
I have been coding in PHP and other open source languages for ages but never donated to such open source organisations. I feel should do more. This is my start. Did my bit of sharing :)
Do the smart, logical thing: build cheap wooden ramp, problem solved.
Local regulation thugs ("zoning enforcement" or similar) come around and destroy ramp or otherwise take it away / require its removal, fine you for daring to violate their rules. You can sometimes avoid this step if you pay into their bribery system (more common in some locations than others, eg Los Angeles runs strictly on a bribe system).
If you're lucky, then there's an outcry in the community, some local government thug's feet are put to the fire, and they relent. Said thug then holds a community celebration anointing the new ramp, noting how it was all just a misunderstanding, and said thug is not really against people with cancer or disabilities.
This whole process will take weeks or months to play out.