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Comment by forca | Hacker News Reader

Great read. This just show how evil for-profit medicine really is. The fact that the pay is so high in the west is disturbing. I really pray we see a single-payer socialised system in our lifetime in the US. Growing up with socialised medicine has shown me the truth. No doctor, no matter how talented, needs to make what they do. All of this should be government run as a non-profit. Government should mandate and force all pharmaceutical companies into non-profit status as well for the good of mankind.

I'm sick to death of not being able to go to hospital here in the US, even with insurance, because what with the co-pays and deductibles, it costs a fortune. I just don't go, and I am in need of surgery that I cannot afford.

QUESTION:

Would an Indian facility in India treat me for a relatively small amount of money? Even after the flights, it would still be cheaper than the $22k I've been quoted here by multiple sources.

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Great read. This just show how evil for-profit medicine really is.

I think you mean how evil semi-socialized, heavily regulated medicine really is. India's medical system is as close to free market health care as I've ever encountered.

You walk into a hospital, ask the price, pay it. If you don't like the price, you can go to a different hospital and ask them. If you have insurance, you send them the bill afterwards. That's basically it, and most hospitals are for-profit. In my experience, the government hospitals are significantly dirtier than the private ones. Employer sponsored health insurance isn't a big thing. Doctors who won't talk to you without insurance [1] are more or less nonexistent.

Most likely an Indian facility can treat you. The cost is unlikely to be more than 1 or 2 lac (e.g. $3k tops), depending on your condition. Throw in another $1k for the flight + $1k for a decent hotel. If you want to learn more, send me an email.

[1] In the US I'm willing to pay cash for care before treatment, but most doctors won't talk to me. I'm told it attracts undesired regulatory attention.

The U.S. insurance system is not semi-socialized on that part, it is a result of collusion between hospital administration and insurance companies to maximize profits instead of health of the nation. Corporatism keeps laws on the books that reduce competition and take the decisions out of the hands of patients and doctors and puts it into bureaucrats.

Medicaid and Obamacare are the socialization aspects, which try to work within the Corporatist solution... we should have and should just tear the whole system apart.

Too many good minds work in billing and adminstrative research and development, not in medical development.

Disclaimer: I make medical billing and administrative software. I have a job because of a broken system... I'd sacrifice my comfort for a better system.

The US insurance system is heavily tuned to make some people pay for others. Employer sponsored insurance, together with accompanying regulations about individual costs, is tuned to make sure the smoker and the healthy person pay the same price. See also community rating in the private market. On top of that, the US government pays more for it's own socialized medical programs than most other nations do.

And this isn't even getting into all the ways regulations micromanage doctors and other parts of the system. Not to mention micromanage financial services - India actually has innovation in that space.

Any theories which claim that for-profit systems are horrible need to be tested against the Indian system. It's mostly for-profit, free market, etc - all the incorrect claims people make about the US are pretty much true there.

Employer sponsored insurance, together with accompanying regulations about individual costs, is tuned to make sure the smoker and the healthy person pay the same price.

That is kind of what insurance is for though - to level out the cost for everyone.

It's a common misconception that smokers cost society. The truth is, smokers die earlier and cost tax payers less in insurance benefits and health care than non-smokers. [1] We should be encouraging people to smoke if we want to save money. (I'm joking!)

[1] http://www.plosmedicine.org/article/info:doi/10.1371/journal...

That is kind of what insurance is for though - to level out the cost for everyone.

No, the point of insurance is to reduce the variance of an individual's future cost. Due to the law of large numbers, averaging across independent identically distributed people is equivalent to averaging over the future, but that's a side effect.

Averaging over independent non-identically distributed people is NOT part of insurance at all - that's what I'm describing as "the socialist part".

An example illustrating the difference - say you have 10 dice, and if a die rolls a 6 it costs $1,000. You also have 10 coins, and if the coin comes up heads, it costs $1,000. Insurance is when you charge the dice $166 and the coins $500. Socialism is when you charge everyone $333 - that's redistribution from the dice to the coins.

The link about smoking costs is interesting, however that applies at the level of government paying for lifetime costs. Annual costs are higher. So insurance for this year should cost the smoker more than the healthy person.

There's this story about health care that goes like this:

1. There are two kinds of health care systems in the world.

2. The first kind is private-run, profit-driven and super-expensive, the second kind is government-run and much cheaper.

3. America has the first kind. Every other country has the second kind.

You can see that story being repeated all over this page.

You forgot to mention that that story is a fiction, albeit a popular one.

That's true

I agree with everything but the "not semi-socialized" statement. It is half socialized, half corporatism with the worst of both worlds. You even refer to the socialized aspects which it wouldn't have were it not semi-socialized.

> we should have and should just tear the whole system apart.

And replace it with what? I left Canada because of the abuse of their healthcare system, so please, share with me a model that isn't like Canada's that you'd want to move to?

I agree with almost everything you have written. But I'll add that it can be quite a bit more complicated than "ask the price, pay it". You're right about the financial aspect. But the technical aspect can be quite muddled.

Many doctors tend to show off expertise that they do not really have. I have a dead family member to show for as an instance of doctors who are too too stupid to understand what the reports were screaming at them. My family member did get top-quality care after an emergency incident put them under the purview of a different department: the department that the initial report had already made blatantly clear. And this was at one of the best hospitals in Bangalore. I have chronic health issues, myself. I had to "shop around" until I found a doctor who was (1) aware of the current recommended treatment procedures and (2) not making grandiose claims about the success of my treatment options.

And yes, medicine here is quite wonderfully capitalistic. Most drugs are very cheap, and the penurious get "BPL cards". That's enough for most people. However, things aren't all that rosy for people with weird chronic diseases, or diseases that need the latest in therapy... like cancers, etc.

> I think you mean how evil semi-socialized, heavily regulated medicine really is. India's medical system is as close to free market health care as I've ever encountered.

> You walk into a hospital, ask the price, pay it. If you don't like the price, you can go to a different hospital and ask them. If you have insurance, you send them the bill afterwards.

Yeah, it looks great from the perspective of rich people like yourself. It's not so great from the perspective of many of India's poor people, especially in rural areas, who cannot afford the market rate.

I'm aware that most people in India can't afford even a small portion of the things Americans take for granted. Forget medicine - what about a flush toilet or clean drinking water (let alone expensive things like cars or even two wheelers).

Poverty is an orthogonal problem.

> who cannot afford the market rate.

Any sources for that? As far as I have seen, admittedly, a fraction of the massive population, cost of healthcare is not the issue. Some of my doctors charged me rather high amounts and explained that they use it to offset the cost of treating poor people for free. Drugs are extremely cheap, and many docs give it away to the poor. India has problems with access, sanitation, hygiene, and education. As far as I have seen, "cannot afford the market rate" is not a common issue.

You would think Indians are lucky in this regard. It's actually the opposite, despite being a software developer who earned reasonably well (compared to the norm) I dread the thought of going to a good hospital. I just don't have the sort of money they ask for. I cannot even imagine what it is like for a poorer shopkeeper or factory worker. For comparison, I earned $1000/month after 6-7 years of experience. $1700 after a decade of experience and ability to program in 3-4 languages. Most jobs will earn you around $500-$600/month.

That is why in India people save money because the parents tell them from childhood that hospitalizations / accidents can cost a lot of money so better save up in case you get sick.

If you make a lac/month, surgeries of the sort I've received will be one month of income. In the US, prices will be both higher relative to income and unknown, i.e. the doctor just won't tell you.

As for saving, people in the US don't save. And they refuse to spend money on medicine - I know a woman who easily spends $10-20k/year on entertainment, but balked at spending $8k to repair her knee.

Same thing in Vietnam. A family member ended up sick so she went to the brand new, for-profit hospital. Spent 1/2 a day in the ER and the cost was $150USD.

If people can afford it, they would never step into a gov't run hospital in Vietnam.

Interesting, but I want, in my lifetime, to see a more or less tax-based system that means I see my GP and pay nothing save what I'm taxed in my pay packet every fortnight. There needs to be caps on costs. Costs determined by government, not for-profit entities. In essence, health care is a basic human right. I don't mind a slight ~10% uptick in my taxes to pay for it. That 10% is still orders of magnitude less than I pay annually for health insurance, which is sinfully expensive. I'm praying Hillary Clinton, when she gets elected, will finish what she started.

> That 10% is still orders of magnitude less than I pay annually for health insurance, which is sinfully expensive.

I don't think you understand what "order of magnitude" means. You pay more than your gross salary for health insurance? If 10% is "orders of magnitude less", then you must pay at least 100%.

Also, I don't know where you are buying insurance from, but I can get insurance for about 4% of my gross salary.

Good on you, and I mean that nicely. My insurance monthly is 1/3 of my salary after taxes. Blue Cross through my employer. I tried to fall back on something from the ACA Web site, but because my employer offers insurance, I don't qualify for the better rates. Stupid rules.

> My insurance monthly is 1/3 of my salary after taxes. Blue Cross through my employer.

Uh, that 4% is if I was self-employed. I pay $35/month through my employer.

> I tried to fall back on something from the ACA Web site, but because my employer offers insurance, I don't qualify for the better rates. Stupid rules.

The price I can get insurance for through the ACA website is the same as the unsubsidized cost of what I get through my employer. I suspect that is because we are a small company that is not getting a break from Blue Cross. I honestly don't know if I am benefitting from being in Texas, but I can buy a gold plan for $350/month.

Just a note: Most often, it is not the doctors' salaries or time that is the major contributor to the cost of surgery. Instead, the ridiculous fees are created by the hospital administrators as a result of a long history of negotiations between insurance providers and hospital admins. Simple parts that cost $0.10 to manufacture will be billed at $20, rooms will be billed at $8000/night, etc.

To my knowledge, most doctors are trying to actively reduce healthcare costs on the end user. They don't see much of the profit, that just lines the coffers of the billion dollar for profit hospitals out there.

There are a lot of reasons American health care costs more. Most people want to blame it on just one group or reason (which not coincidentally matches their political priors).

The answer tends to be "a little bit of everything." And it's really hard to cram down the costs on someone who is already making a certain amount of money.

I mostly agree, but Doctors get paid a lot too. We let the American Medical Association artificially limit the number of doctors in order to keep their salaries up (which has the side effect of over-working the doctors).

The costs you mentioned are the primary ones, but doctors salaries are a major contributor as well.

The number of physicians is primarily limited by the number of available residency slots, over which the AMA has little control.

It's not their salaries?

Watch them come to work, note the care they drive. Follow them home, note the house they live in. I've yet to see a dr in the US come to work in a civic, or live in a modest house...

Right, the answer is somewhere in between.

When I worked on an ambulance, I'd be at the hospital several times a day - in the ER doctor lot, a sampling of the cars:

- multiple Tesla S's - 3 Porsche Cayenne - 2 Audi S5s - several Escalades

Whilst there are two sides to the story, let's not pretend that doctors live hopeless lives, saddled with a lifetime of crippling student loan debt, barely able to keep their heads above water to selflessly help people.

There is a medical group in Kansas/Indiana, I think, that was trialling the novel idea of "fixed price surgery"... looking at right on $100K for cardiac bypass.

Me? To look at my explanation of benefits, the billing for my kidney stone last year peaked at over $60K.

Did you see the age of those same doctors? Virtually guaranteed none of them were < 40.

A fair calculation of salary is some evaluation of (years of training required * intrinsic skill required * benefit to society). If you accept that, then doctors are surely near the top.

The salaries are high but the fact that a surgery costs $34,000, most of it doesn't go to the Doctor. I'm sure they get a lot, but the hospital needs its cut, the insurance need it's cut, etc.

You have no idea what you are talking about. India's hospitals are run as profitable businesses. There is literally no government support. In fact, practically speaking, there is almost no government regulation period. Reputation and successful past patient experiences are the signal that consumers use to select a medical institution for care.

The American system is the one that is highly regulated and semi-socialized.

The Indian system is free to innovate as any start up can innovate. That is why American doctors are stunned when they go to a private Indian hospital and see the amount of digitization and high tech involved in Indian care.

You should watch this so you become enlightened as to how entrepreneurs in India are reducing the cost of health care, but still getting world class outcomes:

https://www.ted.com/talks/thulasiraj_ravilla_how_low_cost_ey...

Great read. This just show how evil for-profit medicine really is.

There are no for-profit hospitals in India? From what I've seen from a quick google search, all the best ones are private, for-profit.

Americans are quick to brand things evil.

Of course there are for-profit hospitals in India. All the private ones are. Its just that the system has not deteriorated so much as the US, that price of basic care has shot up so much.

The procedure described in the article is reasonably simple. I am not a doctor; the reason I know is my dad had the same procedure, once in 2005 and once in 2013.

Once the procedure was done, his doctor had a post-surgery chat with my mom and me, and gave us the box the stent came in. The cost of the Stent was approx Rs 150000. The whole cost was about 200,000 (including preliminary testing, doctor's fees, stay, surgery, post-surgery, and a ride home). We did it at one of the top hospitals in India (http://www.madrasmedicalmission.org/), and talking to some folks there, I was told that the profit was made in the cost of the Stent. Even though the box quoted Rs 150000, the hospital acquired it at 1/10th that price directly from the manufacturer (Abbott).

"This just show how evil for-profit medicine really is. The fact that the pay is so high in the west is disturbing. "

Pay for which workers? More than Physicians are involved.

I would say that the average billing clerk in the US and the average nurse in the US and even the person who runs the mechanical systems and drive the emergency vehicles as well as any supplies (if they are sourced locally) are much much much cheaper in India than in the US.

Separately in the US I know of Indian doctors who could practice in India but fail to do so. And they have even pointed out how much "help" they could have (they actually called them "servants") if they lived over in India. Labor is much cheaper in India. This may not account for all of the price differential but running a Hospital in the US is almost certainly way more expensive than in India.

So a better metric is % of GDP spent on healthcare, and the relative outcomes.

The US spends a much greater proportion of GDP[1] on healthcare compared to many other industrialised nations, and the outcomes are broadly the same as those who spend far less.

[1] http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?order=wba...

> Would an Indian facility in India treat me for a relatively small amount of money?

http://www.bbc.co.uk/news/health-10837726

While there are some good ideas the ruthless efficiency is a bit scary.

If they have good outcomes, which they seem to it makes sense. While there may be a place for a hospital that does it all, it makes perfect sense that you would have a hospital that does just heart surgery and a lot of it.

You probably have less contagious people around; you're going to have staff that is familiar with the various complications available all the time; and you can probably negotiate better prices based on volume for the various tools and disposables; it just makes good sense.

Why is it scary?

Is there something inherent about health care that prevents an industrial philosophy towards production?

Best practice around canula tells us to do one thing. But if you have all these patients and you have your own data you can drop the standard a little bit. You've saved a bit of money, and raised risk by a tiny bit. While no surgery is risk free it's kind of odd to increase risks to save a few dollars. I guess I don't mean scary, just, it's something to think about.

You have no right to the free labor of others. Why should a doctor work under indentured servitude to whatever this nonprofit decides to pay him or her after over a decade of study. That's outright theft.

Maybe? Medical tourism is a well-established thing.

I've often thought about establishing a medial tourism non-profit. Think Watsi.org, but for first-world consumers of healthcare, taking them to near-first-world country locals where the cost of the same quality service is much lower.

> Great read. This just show how evil for-profit medicine really is.

To be fair, I can share an appalling story of how Canadian healthcare abused my son for more than a year, and how it wasn't until we started making plans to move to the US that we saw much better care (in the US).

Please do.

I told my story many times. I'll give the short version. My son got an initial diagnosis of autism as 18 months while living in Quebec. Despite laws stating otherwise, after a year of waiting (and being flat out lied to and dealing with gross negligence), we'd had enough and moved to the US, where we were able to start getting care faster than it took to get our stuff moved down here, all at no cost. In Canada, the wait time was over 3 years for public care, and going the private route was still a 1 1/2 year wait at a cost of $30k+ a year. In the end, I'm left with the knowledge that I trusted in the Canadian Healthcare system for over a year, and the price was putting off my son's early intervention. My younger son (also autistic) received care at 18 months, and is doing much better.

To this day, I still can't share this without getting really angry at all they did, or didn't do.

Yes! I don't know about India, but if you went to Argentina you could probably get treated for pretty much anything for that amount.

I have my own story about how shitty the US health care/insurance system is, but I've told it before.

forca, email me? I'd like to help you out and I can probably do so. So don't hesitate. Let's talk.

I'm based in India and you haven't described your condition, but I can tell you that yes world-class healthcare is available in India and compared to US at relatively affordable prices. I would like to help you out to arrive at an objective decision.

There's no contact # or email in your profile so I can't reach you.

>No doctor, no matter how talented, needs to make what they do

You are blaming the wrong person.

The question is: would you be comfortable being treated in India if India had 19th century medical equipment and a 19th century medical practicum? Because that, effectively, is what you are condemning your great grandchildren to.

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