I have garden-variety hemorrhoids. All I need is one or two 30-minute in-office procedures to treat these things. I'm a senior software engineer working for a FAANG company with "top-tier" employer-sponsored health insurance. I've been trying to get this stuff treated for eight months. I've gone to at least seven or eight appointments with several different offices and I've already spent $3000 out of pocket, and I might actually start treatment in January. That's fucking insane.

The next time I need a minor in-office procedure, I'm seriously going to consider flying to Mexico instead of wasting almost a year of my life fucking around with the ass-wipe US healthcare system.

If you're planning to adopt, broadcast it via your social network as much as possible. If you can avoid going through an adoption agency, you'll only have to pay for the legal work ($7,000 - $10,000).

1) The insurance premiums are tax deductible for the self employed so probably 30% or $8000 less

2) He should have planned to have two of the children in the same calendar year could have saved $14000 (jk)

For profit hospitals subsidized and enforced by the leviathan, what could go wrong?

How much does something cost? Whatever the seller can get people to pay for it. Hospital B charges 6 figures for the delivery of a child? Wow, that's expensive, they must be really good to be able to charge that much.

All the dark patterns, negative dynamics, perverse incentives of bad government, stupid healthcare policy, and humans being shitty combine to form for profit hospitals. Those determine how other institutions have to run in order to operate at all, and they're not being managed by well meaning, good faith citizens looking out for the patients and the public.

There's a reason mangione became a cult phenomenon, and $40k babies, multimillion dollar ambulance trips, and other bullshit are exactly why.

Good luck fixing that mess. I don't even know how to conceptualize where you'd even begin to try to fix American healthcare. It's so tangled up and beholden to all the other problematic elements in modern life that it looks nigh on impossible to repair, so my goal in life is to minimize contact with any element of the system as much as humanly possible.

At least, that is what they did to me.

It's all a scam.

The alternative view, that I would hold if it wasn't for the above considerations, is that first world child rearing is currently an expensive hobby, and why should we subsidize it at all? If it wasn't a personal project most would be parents could easily adopt.

Unfortunately I'm type 1 diabetic which is either a death sentence there, or you are rich. But then I also accidentally broke my collarbone this summer. And I had this weird throat infection.

As a type 1 diabetic I have had to go to the ER numerous times in my life, and as traumatising as that experience can be, I can't imagine the feeling of also being financially ruined for the pleasure of not dying.

It's weird, I know plenty of people who avoid going to the doctor because it's annoying to wait for over an hour.. but I could see that for an American you might just NEVER go. I guess it's like, ok someone in the family is sick, and we're not rich, so we will sacrifice them to the sun gods. Or I guess you go into indentured servitude? There are people for whom $100k is made very very slowly.

I just do not get it! I guess these things add up properly if you are very wealthy, but people here think that it's the function of the society to make sure you can have basic things like medical treatment. Of course it's not perfect here... try going to the dentist for example. Then you're almost in the USA. Somehow it's not considered medical. A long session could run you over $500 or more.

I have compassion for all the USAians out there! If I was USAian and planning to have a child.. I guess I would consider just going to a civilized country for a while, like... I don't know, Rwanda or Ghana or somewhere that can afford people to be alive(?). In seriousness though (as those countries are very far) you could just go North or South. It's closer. If you go to Canada, a lot of times you wouldn't even need to present ID.. you could just.. get treated right there by walking into a hospital, being triaged, and then waiting (admittedly for maybe almost a day).

Always bring fun things to the hospital if you aren't literally bleeding out all over the place, because you'll be in the waiting room for 12 hours if you're in a big city.

But when it's over you're alive and about as rich as you were before. Seems like a good societal deal to me. I'm scared of being trapped somewhere like the US honestly. It's a nightmare scenario. Although I'm sure it's pretty great if you're a billionaire with slaves and so on... but someone has to incur that cost (the slaves from the lower castes).

The value the article comes up with (he says like $130,000) is more like the living wage, which might be a good target. The living wage for Bergen County, NJ, is calculated to be $145k for a family of 4 with 2 working parents, and about $100k for the same family without childcare expenses (1 working parent).

https://livingwage.mit.edu/counties/34003

I am not sure what counts as poor in reality. Obviously the federal poverty guideline is pretty low. It can't really make sense as a contiguous-48-states guideline for the purpose of feeling "not poor". The calculated living wage is above the median household income for most areas. I have not heard a serious proposal for increasing the median (or, preferably, the 30th %ile) income up to the living wage. I reckon that most proposals that involve the government sound too much like communism for the average American voter.

But we could bring the living wage down to the median. We could make housing cheap, reduce our health care costs, and reduce the childcare component.

My libertarian friends criticise this from the point that "everything state-run is inefficient". Even if this is true, they fail to notice that state-run healthcare keeps prices of the private sector down. You don't have to sell a car if you're seriously sick.

In 1992-96 on Russian state TV, there was a translated program called something like "Rescue number 911", with nobody else but William Shattner. (We already knew him at the time.) I got an impression that the US healthcare was impeccable.

keep running US business, but live in a different country n get private healthcare.

It will require nothing short of a full revolution and violence is never ideal.

I think the solution is to create a new parallel medical system, that can slowly replace the old system. Start with medical schools that train Doctors and Nurses that are affordable/free but also require working at this new parallel medical system. They would earn less but would avoid massive loans and have less bureaucracy.

When for-profit hospitals go under, which happens all the time, they can be folded into this new system.

Its "not afford to have children", but instead "not afford to live".

And we're already seeing these strong signifiers of extremism everywhere. Shooting CEO's is halfway acceptable, if they are sufficiently horrible (and yes UHC was horrible).

Violence is more and more routinely considered the only answer that works.

Corruption isn't something hidden, but instead openly done. And this is at all levels, from petty theft, up to 'let's rearrange government to screw the other party'.

Look at how much tax dollars you pay in, and what you get for that. Its more and more a socialist country amount of tax, with low/no benefits to the citizenry. And no, shoveling billions to Israel or Ukraine, or project of the week does NOTHING to help me, my friends, and people around me.

It is pretty bleak. Has been for quite some time. I can understand why some might want to vote for Trump- he did and is still making good on his promises. Terrible promises, sure. But he's doing them.

Far as I can tell, none of the candidates are for the public, and willing to do and help the public. Just feels like a corrupt-o-cracy where if you're not in the In group, you're screwed.

And yeah, extremism, revolution, and revenge is spot on.

All part of the plan. Gotta get that world population down to 500 million somehow. You've had three children? That's above replacement! Shame on you for contributing to the overpopulation problem. /s

Some will argue that consumption drives production but according to the common definition children don’t contribute to GDP.

Assuming governments are going to address population growth/decline then it’s a choice between incentivising births or issuing visas.

Even in countries that have free healthcare births are in decline so it’s not the cost of children alone that is causing this situation. I would argue it’s the economic crutch called immigration.

When somebody is sick we generally save them even if the cost/benefit is poor. No market is going to solve this if you want to save sick people who don’t have a lot of money.

There is no place in the world where health care is solved, it’s one trade off vs another.

The US system is also far far from perfect but your solution is quite shallow and unlikely to fix things in a way society wants.

Of course, but life is just so easier when you can attribute every problem to an imaginary enemy.

That makes me think they are artificially inflating prices so that when the insurance company negotiats their discount, well, it might be the same as what I pay

They're talking about a very particular sort of pseudo-insurance plan.

https://en.wikipedia.org/wiki/Health_care_sharing_ministry

They can and do exclude whole swaths of what normal health insurers have to cover. They don't even have a legal requirement to pay out at all.

https://www.nbcnews.com/health/health-care/health-care-cost-...

> Beyond restricting maternity coverage, many groups’ policies state that they won’t reimburse for prescriptions, routine doctor’s visits, contraceptives or mental health or substance use services. Coverage for medical conditions that predate someone’s membership is often excluded, as well. And health care sharing ministries aren’t required by law to limit out-of-pocket costs or maintain large cash reserves to cover members’ bills the way insurance companies are.

I've run into folks who claim "wine" was a mistranslation of "grape juice", and some denominations don't use wine.

https://en.wikipedia.org/wiki/Eucharist

"The elements of the Eucharist, sacramental bread—either leavened or unleavened—and sacramental wine (among Catholics, Anglicans, Lutherans, Eastern Orthodox and Oriental Orthodox) or non-alcoholic grape juice (among Methodists, Baptists and Plymouth Brethren), are consecrated on an altar or a communion table and consumed thereafter."

Is that true for a median-wage earning person?

Waiting times for appointments and procedures can very widely in the US. Approvals to get needed treatments can also be denied for seemingly flimsy reasons in the US as well.

A lot of countries are likely clear overall losers though.

Healthcare has to be rationed. Rationing by market is the least bad kind of we learn anything from history... Too bad healthcare in the US is not a market in any way or form, and in fact the most expensive least DALY efficient interventions (Medicare) are subsidized at the expense of everything else.

As fun as it sounds to go back to 25-50% infant mortality, I would prefer we keep this in hospitals and do cesarian sections and other interventions when necessaru.

  Health spending in 2023–24

  In 2023–24, Australia spent an estimated $270.5 billion on health goods and services– an average of approximately $10,037 per person. In real terms (adjusted for inflation), health spending increased by 1.1%, or $2.8 billion more than spending from 2022–23. 

  In 2023–24, health spending accounted for 10.1% of the gross domestic product (GDP) in Australia, approximately 0.2 percentage points higher than in 2022–23.

From the bottom:

  In Australia, 15% of all expenditure on health care comes directly from individuals in the form of out‐of‐pocket fees — this is almost double the amount contributed by private health insurers.

  There is concern that vulnerable groups — socio‐economically disadvantaged people and older Australians in particular, who also have higher health care needs — are spending larger proportions of their incomes on out‐of‐pocket fees for health care. 

  A 2019 study identified that one in three low income households are spending more than 10% of their income on health care. 

There's little to no public advertising of prescription drugs, cheap generics are widely available from federal scale bulk negotiation deals.

Health outcomes are greater life expectancy than the US, national scale cancer survuival rates are better by a few percentage points (IIRC - they are close but higher).

Australia has long had an innate "we're all in this together" society built on individualism. It's not great, it's not perfect, but the first instinct is generally to look after our own - across the board.

If I worked in the US, I would have health insurance and would be paying lower out of pocket costs than I would in Australia. Combined with the higher salary and cheaper housing that's a pretty good deal.

Edit:

We allegedly have universal healthcare but that doesn't cover any actually competent specialist (need private healthcare for this) so paying $400 for 25 minutes of a psychiatrist every 2 months and $95 for 7 minutes of a GP is common.

It’s basically the Kohl’s pricing model except there’s no hope of ever finding out what that single bottle of meds will cost until you’ve completely forgotten it 6 months later and you get a bill for $600.

fixing homelessness doesn't make me money

1. The quality is high.

2. The OP pays the full price.

1 is incorrect. The OP is paying a lot, but is getting the same subpar quality healthcare as everyone else. He differs with people without money in only one thing: the latter don't get the full access to the subpar health system. The system itself is the same and its general quality is well indicated by the core metric of the infant mortality.

The health system is subpar and there is absolutely no reason why such a system should cost that much.

That's really nice - are there state/government subsidies involved?

I work for a top tier company and my premiums are not that much lower than yours.

When I checked the public market's insurance options, getting a $3000 or so deductible was a lot more expensive than yours if one is not low income (i.e. not subsidized).

Edit: I'm too dumb to know whether to include superannuation as a tax or not so I'm not sure if I'm right or not.

The sound way to manage costs and avoid these games is via Medicare for all, with premiums paid by progressive rate taxation of income. Maybe even wealth beyond a very large amount.

You can get it for basically nothing in the public system but you might have to wait a year or so if it's considered elective (emergency surgery is immediate of course), but most people with private health insurance can get the procedure done within in a few weeks and would only have to pay about $1000 (US$650) out of pocket with a $500 excess (which is pretty common), because the anaesthetist and surgery are usually invoiced separately. Some plans do have lower excesses (like $350) though if you pay higher premiums.

And what the OP is pointing out is that if your injury is $30K, insurance covers nothing, because the premium + deductible is $40K.

I had to read again 3 times. Are you serious?

If there is any complication, you're risking 2 lives.

In other areas, like heart attacks and strokes, you do not get to shop around. And you pay whatever they say you will pay. When those are the circumstances, there is simply no free market. And since no one is competing for your business with lower prices in that case, you do not get to see lower prices. They charge whatever they can maximally wring out of you.

Hence why the US already has government healthcare that covers almost half the population (Medicaid and Medicare cover the old, young, disabled, veterans, and poor people).

However, the place you give birth is, in the vast majority of cases, something people do like to have agency over, especially given the 9 months of heads up given by nature.

If healthcare weren't so perversely incentivized by the twisted triangle of regulated public/employer/private systems and their interactions, I would argue this is something that could be a functioning market.

Like Universities with their endless ability to raise prices due to the US government guaranteeing student loans of any size to anyone, a big problem in healthcare is there being no anchor to reality due to the principle-agent nightmares of the current regulated system.

In Europe, when you give birth it is not a luxury experience with a doctor of your choosing in a 4-5 star level private room where you're sent home with a big basket of freebies. If all Americans had to pay directly out-of-pocket (as Europeans de-facto do via taxation), you can bet reality would set in quick.

lol..

Dr Evil in the time you've been in cryostasis...

This is only done for very specialized treatments where the province (they run the health care delivery) doesn’t have the treatment and/or the American resource is closer than a Canadian treatment location.

For example Nova Scotia will send some complex paediatric cases to Boston. They could send them to Toronto, but Boston is closer. Same with Manitoba but they use Minneapolis.

Canada is only 40m people and almost half that is in one province. The smaller provinces simply don’t have the population to justify having every possibly medical bell and whistle.

Point is when province sends Canadians for US treatment is isn’t actually about better quality as not all provinces have the same in house capacity and often the next largest city with such capacity is an American city.

Car dependency and castle doctrine is essential in a low trust society with a legal system that puts violent offenders right back on the street.

They rather try their luck at home than leverage a thousand years of medical research that culminates in hospitals.

Not once but 3 times. I'd be pissed knowing my parents put me through such unnecessary risk.

(And even in the case of a surgical center, your decision is likely to be significantly impacted by who your insurer will agree to cover.)

You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf

Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max, so the childbirth should top out at the 7150. Other expenses might put you at the same 40K cost for the year, but not the childbirth alone.

I don't know if you have a CPA, but this is a sentence my CPA has never uttered.

> but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)

Including...? I have never heard of this, and actually have delivered babies and worked with post-partum mothers.

Yes, but crucially none of those expanded options cost $0, so I still don't understand your math at all. I feel like we're talking in circles here.

You should be deducting a substantially non-zero number from the amount in the headline to account for your "normal" non-childbirth-year best-case medical insurance premiums (or out-of-pocket cash costs if foregoing insurance altogether).

If this was true it would be plastered in every newspaper for the last 15 years.

I surmise that either Americans are all rich and have 40k in savings that they can lose with no sweat or

America is hell for anyone not rich

Midwives are medical professionals who have the equipment and expertise to intervene in the most common scenarios that require it.

[0] https://www.yesigiveafig.com/p/part-1-my-life-is-a-lie

Driving is more dangerous, and it's not even close. For example, in NYC you're over 100x more likely to die in a car on the roads above the subway than on the subway.

If you examine the statement of benefits for your plan, you will find that it says something similar to this:

> Emergency Services are covered at the in-network cost-sharing level as required by applicable state or federal law if services are received from a non participating (out-of-network) provider.

> The member is responsible for applicable in-network cost-sharing amounts (any deductible, copay or coinsurance). The member is not responsible for any charges that may be made in excess of the allowable amount.

First, there's a widespread belief that M4A is popular, based on public opinion polling. The problem is that you can make almost anything popular in public opinion polling, and a lot of public opinion polling is deliberately run by interest groups to generate narratives about popularity. It's true: the "M4A" that poll respondents support would be enormously popular: it's proposed as abstraction with no clear tradeoffs. When you confront voters with the prospect of increased taxes and the loss of their current insurance policies, the wheels come off the wagon.

The second big factor is that the demographics of people with employer-provided coverage --- the majority of all non-Medicare covered people in the US --- are not what you'd expect. As soon as you stipulate employer coverage, the cohort you're describing excludes basically all fixed-income and Medicaid-eligible households. The median household income of a family with employer-provided health insurance is closer to $120k than it is to $50k.

For those households, M4A is not a very compelling deal:

* There is a very clear trend in the data for them to already be satisfied with their existing health care.

* The visible component of their insurance spending (their out-of-pocket, excluding employer side payments) is usually quite small compared to total spending.

* M4A would mechanically eliminate the availability of existing plans (unless you came up with a truly weird and distortionate system of tax incentives to keep Anthem and United and Aetna policies going).

Best case: costs that are hidden from those households today become visible, and you hope people are chill about that (in sort of the same way we hoped that people would be chill about inflation given wage increases outpacing it --- see how that went). Worst case, a lot of these households would lose their existing, favored insurance plans and pay more.

Useful here to note that broad taxes on the middle and especially upper-middle class are how Europe funds generous social service packages; you can't get there by taxing the bejeezus out of billionaires. You should do that anyways, just because it's a good idea, but there aren't enough of them to pay the absolutely gobsmacking cost of a single-payer health system in one of the wealthiest large countries in the world.

I'll cop to this: what I wrote last night, about "currently insured" people, was way too vague. I should have said "households with employer-provided health coverage" (again: that's most non-Medicare households). I plead strep throat; you're going to have to give me a break on clarity today.

Is it for "a smartphone" with service, and presumably financing the phone as well? Or is it the total for all of your family's smartphones, which is how many phones/lines?

Edit: what do I have to gain from spreading "misinformation?" I just want better / more options?

I suspect needing to make a lot of international calls may be the culprit.

What if the CEO needs to supply an entire 1,332 person company with business phones?

What about an assistant to answer them! What if we're sleeping!

Oh god!

But just to put my comment in context, here is what he said:

> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.

[1]: (n.b., the plan is not truly unlimited.)

5 GB is pretty reasonable for the bulk of the country. The only common things that can make it go over are games and streaming - both of which really are luxuries if you simply can't wait till you have Wifi access. So yeah - of course you should pay a lot more if you insist on doing those things.

Regardless if you’re not willing to support your argument that’s fine, but at the same time if you’re going to put something out there and and then be upset if other people being skeptical of your skepticism then I don’t know what to tell you.

I still don’t really see how anything you’ve offered necessarily means people who currently have employer provided private insurance plans will be worse off. I especially don’t see it because people with incomes like you proposed the median income for households with employer provided insurance plans often have employer provided private insurance plans in countries that also have a public health system.

I guess maybe here is the meat of it and what matters. How are you defining worse off? Are you defining it based on quality of care/outcomes or in a financial sense? Either way seems pretty speculative to me but I’d be interested to know which (or both) of those you think makes them worse off.

Yeah, I'm gonna need a citation for that. Because it sounds like a health insurance propoganda rather than the actual truth.

Ive been to doctors in different countries including the USA. Theres nothing special with general practitioners with the USA.

Or if you end up in China, you can get blood panels for like 10RMB, MRI for 30RMB, and damn near automated to boot.

Go to Mexico for dental work. What costs you here $30k costs you $2k, and they take your insurance.

The US citizens are being gouged, because our government has been bought out by corporate interests who bribe, err, campaign donate to both parties. And thats across every economic activity. Medical is just an egregious one, alongside academics.

Maybe the top 0.5% is getting better care, but I really wouldn't shed a lot of crocodile tears for them.

Simply not true.

Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...

Source, backup your claims.

Health outcomes are WORSE than most other developed countries and that's the only statistic that matters here

Do you have any evidence of that?

Health outcomes do not support that statement.

If you have internet access on your phone while you're actively moving, it should work all the time, without any traffic limits or the need to keep asking for shitty cafe wifi (because your mobile internet is even worse).

It really reminds me of the Healthcare System conversations, when Americans are justifying why their way of doing things is logical and correct, while the rest of the world shakes their heads.

Also when you’re beyond the Medicaid threshold but not that much beyond it absolutely sucks. One year I was paying for dramatically worse insurance with a deductible that would have just made it better for me to just not make more money because if I hit that deductible I would be net negative on my income vs the threshold for Medicaid.

Also I think this is such a false premise. You can still have private plans if you want in the UK or elsewhere with a public health system. Nobody is forcing you to use the public system if you don’t want to. To wit, I don’t have children but I still pay for schools with my taxes. You might not want to use the public health system and instead go private, but yes, you should still be paying for a freely accessible healthcare system.

Here’s the rub on that too: The prices we pay here are so much higher than in Europe even if you go private in those countries. Our system is terrible. Point blank.

I would agree that the NHS in the UK has gotten pretty bad. A large part of that is the result of the Tory government actively working against it though for a very long time. The waitlists for a lot of things are quite long and my fiancé who is from the UK and still lives there has to do some things there are crazy to me. On the other hand she still is able to get care freely. She’s paid private for some dental work but that also cost her pennies on the dollar compared to what I’d be paying if I did the same thing here.

If you’re happy with your insurance I am truly thrilled for you because I don’t think of that as being a common experience.

Asked and answered in the piece dude - I wish I had the confidence of a Hacker News commenter who didn't read the article.

My argument is that specifically the best care in the US is the best in the world. We have the best doctors and the best technology and the best treatments. This is not completely universal but it is also generally accurate.

Whether or not this care is accessible or the median quality is care is good, that is different.

I’m just saying we do get something for the money, it’s not like it all gets thrown down the drain. The best and brightest come to the US to get some of the huge spigots of money in the US healthcare system and it does drive innovation.

If we're spending the most for it, shouldn't it be? Why would I want to pay more for worse outcomes?

Even in the US, many (most?) insurances and healthcare systems have programs to address all those. My HMO certainly does - I can engage with them and craft a healthy nutrition plan, and my doctor can be involved in that as well. Ditto for exercise.

False. Someone with significant medical issues may well need a higher acuity plan than the employer offers. I, for example, was on the exchanges until last year, for this very reason; my employer's coverage would not have made financial sense.

> There are a lot of chronically ill people with employer-provided coverage…

The chronically ill are less likely to be employed.