Edit: since https://news.ycombinator.com/item?id=41911099 was the first submission of the article, I'm going to merge the comments thither and re-up that one. But only the on topic comments. There is way too much dross in this thread—perhaps a fresh start will make for a healthier discussion.
(Sorry, l1n — not your fault at all, and I'm sorry we don't have karma sharing implemented yet.)
Shigellosis is god awful. I've had it three times, from sexual contact. Let's just say I won't do anything more than a peck on the cheek unless I've witnessed the person shower first as many people's hygiene standards are disgusting
This is possibly way too personal, and obviously I get it if you don't reply. But I'm curious -- was the sexual contact of a sort that would obviously carry this risk? Or a sort where you had to get very unlucky, or something in between?
This article hit different for me.. It had a weird font so at the beginning I thought it said...
"I spent the days just prior to my 80th birthday sick with shigellosis"
Articles like this are a nice reminder of just how wonderful life is in America, and just how far civilization has to fall if shit REALLY hits the fan someday. If you need a reason to be grateful in spite of mundane crap like housing costs and white collar jobs, the developing world offers some lessons in humility and gratitude.
> Articles like this are a nice reminder of just how wonderful life is in America, and just how far civilization has to fall if shit REALLY hits the fan someday.
While I agree its cool to see progress. If I get sick in the US and need medical attention, just fly me back to Europe. Id rather not go bankrupt.
I’d go to somewhere like India that has medical tourism. Any procedure that you can wait long enough to fly to Europe will have a long waitlist there.
Besides I was completely blown up in the US on my motorcycle with fractures all over and in the ICU for days and I paid a grand total of $2k. I think it was pretty cool honestly.
There was some therapy afterwards that cost a little more but overall I’m back to normal except for a few thousand. Since I make hundreds of thousands more this feels like a good deal.
The idea that it costs nothing somehow is bizarre.
If you divide the NHS budget for 2024 (192 billion) by the UK population (67 million) you’ll find it works out to just under 3000 pounds per person just for 2024.
Assuming your wife’s visit was this year your family paid about 3x what the poster you are responding to did.
I’m also working from the assumption most posters here are in high tax brackets; I understand tech jobs in Europe pay much worse than the US so that may not be true.
I think you're glossing over a few details here which - although understandable - deserve a little clarification.
The poster is referring to cost at the point of care - which under the UK's NHS model is £0. The "£3000" per year should really be viewed as the cost of an insurance policy (in fact, NHS funding comes from a progressive tax called National Insurance - at least in theory). This "£3,000" on average then compares to the average cost per person of a health insurance policy in the US of around $7,700 [0] - plus of course in the USA you generally have point-of-care costs too.
Additionally tax by its nature in the UK is progressive and the income distribution is fairly heavy-tailed, so it's not really a cost of "just under £3,000pp" - the average citizen pays far less than that, and even most high earners will pay less. For example someone on £100,000 (top 1-2% of salaries in UK) will pay just over £4,000 in NI [1] - but NI funds more than just the NHS and also funds social care and state benefits.
Of course in the UK some people choose to supplement NHS care with some form of private insurance - either paid for privately (uncommon) or provided as an in-kind benefit through an employer (still not ubiquitous but recently more common). Private care is typically used for things like skipping waiting lists for certain treatments or access to alternative care not offered by the NHS.
These private policies tend to have a lot less coverage than the NHS, so I would say aren't directly comparable to the NHS - nor are they generally totally adequate as standalone insurance policy so aren't comparable to an insurance policy in the US either.
The model is just very different in the UK and the US, and it's hard to compare them directly. However, what is inarguable is that the NHS provides very good value for money, especially when compared with other G7 nations [2] - on average less than half of the expenditure per capita of the US.
And people I know in the uk, at least those working for large US companies, also have private insurance in addition to NHS.
Probably not a bad idea to get travel insurance if vacationing in the US. The other way around you may want some sort of additional insurance if traveling from the US to Europe.
Yeah, that's what I mean. I would gladly pay $2k in an emergency to make the hundreds of thousands of dollars more every year. That's a trade I consider reasonable. To save $2k in an emergency I'm not eager to be making £200k.
Sure you might not have the financial burden but actually getting attention is not as straightforward as I infer from your wording. Wait times in much of Europe are kind of ridiculous.
One isn’t better than the other. There are trade offs. Your preference appears to be financial.
> Wait times in much of Europe are kind of ridiculous.
It's prioritized as per need, for example elective/preventative operations or procedures will be delayed if there is a new higher level emergency, this makes practical sense given the nature of healthcare and I have never had a problem with that.
It's slightly off topic though, my comment was off the cuff but it's a reality.
> Your preference appears to be financial.
Well regardless of financial accessibility if you can justify why in the US the markup of pharmaceuticals is so extraordinarily high for everything vs the rest of the world ?
> Well regardless of financial accessibility if you can justify why in the US the markup of pharmaceuticals is so extraordinarily high for everything vs the rest of the world ?
We do a lot of the (very expensive) drug discovery and testing.
And that means those same drugs, from those same companies are now cheaper outside of the US? That makes zero sense. That's like Amazon charging their employees 100x to use AWS vs outside people.
They charge more in the US because they can, because of people who gleefully accept it and defend it by saying "we do a lot of expensive drug discovery and testing"
> And that means those same drugs, from those same companies are now cheaper outside of the US?
Drug development essentially results in the creation of very expensive intellectual property. A wide variety of drugs are easy and cheap to manufacture [1].
The cost to develop a drug can range from $314 million to $2.8 billion [2]. Fewer than 8% of drugs make it through the development and trial process [3]. It's super expensive and risky.
Other countries do not have to respect US drug IP and can produce these drugs for near zero cost. They benefit from the expensive drug discovery and vetting that the US pharmaceutical industry perform and the US FDA requires, but they don't have to pay for any of it.
When countries do pay for US drug IP, they do a lot of strong arm bargaining. If this happened in the US, many of the drugs, especially for rarer illnesses, wouldn't be developed in the first place.
[1] Gene therapies, monoclonal antibodies, viral vectors, and other types of treatments not so much.
In some cases. But the point is other countries enforce lower prices, and they make up the margins in the US. On the one hand it is obscene but on the other we do see a pretty regular supply of miraculous new drugs. Something clearly needs done but the system does make sense (whether or not its optimal).
Re the comment about the US doing a lot of the very expensive parts of drug development...
Where are the costs, and what would it take to break tyem down?
For example if the costs are in screening molecular candidates, that could be done in a lab on a computer in India or Vietnam just as easily as in New Jersey. If its clinical trials, Europe is cheap and Asia cheaper still, both with high quality medical staff. Etc.
Any commenters understand where the major costs are?
> For example if the costs are in screening molecular candidates, that could be done in a lab on a computer in India or Vietnam just as easily as in New Jersey.
The market can do this right now. The US has a lot of the talent and expertise, though.
> If its clinical trials, Europe is cheap and Asia cheaper still, both with high quality medical staff. Etc.
While the FDA has accepted foreign drug trials as long as they are held to FDA standards, they still prefer to have trials conducted in the US that represent a US population. And no matter the case, it's still extremely expensive to meet these requirements.
Wait times in the US are also ridiculous. A couple years ago I tried to make a doctor's appt, at the clinic where I was regularly a patient, and had decent insurance, but it was for check-up stuff and to ask some questions. I called in July; the first available appointment was December.
On the other hand, when I've gone to that clinic with urgent issues, they see me the same day.
I gather it is much the same in systems with decent healthcare systems; just much, much, much less likely to bankrupt you just for being sick.
I'm seeing this trend as well. It is getting to the point that I can not see my primary doctor without a 2-3 month lead time and specialist referrals are often 2-3 months as well.
Hell, I recently had to find a new dentist because the one I had been going to for years suddenly had 4-6 month lead time if I needed to reschedule a routine cleaning.
It takes like two years to get in with a rheumatologist, or get a psychiatric evaluation where I am in the US, and other, less in-demand specialists are easily 6-9 months from your initial referral from your primary physician. I think it took about ten for my first dermatology appointment.
I've been through this with a broken finger joint. I don't know if I'm a smooth talker or she remembered me as non-problematic, but the MFA at the clinic quite frankly told me: Don't try to go there without an urgent emergency, and ideally a document from a doctor confirming that it's an urgent emergency. If I wanted an appointment without confirmed urgency, I could have one in January - and it might be postponed for urgent cases. That's how booked they are. On the other hand, if my surgeon raises the correct alarm bells, I could also be in surgery next week. It's a roller coaster.
Even though this does make sense if you think about it as a tiered support system. If my finger joints don't come back up, my general practitioner can see that, poke at the fingers a bit and decide if guided physio makes sense - no need for more expertise. If there are subtle breaks in the joint requiring attention - more expertise is needed.
I dunno if it’s really so simplistic. I hear the wait time complaint about Canada a lot but it’s partly because we care for everyone, so sometimes you’ve got to wait if you’re not in real trouble.
Especially with emergency care it’s quite fast. Back in August my son fell off the monkey bars and his elbow exploded. Ambulance in 7 mins. Hospital triage in 5 mins. Doctor 5 mins after. X-ray took 5 mins. Waited 7 mins. Diagnosis and sent to Children’s hospital one town over. More x-rays, surgery prep, surgery with two paediatric orthopaedic surgeons, four steel pins inserted, post-op, sleep, and he was home by 7am. Three more checkups with the main surgeon followed over the months.
Cost us $8 in parking. Never even saw a bill. I would never, ever, trade this for the American approach. I need to know that every kid on that playground gets this exact same level of care.
Since you have a specific anecdote as an argument, could you expand on your “American approach” concept and how it applies to your situation?
I don’t mean talk in vague assertions about how you have read some other specific yet unrelated anecdotes about childbirth costing $125,000 or something. I mean how much would your son’s specific situation cost you in a comparable area of America for a family of comparable income?
The reason I ask is because the general approach should not be argued against with anecdotes. You commonly hear of wait time issues in universal healthcare countries. You commonly hear about cost of care issues in America. Generally speaking there is an obvious trade off.
And just like wait times and cost are preferences, your preference is equal care for children. In America that does not happen. That is part of the trade off.
I am not implying that all things are equal. I am unhappy with the health insurance cartels that drive up cost in America making the lower middle class suffer. I am unhappy with the inconsistent care availability from region to region across the country.
But I also resist the implication that American healthcare always bankrupts a person and that free / low cost care is a simple decision.
> I mean how much would your son’s specific situation cost you in a comparable area of America for a family of comparable income?
That's the fun thing about the US system. The only way to find out how much it costs is to wait for the bill. So while your question is a fair one, logically speaking, it's unanswerable in practice.
I wouldn't go that far. But it is true that there are far many more possible outcomes because of how diverse the private insurance system is.
At the very least one guaranteed difference is that you would NOT not get a bill.
Then, a common scenario is a health insurance setup that covers 100% of the cost beyond a threshold, while the individual is responsible for the cost below that threshold.
My threshold is $6k for example. In the above scenario with the elbow, I estimate that the total cost would be around $100-200k. So I would end up paying the full $6k, and the insurance would take care of the rest.
The other common scenario is one where the threshold is much lower (e.g. $200) but the insurance covers e.g. 90% of the total cost. I find that option more risky, because I know the total costs can be staggeringly high, and 10% of a staggering number is usually also a staggering number :-)
You might know that you won't have to pay more than $X, but you generally can't find out beforehand the theoretical cost of the procedure as billed to the insurer. So if you're on the hook for any fraction of that (as in your second scenario) then you're very much in unknown territory.
There is also the question of how well you really understand the terms of your insurance policy, which can be extremely complex.
What gets me about the insurance billing is that besides being complex for me, it is also complex for the insurance company - people on the other side are just people, after all, not some infallible super-intelligent aliens. And the failures that come out of that are kind of hard to believe for people used to nationalized health care; my favorite example was a $15k bill I received months after a surgery that I called back to get more details, upon which the agent said something like "oh that's coded wrong" and after a few keyboard taps I owed $500. What if I had paid the original amount without asking? How many people do not ask? And the cynical question, how often do the "coding errors" happen the other way?
I can speak to even routine things like a childbirth still costing thousands of dollars with "good" insurance with a "low" out of pocket maximum and 100% coverage after the deductible.
It still cost 3 or 4 thousand dollars. So it's not necessarily those six figure costs that are tough to deal with but even routine hospital care that gets very expensive in the US. I'm fortunate that we can afford that cost. But for a lot of people even making the payments on that would be a hardship. We didn't even know it would cost that much even though we had called our insurance to try to figure it out. Nobody can tell you how much it will cost until you incur the cost which is absurd. And the hospital "price lists" are beyond useless.
It shouldn't cost anything to birth a child in a hospital setting like a birth center in any civilized country, and we shouldn't have to deal with billing issues and insurance companies in the insane first 12 weeks of a child's life when we're sleep deprived and just dealing with actual medical issues and adjustment. We've spent collectively hours on the phone with insurance for this and various other charges. The "private payer" "employer provided" system constantly produces bad experiences and outcomes for everyone. Every insurance provider I've had over the past 5 years is a company that constantly screws up and that I can't fire, unlike my car insurance.
The American healthcare system doesn't bankrupt us right away, but it does so slowly by bleeding us for costs we shouldn't have to pay and by robbing us of time right when we need it most.
My daughter was premature and spent weeks in the NICU.
My family paid exactly $0 for this experience, with good US insurance.
People paying thousands of dollars with insurance have chosen to purchase cheaper insurance premiums, and then bear higher costs when there’s an expensive event.
This is a fine choice to make. It does not mean the US healthcare system is especially expensive for middle class people.
Like many parts of the US economic system, the US healthcare system isn’t very good for poor people. But don’t go thinking it performs poorly for the upper half of the income distribution.
I didn't choose to purchase cheaper insurance. It's provided by my employer, by law. Paying thousands per month for "better" insurance isn't an option.
I made the mistake of touching on a complicated, important, and oft-contentious topic just before starting my work day. Not ghosting you, but I'll do my best to get back to this when I have the time required to offer a worthwhile response.
Same. I appreciate the reply but apparently this beehive isn’t worth kicking here. Seems like folks don’t know how to avoid the downvote button on emotional topics. I would love to have a deeper conversation about it but HN probably isn’t the place where I will find intellectual satisfaction on this topic.
Wait times in the USA suck. I just moved to a west coast city, need to set up new doctors. Soonest I could get for an endocrinologist is February, and I made the appointment a month ago.
I love and work in emergency medicine in the US. We still see Shigella on the Navajo Nation, where many of our patients do not have electricity or running water at their home.
Fallacy of relative privation. Also in a way, people in poorer countries have stronger families because they actually spend time together. Compared to Western family stereotypes where mom and dad ignore their kids all day while they commute and work their fancy jobs to keep up with housing costs.
I mean, the US has lots of areas where the water is contaminated with carcinogens and other toxins and pollutants. The oil pipeline spills alone are already a handful, and then there's mining slurry, and industry dumping their waste where they really shouldn't etc. etc.
Downvoted to hell for some reason even when I am not trying to be nasty. What I mean that the end of human civilisation is inevitable by natural law. I would argue that the number of possible ends that involve breakdown of civilisation and presence of the misery the cited post mentioned is much larger than the number of ends of a different nature (sudden end or some sort of transformation).
I live in a rural area. It is filled with all kinds of wildlife from earthworms to bears, all of whom leave their metabolic waste in large quantities everywhere. Should they all be eradicated and all the fields and forests be cleansed in the name of Good Hygiene?
Not in forests! But in cities and houses yes, absolutely! And we actually do that, if dangerous bear wanders into town, it gets removed! In cities we eradicate rats, cockroaches and all sorts of filthy animals!
Dangerous predators belong to nature and forests. Public city parks are not nature (or toilet)!
There is not a single city on the planet that managed to eradicate rats, and the only cities without cockroaches are in climates where they don't survive.
Do you have any source for this statement? If you get stomach infection (like ulcer), there is no investigation of source of bacteria. Every municipality just accepts dog poop as "part of nature". And nations that do not tolerate dogs are healthier.
Toxoplasma can be actually traced to cats, and like 60% of population are infected!
Huge part of population have stomach ulcers and other poop hygiene related diseases with "unknown sources"!
I don't think you can demand sources if your own claims are not only unsourced but also some of them are demonstrably incorrect or misleading.
You talk about dog poop but then speak of "stomach ulcers and other poop hygiene releated diseases with "unknown sources"". The main cause of stomach ulcers (other than painkiller overuse) seems to be (certain strains of) heliobacter pylori:
The transmission route of heliobacter pylori is both fecal-oral AND oral-oral with the latter apparently being far more common. Heliobacter pylori is transmitted between humans and has been with humans since before humans first migrated from Africa. So "stomach ulcers" are neither a "poop hygiene related disease" nor have mostly "unknown sources".
Also no, "every municipality" does not "accept dog poop as "part of nature"". Numerous (if not all) US states and many (if not all) EU countries have "pooper scooper" laws that come with considerable fines for letting your dog poop in public and not cleaning up after them. In Italy there have even been cases of DNA testing being used to investigate abandoned dog poop.
Not only are your claims unsourced and don't stand up to scrutiny but some of them are completely incomprehensible:
> And nations that do not tolerate dogs are healthier.
What does that sentence even mean? I assume by "nation" you mean "country" but what do you mean by "not tolerating dogs" and what do you base the definition of "healthier" on?
So no, nobody owes you any sources. You have to back up your claims first.
> And nations that do not tolerate dogs are healthier.
Yeah, the furry bastards force people to walk every day, two times a day, train their launching skills, make people laugh, alleviate boredom and mental issues, save children from their bad ideas, and drag its owners directly to interact with other dog owners and make friends.
Social interaction, exercise, security, happiness... just the opposite to following a healthy life style.
It's hard to tell with the throwaway, but I suspect I've seen you posting on HN before, making similar claims relating to the horrors of dog ownership. This is a pretty suspect one.
I see one study claiming 1.1% of visits to Emergency Departments are dog-caused, and another estimating 14% of visits by women are due to domestic violence. These numbers, while not a perfect refutation, don't seem to align with your claim at all.
The idea of dogs being the main source of domestic violence in the U.S is hilarious. Is there some epidemic of drunken dogs coming home to beat their owners that I haven't heard of yet?
But seriously, you seem to have a bizarrely pathological hatred of dogs, enough of it to just throw out completely random accusations against them with nothing at all to back your weird bullshit. Why? Who knows, but if you're going to do it why not add a source or two?
> drunken dogs coming home to beat their owners that I haven't heard of yet?
Yes, it is called "reactive" dogs. Remember the definition of DV, next time someone is blamed for provoking the dog. Even if dog is "provoked", that is not valid reason for violence!
And I am not talking about dog owners, but their victims. Mostly children, spouses... They have no option to leave an abusive household. Many times they are gaslit and shamed. Dog owners have many privileges, and can get away with brutal child murder!
Even threats of violence (growling), or forced sleep deprivation are DV!!!
There's no way you can imply this much malicious intent to an animal that basically.... doesn't possess the capacity for malicious intent.
Either you're some sort of troll or you've let this hatred totally cloud basic reasoning. They're dogs dude, very different from people and their capacity for malice.
And most dog owners, being the family members of all these abused people you claim, would themselves do what they could to train their dogs against freely harming others.
This seems too strong. Assuming they're 100% indoor, you could say they don't have any pathogens that haven't at some point been present in your house. But that's not so comforting.
