I donated $50, but I really wish US (and other countries) would reconsider their broken healthcare systems. My dad died of cancer a few years ago and I am really glad we lived in Denmark when he got it - - with a great public healthcare system. He lived 2 years with his cancer, which is a lot when you are counting days. Not many normal people can afford these things (as each of my dads treatments cost about 20.000USD+ and he had a lot of them).
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)."
I donated $100, and yeah, our healthcare system is a goddamn travesty. I don't get it. If you're fortunate to live long enough, the one thing that's guaranteed to eventually happen is you're going to get sick in a very expensive manner. It's not an "if" question, it's a "when" question. I don't think that should mean financial ruin. People against universal healthcare must think they're just immune to ever getting sick or something.
People against universal healthcare are just good people who are confused and/or deluded. Their arguments will never really add up because it's only about corporations making profits and to that end people will need to be deluded and manipulated into believing that we shouldn't implement a proper system. Just remember this when you say you don't get it: it's just the political power of traitors speaking through humans via propaganda.
I'm against public healthcare in the USA because there's no way (in the current political climate) it won't be massively corrupt. Did you know the insurance companies were lobbying in favor of our new system? It's still about corporations making profits.
By living in a few different countries, I found out believing that the current political climate of your own is somewhat worse than other ones where supposedly things work better is a common fallacy.
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.
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).
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.
Tort reform also has no bearing on cost outcomes, according to the data. Texas is one example. It's solely designed to prevent human beings from holding corporations accountable for their actions.
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.
of course! Centralized economic solutions always work the best. The USSR is the best example of that. You people go back to coding and leave economics to economists.
Markets are not always the most efficient way to determine price information.
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.
Tragedy of the commons type problems. Concrete example: CFC Regulations.
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).
You claim cigarate bans helped tobacco industry? CFC helped grow corporations? Because if all you are saying is that regulation is destroying industries, well that's actually my point.
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.
Firstly the entire point of my comment was that capitalism is not the best system in all cases and that there are situations especially those involving externalities where an approach involving regulation is the better solution. I repeat it here so you realise what I'm arguing and what statement you made earlier.
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?
Free markets means that stupid/wrong decisions (i.e. Google hurting people) result in competitive advantage to companies that don't do those stupid things. I'm sure CEO of DuckDuckGo.com just can't wait for Google to start hurting its customers.
And then I take corporations competition every day over Government regulation.
I'm continually amazed at the number of ways the current US system is centralized, usually in an arcane manner e.g. prices that hospitals can charge for things being set by a committee.
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.
Public healthcare ought to be implemented at the local level for those that want it (which I don't). I'm quite fine with not seeking treatment when I get a terminal illness. If it ever gets to that point I would prefer euthanasia (illegal in the USA).
> I'm quite fine with not seeking treatment when I get a terminal illness. If it ever gets to that point I would prefer euthanasia (illegal in the USA).
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?
>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.
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.
> that's guaranteed to eventually happen is you're going to get sick in a very expensive manner.
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.
That's why I qualified it with "if you're lucky to live long enough".
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.
If the probabilities were as bad as you suggest, there would be no such thing as health insurance. They need to bring in more than they spend on health-care costs. Most people can't end in a devastating health-cost manner.
So.. your argument is that because insurance companies can profit, it's not so bad? "Well, your legacy might be financial ruin for your children, or an early death to avoid that, but since most people die before they realize they're severely ill, ¯\_(ツ)_/¯
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).
>So.. your argument is that because insurance companies can profit, it's not so bad?
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.
But the problem is also that healthcare in the US is just absurdly expensive, insurance or not. Sure, many EU countries have universal health insurance, but if you look behind those, costs (paid by the insurance or not) are quite a bit lower than the US. They're still quite hefty and you do want to be insured for them, but why is healthcare in the US so expensive in the first place?
1/3rd of US healthcare costs is administrative. Single payer (Medicare for all) fixes that.
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.
I think the real problem that affects everyone in US is the cost of anything health related before insurance. This may be a consequence of the fact that everything is private, but just look at the numbers.
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.
Not really. Hugely ruinous medical expenses could be something that happened, say, once every hundred or two hundred person-years and still affect a massive proportion of people who lived long enough. Also, even just health insurance for critical illness and emergencies isn't exactly cheap...
Well it's not like the health insurance companies really want to pay for the bills the contracts are always phrased in such a way that the can just say... well we don't cover that when you get sick but the do expect you to pay every month when you are healthy.
They wouldn't have that ability in a European like country sponsored insurance since everything would be covered.
> 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
I think a key feature of health insurance is that not everyone gets hit with 6 or 7 figure healthcare bills. It's because of that fact that we can and should do better as a society.
My mom just got diagnosed with extensive small cell lung cancer (thats spread to her brain) and I am fucking terrified about whats going to happen to us financially. I can't even focus completely on my mother as a person because I'm wondering about the bills, then I feel bad for worrying. It fucking sucks.
Sorry to hear that. I lost my mother to that exact same thing ten years ago. Her husband had barely OK union insurance (which he was forced to purchase even though it sucked, as a kick-back to the union), that quickly got tapped out (couple hundred thousand dollars worth). She was randomly fortunate enough that the state she was living in had a mandated twice per year, take any patient with an existing condition, requirement for insurance providers in the state, and she was able to pick up a new policy. I don't know about your state, but you might look into that, a lot of states have programs of that sort apparently (the cost was a little high relatively speaking, around $600 per month, but it gave her another million plus in coverage).
Very sorry. Speaking from experience, this is exactly how it is. When there's a serious medical situation, the focus is necessarily on the bills. They even send you separate envelopes for every little line item and provider, staggered over time, even more than a year after the service, so you can never stop thinking about it. Always fearing opening the mailbox, having to deal with confusing hard to reconcile charges, trying to catch double-billing, dealing with payments to multiple providers. The stress of the bills can easily make the illness worse. The US is truly a barbaric system. But it has this small bubble of well-off people, who have a disproportionate platform for their propaganda, so you can get this public picture that everything is great. Everyone beams smiles in the commercials, consuming the miracle products. The well-off only associate with others who are well-off, so they can pat each other on the back and say "What a country! All this opportunity for those with the right sort of character, like us!"
> "you can get this public picture that everything is great"
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.
You would be surprised. It wasn't long ago when I met an intelligent and otherwise very well informed American who truly believed that the "socialized" Canadian healthcare system was a 3rd rate disaster and feared any change to the precious US system would lead to a similar situation.
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.
I'm from the UK. The NHS is shambles and is spread very, very thin. Doctors are pissed off. Patients are pissed off. The government seems to be too. However I would prefer the 3 hour A&E (ER) waiting times, being spoken to like shit if it isn't as serious as originally thought and epic waiting lists for outpatient services than having companies profit from my health and the massive vulnerability that puts me in (on top of just bad health). Even for all the bad of the NHS, when things really to hit the fan, I can be sure I get seen to ASAP when it is deadly serious.
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?
I just had a baby daughter. The care was excellent at a hospital a couple of miles from home. At one point we had 3 midwives helping, then the anaesthetist and for the delivery we had 3 doctors at one point. After-birth care was great too and we were encouraged to stay at the hospital until we felt comfortable going home all the while with adequate food and a private room.
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.
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.
In my experience the location matters. I sprained my ankle in Edinburgh once, and the hospital visit was almost enjoyable. The staff were great. Where I live in London, it's not so great. They have to deal with a lot of annoying drunks and are overworked, but also the place was just not very clean. Our local A&E is closing down too.
As a patient, I'm not really arsed. As a patient, I actively discourage putting strain on the system when unnecessary. I'm really moaning about how doctors are treated, and they are spread thin and are not rewarded by the system fairly by the effort they put in. The targets in place mean they cannot give patients the care they want to give, meaning there is little intrinsic motivation too.
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.
My girlfriend just had a major operation on the NHS.
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.
"The best health care system in the world" is a pretty common refrain among American right wingers. Many of them truly think that we are #1 in this area and that the great tragedy of socialization will be destroying that.
> ""The best health care system in the world" is a pretty common refrain among American right wingers"
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.
Right, but I think "best in the world" is more a negative comment about other systems being terrible than a positive comment about this system being actually good.
My experience is that the system outside of payments and such is seen as superb (when it's actually average), and the rest is seen as OKish (when it's terrifyingly bad).
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.
I'm not sure what you base the statement "that's what a free market solution gives you" on, since as far as I know we've never had anything remotely resembling a free market solution. In my experience, one of the most common refrains from that side is "the current solution is bad precisely in the ways that it's not free market". Granted, they're just guessing what will happen, but I don't see that as meaningfully different from your guess about people dying in the streets etc.
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.
The USA has the best health care money can buy. The problem is that some people only see the first half of that sentence and it's the second half that's so damaging to society.
While I could only donate $50, I feel everything you said is absolutely true. We must learn to live within our means and be content with a less materialistic (higher quality of) life. Universal healthcare makes this a reality. Not having to worry about increasing premiums as one gets older is a reason in itself to justify for higher taxes that come with it.
We need to educate the youth to start thinking about life holistically and not just in terms of vacations and latest toys.
I don't understand, I thought the AFA (Obamacare) won and all those curmudgeons fought it all the way to the Supreme Court and lost and we now have healthcare for everyone.
What am I missing?
Why does this gentlemen have to loose his house to get medical treatment if healthcare is affordable?
I can't tell if this is snark or not, but the "ACA" does provide subsidies on a sliding scale based on income, however, I can't comment on his situation. More likely though, it would be Medicaid, not subsidized private insurance at lower incomes, and the ACA expanded eligibility to 125% of the poverty level.
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 don't particularly see this as being a strong problem with American healthcare. You can buy health insurance to pay for any and all medical expenses. The healthcare system is broken if you do an honest day's work and can't afford insurance, but that's not what we're talking about here. There is a reason that most of the best hospitals in the world are American, and the way we fund our healthcare is that reason. Yes there are plenty of efficiencies to be improved, and much in the way of helping everyone access affordable care. However, you're never going to have Americans shifting away from exchanging dollars for doctors.
> The healthcare system is broken if you do an honest day's work and can't afford insurance, but that's not what we're talking about here.
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 buy insurance which covers home health care and doesn't cost a cent after a deductible of a few thousand dollars. You can buy insurance which provides income if you can't work because of an illness... there are also several government programs that help the disabled.
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.
> If you get sick and can't work, is the health care system supposed to pay your mortgage too?
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.
The problem with your Rand-esque proposal that if we all saved and lived below our means would be rolling in it, is that we don't all have the privilege of living in state or region that provides reasonable healthcare.
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.
The Affordable Care Act requires routine medical visits to be covered by your insurance provider without a copay. If you aren't seeing a doctor every year, you're throwing away money.
That's new in the past 45 days. For what it's worth, under the ADA the insurance subsidy I get from taxes is enough that I actually am insured, but it doesn't bring the monthly cost of an insurance plan down any ... just pushes the cost off to taxpayers.
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.
Insurance companies generally have to spend 80% of premiums on medical expenses[1]. The profit and marketing expenses aren't that much of your premiums. What you seem to be asking for is price fixing the way much of the rest of the world handles healthcare, which will reduce the incentives to advance medicine. I prefer our current approach, where those who can afford to pay are left to pay as much as they're willing to, which increases the number of smart people who are willing to solve everyone's medical problems.
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.
But 90% of the world doesn't die from exotic cancers, at least not below the age of 50 (or 60 ... keeps creeping up). The idea that advanced medicine is an justification for for-profit medicine is a straw man argument.
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.
I don't fear the rest of the world getting better than us at medicine. Money motivates most people. The best doctors will go where they can get the most money. That is here.
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.
"...the UK's system, where price controls help pay for healthcare for those who can't afford it..."
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.
The vast majority of the UK's health expenses flow through the NHS. This gives NHS the power to demand prices that are lower than they would be if there were many competing insurers. That is effectively a price control. If you don't agree to accept the NHS's price, you're left with few, if any customers.
> Money motivates most people. The best doctors will go where they can get the most money.
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.
An interesting thing I learned when my uncle had cancer was that "the best doctors" would often only treat cases with at least a moderate chance of survival since they didn't want to ruin their stats.
No, but if your theory of healthcare is that private healthcare produces the best, most advanced treatments, then by all rights you should fear the world getting better than us at medicine. Healthcare is by it's nature a social issue as well as an economic issue. And a draining of doctors in the USA would have a devastating effect on general health.
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.
There is a private health care sector in the UK - doctors can choose to work there exclusively or share their time with the NHS. You aren't forced to use or work for the NHS - although everyone does have to pay for it.
I don't know you, but I'd wager that in order to be able to say things like this, you're very privileged. And it's leading you to say extremely ignorant things.
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."
If you have an especially difficult medical problem or you have the money and want the best possible care, your hospital of best choice is probably American.
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.
If you have an especially difficult medical problem or you have the money and want the best possible care, your hospital of best choice is probably American.
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.
Sounds like you might want to apply for your passport for the first time. Don't worry, it's common, lots of people in your country haven't been outside it.
> The healthcare system isn't broken if you do an honest day's work...
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.
"The healthcare system is broken if you do an honest day's work and can't afford insurance, but that's not what we're talking about here."
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?"
It saddens me that some people look at travesties like this and think "fuck him, the system is great, three cheers for the status quo."
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.
The top can get the best care for the right price, the bottom has been inadequately supported though much progress has been made with ACA, and lots of people in the middle are inadequately prepared, because given the choice, they choose a higher standard of living instead of more safety for the future. To be given that choice is engrained in a lot of American culture.
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.
"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."
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. ;)
The thing that seems to be missing from most people's argument is that the cost doesn't go away if you move to a single-payer healthcare system. You still pay for that $75k in the form of higher taxes and higher prices... it doesn't get erased. Wanting a non-standard treatment and not being approved won't change with single-payer... you'll still have to sell everything you own to pay for it.
Saying the cost doesn't 'go away' is deflecting from the fact that it does reduce overall, because of a number of reasons. Administrative costs are vastly reduced. Employers no longer have to negotiate individual contracts with insurers. Hospitals don't need huge administrative staff for deals with different insurers and paperwork for each one. On the whole, the cost savings from moving to single-payer take a huge bite out of the increased taxes.
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.
My god you're a privileged, elitist, self centred... calm, be calm. The fact that you keep posting this crap on a thread about some I look up to who is DYING OF BRAIN CANCER is really upsetting. So please stop.
If you don't like discussing the costs and methods of delivering health care, downvote the parent comment which mentioned it initially, not a person whom you disagree with.
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.
I don't even live in the US, so nice try -- I'm telling you to pull your head out and show some respect for the fact that someone who is one of us is dying.
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.
It's so sad that the country where Richard lived, worked and paid taxes for about 30 years can't provide for him. I'm glad to be able to help. But what happens to those that don't reach the front page of HN? No one enduring the stress of a terminal cancer should have to stress about getting ends to meet during their last months alive. EVER
My family is one of them (stressing about getting ends to meet).
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.
You need to contact a lawyer. If you're clearing out your savings to pay for her treatment (but not for the in-home PCA), there's a good chance her insurer is committing a number of violations regarding her coverage. For many insurers, having a lawyer breathing down their necks about coverage decisions also tends to be a good way to get them to approve treatment without giving you the runaround.
So they would have spent that money on a lawyer instead. It doesn't matter what you do, you can't escape the astronomical cost of healthcare in the US.
As someone who has been in this situation, I can attest the only difference between the two situations is that if you go to a lawyer your mom doesn't get all treatments in the meantime.
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.
You're barely older than me, and I can't begin to fathom how I would handle that situation. Your actions demonstrate incredible selflessness, and a startling degree of competence in the face of something no one your age should have to consider.
Your efforts are truly amazing. I hope one day in the face of such challenges I could be half the person you are now.
This is certainly terrible news. I cannot imagine being in that situation. My thoughts with him and his family.
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.
Yeah, that's the pretty answer, kind of like "Cops are there to protect you" or "Poor smart kids get scholarships." That stuff exists in theory, but whether it materializes for you is arbitrary. The government can fight you for any length of time to refuse or minimize benefits, or they can make you provide prohibitive amounts of documentation you can never fulfil. People have to get lawyers to get benefits. Or you might luck out and deal with an SS office that's more accommodating.
In USA it's still much better. In many countries including India for example, people pay taxes for their whole life but if they lack money in the end, there's no health/food/shelter security - you are basically on your own. Legislative Bills are there, but they are just that - dormant bills. Nothing exists in reality.
I am also from a developing country (Uruguay) but if any of my family ever has cancer all our concern will be in the emotional issues, the economic issue are already resolve: basically the health system coveres all diseases that you could get.
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.
Uruguay isn't really a developing country. Not like India, that's for certain. Anyway, the health care system in the US isn't something that was willed into existence. It came from a series of accidents and circumstances.
I am a Canadian who occasionally complained about long (several hour) emergency waits for broken limbs from mountain bike downhill racing. The triage system prioritizes people who are dying, not adrenaline addicts.
... 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.
Sorry if I wasn't clear. I went from "Hmm, that's a weird lump" to chemo in just over two weeks. The quality of care was stunning, and the success rate is one of the highest in the world.
There are medications I need that cost an entire order of magnitude more in the US than in Canada. I'm not exaggerating. They're about $80 full price from Canada and $800 here in the US.
That's the pharma industry's 'America pays' system. Canada receives subsidized costs on medications like much of the world, and America picks up the tab.
Not sure what point you're trying to make here. The pricing on the medication was exceedingly high, about $200/dose, but as far as I can tell, that is the same price as in the USA:
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.
Here in Fiji we've always had universal healthcare. When people need surgery/treatment they can't get here, the government sends them to India (Used to be Australia/New Zealand, but not any more).
Context: Australian and NZ relations with Fiji have seriously deteriorated (expelled diplomats, aid cuts, trade sanctions) since the military coup in 2006, and the resulting dictatorship there. [0]
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.
The choice to send patients to India is purely based on financial, rather than political reasons. Even with the higher airfares, it often turns up significantly cheaper to send patients there. Of course in outlier cases where its thought that there is a higher chance of survival in Aus/NZ, patients are sent there instead.
Australia and New Zealand only deny medical visas for people in the Fiji government and military (and their family).
Yeah. Thanks to India's affordable health care, we don't have to be dependent on this national scam called health insurance. We just go to doctors, they give us treatment, we pay money, that's it. I remember how here in US I had to go to a doctor to be told "You don't have any disease, that happens to everybody" (no diagnosis) and charged $400. Insurance paid $300, I paid $100.
Right.. That "national scam" is working great all over Europe. It's cool when you can pay your treatments, but cancer treatments are in the 6 figure range - enjoy paying that from you bank account.
The funny thing is, at least here in the US, even if you have medical insurance you are totally ripped off your pockets if you have something like cancer. Mostly, you just don't pay the price which was anyway artificially inflated by this scam I'm talking about. There was an article only a few days back about this guy who had his appendix treated:
http://imgur.com/a/WIfeN
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. )
That image is insane. $7,500 for a couple of hours in a recovery room. Not sure how that can be justified, they're clearly just getting as much money out of people as possible. As the services are not exactly optional.
>On the other hand, if you adjust the costs for purchasing power, the unfortunate result is that most of the people are pretty much fucked.
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]).
I agree with some of your points here, but this has to be noted.
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.
Humm ... That's a mistake on my part. But this is because I'd seen another article from 2009 [5] which clearly said it was 6 million. And this article was from 2014 so I quickly read that as 7.5 million.
See my reply to markdown for context on his/her comment (if you're not aware).
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.
Health care in India has a lot of issues, but it's affordable for most part. And if you read my reply to plaguuuuuu below, I wrote that it's still not good - but going the US way of insurance lobbying is not a solution either (because certainly, it's not working). Unfortunately, there are a lot of people who don't even have money to pay food, understandably they won't have money to pay for medicines. They get free government treatment in many cases (though no free food). There is a new Food Security bill passed late last year which is made to tackle those 42% undernourished children and other poor people. Implementation of that, in a populous country like India will take time. Poverty is a complex problem to solve.
Per the article you linked [1], the wifi is funded by a donation from the Fuhrman Family Foundation, not public funds. Additionally the quote from Bloomberg included substantially more than the Knicks and Nets: "Our new Harlem wireless network brings critical connectivity to residents and visitors, giving them 24/7 access to everything from education materials for kids, to information about Harlem’s rich history and attractions, to everyday needs like paying bills, checking library hours — or even just keeping tabs on the Knicks and Nets"
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.
You (and the downvoters) don't get it: my surprise is that bestham's first reaction was not human sympathy for someone suffering; his first reaction wasn't to try to help; his first reaction was to score a cheap political shot.
That's awfully sad, albeit not as sad as the fact that it was successful.
You're right, I don't get it. We're not politicians, we're developers. He's pointing out the fact that he's paid taxes for $x years and in the moment he needs the most help, his government is not here to provide for him.
He's not saying Obama or Bush or Clinton or Bush or $foo, he's saying the government.
My first reaction was to provide some help for him, I did and boy am I sorry for him and everyone in his predicament. While doing that I could also identify an underlying problem in the way he has to beg for help and how unfair a system like this is to everyone that is suffering from similar diseases, terminal or not.
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.
Not to be rude, but that doesn't obligate the government to provide that particular service. Just because I pay taxes doesn't obligate the government to provide me a house. Why is that the case for health care?
To answer your question seriously and without any implied political bent, the reason is: healthcare in the first world has become considered a right or entitlement. It's really no more complex than that.
>To answer your question seriously and without any implied political bent, the reason is: healthcare in the first world has become considered a right or entitlement.
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.
It's a purely subjective priority issue, is what I was saying. All things that are entitlements only become such because they're first provided, naturally (can't have an entitlement without it first existing). I suppose your implication is meant to be that if it weren't provided, it could have never become an entitlement - that's true, but it wouldn't prevent the population from looking across the border or oceans and yearning for the entitlements others have in first world nations.
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.
Well, it's in the best interest of society as a whole to keep people in good health. For many reasons but in particular public health, because if people don't get vaccines or don't cure infectious diseases it can spread and potentially affect everyone.
This is why in France we have universal healthcare, that goes beyond legal residents but also benefits illegals (with AME, Aide Médicale d'État).
A point i think is important that hasn't been explicitly raised in any other reply to you is that a a societal reliance on friends and family as the measure of last resort is significantly less egalitarian than nation state support could be.
Just read his series of post over his ordeal. He really has had a rough time.
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..
I was pretty surprised at how easy PayPal has made it. I know that people prefer other services and the reasons they do, but at least PP has been moving forward in their ease of integration. Noticed it on Bandcamp recently as well. Just type amount, enter email and password then confirm and done (assuming you've got PP setup already).
I work with PayPal and to be honest my dislike doesn't come from the user experience but the developer side, the api, the tools, the interface, they are all broken, it is amazingly demotivating.
I worked with it years ago and had a similar experience. I guess I was try to say the recently I had a few pleasant, easy transactions. Upon further inspection, that might not be something to be too excited about.
I was feeling for him & those that knew him, but purely observing, as I was well outside his circle of influence. Then I read your comment and snapped back to humanity, remembered that this was a person and I was a person and I'm doing OK enough to extend some cash, regardless of the separation of our worlds. Thanks for posting your comment.
I don't know Rich but anyone who makes as much of a commitment to the web as he has deserves a lot of respect. I donated and am looking forward to see how the HN community helps out in a few weeks.
Oh jeez... seeing Rich's name made my heart jump. I worked with him in the late 90's. He's a great guy, smart dude, and he wrote some hilarious poetry about Microsoft in his code comments during his late night coding sessions. I hate to hear about what he's going through.
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've looked up to Rich since I learnt PHP back in... what, 2004? I haven't seen his name around in a while, and I guess I know why.
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.
Rich ran the Chicago PHP Users Group for something like a decade, getting a lot of people into web coding or writing better code. He's a generous, kind person who could really use a little generosity himself.
This should absolutely not be necessary in a civilized society. I don't know Richard or his work, but I donated. I'm proud to do so, and ashamed that the nation I call my home does not provide adequate support.
It took me a while to actually see there was a paypal donation button on the right. Perhaps ad-blindness, perhaps just taken in with reading recent updates - in January, Richard was given 3-6 months to live (http://richardlynch.blogspot.com/2014/01/end-game.html). Donation sent - I hope every little bit helps.
I work for Crowdtilt -- if someone who knows Richard can contact me (lebel at crowdtilt dot com), I can help get a campaign set up with all fees waived.
The fact that this is currently #1 on HN makes me really proud of our community. I don't know Richard, but I chipped in a few bucks anyway. Let's get this guy a chair lift.
My father's best friend (a friendship of over 60 years).
Got 3 brain tumors... They all were removed with brain surgery.
And he lived for another 3 years with good quality of life.
Thanks to the biweekly physical therapy he had.
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.
To answer your rhetorical question, America is coming from being a hyper free market system, in which both culturally and legally people were expected to fend for themselves. This approach was extremely ingrained into American life for 200 years. Culturally the attitude was all-pervasive, and it was regarded as something that made Americans distinctive: self-reliance.
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.
You may be able to contact him (and family) via comments on the post in question - potentially less intrusive than unsolicited personal email, particularly if he's not necessarily reading his own email these days.
Wow. Can't even imagine what that's like. My $20 are a drop in the bucket, but hope that bucket is getting more full.
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?
The brain is remarkably plastic, and can compensate for all sorts of damage ... right up until the point that it can’t. This is a tautology, but the point is that there usually aren’t any symptoms until these are fairly far developed, which is a big contributor to the fairly terrible prognoses, and the fact that deterioration after the first noticeable symptom is rapid. The effect is magnified in the young and those otherwise in good health, as they have more effective reserve.
It looks like a Novocure TTF System. A fairly brilliant piece of technology that unfortunately is only useful in patients with glioblastomas that are past the point of surgery or chemotherapy.
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.
Just because it is called insurance doesn't mean it actually is. The health care industry is pay by activity/procedure/items consumed, and everyone has a vested interest in others not knowing what is paid while (usually) increasing activity. In general everyone is spending someone else's money.
"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
>"Doesn't the insurances cover with these expenses in USA?"
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.
Still confused...this is a terrible reputation for the insurance of this fellow. Aren't any insurance provider covering these kind of things? If so, why anyone would take a insurance that doesn't?
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 a whole range of things. I don't have a comprehensive link at hand and these questions are so heavily politicized right now in the US that searching is all but pointless.
>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.
Due to a couple of historical accidents, most Americans have health insurance through their employer--which means they get their employer's choice of insurer. And employers are not incentivized to pick an insurer based on how well the insurer works with cases like this.
There are all sorts of different health insurance plans. Most of them have a deductible, so you have to pay the first few thousand dollars yourself every year. Many plans cover a large percentage of costs after that deductible... say 80% ... which means that he'd still have to pay for the remaining 20% of some pretty expensive bills. (some plans cover 100% after deductible)
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.
read the comment about his life in chicago - giving money to bands as one example. he's spent much of his life helping the larger communities around him - php and music are just two that have been mentioned.
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%
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.
I was so excited, my digital album had it's first sale today. When I saw this post, I donated the album's proceeds. Here's to making the world a better place!
Could someone he trusts and someone capable of setting up a cryptocurrency account do so for him? I imagine a community like Dogecoin would help any way that they can.
Richard called me back and asked that we use his wife's e-mail -- sunshinysmile08@att.net -- if you want to setup a wallet or e-mail her instructions on how to setup a wallet that would be awesome!
In a large enough sum, almost any crypto-currency is worth the hassle involved in conversion. For Doge's current position, I'd argue that it is worth it.
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.
Don't have much to give right now, but it's a great cause. Such a shame to see anyone like this, especially someone as kind and active in the community (judging by people who know him). Wishing him all the best.
I don't have money to give but it pains me to see stories like this. I think there is more that can be done to prevent this type of suffering (though I don't know much about cancer per se). I have a different serious medical condition, as does my oldest son. We have figured out how to get well. What I can't seem to figure out is how to constructively share info on what we did. Any suggestions?
(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.)
Ditto. I have benefited immensely from PHP and very much appreciate the contributions from people like Richard. Very sorry to hear this happened to him and hopefully donations help take some of the stress off his family in this very difficult time.
Does anyone know how to contact Mr. Lynch or someone associated with him? I attempted to comment but don't want the extra accounts created, and would happily create and host Stripe (or whatever other payment gateway) donation forms might help people that can't or won't go through PayPal (assuming, of course, someone on the other end creates the appropriate accounts and provided they're legitimately associated with him).
A few weeks ago we started an organization called Capacity 2 Care (http://cap2care.org) for situations just like this -- it's in the early stages so we only have a few hundred members at this point, but I posted it to the Facebook group to see what we can do...
Normally I'd jump in on the practicality bandwagon, but this really is not constructive. People who are going to pray will; people who are going to donate will. Your denigration of their faith, justified or not (and we'll never really know until we die), helps no one, particularly in this context.
Nobody's denigrating his faith, as much as his transparent attempt to leverage it for social credibility by advertising his piety on Hacker News while (evidently) doing nothing actually helpful.
If that's not worthy of denigration, take it up with Jesus himself, who said pretty much the same thing.
This is even more cynical than I'm willing to be. Yes, a lot of what goes on on HN is just "hey look at me," but really? Someone says "I'll pray for you" to a guy dying of cancer and your reaction is that he's attempting to "leverage [his faith] for social credibility?"
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.
"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…"
it's not an attempt for social credibility, it's a way of expressing sympathy. seriously, it's such a common way of saying "i have read about what you say and wish you well" that you have to be particularly cynical to read it as a show of piety.
Magical thinking is probably the single greatest threat to the longterm survival of the human race. I can think of no situation where it is not appropriate to criticise it. Furthermore, illness and death are exactly the times when human beings are most likely to abandon rationalism and cling to magic, so these are the very times when the fight is most important, and we shouldn't shy away from that just because it makes us uncomfortable to tell the dying their fairytales are untrue.
The only person you are trying to benefit when you are trying to convince the dying of atheism is yourself. We should let people live their final days believing whatever they want. Even as an atheist, its clear to me that the right thing to do is allow the dying to be happy and comfortable, however they want that. Furthermore, there are many, many threats to longterm survival, not just mysticism.
I am still a student so donated $50. I know its not much but neverthless.
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.
Is he a part of any organisation that could recieve funds for him? Someone living in the US can fill out this donation forms:
http://www.redhawkcasino.com/community
I donated a small amount, hopes that helps. I hope it's not some "Save Walter White" scheme :)
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.
The "problem" in America used to be that not everyone paid into the insurance programs. "Obamacare" aims to fix that problem but Congress is full of assholes who tend to use the Constitution as a political weapon to fight the so-called "tax" for universal healthcare. Tough a myopic lense, e
I attempted to donate with a credit card and was rejected; I'm not sure if it's because it was previously (and not currently) registered with PayPal or whether a donation request can't be filled by credit (my successful donation was via debit). Just something to be aware of for others trying to donate.
I wish that there was a sufficient safety net in the US so that people who get catastrophic illnesses didn't have to negotiate stressful financial situations while dealing with extreme medical problems.
I am really glad this made to the front page of HN, it is great to see people helping him and his family out.
I donated $25, don't know this guy, but thanks for all he did on PHP that all my websites run on.
As a separate note, php.net probably can have some donation button, that it can use to boost PHP community, including helping key contributors like Richard too.
Lost my mom to a series of complications, including cancer a couple years ago. A donation to help with Richard's quality of life and his family is a truly kind thing. I'm in.
Gave what I can right now. It's sad when I look at what I'm paying per year on health insurance and realize that most of us are a few stray cells away from being in the same situation as Richard.
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 :)
Donated. Best wishes to Richard. I had never heard of him, but I used PHP for years, and I suspect in some way he has contributed to my well being, so I consider this returning the favor.
Can we pay him to get treatment in another country? I'd do that if I was in as bad of shape as this guy. At least there'd be some money left over for my heirs.
The process would normally go like this in modern hyper regulated America:
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.
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.