First kid was no cost to us. My wife was on insurance with her employer. Long day, but no complications. I kept waiting for a bill that never came. Couldn't believe we didn't pay anything!
By the time the second kid came around, we were self-insured on the healthcare.gov marketplace. We ended up paying $5000 out of pocket - $2k for the prenatal care and doctors' services, $3k for the delivery and stay at the hospital.
We made a $1500 mistake. My wife had a really fast and normal delivery, but it was so fast that they didn't have time to administer an antibiotic that they otherwise would have. They wanted to monitor her for a day to look for an infection. We said okay, but if I had more closely read my policy I'd have learned that the policy had a $1500/day copay for labor and delivery. We'd have taken our chances and gone home had we known.
Kid three is coming! And this year's marketplace plan says that we're on our own up to the individual deductible of $6950. That's a bronze plan that carries a $950/month premium for 4 people; financial assistance from the government drops that down to $700/month. So we pay $8400/year for the privilege of not paying more than $7000 for an individual ($14,000 for the family) on our plan.
I don't think state-run healthcare is the only solution here (nor is it an inherently bad solution; I'm no libertarian), but I have to think that I'm living in the worst of all worlds here. I'm forced to buy an expensive product that I'm afraid to use, a product that costs more than the roof over my head per month but delivers a fraction of the value. It's expensive because it's violating basic principles of insurance, because the people who made the law are trying to implement universal healthcare in a system that's not built for that idea (at least not in the way it currently exists).
If I lived in a more market-based system there'd be price transparency, presumably a better way to monitor outcomes, and a lot more say in what kind of policy I could get to better accommodate the needs of my family.
Anyways, there are alternatives and means for assistance out there, and we're exploring them. But we like our doctors and our hospital; it's a shame that we have to look elsewhere. Not looking for sympathy, just adding a data point! My takeaway from that article was that maybe we should price out a trip to Spain sometime late in the third trimester :)
> We said okay, but if I had more closely read my policy I'd have learned that the policy had a $1500/day copay for labor and delivery. We'd have taken our chances and gone home had we known.
What the bloody flying everliving fuck??
Does this not seem absolutely absurd to anybody else? You'd have risked a severe infection for the mother of your newborn child had you known there was a monetary cost attached to not risking it? This is patently ridiculous, and it is inhumane that people have to make such calculations.
You go to the place with the people in white robes when you're sick. No ifs, no buts, no strings attached. This is how you keep a healthy, productive populace.
No wonder the US, the largest economy in the world, ended up with a terrible infant mortality rate…
> "Persistently high poverty rates, poor educational outcomes, and a relatively weak social safety net have made the US the most dangerous of wealthy nations for a child to be born into."
… yeah. As a young person who's planning on having a family: I will go work in the US exactly never.
> Does this not seem absolutely absurd to anybody else?
It is obviously an insane way to run healthcare. But for the majority of US citizens, they've never experienced anything else. So this insanity is considered totally normal to them. Medical bankruptcy isn't just a thing, it's an expected outcome of any major illness -- medical bills are the most common reason for bankruptcy in the US.
If the US just switched to a proper universal national healthcare system (like say, a clone of UK's NHS), for even just one month, America would never go back to the way it is today. Not suggesting that UK's system is perfect, but it's so much objectively better than the US system that there would riots in the streets, if anyone suggested going back to today's US system.
Which is why we see so much lying about how terrible socialized medicine is, and so much money/time poured into preventing Americans from learning/experiencing it in any way.
Having a Baby in US. I will definitely give my insurance provider a call. They didn’t pay much for the OB and I work for a very solid tech company.
America’s healthcare is a f*ing joke. It’s riddles from the top to bottom with people who want to leech money at every step and provide the most minimal service.
I had a slight fracture in my scaphoid. I paid $2000 out of pocket and insurance paid half of that.
In Australia where I don’t need employer golden handcuffs for health insurance, it would be less than a third of that.
I'm american. This time last year I had a minor bone break in my hand (not emergency, no severe pain).
I have a preferred doctor who doesnt have an xray machine. Obviously getting an xray image is the first step before even talking to the doctor. An xray of your hand is a _very_ basic procedure. My plan was to get my own image from a conveniently close facility of my choice and bring it to the doctor.
This is an open commercial market right? I decided to play a quick game with this and ask all my in-network local providers what their charge would be for just an x-ray of my left hand.
A car mechanic should be able to quickly give you an up-front estimate for common procedures, why not an imaging facility?
If youve read this far youre probably not surprised I called 4 different facilities, followed up with a series of requests over multiple days and failed to receive even one straight answer except "come in and we will see what we can do".
It makes me realize how soul-crushing the experience can be in this so-called "open market" to find the best possible treatment when you have a more complicated problem. The amount of leg-work, scheduling, waiting for doctors and getting opinions all while in pain would break the spirit of most anyone.
Is it really that much simpler in other countries to connect with the proper provider? I was under the impression countries like canada handle simple problems like mine much more gracefully but serious issues remain problematic.
>> Is it really that much simpler in other countries to connect with the proper provider? I was under the impression countries like canada handle simple problems like mine much more gracefully
In Canada and in Britain, you simply go to your local GP and get a referral, or go to A&E (Emergancy).
>> but serious issues remain problematic.
No, generally treatment in Canada and Britain for 'serious issues' is very good as well.
We all hear about the well publicised failures of the NHS and Canadian Healthcare, but by and large it works very well. I have seen close relatives and friends have cancer, septicemia, strokes, severe bone breaks, a life changing injury that made a friend a quadrapeligic, and more. For the most post part, the level of healthcare in Canada and Britain has been excellent.
My friend who had septicemia was in a very remote location, and once diagnosed was airlifted to a major hospital.
All of this is covered by public healthcare. It is amazing.
It is even more astounding that the USA still has this Byzantine 'private' system that tries to claim that it is an open market, but it is not.
From a macroeconomic point of view, the USA pays 18% or 19% of GDP for its healthcare system, where as Britain and Canada, and pretty much every other western country pay about 10%. (These are OECD figures) The American healthcare system is horribly inefficient, and puting in a public system ought to be every American's politicial priority.
Imagine that, a universal healthcare system is cheaper to operate than the private system?
The rhetoric and hyperbole that comes out of those who are vested in the status quo is outright criminal.
I agree, I have no real complaints about the Canadian system. ~14 years in Ontario versus ~29 years in US. Are there differences? Sure. Is there peace of mind knowing that I won't be uninsured or out of pocket for a relatively minor procedure that might cause me real financial hardship in the US. Goddamn right.
I live in Germany and I would probably just go to the next hospital, wait for a while, get x-rayed and see a doctor. In this situation I wouldn't even have to think about money and I don't have to search for the best provider because they are all good. Even if I wouldn't go to a hospital, every doctor who can treat you usually can do an x-ray at his practice. I cannot imagine how it must feel in such a system in urgent cases. (edit: "such a system" refers to the American system)
My wife banged her foot about a year ago. We were pretty sure it wasn't broken, but we went to the hospital to get it checked out anyway. We never even considered which hospital we should go to - we basically expect them all to be decent, so why bother thinking about it? We had to wait in the emergency room for an hour or so, but then we were seen. My wife's foot was X-rayed 30 minutes later and it was confirmed that everything was fine.
I was in the US once, and had developed a cyst on my finger that hurt (due to the pressure of the liquid inside -- could have been a ganglion cyst).
What you do with those, is you burst them open to relief the pressure, clear the liquid inside (white cells and such) and put some disinfectant. In my (Western European) country it's a trivial 10 seconds operation every pharmacy is authorized to do.
So I go asked at a pharmacy/drugstore for that (probably a Walgreens) -- and they said they weren't allowed to do it and that I should ask at a clinic. I asked how much it would cost for this, if I went at one, and they told me about $150.
Yeah, right.
I just went on and bought a regular clothespin from that pharmacy, burned it with a lighter to disinfect it, and burst the cyst myself...
(And it's not about government mandated insurance vs "really free market" and such. We have mandatory insurance were we are, and the prices for all kinds of operations, both with and without insurance coverage, are still way lower).
And higher rates of teenage pregnancy, pregnancies by obese persons. Using the infant mortality rate as a proxy for US healthcare quality isn't reasonable, as you say.
On the flip side, one could argue that teen contraception and nutrition education are important parts of a properly functioning health system. To put it another way, who is to say high rates of teen and obese pregnancies are not caused, in part, by our health system?
> who is to say high rates of teen and obese pregnancies are not caused, in part, by our health system?
Sure, perhaps in part, just as any occurrence in other countries with any recordable teen or obese pregnancies. However, it would be inappropriately reductive to say the health system is the cause of these, and I'd argue it would be incorrect to say the health system is the primary cause. To do so would be to ignore the entrenched historical and cultural influences on the present state.
>>Does this not seem absolutely absurd to anybody else?
It does, and it's shit like this that makes me absolutely convinced that US is a 3rd world country, where people have to weight their own health vs the financial cost. There's plenty of people saying they don't want to call an ambulance because they are worried what their bill would be. That people would risk their lives and that of their new born baby because there is a financial cost associated with staying at the hospital for another day is beyond absurd, it's like bad fiction about some distant society where things have gone horribly wrong, except that this is real and calls itself the greatest country in the world.
If individuals aren't free to make these financial decisions for themselves, then insurance companies or the government will. My mom had a severe infection while on chemo because the insurance company didn't want to pay for an injection that would've boosted her immune system. Having these decisions made at the population level, instead of the individual is far worse.
If the state was paying and your mother wanted to pay out of pocket nothing would stop her. Elective course of action is not banned in any single payer system that I know of.
Canada -- a Quebec ban on private health insurance was overturned in 2005, but there are still open court cases on whether that applies nationally and whether healthcare providers may charge privately for services.
I don't know about Canada obviously but in Poland hospitals are not allowed to charge for anything that is refunded by the national health service, but they are free to charge for anything else. So if a patient says they want an extra injection that is not funded and they will pay out of their own pocket for it, they absolutely can.
What do you mean individuals aren't free to make that decision? Even in a fully public healthcare system you can always opt to pay for treatment which is not covered(as rare as those are). How is that different than your insurer in US refusing to pay for treatment and you paying from your own pocket?
That’s a red herring though. Few countries have a system that forbids paying extra for extra care. The point is that in the U.S. system you can’t get basic care without paying extra, which is not the case in other countries.
why not do some research online, buy the meds for a penny on the dollar via the darknet, and give them to your mom's nurse with a $100 note to seal the deal?
is it absurd that i have plans for these exact situations already worked out?
Socialized medicine (e.g. one paid by state) also weights costs and risks. You just don't see it and don't have to make those decisions by yourself.
You don't know how much for them 1500 wad nor how high the risk nor whether coming back from home was that much dangerous in case that bacteria happened.
Funnily enough I agree with you but I have to disagree a little bit.
The truth is no one knows what the right level of care is even in many common situations.
Up front I'll say I'm a state and universal healthcare advocate.
But it comes with its own forms of waste.
Our first child had a borderline kidney tube measurement. We had 8 follow up scans costing the taxpayer $300 each.
Gradually I realised that the clinics had figured out a way to game the funding system, because at the level of deviation i saw I could find no research supporting the need for 8 extra ultrasound scans and in fact the only measurable risk was an increased risk of uti escalating to kidney infection which actually an ultrasound is not the best diagnostic tool for anyways.
In fact none of the doctors or technicians I talked to could coherently explain the level of risk or how the scans mitigated that risk.
What they did have was numeric guidelines and some measurement uncertainty. Plus a blank cheque to do more scans if they could justify it under current guidelines.
On the gripping hand they were $300 scans not $1200 scans like in insurance driven systems so...
Parent I responded to does not know. He is just horrified that couple would save on healthcare. If you live in system with socialized healthcare, you don't have to make these decisions.
However, if you pay out of pocket then you do have to make those decisions personally. Else you will be taken for financial ride.
I would really liked to know why is this downvoted. Do people think insurance dont make those decisions? Or that those decisions being made implies I think socialized medicine is bad?
Or they all know everything about that particular bacteria and assume everyone should?
My wife is a resident physician. She also went through the same experience of delivering a kid.
Here's what I've learned:
* Pricing is not transparent. When the hospital tells you how much the procedure will cost, they are not telling you about the anesthesiologists portion, or the room fee, ect. There will be surprise bills. Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?
* Doctors are in short supply. This is because becoming a doctor is impossibly hard. Why can't undergraduates enter straight into a medical school program? Doctor's are in the 30's when they complete training and are already halfway toward the retirement age
* If things go badly during the delivery, you will be glad you are at a well equipped Hospital. A $5000 bill is a small price to pay to ensure the baby does not arrive brain damaged.
Doctors are in short supply. This is because becoming a doctor is impossibly hard
That's an entirely artificial problem created by the AMA (or BMA in the UK) to keep wages high. What if everyone who had the academic ability could train, rather than having to compete for a restricted number of slots? It's how every other discipline does it (they defer competing for places until the job market).
This is a huge problem. The limiting factor appears to be the number of residency spots, not the number of accepted medical school students.
We should take some of the billions our Federal government spends and increase the number of residency spots and increase funding for tuition reimbursement for practicing in underserved areas.
I can't personally speak to the accuracy of the linked claim below, but it suggests that the coverage of residency spots is controlled by a physician led advisory board called RUC that intentionally limits the reimbursement so as to control wages.
I'm sorry, but if someone is going to be cutting into my body, I want them well trained and I want them to have dissected a human. I don't want someone who "moves fast and breaks things" puking on my exposed parts.
Why can't undergraduates enter straight into a medical school program?
That is a thing called a direct entry medical program. It gets you the the end of medical school in 6 years instead of 8 by dispensing with the undergraduate degree. The extra two years cover the sciences and how to learn at medical school speeds.
It shaves two years off, but at the cost of pinning the student into a rigid track. The number of high school seniors who think they want to be doctors and change their mind during an undergraduate is pretty high.
This is an important point. I think I'd be ashamed if my kid grew up and found my archives here, lamenting a $5k bill. Bringing a human into the world is a big deal, and worth at least that much. And I'm not lamenting too much; we were blessed enough financially to be able to cover it without going into debt.
But if it's being done for less elsewhere, then I don't think it's wrong to let that influence your expectations.
I believe in the UK, hospitals are by law required to give you the fully itemized bill. Knowing transaction price up-front seems to be an obvious part of market health.
> 7.—(1) The registered person shall produce a written guide to the establishment or agency (in these Regulations referred to as “the patients' guide”) which shall consist of—
> (a)a summary of the statement of purpose;
> (b)the terms and conditions in respect of services to be provided for patients, including as to the amount and method of payment of charges for all aspects of their treatment;
Yes, but also there is the fact that there is an artificial cap placed on total US residency class size, meaning there is a pretty effective bottleneck on actually becoming a medical doctor.
Seriously though, listen to the advice of giving birth in a hospital setting. If they have a midwife center then take advantage of it, but I would highly caution against the trend of birth clinics and home birth unless you live very close to an emergency room. Things can wrong in an instant.
Source: Experience. First born was in NICU for 12 days and mother had bad complications. We had to be rushed in an ambulance from a natural birth center when things went south.
Actually Dutch child mortality (birth mortality?) is high compared to surrounding countries, in part because of home birthing (the occurrence of which is trending downwards, btw)
> Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?
Medicare would oppose this tooth and nail. The lack of pricing transparency enables them to keep reimbursing less than cost, because they can expect private insurers to be forced to pay the difference.
I'm not sure what you're implying by posting that link. Medicare posts its fees and schedules, yes, but the point is about what private insurers reimburse.
I can't imagine dealing with such bills for bringing a child into the world. I was a military wife when I had kids. It cost me a few dollars a day for a hospital stay. I think both births were around $20 out of pocket, give or take a few bucks. I was in the hospital three days the first time and two days the second and the price went up a bit in between the two births.
but I have to think that I'm living in the worst of all worlds here.
I worked in insurance for a time. I do think Obamacare is the worst of all worlds. Requiring universal insurance is a terrible way to try to arrange universal health coverage for the nation.
> Requiring universal insurance is a terrible way to try to arrange universal health coverage for the nation.
The country where Obamacare was copied from, Switzerland, also outlawed group insurance so (a) you didn't get health insurance from work and (b) EVERYONE was in the same risk pool.
The current situation, you have group policies that are actually affordable because...people with good jobs to provide it typically are lower health risks. Everyone else is stuck a shitty individual pool with lots of high risk individuals. As long as the group pools siphon off all of the low risk, Obamacare won't work.
I was also active duty military when my wife had our first child so I know what you mean. It's been pricey having the other kids but at least I've had decent insurance to do it. My heart goes out to those with no insurance or crappy insurance.
Regarding universal healthcare, we have a unique viewpoint because we've actually lived universal healthcare in the military.
Long wait times for appointments, crappy doctors that you have no choice but to go see (or have fun paying out of pocket at a civilian doctor), an employer with 100% insight into your medical situation, the loving kindness of a DMV clerk surrounding you while going through the wonder of childbirth for the first time... Ah, those days don't come back.
What are your thoughts on universal (or single-payer) healthcare?
I think it would make more sense than what we are doing currently. Given the high percentage of US GDP and individual income going to healthcare, it would also make a lot more sense than all this talk of Basic Income.
When I was a military wife, I never had to wonder if my kid was sick enough to justify seeing a doctor. I never had to consider cost as a factor. I never had to save for retirement. If he made 20 years, we would have a retirement check. When I was in quarters, I didn't have to worry about rent going up or other related expenses.
That security and stability was incredibly valuable for my peace of mind. It made life simple. We just needed to stay out of trouble and make sure my husband was a good soldier and everything would be okay.
We had two special needs kids and I have serious health issues. I had a college class on homelessness while still married. These kinds of problems are a root cause of homelessness in the US. After the divorce, my adult sons and I spent nearly 6 years homeless.
I think universal basic healthcare and a solution for the affordable housing crisis in the US would drastically reduce homelessness and be a vastly better solution than Basic Income. These are proven solutions with many available models. Basic Income is an unknown that has a lot of potential problems.
If people think single payer medical us not politically viable in the US, what in earth makes them think Basic Income is more politically viable? And if they don't think it is politically viable and are touting it anyway, doesn't that mean they are just jerking our chain and hoping that talk if some feel good answer will keep the masses mollified and not rioting in the streets while we continue to be crapped all over?
Interesting, and sorry to hear about your bout with homelessness. I spent some time homeless as a teenager and it was awful. I can't imagine going through that with kids.
I've wondered quite a bit about the basic income idea. One of the issues that has me stumped is what to do when AI and automation are taking lots of jobs that people currently do (like truck driving, which is going to disappear fast). I'm not sure providing only health care and not basic necessities will be enough.
Maybe at first people can retrain into other career fields, but the AI revolution will come swiftly and leave much wreckage in its path. I tend to think this will eventually be a very good thing, but it will wreak havoc and cause a lot of short term pain like the industrial revolution did in the 19th century.
Definitely interesting stuff to think about. Thanks for sharing.
Machines previously were threatening to take jobs away. It ultimately led to many improvements for commoners, such as the 40 hour work week. We call it The Industrial Revolution.
But no need to learn from history. We can just pretend that restructuring work isn't possible and act like what we are currently facing is utterly unique and the world hasn't seen anything like it before.
(Not a swipe at you. I am just angry and frustrated about the entire world acting like only UBI can save us from the robot-job-pocalypse.)
This time is fundamentally different because AI automates the human mind. Human input may always be needed, but fewer and fewer jobs are required to support the needs of the population. New quality jobs are not being created at a sufficient enough pace to be offset the loses.
I'm not trivializing anything. I spent 5.7 years homeless. I got off the street 4.5 months ago.
We have a ridiculous number of homeless in the US. Meanwhile, rich tech giants talk of giving UBI to everyone as their solution to so many jobs going away. The jobs that are going away pay about $20k-$50k. UBI is expected to be $10k or maybe $18k. Articles that talk about this then write warm little vignettes about how lovely it will be to have that supplemental income on top of your low paid job, utterly ignoring the actual scenario posited that this money is in place of a job in a climate where there is little or no hope of getting another job.
If you think the Industrial Revolution was bloody, you don't want to see what happens with millions of people getting just enough money to sleep in a tent and keep eating while the cops harass them and the system gives them no hope of getting back to a middle class lifestyle. They won't be actually starving. But they will be mad as hell and have nothing but time on their hands to plot a revolution and train for it.
- You can move away from expensive locale to a cheapest one.
- You can find supplemental income: do something with your hands, provide services, etc. You have all day to do that. It shouldn't be that your time is worthless and nobody is willing to pay anything for it.
- You can pool with other people to form a community, save on bulk.
You can find supplemental income: do something with your hands, provide services, etc. You have all day to do that. It shouldn't be that your time is worthless and nobody is willing to pay anything for it.
People are positing that we need UBI because jobs are outright going away and there will be no paid work to be found. If it is possible to create earning opportunities in the post robo-job-pocalypse, then why can't we focus on restructuring work to begin with?
I wish people would pick one. Either it will be possible to keep earning money somehow, in which case we don't need UBI to replace jobs and we can, instead, focus on restructuring work to improve quality of life generally. Or it won't be possible to find earning opportunities, in which case UBI is all the money you will
have.
If someone wants to do that, they are currently free to move someplace cheap and do that.
On the other hand, a lot of low cost areas, like rural parts of the US, don't have the high speed internet necessary to do something like that. It doesn't work unless you have both low cost of living and amenities like high speed internet. Right now, amenities like high speed internet and jobs are mostly concentrated in big cities. So just giving people a check (UBI) and telling them to work the rest out themselves while the world is actively against the idea of restructuring work simply doesn't work.
Either we can make a world that supports living someplace cheap and earning money online or we can't. Basic Income has no bearing on the logistics of making that work.
This world kind of exists already. A lot of people move to Southeast Asia (for cheap and comfortable living) and there travel between countries while making money remotely.
I work remotely. I moved someplace cheap within the US. I am still struggling for various reasons, but I currently live like you describe.
So if it can be done without UBI, why do we need UBI?
Either we need UBI because you can't get paid work and you need to live off UBI, or you can get paid work, in which case we don't need UBI. Please pick one
You can't still work if all the big wigs with the power to create jobs are not bothering to make work available because you have your UBI.
I have already laid out my solution: accessible healthcare, affordable housing and restructuring work.
And the reason I hold the position I hold is because I was homeless. So I know what bs it is to say "You can just move someplace cheaper and supplement your income." I was both willing and able to do both of those things. It isn't the easy answer folks imagine.
I owe a bunch of money from making the move. People who, themselves, make money online mostly shat all over me and wouldn't help me figure out how to make money online while saying things to me like I was panhandling the internet for trying to figure out how to earn money online etc.
UBI will not give anyone the knowledge, skills and connections necessary to turn free time into income. What it will do is allow classist or sexist or racist assholes to be more comfortable with shutting out Those People from the paths to an earned income because, hey, you don't need me to give you an opportunity. You have your UBI.
If we don't fix the affordable housing mess, UBI fixes nothing. There are lots of places where $10k is basically just rent for the year, with no money leftover for anything else. And if you think people can just move to the cheap seats, it is hard to find a place for under $500/mo. That leaves less than $500/mo to cover all other living expenses.
I have lived on that kind of a budget. I have looked for housing on that kind of a budget. I know firsthand how hard it is to make that work. So when folks who likely have more income than me post imaginary stories about what a piece of cake life will be when there are no jobs but everyone has UBI, that really sticks in my craw.
You telling me that UBI is supplemental income tells me you don't get it. UBI is not supposed to be supplemental. It is supposed to make sure most people don't starve when there simply is no paid work to be found.
These kinds of comments are crazy making. If it is supplemental, we don't need it. If it isn't supplemental, it doesn't work without also fixing healthcare and housing.
I think we don't need it. We just need to fix healthcare and housing and restructure work. We need to do all that with or without UBI. I think without UBI, we will do a better job of fixing those things. With UBI, too many people think those problems don't really matter that much. Poor people can just move elsewhere or something.
I'm totally with you on fixing affordable housing and healthcare, and that a UBI can only do so much without fixing those problems.
I don't buy the idea that UBI will make it harder to solve those problems. I think UBI will make it easier to fix those problems because it would free up more peoples' time (especially the lower and middle class) to be politically active and fix these fundamental problems. Right now nothing is really improving because the wealthy who've bought out the politicians don't care, and the poor have no time or energy to protest because they're too busy working multiple jobs and worrying about whether or not they'll make rent next month.
> You can't still work if all the big wigs with the power to create jobs are not bothering to make work available because you have your UBI.
Jobs aren't some kind of charity case that companies offer to appease the financially desperate masses. Jobs are created when there's a need for labor, and they believe the revenue generated by the labor will offset the wages. UBI does not mean that companies go "well looks like the masses don't need our money anymore, we can finally take away these jobs". Businesses are there to maximize profit, and UBI doesn't change that.
UBI however would massively increase the bargaining power of laborers by giving them the option to walk away. Wages of jobs that nobody wants to do but are services that we need would rise. We'd probably see more people opting to work less hours. The whole dynamic of interviews would change in favor of the laborer (as opposed to right now where the employer has the upper hand). Overall, it'd be a massive boon to labor.
Currently, multiple tech giants are pro UBI. Sam Altman is constantly on the front page of HN talking about it. He is putting millions of his own money into UBI experiments.
I am not aware of him doing anything about healthcare or affordable housing. Since he became president of YC, he has used it as a platform to promote various social agendas he is interested in. YC fosters the development of businesses.
You cannot convince me that the focus of someone like that has no impact on the kind of world we are creating. I do not believe he in any way cares about the little people. I do not believe he has any interest in or willingness to open doors for poor people. His interest in UBI strikes me as a huge fuck you and quit your bitching to the little people.
You need to be very leery of the motives of the architects of such a system. Currently, American welfare does an excellent job of trapping people in poverty. I have no idea why you are so strongly convinced that some new welfare scheme with a shiny new name won't continue that pattern. I have seen zero evidence that it will.
Since healthcare and affordable housing both need to be fixed anyway, I would much prefer to see time and effort to into those things in the here and now rather than into all this talk of UBI. If both of those things get fixed first and people still think UBI is a good idea, I would be much more willing to support it at that point. But at this point in time, talk of UBI looks to me like a lazy concept if throwing money at the problems of poor people as if their problems are easily solved. This makes me extremely leery of both the idea itself and of the idea that people trying to spearhead the movement are at all qualified to do the heavy lifting involved in solving healthcare and affordable housing.
I have a bit over $10k a year in alimony. To get off the street, I spent 2 years researching where in the western half of the US I could a) travel inexpensively without a car and b) afford to buy a house. I am in a cheap rental trying to figure out how to buy a house with no money down.
There are places in the US where you can rent for $500/mo or less, but they are pretty hard to find. If it is just you, you may be able to make it, especially if you are willing and able to get a roommate.
If you have dependents, high health costs or any complications whatsoever, it rapidly falls apart. If we don't give UBI from birth, poor families with children won't be lifted out of poverty like we imagine. If we do, you can guarantee that some women will crank out babies as a means to raise their income and be lousy, abusive mothers who don't actually care about the kids.
For the vast majority of people, cutting their income 50 to 80 percent in exchange for going jobless will be a hardship. Most lottery winners are bankrupt within 5 years. I suspect part of the reason for this is that most people divide their time between working to make money and consuming in their off hours. When you remove the job from the equation, they suddenly have about 50 hours more a week that they need to entertain themselves. If you are used to spending money in your leisure time, it can be incredibly hard to shift gears and find cheap or free means to do so.
It can be done. I have lived on damn little for a long time and I do a lot for free because my income supports three people, not one. So the budget is quite tight. But a lot of people fail at it.
Currently, people failing to make ends meet can turn to food stamps, section 8 housing, etc. Many people feel that the way to finance UBI is to eliminate all that stuff. So if you get UBI and fail to make it work, it is possible there won't be a safety net to catch you when you fall. It may be one huge fuck you.
I have also wondered if that wouldn't be the case. As machines take over, we may see new jobs created that never existed before, just (as you rightly pointed out) happened in the industrial revolution. I really hope this is the case actually.
My certainty diminishes somewhat when listening to people like Ray Kurzweil talk about his Law of Accelerating returns (exponential growth)[1]. I wonder if things might be different this time around (change is too fast, too extreme/disruptive) due to things like the exponential growth curve. Of course we humans always like to think "this time is different" so who knows.
Most of those complaints seem to be specific to your individual situation, rather than features of universal health care systems. I would argue that experiencing universal healthcare isn't that unique (Most developed countries) - what's unique is the specific (US Military) system you've experienced.
Employer knowing your medical situation? State-run healthcare keeps your employer out of healthcare completely.
Crappy doctors? Outcomes vary across countries and by treatment, but I think it's hard to argue that US outcomes are in general better than the average socialised system.
Choice of doctor? There's no reason private insurance can't co-exist with socialised healthcare. We have private healthcare in the UK (which is, I believe, kept to a reasonable price / practice by having to compete with the NHS). Furthermore, you do have some choice of your doctor in the NHS. If I want to see a doctor, I can choose where I make the appointment. Nobody is compelling me to see a particular doctor. For more serious issues, requiring complex treatments the choices do narrow. But this seems right to me - If I'm seriously sick, I want to rely on the expertise of a specialist. Even then, nobody is compelling me to have any particular treatment and I always have pretty much the same choice a US patient does - to go private.
Long waiting times? Perhaps, but it's pretty horrific to argue that this is worth the pain and suffering caused by shutting a significant portion of society out of the healthcare system.
I am not seeing anything described here remotely like Obamacare. It sounds like bald faced copying any of those systems to the best of our ability would be a vast improvement.
I was homeless when Obamacare passed, so I was exempt. I am no longer homeless. I worry how this will impact me and I wish Trump would actually fix it like he said he was going to do when he took office. If he fixed our completely broken health coverage system, I would be willing to largely overlook what an utter shit show of a politician the man has been.
In Austria if you are self enployed there is a mandate for medical insurance and pension contributions. If you are employed there is a mandate which is shared with the employer.
Inertia, probably. Any gradual change adds to the bloat; any radical change is rejected out of fear, or maybe ideological concerns.
Not picking a fight here, just curious: another person commented on my original post noting that when I said my first birth didn't cost us anything, that wasn't true - my wife's employer paid a fair amount for her insurance.
Are your taxes broken out in the UK? Do you know how much you pay a year for healthcare?
For my family it's about £2800, or $3900. My wife doesn't pay tax, but I earn in the top decile. Probably a little more due to spending on vat and other indirect taxes (petrol tax etc), call it $4200.
However my parents, gran, and my mother in law combined pay under $1000 a year between them.
On the other hand a premiership footballer pays about $250,000 a year for health. Plus their own private health care costs of whatever. That's the price they pay for living in our society though, a society where people aren't afraid to go to the doctors to check out that mole, or rush to give birth because they can't afford an extra day in hospital.
Have you and your wife considered using a birth center for #3 if there are no complications or high risk factors? My wife and I had our son at a midwife center in the US, and our prenatal, delivery, and postnatal care combined ran about $3k (of which our insurance covered about 2/3). The midwives were great, and overall I think it was a less stressful experience than the hospital might have been.
The most SEO-friendly one in the area that I found will run me about $6000, and I'm assuming I'd be on the hook for all of it if I read my plan correctly. Still in the early stages of research though.
My wife is open to a birthing center, unlike my home-birth overtones which she summarily rejected :)
Tough call there. The antibiotics were likely for Group B Streptococcus, meaning during prenatal screening she tested positive. I work in the field and we see some terrible outcomes from GBS (and other bacterial) infections such as blood stream infections, neonatal infections to hysterectomies and death. I've seen cases where moms have symptoms at home but they simply chalk them up to "what happens after giving birth". So whatever choice you make, tell your wife to listen to her body.
I think you're right. I say "we would have gone home" pretty flippantly; I have the benefit of hindsight where everything was fine, and presumably if we said that in a hospital we'd have gotten someone give me a spiel similar to yours, then we would have had to sweat the decision at that time. Maybe we'd have stayed anyways.
> So whatever choice you make, tell your wife to listen to her body.
My first son was born 10 weeks too early, we lived in Denmark at the time, cost 0.
My second son was born in New York and we had good health care coverage costed us nothing.
Right now we are on Cobra and we are fine. But once thats up we will have to find something else and I worry about the cost of that plan.
One thing I have learned though is that it's normally possible to negotiate the price down quist substantially (more than 50% sometimes) especially because these days it's the hospitals themselves who need to do the collecting and they simply aren't prepared for that (patient cost sharing up 230% and deductibles up more that 60%) They just want some money.
To add, I have almost identical numbers across the board w/ a delivery in 2017. My bronze plan is up to $1100/mo though and I get no assistance.
> If I lived in a more market-based system [...]
Unfortunately you can be vilified for saying this stuff in public. If you believe others, you are helping subsidize the poor and those with preconditions. In a market-based system you end up paying for what you need which, while it seems rational, is often considered amoral.
I think that's one of the biggest disconnects when it comes time to purchase. I'm being asked to purchase a product, but that product is being used with other goals in mind.
In other words, I bought a bronze plan because it fit best with my family situation and my budget, but was I selfish doing so? Should I have purchased a gold plan and therefore put more money in the system which would hopefully help more people?
I think there are a lot of potential solutions to the healthcare issue; either market-based or single-payer, if well-implemented, would be better than what we're doing now.
Insurance through employer is not a “no cost to us”. Employer is taking a significant chunk out of your income and giving it to insurance company. Government has already made insurance “self-funded” through HSA as well. So first few thousands dollars are coming directly out of your pocket.
I understand that's objectively true. "There ain't no such thing as a free lunch", etc.
Practically, it's hard to think like that. I don't know what her employer was paying the insurance company for premium subsidies or the care we received.
My question is specifically about the phrase and a lot more say in what kind of policy I could get to better accommodate the needs of my family.
I'm wondering where the other poster thinks they would save money vs insurance that covers things like child birth, hospitalization, emergency room visits, etc.
I was looking at a co-op alternative for 2018 - Our family premium would have been about $650/month unsubsidized, and our max out-of-pocket would have been $2500. Pregnancy is a pre-existing condition though, and co-ops are still allowed to exclude for that, so it wasn't a viable choice for this year.
Regardless, I was alluding to the fact that I have no control over my health insurance costs, unlike every other kind of insurance I purchase.
In India, there are small boutique hospitals that solve this very problem (e.g. https://www.cloudninecare.com/;https://www.motherhoodindia.com/;http://ovumhospitals.com/ and hundreds more in every city). I have always been so surprised by how "broken" maternity is in the U.S. and just how overtly "scammy" some of the things are e.g. if one needed breast-pumps, there is a 'company representative' that would deliver it to your hospital room and you get charged separately - by the company - and nurses get a kick-back; There is a nexus of private practitioners roaming the hospital wards helping mom's with early care - most of them looking for 'repeat business', after one is discharged. This is from experience in San Francisco. Not to mention the 'baby-product-industrial-complex' where one is convinced that highly special, safe and pink or blue colored equipment is needed for baby care. So there is a LOT of money made in the U.S. from every birth by a vast nexus of companies. Just the product choices one is forced to make drives millions of panicked google searches a year (with 'listicle-focused-SEO-hog-blogs' feeding off of this) -- just to search for the "right" equipment. Why can't just one company consolidate this -- and offer a one-stop-solution? Naked Capitalism is on its full-show during the birth process in America. It is indeed very strange.
The reason for this comment is that HN has a 'startup' bent to it, so I hope some entrepreneur just Warby-Parkers (is it a verb?) the baby birth process. There is definitely room for massive simplification. Make each decision simple -- that alone is a giant opportunity.
Interestingly, Scotland now has 'baby boxes' too [0] - but not the rest of the UK, it is an initiative by the devolved Scottish government only it seems.
The box itself is great, but the reason that Finnish mortality rate for babies fell so sharply after the box was introduced was because to qualify for one you had to visit a doctor early in your pregnancy.
Having early contact with healthcare, when pregnant, means you're more likely to do well. The doctors/nurses/midwifes/assistants can frown at you, tell you to eat your vitamins, stop smoking/drinking, etc.
For what it is worth healthcare is not free in Finland, but we paid about €300 for mother, father, and baby to stay in a private room for 3-5 days. (Just over a year ago, I can no longer remember that period. I just remember in the 3-5 days I drank a full bottle of whisky, and smoked a cigar in the car-park, in subzero temperatures. Finland, remember?)
A free-standing birth center, without a financial incentive to divert you into an associated hospital, could run you $700 out of $3000. (you pay $700, insurance pays $2300) Some of these places are very nice, feeling far less like a prison or mental institution than a hospital. I know one where the laboring mother can open the door to her room, then step out on to a patio that is separated from the street only by some large bushes. There is no feeling that the place is ready to lock you in and call social workers over a bit of dark humor.
A midwife at home would be perhaps $1000 out of $5000. (you pay $1000, insurance pays $4000) Residents of California may have trouble finding this; the obstetricians got their competition mostly outlawed.
Doing things by yourself is of course free. I did that with twins and with a 10-pound (4.5 kg) kid.
With all of the above, you are far less likely to be subjected to time pressures that will lead to drugs and ultimately to major surgery. Surgery is not just an expense; it is a hazard to both mother and babies because it impairs the ability to maintain and deliver future pregnancies. Surgery rates in the USA are improperly high because of how an uneducated jury is thought to respond; death and injury from surgery ("at least they tried everything") looks better than death and injury from non-action.
Except for the do-it-yourself option, there is emergency equipment. People greatly overestimate the chance of having a fast-developing problem, and they overestimate the ability of a standard hospital to respond effectively. If you truly need surgery, the time to travel for it can overlap nicely with the time it takes a hospital to prepare.
>With all of the above, you are far less likely to be subjected to time pressures that will lead to drugs and ultimately to major surgery.
See here's the problem with the American system. You feel like the 'better choice' is a private birthing centre rather than a hospital because of the issues you outlined. The better option is single payer health. In Canada, where I live, there's no pressures to get it over with. If you have a 3 day labour, you have a 3 day labour. If you need an extra day stay, you stay an extra day. Not once does someone bring up cost... not the doctors, not the patient, not the family, nobody. We have birthing centres for those who want them. You can deliver at home with a midwife if you want. When I had my two kids, my cost was $14.95 for parking and ~$20 for my lunch/dinner.
Birthing centers, statistically, offer better outcomes for both mother and child than hospitals. This is even after you adjust for everything like if you have a high risk situation you would always wind up at the hospital.
I remember being in our pre-natal class and the instructor talking about hospitals etc. People in the class were talking about how they wanted to deliver at X hospital because they heard that Y hospital had double the amount of C-sections etc.
I had the benefit of being an epidemiologist that worked in Y hospital and knew a few things that others didn't. One, we don't publicly report c-section rates at a hospital level and two, hospital Y is a tertiary care centre with a level 3 NICU where all risk mothers are sent. So of course we are going to have a higher c-section and complication rate. We just don't send high risk mothers to other hospitals.
So even though you said outcome is better even after adjusting for risk, I'd still like to see the data. I assume there aren't a ton of matched cohort studies that looked at birthing centres vs hospital deliveries.
>However, Virginia R. Lupo, M.D., chair of the department of obstetrics and gynecology at Hennepin County Medical Center in Minneapolis, said the problem with these types of studies is that they "compare apples and oranges."
"Women who have no risk factors do better, no matter where they are," Lupo explained.
This is a retrospective study where the authors had no control of who went where. What's needed is an RCT.
>For women without medical complications who can be served in either setting, the study concluded that midwife-directed prenatal and labor care results in equal or better outcomes for the mother and newborn.
Women with medical complications don't start at the birthing center to begin with. That's of course part of what I stated in the beginning that the data is corrected for at-risk patients. You compare the healthy people who choose birthing centers against the healthy people who go to hospitals. Unhealthy people only go to the hospitals, but they aren't counted against.
I stand corrected. That paper is pretty good, however it is only a single centre in DC. I went searching for others and did find some similar papers finding similar results.
Depends on where i suppose. State hospitals have a sigificantly better outcome rate than private hospitals in Austria and they generally need to send mothers and the newborns to a state hospital in emergency reasons.
Why? Because they are too small relatively speaking and don’t have enoughs births.
The general rule of thumb is that birthing centers are less likely to interfere with the natural birthing process. For example, babies are more likely to be born on weekends at birthing center than hospitals. This is because births at the hospital are less "convenient" for staffing reasons. Hospitals are less likely to force labor to go faster with drugs, and obviously birthing centers don't perform any c-sections, so mothers giving birth there will be less likely to get unnecessary c-sections which increase risk to mother and baby.
> Doing things by yourself is of course free. I did that with twins and with a 10-pound (4.5 kg) kid.
Do not attempt this at home...
Sure, 95% of the time you'll be fine and have no complications (for mom or baby), but do you really want to risk it for that 5%?
I suspect this will be one of those trends that seems very appealing until we get a few headlines of home births gone wrong. Especially dangerous if it is your first baby, or if you have other risk factors.
For the first couple births, I really recommend a midwife at either a free-standing birth center (no financial incentive to do a bait-and-switch) or at home.
With the experience of a midwife, you are less likely to panic or do something dumb, and you'll have somebody to tell you if there actually is a serious issue.
By being away from pressure for intervention, you will avoid life-altering surgery. If it turns out that you like having kids, you might want more... but this can turn out badly if there are big nasty scars from surgery. To properly consider the hazards of surgery, it is important to consider not merely the present birth, but also all future births.
The idea that at home birth is so much more dangerous is controversial. Look at this very lengthy review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399594/ (search for death and mortality to find the interesting sections).
My son had cord wrapped around neck and SO glad I was around people who knew what they were doing with medical support.
It might be only a few % different but if its your few % you might come to feel differently in the end.
I suspect homebirth statistics in the west suffer heavily from selection bias since sensible antenatal care will direct complicated births to hospitals. They do mention this in the intro to the study you linked - homebirths in western countries tend to be experienced mothers from advantaged backgrounds having second or further children.
Cord wrapped around the neck is quite common actually, the occurence is about 1 in 3 babies. It’s normally nothing to be concerned about, as blood flow is not hindered, even if it’s wrapped around twice. This would be no reason to not give birth at home.
Misconceptions or fears like this make people totally dependent on hospitals, which is IMO a shame - it hinders making a well informed decision (weigh actual risks vs benefits).
Most home births involve a midwife though - I'd guess the figures were rather different for 'DIY' home births like the parent refers to (I don't have any evidence to back that up tho)
My second child had a defect meaning she couldn’t breathe until after surgery. Nothing looked odd beforehand. She likely would have died in my arms after being delivered if we hadn’t been in a hospital. It’s just not worth the risk.
The delivery, 10 hour surgery, 3w stay in hospital with 3 says in ICU etc was paid for by single payer thank god.
> Residents of California may have trouble finding this; the obstetricians got their competition mostly outlawed.
I live in Berkeley. In our recent birthing class, of 9 couples, 3 had home births. YMMV in more far flung places of California but I've not heard of any problems here having talked in detail about birth stories with these families.
(We were not one of them, we opted for Hospital birth and it cost around $12k)
Indeed, "mostly". There are ways to make it work, most obviously by the "midwife" actually being an obstetrician. There are a large number of midwifes practicing illegally in California, and I would bet that Berkeley is a hotbed of this. There are a few other ways too, but generally is it sort of banned.
A popular strategy is for the midwife to claim to be just a birth coach. They will not admit to actually helping to ease the baby out, whether they do or not. They claim to show up, maybe give suggestions, and then perhaps do some limited care afterward. Often these midwives require the family to take care of filing for the birth certificate.
It's like how the slightly older profession often claims to be just an escort service.
We had a homebirth in San Francisco, it was all on the up and up. The Midwife was notionally under the supervision of an Obstetrician, but the reality was that my wife’s obstetrician simply recommended a midwifery practice when we asked about home birth. It probably helped that the Obstetrician in question had her own children at home.
A lot of the scare tactics about homebirth are ill founded. The whole “what if something goes wrong?” question is predicated on the idea that a situation will develop extremely quickly, more quickly than a hospital transfer can happen. The reality is that (for the most part) childbirth is a relatively slow process, midwives are typically highly risk averse and recommend a transfer at the slightest sign of a complication (e.g. any evidence of meconium in the water).
The advantages for us included: knowing everyone in the room (only 3 in total, 2 midwives and a student); after the delivery the midwives cleaned up and were gone within 2 hours; a rich level of support before and after the birth (in reality a life long relationship with the midwives); during early transition my wife was hungry so I made chimichangas; nearly 48 hours between water breaking and delivery but no pressure to induce; family dog could provide nose to nose licking support during pushing phase
Cost was $4000, of which insurance paid (eventually 70%)
>I know one where the laboring mother can open the door to her room, then step out on to a patio that is separated from the street only by some large bushes.
Oh man, I'm trying to picture walking by those bushes and hearing the screams behind them.
>There is no feeling that the place is ready to lock you in and call social workers over a bit of dark humor.
Not all hospitals, I guess. Ours has a really nice maternity ward and we got along well with the staff, and we had already met all of the doctors prior to delivery. Had one incident where they didn't want to admit us and sent us home for a few hours, but apart from that it was a positive experience.
I don't think it normally is screaming, especially since labor would not be induced. (that creates extra-strong contractions when the tissue hasn't yet softened up) Typically it would be weird patterned breathing and loud statements like "GET THIS BABY OUT OF ME" or "I WANT THIS OVER WITH".
Lots of my friends have had horrid hospital experiences. One had a doctor brutally cut her with a scissors, from her vagina almost to her anus, cutting across all sorts of tendons and meaty bits. (this can cause anal incontinence) She later learned that he was trying to get out of there to not miss his golf tee time. My wife had a similar situation due to the doctor wanting to deal with his flooding house; thus we did our later births elsewhere. Doctors are definitely humans with their own priorities.
Hollywood has perpetuated the stereotype of screaming mothers. I work in a hospital and visit the labour and delivery ward quite frequently. Have never heard screaming.
If anything, the administrators should go down in that time period that just happens to coincide with the mass adoption of computers by all businesses. What this graph is saying is that while the US population grew about 50% in that time (203-308 million), administrator incompetence grew 2300% over that time despite the mass adoption of computers. In other words, one administrator from the 70's could easily replace dozens if not hundreds of administrators today and get the same amount of work done. This kind of incompetence is beyond comprehension both at the administrator level and the executive level that hires them.
They apply "MBA 101" to the system, best summarized as "extracting more money with better care as a distant second".
Was chatting with the doc during our second birth, the admins had just pulled a bait and switch on the practitioners. Instead of better equipment and surgery rooms, they were getting a few hundred more beds. Beds are easy to bill for. Surgery and actual care are way less profitable.
When my son was born, I paid $5K to a birthing center in Boise, a couple of blocks from the hospital.
We visited frequently over the 9 months, and each time stayed for about 4-5 days in a birthing room with a hot tub. Also true after my son was born. And then for a few return visits for checkups. And then for a return visit just to visit Boise and hang-out and chill with other parents, expecting parents, etc.
$5K, all inclusive. Just like Club Med (been to the one in Cancun... lovely vacation spot).
I had insurance... if anything would've happened, an ambulance would've picked us up and taken us to the hospital and then insurance coverage would've kicked in.
That is all fine and well until it isn't. I know of a couple who had their baby die on the short trip to the hospital because the "midwives" lacked even basic pediatric emergency care skills.
Yes, it’s worth evaluating preparedness anywhere a birth will be happening.
It’s probably easier to improve training and inexpensive emergency equipment at a birthing center than for a hospital to significantly decrease its cost. If high cost affects quality of healthcare provided, it might be better to fix birthing center edge cases than to avoid them.
That's not an general option that will have good societal outcomes, if you apply the categorical imperative. The US would rocket ahead from its current lead in infant mortality.
“
Digging deeper into these numbers, Oster and her colleagues found that the higher U.S. mortality rates are due "entirely, or almost entirely, to high mortality among less advantaged groups." To put it bluntly, babies born to poor moms in the U.S. are significantly more likely to die in their first year than babies born to wealthier moms.
”
Additionally: they're optional procedures, ones for which there are often long-accepted reasonable substitutions, and you can take your time researching and comparison shopping. Given those conditions, you could reasonably expect a market of competing private providers to do pretty well at yielding reasonable prices for effective services.
(Absent those conditions -- anywhere that care and treatment are oriented around alleviating illness and suffering with any kind of immediate debilitating effects or urgency, really -- you might well expect that a market of competing private providers doesn't yield the same effects.)
In other words you could expect the market to improve virtually all medical care. The "urgent" stuff you describe where a person could not temporarily postpone our shop around is in the vast minority.
I’m curious why you think this. When last I looked, a very large percentage of medical care was urgent care; in several demographics, it was a large majority.
There are a variety of ways of measuring ‘how much’ medical care is given, which has a big impact on how things compare. Cost per capital, for example, is a fairly intuitive measurement and it skews heavily towards urgent care.
The study cited in this article suggests emergency care accounts for just 2% of all healthcare costs. There's some other ways it could be calculated, but it's definitely not getting out of the single digits.
India has free, government-run hospitals but they're few and far between, so most people prefer the private ones. In a private, for-profit hospital, an uncomplicated Caesarean section with around a week's stay for mom and baby would cost ~ $1500, out of which insurance would cover ~ $900. According to the article, this would cost ~$51k in the US, so even non-free services are much cheaper outside the US.
As an aside, Indian private hospitals are far from altruistic when it comes to cost, as recent incidents[1] have shown.
Yes, my local grocery chain gives away a large number of medications including antibiotics and some heart meds free, not even paid for by taxes. The drugs are so cheap on the free market that they make it up by people just buying groceries there.
Wow, are antibiotics not controlled in the US? Here in the UK you can only obtain them with a prescription, and I just assumed most/every developed nation would be the same.
It's well beyond theoretical. The system is total nonsense.
I think a sane first step would be a N-month statute of limitations on bills. Anything you're going to be billed for should be sent within N-months. I'm not saying that it should take that long. I'm saying right now there's no limit whatsoever. You could receive a bill for some itemized sub portion (lab work, specialist, a different doctor, etc) a year after a hospital visit and you have no clue what it's for.
And this happened to me. Got a call from a collection agency claiming I owed them money a year after the birth. I called the hospital and got a written confirmation that they had no record of an unpaid or even late bill. I called my insurance and confirmed they had never received a bill for the amount claimed. Upon getting details from the debt collector (later than required by law), I saw a doctor's name. So I went to the hospital, and they had no record of a doctor by that name ever working for them.
The bill turned out to be legitimate, in that the doctor was a "traveling anesthesiologist" and was never an employee of the hospital. And they billed separately, and were never given my insurance information. The whole case ended up relying on my wife's signature on a long legal form that she signed while she was dilated to an 8. All the contact information (address, phone, company name) on the documentation led to people who could not confirm any details on the bill. The hospital told me that they have had a lot of reports of doctors who do their own billing not sending bills for months because they're not very organized.
Eventually the anesthesiologist billed it to my insurance correctly and I paid 10% of it. I later found out I could sue the debt collector for not providing details fast enough, but the statute of limitations on their violation had expired.
1 year. It was also a 1 year limit on when they could collect the bill if it wasn't billed to my insurance. Not sure if that would've counted, since the hospital had my insurance and technically I didn't give it directly to the independent doctor, but the only reason they billed my insurance days before it hit a year is because I was crazy persistent and proactive about getting to the bottom of this. Next time I'll let more of the burden of proof remain on them longer.
This happened with our first child on our PPO. We kept getting bills for over a year. I had no idea what half of them were for or who any of the doctors mentioned were. I wouldn't be surprised if some of those bills were scams from people who look for birth announcements in the paper.
Subsequent children were under an HMO, and we never saw a bill.
If scammers do use those announcements, then you would have gotten their fake bills for the subsequent children, because those scammers wouldn't know about the HMO coverage.
(One of the hospital staff could be in on the scam, and target based on insurance coverage, but then they wouldn't need the birth announcements in the paper.)
Even 2.5 years later. The worst part of that all is that you then have to waste time contacting the hospital to make sure it's a legitimate bill, contacting the insurance company - which by then might well be your former insurance company - to make sure they paid their fair share, etc.
I'm not arguing it's cheaper to give birth in America, but it doesn't seem like this article makes fair comparisons. What an insurance company or hospital charges includes some amount of mark-up, so is more than just the "cost." Likewise, in countries with socialized medicine, the hospital might charge the patient nothing, but it _cost_ someone something (people's time, depreciation on equipment, electricity, and lots of other things). Adjusting for these probably doesn't make everything come out the same, but it would make the claims less sensational.
Healthcare here is a joke. No clear pricing, no clarity on what is or isn't actually covered, mega bills that get delivered a year late then you then have to argue over.
The only way to not go bankrupt is to not get sick, ever.
Isn't this the truth. I had a test done and got bills from 3 different people, at 3 different times, separated by a couple of months. Some submitted to insurance, others didn't.
I agree that our healthcare system is messed up but the insurance company paid for 95% of her bill. Seems like she got her money's worth from the insurance company.
Isn’t this kind of like TJ Maxx or Ross labeling clothes at insane “retail” prices so you feel like you got a good deal when you saved 95% but still spent $50?
Because their profits are limited as a percentage of revenue (aka "they must spend x% of their revenue on patient care"), and thus there's a huge incentive for prices to go up across the board to increase their dollar amounts that don't have to be spent on patient care.
When we had our daughter I was annoyed that I ended up paying about £50 for parking for the week that recovery from the cesarian took.
Looking back I guess that was a bit short sighted!
At the company I work for, our previous insurer doubled our premiums, so we switched. It went from so-so to terrible.
My daughter cut her hand and needed stitches; I took her to the ER; their surgeon was booked, so they sent me to a different one. I got a $160k bill for an "elective surgery."
It took a couple of phone calls to get the point across that stitches for a hand bleeding through 3 dressings is not elective. 6 months later, the surgeon still has not gotten paid (I know this because sometimes get copied on the "request for extra information" that is sent out by the company).
Also I get about 3 letters from the insurance company for every visit that involves insurance (PT after the hand injury was weekly, so this was a lot). I asked if I could get those electronically, and apparently my plan doesn't qualify for paperless...
no, it's now pending on the insurer, who hasn't yet paid the doctor for most of it (they have sent about 6 letters asking the doctor for more information).
My wife ended up w/ an unplanned C section to deliver our daughter in 2013 in Dayton, Ohio. Both mom and daughter had reasons for two extra days in the hospital. The bill to my wife's insurance company was just under $60,000 for her portion. My daughter's portion was out-of-pocket (because she was on my insurance) and was around $12,000 after the hospital's "cash discount".
A lot of factors contributed to our decision not to have any more children, but the cost of maternity care, birth, and follow-up medical care figured-in prominently. My wife was leaving her job after the birth and everyone was going on my insurance (self-employed, have bought my own insurance since 2004). Had the costs been less I'm not sure we would have opted to have any more, but it would have changed the calculus.
Our insurance had excellent coverage, but I remember being excited when I payed a bill for my wife, and thought that we were good, since we hit the $3,000 max out of pocket per person. And then bills started arriving in my Son's name.. So another $3k..
It cost us $2000+ for the hospital to help my wife deliver our dead baby. The shitty part is that it would have been free under our insurance if the baby were alive. Yay insurance...
Wow, that's a terrible emergent cruelty from a complex labyrinth of years of backroom negotiations. I'm sorry for your loss and that you had to pay for it like that monetarily as well.
I think there are two sides to this. You paid nothing because you were subsidized by others. I can definitely see the other point of view from folks who do not have children and/or do not want children.
Here in the US, I don't particularly want to pay for the masses of folks who refuse to use contraceptives and are up to 4+ children already. There are already way too many people here (and on Earth in general). On the other hand, people should be entitled to free healthcare to a MUCH larger extend than we currently have here. There's a big difference between having a child and you catching the flu, breaking a bone, or getting cancer. The environmental and social impact of having a kid is much larger, and I can see how some folks don't want to subsidize this.
> You paid nothing because you were subsidized by others.
This is the story of civilization. You've been around for a blip and yet the Internet, flight, mobile phones, vaccines, civil rights, central heating etc. are all available to you.
You didn't contribute to any of that and yet you're the benefactor. For society to flourish it's necessary - within reason - to think beyond your own individual interests, and consider what type of society you want to live in and leave behind.
One in which people are financially ruined if they fall or give birth is surely not the best we can do.
To add to this, I'm a selfish guy from Canada. However, I realize it's in my selfish interest to have an healthy and well educated population in order to improve my own quality of life and those of my loved ones (to which my selfish interests extend).
I mean, we are not saints here, we all make decisions that we believe are good for us. I just can't imagine how one can rationalize that private healthcare and insurance is good for them.
> I can definitely see the other point of view from folks who do not have children and/or do not want children.
The society you live in needs to replace its dying citizens with new citizens. The easiest way to do that is by existing citizens having children. If having children is too expensive such that the birth-rate shrinks below replacement levels, your society will shrink, and your economy will shrink. This is bad for you, regardless of you having children or not. Therefore, it's in your interest that society uses some of its pooled resources to ensure that the birth-rate is kept above replacement level, i.e. use your taxes to subsidize children.
> the world is full of short-sighted morons who can't think long-term
is counterproductive (and probably a violation of HN guidelines (see "In comments, paragraphs 1 and 2): https://news.ycombinator.com/newsguidelines.html) since it seems to be calling the person you are responding to a moron.
It's easier initially. But dealing with the resulting social issues that may result certainly is not easy. Accounting for everything, I'd say immigration is the harder route.
But if you accept immigrants, you also need to instill some of the ethos that makes your country first-world, and this challenge is something that many first-world countries fail miserably at. :-/
(And I'm not trying for some sort of wacky cultural superiority angle here, it's not the shape of your culture, the colour of your skin, or the language you speak that makes it first-world, it's simpler things like your society being high-trust, not tolerating corruption, and accepting and embracing diversity and individualism. These things are also culture, but pretty hard to teach others.)
How about all those heavy haulers who pay for your usage of the roads?
Most countries have 'socialised roads' and 'socialised healthcare, but the US sees 'socialised roads' as something good but 'socialised healthcare' as something bad. Whereas most other countries, even the so-called 'poor' countries can afford their single-payer 'socialised healhcare', the US finds that too difficult.
"The environmental and social impact of having a kid is much larger, and I can see how some folks don't want to subsidize this."
Eh, what? Isn't continuation of the human species our number one priority? What's the point with all of this if there are no children to continue. We all will be dust one day, and if there are no children we totally, and completely seize to exist.
Continuation of the species is not a lifestyle choice. Children are not a lifestyle choice. They are necessary.
You can't seriously discuss children in the same context as you would describe any service, investment or consumer goods.
Interesting, lets look at a link from the article:
<i>
Results—In 2010, the U.S. infant mortality rate was 6.1 infant deaths per 1,000 live births, and the United States ranked 26th in infant mortality among Organisation for Economic Co-operation and Devel opment countries. After excluding births at less than 24 weeks of gestation to ensure international comparability, the U.S. infant mortality rate was 4.2, still higher than for most European countries and about twice the rates for Finland, Sweden, and Denmark. U.S. infant mortality rates for very preterm infants (24–31 weeks of gestation) compared favorably with most European rates. However, the U.S. mortality rate for infants at 32–36 weeks was second-highest, and the rate for infants at 37 weeks of gestation or more was highest, among the countries studied. About 39% of the United States’ higher infant mortality rate when compared with that of Sweden was due to a higher percentage of preterm births, while 47% was due to a higher infant mortality rate at 37 weeks of gestation or more. If the United States could reduce these two factors to Sweden’s levels, the U.S. infant mortality rate would fall by 43%, with nearly 7,300 infant deaths averted annually.
<i>
How much does treating babies with low-birth weight add to the average cost?
For some reason the article didn't mention the cost of malpractice insurance. I wonder why? My cousin, a doctor in Pennsylvania, said at one point, the insurance was getting so expensive, it was driving obstetricians from the state.
Yup- Wanted to burn off some blackheads and a US skin specialist charged $175 to take off 1 using a Ultrasonic machine, went to Mexico and took off 20 for $5 using the same machine.
I've long suspected that a driver of the cost of medical care in America is the middle-people. Everyone who wants to take a cut, and tack on a fee, and increase profits. From the drug maker to the bandaid company. There was a really fascinating article here recently on doctors who only take cash, and I think it really hits to the idea that we're being taken for a ride from a lot of these companies, hospitals, insurers, etc.
I don't recall what the itemized bill was before insurance took care of it, but with health insurance, each of my kids actual cost to me was $100 out of pocket. In the US.
I'm sure the quoted price before insurance was probably ridiculous, though.
No one knows how much healthcare costs in the United States. Not the insurance companies. Not the hospitals. Not the doctors. No one. The prices vary widely across providers, and insurance companies. I was reading a few years ago (alas, I can't find the link, but I think it was in the LA Times. KQED was also working on this recently.[1]) where the author tried shopping around and found where same provider would come up with different itemized breakdowns depending on the insurer. It came down to the provider and the insurer negotiated prices. Say the insurer provider agrees that a procedure costs $1000, but says an x-rays can only cost $500, so the doctor fee is $500. Another insurer says treatments can cost $800, and x-rays can only cost $!00, so suddenly the doctor fee is $700. What's the true price of anything?
Under America's about the only thing you can tell is that total costs are much higher than the rest of the world, and outcomes are actually slightly worse than the rest of the OECD countries.[0]
It shocks me that this isn't criminal. I can't think of any other good/service where we accept this sort of thing. It also really exposes the extreme arbitrary nature of healthcare pricing.
The thing is, you could figure out how much an x-ray costs. You just have amortize the cost of the machine, consumables, technicians, and radiologists over the number of images taken. The data is sitting there at every hospital, just spread out across departments. The thing is, gathering that data and calculating these numbers requires a nontrivial amount of effort, and if all you care about is if your bottom is going up or down, then what’s the point?
I understand that you think this is relevant, but I don't think it adds anything to the conversation. Sure, sometimes fees are reasonable, and sometimes (even if you 'go to a hospital covered by insurance, [see] an obstetrician in [your] plan') you get completely fucked. That's the point here, it's really tough to know what you're "signing up for" and what the costs are, even when they SHOULD be fairly transparent.
Nope. Software Engineer. The reason it was so low is the youngest was born 18 yrs ago - long before current cost skyrocketing. Things used to be a lot better.
I think the idea is that since older mother age increases complications, the average cost is higher and so the hospital risks to lose more if you don’t pay. I don’t agree if this is the thinking, though, since $5,000 as insurance against non-payment is too large a step, and I would imagine older parents, on average, are more likely to be able to, and choose to, pay their bills.
I don’t know how being on one’s second or third child affects the likelihood of complications.
Having a baby should be expensive. There are nearly 8Bn people in the world; "making more people" is not a problem that the human race has. The problems we do have with pollution, climate change, resource depletion, extinction of other species, food and water supplies are entirely caused by there being too many of us competing for too little of everything else. This is especially the case in the US where individuals are extremely high-impact on the environment in terms of natural resources consumed and pollution generated. Those externalities have a real cost attached, that isn't reflected in the current price, which would be much much higher if parents had to pay their child's say CO2 impact up front.
I find it hard to read your argument and not feel that the nations and individuals who follow your advice will be replaced by those who don't. I suppose this is "wrongthink" and I'm troubled by it because it's hard not to feel it's semantically close to nationalism and racism.
In the anglosphere though, fertility is universally below replacement already. This is also true in countries where the cost of birth is much less than the U.S. Everyone is making up the shortfall with immigration.
To follow your argument through to its conclusion we should also make immigration to wealthier countries more difficult and expensive because it comes with a corresponding increase in personal resource consumption.
> Having a baby should be expensive (...) This is especially the case in the US where individuals are extremely high-impact on the environment in terms of natural resources consumed and pollution generated.
So those who benefit the most from resource depletion (i.e. those who can afford the hypothetical Baby Tax) would be free to have as many babies as they want, while the poor, already impeded in most activities and burdened by the cost of livinng, would make a sacrifice.
> So those who benefit the most from resource depletion (i.e. those who can afford the hypothetical Baby Tax) would be free to have as many babies as they want, while the poor, already impeded in most activities and burdened by the cost of livinng, would make a sacrifice.
Yes. Because those population strata, not only in the US but across the world, produce the bulk of population with no education, high ecological impact, and scarred by social depravation. It doesn't advance humanity toward an 22nd century-appropriate standard of living to raise a vast population of people who are to become even more utterly worthless in the face of automation and extreme competition even among the elite of the 1st world.
It is beyond me how humanists can support unlimited population growth/"self expression of the individual/right to give birth" when that populuation growth is going to drive countries and continents toward a demographic and social catastrophe. Then again, my personal opinion is we are already on track and about to arrive there on schedule, so what gives.
>a vast population of people who are to become even more utterly worthless in the face of automation
"At this festive season of the year, Mr Scrooge, ... it is more than usually desirable that we should make some slight provision for the Poor and destitute, who suffer greatly at the present time. Many thousands are in want of common necessaries; hundreds of thousands are in want of common comforts, sir."
"Are there no prisons?"
"Plenty of prisons..."
"And the Union workhouses." demanded Scrooge. "Are they still in operation?"
"Both very busy, sir..."
"Those who are badly off must go there."
"Many can't go there; and many would rather die."
"If they would rather die," said Scrooge, "they had better do it, and decrease the surplus population."
You're barking at a wrong tree here. Absolute absolute majority of children in poverty and without access to education are born outside the USA. You solve nothing other than being explicitly mean to (I assume) your compatriots. See if it gets you anywhere in the long run.
Let me repeat it for you: you've got two arguments and they're in major conflict. You can't use both and neither one holds water sole.
> Absolute absolute majority of children in poverty and without access to education are born outside the USA.
That's a fact. Just that doesn't mean that the USA would do better now or in the future with more poor people giving birth to more disadvantaged children inside its own borders. Also, I wasn't explicitly limiting my argument to the United States on purpose.
> You solve nothing other than being explicitly mean to (I assume) your compatriots.
[I'm not American.] All I'm advocating is a realistic and pragmatic approach to demographic management. The goal should be to ameliorate life for any given compatriot in the long run. Though of course in the long run, the population of the present will be dead.
> with more poor people giving birth to more disadvantaged children
Maybe they wouldn't be poor if not for excessive charges in some areas? How is that for an idea?
Many people who are considered "poor" in the USA, would be considered "totally ok, just in slightly disadvantaged line of work" in less polarizing locales. That after a safety net that won't put $10k worth of charges on you after hospital visit.
There are poor and marginal, who should probably be incentivized to avoid children - and then there's working poor, who should have their condition fixed. That's all.
So those who benefit the most from resource depletion (i.e. those who can afford the hypothetical Baby Tax)
Not if it was configured appropriately. In Sweden for example if you pay a fine for bad driving, it's not a fixed amount but a percentage of your income.
You are arguing against overpopulation and nobody would disagree with you. What you should argue is that extortionate hospital bills and overall poor natal health care are an effective and humane way to fight overpopulation. Can you?
I spent two years in Latin America (all over) and now have been through West Africa in the last 18 months.
The more I think on this topic, the more I strongly believe the only chance we have as a species is to do something about overpopulation. We need to seriously start thinking about population control.
I genuinely believe China were on to something with their one child policy. Yes, it has some horrible side effects, though I think they are less-bad than a planet with 20+ billion people on it.
It's going to be an extremely unpopular thing to talk about, and it's probably going to take generations before people come around to the idea, which is why we need to start now.
Still, people who have the least money have it cheapest. An illegal immigrant will be probably treated for free in most countries immigrants flock to. If you use money as human worth, which is IMO questionable, you should see a conflict here.
Who gets really screwed here is lower middle class as usual.
Money is just a token of exchange. What if a certain amount the baby tax was hypothecated to planting trees, to offset the extra CO2 that that individual would produce? You can quite literally figure out how many trees/how much land you need, get the prices and work backwards from there to arrive at a cash amount.
I see you ran with a different notion of what I meant by "addressed".
I'm certain victims of mass shootings will beg to differ. Individuals also have a right to not be deceased or live in fear of mass shooters whom you are right, has been addressed with individual right to carry.
Having laws that favor one side heavily is not a standard for 'addressed'. Take a look at Australia, that is proper 'addressing' the issue.
Other way round: it's not surprising that a country with terrible consumer protection has high inequality. Easy to get rich if you're taking a percentage off all those multiple thousand dollar births or multiple hundred dollar guns.
It seems you're assuming a causal connection between the existence of billionaires and the issues you mention else why would the statistic boggle you? But what is the connection? Is this a plea for equality of disposable income?
well the US is the richest country in the world is it not? reflected by having the most amount of high net worth billionaires?
is raising the safety net for the citizens of a rich country that other poorer country have such an existential and threatening notion?
you used the term, plea to describe such safety nets, which is a request made in an urgent and emotional manner. So you recognize that these are the voices of desperate people but still deny their rights.
In a negative connotation: because insurance companies and hospital owners are taking you for a ride and politicians sit back, sipping their whiskeys and enjoy their lobbying. And if anyone DARES to make such comparisons to Sweden or Finland, some republican will start yelling "down with socialism!!!". One day USA's citizens will "have enough of this" and perhaps do something about this, but this day is anything but close.
Would you please not post ideological rants to Hacker News? These things invariably turn into low-quality discussions and/or flamewars, dragging down the quality of the site. You don't have to change your views to post here, but you do need to post civilly and thoughtfully, rather than in rant/battle mode.
You do, through taxes, but would you rather pay lower taxes for fewer benefits and more aircraft carriers in the US, or more taxes for huge benefits like maternity leave and education?
The decisions are still rational, we're just optimizing a different variable. In my view the majority of the money I give the government gets squandered and I have no realistic expectation of getting back anything close to what I've contributed to social security.
By that standard if someone suggests raising taxes further to increase the amount of money in the equation I'd be firmly against it. The problem with our government is that it doesn't collect enough taxes, it's that it doesn't spend the money it collects wisely.
We're getting off topic from the original article though. If this was a conversation about something like a single payer system it'd be apt (and I'd be for it as well!) but (chronically underfunded) pensions are an entirely separate topic.
I'd think most people would realize that having a society raised by loving, caring, well-adapted parents would pay off in the long run. I certainly think it would be in my best interest to have my future fellow peers raised well.
Now, maybe you REALLY want to stare into the void and declare that the decisions made now won't affect your life, won't change your peers. I guess that's your right, but that's not how my societal calculus functions. To me, this is a bargain for maintaining an upright, well functioning, positive society.
So why stop at 75% for maternity leave? Why not 100%? Or even 200% of your original salary? It’s for families and kids right? Why not double subsidize it?
You claim it’s a bargain. At what tax rate is it a bargain? 5% increased tax rate? 10%? 25%? 50%?
Specifics matter. Make your case with an actual proposal. Claiming I’m heartless because I don’t want others to spend my money is hardly an argument.
Germany and Switzerland have complicated systems where you are mandated to have insurance but the state provides you with insurance if you cannot afford it.
>I think it's not just Sweden or Finland, most of Europe has socialized healthcare and birth is one of the things that come free.
AFAIU in general you pay for stuff like private rooms or such.
I can confirm this is the case for both Italy and Spain.
But I have to say that sometimes, even if the National Health Service does provide for free[1] a given cure or analysis (or assistance to birth), in some cases they may be not fast enough (not for the actual delivery, but for some exams/tests) and there are private services (hospitals, diagnostic clinics, etc.) where sometimes you need to go, paying out cash (or - it is now becoming more common - having a dedicated insurance).
In my experience these - though not actually "cheap" - are anyway a fraction of the costs they I have seen mentioned about the US.
While the average income in Italy and Spain is lower than the US, the cost of these services is proportionally much, much lower.
A problem - common enough - has been in recent years the increase in the number of Ceasarian sections, even when there wasn't any need for it, allegedly (but it has not been actually proven) to increase the reimburse to the hospital by the NHS (SSN in italian) or by the insurance company, or to limit the legal responsibility of the doctor in case of complications.
[1] Actually almost for free, there is a complicated system where depending on your income level you may pay a part of the cost.
I used Finland and Sweden as they have dreamy metrics on everything-healthcare, but I understand that taxes are sky-high. In these countries I consider taxes to be an "investment" and when you need the State, then the State is there FOR YOU, and doesn't throw you under the bus in a time of need.
In some other European countries (e.g. the PIIGS) with the budget cuts, all social care/benefits have worsened dramatically.
I moved to Finland a while back. Taxes are indeed sky-high, but at the same time I can see that they're being used.
Streets are clean, local transport works (busses, trams, local-trains), education is world-leading, healthcare is great, etc, etc.
I'm sure there are people scamming money off the top, corruption is universal, but I can't begrudge paying taxes when the country seems to be so well run.
(I'm a foreigner, I suspect I wouldn't know if it were badly run!)
This has given me a lot to think about, because I have felt like I've been on both sides of the line, but, I have of course because it's suited me when I need it.
I feel like government is still not the right institution to make purchasing decisions, but until we make one, it's unbeatable.
But, this might also be cultural. People who come to the US are usually willing to take high risks and carry with that a certain sense of irritation with those who don't, and I feel like that might be where a lot of our national culture carries with it this sort of perspective.
I could of course be super wrong, but I think if we could erase the concept of "fairness" in this area, we might make more progress in actually helping real people with real problems
I think that's some of it, but there's probably other causes too. Like malpractice risk driving certain decisions about care and US specific cultural expectations around the role of nurses or midwives, pain management, etc.
> One day USA's citizens will "have enough of this"
Won't happen because a big portion of the middle class doesn't experience these problems so they just shrug it off and see it as only a problem for "those" people.
This manages to combine ideological battle with fluff, the two things that are worst for Hacker News. Please read https://news.ycombinator.com/newsguidelines.html and don't post like this, regardless of which ideology or which fluff.
"Crony capitalism is an economy in which businesses thrive not as a result of risk taken for them, but rather, as a return on money amassed through a nexus between a business class and the political class."
It's Capitalism applied to something that doesn't have a market, shouldn't have a market, and who's participants are unable to properly participate in it in any way that resembles a market.
And yet for profit entities proliferate it at every level, and the constant drumbeat of people against nationalization is for people to be "smart" consumers of healthcare, as if you can make an informed market-based decision about which provider to use while in the back of a damn ambulance.
How does the ambulance know where my insurer wants me to go? For that matter, why is it the responsibility of EMT's to, whilist driving at high speed through traffic and attempting to keep my organs in my torso, go through my insurance info and figure out which hospital I should go to and potentially risk both my and their safety with a longer trip, to respect the wishes of a corporation which barely knows I exist?
How about instead, we just fix people? And figure out the rest of the BS later?
This is a good argument for why we should reject meta-narratives for how the world should work. Capitalism (and/or consumerism?) is one such narrative. Ignore or criticize data points that don't fit the meta-narrative. In that sense, Scandinavian policy is light years ahead, as it is pragmatic and have reasonably high amounts of evidence-driven policy (disclaimer, i live in Sweden).
Middlemanism? A promiscuous value-chain of “service providers”. The capitalism part is that the top terminates at a public corporation or private equity firm.
It's mainly to minimize risk. If everything goes well, home birth is an option, best with a midwife. If it's legal, anyway. But if something goes wrong, you'll end up at hospital, mother and/or child may die or be disabled, and the overall price will likely be greater.
With regulatory capture and corruption of the government, isn't our problem a textbook definition of facism (in the academic sense of the word, not in the nazi sense of the word)?
Personally I think the word is overused and too heavily charged, and a more appropriate and descriptive term is corporatism.
I also agree with Chris Hedges and Sheldon Wolin that inverted totalitarianism is an apt definition.
According to the Princeton study of congress, we are also an oligarchy due to the public having almost no influence on legislation, meaning we are not being represented by our elected officials.
I would also argue with the increasing disparity of power and resources between the uber-rich and the rest of, and as the middle class is attacked from all sides and shrinks, that our system also matches the definition of neo-feudalism.
So, to put it all together, America has allowed itself to become a neo-feudal oligarchical corporate inverted totaltarian surveillance state.
I don't understand your comment? The question of the post is why does it cost this much? A responder said capitalism, and I am just going further into the various political definitions that describe the current system, which is helpful in inderstanding the original question of the article.
If it's an oligarchical corporate state, then it would make sense that hospitals (companies) abuse of their regulatory capture (oligarchism) are exploiting the majority of people financially and otherwise (neo-fuedalism), largley by making them dependent or subservient to their systems.
>I don't understand your comment? The question of the post is why does it cost this much? A responder said capitalism, and I am just going further into the various political definitions that describe the current system, which is helpful in inderstanding the original question of the article.
That's what I am referring to. Instead of looking into some idealistic "political definitions" and say "according to this this system isn't capitalism", we should look into what's going on (in reality) and say "this is what capitalism looks like".
Else it's like those marxists, that instead of accepting that communism can result in a BS bureaucratic state, they said that USSR and co weren't "real communism/socialism", because they didn't match the theory, and that real communism hasn't been tried etc.
That's what I call going backwards. One has a definition, and compares reality against it.
Instead they should derive their definition from what happens in reality -- and maybe even accept that their idealistic definition can't ever happen anyway.
It's like some zoologist had a definition of animal X, and then matched it with various animals and said "this can't be X, because it doesn't match the definition". Well, if that X existed only in theory that's a bad practice. The definition of any X should come from studying actual animals (e.g. this animal species has so and so characteristics, we'll call them an X, e.g. tiger). So, where has this ideal "capitalism" even been seen in the wild?
>That's what I am referring to. Instead of looking into some idealistic "political definitions" and say "according to this this system isn't capitalism", we should look into what's going on (in reality) and say "this is what capitalism looks like".
It is not capitalism. In all the countries mentioned above where child birth is less costly there is significant projected population drop, and governments are under pressure to subsidize families with children.
It was a shitty comment, but replying with another shitty one is the wrong thing to do. You've been abusing this site for a long time and ignoring our requests to stop, such as https://news.ycombinator.com/item?id=15672810. Even if you're 100% right about everything, it's not ok to vandalize HN with uncivil, unsubstantive comments.
I'm not going to ban you right now because you've also posted good comments. But if you want to keep commenting here, please fix this. You know how to use HN properly; would you please do that exclusively from now on?
this trope about how much things cost in the US vs other countries never dies. Things are not free in Spain, they are paid for by heavy taxation, which then results in a massive unemployment rate of 17% AND a lower birth rate than US.
So cherrypick any other country with a working universal healthcare system and lower unemployment rate. You can almost pick any tax rate too, and there’s a country with that.
So, why don't you do if then? Which country has lower unemployment rate and higher birth rate than US where taxation is low ? Can you name one ? I love the downvotes. I make a factual statement that Spain, which is referenced in the article, has higher tax burden, a 17% unemployment rate and a lower birth rate than US and they freak out.
Almost all other modern democracies (e.g OECD) have universal healthcare. Almost all have lower unemployment rates than Spain (if not all).
Taxation varies. Was my point. Those that have the healthcare as a public insurance on the side of taxes can have low taxes. Those with tax funded single payer obviously have higher taxes.
My example of choice of low-ish taxes, high birth rate and universal healthcare would be Ireland. There are others.
You are missing the point. Yes, countries have lots of benefits, what I am having issue with is the claim those benefits are cheaper. No, they are paid for in different ways.
There aren't any others.
US has a lower tax burden than almost all OECD countries except for Ireland.
Technically, Ireland fails my test because it has a higher unemployment rate than US.
Safe to say, Ireland is an exception due to being probably most catholic country in the western world, which keeps birth rate high
My specific test is, find me a developed country with lower unemployment rate, lower taxes and higher birth rate than US.
There isn't one. And that's how those benefits are paid for
Whether single payer or other universal systems are “cheaper” is one question. The US system isn’t the only way of having a private system, and there are reasons for it being expensive other than it being market based (monopolies, legal reasons etc). While it’s hard to say why US healthcare is more expensive, it’s at least pretty easy to say that other systems aren’t like the US, and are cheaper. They are paid for in different ways (e.g taxes, fees,...), correct. And those costs are lower. Naturally countries with tax funded healthcare have higher taxes. An apples-to-apples comparison is of course between tax+healthcare in both countries.
Third: unemployment rate. This is also locally dependent on what full employment is, which depends on, for example, unemployment benefits etc. 6% unemployment in Sweden is pretty good, but would be terrible in the US. So percentages are not directly comparable. (For example 6% in Ireland is comparably lower unemployment than the current 4% in the US in a fair comparison as Ireland’s full employment rate is 5% - They are at full+1%)
As such, finding countries which have lower taxes despite including healthcare and lower unemployment despite perhaps having 80% unemployment benefits isn’t just impossible it’s a pretty useless comparison to begin with.
To make a fair comparison you have to correct for local factors: taxes excluding healthcare, and unemployment as difference from full employment (to begin with).
it's not a useless comparison. In aggregate, US has one of the lowest tax burdens in OECD. So, in countries where you have lots of benefits, those benefits are paid for with higher taxes !!! so, to say, that in aggregate those benefits cost less is simply inaccurate. You have to correctly account for the costs.
Yes. And healthcare costs are lower in nearly every way you measure: individual procedures, cost per individual per year etc. That Americans (and their employers) pay more than others pay for healthcare through taxes isn’t just widely known it’s also by a pretty wide margin. So yes benefits are paid for by taxes. And the question is: does that make it cheaper?
cost per individual per year is lower in other OECD countries because its subsidized through heavy taxation. So, it's not really lower, it's just shifted into a different bucket for accounting purposes. But it didn't go anywhere - that's the point. You can see it easily by the fact that taxation as % of GDP is much higher than in the US. Where does that extra money go? Subsidizing healthcare and other benefits
No. That’s not what I’m talking about. If you think thats what people mean when they say “healthcare is cheaper in countries with single payer” then no wonder you don’t seem to find it attractive.
The cost of providing healthcare (total) is lower in all those countries. That is, a country might use $10k per individual per year for healthcare, financed by taxes. Meanwhile the average for a US individual (paid with insurance) is twice that (those numbers were made up but you get the point).
As you are saying, there is nothing magic about this. Having a single insurance pool and putting the premium on the tax bill doesn’t change much - it’s just accounting. And obviously it will make taxes look higher. But if you pay $1000 per month in taxes and $1000 to healthcare, or $2000 in taxes, it’s just the same thing with a different name.
The difference is this: you could pay $1500 in taxes (with healthcare costing 500 when single payer instead of 1000 via private insurance) And then it’s a very real difference. Again, numbers made up for illustrative purposes. A new US system would likely look like Canadas, so should have similar costs.
No, you don't understand. The actual, economic cost of providing healthcare in those countries isn't lower. It looks lower from accounting point of view because of various hidden subsidies. How do we know this? It's very simple - they have to have a significantly higher overall burden of taxation. Where does that money go ?
In many of those countries the healthcare is completely tax funded. You don’t have to ask people what they pay for healthcare, it’s known from the tax budget.
So these aren’t somehow made up numbers. We know exactly how much money the Swedish government uses to provide healthcare for each Swede.
It’s ALL tax money.
So we can compare that number to what an average American pays for healthcare. And when doing that we have a fair comparison of the cost of healthcare.
Tax burden etc does NOT change this comparison. It’s exactly what this comparison IS. One persons TAXES vs another persons insurance policy + out of pocket expenses for healthcare.
Please don’t reply now with “but taxes are higher so it just looks cheaper!” - if it didn’t sink in now there is nothing more I can do to explain it.
You still don't understand. The total level of benefits and taxation is relevant. Healthcare doesn't exist in isolation. For example, you can pay doctors a lot less because they go to medical school for free and don't have malpractice insurance at the same level and also because their retirement is taken care of by the state. You can pay hospital administrators less and on and on. This lowers the accounting cost of healthcare - but not economic cost. Somebody paid taxes to send that doctor to medical school for free
This high overall taxation enables subsidies which are then used to make it look like healthcare costs, when looked at in isolation, appear lower.
Empirically, we can see this: very few developed ountries are able to provide lower healthcare costs than US while also having a lower overall taxation burden.
Oh. You are thinking of secondary effects of high-tax societies, such as flatter wage structures influencing (production) costs of healthcare. Yes - I absolutely agree that is a factor, and I genuinely believe that if the US wants to see the full economic benefits of single payer they must also make higher education cheaper, reform the malpractice legal frameworks, and so on. The fact that I tax-pay my doctors MD likely makes less of my tax money go to healthcare. Agree.
The UK does have a good single payer system and not (entirely) free higher education, so they naturally have more wage inequality (for other reasons as well including much weaker labor unions and labor laws) and should be a better comparison than e.g Scandinavian countries which has flat wages and tax-funded everything. Canada seems similar (tuition there seems to be around 50% subsidized?)
By the time the second kid came around, we were self-insured on the healthcare.gov marketplace. We ended up paying $5000 out of pocket - $2k for the prenatal care and doctors' services, $3k for the delivery and stay at the hospital.
We made a $1500 mistake. My wife had a really fast and normal delivery, but it was so fast that they didn't have time to administer an antibiotic that they otherwise would have. They wanted to monitor her for a day to look for an infection. We said okay, but if I had more closely read my policy I'd have learned that the policy had a $1500/day copay for labor and delivery. We'd have taken our chances and gone home had we known.
Kid three is coming! And this year's marketplace plan says that we're on our own up to the individual deductible of $6950. That's a bronze plan that carries a $950/month premium for 4 people; financial assistance from the government drops that down to $700/month. So we pay $8400/year for the privilege of not paying more than $7000 for an individual ($14,000 for the family) on our plan.
I don't think state-run healthcare is the only solution here (nor is it an inherently bad solution; I'm no libertarian), but I have to think that I'm living in the worst of all worlds here. I'm forced to buy an expensive product that I'm afraid to use, a product that costs more than the roof over my head per month but delivers a fraction of the value. It's expensive because it's violating basic principles of insurance, because the people who made the law are trying to implement universal healthcare in a system that's not built for that idea (at least not in the way it currently exists).
If I lived in a more market-based system there'd be price transparency, presumably a better way to monitor outcomes, and a lot more say in what kind of policy I could get to better accommodate the needs of my family.
Anyways, there are alternatives and means for assistance out there, and we're exploring them. But we like our doctors and our hospital; it's a shame that we have to look elsewhere. Not looking for sympathy, just adding a data point! My takeaway from that article was that maybe we should price out a trip to Spain sometime late in the third trimester :)