
How a Medical Catastrophe Can Bankrupt a Life - jseliger
https://longreads.com/2018/02/01/how-a-medical-catastrophe-can-bankrupt-a-life/
======
dawhizkid
Having worked in a tech startup adjacent to healthcare insurance one of the
biggest reasons healthcare costs are out of control is largely a result of how
healthcare is billed. Most consumers (i.e. those insured under an employer-
offered plan) are very far removed from the actual price of a service because,
assuming a medically necessary service or drug is covered, you are paying up
to some deductible, coinsurance, or copay but usually never anything that
closely resembles the retail price. Most insurance companies operate off a
"network model" where they go out and negotiate contracts with different
providers/hospitals to get discounted rates that are usually pegged to
Medicare prices (which is as low as the prices go). Large employers can
negotiate good rates through insurance companies as well to drive prices down
to control their own healthcare costs.

The opaqueness with which care is paid means that consumers receiving care
have little incentive to shop around for prices, quality, value, etc., which
means providers can basically charge whatever they think the gov't (through
medicare/medicaid) will pay and a percentage above medicare/medicaid for
everyone else. Of course, if you are uninsured or go out of network (i.e. your
insurance company has no contract with the provider you saw), then you're
going to be asked to pay ridiculous retail prices that very few people
actually ever pay.

If you look at the difference between price trends for elective vs non-
elective care (i.e. cosmetic surgery, LASIK, cosmetic dermatology), prices for
non-elective care outpaces elective care by a long shot with the main
difference being consumers pay out of pocket for elective care and actually
put pressure on prices whereas consumers do not for insurance-covered non-
elective.

The reality is that if you are ever in this situation you should ALWAYS
negotiate. There's a reason medical debt is bought for pennies on the dollar
because 1) difficulty actually collecting "patient responsibility" in the
first place and 2) everyone know these retail prices are completely BS.

~~~
tomkarlo
It's definitely a problem that pricing is opaque and disconnected, but have
you considered that maybe healthcare isn't a good candidate for a market
solution? Even without this problem, customers have relatively little ability
to choose providers or price shop, and they often don't really understand what
they're being asked to buy.

By extension, it seems like the key difference between "elective" and "non-
elective" care is that one of them is _elective_... it's going to be a very
different market when a consumer can choose to buy something or not buy it at
all, vs. when they _have_ to buy something and may not even understand what or
why they're buying it. It's not necessarily that consumers are shopping prices
more or being stronger negotiators, it's partially just that demand naturally
falls if prices start to rise too much.

~~~
dawhizkid
One of the bigger problems in healthcare is also over-utilization i.e. getting
things are are technically covered under insurance but not objectively
medically necessary or getting a more expensive brand name drug over a
chemically equivalent generic drug.

Agree that the patient-provider relationship today is usually "I'm a doctor
and I'm going to tell you to do this, this, and this" regardless of cost, and
we go with it because if we're insured under today's system it means
marginally more out of pocket dollars for us. If you had an high deductible
plan with an HSA (i.e. paying pre tax dollars out of a health savings
account), I'd bet psychologically you'd be more choosey when shopping around
for healthcare and/or ask more questions of your provider around "is this
really necessary?" or "is there a cheaper option?"

~~~
emodendroket
I mean, you're right that people get less medical care if their out-of-pocket
costs are higher. The problem is they're really poor at judging for themselves
whether procedures are necessary and so they end up sacrificing their health
or sometimes outright dying because they didn't get care they needed. "Skin in
the game" is one of those zombie ideas that just don't die.

~~~
pdonis
_> "Skin in the game" is one of those zombie ideas that just don't die._

No, the idea that people who have _no_ skin in the game--regulators and
bureaucrats--can make better decisions than the people directly involved,
particularly about matters with as much at stake as health care--is one of
those zombie ideas that just don't die. No regulator or bucreaucrat ever
suffers any negative consequences because of bad decisions about other
people's health care.

As for people being poor at judging for themselves whether procedures are
necessary, another comment upthread already addressed that: there are plenty
of other areas (auto repair, for example) where most people don't have the
technical knowledge to judge for themselves whether procedures are necessary,
yet markets seem to function in those areas. Furthermore, under the current
system in the US, people have little incentive to become more knowledgeable,
because they are not going to be given a choice anyway; they're going to get
whatever their health insurance provider says is the standard care. Under a
market system, people would have much more of an incentive to actually learn
about the various options. And there would also be much more of an incentive
for independent third parties to provide information, particularly information
that health care providers might not want people to know.

More generally, the reason market advocates, like me, advocate markets is not
that they always give optimal outcomes. They don't. But in cases where they
don't, non-market alternatives give outcomes that are even worse.

~~~
tomkarlo
And yet the data shows that when you leave the decision to regulators and
bureaucrats, you seem to get better value for the healthcare dollar than if
you let individuals make their own decisions. The US, in particular, spends
more and sees worse outcomes than other counties.

This shouldn't be a surprise. An individual is going to not make very good
decisions about how healthcare dollars are allocated over the course of their
life. They're going to usually tend to underspend on preventative care (which
has the highest ROI) and tend to overspend on end-of-life care (which has a
lower ROI). You can see this played out in things like the US's infant
mortality rate (3X other developed nations) and life expectancy (31st
worldwide, declining).

~~~
pdonis
_> The US, in particular, spends more and sees worse outcomes than other
counties._

I think this "conclusion" depends strongly on how you define "worse outcomes".

 _> An individual is going to not make very good decisions about how
healthcare dollars are allocated over the course of their life._

Not if they have no incentive to learn how, no. And our current system gives
them no such incentive, since they don't control the dollars to begin with.

In other words, the system complains that people don't do something that the
system prevents them from doing.

~~~
tomkarlo
It's not very hard to define "worse outcomes"... the US trails other developed
nations in just about every wide-reaching healthcare metric at this point. If
you have counter-examples, feel free to raise them.

> In other words, the system complains that people don't do something that the
> system prevents them from doing.

Uh, this has nothing to do with the system, and mostly everything to do with
behavioral economics and risk pooling. People are poor at investing in
preventative care, because the benefit is extremely hard to perceive at the
individual level. And they over-invest in end of life care, because, well,
they don't want to die. That's not the result of "the system", that's human
nature. Attempting to build a healthcare system on how we "should" act instead
of how we actually do isn't a plan.

~~~
emodendroket
In addition, the "market-based" proposals to address this problem mostly
exacerbate it. The suggestion is always that patients need more "skin in the
game" \-- in other words, that they need to be responsible for even more costs
out-of-pocket -- and yet it's completely predictable that fewer people are
going to seek preventative care if they have trouble paying for medicine now.

This also ends up being a pretty unfair way to apportion care because a rich
man couldn't care less about a $100 fee and a poor man can find it
prohibitive.

------
radoslawc
I've heard multiple times that medical care in USA is pretty expansive if you
don't have insurance. But I had no idea to what extent, until someone posted
comments section form amazon's page for fish antibiotics. People are buying
those for them self (well, still it's amoxycycline), just check any comment,
most of them have something like: my 'fish' is better, $300 saved. That's just
inhumane.

~~~
Firebrand
There’s only three parts of the economy where prices have consistently
outpaced inflation: education, health care (including prescription drugs) and
real estate over long periods of time.

These are all sectors in which public policy subsidizes demand and restricts
supply.

~~~
justin66
> education, health care (including prescription drugs) and real estate over
> long periods of time.

If you're talking about the housing market, the Case-Shiller index indicates
that over _long_ periods of time, the value of housing tracks inflation, it
does not outpace it. (Which does not exactly help the homeowner caught riding
enormous peaks and valleys in pricing, of course.)

[https://en.wikipedia.org/wiki/Case-
Shiller_index](https://en.wikipedia.org/wiki/Case-Shiller_index)

The other two are interesting. It seems safe to say that as more and more
technology becomes available to help people stay healthy and alive, medicine
will continue to get more expensive. Or maybe medicine will essentially become
an information technology where Moore's Law applies and costs will go down, as
Kurzweil predicted.

Maybe education will become less expensive as credentialism collapses under
its own weight and online learning becomes more prevalent. Or maybe we will
need more and more education as job hopping becomes the norm and wrangling all
different sorts of technology becomes the lot of pretty much everyone who
wants to earn more than the universal basic income.

~~~
mercutio2
The Case-Shiller index doesn’t include income (real, or imputed rent), and the
index doesn’t go all that far back.

When you include imputed rent, maintenance, and property taxes, it’s much less
clear whether residential real estate or equities have better total returns
over century timelines.

I was surprised by this, when I read abstracts of a paper about this recently,
but it seems to be at least not as settled as I used to think it is.

~~~
justin66
I'd be terribly interested in a link to the paper you mentioned. I've never
seen anything credible which indicated real estate was as profitable as
equities over time (but I've been focused on the United States).

I'm not sure how or why Case-Shiller would involve rent or imputed rent. Are
you thinking more of commercial real estate?

------
rwx------
At least in US you get the medical treatment first and then they hand you a
large bill to pay. In poor countries the hospitals will turn you away until
you pay a significant sum in advance (not exaggerating it has happened to me).

~~~
chimeracoder
> At least in US you get the medical treatment first and then they hand you a
> large bill to pay.

A large bill which, if you're uninsured, you can almost always negotiate down
to 10% or less of the original.

Of course, most people don't know this, but those large bills aren't what the
hospitals expect uninsured patients to pay. They just legally have to present
them the same initial bill that they present private insurers.

~~~
emidln
Of course then you get taxed on the remaining 90% as income.

~~~
AnimalMuppet
No, because it wasn't income. When you find something on sale, you don't pay
income tax on the difference between the sale price and full price.

~~~
emidln
That depends on if they are willing to negotiate with you before considering
it a debt. If they send you to receivables with a 100k bill and you negotiate
down to 10k cash, they are well within their rights to write off the 90k as
debt forgiven. If they do so, you will be taxed on it.

Good luck finding a 90% off coupon for a surgery prior to the event.

------
ChuckMcM
I understand the narrative, its the 'tiger outside the village'or the 'wolf in
the forest' sort of tale that there is this "bad thing" that will randomly
attack/kill/impoverish people that collectively we could eliminate if we just
had the will, as a community, to do so. And I don't disagree, we could
overcome the badness if we had the will.

Where I part company with the narrative is over looking how we have
structurally made the 'collective' so large as to prevent such a decision to
be taken.

I expect that if you were to poll San Francisco you would find overwhelming
support for a single payer, 'state' (and by that I'm using the notion of the
collective government not the state of California) administered health care
system for residents. No doubt it would be paid for by taxing some of the
wealthiest residents or as part of some sort of rent/property taxation plan.

You might even be able to get this passed (agreed to) for the entire state of
California.

However, country wide consensus on the issue is elusive and often divisive.

The saying goes that "all politics are local" and to a large extent that is
true. But I wonder why it is that the state of California was progressive
enough to legalize marijuana but can't get something like this done? The
current punch line is "This isn't a problem in North America if you are
Canadian."[1] so why is that the case in California? We've got the largest
state economy in the US, we've got the largest population base, and we're
bigger than France[2]. So what is the hangup with just showing the rest of the
country how things 'should' be done rather than complain about how things are
being done 'wrong' ?

[1] And yes I know there are plenty of complaints about the system there as
well, it is still better than what you get south of the border.

[2] [https://www.weforum.org/agenda/2016/07/american-state-
bigger...](https://www.weforum.org/agenda/2016/07/american-state-bigger-
economy-than-india/)

~~~
philipkglass
I think that single payer is a great plan for a country. I don't think that
its cost-saving merits would be evident in a single-state experiment. If
California alone offered single-payer health coverage I would expect it to
become a magnet for people with expensive health problems from the other 49
states, who either currently pay a lot for medical care or go without medical
care. The savings of a single-payer system for Californians could be swamped
by the increased costs from people who become Californians out of medical
desperation. And then every vested interest currently opposed to American
single payer health service would say "see, we told you it's too expensive."

Individual states could easily experiment with e.g. gay marriage or legalizing
cannabis before the rest of the country, because the first has negligible
revenue impact and the second actually _enriches_ state coffers. But I don't
think that you can run the same one-state experiment with single payer health
care without incurring steep costs from medically desperate migrants from
other states.

~~~
ChuckMcM
This is a good counter argument, although as I see it there are assumptions
here that are hard to test.

You started with "I think that single payer is a great plan for a country. I
don't think its cost-saving merits would be evident in a single-state
experiment." I completely agree that the scale is an important part of how
well one could evaluate the success. If you read reference #2 in my comment
you saw that Calfornia's GDP is slightly larger than that of France, and
France has a universal health care system[1]. My thought is that if it was
good enough for an economy like France then California is a large enough test
case. I could not make such a case for Wyoming for example.

The argument that 'it would be a magnet, and all these high cost patients
would move here' has intuitive appeal but I struggle with it. Here are my
challenges with that sort of rebuttal, first I would like to understand better
how France deals with the situation given that migration around the EU is
fairly easy, and by some accounts France has the best health care, are they
over burdened by the high cost cases flooding in? Also there are plenty of
reasons to want to live in California but the high cost of living (excluding
health care) has been a disincentive for many. As I see it, the set of people
who would move to California, _for the health care_ , would be that population
who could otherwise afford the cost of living, or by covering their medical
costs could _now_ afford the cost of living. And I wonder how big a group that
is relative to the overall existing population. I also assume that someone
would rather live in a home and pay for health care than be homeless in
California and get free health care. There is also the 'reverse' effect where
people who are currently bankrupt/underwater and already live in California,
becoming productive again after the burden of health care was removed. So what
is the net change?

There is also a big fuzzing effect on the healthcare debate which conflates
the cost of providing medical services and the cost of insurance. I am
convinced by the evidence of concierge doctors and all cash procedures that
are _significantly_ less expensive than the 'advertised' or 'billed' prices
for procedures, that a form of capture has occurred whereby the medical
services providers and the medical insurance providers are colluding (possibly
inadvertently) to maximize those costs in order to maximize the transfer of
money from patients/businesses into their possession. And while I recognize
that state efforts to minimize that (a state insurance commissioner who
oversees and regulates that capture) have not been as successful as I would
like, I am not convinced that the problem isn't solvable. After all, places
like France solved it for some definition of solved.

[1]
[https://en.wikipedia.org/wiki/Health_care_in_France](https://en.wikipedia.org/wiki/Health_care_in_France)

~~~
philipkglass
France has additional factors mitigating against a potential flood of medical-
care-seekers:

1) Most (all?) other countries in the EU don't have terrible American-style
systems of healthcare provision, so the pull isn't as strong.

2) Language barriers make e.g. a Poland-to-France move more difficult than a
Missouri-to-California move, even though the latter move actually requires
covering a greater geographic distance.

Of course there are practical barriers against _every_ medically underserved
American moving to California to take advantage of a single payer system. My
intuition is that there could easily be _enough_ of them to more than cancel
the economic benefits that you'd expect from imitating the successful single
payer systems of other countries. YMMV. I'd love to be wrong about this.

EDIT: dragonwriter brought up a good point about business-magnet effects,
which offsets some of my pessimism about the outcomes of trying this in
California. And you have a good point about Californians who might be able to
re-enter the workforce.

------
jsnk
I have some questions about American health care system.

If patients are being charged this much for anything, the money must be going
to someone? Who's making all the money? Drug companies? Hospitals? Health
insurance? Doctors or nurses? Why don't people honestly follow where the money
end up and actually solve the problem once and for all. Increase the supply of
X or many other bottlenecks by deregulation and result in decreased price?

~~~
maxerickson
_Who 's making all the money? Drug companies? Hospitals? Health insurance?
Doctors or nurses?_

Yes.

~~~
cratermoon
Not the nurses. Definitely not the nurses.

~~~
maxerickson
[https://www.bls.gov/oes/current/oes292061.htm](https://www.bls.gov/oes/current/oes292061.htm)

[https://www.bls.gov/oes/current/oes291141.htm](https://www.bls.gov/oes/current/oes291141.htm)

The majority of nurses are RNs and make well above median wages. LPNs still
make better than average money.

They aren't getting incredibly wealthy, sure, but they aren't working for
peanuts either.

~~~
cratermoon
Why is a nurse's services worth less than a computer programmer's?

~~~
maxerickson
In the US, literally because there are not people offering them larger
salaries.

It's anyway probably not a great argument if you are trying to make people
making 5-10x the median wage some kind of baseline.

------
ypeterholmes
Insurance companies are the problem. Single payer + Universal Healthcare is
the answer because it will eliminate insurance companies from the equation and
get us back towards actual cost and remove this threat that hangs over all of
us.

~~~
refurb
You realize that countries like Switzerland and Singapore have private
insurance companies, universal coverage and reasonable costs?

That would suggest insurance companies are not the problem.

~~~
ohples
They are also very small countries compared to the US

~~~
cgmg
Why do you think that's relevant?

In any case, the same point would apply in the other direction.

------
trs80
The scary truth about doctors is they frequently misdiagnose. When I was
healthy each diagnosis was pretty accurate "you're fine". Then I had a real
catastrophe and was mistreated by the medical community. Till this day I
suffer and I'm still not content with their diagnosis. Don't put too much
faith in them to save you.

~~~
conanbatt
Healthcare produces a mental model on patients that is not how medicine is
practiced.

Doing tests is not only economically costly, its also costly in terms of
health, so ordering unnecessary tests is in detriment to health. There are
also false positives. So tests without symptoms should not be performed. But
that also means you dont find things pre-emptively.

For example, you are worried that your fatigue is due to a brain tumor (google
surely told you that), so you ask your doctor to do an MRI to rule it out. MRI
comes in negative. But the MRI radiation gave you cancer, because it does (in
a very small amount of people), as well as gave you very expensive bill for
it, because MRI are expensive everywhere, not only in the US.

~~~
philipkglass
_For example, you are worried that your fatigue is due to a brain tumor
(google surely told you that), so you ask your doctor to do an MRI to rule it
out. MRI comes in negative. But the MRI radiation gave you cancer, because it
does (in a very small amount of people), as well as gave you very expensive
bill for it, because MRI are expensive everywhere, not only in the US._

Good example, except you're thinking of a CT scan, not MRI. CT scan uses
x-rays. MRI uses no ionizing radiation.

~~~
conanbatt
Sorry! Thanks for the correction.

------
joe5150
I recommend reading the linked article by Molly Osberg as well

[https://splinternews.com/how-to-not-die-in-
america-182255515...](https://splinternews.com/how-to-not-die-in-
america-1822555151)

------
knorker
tl;dr: Life In The USA, the worst country in the world to have medical issues
in, that also refuses to change to what everyone in the world knows works, for
some reason.

~~~
refurb
I would say the US is the best country in the world to have medical issues in
if you have good insurance.

That's why you see Canadians making the trek down for treatment when they
can't get it (or at least the quality they want) in Canada.

~~~
jasonlotito
> That's why you see Canadians making the trek down for treatment when they
> can't get it (or at least the quality they want) in Canada.

We did that for our children's autism. It was faster, better, and cheaper than
anything Canada offered, which is monstrously bad.

~~~
refurb
Here is a recent example in the Canadian news.[1] Two friends, one in Canada,
one is the US. The one in the US got the latest cancer treatment and is in
remission. The one in Canada is stuck with old drugs because the gov't hasn't
decided whether to pay for the new drug.

 _" It's crazy that I live in Canada, but now I'm looking at having to sell my
house for coverage of my medication."_

People act like a single payer system is a panacea for all the US's problems,
but there are also trade offs involved.

[1][http://www.cbc.ca/news/canada/british-columbia/a-tale-
of-2-f...](http://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-friends-
with-breast-cancer-1-has-coverage-for-costly-drug-the-other-forced-to-
pay-1.4495123)

------
booleandilemma
I have a naive question:

Why can’t healthcare be like going to the mechanic to get your car fixed?

You go to the shop, they tell you the problem and give you an estimate, and
you go from there.

Why is healthcare so much more complicated?

~~~
tathougies
Have you ever had an undiagnosable condition? A car is a human invention, so
fixing it is easy. Moreover, if it can't be fixed, the solution of buying
another car is an option. The same is not true with your body.

------
matthoiland
Welcome to the USA. Uninsured appendectomy in California – now I owe $45k.
#freedom

~~~
ithinkso
I've been thinking about getting a job in US (San Diego, from Europe), my
field, perfect match and all, pay is much better if you compare absolute value
in USD but after reading about all that stuff about US it seems like after
paying taxes, rent and for everything else I'll end up with jack shit with the
risk of bankruptcy if I broke my leg or sth (being sued for some bs etc).

Scary stuff.

But at the same time, my friend is living there (Chicago, I think, northwest
for sure) and is doing fine with less than 50k gross a year. I don't know what
to believe when I'm reading about US. Internet makes it look like a crazy
place to live but is it classical "you only remember failures"/ "if you aren't
poor it's fine" or something? What would you (US citizens) advise?

~~~
pchristensen
The US is very large and diverse, but here are some general rules of thumb:

1) The US Gov doesn't protect much against extreme cases - that's why health
insurance (generally through an employer) is important.

2) America is a very, very hard place to be poor.

3) Living like you see on TV (in NYC, LA, SF, etc, or in a cool downtown loft
in an urban neighborhood) is _insanely_ expensive and it's only possible if
you design your career and life around it.

4) By trading commute time, "coolness"/novelty of neighborhood, and/or school
district, and metro area, you can live well on a very reasonable middle class
income. Living in Chicago, Charlotte, Minneapolis, Indianapolis, Pittsburgh,
any big city in Texas or Ohio, avoids the super high cost of coastal cities.

IANAL, but as far as getting into the US, if you can have an employer sponsor
you, I believe it's much easier than applying on your own. This ... may not be
the easiest time to get into the USA.

~~~
ithinkso
Thank you all for your responses, that's definitely reassuring though there
seems to be a common theme to avoiding poverty cause it's hard to get back on
your feet. Well, that's probably true everywhere so...

By the way, when I was talking about going bankrupt I meant despite having
health insurance but often you see cases where the insurance only covers
accidents that happened 'while on a red or green bus going no more that 30mph
at night, full moon required'. Reductio ad absurdum obviously but I think you
know what I mean (probably yet another stereotype I have about US).

~~~
pchristensen
This shows another feature of life in America - it depends on which "team"
you're on. Working for a large employer, especially with a white collar job,
you generally get a better policy. While you're insignificant, your employer
(who is buying the insurance and defining the policy) is valuable to the
insurer, so you're treated better. Same for if your insurance company is a big
player in that metro area - they get pricing power vs hospitals and providers
so your coverage and exceptions tend to be better.

The crap insurance with lots of exceptions come a) if you're choosing it
yourself and paying low premiums, or b) if your employer is less profitable
per employee or you're in a low status job (e.g. Wal-Mart offers worse
coverage than Google)

~~~
ithinkso
Hmm... this contradicts everything everyone else said in this thread. I mean,
everyone says that if you have insurance you have no chance of going bankrupt
but it is not enough, you have to be insured for _enough_ money in a first
place, which I think might not be possible even for non-poor people and that
defeats the purpose. And it's very scam prone...

~~~
ithinkso
My apologies in advance if that seems overly critical of US, I understand why
it might look like it but, truly, it's one of those things I just cannot grasp
about living there and that's why I'm asking questions, no malice intended.

~~~
DoreenMichele
I paid accident claims for over 5 years. Only a tiny percentage were a case of
_wrong place, wrong time, shit happens._ The vast majority were either
_accidents waiting to happen_ or policy abuse, where policyholders were
essentially scamming the company completely legally to cover routine
chiropractic visits.

My mother is German. I have lived in Europe. I will suggest that the fact that
you are European will likely inoculate you against a lot of worst case
scenarios because normal American practices that promote disease and injury
simply are not part of your culture.

Diet plays a very large role in disease. Immigrants don't typically start
living off of fast food burgers. They continue eating largely like they did at
home.

Europeans tend to drink responsibly. They have wine with dinner or drinks with
friends at a pub. The US has rampant addiction problems killing people.

If you don't plan to abandon your current healthy lifestyle habits, suddenly
start drinking and driving just because you set foot on US soil and otherwise
abandoning all common sense as you have known it for your entire life, you
probably don't need to fear that taking an American job will trap you in
American medical poverty hell with no hope of escape.

You can email me if you want to talk further.

~~~
ithinkso
Yeah, I want to talk further, It's 4am in Poland though, would you be willing
to postpone it a little bit? Thanks in advance

~~~
DoreenMichele
No problem. Email me whenever.

------
Firebrand
Medical care is a commodity, and aren’t we all often faced with commodities we
cannot afford?

People who cannot afford medical care have no right to demand it from anyone.
Maybe someone will be empathetic enough to offer charity; friends and family
may choose to band together and fund a sick person’s medical care. But even a
poor person’s necessity does not change the fact that healthcare is a service
and a good provided by a third party.

No matter how much some starving kid needs food, he doesn’t have a right to
steal someone’s wallet or hold up the local convenience store to obtain it. If
I were in that position, maybe I’d end up choosing to steal since it’s the
least immoral choice under the circumstances, but that does not make it a
moral choice, or suggest that I have not violated someone‘s rights in pursuing
my own needs.

~~~
fao_
> Medical care is a commodity

No, it's a right.

> No matter how much some starving kid needs food, he doesn’t have a right to
> steal someone’s wallet or hold up the local convenience store to obtain it.

 _Everyone_ has the right to life. I cannot imagine how callous one must be to
willingly deprive fellow human beings of that right, purely because it is not
how the economic system works. If we have the resources to provide healthcare
to everyone, then we should. No matter what the cost.

Repeat after me: Property is worth less than people.

""This means that nobody - including the government - can try to end your
life. It also means _the government should take appropriate measures to
safeguard life by making laws to protect you and, in some circumstances, by
taking steps to protect you if your life is at risk._ Public authorities
should also consider your right to life when making decisions that might put
you in danger or that affect your life expectancy.""

In the UK, Sweden, Norway, and many other civilized countries, everyone pays
into a public pot that is used to provide medical care. Because of this, our
workers are much more healthy, and much more able to work without the stress
of "what if I get injured during work". They do not have to die of preventable
diseases like septicemia, from something silly like duct taping their glass
cut because they cannot afford to be treated.

~~~
conanbatt
> Medical care is a commodity > No, it's a right.

You cannot have a right to healthcare without taking the right to not work for
someone else. You have a right to access healthcare, you dont have a right to
force someone to service your health.

And you shouldn't either.

> In the UK, Sweden, Norway, and many other civilized countries, everyone pays
> into a public pot that is used to provide medical care. Because of this, our
> workers are much more healthy, and much more able to work without the stress
> of "what if I get injured during work". They do not have to die of
> preventable diseases like septicemia, from something silly like duct taping
> their glass cut because they cannot afford to be treated.

This is medicare. Would you say medicare is economically successful?

~~~
Voloskaya
> This is medicare. Would you say medicare is economically successful?

Good old late stage capitalism.

Because economic success is paramount to all things right? Certainly more
important than increasing the quality of life of citizens.

~~~
refurb
Economic success is why you're not dying of some random disease in a cave and
instead typing on a computer that is a part of a worldwide network.

Without economics you can't pay for all the fancy stuff!

~~~
Voloskaya
You don't understand what I am saying.

In countries with free healthcare, if you only take the department of health
budget in isolation it's of course not going to be an "economic success", and
I'm just saying that's ok, we shouldn't expect it to be.

Should we expect our armies to be economically successful as well?

~~~
refurb
Working in healthcare, economic success is much broader than making a profit.
Looking at long term cost effectiveness is very common, so I would argue you
could say that health care is an economic success.

------
crankylinuxuser
I saw this critique a while back on reddit:
[https://pbs.twimg.com/media/BiCvPKWCUAA7Rtl.jpg:large](https://pbs.twimg.com/media/BiCvPKWCUAA7Rtl.jpg:large)

The long story short, Breaking Bad, wouldn't be a TV show. That's because of
socialized medicine didn't try to profit on the sick. So he wouldn't have
started making methamphetamine.

\------------------

Edit: Sigh, at -4. I thought this added a valid discussion, that the idea of
lack of any sort of medical program across the US is a definite detriment to
all. Not only that, but saying he had insurance through the employer only
reaffirms:

1\. You're trapped at your employer if you're sick

2\. You're bound by the quality of care the employer offers via agreements you
can't have access to (chosen insurer)

3\. Lack of choice by mandated "care plans" and coverage agreements that
exclude you from treatment due to insurance not covering it

I really don't get HN some days.. :/

~~~
cortesoft
I am pretty sure even in places with socialized medicine, they don't always
pay for experimental treatments. Walter White had insurance in the show, but
they refused to pay for an experimental treatment he wanted to get. That will
always happen, and needs to happen, in any insurance system; we can't just pay
for every quack treatment just because someone who is sick hopes that it would
work.

~~~
madengr
All treatments are experimental, at the beginning. Very frustrating.

~~~
crankylinuxuser
I have a good friend who is type 1 diabetic.

Her 1 year term at a university elsewhere ran out, and obtained a job
elsewhere. Both have insurance. But the insurance is the problem... Let me
explain.

Since she's T1, she takes insulin. There's different types of insulin. Fast
acting, slow acting, and various compounds and mixtures of each. In her case,
she was prescribed Humalog, and has taken it for the last few years.

On Jan 1, at the start of her new job, the job offered a different insurance.
Humalog was considered an "Uncovered drug". In other words, this maybe what
the doctor prescribed, and what your body is used to - but the insurance
company is the primary "doctor" that makes medical decisions above and beyond
your PCP.

She didn't have much choice. She went on an insulin that was "covered". The
insurance said it was "virtually the same". Bullshit. She took too much the
3rd day and had to take the day off, while asking friends to check up on her.
Diabetic comas and death are a thing. She's never had that happen before. (Her
A1C stays around 5.1-5.2 , which is impressive for any diabetic.)

~~~
dfraser992
I'm not going to argue with you about "the insurance company is the primary
"doctor" that makes medical decisions above and beyond your PCP." They
certainly shouldn't be.

But unless she is some rare outlier (I would need a bunch more information
about the situation), their stance is logical and acceptable. My first
impression, and I certainly may be wrong, is that anyone with a 5.1 HbA1c is
controlling things a bit too tight. Her life, I won't argue, but switching
insulins is not that precarious.

Source: me, diabetic for 30 years now. Hell, I've fasted (no food) for 3 weeks
and am still alive... In the grand scheme of things, my attitude is eking out
a year or two at most at the _end_ of your life due to totally tight control
over 30, 40 years is not worth the effort. Losing weight and eating more
vegetables (and less carbs) is more important.

