
The $200K lesson I learned from getting shot - Lusake
http://www.salon.com/2013/09/23/why_nobody_without_insurance_should_skip_obamacare/
======
adambard
Can I be the first non-US citizen in this thread express my incredulity that
anything less than universal health care is tolerated? "Barbaric" is the term
that seems to strike me whenever I hear of it, hyperbolic though it may be.

~~~
dnautics
you don't understand what it means to be a minority. We don't get anywhere
near equal quality coverage and are basically forced to subsidize better
medical care for white folk. For years, my father was prescribed a drug
(simvastatin) that actually did damage to his body because it's nearly
universally assumed to be good for him (it is for most white people), and
strongly subsidized by the government (he's a military vet).

I only found out because I got 23andMe, and I actually know biology. It was
dismaying to find out that very few of the tests on 23andMe are useful for
Asians like me (fewer still if you're hispanic and if you're pure African, the
affymetrix chip they use is basically useless). As we move into an era of
personalized medicine, we'll be subsidizing better healthcare and better
outcomes for some ethnic groups over others.

The faulty assumption behind universal healthcare is that a one-size-fits-all
prescription is good for everyone, but there are some really ugly disparities
that no one talks about; and these disparities serve to reinforce preexisting
social inequality. While I'm lucky to be in a minority group that's likely to
live a long time - if we have it, a lot of universal healthcare coverage will
wind up being plowed into gerontological care costs, which tend to be super-
expensive; so in a way, it's a subsidy for rich white people.

Now, I do think the american healthcare system is awful. In particular being
able to be put into permanent lifelong debt from healthcare costs is only one
small step above barbarism. But I don't think that universal healthcare is the
solution we're looking for. Obamacare is even worse, it combines the worst
parts of universal healthcare with the worst parts of the crony capitalist
system we have, and I won't be surprised when it turns out to be an even
bigger albatross on the shoulders of this country.

~~~
sliverstorm
It sounds to me like your father's issue was not that he was not white, but
that he had a rare genetic condition...

There was even a study that found on the whole, simvastatin is equally helpful
across races:
[http://www.ncbi.nlm.nih.gov/pubmed/16709304](http://www.ncbi.nlm.nih.gov/pubmed/16709304)

~~~
dnautics
Oh, it reduces his cholesterol level[0]. But he has at least one allele that
increases the risk of myopathy when taking simvastatin (Assuming there were no
milkmen - I do look quite a bit like him - I'm homozygous, and this allele is
not _terribly_ rare).

The part about being asian is that asians tend not to catabolize statins as
effectively, so his plasma levels are probably higher, since I found out he
was taking a full "white person dose" despite advisories that simvastatin
should be given at half dose for asians.

[0]I also recall hearing somewhere from a biochemist that while statins
decrease cholesterol levels in asians the effect on coronary heart disease
(which is what your _really_ care about) is attenuated, and that there may be
a secondary mechanism for CHD in asians... But I cannot find the source he was
quoting.

~~~
dnautics
ah, I found it, after all these years:

[http://www.ncbi.nlm.nih.gov/pubmed/21160131](http://www.ncbi.nlm.nih.gov/pubmed/21160131)

as a bonus, here is the review on why asians should take less statins (hepatic
enzyme clearance, probably a cyp450):

[http://www.ncbi.nlm.nih.gov/pubmed/17261409](http://www.ncbi.nlm.nih.gov/pubmed/17261409)

~~~
sliverstorm
That's not a consequence of being non-white so much as it is a consequence of
your doctor being uninformed, which impacts people of all races.

I'm not saying it doesn't suck, I just take issue with your narrative of how
race is the issue at hand, and how the medical system is bigoted towards
minorities.

~~~
dnautics
It's not just the medical system. It's just _reality_. I live with it. I'm
okay with it. I'd just rather not these disparities be magnified and
exacerbated by universalizing something which shouldn't be.

>That's not a consequence of being non-white so much as it is a consequence of
your doctor being uninformed, which impacts people of all races.

But it impacts minorities in the most general sense (i.e. not just color of
skin) more than non-minorities. For fundamental reasons, studies are less
statistically reliable, for starters.

I should remind you also that my father is being cared for under a universal
system (the VA) I think that the unversality of it does play into the way that
the doctors are informed.

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coryrc
> They also enter a social contract that promises to provide them affordable
> coverage when they’re older and no longer healthy, as a form of back payment
> for cross-subsidizing today’s aged and ill.

This is only true if the law requires younger people to pay more than their
cohort consumes on an average basis, so as to transfer even more wealth from
the working young to the retired, wealthy elderly.

Hmmm [http://www.forbes.com/sites/chrisconover/2012/11/27/young-
pe...](http://www.forbes.com/sites/chrisconover/2012/11/27/young-people-under-
obamacare-cash-cow-for-older-workers/)

~~~
hsitz
I'm not clear on to what extent the mandatory coverage requires young people
to pay more than the expected cost of their cohort, or if it simply requires
them to carry their own expected cost so that the older insured people (or,
perhaps, simply the taxpaying citizenry) don't have to pay health care costs
of the younger uninsured generation.

The author of the article also says, "Young people are typically healthy. On
average, they incur very low medical costs each year. In any social insurance
system, most of them will end up paying in more than they get out during their
early years"

It's not just the early years, it's all years. The way insurance works is that
most people pay in more than they ever get out. You're insured so that in the
unhappy event that you end up with a huge, abnormal, way above average
expense, insurance will cover it. This is possible because, on average, most
people pay in more than they ever get out. This fact in itself is not anything
specific to insuring the youngest and healthiest people. The value of
insurance is not measured by how much you "get out". It's measured by how much
coverage you had, regardless of whether you used it.

I hope to never use my health insurance, or to use it (i.e., "get out of it")
as little as possible. So far I've done great at that. Does not "getting out"
what I've paid make me think I've been paying without getting value? Hardly.
And my belief in that value is not conditioned on my expecting to get payments
out of it in the future, any more than my belief in the value of my auto
insurance is. I hope also to never get any money out of my auto insurance
policy, this year or in any future years, yet it will still be worth every
penny I pay.

~~~
coryrc
"The newly announced rules limit insurers to charge their oldest customers no
more than three times as much as younger ones"

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restlessmike
I'm sure this has been pointed out many times when these posts pop up, but
what is shocking to me is that we tolerate $200k medical bills for this sort
of emergency care, as long as we aren't the ones paying for them ourselves.

The healthcare industry needs a lot more transparency. Every hospital should
be required (if they choose to accept Medicare/Medicaid patients) to publish
prices in an easily comparable format tied to standard medical codes for every
service/procedure they provide, and should be required to charge individuals
without insurance no more than the government or other large insurer pays.
This would seem pretty simple to implement and would, over time, help keep
prices lower simply by making them public and allowing people to compare them.
The information asymmetry in the industry has created a situation where people
are powerless to help themselves and make smart choices with regard to getting
healthcare, and has led to the creation of another expensive program that we
can't afford.

Sadly, we have a system in which the industries being regulated control the
dialog, and they are all too happy to tiptoe past prices and on to who is
footing the bill.

~~~
robomartin
> The healthcare industry needs a lot more transparency.

OK, yes. What it really needs is to be an open market both for care and
insurance. Competition has amazing ways to both improve quality and
affordability. This has been proven time and time again across a myriad of
fields both within and well outside of medicine. Nothing beats open market
competition. When providers and insurance companies truly have to compete for
your business things change.

The ACA (Obamacare) is a disaster full of typical government-driven unintended
consequences. We are just starting to see the tip of the iceberg. Funny that
the very people who passed it will not have to live within this monstrous
framework. And now the very unions who helped push it forward had an "oh-
shit!" moment. They learned just how fucked it's going to be and want out.

I say, we are all on the same boat or shred the damn thing. If we are going to
have socialized medicine the only equitable approach is that everyone, without
exceptions, has to use it. All exceptions granted by POTUS need to be
rescinded.

~~~
tzs
> Funny that the very people who passed it will not have to live within this
> monstrous framework.

It applies to Congress.

~~~
sp332
Thanks to political one-upmanship, confusing language, and uncertain policy,
that wasn't clear for a while.
[http://www.forbes.com/sites/rickungar/2013/04/25/is-
congress...](http://www.forbes.com/sites/rickungar/2013/04/25/is-congress-
really-attempting-a-last-minute-end-run-to-exempt-itself-from-obamacare/)

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Frozenlock
Seems to me the author is conflating the principle of insurance with
Obamacare.

Or in other words, it's not because the general concept of insurance _can_ be
wise that every implementations are interesting.

~~~
fennecfoxen
Yes...

"One of the less obvious consequences of serious accidents is that victims
often become uninsurable on the individual market as a result.... Obamacare
really will change that."

Making this sort of insurance available amounts to a wealth transfer to people
who have been victims of injuries. That's fine, if you're into wealth
transfers and all that, but...

wouldn't it be better if we just admitted it was a big fat subsidy to the sick
and injured, and paid for it out of the general fund, instead of paying for it
by making insurance more expensive, especially the young healthy twenty-
somethings who struggle to afford it? so that these twenty-somethings wouldn't
be tempted to skip it, among other things, and would be less vulnerable to
these $200,000+ risks (and further undermine the system)?

I mean, all else being equal, it is probably a good idea to be insured if you
can, Obamacare notwithstanding, but the fact that it incentives people this
way is a fundamental design flaw, not a feature or a fix.

Oh, wait, I know why we're paying for it this way. It's so we can pretend that
it doesn't cost anybody any money. :P

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skizm
> But there’s no equity, dividend or residual value in a splenectomy.

I'm gonna go ahead and disagree with that. The residual value is every day
afterwards that you get to live. (not that I disagree with the sentiment, just
sayin)

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iloveyouocean
Beware the automatically played, LOUD advertisement.

~~~
iopq
[https://adblockplus.org/](https://adblockplus.org/)

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pjbrunet
The lesson: health insurance = bad luck

