A Mexican Hospital, an American Surgeon, and a $5k Check(nytimes.com)
nytimes.com
A Mexican Hospital, an American Surgeon, and a $5k Check
https://www.nytimes.com/2019/08/09/business/medical-tourism-mexico.html
106 comments
> I wonder if there's a topology of illnesses where a financially optimal course of action to acquire treatment is to commit some petty crime and receiving treatment in prison?
YES!
https://www.theatlantic.com/health/archive/2013/02/on-purpos...
"The next week, he went to a department store and, making sure a security guard saw him, pocketed some moisturizing cream. He looked up at the guard, smiled, and walked out.
"After he was arrested, he wrote a note to the judge saying that he needed to get back into prison for a year, to get an operation. He told me the judge said "I'll give you 14 months, go get your surgery."
YES!
https://www.theatlantic.com/health/archive/2013/02/on-purpos...
"The next week, he went to a department store and, making sure a security guard saw him, pocketed some moisturizing cream. He looked up at the guard, smiled, and walked out.
"After he was arrested, he wrote a note to the judge saying that he needed to get back into prison for a year, to get an operation. He told me the judge said "I'll give you 14 months, go get your surgery."
This was a great read.
>Any patient with end stage liver disease who does not have insurance (and is not eligible for Medicare) has the option of trying to qualify for state-funded Medicaid (which includes demonstrating both poverty and disability), stealing moisturizing cream from a department store, or dying.
>I have personally taken care of a number of patients who did not want to put their family through the formidable weight of bankruptcy and opted for number three.
>Any patient with end stage liver disease who does not have insurance (and is not eligible for Medicare) has the option of trying to qualify for state-funded Medicaid (which includes demonstrating both poverty and disability), stealing moisturizing cream from a department store, or dying.
>I have personally taken care of a number of patients who did not want to put their family through the formidable weight of bankruptcy and opted for number three.
Americans need to raze their healthcare system down to the ground. None of the bandaid fixes like getting the government to pay but still having private companies dictating the prices. The whole system has to be torn down and rebuilt from scratch, with the state the main owner of hospitals and provider of healthcare. The kind of things that you read about the current system are just absurd, but it's past the financial absurdity at this point, reading about insurance companies literally deciding whether cancer treatment is "strictly necessary" for weeks without approving it is not a healthcare system, it's hell, it's barbarism.
Healthcare has been a political football for decades, with massive interventions by government up and down the stack of services.
Think about the market's provision of grocery stores: plenty of competition. Most places they don't enjoy geographic monopolies like car dealerships do. They manage to get one of the most vital goods to a huge population spread across a huge area on time and at a great price, with local variations anticipating the specific desires of local consumers. There is no central coordinator or Department of Grocery Services. The market figures it out.
How can someone look at healthcare, with its absolutely absurd outcomes, and not understand that it is precisely because of government interference that nothing makes any sense? Costs keep rising unsustainably, which is the opposite of the way markets work. Paperwork and administrative staff balloons in proportion to patient care.
Once the state gets involved, now it becomes political. Do you think the current political climate in the US should be further embedded into healthcare? If the state controlled everything, then you'd get outcomes like red/blue states losing/gaining funding depending on the results of the most recent election. One could imagine more dystopian outcomes quite easily.
Think about the market's provision of grocery stores: plenty of competition. Most places they don't enjoy geographic monopolies like car dealerships do. They manage to get one of the most vital goods to a huge population spread across a huge area on time and at a great price, with local variations anticipating the specific desires of local consumers. There is no central coordinator or Department of Grocery Services. The market figures it out.
How can someone look at healthcare, with its absolutely absurd outcomes, and not understand that it is precisely because of government interference that nothing makes any sense? Costs keep rising unsustainably, which is the opposite of the way markets work. Paperwork and administrative staff balloons in proportion to patient care.
Once the state gets involved, now it becomes political. Do you think the current political climate in the US should be further embedded into healthcare? If the state controlled everything, then you'd get outcomes like red/blue states losing/gaining funding depending on the results of the most recent election. One could imagine more dystopian outcomes quite easily.
You don't seem very familiar with our system of production, distribution, and consumption of food. The government is _very_ involved in all aspects of this. They intervene on the supply side to guarantee prices for commodities. They intervene on the demand side by directly subsidizing 10% of consumers. The federal government inspects all meat, fish, and poultry packed in this country. There is a USDA agent filing a market report every morning from every produce terminal in America. The government maintains a detailed database on soil conditions across the nation. The USDA alone has over 100000 employees. The government also funds a nationwide system of agricultural universities, extensions, and bureaus through the land grant program.
I think if you want to pick some aspect of American life that is free of government involvement, you started in the wrong place.
I think if you want to pick some aspect of American life that is free of government involvement, you started in the wrong place.
I had to go to the ER yesterday. I was taken to the closest ER. You bring up geographic monopolies without any irony and yet healthcare has huge and very obvious geographical monopolies.
At the ER I was made to sign something on the way in in a state in which I couldn’t really tell what I was signing. I was given various drugs and sent through a CT scan. I had no idea what was going on. I certainly was in no position, with symptoms of a life threatening condition on top of being incapacitated to say “hey hold up, I think the Safeway has cheaper CT scans can you guys transfer me there!”
Healthcare is entirely different from buying groceries. It does not and will never operate like a typical market for typical commodity items.
At the ER I was made to sign something on the way in in a state in which I couldn’t really tell what I was signing. I was given various drugs and sent through a CT scan. I had no idea what was going on. I certainly was in no position, with symptoms of a life threatening condition on top of being incapacitated to say “hey hold up, I think the Safeway has cheaper CT scans can you guys transfer me there!”
Healthcare is entirely different from buying groceries. It does not and will never operate like a typical market for typical commodity items.
Emergency medicine is a small fraction of all medicinal needs.
A lot of medicinal procedures allow time for determining what the most cost effective offering is.
A lot of medicinal procedures allow time for determining what the most cost effective offering is.
But is the ideal system one with several hospitals per city, duplicating expensive resources or one big centre with centralised resources?
The market only provisions grocery stores after massive subsidization, centralization, and exploitative labor. Can you usually purchase cheap local produce for less than that offered by a conglomerate? I'm certain there are useful parallels between healthcare and the grocery market, but I feel like you left them out of your comment. Take bananas for instance: ubiquitous, constantly in demand, sold mostly by two companies, and widely produced by slave labor.
Disclaimer: I'm in favor of a preventative care system available to everyone, regardless of income.
Disclaimer: I'm in favor of a preventative care system available to everyone, regardless of income.
> Can you usually purchase cheap local produce for less than that offered by a conglomerate?
You can never purchase local, small batch ____ than you can from large companies. That's why companies get large - they are more efficient the larger they get (to oversimplify).
Your local farmer has much less land than factory farm, and he doesn't have the state of the art equipment to harvest or store his crops. He can't justify spending so much money on equipment when he runs such a small farm.
There's also a good chance he uses "organic" as a selling feature, which means his yeild per area land is way lower than an efficient farm.
He also has to work much harder to actually sell his crop. He doesn't have large commercial deals that put his product directly onto shelves at Aldi. He has to spend half his time driving all over the place to various farmers markets to try and get people to buy his stuff.
You might think all of this is pedantic or obvious, but I think efficiency of food production is very important. Food production is a massive contributor to climate change and opting for methods than can save on land area and water usage can have big impacts.
You can never purchase local, small batch ____ than you can from large companies. That's why companies get large - they are more efficient the larger they get (to oversimplify).
Your local farmer has much less land than factory farm, and he doesn't have the state of the art equipment to harvest or store his crops. He can't justify spending so much money on equipment when he runs such a small farm.
There's also a good chance he uses "organic" as a selling feature, which means his yeild per area land is way lower than an efficient farm.
He also has to work much harder to actually sell his crop. He doesn't have large commercial deals that put his product directly onto shelves at Aldi. He has to spend half his time driving all over the place to various farmers markets to try and get people to buy his stuff.
You might think all of this is pedantic or obvious, but I think efficiency of food production is very important. Food production is a massive contributor to climate change and opting for methods than can save on land area and water usage can have big impacts.
[deleted]
Or, you do the rational thing that many other nations have done and decide that healthcare is a human right, then stop playing hot potato with the ticking bomb of healthcare.
America is the only one with this very unique problem and going further in the direction of a 'free market' won't work. Because healthcare can never be a free market. The insurers have an incentive to not give quality healthcare and give people the bare minimum while hiding details from customers and no amount of freedom would solve this. The end result is that you'd see something like ISP companies where they work together to enforce a regional monopoly and gouge people all the same.
America is the only one with this very unique problem and going further in the direction of a 'free market' won't work. Because healthcare can never be a free market. The insurers have an incentive to not give quality healthcare and give people the bare minimum while hiding details from customers and no amount of freedom would solve this. The end result is that you'd see something like ISP companies where they work together to enforce a regional monopoly and gouge people all the same.
Veterinary services and dentistry aren't in the same situation though.
And you can have both a public option alongside a free market.
And you can have both a public option alongside a free market.
Honest question - are there any successful healthcare systems that have more privatization than the US?
> they don't enjoy geographic monopolies like car dealerships do
This is a bit of a tangent, but do car dealerships have geographic monopolies in some places? I don't think I've even seen just one dealership. They always cluster around each other where I'm from - you could car shop on foot and see at least 3-4 different dealerships.
This is a bit of a tangent, but do car dealerships have geographic monopolies in some places? I don't think I've even seen just one dealership. They always cluster around each other where I'm from - you could car shop on foot and see at least 3-4 different dealerships.
> How can someone look at healthcare, with its absolutely absurd outcomes, and not understand that it is precisely because of government interference that nothing makes any sense?
Because they see how much of the mess is the markets fault. They also see how nearly every other first world country has a working system while spending less on healtchare. In some places its private non profits subsidized and regulated by the government, in some its the government providing insurance like in Canada, in some it's really socialistic and government employs most doctors like the NHS. In each case the system works much better then the US and the US system is rightly considered a bogeyman. I'm unaware of any place that works like you've described
Because they see how much of the mess is the markets fault. They also see how nearly every other first world country has a working system while spending less on healtchare. In some places its private non profits subsidized and regulated by the government, in some its the government providing insurance like in Canada, in some it's really socialistic and government employs most doctors like the NHS. In each case the system works much better then the US and the US system is rightly considered a bogeyman. I'm unaware of any place that works like you've described
Please define "works much better." Thanks.
> The whole system has to be torn down and rebuilt from scratch, with the state the main owner of hospitals and provider of healthcare. The kind of things that you read about the current system are just absurd,
How involved are you with other US government organizations? Do they usually strike you as highly competent and efficient? Are you sure that if we did what you suggest we wouldn't have a whole different set of monstrous absurdities?
How involved are you with other US government organizations? Do they usually strike you as highly competent and efficient? Are you sure that if we did what you suggest we wouldn't have a whole different set of monstrous absurdities?
Yes, actually.
NOAA and NASA do a great job forecasting weather and tides. The CDC does a ton for public health: no recent pandemics I can recall. The NIH is one of the best biomedical research agencies in the world—-and the NSF, NASA, DoE, and DoD research divisions are no slouches either (GPS, internet, etc). The Library of Congress and Smithsonian make a lot of American heritage accessible to everyone—-and also do serious research of their own. The National Parks are awe-inspiring. The USPS can reliably get something to my family on the other side of the continent for $0.50. The USDA has kept our food supply wholesome, and the FAA/NTSB have made flying—an intrinsically crazy activity, absurdly safe. The SEC and FDIC have keep American markets aboveboard and attractive to investors from around the world.
There’s more to the government than the DMV and taxes.
In fact, if you’ve ever had to interact with the IRS, they are astonishingly pleasant—-I got a question answered and a (small) amount of money refunded in a ten minute phone call. It was vastly better than calling Comcast or the insurance company.
NOAA and NASA do a great job forecasting weather and tides. The CDC does a ton for public health: no recent pandemics I can recall. The NIH is one of the best biomedical research agencies in the world—-and the NSF, NASA, DoE, and DoD research divisions are no slouches either (GPS, internet, etc). The Library of Congress and Smithsonian make a lot of American heritage accessible to everyone—-and also do serious research of their own. The National Parks are awe-inspiring. The USPS can reliably get something to my family on the other side of the continent for $0.50. The USDA has kept our food supply wholesome, and the FAA/NTSB have made flying—an intrinsically crazy activity, absurdly safe. The SEC and FDIC have keep American markets aboveboard and attractive to investors from around the world.
There’s more to the government than the DMV and taxes.
In fact, if you’ve ever had to interact with the IRS, they are astonishingly pleasant—-I got a question answered and a (small) amount of money refunded in a ten minute phone call. It was vastly better than calling Comcast or the insurance company.
We could choose to staff them with competent people instead of deliberately sabotaging it. There are viable alternatives to the GOP strategy.
[deleted]
If only someone had thought of that before
Maybe we could run it similarly to the government-run air traffic control system, which is superb.
“Government” doesn’t have to mean “incompetent and inefficient.”
“Government” doesn’t have to mean “incompetent and inefficient.”
Maybe we could. Or maybe we'd run it like the VA.
[Edit: enraged_camel said that the VA is pretty good. Is that accurate? I've heard otherwise, but I don't know firsthand. If the VA example isn't accurate, though, replace it with "California high speed rail" or "Amtrak" or "the Department of Education".]
It doesn't have to mean incompetent and inefficient, but it seems that it often does.
[Edit: enraged_camel said that the VA is pretty good. Is that accurate? I've heard otherwise, but I don't know firsthand. If the VA example isn't accurate, though, replace it with "California high speed rail" or "Amtrak" or "the Department of Education".]
It doesn't have to mean incompetent and inefficient, but it seems that it often does.
How often?
People love to act as though government can’t do anything right. Government does plenty of things right, those just don’t get much attention.
I sit here next to my government road with government postal service, lights powered by a private utility heavily regulated by the government, and wish the government provided trash service to me like they do for my neighbor because I’m getting fed up with the shoddy trash service I get from the company I pay, and think, yeah, government health care could be pretty good, just like it is in so many other countries. The US is not uniquely incompetent here.
People love to act as though government can’t do anything right. Government does plenty of things right, those just don’t get much attention.
I sit here next to my government road with government postal service, lights powered by a private utility heavily regulated by the government, and wish the government provided trash service to me like they do for my neighbor because I’m getting fed up with the shoddy trash service I get from the company I pay, and think, yeah, government health care could be pretty good, just like it is in so many other countries. The US is not uniquely incompetent here.
That gov’t road was likely built by a private company. And being heavily regulated doesn’t make a private utility a good example.
> Government does plenty of things right, those just don’t get much attention.
Fair point.
Fair point.
Along the Northeast corridor, taking Amtrak downtown-to-downtown takes about as long as flying and is vastly more pleasant. The service out west is bad because it's a gongshow of interactions between Amtrak and a bunch of private companies, which seems...oddly reminiscent of something.
My only direct experience with the Department of Education was college financial aid. The FAFSA wasn't particularly awful and I appreciate the help I got--the work study job not only paid for my books and food, but got me started in my career.
My only direct experience with the Department of Education was college financial aid. The FAFSA wasn't particularly awful and I appreciate the help I got--the work study job not only paid for my books and food, but got me started in my career.
Perhaps we could call it "Medicare" and it would be way more efficient than any of the private insurers.
Air traffic control is not a great example to cite here. The USA is one of the few countries where the regulator also provides the ATC service. In comparison to Canada, the US government run air traffic control is noticeably less productive and more expensive. Some examples here:
https://jdasolutions.aero/blog/guest-author-robert-poole-faa...
Some more descriptions of the problems with US air traffic control:
>...Much of the system still depends on radar technology developed in the 1940s. A new system called NextGen has taken so long to develop and install that controllers are still operating a clunky patchwork that combines antiquated and updated equipment.
>...You could hardly find a more egregious example of serial mismanagement than the history of NextGen. Between 2004 and 2006 the FAA spent nearly $26 million just planning the system. Since 2010 it has spent nearly a billion dollars a year on attempting to implement it, frequently missing deadlines and, according to government watchdogs, exceeding budgets.
https://www.thedailybeast.com/lobbyists-and-congress-just-ki...
https://jdasolutions.aero/blog/guest-author-robert-poole-faa...
Some more descriptions of the problems with US air traffic control:
>...Much of the system still depends on radar technology developed in the 1940s. A new system called NextGen has taken so long to develop and install that controllers are still operating a clunky patchwork that combines antiquated and updated equipment.
>...You could hardly find a more egregious example of serial mismanagement than the history of NextGen. Between 2004 and 2006 the FAA spent nearly $26 million just planning the system. Since 2010 it has spent nearly a billion dollars a year on attempting to implement it, frequently missing deadlines and, according to government watchdogs, exceeding budgets.
https://www.thedailybeast.com/lobbyists-and-congress-just-ki...
>Between 2004 and 2006 the FAA spent nearly $26 million just planning the system
Or less than .10 USD per American. Nor does spending a billion USD a year since 2010 scream mismanagement to me given the magnitude of the public benefit if it eventually works.
By far the most important barometer of the quality of the US's air-traffic control system is how many fatal collisions there have been between aircraft being controlled by the system, and you haven't offered any data about that.
Or less than .10 USD per American. Nor does spending a billion USD a year since 2010 scream mismanagement to me given the magnitude of the public benefit if it eventually works.
By far the most important barometer of the quality of the US's air-traffic control system is how many fatal collisions there have been between aircraft being controlled by the system, and you haven't offered any data about that.
I agree that safety is paramount here. This is why other countries like Canada have implemented newer technology like GPS flight tracking and digital messaging between pilots and controllers. Improvements like this makes flights safer. In the US, they try to mitigate the dangers of the aging air traffic control system by spacing the planes out further. As the American Airline CEO has said:
>“Today to fly from DFW to Philadelphia is about 30 minutes longer than it was in 1979,” Parker said, “simply because we have an [air traffic control] system that hasn’t kept pace with the rest of the world.”
https://www.dallasnews.com/business/american-airlines/2017/0...
This wired article also has some more background on the US air traffic control system:
https://www.wired.com/2015/02/air-traffic-control/
The US is the last major country to still have government act as the regulator and provider of air traffic control. This is an inherent conflict of interest for the regulator that other countries avoid. By having political control of air traffic control, it also means air traffic control is routinely held hostage to government shutdowns and budget impasses which can also impact safety. For example:
https://www.theatlantic.com/ideas/archive/2019/01/how-shutdo...
Doing a google search on air traffic safety brought up this paper which examined the air traffic control systems of the US and Australia, Germany, New Zealand, and Switzerland:
>…An analysis was made to determine the effect privatization had on operating cost and air MIC safety involving the privatized ATC systems of Australia, Germany, New Zealand, and Switzerland. The study showed reduced operating cost and increased safety would result from corporate structuring of the ATC system. It was concluded that corporate style policy regarding personnel management and equipment procurement procedures would increase efficiency, which would reduce operating cost and increase ATC flight safety.
https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&co...
Considering that every other major country has separated the regulation and provision of air traffic control, those who are opposed to it should cite some evidence why the US should be different in this regard.
>“Today to fly from DFW to Philadelphia is about 30 minutes longer than it was in 1979,” Parker said, “simply because we have an [air traffic control] system that hasn’t kept pace with the rest of the world.”
https://www.dallasnews.com/business/american-airlines/2017/0...
This wired article also has some more background on the US air traffic control system:
https://www.wired.com/2015/02/air-traffic-control/
The US is the last major country to still have government act as the regulator and provider of air traffic control. This is an inherent conflict of interest for the regulator that other countries avoid. By having political control of air traffic control, it also means air traffic control is routinely held hostage to government shutdowns and budget impasses which can also impact safety. For example:
https://www.theatlantic.com/ideas/archive/2019/01/how-shutdo...
Doing a google search on air traffic safety brought up this paper which examined the air traffic control systems of the US and Australia, Germany, New Zealand, and Switzerland:
>…An analysis was made to determine the effect privatization had on operating cost and air MIC safety involving the privatized ATC systems of Australia, Germany, New Zealand, and Switzerland. The study showed reduced operating cost and increased safety would result from corporate structuring of the ATC system. It was concluded that corporate style policy regarding personnel management and equipment procurement procedures would increase efficiency, which would reduce operating cost and increase ATC flight safety.
https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&co...
Considering that every other major country has separated the regulation and provision of air traffic control, those who are opposed to it should cite some evidence why the US should be different in this regard.
I hope you’ll forgive me for being skeptical of arguments for ATC privatization from the founder of Reason.
It goes without saying that you should be skeptical of any argument someone makes, but discounting something solely based on the messenger seems like a logical fallacy.
In the article written by Poole, the data he quotes is from:
>...The data source is CANSO’s Global Air Navigation Services Report 2017: The ANSP View. This online document provides the raw data, explains the methodology to construct each key performance indicator (KPI), and notes that all cost numbers have been converted to U.S. dollars, for apples vs. apples comparison. Reviewing the data from all 32 participants in the 2017 report, it is clear that there is some degree of economies of scale, but since costs such as payroll are so much lower in developing countries, metrics involving costs are best compared among ANSPs in countries at the same level of economic development.
Is the data source bad? Was the data inaccurate?
The other article which goes into more detail is not associated with Bob Poole.
In the article written by Poole, the data he quotes is from:
>...The data source is CANSO’s Global Air Navigation Services Report 2017: The ANSP View. This online document provides the raw data, explains the methodology to construct each key performance indicator (KPI), and notes that all cost numbers have been converted to U.S. dollars, for apples vs. apples comparison. Reviewing the data from all 32 participants in the 2017 report, it is clear that there is some degree of economies of scale, but since costs such as payroll are so much lower in developing countries, metrics involving costs are best compared among ANSPs in countries at the same level of economic development.
Is the data source bad? Was the data inaccurate?
The other article which goes into more detail is not associated with Bob Poole.
Logical fallacies deal in absolutes. "This is false because the person making the claim is..." is a logical fallacy. "I'm skeptical and don't find this to be convincing because the person making the claim is..." is not.
We all have to apply heuristics to the information we take in, because there's far too much to be rigorously logical to it all. And my heuristic here is that libertarians in general and Reason in particular are not typically purveyors of good arguments, and this is very clearly an ideologically motivated argument, not a dispassionate analysis. Ideologically motivated arguments can be correct, but they're much less likely to be.
I'm sure the data is just fine. Interpreting it is tricky. The US and Canada are such vastly different countries. For example, Canada has a huge number of flights passing over it without stopping there (lots of flights between the US and Europe and Asia pass over Canada) and ATC for flights in cruise is vastly easier than ATC for flights descending to land or climbing to cruise. Does this actually make a significant difference? I have no idea. But the fact that this isn't even mentioned in the article, nor are any other potential explanations for the difference other than the supposed inherent superiority of privatization, makes it suspect.
At any rate, privatized ATC is still under strict government regulation and control, so they really just show us another effective model for socialized health care, rather than serving as an argument against it.
If there's a country where ATC is run by many different competing businesses with wide latitude in how they operate, and that country's ATC is better, then that would be another matter. I doubt there are any.
We all have to apply heuristics to the information we take in, because there's far too much to be rigorously logical to it all. And my heuristic here is that libertarians in general and Reason in particular are not typically purveyors of good arguments, and this is very clearly an ideologically motivated argument, not a dispassionate analysis. Ideologically motivated arguments can be correct, but they're much less likely to be.
I'm sure the data is just fine. Interpreting it is tricky. The US and Canada are such vastly different countries. For example, Canada has a huge number of flights passing over it without stopping there (lots of flights between the US and Europe and Asia pass over Canada) and ATC for flights in cruise is vastly easier than ATC for flights descending to land or climbing to cruise. Does this actually make a significant difference? I have no idea. But the fact that this isn't even mentioned in the article, nor are any other potential explanations for the difference other than the supposed inherent superiority of privatization, makes it suspect.
At any rate, privatized ATC is still under strict government regulation and control, so they really just show us another effective model for socialized health care, rather than serving as an argument against it.
If there's a country where ATC is run by many different competing businesses with wide latitude in how they operate, and that country's ATC is better, then that would be another matter. I doubt there are any.
Disagree. You preemptively publicly say that you "are skeptical" because of something irrelevant to the argument and don't address anything I brought up - that is kind of the definition of poisoning the well.
>...To commit a preemptive ad hominem attack against an opponent. That is, to prime the audience with adverse information about the opponent from the start, in an attempt to make your claim more acceptable or discount the credibility of your opponent’s claim.
https://www.logicallyfallacious.com/tools/lp/Bo/LogicalFalla...
>...For example, Canada has a huge number of flights passing over it without stopping there (lots of flights between the US and Europe and Asia pass over Canada) and ATC for flights in cruise is vastly easier than ATC for flights descending to land or climbing to cruise.
This is odd speculation on your part. Doing a google search on air traffic safety brought up this paper which examined the air traffic control systems of the US and Australia, Germany, New Zealand, and Switzerland:
>…An analysis was made to determine the effect privatization had on operating cost and air MIC safety involving the privatized ATC systems of Australia, Germany, New Zealand, and Switzerland. The study showed reduced operating cost and increased safety would result from corporate structuring of the ATC system. It was concluded that corporate style policy regarding personnel management and equipment procurement procedures would increase efficiency, which would reduce operating cost and increase ATC flight safety.
https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&co...
>...At any rate, privatized ATC is still under strict government regulation and control, so they really just show us another effective model for socialized health care, rather than serving as an argument against it.
Most people don't associate the idea of "socialized health care" with the regulatory bodies that exist like the FDA. Most people would not say we have "socialized nuclear power" just because the NRC regulates nuclear power plants, etc.
>...If there's a country where ATC is run by many different competing businesses with wide latitude in how they operate, and that country's ATC is better, then that would be another matter. I doubt there are any.
Straw man. I didn't claim there was. What I said was "Air traffic control is not a great example to cite here. The USA is one of the few countries where the regulator also provides the ATC service." and I cited 2 articles showing how it is less efficient and behind other countries. Your claim was that it was "superb".
Considering that every other major country has separated the regulation and provision of air traffic control, if you want to claim the current ATC system is "superb", you should provide some evidence why you think that.
>...To commit a preemptive ad hominem attack against an opponent. That is, to prime the audience with adverse information about the opponent from the start, in an attempt to make your claim more acceptable or discount the credibility of your opponent’s claim.
https://www.logicallyfallacious.com/tools/lp/Bo/LogicalFalla...
>...For example, Canada has a huge number of flights passing over it without stopping there (lots of flights between the US and Europe and Asia pass over Canada) and ATC for flights in cruise is vastly easier than ATC for flights descending to land or climbing to cruise.
This is odd speculation on your part. Doing a google search on air traffic safety brought up this paper which examined the air traffic control systems of the US and Australia, Germany, New Zealand, and Switzerland:
>…An analysis was made to determine the effect privatization had on operating cost and air MIC safety involving the privatized ATC systems of Australia, Germany, New Zealand, and Switzerland. The study showed reduced operating cost and increased safety would result from corporate structuring of the ATC system. It was concluded that corporate style policy regarding personnel management and equipment procurement procedures would increase efficiency, which would reduce operating cost and increase ATC flight safety.
https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&co...
>...At any rate, privatized ATC is still under strict government regulation and control, so they really just show us another effective model for socialized health care, rather than serving as an argument against it.
Most people don't associate the idea of "socialized health care" with the regulatory bodies that exist like the FDA. Most people would not say we have "socialized nuclear power" just because the NRC regulates nuclear power plants, etc.
>...If there's a country where ATC is run by many different competing businesses with wide latitude in how they operate, and that country's ATC is better, then that would be another matter. I doubt there are any.
Straw man. I didn't claim there was. What I said was "Air traffic control is not a great example to cite here. The USA is one of the few countries where the regulator also provides the ATC service." and I cited 2 articles showing how it is less efficient and behind other countries. Your claim was that it was "superb".
Considering that every other major country has separated the regulation and provision of air traffic control, if you want to claim the current ATC system is "superb", you should provide some evidence why you think that.
I thought the evidence was pretty clear: the safety record of American ATC is nearly perfect and delays caused by ATC are nearly nonexistent.
As far as "socialized health care," there are many different models for it. The oft-discussed "medicare for all" plan would be a system where regulated private entities provide health care and the government pays for it. Another common model involves public and private insurance and private providers, regulated to provide for universal service (essentially the ACA, but less crappy). If "socialized health care" means the government directly runs it all, then that excludes most countries commonly considered to have it, including Canada, Australia, and most of Europe. I realize that the comment I originally replied to specifically discussed government owned health care from top to bottom, but I'm expanding the discussion to include more real-world models. I think one of the big problems with this discussion in the US is our complete unwillingness to look at what other countries do and how they work, and there are a variety of different examples to consider there.
As far as "socialized health care," there are many different models for it. The oft-discussed "medicare for all" plan would be a system where regulated private entities provide health care and the government pays for it. Another common model involves public and private insurance and private providers, regulated to provide for universal service (essentially the ACA, but less crappy). If "socialized health care" means the government directly runs it all, then that excludes most countries commonly considered to have it, including Canada, Australia, and most of Europe. I realize that the comment I originally replied to specifically discussed government owned health care from top to bottom, but I'm expanding the discussion to include more real-world models. I think one of the big problems with this discussion in the US is our complete unwillingness to look at what other countries do and how they work, and there are a variety of different examples to consider there.
>I thought the evidence was pretty clear: the safety record of American ATC is nearly perfect and delays caused by ATC are nearly nonexistent.
As I noted elsewhere, other countries like Canada have implemented technology like GPS flight tracking and digital messaging between pilots and controllers which makes flights safer. In the US, they try to mitigate the dangers of the aging air traffic control system by spacing the planes out further. You might not notice the inefficiencies being put into the system, but as the American Airline CEO has said:
>“Today to fly from DFW to Philadelphia is about 30 minutes longer than it was in 1979,” Parker said, “simply because we have an [air traffic control] system that hasn’t kept pace with the rest of the world.”
https://www.dallasnews.com/business/american-airlines/2017/0...
At a minimum these kinds of inefficiencies result in more pollution and higher ticket prices.
By having political control of air traffic control, it also means air traffic control is routinely held hostage to government shutdowns and budget impasses which can also impact safety. For example:
https://www.theatlantic.com/ideas/archive/2019/01/how-shutdo...
This article talks about how LaGuardia was shut down due to the government shutdown:
https://www.zdnet.com/article/how-the-air-traffic-control-sy...
These sorts of things don't make air travel more safe - they make it less safe.
Having the regulator regulate themselves is an inherent conflict of interest. For example, this paper done by the NTSB a long time ago addresses the issue of the lack of study of ATC failures:
>…However, current accident and incident reporting systems were not designed with ATC errors in mind, making the analysis of latent factors, such as supervisory and organizational issues, extremely difficult. What is needed is a new error-analysis framework that will facilitate the gathering of information during ATC related accident and incident investigations ...
https://www.faa.gov/about/initiatives/maintenance_hf/library...
later we see:
>…In April 2007, the NTSB made four further recommendations, three measures to avoid fatigue affecting the performance of air traffic controllers
These recommendations were prompted by analyzing _4_ previous accidents.
https://en.wikipedia.org/wiki/Comair_Flight_5191
Yet this quora discussion implies that fatigue and the unwillingness to report mistakes are still a problem at the agency:
https://www.quora.com/What-is-the-penalty-to-air-traffic-con...
Does anyone actually think having the regulator regulate themselves is a good long term approach?
In terms of your comments health care reform, you make some good points, but your argument deserves a HN discussion all its own. In this one, I am simply trying to show that the current ATC system in the US is not an example of "a superb" government program and I would say it should be reformed to be more like every other major country.
The US government is alone among major countries of being the regulator and provider of air traffic control. In comparison to other countries we have higher costs, less efficiency and arguably less safety. The first proposal to break out the regulation of air traffic control with the provision of the air traffic control was done by the Clinton administration. Support since then has been bipartisan and opposition has also been from members of both parties for various reasons. (I read somewhere that one of the biggest long time opponents of breaking out the air traffic control has been the associations of owners of private jets as they currently pay about 1% of the cost of ATC, but are closer to 10% of the flights in major airports. In reality, owners of private jets can likely afford to pay a more proportional percentage of the costs they impose on the system.)
In the end, it i disappointing to see people immediately reject the idea without even examining the evidence. If we can't reform something this blatantly obvious, I wonder how we will ever come to a resolution on big complex issues facing the country. Those who want to keep the status quo on air traffic control should provide some evidence why having a self regulator who relies on decades old technology and is more costly than other countries is the best we can do for air traffic control.
As I noted elsewhere, other countries like Canada have implemented technology like GPS flight tracking and digital messaging between pilots and controllers which makes flights safer. In the US, they try to mitigate the dangers of the aging air traffic control system by spacing the planes out further. You might not notice the inefficiencies being put into the system, but as the American Airline CEO has said:
>“Today to fly from DFW to Philadelphia is about 30 minutes longer than it was in 1979,” Parker said, “simply because we have an [air traffic control] system that hasn’t kept pace with the rest of the world.”
https://www.dallasnews.com/business/american-airlines/2017/0...
At a minimum these kinds of inefficiencies result in more pollution and higher ticket prices.
By having political control of air traffic control, it also means air traffic control is routinely held hostage to government shutdowns and budget impasses which can also impact safety. For example:
https://www.theatlantic.com/ideas/archive/2019/01/how-shutdo...
This article talks about how LaGuardia was shut down due to the government shutdown:
https://www.zdnet.com/article/how-the-air-traffic-control-sy...
These sorts of things don't make air travel more safe - they make it less safe.
Having the regulator regulate themselves is an inherent conflict of interest. For example, this paper done by the NTSB a long time ago addresses the issue of the lack of study of ATC failures:
>…However, current accident and incident reporting systems were not designed with ATC errors in mind, making the analysis of latent factors, such as supervisory and organizational issues, extremely difficult. What is needed is a new error-analysis framework that will facilitate the gathering of information during ATC related accident and incident investigations ...
https://www.faa.gov/about/initiatives/maintenance_hf/library...
later we see:
>…In April 2007, the NTSB made four further recommendations, three measures to avoid fatigue affecting the performance of air traffic controllers
These recommendations were prompted by analyzing _4_ previous accidents.
https://en.wikipedia.org/wiki/Comair_Flight_5191
Yet this quora discussion implies that fatigue and the unwillingness to report mistakes are still a problem at the agency:
https://www.quora.com/What-is-the-penalty-to-air-traffic-con...
Does anyone actually think having the regulator regulate themselves is a good long term approach?
In terms of your comments health care reform, you make some good points, but your argument deserves a HN discussion all its own. In this one, I am simply trying to show that the current ATC system in the US is not an example of "a superb" government program and I would say it should be reformed to be more like every other major country.
The US government is alone among major countries of being the regulator and provider of air traffic control. In comparison to other countries we have higher costs, less efficiency and arguably less safety. The first proposal to break out the regulation of air traffic control with the provision of the air traffic control was done by the Clinton administration. Support since then has been bipartisan and opposition has also been from members of both parties for various reasons. (I read somewhere that one of the biggest long time opponents of breaking out the air traffic control has been the associations of owners of private jets as they currently pay about 1% of the cost of ATC, but are closer to 10% of the flights in major airports. In reality, owners of private jets can likely afford to pay a more proportional percentage of the costs they impose on the system.)
In the end, it i disappointing to see people immediately reject the idea without even examining the evidence. If we can't reform something this blatantly obvious, I wonder how we will ever come to a resolution on big complex issues facing the country. Those who want to keep the status quo on air traffic control should provide some evidence why having a self regulator who relies on decades old technology and is more costly than other countries is the best we can do for air traffic control.
> Do they usually strike you as highly competent and efficient
Far from all but,a decent number of them yes
Far from all but,a decent number of them yes
Medicare and VA, while not perfect, are both well-run and extremely popular. So yes, the US government is in fact capable of handling healthcare.
Much of the Medicare business is funded by the gov’t, but executed by private insurers (Part C and Part D).
And based on the scandal around the VA a few years ago, no it wasn’t well run at all.
And based on the scandal around the VA a few years ago, no it wasn’t well run at all.
>>And based on the scandal around the VA a few years ago, no it wasn’t well run at all.
Scandals aren't unique to government. The private sector has them all the time. In fact, sometimes private sector scandals are so massive they crash the entire economy.
Scandals aren't unique to government. The private sector has them all the time. In fact, sometimes private sector scandals are so massive they crash the entire economy.
Of course, but the VA is the largest gov’t run healthcare system in the US and the scandal impacted tens of thousands of veterans. Doesn’t exactly engender confidence.
I tell myself there are easily hundreds or thousands of Front Page NYT stories every day, but they never leak to the public.
> Are you sure that if we did what you suggest we wouldn't have a whole different set of monstrous absurdities?
Most people on Medicare are generally quite happy with it. The idiocies generally start when the government let private companies get involved (Medicare Part D).
In addition, the person who brought "socialized medicine" to Canada is regarded as as a hero.
Talking points without citation are not data.
Most people on Medicare are generally quite happy with it. The idiocies generally start when the government let private companies get involved (Medicare Part D).
In addition, the person who brought "socialized medicine" to Canada is regarded as as a hero.
Talking points without citation are not data.
At the rate we are going, whoever finally brings Medicare to everyone in the US will be regarded as a hero as well. I have what qualifies as pretty good coverage by US standards and I still won't shed a single tear when it gets replaced with single payer. In fact I look forward to having more flexibility to switch jobs or start my own business without having that consideration.
>Decent vision means less chance of falling and breaking bones, and yet new research reveals a heartbreaking state of affairs – the NHS is rationing routine operations that can restore sight, by categorising the procedure as “non-essential”. As a result of this misguided policy, hundreds of thousands of people are currently marooned at home with cataracts, their lives diminished by NHS pen-pushers callously deciding their condition isn’t life-threatening. Cataracts might not be “life-threatening” but they are most definitely “life-diminishing”. https://www.independent.co.uk/voices/scandal-nhs-eye-operati...
>Thousands more patients made to 'beg for treatment' as NHS rations hip operations, investigation finds https://www.independent.co.uk/news/health/nhs-rations-operat...
>Thousands more patients made to 'beg for treatment' as NHS rations hip operations, investigation finds https://www.independent.co.uk/news/health/nhs-rations-operat...
> A quick google suggests prisoners have to pay 10-100$ copays in some states, but otherwise receive care.
Dude I know you're going for the absurdum but if your search term was "prison health care" and you'd wish for that level of treatment - the actual level provided, not the one the law promises - then one of us needs to check our search engine or treatment expectations. A felony conviction's not going to land you in the Cleveland clinic. You'll be lucky to get antibiotics and sewn up if you survive having the shiv pulled out of your stomach.
Dude I know you're going for the absurdum but if your search term was "prison health care" and you'd wish for that level of treatment - the actual level provided, not the one the law promises - then one of us needs to check our search engine or treatment expectations. A felony conviction's not going to land you in the Cleveland clinic. You'll be lucky to get antibiotics and sewn up if you survive having the shiv pulled out of your stomach.
I promise you I am not trying to be absurd. Absurdum is flying you and your doctor 3000 miles away because the _ancillary_ cost savings make it a rational, no brainer decision.
I'm trying to look at the factors that build up this reality and see other ways to zag through it. My hypotheticals, properly evaluated, would take into consideration the expected quality of inmate care. You might notice by tone that I grabbed onto it as an idea more gingerly than enticing a doctor with waivers and cookies to cut me open in my living room.
Lawyers are the only thing that might possibly make that one not a winner in my way of grading. Prison requires a whole new calculus.
The situation is BAD. I have a vested interest in this. My consulting career was great for the people that live with me. Unfortunately, my abjectly poor father in-law needs a heart transplant, insulin, and much else.
Taking the system for granted, It's a shame I like him so much. Now I need to find a full time salaried position that's remote or in my area. My stochastic income can't be relied upon anymore, a life is on the line. I'm doing my best, but it makes me pretty angry to be in this position.
A remote position specifically would be great, then I could make sure this guy gets to spend his final years (months?) without financial stress living next to his daughter... I'll take any interview, I'm pretty good at most software engineering... React/Nodejs/C#/WPF/ASP/PHP/Python/Unity/GLSL/HSL/C++.
Fuck the U.S. healthcare system.
I'm trying to look at the factors that build up this reality and see other ways to zag through it. My hypotheticals, properly evaluated, would take into consideration the expected quality of inmate care. You might notice by tone that I grabbed onto it as an idea more gingerly than enticing a doctor with waivers and cookies to cut me open in my living room.
Lawyers are the only thing that might possibly make that one not a winner in my way of grading. Prison requires a whole new calculus.
The situation is BAD. I have a vested interest in this. My consulting career was great for the people that live with me. Unfortunately, my abjectly poor father in-law needs a heart transplant, insulin, and much else.
Taking the system for granted, It's a shame I like him so much. Now I need to find a full time salaried position that's remote or in my area. My stochastic income can't be relied upon anymore, a life is on the line. I'm doing my best, but it makes me pretty angry to be in this position.
A remote position specifically would be great, then I could make sure this guy gets to spend his final years (months?) without financial stress living next to his daughter... I'll take any interview, I'm pretty good at most software engineering... React/Nodejs/C#/WPF/ASP/PHP/Python/Unity/GLSL/HSL/C++.
Fuck the U.S. healthcare system.
I understand (really!) You have every right to be angry. If we all were angry maybe we could get traction out of the shit for brains in office that keep the system the way it is. You shouldn't have to pick a job for health benefits, those should be a given whether or not you have a job, for you, for your in law too. WTF is wrong with this country that we have to put up with this horseshit? Peace
hey, hopefully this doesn't come across as strange but you have an incredible talent for writing (or at least, writing HN comments)
best of luck and i hope things go as well as they can.
best of luck and i hope things go as well as they can.
Thank you. Last time someone commended me on my writing I was all sorts of chuffed. This time, I'm just embarrassed. I'm ashamed I can't carry the weight of my dying family.
It's probable that I'm angry at a system as a proxy for anger I would otherwise direct myself. I should be able to handle this.
It's probable that I'm angry at a system as a proxy for anger I would otherwise direct myself. I should be able to handle this.
>the shiv pulled out of your stomach.
And where did you get your knowledge of prison, reality TV? The type of felony you would commit to get prison treatment isn't going to put you in a situation where that is commonplace...
And where did you get your knowledge of prison, reality TV? The type of felony you would commit to get prison treatment isn't going to put you in a situation where that is commonplace...
The information was good, the snark was unnecessary.
> Put payment for a procedure in escrow, sign all the malpractice waivers and try to attract a doctor like tinder. I'll sign all malpractice waivers if you'll just cut this cancer out of my gut. We can use my living room! It's this or death anyways so fuck it! America WOO
Nice try, buster. The medical profession is one of the most intensely regulated that exists. There is simply no opportunity to sell "best effort gallbladder removal by a student who took some years of medicine in Guatemala". You would be instantly jailed for a very long time.
Even if, overall, the availability of such a service would save much more lifes than the current situation. Americans painted themselves into a corner: they asked the state to guarantee the quality of medical services while allowing providers to run for profit. What you get is an out of control lobby spiral that optimizes for more regulation that makes it even harder to compete, pushing competitors out of the market and the prices and profits of the incumbents soaring.
Nice try, buster. The medical profession is one of the most intensely regulated that exists. There is simply no opportunity to sell "best effort gallbladder removal by a student who took some years of medicine in Guatemala". You would be instantly jailed for a very long time.
Even if, overall, the availability of such a service would save much more lifes than the current situation. Americans painted themselves into a corner: they asked the state to guarantee the quality of medical services while allowing providers to run for profit. What you get is an out of control lobby spiral that optimizes for more regulation that makes it even harder to compete, pushing competitors out of the market and the prices and profits of the incumbents soaring.
> For anything ~ 200k+ that isn't literally holding your baby hostage from imminent death, it's probably cheaper to get a degree in chemistry and some lab equipment.
Or find a chemist who was tempted by Breaking Bad but found the ethical problems and risk profile unsatisfactory, who would jump at the chance for a little profitable humanitarian patent infringement.
Which leads to an interesting HN startup idea (or at least a Cory Doctorow novel): SciHub, but for drugs…
Or find a chemist who was tempted by Breaking Bad but found the ethical problems and risk profile unsatisfactory, who would jump at the chance for a little profitable humanitarian patent infringement.
Which leads to an interesting HN startup idea (or at least a Cory Doctorow novel): SciHub, but for drugs…
Not if.
It's a question of how contrieved the scenario would need to be.
It's a question of how contrieved the scenario would need to be.
America is the only country where a TV show about a chemistry teacher who started selling meth to afford cancer treatment makes sense.
It’s worth noting that Walter White could have had cancer treatment under his insurance, he just wasn’t happy with the quality of it. (This was an important plot point — all along the road it was demonstrated that Walter
did have other options, but due to his pride and greed he didn’t take them.)
In countries with fully socialised medicine, if you’re not happy with the level of care provided you don’t even have the option of paying for better care.
In countries with fully socialised medicine, if you’re not happy with the level of care provided you don’t even have the option of paying for better care.
That is simply false.
In most countries with socialised healthcare, you can buy extra private health insurance that allows you to be transferred to a private hospital, for example, to receive better care if that is what you wish.
In this type of scenario, the government would still pay what it deems is the price of the service, then your health insurance will pay some % on top of that and the rest of will be from your own pocket.
Finally, even if you can somewhat argue for some potential benefits of private health insurance, in Australia I can buy the very best health insurance for me and my wife for the price of $AUD125 per week with no deductible and very small waiting periods.
In the USA I would probably have to pay triple that amount and have a 10k deductible on top of that.
Finally, not having to think twice before to go to the doctor is amazing.
My wife has a lot of health issues and even though I would love one day to emigrate to the USA for potential career opportunities, I know that not having a proper healthcare system is a deal-breaker because I want my family to be treated properly when they are sick no matter what kind of income we have.
In most countries with socialised healthcare, you can buy extra private health insurance that allows you to be transferred to a private hospital, for example, to receive better care if that is what you wish.
In this type of scenario, the government would still pay what it deems is the price of the service, then your health insurance will pay some % on top of that and the rest of will be from your own pocket.
Finally, even if you can somewhat argue for some potential benefits of private health insurance, in Australia I can buy the very best health insurance for me and my wife for the price of $AUD125 per week with no deductible and very small waiting periods.
In the USA I would probably have to pay triple that amount and have a 10k deductible on top of that.
Finally, not having to think twice before to go to the doctor is amazing.
My wife has a lot of health issues and even though I would love one day to emigrate to the USA for potential career opportunities, I know that not having a proper healthcare system is a deal-breaker because I want my family to be treated properly when they are sick no matter what kind of income we have.
Sadly at least one of the major parties in Australia seems to want to emulate the US healthcare system here:
https://www.theguardian.com/business/grogonomics/2019/jul/27...
https://www.theguardian.com/business/grogonomics/2019/jul/27...
> America is the only country where a TV show about a chemistry teacher who started selling meth to afford cancer treatment makes sense.
He didn't sell meth to afford cancer treatment, he sold meth to preserve his ego and avoid taking money from his ex and his former business partner, to whom she was married, who had become wealthy from the business that he had thrown a fit and demanded to be bought out from years before.
He didn't sell meth to afford cancer treatment, he sold meth to preserve his ego and avoid taking money from his ex and his former business partner, to whom she was married, who had become wealthy from the business that he had thrown a fit and demanded to be bought out from years before.
However in other counties you can be denied care completely for experimental or even low percentage treatment. That little boy in the UK that had an Italian hospital willing to treat him was denied the right to leave the UK. Freedom has its upsides too.
Why are people so surprised? This is a great story and everyone should do it. The US system is gridlocked regulatory capture by scammers scamming scammers. Anything to route around it is a great idea.
In Japan I had no insurance, but my shoulder bothered me so I walked in to see my doctor the next morning (no appointment, $100), he scheduled an MRI for the next day ($300), and two days later I paid extra to talk to the radiologist($75) to see the damage up close. By the time I saw the surgeon the next week, I already knew I should do physical therapy instead of surgery. In the US this would have taken many weeks and thousands of dollars.
Meanwhile, back in Seattle, a doctor said "take this paper to the emergency desk to get a scan". Bad idea, that cost me $5500 and 8 hours of imprisonment. I couldn't leave after the scan, I waited hours longer for the doctor on duty to give a diagnosis (for a scan?), and of course she billed me separately for that.
In Japan I had no insurance, but my shoulder bothered me so I walked in to see my doctor the next morning (no appointment, $100), he scheduled an MRI for the next day ($300), and two days later I paid extra to talk to the radiologist($75) to see the damage up close. By the time I saw the surgeon the next week, I already knew I should do physical therapy instead of surgery. In the US this would have taken many weeks and thousands of dollars.
Meanwhile, back in Seattle, a doctor said "take this paper to the emergency desk to get a scan". Bad idea, that cost me $5500 and 8 hours of imprisonment. I couldn't leave after the scan, I waited hours longer for the doctor on duty to give a diagnosis (for a scan?), and of course she billed me separately for that.
> In the US this would have taken many weeks and thousands of dollars.
The many weeks part is not true, the $ part is pretty much random and unknown.
Every time I've gotten injured, it has been a next day appointment, or I just walk into urgent care, and an MRI/Xray scheduled a day or two later.
The imaging clinic my doctor uses provides a complete price sheet before any services are given, saying exactly:
1. How much the overall bill is
2. How much they will be billing and reimbursed from the health insurance company
3. What the patient's total will be
> Meanwhile, back in Seattle,
I'm also in Seattle, find a better clinic! (Also ERs are overkill for 99% of things, sucks if you get injured after Urgent Care hours though...)
The many weeks part is not true, the $ part is pretty much random and unknown.
Every time I've gotten injured, it has been a next day appointment, or I just walk into urgent care, and an MRI/Xray scheduled a day or two later.
The imaging clinic my doctor uses provides a complete price sheet before any services are given, saying exactly:
1. How much the overall bill is
2. How much they will be billing and reimbursed from the health insurance company
3. What the patient's total will be
> Meanwhile, back in Seattle,
I'm also in Seattle, find a better clinic! (Also ERs are overkill for 99% of things, sucks if you get injured after Urgent Care hours though...)
It wasn't an injury. I was at Swedish for a routine checkup and the doctor handed me a piece of paper and said "take this to the emergency desk, they can get you a scan". I had no intention of being checked into the ER and no idea I was about to be imprisoned for 8 hours.
It wasn't a big deal for me to be robbed like that, but for most working people a surprise unnecessary $5500 bill would be a real problem, so it's infuriating.
It wasn't a big deal for me to be robbed like that, but for most working people a surprise unnecessary $5500 bill would be a real problem, so it's infuriating.
> imprisoned for 8 hours
You mentioned this twice, but unless you left out some major details you were never actually imprisoned. If you demand to leave it's almost always a felony to stop you.
You mentioned this twice, but unless you left out some major details you were never actually imprisoned. If you demand to leave it's almost always a felony to stop you.
They kept telling me I could not leave. If I knew how long it would take I would have called my lawyer to confirm, but it was always, “Just 20 more minutes and the doctor will be here”
It was especially frustrating because I’d been asked to show up to the morning appointment fasted, and of course there was no food in the ER, but I guess it was more important to run up the tab.
I’d prefer a Mexican hospital any day.
It was especially frustrating because I’d been asked to show up to the morning appointment fasted, and of course there was no food in the ER, but I guess it was more important to run up the tab.
I’d prefer a Mexican hospital any day.
This is a crazy story. All that’s missing is a connecting flight through Canada on the return to pickup some prescription drugs.
Probably still cheaper in Mexico.
> Mr. Stackpole said only a limited number of Americans were willing — even with a financial incentive — to travel abroad, because most perceive the care won’t be as good.
this meme that the US has the best and brightest in everything and nobody else holds a candle is both hilarious and depressing. it is now costing people their lives and creating financial ruin, but it seems that US health parasites are still pumping it.
this meme that the US has the best and brightest in everything and nobody else holds a candle is both hilarious and depressing. it is now costing people their lives and creating financial ruin, but it seems that US health parasites are still pumping it.
It's incredible that medical tourism can allow people to be treated by a Mayo & Brigham and Women's trained physician at a fraction of the cost, and that the physician actually makes more. I suppose much of the expense here is what American facilities normally charge, though I wonder if the stated prices in the article are before any negotiations between the providers and payors.
Don’t mistake “more than what the doctor would make from Medicare” as anything close to what they make normally. Medicare pays pennies on the dollar.
The US doesn’t have a free market healthcare system, it has some corrupt charade where aspirin can cost $300 and seeing a doctor in an ER for 2 minutes can cost $3,000.
This is a misleading article.
If the patient truly qualified for outpatient total knee replacement (orthopedic surgeon was out of Cancun in less than 24hrs per the article), the cost of this procedure would have been around $11,677 in the US at an ambulatory surgical center. Per the article, the cost of the procedure in Cancun was..."but at Galenia, it is only $12,000". I will definitely give credit where it is due, as the inpatient cost in Mexico would be far cheaper than in the US.
Disclaimer: I am a medical student, so please keep my biases in mind. I have no skin in the game, and I totally get that prices in the US are abhorrently high. Please read the following articles to gain a better understanding:
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.... https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144
Source: https://www.eurekalert.org/pub_releases/2019-03/hfss-nir0313...
If the patient truly qualified for outpatient total knee replacement (orthopedic surgeon was out of Cancun in less than 24hrs per the article), the cost of this procedure would have been around $11,677 in the US at an ambulatory surgical center. Per the article, the cost of the procedure in Cancun was..."but at Galenia, it is only $12,000". I will definitely give credit where it is due, as the inpatient cost in Mexico would be far cheaper than in the US.
Disclaimer: I am a medical student, so please keep my biases in mind. I have no skin in the game, and I totally get that prices in the US are abhorrently high. Please read the following articles to gain a better understanding:
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.... https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144
Source: https://www.eurekalert.org/pub_releases/2019-03/hfss-nir0313...
You’re mental if you think you can get a knee replacement for $12k in the us. People who make one trip to the Ed here, with insurance, for something simple like an infection end up with bills over $20k for little more than what ends up being an ultrasound,
A lab test and a script for antibiotics.
$15.5k at Surgery Centre Oklahoma for a total knee replacement:
https://surgerycenterok.com/
EDs don’t have competition like outpatient surgical centres do.
https://surgerycenterok.com/
EDs don’t have competition like outpatient surgical centres do.
I don't think he read my comment in full, where I specifically mentioned that it would only cost that much at an ambulatory surgical center, linked to a source, and accepted that it would definitely cost more in a hospital.
As this grows in awareness and popularity, I can see US healthcare providers lobbying to make it illegal. Which would be tough - what do you do, put heart surgeons on the no-fly list?
We have pretty good doctors down here too, why the need to fly one form the USA other than prejudice?
As the article mentions, so you can sue if something goes wrong.
My mother’s friend did medical tourism and it went horribly wrong. When she got back home, local doctors were like “i’m not dealing with that problem because I didn’t cause it”.
The continuity of care is way better if you can keep the same doc once you get home.
The continuity of care is way better if you can keep the same doc once you get home.
States could decide to take away their medical licenses. I would hope politicians would choose to fix their mess of a system rather than punish doctors but perhaps that's overly optimistic of me.
A politican will have a choice: a 50 M bribe from healthcare mafia or being the good guy for a few weeks until his name is forgotten.
Seems like a win for the patient and the insurance company and clearly worth the surgeon's while (or he wouldn't have gone). Personally I'd have no problem signing up for a "everything over $x and we send you to Mexico" plan.
I live in Mexico with my Mexican wife.
Earlier this year she had a minimally invasive heart valve replacement (instead of opening all the chest they did via a smaller cut on the side). She was walking out of the hospital 4 days after the surgery.
We paid about $6500 USD which included everything. The mechanical valve, surgery, hospitalization, etc.
Some people pay a lot less than that since the price is according to a socio economic background check the hospital makes.
Earlier this year she had a minimally invasive heart valve replacement (instead of opening all the chest they did via a smaller cut on the side). She was walking out of the hospital 4 days after the surgery.
We paid about $6500 USD which included everything. The mechanical valve, surgery, hospitalization, etc.
Some people pay a lot less than that since the price is according to a socio economic background check the hospital makes.
In the US, the valve would have cost that.
Having had a number of surgeries in my life, I do care that my surgeon is well-trained. But I care even more about the anesthesiologist.
How long until someone converts a cruise ship to a hospital ship and parks it off the coast.
The US healthcare system just gets weirder and weirder, almost everything has been tried except fixing it.
The US healthcare system just gets weirder and weirder, almost everything has been tried except fixing it.
In 2004 I was in Cancun and met a few people doing this kind of thing. It was for plastic surgery type stuff that wasn’t covered by insurances. Not nose job stuff more disfigurement or getting something unsightly fixed. 15 years later they have a hospital catering to this. It was sketchy back then and I heard of botched jobs with not so great surgeons.
Here we are 15 years later where they fly in surgeons and pay the patients.
Anyone want to build a system to connect hospitals overseas with insurance companies/patients?
Here we are 15 years later where they fly in surgeons and pay the patients.
Anyone want to build a system to connect hospitals overseas with insurance companies/patients?
In Florida they have a boat that goes out to international water, drops anchor, and lets everybody gamble for the day.[1] Perhaps we aren't too far off from Norwegian Cruise Knee Surgery and Holland America Hip Replacements.
[1] https://victorycasinocruises.com/day-cruise-central-florida/
[1] https://victorycasinocruises.com/day-cruise-central-florida/
How does one find any hope in a system like this?
Despite all the structural crazy, two self-interested parties agreed to a mutually beneficial trade. That is, capitalism finds a way.
Sometimes I'm thinking I'd love to work in USA. But reading this stories is very scary. When you have an emergency situation, you shouldn't need to find out if the doctor/hospital is on some network. One commenter on the article complains she was charged 65k.. waw.
I'm glad for the nhs.
I'm glad for the nhs.
> Dr. Parisi, who spent less than 24 hours in Cancún, was paid $2,700, or three times what he would have received from Medicare, the largest single payer of hospital costs in the United States. Private insurers often base their reimbursement rates on what Medicare pays.
This is what happens when most of the actual health care cost is going to fat administrator paychecks.
This is what happens when most of the actual health care cost is going to fat administrator paychecks.
It's 25% in the US on administration. The low end is 12% in public health systems. https://www.nytimes.com/2018/07/16/upshot/costs-health-care-...
The more likely answer is: Everyone else is paid less and everything else costs less.
The extra costs in the US will be some combination of total nonsense, marginal (you should get some compensation when errors cause you harm) and very real (e.g. Replacing HVAC filters on schedule, having someone go through lab results for the last month's infections and figure out which antibiotics to use the next time when you can't wait for results).
The more likely answer is: Everyone else is paid less and everything else costs less.
The extra costs in the US will be some combination of total nonsense, marginal (you should get some compensation when errors cause you harm) and very real (e.g. Replacing HVAC filters on schedule, having someone go through lab results for the last month's infections and figure out which antibiotics to use the next time when you can't wait for results).
> Dr. Parisi, who spent less than 24 hours in Cancún, was paid $2,700, or three times what he would have received from Medicare
This illustrates perfectly the point I (and most everyone on Europe) tries to get to Americans and often they - for some weird reason - refuse to understand: healthcare can be cheaper and better to everyone (yes, this means that universal healthcare can and is cheaper on the taxpayers in most of the EU than for American taxpayers... with ours being universal), if you just understand that the middle man you created by wanting the state out of it, is getting most of the money.
It's really so simple to understand...
This illustrates perfectly the point I (and most everyone on Europe) tries to get to Americans and often they - for some weird reason - refuse to understand: healthcare can be cheaper and better to everyone (yes, this means that universal healthcare can and is cheaper on the taxpayers in most of the EU than for American taxpayers... with ours being universal), if you just understand that the middle man you created by wanting the state out of it, is getting most of the money.
It's really so simple to understand...
I’m not sure I understand your point. The surgery was done in a private hospital and paid for by a private health insurance company. It certainly points out that care in the U.S. is too expensive, but I’m not sure how it indicates a single payer system is the best course of action. The doctor was also paid 3x the Medicare rate which sounds like a good thing to me. Am I missing something?
He literally said "healthcare can be cheaper and better", and this story definitely proves that.
Medicare for all is incredibly popular when you compare our system as a whole to others. The perception of loss, that people will suffer waiting in line or that their trusted doctor will be unavailable, has been the lynchpin in the campaign advocating for middlemen. Scare tactics are tried and true here in the U.S.
Healthcare in Europe IS NOT SIGNIFICANTLY cheaper. It is just someone else footing the bill for you.
Since it's this bad, it alludes to vast untapped potential for more cost saving measures that are both funny and embarrassing.
A quick google suggests prisoners have to pay 10-100$ copays in some states, but otherwise receive care. I wonder if there's a topology of illnesses where a financially optimal course of action to acquire treatment is to commit some petty crime and receiving treatment in prison? After lost wages, and earnings potential from your now tainted record, and all else. There might be!
Here's a business idea that might already exist, vocational-technical elementary / pre-school for trying to lead your own children into and through medschool. Doctors are so expensive you might as well make your own!
That one baby saving medicine that just got approved costs like 2 million dollars, right? For anything ~ 200k+ that isn't literally holding your baby hostage from imminent death, it's probably cheaper to get a degree in chemistry and some lab equipment.
https://www.vice.com/en_us/article/43pngb/how-to-make-your-o...
It's crazy, but only in a crazy system can things like this approach rational.
Here's another idea. What if patients could rent hospital administration as a service. Put payment for a procedure in escrow, sign all the malpractice waivers and try to attract a doctor like tinder. I'll sign all malpractice waivers if you'll just cut this cancer out of my gut. We can use my living room! It's this or death anyways so fuck it! America WOO