No One Goes There Anymore(noonegoesthereanymore.blogspot.com)
noonegoesthereanymore.blogspot.com
No One Goes There Anymore
https://noonegoesthereanymore.blogspot.com/2020/05/no-one-goes-there-anymore.html
317 comments
From this side of the Altantic, it looks like the US economy is organized so that the lower working class only earns just enough to live. No wonder they are homeless when illness, disability or bad luck strikes.
I am not implying this applies to OP.
I am not implying this applies to OP.
I worked at an international company where we frequently had employees from other countries visit the US for a while. Some even chose to relocate to the US.
These were almost all technical people, raised on the Internet, social media, and discussions in comment sections. It was fascinating to see how bad they expected America to be according to Internet comments and news articles. Many of them were shocked to realize that we do have social safety nets, disability programs, heavily subsidized or government healthcare for lower incomes, and so on.
I’ll be the first to admit that our systems require improvement and are far from perfect, but at the same time it’s not the dystopian society as portrayed on Reddit’s front page or in certain media outlets day in and day out.
I can’t speak to the OP’s situation because obviously we don’t know the particular details, but given the mention of nearly $10 million of medical treatment it’s possible they were referring to a new or experimental treatment that wasn’t yet covered by traditional healthcare options. We have a lot of cutting-edge and experimental treatments in the United States, but insurance usually refuses to cover expensive experimental treatments until the evidence is sufficient to support their use. For rare disorders, it can take an extremely long time to collect enough evidence to reach that tipping point. It should be noted that many nationalized healthcare programs won’t cover or offer these treatments for the same evidentiary reasons, so I wouldn’t assume this was a uniquely American problem without further details.
These were almost all technical people, raised on the Internet, social media, and discussions in comment sections. It was fascinating to see how bad they expected America to be according to Internet comments and news articles. Many of them were shocked to realize that we do have social safety nets, disability programs, heavily subsidized or government healthcare for lower incomes, and so on.
I’ll be the first to admit that our systems require improvement and are far from perfect, but at the same time it’s not the dystopian society as portrayed on Reddit’s front page or in certain media outlets day in and day out.
I can’t speak to the OP’s situation because obviously we don’t know the particular details, but given the mention of nearly $10 million of medical treatment it’s possible they were referring to a new or experimental treatment that wasn’t yet covered by traditional healthcare options. We have a lot of cutting-edge and experimental treatments in the United States, but insurance usually refuses to cover expensive experimental treatments until the evidence is sufficient to support their use. For rare disorders, it can take an extremely long time to collect enough evidence to reach that tipping point. It should be noted that many nationalized healthcare programs won’t cover or offer these treatments for the same evidentiary reasons, so I wouldn’t assume this was a uniquely American problem without further details.
I don't buy it, due to first-hand & second-hand experiences of friends and relatives I have in the US.
Let me give you one example: my friend(and at the time business partner)'s wife got cancer in the US. It was fairly "mundane"/common cancer that got treated and everything was alright at the end. He was working as a software developer (normal employee, not self-employed - our venture was a side project) with the aforementioned "good health insurance" well paid professional middle-class Americans get. At the end of the ordeal he was stuck with a $65k bill (presumably that's just the tip of iceberg and insurance paid more).
Years later I had a malignant tumor here in Germany. Again everything is fine at the end, but it was in many ways a worse case than my friend's wife (due to where the tumor was) & I spent several weeks in a (very nice) hospital in Berlin. I also get an MRI every 6 months to keep track of the situation. I paid a grand total of ~€500 despite being self-employed at the time (so I only had standard public insurance everyone in Germany gets). My twice-yearly MRIs are free. When I was diagnosed with the tumor they offered me an appointment for surgery for 3 days later (I ended up taking it a week later than that as I wanted to get a 2nd opinion).
Neither mine nor my friend's experiences are exceptions.
Let me give you one example: my friend(and at the time business partner)'s wife got cancer in the US. It was fairly "mundane"/common cancer that got treated and everything was alright at the end. He was working as a software developer (normal employee, not self-employed - our venture was a side project) with the aforementioned "good health insurance" well paid professional middle-class Americans get. At the end of the ordeal he was stuck with a $65k bill (presumably that's just the tip of iceberg and insurance paid more).
Years later I had a malignant tumor here in Germany. Again everything is fine at the end, but it was in many ways a worse case than my friend's wife (due to where the tumor was) & I spent several weeks in a (very nice) hospital in Berlin. I also get an MRI every 6 months to keep track of the situation. I paid a grand total of ~€500 despite being self-employed at the time (so I only had standard public insurance everyone in Germany gets). My twice-yearly MRIs are free. When I was diagnosed with the tumor they offered me an appointment for surgery for 3 days later (I ended up taking it a week later than that as I wanted to get a 2nd opinion).
Neither mine nor my friend's experiences are exceptions.
To add my own anecdote about US healthcare, I needed a hernia repair surgery in my early 20’s.
My dr referred me to a specialist, I asked if he was in network for my insurance and everything seemed good. But in what I have since come to realize is a quintessential US healthcare experience, it turns out the facility that this independent surgeon used and the anesthesiologist were not in network. Nobody bothered to tell me about this before the surgery, so I went through with it.
Later I see the bill is about $39k, and my insurance has decided they’ll pay $1174. I was freaking out, but I got a call from the billing department and they asked if I could just pay $200, which I did and they called it a day and everything was settled.
It makes just as little sense as any of the horror stories I’ve heard, but somehow worked out pretty reasonably for me. I still have no idea how this happened. Did I get incredibly lucky? Or are more of these horror stories you hear where someone “ended up with a $50k medical bill”, just on paper and those amounts rarely actually need to be paid?
My dr referred me to a specialist, I asked if he was in network for my insurance and everything seemed good. But in what I have since come to realize is a quintessential US healthcare experience, it turns out the facility that this independent surgeon used and the anesthesiologist were not in network. Nobody bothered to tell me about this before the surgery, so I went through with it.
Later I see the bill is about $39k, and my insurance has decided they’ll pay $1174. I was freaking out, but I got a call from the billing department and they asked if I could just pay $200, which I did and they called it a day and everything was settled.
It makes just as little sense as any of the horror stories I’ve heard, but somehow worked out pretty reasonably for me. I still have no idea how this happened. Did I get incredibly lucky? Or are more of these horror stories you hear where someone “ended up with a $50k medical bill”, just on paper and those amounts rarely actually need to be paid?
Two anecdotes in support of your last sentence:
I once paid cash up front for a procedure, charged at 25% of the insurance rate. This was put in writing as the total cost of the procedure. Afterwards, they billed me as if I owed 75% of the other rate, with threats of legal action accompanying invoices. I did not immediately locate in my files my copy of the initial contract. Like you, I was freaking out. Even after finding my copy, and knowing that I would prevail in court if it came to it, I worried about all the indirect ways the situation could harm me. Eventually they dropped the issue.
A friend agreed to a few procedures without knowing the price, and was then charged a bizarre, absurd amount of money (I comparison researched, after the fact). He offered to pay 50%, and they gladly, eagerly accepted. I heard the call, they sounded surprised and happy. Clearly he could have paid much less.
I once paid cash up front for a procedure, charged at 25% of the insurance rate. This was put in writing as the total cost of the procedure. Afterwards, they billed me as if I owed 75% of the other rate, with threats of legal action accompanying invoices. I did not immediately locate in my files my copy of the initial contract. Like you, I was freaking out. Even after finding my copy, and knowing that I would prevail in court if it came to it, I worried about all the indirect ways the situation could harm me. Eventually they dropped the issue.
A friend agreed to a few procedures without knowing the price, and was then charged a bizarre, absurd amount of money (I comparison researched, after the fact). He offered to pay 50%, and they gladly, eagerly accepted. I heard the call, they sounded surprised and happy. Clearly he could have paid much less.
Makes me think they can write it off their taxes as "uncollectable."
Yes, but they also had to add 50k of uncollectable revenue. So its not really doing anything for them for their taxes.
It's mostly a game played between insurance provider and medical provider. They ask for 50k--knowing it the insurance is going to low ball them.
It's mostly a game played between insurance provider and medical provider. They ask for 50k--knowing it the insurance is going to low ball them.
If they write off $39k, that counts against $39k in other income they actually get that they then don't have to pay taxes on.
My dad’s been a chronic diabetic for 25 years, and we’ve never had a large surprise medical bill.
Even among people who file for bankruptcy, most have little medical debt: https://www.forbes.com/sites/aparnamathur/2018/04/09/exposin...
> Department of Justice did a similar survey of bankruptcy filers between 2000 and 2002, which included a much larger sample of 5,203 filers, and found that 90 percent of filers had medical debts less than $5,000, and 54 percent had no medical debt.
We’re talking about 10% of 1% of people that file for bankrupt y and have more than $5,000 in medical debt.
The other thing people don’t mention is the aggressive cost controls in other countries. In the U.K., the NHS will pay $30k on average for treatment that is expected to increase life by one quality-adjusted year: https://www.kingsfund.org.uk/publications/articles/ministers.... For cancer, etc., it’s double that.
> NICE has on occasion approved treatments that cost more than £30,000 per QALY. In addition, since 2009, there has been a higher threshold of £50,000 per QALY for end-of-life care, which in practice has applied chiefly, although again not exclusively, to cancer drugs.
In the pre-Obamacare days when there were lifetime limits, you’d see stories of people blowing through a $1 million limit, and then dying a couple of years later $500,000 in debt. Tragic yes, but in the U.K. or Germany these people would have been counseled into hospice instead.
https://www.politico.eu/article/cancer-europe-america-compar...
> Speedy access to cutting-edge treatments cuts deep into America’s national purse. One study, summarized in the New York Times, determined that the U.S. averted 265,000 more deaths of colorectal cancer compared to Western Europe between 1982 and 2010. Each year of healthy life gained cost $110,000. The costs for gains in prostate and breast cancers were even more dramatic.
The incremental lives we saved in the US for these cancers came at a cost double that of what would have been approved by the U.K. NHS.
Finally, the other thing most people don’t mention is that Americans have vastly more money in their pockets due to higher incomes and lower taxes: https://images.app.goo.gl/n8Qs8eBa84yuo3by7
There is a small chance that, in the US, you’ll get cancer or have a heart attack, and fall through the cracks of health insurance, Medicaid, and Medicare. But you pay a significant price for reducing that risk.
Even among people who file for bankruptcy, most have little medical debt: https://www.forbes.com/sites/aparnamathur/2018/04/09/exposin...
> Department of Justice did a similar survey of bankruptcy filers between 2000 and 2002, which included a much larger sample of 5,203 filers, and found that 90 percent of filers had medical debts less than $5,000, and 54 percent had no medical debt.
We’re talking about 10% of 1% of people that file for bankrupt y and have more than $5,000 in medical debt.
The other thing people don’t mention is the aggressive cost controls in other countries. In the U.K., the NHS will pay $30k on average for treatment that is expected to increase life by one quality-adjusted year: https://www.kingsfund.org.uk/publications/articles/ministers.... For cancer, etc., it’s double that.
> NICE has on occasion approved treatments that cost more than £30,000 per QALY. In addition, since 2009, there has been a higher threshold of £50,000 per QALY for end-of-life care, which in practice has applied chiefly, although again not exclusively, to cancer drugs.
In the pre-Obamacare days when there were lifetime limits, you’d see stories of people blowing through a $1 million limit, and then dying a couple of years later $500,000 in debt. Tragic yes, but in the U.K. or Germany these people would have been counseled into hospice instead.
https://www.politico.eu/article/cancer-europe-america-compar...
> Speedy access to cutting-edge treatments cuts deep into America’s national purse. One study, summarized in the New York Times, determined that the U.S. averted 265,000 more deaths of colorectal cancer compared to Western Europe between 1982 and 2010. Each year of healthy life gained cost $110,000. The costs for gains in prostate and breast cancers were even more dramatic.
The incremental lives we saved in the US for these cancers came at a cost double that of what would have been approved by the U.K. NHS.
Finally, the other thing most people don’t mention is that Americans have vastly more money in their pockets due to higher incomes and lower taxes: https://images.app.goo.gl/n8Qs8eBa84yuo3by7
There is a small chance that, in the US, you’ll get cancer or have a heart attack, and fall through the cracks of health insurance, Medicaid, and Medicare. But you pay a significant price for reducing that risk.
Would statistics on medical debt be skewed by a society that has potentially grown accustomed to turning away medical aid for fear of the financial fallout?
Maybe, but are there statistics to support that? People point to things like the U.S. lagging on indicators like maternal and infant mortality, and life expectancy. But if you dig into the data, non-white Hispanics (which have a 20% uninsured rate) have similar maternal and infant mortality to whites (which have only a 5% uninsured rate). And hispanics have significantly longer life expectancy. American hispanics, despite widespread lack of insurance, live as long as people in Denmark or Sweden, who have comprehensive universal health care. Moreover, Asian Americans, which have a slightly higher uninsured rate than whites, live the longest of any people anywhere in the world. They live 2-3 years longer than people in Hong Kong or Japan. (And trust me, there is no secret health system for us Asians. We have the same shitty UHC or Cigna insurance everyone else does.)
There is a lot of rhetoric in this area, but few firm conclusions to be drawn.
There is a lot of rhetoric in this area, but few firm conclusions to be drawn.
Where are you deriving these stats for Asian Americans and do they split out south vs east Asian?
Yep.
That's because in Germany, "healthcare" is about caring for your health.
In the US "healthcare" is about keeping laborers productive. Anyone who can generate value for capital will get the care they need to remain productive. When the cost of that care exceeds the value they generate, they are not covered. Public assistance programs are really just the bare minimum that is necessary to keep the following QOL issues from popping up in view of the upper class: homeless overrunning the streets, shantytowns and slums, rioting, black markets.
That's because in Germany, "healthcare" is about caring for your health.
In the US "healthcare" is about keeping laborers productive. Anyone who can generate value for capital will get the care they need to remain productive. When the cost of that care exceeds the value they generate, they are not covered. Public assistance programs are really just the bare minimum that is necessary to keep the following QOL issues from popping up in view of the upper class: homeless overrunning the streets, shantytowns and slums, rioting, black markets.
While I don't wish for this level of utilitarianism and inequality, I do wish our system here in the US had this level of organized clarity that you are describing. I think instead much more of the problem needs to be attributed to sheer incompetence and bureaucratic inefficiency.
Recently I went to the local medical center and had got some basic checkups and diagnostics. The healthcare was fine, but the billing and medical record interactions were terrible. The negotiation about the amount I owed, which was always in the $50-150 range, was dragged out over six months and involved five different corporations (the medical center, their independent billing agency, the collections agency, my insurer, and my insurer's third party negotiation firm). It went to collections even though all parties had agreed it should be on hold pending the "investigation", which never seemed to bring any new details to light. Then finally they lowered it significantly at the end and never provided a reason why it was different.
Recently I went to the local medical center and had got some basic checkups and diagnostics. The healthcare was fine, but the billing and medical record interactions were terrible. The negotiation about the amount I owed, which was always in the $50-150 range, was dragged out over six months and involved five different corporations (the medical center, their independent billing agency, the collections agency, my insurer, and my insurer's third party negotiation firm). It went to collections even though all parties had agreed it should be on hold pending the "investigation", which never seemed to bring any new details to light. Then finally they lowered it significantly at the end and never provided a reason why it was different.
> I paid a grand total of ~€500 despite being self-employed at the time (so I only had standard public insurance everyone in Germany gets).
IMO, this is a somewhat misleading statement as Germanys public insurance (that everyone can sign up for), costs quite a lot. Normally the employer would cover 50% of the contribution, but as you mentioned being self-employed that could easily be over 800 Euros per month.
That doesn't quite tip the scale in favour for the US, but the differences between the two health care systems are more nuanced as you're making it out to be.
PS: From personal experience, I find that health care providers in North America will jump to expensive tests or hospitalization much quicker than European counter-parts. I don't know if that's common (I don't have enough data-points) but this could be another factor explaining the difference in cost.
IMO, this is a somewhat misleading statement as Germanys public insurance (that everyone can sign up for), costs quite a lot. Normally the employer would cover 50% of the contribution, but as you mentioned being self-employed that could easily be over 800 Euros per month.
That doesn't quite tip the scale in favour for the US, but the differences between the two health care systems are more nuanced as you're making it out to be.
PS: From personal experience, I find that health care providers in North America will jump to expensive tests or hospitalization much quicker than European counter-parts. I don't know if that's common (I don't have enough data-points) but this could be another factor explaining the difference in cost.
The costs for public health insurance is 14-15% of your income with a lower income bound of 1061,67€ and an upper bound of 4687,50€. Thus the minimum cost is 148€ and the maximum is 656€ (for the exact same service).
In addition you need to pay 3% Pflegeversicherung (nursing care insurance).
https://www.krankenkassen.de/gesetzliche-krankenkassen/krank...
In addition you need to pay 3% Pflegeversicherung (nursing care insurance).
https://www.krankenkassen.de/gesetzliche-krankenkassen/krank...
If you read down-thread I compare total taxation+insurance costs.
I believe that outside the absolute top couple of % of wage earners German total costs are similar to high-tax US states like California.
I believe that outside the absolute top couple of % of wage earners German total costs are similar to high-tax US states like California.
I thought everything is covered after you got your total out of pocket expense (~$6k IIRC) in the traditional PPO healthcare plan? How did your friend get hit with $65k?? Out of network doctors/hospital?
I have no idea, I didn't dig in as it seemed a touchy subject. But I have heard similar anecdotes from other Americans.
I don't buy your story either. Extraordinary claims require extraordinary proof.
Which is the extraordinary one, my friend getting handed a massive bill or me getting a small one?
It's very possible he could have haggled it down but why should you need to? Especially in a vulnerable situation like after getting out of cancer treatment.
I can guarantee you I wouldn't have had the wherewithal to fight it in his spot. I barely managed to do anything for 6 months after getting out of my own cancer treatment (and for psychological, not pyshiological reasons).
It's very possible he could have haggled it down but why should you need to? Especially in a vulnerable situation like after getting out of cancer treatment.
I can guarantee you I wouldn't have had the wherewithal to fight it in his spot. I barely managed to do anything for 6 months after getting out of my own cancer treatment (and for psychological, not pyshiological reasons).
If I had cancer in the US a $65k bill really isn’t bad. Consider in the US taxes are typically <20%. So if you make $100k a year, you pay $20k in taxes. So you have $80k, minus insurance (let’s eat $500/month) you have $74k
In Germany (if I recall) it’s closer to 50% taxes so $50k a year.
Presumably you can expect cancer once or less, but effectively you only need ~4 years of income to make up for that $65k bill in the US. Not bad at all. Obviously that differs based on income, but you can a see how (for many people in the US) the system works great
In Germany (if I recall) it’s closer to 50% taxes so $50k a year.
Presumably you can expect cancer once or less, but effectively you only need ~4 years of income to make up for that $65k bill in the US. Not bad at all. Obviously that differs based on income, but you can a see how (for many people in the US) the system works great
Germany's average tax rate (according to the OECD) for a one-earner married couple with two children is 34.3%, while the same in the US is 18.8%. Taking these, the difference for your $100k/year example would be about 15k. You'd have about 80k in the US, and about 65k in Berlin.
Now to compare cost of living - let's say you wanted to compare Berlin vs SF, for similarly ridiculous housing markets. A quick search[0] suggests that living in Berlin costs nearly half as much - Berlin's $65k is more like a San Francisco $130k.
Now the downside is that you're not actually going to get paid as much in Berlin - maybe $68k as a senior software developer, as opposed to $135k-ish in SF. Plugging these numbers into a couple of actual quick tax calculators rather than using the averages, the Berliner makes about $41k, while the worker in San Francisco makes about $87k - although these are both without going through an accountant to massage the numbers. After our magic divider, that's a difference of about $2.5k.
Perhaps the US allows an accountant to massage the numbers more than Germany, but honestly, as someone currently in Germany, that doesn't pass the smell test.
So all in all, you wind up with $2.5k a year over the Berliner with which to cover everything that Germany's system does. And this is one of the best case scenarios - a high-salary tech worker with good benefits. For everyone else in the US, their quality of life and access to effective healthcare is likely to be significantly lower.
[0] https://www.numbeo.com/cost-of-living/compare_cities.jsp?cou...
Now to compare cost of living - let's say you wanted to compare Berlin vs SF, for similarly ridiculous housing markets. A quick search[0] suggests that living in Berlin costs nearly half as much - Berlin's $65k is more like a San Francisco $130k.
Now the downside is that you're not actually going to get paid as much in Berlin - maybe $68k as a senior software developer, as opposed to $135k-ish in SF. Plugging these numbers into a couple of actual quick tax calculators rather than using the averages, the Berliner makes about $41k, while the worker in San Francisco makes about $87k - although these are both without going through an accountant to massage the numbers. After our magic divider, that's a difference of about $2.5k.
Perhaps the US allows an accountant to massage the numbers more than Germany, but honestly, as someone currently in Germany, that doesn't pass the smell test.
So all in all, you wind up with $2.5k a year over the Berliner with which to cover everything that Germany's system does. And this is one of the best case scenarios - a high-salary tech worker with good benefits. For everyone else in the US, their quality of life and access to effective healthcare is likely to be significantly lower.
[0] https://www.numbeo.com/cost-of-living/compare_cities.jsp?cou...
A high-tech worker living in SF is actually not “one of the best case scenarios.” As your calculations show, the insane cost of living blows out the somewhat higher income. In terms of actual prosperity, run the numbers for places like Iowa. Salaries are 1/2 as much in Des Moines than San Francisco, but a house costs about 1/8th as much. And 95% of people have health insurance. There is a reason people are actually flooding out of California and New York.
I wonder if the insane costs and dysfunction of coastal cities is one of the driving factors of the differences in politics between those places and the rest of the country. I live in a Trump precinct in a historically red but recently purple county about an hour from DC. Median income in my county is $90,000, and you can buy a family house in a good school district for $300,000. We might feel differently about politics if our incomes were no higher and houses cost $1.3 million and our schools were among the worst in the country. But that’s California’s self-inflicted problem.
I wonder if the insane costs and dysfunction of coastal cities is one of the driving factors of the differences in politics between those places and the rest of the country. I live in a Trump precinct in a historically red but recently purple county about an hour from DC. Median income in my county is $90,000, and you can buy a family house in a good school district for $300,000. We might feel differently about politics if our incomes were no higher and houses cost $1.3 million and our schools were among the worst in the country. But that’s California’s self-inflicted problem.
And someone not living in Berlin can live significantly cheaper too - do you want to pick a city similar to Des Moines in Germany?
EDIT: I took your number of 1/2 as truth, went through the numbers, and... our worker in Des Moines makes about 5k a year more than the one in Berlin. It'd still take 12 years to pay off the person above's unexpected medical expenses.
Then, after running the numbers for a high-tech worker, do you want to run the numbers for your janitor?
The definition of "health insurance" in the US is weird - it doesn't actually seem to mean you're going to be able to be able to access either expected or unexpected healthcare needs at a price you can afford.
EDIT: I took your number of 1/2 as truth, went through the numbers, and... our worker in Des Moines makes about 5k a year more than the one in Berlin. It'd still take 12 years to pay off the person above's unexpected medical expenses.
Then, after running the numbers for a high-tech worker, do you want to run the numbers for your janitor?
The definition of "health insurance" in the US is weird - it doesn't actually seem to mean you're going to be able to be able to access either expected or unexpected healthcare needs at a price you can afford.
> I took your number of 1/2 as truth, went through the numbers, and... our worker in Des Moines makes about 5k a year more than the one in Berlin. It'd still take 12 years to pay off the person above's unexpected medical expenses.
That's probably quite accurate. But most people don't have a $60,000 unexpected health expenditure before they're eligible for Medicare at 65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865642/
> We calculated this estimate as follows: the graph shows that, on average, a hospitalization increases the annual probability of going bankrupt in the following 4 years by 0.004. Multiplying this figure by the annual hospitalization rate of 7.8% for our population (which we calculated using the 1999–2010 Medical Expenditure Panel Survey) reveals that 0.031% (0.004 × 7.8%) of the population goes bankrupt each year as the result of a hospitalization.
If you extrapolate this out over the 40-year period covered in the study (it covers people ages 25-65) there is just a 1.2% chance that you'll go bankrupt as a result of medical debt in your working lifetime. In a country of 205 million working-age adults, that amounts to 2-3 million people. That's why you see so many news stories about it. But the odds of it actually happening to you are fairly low. Meanwhile, the higher taxes from universal healthcare are something that affect 100% of people.
If you ask people "would you rather make $5,000 more per year, or have a 1.2% chance that sometime in your working life, you'll have to declare bankruptcy due to exorbitant medical bills?" You can't say it's an irrational choice if people choose to have more money in their pocket now.
> The definition of "health insurance" in the US is weird - it doesn't actually seem to mean you're going to be able to be able to access either expected or unexpected healthcare needs at a price you can afford.
And what are you basing this on? I've got a wife and two kids. We've need to rely on our health insurance for everything from a car accident that almost resulted in a pre-term birth, to child births. The system is chaotic and confusing, but as long as you're on top of the paperwork the coverage is usually very good. According to Gallup polling, people have negative views of the healthcare system as a whole, but most rate their own coverage as good or excellent (69%) and their own healthcare service quality as good or excellent (80%): https://news.gallup.com/poll/245195/americans-rate-healthcar....
That's probably quite accurate. But most people don't have a $60,000 unexpected health expenditure before they're eligible for Medicare at 65. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865642/
> We calculated this estimate as follows: the graph shows that, on average, a hospitalization increases the annual probability of going bankrupt in the following 4 years by 0.004. Multiplying this figure by the annual hospitalization rate of 7.8% for our population (which we calculated using the 1999–2010 Medical Expenditure Panel Survey) reveals that 0.031% (0.004 × 7.8%) of the population goes bankrupt each year as the result of a hospitalization.
If you extrapolate this out over the 40-year period covered in the study (it covers people ages 25-65) there is just a 1.2% chance that you'll go bankrupt as a result of medical debt in your working lifetime. In a country of 205 million working-age adults, that amounts to 2-3 million people. That's why you see so many news stories about it. But the odds of it actually happening to you are fairly low. Meanwhile, the higher taxes from universal healthcare are something that affect 100% of people.
If you ask people "would you rather make $5,000 more per year, or have a 1.2% chance that sometime in your working life, you'll have to declare bankruptcy due to exorbitant medical bills?" You can't say it's an irrational choice if people choose to have more money in their pocket now.
> The definition of "health insurance" in the US is weird - it doesn't actually seem to mean you're going to be able to be able to access either expected or unexpected healthcare needs at a price you can afford.
And what are you basing this on? I've got a wife and two kids. We've need to rely on our health insurance for everything from a car accident that almost resulted in a pre-term birth, to child births. The system is chaotic and confusing, but as long as you're on top of the paperwork the coverage is usually very good. According to Gallup polling, people have negative views of the healthcare system as a whole, but most rate their own coverage as good or excellent (69%) and their own healthcare service quality as good or excellent (80%): https://news.gallup.com/poll/245195/americans-rate-healthcar....
> And what are you basing this on?
Talking to working-class friends in the US about their access to healthcare. They feel concerned about the price of going to their doctor about things that our doctors urge us to talk to them about. Routine, expected medical treatment often takes years of saving up, and I've had friends die before they managed to get that treatment. When people wind up with an illness requiring ongoing treatment, any additional money they might make quickly goes down the drain.
They also feel scared about losing their job, and therefore their access to healthcare, if they ever become ill enough to have to call off sick, thus compounding the problem.
Yes, it's rational when you're well-off to want to keep your money. But I'd very much prefer to make sure the people around me have real access to healthcare than that I can maybe buy a slightly nicer house.
Talking to working-class friends in the US about their access to healthcare. They feel concerned about the price of going to their doctor about things that our doctors urge us to talk to them about. Routine, expected medical treatment often takes years of saving up, and I've had friends die before they managed to get that treatment. When people wind up with an illness requiring ongoing treatment, any additional money they might make quickly goes down the drain.
They also feel scared about losing their job, and therefore their access to healthcare, if they ever become ill enough to have to call off sick, thus compounding the problem.
Yes, it's rational when you're well-off to want to keep your money. But I'd very much prefer to make sure the people around me have real access to healthcare than that I can maybe buy a slightly nicer house.
I'm sure that as you say it works out for most people on a purely rational game-theory economic sense but I would definitely chose 100% coverage over an extra $5k/year.
The whole system (not just health care) seems so stressful and antagonistic in the US.
If I had an extra $5k/year I'd probably just spend it on meaningless consumption like a bigger TV or a better car, where as not having to give a second thought about costs for medical care or higher education for my kids gives me so much more peace of mind.
Also keep in mind that not everybody has their proverbial shit together. You have to be resilient and make a lot of right life choices or you can fall into a pretty deep hole. The "paternalistic" approach of welfare states like in central & northern Europe means that as long as you basically "follow the rules" (like not breaking the law & having/keeping just about any job/career, even working-class ones) you're going to have a decent life, at least materially.
The whole system (not just health care) seems so stressful and antagonistic in the US.
If I had an extra $5k/year I'd probably just spend it on meaningless consumption like a bigger TV or a better car, where as not having to give a second thought about costs for medical care or higher education for my kids gives me so much more peace of mind.
Also keep in mind that not everybody has their proverbial shit together. You have to be resilient and make a lot of right life choices or you can fall into a pretty deep hole. The "paternalistic" approach of welfare states like in central & northern Europe means that as long as you basically "follow the rules" (like not breaking the law & having/keeping just about any job/career, even working-class ones) you're going to have a decent life, at least materially.
> If I had an extra $5k/year I'd probably just spend it on meaningless consumption like a bigger TV or a better car, where as not having to give a second thought about costs for medical care or higher education for my kids gives me so much more peace of mind.
We do. The median house in the US is twice as big as in Germany or France. We have 50% more cars per person than Germany and almost twice as many as France. Even excluding healthcare (to exclude the effect of inflated healthcare costs in the US), per person household consumption spending is 50% higher in the US than France, based on OECD data.
We do. The median house in the US is twice as big as in Germany or France. We have 50% more cars per person than Germany and almost twice as many as France. Even excluding healthcare (to exclude the effect of inflated healthcare costs in the US), per person household consumption spending is 50% higher in the US than France, based on OECD data.
I'm not sure if this means you agree with me or disagree?
America is a staggeringly wealthy country and yet you spend all that wealth on trinkets while saying you can't afford universal healthcare, free education, fewer working hours, more vacation days, paid parental leave & other social benefits almost every other developed country provides their citizens.
America is a staggeringly wealthy country and yet you spend all that wealth on trinkets while saying you can't afford universal healthcare, free education, fewer working hours, more vacation days, paid parental leave & other social benefits almost every other developed country provides their citizens.
We get comparable treatment as Germany in Australia and pay comparable tax to America. I don't buy that this is a luxury of high tax paying countries. Something is systemically wrong in the US.
Yes. The problem is we simply pay much more for treatment and medicine in the US because it cost more.
It’s actually an issue where I can see the landscape changing rapidly, and fully expect major changes in the next 5 or so years.
It’s actually an issue where I can see the landscape changing rapidly, and fully expect major changes in the next 5 or so years.
Total income-related taxes+health insurance in California are IIRC similar or higher than Germany. Also in either case the taxes on $100k/year are way less than 50%.
EDIT from what I can tell from very quick googling total taxes on $100k in California would be ~29% (not including health insurance) where as in Germany they would be ~34% (on $100k = ~€92k, including health insurance).
So I guess whatever's better in that example depends on if you think German health insurance is worth 5% of your income. Your $500/m amount to 6% of income so similar to Germany either way.
Keep in mind this is for single & childless, and Germany has outrageously generous tax breaks for having children as well as being married when one spouse earns a lot less than the other.
EDIT from what I can tell from very quick googling total taxes on $100k in California would be ~29% (not including health insurance) where as in Germany they would be ~34% (on $100k = ~€92k, including health insurance).
So I guess whatever's better in that example depends on if you think German health insurance is worth 5% of your income. Your $500/m amount to 6% of income so similar to Germany either way.
Keep in mind this is for single & childless, and Germany has outrageously generous tax breaks for having children as well as being married when one spouse earns a lot less than the other.
My number for Germany comes from https://www.brutto-netto-rechner.info/gehalt/gross_net_calcu... & includes Solidaritätszuschlag & health insurance.
But it depends on state and stuff like church taxes (optional, you can declare being atheist & pay none) plus other things like marital status, tax classes, which public health insurance you choose, etc.
And the end of the day you pay similar taxes on income in Germany as you do in a high-tax US states like California.
But it depends on state and stuff like church taxes (optional, you can declare being atheist & pay none) plus other things like marital status, tax classes, which public health insurance you choose, etc.
And the end of the day you pay similar taxes on income in Germany as you do in a high-tax US states like California.
I get different numbers from here: http://www.parmentier.de/steuer/steuer.htm?wagetax.htm
On 92,000 Euro I get 45% total. In California it’s 30%. Moreover, if you’re making $100,000, you’re almost certainly getting health insurance as part of the salary in California, so you don’t need to add the cost of health insurance on top of that.
On 92,000 Euro I get 45% total. In California it’s 30%. Moreover, if you’re making $100,000, you’re almost certainly getting health insurance as part of the salary in California, so you don’t need to add the cost of health insurance on top of that.
Ah, I think I see the difference - for singles (class I) it gives you 43%, I mistakenly chose the married category (class III, in my mind that was the "default" tax class - probably cause that's how I have always filed in Germany), in which case the rate is 33%.
After taxes, health care and Solidaritätszuschlag, your taxrate for 100k ist closer to 42% in Germany
Not sure what you put in to get that number (keep in mind that $100k is roughly €92k) but there are many possible variables that can change your tax rate. In my personal case it is significantly lower than the number I posted above.
I used mostly default values in the first online calculators I found for both California & Germany in the example in my original post.
I used mostly default values in the first online calculators I found for both California & Germany in the example in my original post.
Just from personal experience: 42% is pretty much on the dot. It might be that with 92k you're still taxed in a lower class (or maybe you're married and thus getting a discount).
Yes, I chose the wrong tax class by mistake.
My personal tax rate is even lower than that as we have 2 kids & my wife and I file together (both self employed so we add up our incomes and file with all tax bracket at double the threshold). I think we ended up paying just over 15% off the top of my head but don't quote me on that (I earn less than €92k but still enough to have a very comfortable life).
I knew you pay more as a single/childless person but I didn't realize just how much more - which makes it all the more surprising that Germans have such a low rate of both marriage and reproduction.
My personal tax rate is even lower than that as we have 2 kids & my wife and I file together (both self employed so we add up our incomes and file with all tax bracket at double the threshold). I think we ended up paying just over 15% off the top of my head but don't quote me on that (I earn less than €92k but still enough to have a very comfortable life).
I knew you pay more as a single/childless person but I didn't realize just how much more - which makes it all the more surprising that Germans have such a low rate of both marriage and reproduction.
And what if you make the US median individual income of $31k?
If you make 31k, you likely don't have the good health insurance of the OP, and your final bill would be hundreds of thousands (i.e. it couldn't be afforded)
In reality you would end up on Medicaid. There would be limits to what hospitals you could go to for treatment, but you wouldn't be stuck with the bill in the end.
Basically the way the American healthcare system works, they will eventually pick up the tab. They just go out of their way to bleed you dry on the way.
Basically the way the American healthcare system works, they will eventually pick up the tab. They just go out of their way to bleed you dry on the way.
If you make $31,000 as a non-elderly single person, you’re at 250% of the FPL and there is an 89% chance you’re insured: https://www.cbpp.org/uninsured-rates-are-higher-at-lower-inc.... Under Obamacare, there really isn’t any health insurance plans that will leave you with hundreds of thousands in costs without coverage (leaving aside surprise out-of-network doctors and that’s a loophole people on both sides of the aisle are trying to fix).
About 15.75% according to https://neuvoo.com/tax-calculator/?iam=&uet_calculate=calcul...
Like the Hunger Games. For most people it works great, as long as your name isn't drawn.
I had some visitors over to the SF who were crying in despair over the poverty and suffering seen on some of the streets there. But had a good time in other parts.
Your impression really depends on where you go.
Your impression really depends on where you go.
Wouldn't touch the USA with my worst enemies barge pole.
Visiting is not the same as living it. You can't see how bad it is until you see people around you struggle or fall all the way down because they were short $20 on bills one week and no one around them had money to lend.
and living it as a well-paid white collar employee is _alot_ different than living it as everyone else
That’s true everywhere though. In 2014, the bottom 50% in France warned just 15,000 euros per year on average: https://voxeu.org/sites/default/files/image/FromMay2014/garb.... That’s only a little bit higher than the average income of the bottom 20% in the US: https://www.advisorperspectives.com/images/content_image/dat.... In terms of income, the people somewhat below the median in France are doing similarly to the very bottom in the US. But none are making enough to weather illness or disability.
In most countries, most people are reliant on the safety net in the case of illness or disability. The French safety net is much more comprehensive, but the US has safety net programs. But they’re unevenly distributed across the country. When one of my family members on the west coast was unemployed, his treatment for his heart attack was covered by Medicaid. Most of the populous states extend Medicaid to everyone below a certain income level. Indeed, about 3/4 of the uninsured in the US are eligible for some sort of insurance, and many of them are eligible for Medicaid but simply don’t sign up. Some states like Texas don’t extend Medicaid to working age adults, but they’re in the minority of states.
The gulf between the US and “the other side of the Atlantic” is much smaller than it is made to seem. Federal, state, and local governments spend almost $7 trillion a year on services. We spend 35% of GDP, compared to say 38% for the UK or 41% for Spain: https://www.economicshelp.org/wp-content/uploads/2020/01/top.... There is a bigger gap between Sweden and Spain than Spain and the US.
Moreover, people understate the structural challenges in the US that can’t be solved by money. If we just enacted universal healthcare (Medicare for All) our total government spending would jump to 50% of GDP, higher than Sweden or Norway. (And that’s not even adding in free college, etc.)
In most countries, most people are reliant on the safety net in the case of illness or disability. The French safety net is much more comprehensive, but the US has safety net programs. But they’re unevenly distributed across the country. When one of my family members on the west coast was unemployed, his treatment for his heart attack was covered by Medicaid. Most of the populous states extend Medicaid to everyone below a certain income level. Indeed, about 3/4 of the uninsured in the US are eligible for some sort of insurance, and many of them are eligible for Medicaid but simply don’t sign up. Some states like Texas don’t extend Medicaid to working age adults, but they’re in the minority of states.
The gulf between the US and “the other side of the Atlantic” is much smaller than it is made to seem. Federal, state, and local governments spend almost $7 trillion a year on services. We spend 35% of GDP, compared to say 38% for the UK or 41% for Spain: https://www.economicshelp.org/wp-content/uploads/2020/01/top.... There is a bigger gap between Sweden and Spain than Spain and the US.
Moreover, people understate the structural challenges in the US that can’t be solved by money. If we just enacted universal healthcare (Medicare for All) our total government spending would jump to 50% of GDP, higher than Sweden or Norway. (And that’s not even adding in free college, etc.)
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and our private spending on insurance would drop by a similar amount. its basically zero sum. bernie's plan in worst case scenario was a few hundred billion a year more total but the coverage was superior to almost every private plan out there.
He claims this, but it's far from certain. The argument that public healthcare will be "basically zero sum" with superior coverage is one built on flawed assumptions, with cherry-picked data, and ultimately overestimates the potential savings.
https://www.politifact.com/factchecks/2020/feb/26/bernie-san...
https://www.politifact.com/factchecks/2020/feb/26/bernie-san...
I'm indifferent to bernie's claims honestly. the point I'm making is that just switching people over to medicare/medicaid is a win for efficiency and costs because the 20% overhead of private insurers for profits + operating costs drop to 2%. savings of 18% right off the bat.
that part is absolutely a zero sum game.
now once you start adding in the rest of the plan the costs go up but that is a result of actual improvements in benefits (a good thing).
when I said worst case I was picking from studies unrelated to bernie's platform that showed an increase vs current system projects spending but it was modest. 700 billion/year in additional costs beyond what bernie has accounted for. and that is using the most expensive analysis I could find.
its probably not going to work quite that cleanly in reality. but the numbers are close enough that its worth it for our country to move to single payer with the additional benefits.
here is one of the sources I used to pull total costs from. most of the stuff I found personally ended up below their estimates. politifact's range is actually far less than the one I used by almost 20 trillion.
https://www.urban.org/urban-wire/dont-confuse-changes-federa...
--- this is a document i wrote up for my friends/family on the topic has all my sources and various other commentary.
https://docs.google.com/document/d/1-4-fYlRSRvtCar98APl6PzLL...
that part is absolutely a zero sum game.
now once you start adding in the rest of the plan the costs go up but that is a result of actual improvements in benefits (a good thing).
when I said worst case I was picking from studies unrelated to bernie's platform that showed an increase vs current system projects spending but it was modest. 700 billion/year in additional costs beyond what bernie has accounted for. and that is using the most expensive analysis I could find.
its probably not going to work quite that cleanly in reality. but the numbers are close enough that its worth it for our country to move to single payer with the additional benefits.
here is one of the sources I used to pull total costs from. most of the stuff I found personally ended up below their estimates. politifact's range is actually far less than the one I used by almost 20 trillion.
https://www.urban.org/urban-wire/dont-confuse-changes-federa...
--- this is a document i wrote up for my friends/family on the topic has all my sources and various other commentary.
https://docs.google.com/document/d/1-4-fYlRSRvtCar98APl6PzLL...
Look at their consumption habits as compared to your country too, though.
This seems disingenuous. Are you implying that the consumption habits of America's poor are a leading cause of their poverty? To me this smells of victim-blaming, especially given that their consumption habits tend to be a result of their poverty, not a cause.
The thing you need to know about US economics (and politics), is that it's always driven by some narrow special interest group. Just follow the money, and you'll find some billionaire with special interest, and their millionaire enablers.
I'm not saying that it's not like that in other countries, but the big difference between the US and many other western countries, is that core services (health, education, freedom, etc.) are unfortunately so heavily influenced by private interest, that the majority of Americans end up paying more for less - while some few end up filthy rich.
And it is quite interesting - if you ever find yourself reading about some policies getting put on the table, just follow the money.
I'm not saying that it's not like that in other countries, but the big difference between the US and many other western countries, is that core services (health, education, freedom, etc.) are unfortunately so heavily influenced by private interest, that the majority of Americans end up paying more for less - while some few end up filthy rich.
And it is quite interesting - if you ever find yourself reading about some policies getting put on the table, just follow the money.
I agree with this, but the problem is always framed as a problem of income inequality. We have an income inequality problem for sure, but at the low end of that spectrum, the problem is cost of living.
For the past 50 years, the following things have outpaced generally used inflation indicators: housing, education, health care. Basically, the inflation experienced by poor people has drastically exceeded the inflation experienced by rich people.
Incomes for our lower quantiles is often higher than countries with comparable gdp/capita. But those incomes don't translate to a comparable standard of living.
For the past 50 years, the following things have outpaced generally used inflation indicators: housing, education, health care. Basically, the inflation experienced by poor people has drastically exceeded the inflation experienced by rich people.
Incomes for our lower quantiles is often higher than countries with comparable gdp/capita. But those incomes don't translate to a comparable standard of living.
I think the actual quote is a little different, but I like this version:
I like to pay taxes. With them, I buy civilization.
https://www.goodreads.com/quotes/17105-i-like-to-pay-taxes-w...
I like to pay taxes. With them, I buy civilization.
https://www.goodreads.com/quotes/17105-i-like-to-pay-taxes-w...
As someone else with serious medical problems which have been paid for by public health systems, the financial difficulties of which are compounded by losing your ability to pay once ill, thanks! I would note though, for the purposes of fairness, it's a small percentage of your taxes that go to paying for such programs versus things like the military and interest on debt.
US government healthcare spend is huge, it is not tiny compared to military. $1.1T according to this source in fiscal year 2018:
https://www.taxpolicycenter.org/briefing-book/how-much-does-...
This website states in 2018, the federal government spent $582B on Medicare, and $389B on Medicaid, plus all the tax exemption for employer sponsored health insurance and ACA subsidies to individual buyers, etc.
https://www.thebalance.com/fy-2018-trump-federal-budget-requ...
Defense and Homeland Security was only ~$630B or so.
https://www.taxpolicycenter.org/briefing-book/how-much-does-...
This website states in 2018, the federal government spent $582B on Medicare, and $389B on Medicaid, plus all the tax exemption for employer sponsored health insurance and ACA subsidies to individual buyers, etc.
https://www.thebalance.com/fy-2018-trump-federal-budget-requ...
Defense and Homeland Security was only ~$630B or so.
That 630B ish is figure is more spin than reality. Excluding say the coast guard is reasonable if you’re talking offensive military capacity but “Defense” should reasonably include CIA, NSA, border security, and anti terrorism expenditures etc. Further, related pensions and VA benefits are clearly part of the overall defense budget.
Exact interest on past military spending is arguable, but those bills still need to be paid.
PS: US healthcare expenditures is similarly a complex topic. Do you include the heath insurance costs of government contractors etc?
Exact interest on past military spending is arguable, but those bills still need to be paid.
PS: US healthcare expenditures is similarly a complex topic. Do you include the heath insurance costs of government contractors etc?
No matter how you cut, a very large portion of taxes paid goes towards healthcare. 30% for social security, 30% minimum for healthcare. Military and interest costs therefore are clearly not the bigger portions of spending.
https://www.thebalance.com/u-s-federal-budget-breakdown-3305...
> The government expects to spend $4.829 trillion in 2021.1 Almost 60% of that pays for mandated benefits such as Social Security, Medicare, and Medicaid.
> Social Security will be the biggest expense, budgeted at $1.151 trillion. It's followed by Medicare at $722 billion and Medicaid at $448 billion.
https://www.thebalance.com/u-s-federal-budget-breakdown-3305...
> The government expects to spend $4.829 trillion in 2021.1 Almost 60% of that pays for mandated benefits such as Social Security, Medicare, and Medicaid.
> Social Security will be the biggest expense, budgeted at $1.151 trillion. It's followed by Medicare at $722 billion and Medicaid at $448 billion.
Overall I agree, but I am pointing out how numbers are framed is really important. For example this puts Defense spending at 1T and heathcare at 1.7T, while leaving out several categories of both. https://www.usgovernmentspending.com/year_spending_2020USbn_...
I am not saying any specific number is correct, but that 1T figure excludes military pensions and heath care excludes related research spending. Neither includes any debt payments from past spending or projections of future obligations. In the end it is actually possible to construct a number for each where federal defense spending is greater than federal healthcare spending, but again I don’t agree with such categorizations.
PS: This gets back to the oldest trick in “cutting“ spending, define a portion as something else. Similarly, define a category of taxes as “income taxes“ so you can exclude payroll taxes when talking about them.
I am not saying any specific number is correct, but that 1T figure excludes military pensions and heath care excludes related research spending. Neither includes any debt payments from past spending or projections of future obligations. In the end it is actually possible to construct a number for each where federal defense spending is greater than federal healthcare spending, but again I don’t agree with such categorizations.
PS: This gets back to the oldest trick in “cutting“ spending, define a portion as something else. Similarly, define a category of taxes as “income taxes“ so you can exclude payroll taxes when talking about them.
That's because of private healthcare that prevent them from properly negotiating prices. If universal healthcare was a thing these costs would be much lower.
It's not just that, the Medicare Prescription Drug, Improvement and Modernisation Act bars Medicare from negotiating drug prices.
How is that?
Nation-sized leverage. The same reason why equivalent pharmaceuticals are cheaper elsewhere in the world.
Quite. That’s why the US pays for more pharmaceutical and medical device R&D than anyone else. The US is where every pharmaceutical company makes the profits that incentivize further drug development.
Or, in the case of Valeant Pharmaceuticals they just jacked the prices up after buying smaller drug companies and getting rid of all the R&D teams ... that doesn't seem to have incentivized further drug development by them, did it?
You are speaking of a specific anecdotal experience and he is talking about the industry in aggregate. Neither of you are invalidating the other's point.
The actual facts are in support of the posters point: https://www.abpi.org.uk/facts-and-figures/science-and-innova...
But your example is a real occurrence of abuse under the US system.
The actual facts are in support of the posters point: https://www.abpi.org.uk/facts-and-figures/science-and-innova...
But your example is a real occurrence of abuse under the US system.
Nation-sized leverage? Piffle. Pass a law that Big Pharma can't price higher in the US than the lowest price negotiated elsewhere. Boom, problem solved.
From 2003 to maybe 2019 Medicare was explicitly forbidden from negotiating drug prices. Second bullet point in this https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Im...
The first world has successfully encouraged the drug makers to sell their product cheaper in the third world. If you look on wikipedia drug articles you'll see the price for the generic in the developed and developing world.
The first world has successfully encouraged the drug makers to sell their product cheaper in the third world. If you look on wikipedia drug articles you'll see the price for the generic in the developed and developing world.
That's the problem... The political conditions that preclude passage of such a law.
To add contrast, australia spends 32b on defence, 36b on education, 82b on health, 180b on social security & welfare, out of ~500b total government spend.
https://mobile.abc.net.au/news/2019-04-03/federal-budget-201...
https://mobile.abc.net.au/news/2019-04-03/federal-budget-201...
My issues have been insanely expensive to figure out. But treatment has been very cheap now that I know the issues and what pills work.
Main problem was being dismissed for 3 years and doctors not taking to each other.
I can see what people start going to alternative medicine.
One of the treatment options is a specialized diet. So all the crazy diet people are actually circling around valid treatment options.
Health care can be done cheaper. But when a doctor has 5 minutes, there is only so much that can be done.
Main problem was being dismissed for 3 years and doctors not taking to each other.
I can see what people start going to alternative medicine.
One of the treatment options is a specialized diet. So all the crazy diet people are actually circling around valid treatment options.
Health care can be done cheaper. But when a doctor has 5 minutes, there is only so much that can be done.
You're assuming they're talking about America, but you're probably not talking to Americans, because:
> if something were to happen to me or my fellow citizen, at least there wouldn't be millions of dollars in hospital bills to pay back and there would be aid for a home to avoid ending up on the streets
Not trying to be an asshole, but that's not a description of the American system.
> if something were to happen to me or my fellow citizen, at least there wouldn't be millions of dollars in hospital bills to pay back and there would be aid for a home to avoid ending up on the streets
Not trying to be an asshole, but that's not a description of the American system.
It depends on your financial situation and what state you live in. Most of the places I’ve lived, such as Minnesota or Oregon, do have systems for emergency medical assistance. They also currently have great insurance for people who truly can’t afford it. People in middle income ranges are the worst off, though.
Personally, I was just hospitalized with a bout of diabetic ketoacidosis, probably just a day away from going into a coma. I haven’t even had to see a bill. It was 100% paid by the state and federal programs.
If I hadn’t set up insurance before going to the doctor, though, I’d have received ridiculously high bills, probably been provided less service, and it would be up to me to get it paid back. I had a situation before where I went to the ER while an insurance application was pending, and then after it was approved and I provided my info, the private hospital dilly dallied and sent it to collections anyway.
Personally, I was just hospitalized with a bout of diabetic ketoacidosis, probably just a day away from going into a coma. I haven’t even had to see a bill. It was 100% paid by the state and federal programs.
If I hadn’t set up insurance before going to the doctor, though, I’d have received ridiculously high bills, probably been provided less service, and it would be up to me to get it paid back. I had a situation before where I went to the ER while an insurance application was pending, and then after it was approved and I provided my info, the private hospital dilly dallied and sent it to collections anyway.
> I would note though, for the purposes of fairness, it's a small percentage of your taxes that go to paying for such programs versus things like the military and interest on debt.
No, its not. US public healthcare spending (which in most states is the lion’s share of public welfare spending, and is also on the US is more than defense spending and is, in fact, pretty typical as a share of GDP, high as a share of taxes (because of the light US tax burden), and enormous per capita compared to other industrialized nations. Its small as a share of total national healthcare spending compared to other countries, because we have to even more private spending on top of it, and the whole healthcare system (or, rather, the literally hundreds of mutually-interfering public and private healthcare systems) is the single most inefficient healthcare delivery system in the world, but we spend plenty of money on it, just not well.
No, its not. US public healthcare spending (which in most states is the lion’s share of public welfare spending, and is also on the US is more than defense spending and is, in fact, pretty typical as a share of GDP, high as a share of taxes (because of the light US tax burden), and enormous per capita compared to other industrialized nations. Its small as a share of total national healthcare spending compared to other countries, because we have to even more private spending on top of it, and the whole healthcare system (or, rather, the literally hundreds of mutually-interfering public and private healthcare systems) is the single most inefficient healthcare delivery system in the world, but we spend plenty of money on it, just not well.
If half your paycheck is going to taxes you must have a bunch of $$$, I personally make around 300k/year and I feel like I'm not paying that much taxes. I could be paying much more and still live pretty comfortable, it's pretty outrageous.
Economists calculate taxes using the “tax wedge”—i.e. what you pay in taxes versus what you cost your employer. According to: https://smartasset.com/taxes/california-tax-calculator#WP4gh..., take home on $300,000 in California is $185,000. But including employer side payroll taxes but excluding benefits, you actually cost your employer $313,000. So your tax wedge is about 41%. Then add in the sales and property taxes you pay directly or indirectly, and you’re probably close to 45%. At $500,000, your tax wedge is 45% before sales and property taxes, so you’re probably over 50% all in.
If we are making international comparisons, I would add the cost of health insurance in california as a "tax". That's the only way to reasonably compare western countries.
I had a friend try to adopt a baby from china many years ago (1990s). He was rejected. The Chinese thought he didn't earn enough to safely raise a kid. They were using a means test designed for US applicants. My friend lobbied to explain all the things he gets in Canada for free, health care being the big ticket item. The Chinese authorities relented and he was allowed to adopt.
I had a friend try to adopt a baby from china many years ago (1990s). He was rejected. The Chinese thought he didn't earn enough to safely raise a kid. They were using a means test designed for US applicants. My friend lobbied to explain all the things he gets in Canada for free, health care being the big ticket item. The Chinese authorities relented and he was allowed to adopt.
> cost of health insurance in California as a "tax"
My company would happily hand our insurance premiums over to California in return for not having to deal with sleazy insurance dickwads.
My company would happily hand our insurance premiums over to California in return for not having to deal with sleazy insurance dickwads.
I like that analogy. But it falls apart in the catastrophic cases where having to pay your own medical bills can bankrupt you, no?
I don't follow how this could be possible. I'd think most people in the US either would be getting health insurance from the government (Medicare, Medicaid), from an "Obamacare" exchange and subsidized, or from an employer where they don't pay cash.
So where would the discrepancy in accounting between that and Canada come from? It seems unlikely that the Chinese government would assume that even Americans buy health insurance retail.
So where would the discrepancy in accounting between that and Canada come from? It seems unlikely that the Chinese government would assume that even Americans buy health insurance retail.
>> It seems unlikely that the Chinese government would assume that even Americans buy health insurance retail.
They aren't assuming anything. They know that healthcare in the US is hit-or-miss, that it is normally for people to move between having and not having healthcare throughout a lifetime.
>> The new report highlights that 5.5% of children under the age of 19 were uninsured, largely because of a decline in public coverage.
https://www.census.gov/library/stories/2019/09/uninsured-rat...
1 in 20 American kids are uninsured, not counting the undocumented who don't answer the census. That's ridiculous today but it was even worse in the 90s. That's why the Chinese didn't want to give kids to non-wealthy Americans. Uninsured children are almost unheard of in Canada. Only some illegal immigrant children, but even there they have systems in place.
They aren't assuming anything. They know that healthcare in the US is hit-or-miss, that it is normally for people to move between having and not having healthcare throughout a lifetime.
>> The new report highlights that 5.5% of children under the age of 19 were uninsured, largely because of a decline in public coverage.
https://www.census.gov/library/stories/2019/09/uninsured-rat...
1 in 20 American kids are uninsured, not counting the undocumented who don't answer the census. That's ridiculous today but it was even worse in the 90s. That's why the Chinese didn't want to give kids to non-wealthy Americans. Uninsured children are almost unheard of in Canada. Only some illegal immigrant children, but even there they have systems in place.
"They aren't assuming anything. They know that healthcare in the US is hit-or-miss, that it is normally for people to move between having and not having healthcare throughout a lifetime."
That's a general complaint that has nothing to do with insurance being a cost you pay out of your take-home salary in the US.
Your anecdote seemed to be predicated on an accounting difference between the US and Canada, that the Chinese supposedly didn't know about. I'm saying that doesn't really exist. The sort of people who adopt would have a job with insurance, but the price of the insurance would not be included in their salary.
In my lifetime, I have been uninsured, insured by my employer, on an ACA (Obamacare) plan, etc. But never been in the situation where I was making a good salary and paying full price out of it for a health insurance policy, like people do with car insurance. Nor have I ever known anyone who did. Of course, somebody probably has, somehow, but it's not common, let alone a norm that some government would assume.
That's a general complaint that has nothing to do with insurance being a cost you pay out of your take-home salary in the US.
Your anecdote seemed to be predicated on an accounting difference between the US and Canada, that the Chinese supposedly didn't know about. I'm saying that doesn't really exist. The sort of people who adopt would have a job with insurance, but the price of the insurance would not be included in their salary.
In my lifetime, I have been uninsured, insured by my employer, on an ACA (Obamacare) plan, etc. But never been in the situation where I was making a good salary and paying full price out of it for a health insurance policy, like people do with car insurance. Nor have I ever known anyone who did. Of course, somebody probably has, somehow, but it's not common, let alone a norm that some government would assume.
I never said my friend had a job. Part of the problem, in the US, is the link between employment and insurance. My friend earned reasonable money as a moderately-sucessful artist but did not have an employer. In the US that would mean paying out of pocket. In canada he didn't have to pay a dime.
Also the self-employed in the USA have to pay over the odds for rubbish schemes. Large employers can be assumed to employ mostly healthy people, but an individual is more likely to want health insurance if they already know they are a bad risk. This "moral hazard" means that selling health insurance to the self-employed is a money-losing proposition unless you screw them at every opportunity.
I’m no fan of health insurance as currently instantiated, but I don’t see it as screwing them at every opportunity if they are actuarially unprofitable otherwise.
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Depends on framing. If you divide the population by an arbitrary standard with a very high health bias (employed, in big co), and adjust payments accordingly, then those on the wrong side of your arbitrary standard get shafted.
The second group may be unprofitable with lower payments, but the insurer doesn't even want the second group, the profits are from decreased expenditures on the first group.
The second group may be unprofitable with lower payments, but the insurer doesn't even want the second group, the profits are from decreased expenditures on the first group.
Absent an individual mandate with actual teeth (or outright government providing of healthcare), do you have a solution that seems workable on a voluntary arms-length basis for all actors involved?
I’m not arguing those other conditions shouldn’t exist, but rather making the weaker, more limited argument considering “given the arrangement of the insurance market as it exists today, what should the price for that insurance offer be?” In other words, “What should a for-profit insurance company do, acting on their own and immediately?” because I think that’s pretty close to the question they’re facing when setting pricing for individual plans.
I’m not arguing those other conditions shouldn’t exist, but rather making the weaker, more limited argument considering “given the arrangement of the insurance market as it exists today, what should the price for that insurance offer be?” In other words, “What should a for-profit insurance company do, acting on their own and immediately?” because I think that’s pretty close to the question they’re facing when setting pricing for individual plans.
Ah, yes, the good old supply and demand theory of health: if you can‘t pay for your healthcare, you obviously have no need for it, because needs are only things you are willing and able to pay for.
It’s more like “if the cost to serve a broad population P is $X, I don’t think it’s screwing them to say ‘the price cannot be lower than $X’ because we are a health insurance company, not a charity.”
I think you’re arguing that perhaps health outcomes should not be funded by private for-profit insurance companies and I’d agree, but while it is, this outcome seems grounded in actuarially sound math.
I think you’re arguing that perhaps health outcomes should not be funded by private for-profit insurance companies and I’d agree, but while it is, this outcome seems grounded in actuarially sound math.
Well, if I was the Chinese government, it sure wouldn't make sense to me to let him adopt in either country regardless.
5.5% of children under the age of 19 were uninsured
>> or from an employer where they don't pay cash.
Most employers in the US subsidize healthcare, but employees still pay. You usually pay X if you are single, a bit more if you are married, and ~2.5X if you are married with children. Each company has negotiated it slightly differently and it also depends on the specific plan and the state you are in.
but that is not all.
You also pay a co-pay ($15-$50) per visit to a doctor and a co-pay for many prescription drugs. In NYC, a pregnancy with my diamond healthplan cost ~$10k
You also pay a deductible (can be $0 to $5000 or more) where you cover the first $X of the annual payments.
Finally, depending on the state you are in (some allow it, some do not) you also pay balance billing. Basically, the hospital/doctor comes up with some surprise figure of how much you owe, they subtract what insurance paid, and you owe the rest. Usually it is nothing. In the case of more complicated things like surgery, it can be thousands.
Most employers in the US subsidize healthcare, but employees still pay. You usually pay X if you are single, a bit more if you are married, and ~2.5X if you are married with children. Each company has negotiated it slightly differently and it also depends on the specific plan and the state you are in.
but that is not all.
You also pay a co-pay ($15-$50) per visit to a doctor and a co-pay for many prescription drugs. In NYC, a pregnancy with my diamond healthplan cost ~$10k
You also pay a deductible (can be $0 to $5000 or more) where you cover the first $X of the annual payments.
Finally, depending on the state you are in (some allow it, some do not) you also pay balance billing. Basically, the hospital/doctor comes up with some surprise figure of how much you owe, they subtract what insurance paid, and you owe the rest. Usually it is nothing. In the case of more complicated things like surgery, it can be thousands.
> or from an employer where they don't pay cash.
I only heard of startups doing this. Outside of that you pay x % for healthcare per paycheck the employer covers some other amount. Healthcare might not be socialized but at least I can always find a new provider if I absolutely wanted one just pay out of my own pocket is the only downside. The subsidizing happens for bigger corps usually and negotations between healthcare providers vs insurance companies. The more clients you have the more effective the negotiations.
I only heard of startups doing this. Outside of that you pay x % for healthcare per paycheck the employer covers some other amount. Healthcare might not be socialized but at least I can always find a new provider if I absolutely wanted one just pay out of my own pocket is the only downside. The subsidizing happens for bigger corps usually and negotations between healthcare providers vs insurance companies. The more clients you have the more effective the negotiations.
When Obamacare was going through I read in The Economist that about 1/3 of Americans had their health care paid for by Uncle Sam. The schemes were Medicare, Medicaid, Veterans Administration, and health schemes for government employees.
Most companies don't pay for 100% of health care coverage - and even if they do, that might only be for you, and not for your dependents. The main leverage of private company health insurance is their negotiating power, but it can still be something in the ballpark of $10k/year/person I don't know exact numbers, but definitely Not Cheap.
It doesn't make sense to me to talk about a "cost to the employer" because obviously we are a profitable enough purchase to continue employing us.
Few countries even in Europe will let your effective income tax rate reach 50% but this may be an effect of tax system structure more than anything else. Eg in the U.K. the max marginal income tax rate is 45% but that doesn’t count payroll taxes (employer or employee), which are called “national insurance”, or student loan “repayments” (9% of income above a threshold, though not super relevant to people in the top band), or oddities of the tax system like a somewhat hidden 60% marginal rate or a discontinuity with the married couples allowance or withdrawal of certain otherwise-universal benefits for children.
It is similar in other European countries (at least as far as I can tell from a cursory search showing that sources can’t really agree on what the highest marginal rate is).
I would be interested in seeing a chart of gross to net income and effective tax rate in different countries but this is hard (eg do you count employer payroll taxes? Do you count removal of state’s benefits that might not be used anyway? How do you deal with countries that have more complicated systems with eg deductions or allowances based on personal situations?)
All that said, I think the post you’re replying to could just mean “approximately half,” ands I think 40% would fit that description.
It is similar in other European countries (at least as far as I can tell from a cursory search showing that sources can’t really agree on what the highest marginal rate is).
I would be interested in seeing a chart of gross to net income and effective tax rate in different countries but this is hard (eg do you count employer payroll taxes? Do you count removal of state’s benefits that might not be used anyway? How do you deal with countries that have more complicated systems with eg deductions or allowances based on personal situations?)
All that said, I think the post you’re replying to could just mean “approximately half,” ands I think 40% would fit that description.
According to an official simulator for France [1], more than 50% of what is paid by the employer goes to taxes and "cotisations" when you earn more than €32k/year (USD $35k) after all taxes.
[1] https://mycompanyinfrance.fr/simulators/salaried
[1] https://mycompanyinfrance.fr/simulators/salaried
in the U.K. the max marginal income tax rate is 45%
That was 50 years ago. The top rate was 75% for income over £20k (something like £250k in todays money). Now how many people were in this category, or how they managed to avoid appearing to have that much income I don't know.
I think income tax was even higher during WW2, but that's pretty much a special case.
I think income tax was even higher during WW2, but that's pretty much a special case.
Also in the UK. When you take into account the council tax and national insurance (extra income tax by another name), the effective tax rate for is easily above 50% for most "high earners". And that is without considering fuel duty, VED, VAT etc.
No, you'd have to be earning an enormous amount to pay 50% tax in the UK. If you earn e.g. £150k, you get to keep £90k. Only £7000 of the money withheld is NI, so NI doesn't make that huge of a difference. Council tax isn't going to cost you £15,000 a year [1], so you're pretty clearly keeping more than 50%.
[1] If you're paying £15,000 a year in council tax, you must have some kind of gigantic property whose maintenance costs would dwarf that figure anyway.
[1] If you're paying £15,000 a year in council tax, you must have some kind of gigantic property whose maintenance costs would dwarf that figure anyway.
Gah, you're right, I accidentally added an extra zero to my council tax!
My effective rate is actually 40%, not 50%. (although this doesn't include VED, fuel duty, insurance tax, alcohol tax, tobacco tax, flight taxes, VAT or any of the myriad of little taxes here and there)
My effective rate is actually 40%, not 50%. (although this doesn't include VED, fuel duty, insurance tax, alcohol tax, tobacco tax, flight taxes, VAT or any of the myriad of little taxes here and there)
* (Edit: Leaving original for traceability, but note my math was incorrect as per subsequent comment:) *
Depends on where and depends how you're counting it.
In Ontario, Canada, and I'm not an accountant so very approximately based on GoC website:
At ~~$150k CAD you are at 29% federal + 12 % Provincial tax.
On anything you buy though you get another 13% VAT
So now we are at 54%, plus CPP and EI.
Plus any other taxes - property, land transfer, etc - overall it's well above 50% for what would be ~100k USD
Depends on where and depends how you're counting it.
In Ontario, Canada, and I'm not an accountant so very approximately based on GoC website:
At ~~$150k CAD you are at 29% federal + 12 % Provincial tax.
On anything you buy though you get another 13% VAT
So now we are at 54%, plus CPP and EI.
Plus any other taxes - property, land transfer, etc - overall it's well above 50% for what would be ~100k USD
You are confusing marginal and effective tax rate, a very common mistake. At $150k you pay only 29%+12% on each additional dollar, but your earlier dollars were taxed much less.
https://www.taxtips.ca/calculators/basic/basic-tax-calculato... is a good resource - it shows that your effective tax rate in Ontario on $150k gross is 30.3%.
You probably also contribute 18% to your RRSP on that huge salary, which drops your effective tax rate to about 27.4%.
Also, you aren't paying 13% VAT on everything you buy - lots is exempt like food and your mortgage/rent. Even if you spend every dollar of your net income, VAT is probably closer to 8% of your total net income (which is 72.6% of your gross, so 5.8% of your gross going to VAT).
CPP and EI total $3754 in 2020, so that's another 2.5% total.
So that's a total of 35.8% tax on your gross salary. Also note it's much less if you have any common deductions, like children, dependents, education expenses, etc.
https://www.taxtips.ca/calculators/basic/basic-tax-calculato... is a good resource - it shows that your effective tax rate in Ontario on $150k gross is 30.3%.
You probably also contribute 18% to your RRSP on that huge salary, which drops your effective tax rate to about 27.4%.
Also, you aren't paying 13% VAT on everything you buy - lots is exempt like food and your mortgage/rent. Even if you spend every dollar of your net income, VAT is probably closer to 8% of your total net income (which is 72.6% of your gross, so 5.8% of your gross going to VAT).
CPP and EI total $3754 in 2020, so that's another 2.5% total.
So that's a total of 35.8% tax on your gross salary. Also note it's much less if you have any common deductions, like children, dependents, education expenses, etc.
Fair point and I stand corrected :)
As an Ontarian it is frustrating how the marginal tax rate has risen over 50% over the last decade, but ignorant people think things are the same as in the US. Of course capital gains on primary residences is taxed at 0% so it isn't really surprising that real estate and its financialization is Ontario's main industry.
I'm actually with the OP - taxes as such don't offend me; I'm more concerned to get value out of them / their efficiency and purpose, rather than what they are in absolute terms. But wanted to point out that 50% is not unheard of and doesn't have to be in "millionaire" category of income.
I don’t think it’s just that it has risen over 50%, the increases over the last ~6 years are quite rapid. Consider BC [1]:
Top income tax bracket in BC in 2013: 43.7%
Top income tax bracket in BC in 2014 and 2015: 45.8%
Top income tax bracket in BC in 2016 and 2017: 47.7%
Top income tax bracket in BC in 2018 and 2019: 49.8%
Top income tax bracket in BC starting in 2020: 53.5%.
I believe that there have been similar effects in ON from increases & new brackets, on both the federal and provincial level.
[1] https://twitter.com/cperciva/status/1229900065726054400?s=21
Top income tax bracket in BC in 2013: 43.7%
Top income tax bracket in BC in 2014 and 2015: 45.8%
Top income tax bracket in BC in 2016 and 2017: 47.7%
Top income tax bracket in BC in 2018 and 2019: 49.8%
Top income tax bracket in BC starting in 2020: 53.5%.
I believe that there have been similar effects in ON from increases & new brackets, on both the federal and provincial level.
[1] https://twitter.com/cperciva/status/1229900065726054400?s=21
Don't forget the tax brackets:
2015 top bracket: "over $151,050"
2019 top bracket: "over $205,842"
So anyone anywhere near that bracket, despite the increased percentages, is probably paying less tax overall.
2015 top bracket: "over $151,050"
2019 top bracket: "over $205,842"
So anyone anywhere near that bracket, despite the increased percentages, is probably paying less tax overall.
How would they be paying less overall? They just added new brackets.
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The rapidity is similar in Ontario. I think that's why the public still thinks that the top rates are around the 2013 values and say we need to raise the top rates higher.
Wouldn’t operating real estate as a financial market all involve secondary or fund-owned residences, and therefore be subject to capital gains tax?
Well, if half your payments is going to taxes it might very mean you have a bunch of €€€ instead of $$$, that bunch being calculated relative to median income of your country - what I'm saying is that while I don't know what country you're from tax rates are also calculated differently in different countries, in Denmark where I live it isn't impossible for a software developer to hit the top tax rate.
I generally assume that 40% of my paycheck will go to taxes and savings. That’s not quite correct, but it’s a good first order of magnitude estimate.
and savings?
That includes anything that’s pre-paycheck, which would include 401k and HSA in my case, but would exclude post-tax savings (I was imprecise in my original comment).
Again, this is a rough rule that’ll typically be personally conservative, not a precise calculation.
Again, this is a rough rule that’ll typically be personally conservative, not a precise calculation.
ciupicri(4)
It's good and important to have a proper function healthcare system. However, we shouldn't fall into the false dichotomy fallacy. We don't have to pay 50% of our pay checks in taxes in order to provide good healthcare for all. It's just that some greedy people at the top will have to give up some of what they're making now.
The fact that you are making that much money is without doubt also something you have to thank society for. Would you be able to make the same amount of money in every other country, and without the sacrifices made by other people over the course of history? This is also something to keep in mind.
"making that much money" is not a beneficial end unto itself, and is really only valuable in a particular socioeconomic context. You can't eat money.
I live in a country with plenty of socialized services, and when I see stories like this it seems to me like it's everyone for themselves in the USA. Seems kinda bleak.
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Should have specified what country. In US, that pay check is more likely going to help the military complex build more weapons than hospitals provide for the needy.
In US, poor people are seen as worker bees who just get enough to live and have an illusion of freedom.
In US, poor people are seen as worker bees who just get enough to live and have an illusion of freedom.
Or perhaps you could just donate that much money to a non-profit that takes care of people in unfortunate circumstances like this
Doreen - have always loved reading your comments on hacker news over the years. Very insightful and unique voice. Good luck on the new blog, will definitely subscribe.
Only other person I regularly follow here, in addition to you, is graycat:
https://news.ycombinator.com/threads?id=graycat
Only other person I regularly follow here, in addition to you, is graycat:
https://news.ycombinator.com/threads?id=graycat
Genuine question: what is the point made in the post? I feel like I'm missing something.
I was wondering this as well. I couldn't find the thesis and for a moment I wondered if this was posted as an example of an AI-generated post.
I read the whole thing and can’t figure it out either. Maybe there isn’t supposed to be a point. Just stream-of-consciousness words on a blog. Performance art?
When the first thing someone tells me upon meeting me is that they have a medical condition, I think “uh oh, heeeere we go.” First of all, it’s none of my business. Second, why do you want me to know this? What am I supposed to do with that information? Is this what we are going to be talking about? And if not, why the need to share this fact? Such a confusing way to start out a conversation or blog.
It’s like saying, “First of all, I really like pancakes. Now here’s my post about programming in Python.”
When the first thing someone tells me upon meeting me is that they have a medical condition, I think “uh oh, heeeere we go.” First of all, it’s none of my business. Second, why do you want me to know this? What am I supposed to do with that information? Is this what we are going to be talking about? And if not, why the need to share this fact? Such a confusing way to start out a conversation or blog.
It’s like saying, “First of all, I really like pancakes. Now here’s my post about programming in Python.”
Unfortunately, for people who suffer from a chronic illness, they have to deal with people like you. You might propose something that seems simple and normal to you, like, let's go here for lunch. They have to explain they can't because they have a very real medical condition, then they have to put up with people not believing them, thinking they're blowing it out of proportion, or just not wanting to make accommodations for them. It can be very degrading and isolating to live like this.
One way to minimize the amount of BS like that that you put up with is by just stating up front, "I have this condition." If the other person listens and responds positively, then you can probably find common ground. If instead they think, "Uh oh, heeeeere we go," you know to dismiss them.
One way to minimize the amount of BS like that that you put up with is by just stating up front, "I have this condition." If the other person listens and responds positively, then you can probably find common ground. If instead they think, "Uh oh, heeeeere we go," you know to dismiss them.
Ok, but since it's a very real medical condition, why not lead with "I have Atypical Cystic Fibrosis, so I can't do X", instead of being all mysterious about it?
You can't really blame humans for being curious when you stoke but deliberately choose not to satisfy their curiosity.
I mean, HN specifically wants you to post "anything that gratifies one's intellectual curiosity". I don't know about others, but my intellectual curiosity certainly isn't gratified when someone leads with "I have a condition" but then gets all squirrelly about what it is.
If you tell people what your condition is and they don't take it seriously, that's their problem. If you don't tell what it is, it might be "a mild fear of puppets" for all I know. Unfortunately there are people that make up medical conditions for themselves, so you can't really expect everyone to just automatically accept "I have this condition" as an excuse for any behavior. For example, I've taught a number of students that made up conditions for themselves right at the moment their homework was due.
You can't really blame humans for being curious when you stoke but deliberately choose not to satisfy their curiosity.
I mean, HN specifically wants you to post "anything that gratifies one's intellectual curiosity". I don't know about others, but my intellectual curiosity certainly isn't gratified when someone leads with "I have a condition" but then gets all squirrelly about what it is.
If you tell people what your condition is and they don't take it seriously, that's their problem. If you don't tell what it is, it might be "a mild fear of puppets" for all I know. Unfortunately there are people that make up medical conditions for themselves, so you can't really expect everyone to just automatically accept "I have this condition" as an excuse for any behavior. For example, I've taught a number of students that made up conditions for themselves right at the moment their homework was due.
Often when you have a medical condition that is not well understood by most people you cannot do x, y or z. It might be exhausting to explain your limitations which may change day to day depending on how you're doing at that particular moment on that particular day. People may not believe you, and it feels awful to have to be around someone who won't take you seriously or gets angry with you if you try their supposed "cure" and it doesn't work. An ex-boyfriend of mine suggested a micro dose of acid would treat my migraines. I tried it and it made my symptoms worse. He got terribly angry with me for not trying hard enough because I didn't want to do acid for the fourth day in a row.
If I tell people I get migraines pretty much all of the time they think I get bad headaches, not that I can't see, lose my ability to talk, have my arm go numb and instead it feels like my jaw is stuck in a vise, I can't look at sunlight and every noise is painful. People don't want to hear about the ways someone they know is silently suffering.
If I tell people I get migraines pretty much all of the time they think I get bad headaches, not that I can't see, lose my ability to talk, have my arm go numb and instead it feels like my jaw is stuck in a vise, I can't look at sunlight and every noise is painful. People don't want to hear about the ways someone they know is silently suffering.
That's fair, but do you really think your (apparently shitty) ex-boyfriend would've behaved better if, instead of telling him you suffer from highly debilitating migraines, you always said something like "no, we're not going out for dinner tonight because I have a condition", failing to ever explain what that was?
Again, if you are open about the condition, and someone responds to that knowledge poorly, that is their problem. Ignore those people. But if you keep the nature of the condition under wraps, that might make it "easier" to deal with in the short term at the cost of others being able to move forward with you at all.
Again, if you are open about the condition, and someone responds to that knowledge poorly, that is their problem. Ignore those people. But if you keep the nature of the condition under wraps, that might make it "easier" to deal with in the short term at the cost of others being able to move forward with you at all.
In this case yes, if he didn't know I was diagnosed with migraines he would not have randomly suggested acid. He had an "evidence based" reason for thinking acid would help. I let people I'm close with know my symptoms. You can't always ignore people who you depend on.
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Was also similarly confused
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In complete sincerity, I believe, for this particular post, the medium is the message.
It's a blog. The person is starting a blog. They want people to visit it. People visit it and liked it. And upvoted this post.
“It’s too crowded”, the punchline to the Yogi Berra quote, is the point of the blog post. It is a sentiment that we can all now relate to due to COVID-19. Living with a genetic disorder that makes one susceptible to respiratory infections also reinforces the set of norms required to live with this virus in our society.
"I was social distancing before social distancing was cool, man."
Nothing improves a joke more than explaining it, like the article did. :-)
If your question is influenced by the apparent popularity of this post, in proportion to it's content, the author is a well known long time contributor to HN.
The likely future content of this blog may have more to do with the signal boosting motivation than the content of this first post.
The likely future content of this blog may have more to do with the signal boosting motivation than the content of this first post.
My guess is its one of those style over substance articles, like something by David Sedaris. Not really something we're used to on hackernews where we expect the author to argue X is bad, or we need more Y. The point is entertainment or poetry. Maybe I'm wrong and the author wants to achieve some rhetorical goal, but I think its just a blog post for the sake of it.
Do you personally find it compelling in a stylistic sense? If I was going to judge the quality of this writing, I don't think I could rate it much higher than "mediocre".
Obviously this is my own opinion, but I don't find this compelling in terms of style or substance. Honestly it comes across as more of a rant.
Obviously this is my own opinion, but I don't find this compelling in terms of style or substance. Honestly it comes across as more of a rant.
I gave up after getting about half way through and realizing it was just making the same vague references over and over without getting to any sort of point.
Victimhood is today's Heroism. We're supposed to admire and respect her for her unnamed mystery ailment, and disparage the society around her.
I agree that you describe a trend in our society, but I believe in this case you are misapplying a heuristic. You don't have enough information to declare that this is the intent in this specific case.
To get people to sign up to their patreon?
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"While homeless, my sons and I routinely tried to find out-of-the-way public tables. For purposes of germ control, we didn't want to eat in restaurants and homeless people aren't welcome in restaurants anyway. So we would get takeout and go find a table somewhere outdoors.
Much to our annoyance, this popularized some of our favorite out-of-the-way eating places."
I'm wondering what this means about how this happened. Did you write articles about these restaurants or review them online? How did getting takeout and eating at a table popularize these restaurants? Just because people saw you eating nearby?
Much to our annoyance, this popularized some of our favorite out-of-the-way eating places."
I'm wondering what this means about how this happened. Did you write articles about these restaurants or review them online? How did getting takeout and eating at a table popularize these restaurants? Just because people saw you eating nearby?
I think the "this" in the text refers to the paragraph before your excerpt, i.e. the pandemic caused a lot of regular people to eat their food outside instead of in rastaurants.
"Getting to that point, where _a global pandemic_ was kind of an annoying blip in my life, was a long strange journey. It included nearly six years of homelessness.
While homeless, my sons and I routinely tried to find out-of-the-way public tables. For purposes of germ control, we didn't want to eat in restaurants and homeless people aren't welcome in restaurants anyway. So we would get takeout and go find a table somewhere outdoors.
Much to our annoyance, _this_ popularized some of our favorite out-of-the-way eating places."
"Getting to that point, where _a global pandemic_ was kind of an annoying blip in my life, was a long strange journey. It included nearly six years of homelessness.
While homeless, my sons and I routinely tried to find out-of-the-way public tables. For purposes of germ control, we didn't want to eat in restaurants and homeless people aren't welcome in restaurants anyway. So we would get takeout and go find a table somewhere outdoors.
Much to our annoyance, _this_ popularized some of our favorite out-of-the-way eating places."
Oh, that's a good interpretation!
Slight change of topic, but relevant to the other content of the quoted passage, I share the same experience. Having had my life and livelihood significantly disrupted since ~2015, the global pandemic did more to bring other people to my level of distress than cause problems for me.
Slight change of topic, but relevant to the other content of the quoted passage, I share the same experience. Having had my life and livelihood significantly disrupted since ~2015, the global pandemic did more to bring other people to my level of distress than cause problems for me.
For those who were wondering over at https://news.ycombinator.com/item?id=23205588, this is the kind of reading we have mostly lost. Just a guy (or gal?) with a life story, I’d come back to read the follow ups in a heartbeat. They also seems to notice the wall from the other side.
Gal.
And if you want to see the follow ups, you can join my Patreon and get an invitation to my private email list where I post new stuff as it happens. And then maybe I can spend less time bitching about how poor and broke I am.
And if you want to see the follow ups, you can join my Patreon and get an invitation to my private email list where I post new stuff as it happens. And then maybe I can spend less time bitching about how poor and broke I am.
If you've got an email list going, 'might look into substack.com to monetize. (No affiliation)
Oh so there is a paywall? That sucks
There is a need to put food on a table. I just made my contribution and not to pass the paywall, Im lucky I still have a job and DoreenMichelle could use some support in these times. HackerNewsers, if there is a time to support others, this is the time! Help anyone you can. Or help Doreen like I did. Anything can help, even words of encouragement if one can’t afford to make any donnation
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Did I just get downvoted? What for?
Please don't break the site guidelines: https://news.ycombinator.com/newsguidelines.html
Corrective upvotes are a thing: https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
Corrective upvotes are a thing: https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
Yeah, sorry about that, i was flabbergasted as I didnt expect to make a good deed and get multiple thumbs down.
Voting is a statistical cloud, meaning you can't relate to it deterministically. There are all sorts of weird outliers for reasons you (i.e. any of us) can't understand or even imagine, so you have to let go of trying to explain particular data points. When all else fails I just remind myself that misclicks happen.
This is a special case of what is in fact the biggest challenge on HN. If you try to interpret individual data points, given that so little information is available, you'll end up curve-fitting the worst picture from your own imagination. It is a sort of demonic connect-the-dots game where, given a few dots, we end up recreating our own shadow: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so.... It's we who are doing it, not the data, which is what makes it so frustrating: only we know where our own buttons are, so only we can push them so reliably, over and over. But since we don't know we're doing it, it feels like the other person is doing it, or the community is doing it, and that feeling is intensely convincing! It's crazy-making.
There are lots of statistical clouds like that on HN—the opinions of commenters are another. This is why users frequently post angry theories about how awful the commenters are, but the angry theories are all contradictory. Each user is recreating their own shadow from the data points they happen to notice and dislike (https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...), and since we have different shadows, we end up with different theories.
This is a special case of what is in fact the biggest challenge on HN. If you try to interpret individual data points, given that so little information is available, you'll end up curve-fitting the worst picture from your own imagination. It is a sort of demonic connect-the-dots game where, given a few dots, we end up recreating our own shadow: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so.... It's we who are doing it, not the data, which is what makes it so frustrating: only we know where our own buttons are, so only we can push them so reliably, over and over. But since we don't know we're doing it, it feels like the other person is doing it, or the community is doing it, and that feeling is intensely convincing! It's crazy-making.
There are lots of statistical clouds like that on HN—the opinions of commenters are another. This is why users frequently post angry theories about how awful the commenters are, but the angry theories are all contradictory. Each user is recreating their own shadow from the data points they happen to notice and dislike (https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...), and since we have different shadows, we end up with different theories.
You’re absolutely right. Thanks for the time and energy in writing this response. I’ve observed your interventions over time and they are all reasonable and needed.
FWIW that down arrow is dang close to the up arrow. I have miss-clicked more than once.
That's why there's an "undown" link now that's active for a limited period after you downvote. Similarly, there's an "unvote" link.
You'd rather an ad-network, or you just expect people to share, give, and benefit you for free, or...is there another option? Kudos to the author for providing value and getting compensated.
One blog post is not enough to warrant a request for money. How do you know they are even telling the truth?
DoreenMichele is pretty well known around these parts. if she's running a hoax, it's an elaborate one.
Maybe click their profile and see 27k karma and them in the top HN user list? Don't pay if you don't know who they are or care. Just because you don't know someone doesn't mean others don't.
It was surprising to see that it might still be difficult for you to get the word out.
As far as I'm concerned, you're Doreen from Hackernews, Internet famous.
Hope that you do get the word out. Hope things improve. And sorry for the condition that makes it all that much more difficult.
Your perspective is valuable, and hope to read more from you.
As far as I'm concerned, you're Doreen from Hackernews, Internet famous.
Hope that you do get the word out. Hope things improve. And sorry for the condition that makes it all that much more difficult.
Your perspective is valuable, and hope to read more from you.
For what it's worth, I've been visiting Hacker News on a nearly daily basis, on-again and off-again for a few years now. I don't recall hearing the name before.
A little investigation led me to https://doreenmichele.blogspot.com/p/me.html
The disease appears to be ACF - Atypical Cystic Fibrosis
The disease appears to be ACF - Atypical Cystic Fibrosis
Now I'm more confused. Why do people "react weirdly" or "strongly" or think she's "some kind of drama queen" when she gives that name? I'm pretty sure my reaction would be to think "I have no idea what that is" and just move on.
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The same reason we don't go around saying we have oral herpes.
You may be atypical. Many people are uncomfortable with disease/death of others (for I suspect selfish reasons and fears).
You may be atypical. Many people are uncomfortable with disease/death of others (for I suspect selfish reasons and fears).
For answers to that question, I would refer you to this thread, although the connection might require some pondering to see.
I wonder if the rather esoteric/elusive style of Doreen's post may have been in part to invoke the very phenomenon she seems to be alluding to, by my interpretation of her intended meaning anyways. Even if not, it worked out quite well in the end.
I wonder if the rather esoteric/elusive style of Doreen's post may have been in part to invoke the very phenomenon she seems to be alluding to, by my interpretation of her intended meaning anyways. Even if not, it worked out quite well in the end.
Yep, she seems to have another blogspot for that specifically.
https://atypicalcysticfibrosis.blogspot.com/
https://atypicalcysticfibrosis.blogspot.com/
It's a bit rude to name something someone made a point of not mentioning.
Hi Doreen, Happy to see your new effort! Have you ever communicated with Johnny Sanfelippo (https://granolashotgun.com). You two have a similar voice and some overlap in perspective. I suspect you’d find his work interesting (if you haven’t already).
Cheers!
Cheers!
Does anyone know what this condition is? I may be living in a bubble but I have no idea what this is. Would love to do some more research myself to understand, and I'm glad my taxes are helping people like this out.
I have Cystic Fibrosis and the post made me feel like it’s that. Started quarantining early Feb. Any severe disease which targets respiratory is a presumed death sentence for people with CF. Fortunately it seems CF patients are surviving.
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Same here, I'm racking my brain to figure out what disease has these characteristics but I'm not coming up with anything.
This is a touchy subject but with my genetic condition I’m scared to have kids. It sucks having this and I don’t know if I would want to watch my kids suffer through it. But I’m glad my parents did cause life isn’t that bad in the end.
I didn't get a diagnosis until my kids were like 11 and 14, I think. I didn't have to think about that aspect, in part because my first child was the result of failed birth control. I was already married, so I didn't consider having an abortion.
But when I was having kids, I was still being treated like I was a hypochondriac. I sometimes refer to my diagnosis as "a better name for my condition than crazy."
But when I was having kids, I was still being treated like I was a hypochondriac. I sometimes refer to my diagnosis as "a better name for my condition than crazy."
Real Talk:
no one is trying to kill you for profit. They just don't care about you because you're can't make money for them. It's still bad, but different.
You meet a lot of skeptics because no matter how honest or correct you are, without access to a large test population and a way to precisely measure your dozens of tiny ideas that add up to a healthier overall life, it's impossible for an outside observer to distinguish you from quacks like Gwyneth Paltrow.
Also, being upfront about your suffering makes people uncomfortable and avoidant. Not your fault, but that's life.
You have a lot of disappointment with HN, largely because you see all these rich people who like talking to you but won't invest in you.
My advice: take a lesson from them. Put on a fake happy face, rewrite your narrative so that your pain is in your past, copy the obnoxious marketing techniques that smell foul but work.
You're in a "line" where everyone thinks you are bullshitting. If you can't beat it, join it. Run your effort the same way the dishonest snake oil salesmen do, and use your own conscience to tell you you are doing good. Make a little money selling whatever to health fad chasers, and put that money to good use as you see fit. Answer to no one but your conscience, but behaving in the way "polite society" demands, not because they are right, but because that's how you'll get paid attention and money.
no one is trying to kill you for profit. They just don't care about you because you're can't make money for them. It's still bad, but different.
You meet a lot of skeptics because no matter how honest or correct you are, without access to a large test population and a way to precisely measure your dozens of tiny ideas that add up to a healthier overall life, it's impossible for an outside observer to distinguish you from quacks like Gwyneth Paltrow.
Also, being upfront about your suffering makes people uncomfortable and avoidant. Not your fault, but that's life.
You have a lot of disappointment with HN, largely because you see all these rich people who like talking to you but won't invest in you.
My advice: take a lesson from them. Put on a fake happy face, rewrite your narrative so that your pain is in your past, copy the obnoxious marketing techniques that smell foul but work.
You're in a "line" where everyone thinks you are bullshitting. If you can't beat it, join it. Run your effort the same way the dishonest snake oil salesmen do, and use your own conscience to tell you you are doing good. Make a little money selling whatever to health fad chasers, and put that money to good use as you see fit. Answer to no one but your conscience, but behaving in the way "polite society" demands, not because they are right, but because that's how you'll get paid attention and money.
Health insurance companies will try to kill you for profit.
Anyway, I upvoted your comment because I feel that you're giving good, or at least useful, advice. The fact that is is good advice kinda sucks. But that's not your fault. It's just the way it is.
Anyway, I upvoted your comment because I feel that you're giving good, or at least useful, advice. The fact that is is good advice kinda sucks. But that's not your fault. It's just the way it is.
You have a lot of disappointment with HN
Much realer talk: I have been here nearly 11 years. I appear to be the only woman to have ever spent time on the leader board and it looks like I am probably on track to also be the second woman to spend time on the leader board under my new handle (this one).
I have my criticisms of what goes on here, but I spend so much time here because whatever sexism and nonsense happens here pales in comparison to the hip deep crap of most other spaces. So I'm quite fond of HN, which is a large part of why I am here so much.
Rumors of my supposedly significant disappointment with HN are somewhat exaggerated for various reasons.
Though I stand by my position that it should be easier to turn my writing into income than it has proven to be and I stand by that not solely for my benefit but because of broader implications throughout the world that this issue has which people complain loudly about on a regular basis here and seem to fail to connect the dots between those issues and their choices. The fact that I choose to use myself as an example of this phenomenon should not be misconstrued as me being hugely personally butthurt with no larger point.
I use myself as an example because then I'm not doxxing other people or making them a target or whatever. I can decide just how much heat I care to take for today and walk away when I have had enough.
I do that as a "best practice" that I have worked out over the years. That's it. It's the least worst option in situations where unpleasantness is unavoidable.
I have zero plans to sell health fad crap. That absolutely will not happen and it's one of the reasons most of my sites have no ads: because the kinds of things I talk about tend to attract ads for things I would never, ever recommend, like colloidal silver which is straight up literal poison. I may at some point in the future move to zero ads. I'm aware that most of HN uses adblockers and I understand and respect the reasons they do that.
But if you want good content and you don't want ads, somehow that has to be paid for. And the current climate adds up to "Writers are just supposed to work for free." I think that's a fundamentally broken mental model. It's not sustainable. It's in line with ideas like "If you aren't the customer, you are the product." People decry content marketing, then don't want to support indie authors.
If you want everything free and don't want to pay your authors, they will work for someone who will pay them. And that means content marketing. If that's not the internet you want, then you need to stop insisting that writing simply doesn't pay and start kicking a few bucks towards indie authors whose content you would like to see more of.
Much realer talk: I have been here nearly 11 years. I appear to be the only woman to have ever spent time on the leader board and it looks like I am probably on track to also be the second woman to spend time on the leader board under my new handle (this one).
I have my criticisms of what goes on here, but I spend so much time here because whatever sexism and nonsense happens here pales in comparison to the hip deep crap of most other spaces. So I'm quite fond of HN, which is a large part of why I am here so much.
Rumors of my supposedly significant disappointment with HN are somewhat exaggerated for various reasons.
Though I stand by my position that it should be easier to turn my writing into income than it has proven to be and I stand by that not solely for my benefit but because of broader implications throughout the world that this issue has which people complain loudly about on a regular basis here and seem to fail to connect the dots between those issues and their choices. The fact that I choose to use myself as an example of this phenomenon should not be misconstrued as me being hugely personally butthurt with no larger point.
I use myself as an example because then I'm not doxxing other people or making them a target or whatever. I can decide just how much heat I care to take for today and walk away when I have had enough.
I do that as a "best practice" that I have worked out over the years. That's it. It's the least worst option in situations where unpleasantness is unavoidable.
I have zero plans to sell health fad crap. That absolutely will not happen and it's one of the reasons most of my sites have no ads: because the kinds of things I talk about tend to attract ads for things I would never, ever recommend, like colloidal silver which is straight up literal poison. I may at some point in the future move to zero ads. I'm aware that most of HN uses adblockers and I understand and respect the reasons they do that.
But if you want good content and you don't want ads, somehow that has to be paid for. And the current climate adds up to "Writers are just supposed to work for free." I think that's a fundamentally broken mental model. It's not sustainable. It's in line with ideas like "If you aren't the customer, you are the product." People decry content marketing, then don't want to support indie authors.
If you want everything free and don't want to pay your authors, they will work for someone who will pay them. And that means content marketing. If that's not the internet you want, then you need to stop insisting that writing simply doesn't pay and start kicking a few bucks towards indie authors whose content you would like to see more of.
My two cents (as someone who also has a medical condition, albeit not as life threatening as yours, that is not taken seriously by many and who makes much of their living by writing) -
People don't necessarily believe what others say about their own medical condition. My doctors agree about mine, I have tangible measurable results, yet some people, both online and in real life, don't believe me. Getting spun up over that is not the most effective use of my time and energy and it may not be the best use of yours.
On getting paid, I do get paid enough to live on, but I have worked for hire and haven't put content in the internet and expected that it would get monetized. Maybe finding more ways to work for hire (which iirc you already do)? I don't know much about the Patreon model, but I checked a YouTuber I follow with a very large subscriber base as an example. His Patreon base is much smaller. If that is representative that might not be a good way to get a reliable income.
People don't necessarily believe what others say about their own medical condition. My doctors agree about mine, I have tangible measurable results, yet some people, both online and in real life, don't believe me. Getting spun up over that is not the most effective use of my time and energy and it may not be the best use of yours.
On getting paid, I do get paid enough to live on, but I have worked for hire and haven't put content in the internet and expected that it would get monetized. Maybe finding more ways to work for hire (which iirc you already do)? I don't know much about the Patreon model, but I checked a YouTuber I follow with a very large subscriber base as an example. His Patreon base is much smaller. If that is representative that might not be a good way to get a reliable income.
I really appreciate the integrity, and am on my way over to Patreon.
But as far as I have been able to discover, colloidal silver turns your skin permanently blue-gray long before it reaches an (otherwise) toxic level. Completely useless, of course, and makes you look like a ghoul. I read of someone who had ?tens of grams in him when he died (of old age), because there is no way to excrete it.
A grey guy was running for US President not long ago. I don't know if he had any other qualifications, but can't help thinking we might be a lot better off having elected him.
But as far as I have been able to discover, colloidal silver turns your skin permanently blue-gray long before it reaches an (otherwise) toxic level. Completely useless, of course, and makes you look like a ghoul. I read of someone who had ?tens of grams in him when he died (of old age), because there is no way to excrete it.
A grey guy was running for US President not long ago. I don't know if he had any other qualifications, but can't help thinking we might be a lot better off having elected him.
I really appreciate the integrity, and am on my way over to Patreon.
Thank you.
Thank you.
My significant other is in a similar boat. We’re convinced she has a genetic mutation that causes the way she looks. (Fortunately for her, that’s all it does so far) A doctor suspected she has it and so on. We haven’t done genetic testing yet to confirm 100% but it’s something we are considering.
Personally, I would like to have children with her that are related to us. But, it’s hard because her genetic mutation carries some heavy risks that she’s avoided so far that I’m not really on board to take.
We avoid talking about it a bit. She wants children desperately too. She isn’t keen on adoption and wants to experience pregnancy.
For anyone curious: it’s waardenburg syndrome.
Personally, I would like to have children with her that are related to us. But, it’s hard because her genetic mutation carries some heavy risks that she’s avoided so far that I’m not really on board to take.
We avoid talking about it a bit. She wants children desperately too. She isn’t keen on adoption and wants to experience pregnancy.
For anyone curious: it’s waardenburg syndrome.
Now that this has dropped off the front page: Just food for thought for you in your relationship concerning the detail that your girlfriend desperately wants children and wants to experience pregnancy (the comment is by me, under my old handle):
https://news.ycombinator.com/item?id=8155574
https://news.ycombinator.com/item?id=8155574
If I were in your position and had money to blow, I'd ask medical experts if it's possible to prevent the genetic mutation from being passed on. Can they do screening? Can they transplant a healthy chromosome to replace the broken one?
If I didn't I'd ask a healthy relative of hers to donate eggs to implant into her.
If I didn't I'd ask a healthy relative of hers to donate eggs to implant into her.
Depending on the condition it may be possible to do genetic screening with potential partners, assuming you are single right now.
And you can always adopt.
And you can always adopt.
Spent 3 years desperately trying to avoid going homeless due a chronic illness.
Turns out disability insurance is a joke.
I still work from home to hide how sick I am most days. But I can function well enough that people don’t notice to much.
Turns out disability insurance is a joke.
I still work from home to hide how sick I am most days. But I can function well enough that people don’t notice to much.
Yeah, I've recently learned how awful disability insurance is from a friend. You have wait something like 2 years before you find out if your application was accepted or rejected and apparently it's always rejected the first time. You need a lawyer to go through the process, but they'll still always reject you the first time from what I've heard. I don't know how they expect people who can't afford their meds to hire a lawyer to go through the process. It's not only absurd, it's inhumane.
It so good to read a story written by the human being.
Compare that to what you can get from a corporate drone doing a content marketing cult: clip-art, annoyingly polished illustrations, artificially smiling people.
Compare that to what you can get from a corporate drone doing a content marketing cult: clip-art, annoyingly polished illustrations, artificially smiling people.
You are an interesting person Doreen. I have subscribed to your blog!
I have to admit that this article sure has me curious what this unnamed condition is...
Me too, but I also feel it’s wrong to ask. And really it doesn’t matter, it’s better not to know as then this post is more applicable to people in the same boat across all diseases the average person doesn’t understand
Holy hell. How do you have a life-threatening disease that puts at you risk of germ infection, costs $250,000 a year to treat AND manage to survive homelessness? Tragic. I'm sorry you don't live in a country with real health care.
Holy hell why did I get flagged? She wrote a huge blog post about needing help and isn't getting it?
Holy hell why did I get flagged? She wrote a huge blog post about needing help and isn't getting it?
Since you've resumed posting flamebait, we've banned you again. Could you please not create accounts to break HN's guidelines with? You're welcome here otherwise; you've posted some quite good comments and I appreciate those, as I'm sure many readers have.
https://news.ycombinator.com/newsguidelines.html
Edit: That was probably the wrong call and I reversed it; see comments below.
https://news.ycombinator.com/newsguidelines.html
Edit: That was probably the wrong call and I reversed it; see comments below.
I must say that I don’t see the alledged “flamebait” in freefriedrice’s comment. What is it that you see that I don’t?
"I'm sorry you don't live in a country with real health care" broke this guideline: "Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents."
On second look, though, I think I mis-moderated and have unbanned the account. See https://news.ycombinator.com/item?id=23214383.
On second look, though, I think I mis-moderated and have unbanned the account. See https://news.ycombinator.com/item?id=23214383.
[deleted]
?
I was reacting more to https://news.ycombinator.com/item?id=23180680 from earlier in the day. But actually I think I overreacted here. You shouldn't have added the flamey swipe about countries and health care, but the intention of your comment was clearly to express support to someone, and I should have weighted that more. Sorry! I've unbanned your account.
I'm glad content like this occasionally bubbles up to the front page on hacker news.
For me purple and yellow is pretty hard to look at.
There is only one post on the blog and it is front page of hacker news? That is some achievement! Are there more writings from this author?
DoreenMichele is a well-known HN user and many of her posts have appeared here. She often makes a new domain per blog topic, but I presume readers recognize her username. The upvotes seem organic, as far as I can tell. There's no issue.
You've posted three dismissive comments to this thread. Could you please stop? If you don't like this reading material, there are 29 other articles on the front page, and don't miss the 'past' link at the top that points to all the most popular threads from past days.
It would be good to review the site guidelines too: https://news.ycombinator.com/newsguidelines.html
You've posted three dismissive comments to this thread. Could you please stop? If you don't like this reading material, there are 29 other articles on the front page, and don't miss the 'past' link at the top that points to all the most popular threads from past days.
It would be good to review the site guidelines too: https://news.ycombinator.com/newsguidelines.html
I did not recognise the username, but will take that into consideration for future. For me, it looked like a request for money and I felt it was not right, but I see I am mistaken and would like to apologise to Michele.
That's really nice of you, and I'm sure not only she but everyone reading this will feel a bit better for it.
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Dang, this is irrelevant to the topic but I needed to ask it. Are you an individual or several 'users/employees/maintainers' using the same username? Your omnipresent has always been intriguing to me
It is one guy. He is full-time employed by YC to maintain HN.
https://blog.ycombinator.com/meet-the-people-taking-over-hac...
https://www.newyorker.com/news/letter-from-silicon-valley/th...
https://blog.ycombinator.com/meet-the-people-taking-over-hac...
https://www.newyorker.com/news/letter-from-silicon-valley/th...
Like Doreen Traylor, Dan Gackle is a figment of your imagination. But he's very polite and well behaved, so he's a figment I enjoy being acquainted with via internet.
I was amused to learn that he's "Dan G" and not "dang!", too. I still think of him as "dang!", though.
I also really appreciate the thankless job he does here. Thanks, Dan! (Does that mean it's not thankless now... Should I edit this comment? Arrghh!)
I also really appreciate the thankless job he does here. Thanks, Dan! (Does that mean it's not thankless now... Should I edit this comment? Arrghh!)
It's both: https://news.ycombinator.com/item?id=22767296
(The inimitable DonHopkins provided the perfect gloss)
(The inimitable DonHopkins provided the perfect gloss)
I believe Dang is Daniel. There was an interesting New Yorker article about HN's moderation a while back you might enjoy: http://archive.is/QiDtu.
Just a guy: https://www.youtube.com/watch?v=jVHq4xo5wcA
To answer your question more directly: yes I'm a person, and we'd never have multiple people hide behind the same username. That corporate hologram shit makes my skin crawl. https://www.youtube.com/watch?v=GrBPFNX23mU#t=6
To answer your question more directly: yes I'm a person, and we'd never have multiple people hide behind the same username. That corporate hologram shit makes my skin crawl. https://www.youtube.com/watch?v=GrBPFNX23mU#t=6
It's almost certainly "echoing" off of a comment in the "If I could bring one thing back to the internet it would be blogs" thread from yesterday: https://news.ycombinator.com/item?id=23205588
https://news.ycombinator.com/item?id=23206784
I saw the "No One Goes There Anymore" post last night while trawling through the "new posts" page, read it, realized it was from DoreenMichele, and, having read and resonated with the aforementioned comment, upvoted it just to make DM feel better.
YMMV
https://news.ycombinator.com/item?id=23206784
I saw the "No One Goes There Anymore" post last night while trawling through the "new posts" page, read it, realized it was from DoreenMichele, and, having read and resonated with the aforementioned comment, upvoted it just to make DM feel better.
YMMV
> While homeless, my sons and I routinely tried to find out-of-the-way public tables.
Food at restaurants is marked up thousands of percent to cover costs of buildings, rent, power, human capital. The raw materials to make your food are pennies and are available to the average consumer. This is straight BS. There -are- people that truly have issues that lead them to a homeless condition, but this person is not one of them.
Food at restaurants is marked up thousands of percent to cover costs of buildings, rent, power, human capital. The raw materials to make your food are pennies and are available to the average consumer. This is straight BS. There -are- people that truly have issues that lead them to a homeless condition, but this person is not one of them.
>> While homeless, my sons and I routinely tried to find out-of-the-way public tables.
> Food at restaurants is marked up thousands of percent to cover costs of buildings, rent, power, human capital. The raw materials to make your food are pennies and are available to the average consumer.
If you're homeless that's not an option, since you probably lack equipment to cook from scratch.
> Food at restaurants is marked up thousands of percent to cover costs of buildings, rent, power, human capital. The raw materials to make your food are pennies and are available to the average consumer.
If you're homeless that's not an option, since you probably lack equipment to cook from scratch.
What about cold cuts, sliced cheese, a loaf of whole grain bread?
This sounds like a cool backpacking story that I've also done for a few weeks / a month.
Now try only ever eating shit food like that for months, years on end, and you're not on holiday wandering around a cool city, it's your life.
Now try only ever eating shit food like that for months, years on end, and you're not on holiday wandering around a cool city, it's your life.
and where, exactly, are you going to keep "cold cuts" and sliced cheese from spoiling, when you're HOMELESS?
Split between 3 people, those 3 items can comprise an entire meal, thus no leftovers.
They can last days safely. I regularly packed freshies when backpacking.
This is "straight BS".
Typical COGS on food at a dine in restaurant is 30-40%. It certainly isn't marked up "thousands of percent".
Typical COGS on food at a dine in restaurant is 30-40%. It certainly isn't marked up "thousands of percent".
>There -are- people that truly have issues that lead them to a homeless condition, but this person is not one of them
Interesting that you determined all that from reading a single blog post and have no ideal what her diagnosis is. Very classy.
Interesting that you determined all that from reading a single blog post and have no ideal what her diagnosis is. Very classy.
Constantly eating out would cost me as much or maybe more than my rent. So I can relate to the feeling of this coming off as a rant of a crazy person with self-image issues.
Try to imagine the calibre of restaurant that would even serve homeless people. We're talking about the very, very low end.
So, in no way is it comparable to your hypothetical of eating out all the time costing as much as your rent.
So, in no way is it comparable to your hypothetical of eating out all the time costing as much as your rent.
I don't understand people who have serious hereditary medical conditions and have children. Yes, I know that "I just don't get it". Though I do have friends for whom serious illness in the family is the reason they don't have biological children.
I do find it a bit selfish to reject adopting a child (and thus presumably making that child's life better), instead of essentially saying "no, I only care about my own genes. If it's not from my body it's worthless".
I said I know people who chose to not have biological children for this reason. I also know people whose life is full of pain and suffering because they chose to reproduce their illness. One wanted multiple children, but after the first came with the illness they now know that caring for just that one (who will never not need help) is their full time job, so they can't have more.
And this in a country that actually greatly supports you. And it's not about the money.
I do find it a bit selfish to reject adopting a child (and thus presumably making that child's life better), instead of essentially saying "no, I only care about my own genes. If it's not from my body it's worthless".
I said I know people who chose to not have biological children for this reason. I also know people whose life is full of pain and suffering because they chose to reproduce their illness. One wanted multiple children, but after the first came with the illness they now know that caring for just that one (who will never not need help) is their full time job, so they can't have more.
And this in a country that actually greatly supports you. And it's not about the money.
I'll quote Doreen from elsewhere in this thread:
> I didn't get a diagnosis until my kids were like 11 and 14, I think. I didn't have to think about that aspect, in part because my first child was the result of failed birth control.
> I didn't get a diagnosis until my kids were like 11 and 14, I think. I didn't have to think about that aspect, in part because my first child was the result of failed birth control.
Ah, yeah that adds information (not in the article) to this case. But note that I have downvotes on my comment. I'm not surprised. I think I'm being respectful here, but people take as a personal attack when the choice to have biological children is in any way questioned.
So this woman did not have that information available to her at the time. Like I said I know people that did.
So this woman did not have that information available to her at the time. Like I said I know people that did.
Your first comment isn't exactly the most diplomatic framing, but I'm sorry you are getting a pile on about this.
This site of mine (below) has already been outed by someone in comments, so let me link you to a page that gives a little more detail about that aspect of my life:
https://atypicalcysticfibrosis.blogspot.com/p/atypical-cf-de...
This site of mine (below) has already been outed by someone in comments, so let me link you to a page that gives a little more detail about that aspect of my life:
https://atypicalcysticfibrosis.blogspot.com/p/atypical-cf-de...
Thanks for the link.
I think this quote from it enlightens me a lot in your case: "Cystic Fibrosis is a homozygous recessive genetic disorder. That means it requires a defective gene from both parents to cause the child to have the disorder".
That tells me that with the "The disease occurs in 1 in 2,500 to 3,500 white newborns" I got from Google, those are not significantly dangerous odds, even if you'd chosen to optimize them even more by not avoiding white men during the relevant years.
(but I may be miscalculating, since you said "defective gene", not "diagnosis" (which is presumably the number from google), and it's not important to my point)
With this extra information I don't put you in the group of people I don't understand with this. (of course not that you'd need my approval or understanding, like that other guy seemed to think I was saying)
But say (from a real example) someone has a grandmother, mother, and sister, with varying degrees of paranoid schizophrenic diagnoses (e.g. ranging from "being a jerk in that particular way" to "institutionalized and forced medication"), I do think that this person, even though apparently asymptomatic, would not be responsible, and would be selfish, if they'd choose to have biological children.
I think this quote from it enlightens me a lot in your case: "Cystic Fibrosis is a homozygous recessive genetic disorder. That means it requires a defective gene from both parents to cause the child to have the disorder".
That tells me that with the "The disease occurs in 1 in 2,500 to 3,500 white newborns" I got from Google, those are not significantly dangerous odds, even if you'd chosen to optimize them even more by not avoiding white men during the relevant years.
(but I may be miscalculating, since you said "defective gene", not "diagnosis" (which is presumably the number from google), and it's not important to my point)
With this extra information I don't put you in the group of people I don't understand with this. (of course not that you'd need my approval or understanding, like that other guy seemed to think I was saying)
But say (from a real example) someone has a grandmother, mother, and sister, with varying degrees of paranoid schizophrenic diagnoses (e.g. ranging from "being a jerk in that particular way" to "institutionalized and forced medication"), I do think that this person, even though apparently asymptomatic, would not be responsible, and would be selfish, if they'd choose to have biological children.
Yeah, questioning peoples' biological choices is pretty bad stuff and you should avoid it.
I understand the concern over somebody with a hereditable condition "maliciously" reproducing. That would certainly be pretty bad.
What's also pretty bad is assuming that the author did such a thing, or feeling that the author owed you an explanation.
I'm childfree; pretty much the opposite of some kind of rabid "everybody should have kids!" breeder type.
But my default reaction to somebody having a child is that it was some kind of reasoned choice on their behalf and that they don't need to justify themselves to me. Especially after the fact. Where is the logic or humanity in questioning the value of having a child once the child already exists?
I understand the concern over somebody with a hereditable condition "maliciously" reproducing. That would certainly be pretty bad.
What's also pretty bad is assuming that the author did such a thing, or feeling that the author owed you an explanation.
I'm childfree; pretty much the opposite of some kind of rabid "everybody should have kids!" breeder type.
But my default reaction to somebody having a child is that it was some kind of reasoned choice on their behalf and that they don't need to justify themselves to me. Especially after the fact. Where is the logic or humanity in questioning the value of having a child once the child already exists?
> "maliciously" reproducing.
That's not what I said. Not even in the slightest.
> What's also pretty bad is assuming that the author did such a thing, or feeling that the author owed you an explanation.
Jeezus, talk about reading something looking to do the worst interpretation possible. You might as well have called me a eugenicist nazi. How about when you read a comment have an open mind that maybe, just maybe, it wasn't written by a nazi?
My comment was pretty general, and mostly talked about people I know, who did do such a thing.
> Where is the logic or humanity in questioning the value of having a child once the child already exists?
That's not what I did. I'm asking why someone with perhaps multiple heritable psychological and physical problems, both in their own body and in their family, would take this huge risk. Do they presume to love an adopted child less than a biological one?
I'm CLEARLY asking about the logic decision BEFORE. Because it's not actually a decision afterwards. Obviously.
And it's not about the "value of having a child". That completely misses the point.
> don't need to justify themselves to me
Wow, you sure are a better person than this straw man you're building. Good for you.
Should I apologize for wanting to understand the world, and people, better? Would you say the same thing about the entire fields of sociology, anthropology, and psychology?
No, nobody owes anybody an explanation. Of course not. But what kind of answer is that? If to you entire fields of knowledge have a taboo on the word "why", with the default answer "I DON'T HAVE TO EXPLAIN MYSELF TO YOU!!" (and neither must anyone else) then you sure are not anybody I'd like to talk to. Good day.
That's not what I said. Not even in the slightest.
> What's also pretty bad is assuming that the author did such a thing, or feeling that the author owed you an explanation.
Jeezus, talk about reading something looking to do the worst interpretation possible. You might as well have called me a eugenicist nazi. How about when you read a comment have an open mind that maybe, just maybe, it wasn't written by a nazi?
My comment was pretty general, and mostly talked about people I know, who did do such a thing.
> Where is the logic or humanity in questioning the value of having a child once the child already exists?
That's not what I did. I'm asking why someone with perhaps multiple heritable psychological and physical problems, both in their own body and in their family, would take this huge risk. Do they presume to love an adopted child less than a biological one?
I'm CLEARLY asking about the logic decision BEFORE. Because it's not actually a decision afterwards. Obviously.
And it's not about the "value of having a child". That completely misses the point.
> don't need to justify themselves to me
Wow, you sure are a better person than this straw man you're building. Good for you.
Should I apologize for wanting to understand the world, and people, better? Would you say the same thing about the entire fields of sociology, anthropology, and psychology?
No, nobody owes anybody an explanation. Of course not. But what kind of answer is that? If to you entire fields of knowledge have a taboo on the word "why", with the default answer "I DON'T HAVE TO EXPLAIN MYSELF TO YOU!!" (and neither must anyone else) then you sure are not anybody I'd like to talk to. Good day.
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I don't know, why do people try to propagate their genes?
I'm sure you've got a better handle on the situation the the force of billions of years of evolutionary history.
Sure. I'm saying I don't understand how the rational part of their brain isn't overruling that, though.
The best thing you can do for evolutionary things is to donate all the sperm and eggs that you can. Literally do that as often as you can. I understand why people don't, though, because humans and animals only instinctively connect their will with procreation, even if it's connected, and instinct doesn't do abstraction. It only does connections with what's worked before. Wide hips, health, liking sex, etc... that's what we've evolved to. But who knows, the few mutated humans who give to sperm banks nonstop may become the majority in a thousand generations, and wanting sex may be a trait that'll be phased out.
I want to stay home and eat candy all day, but I don't. There are many things humans don't do that the "reptilian brain" would have them do nonstop.
I don't want to pay into my pension, and realistically my survival post-65 in the west isn't going to affect how my genes live on. Yet I do pay into my pension.
On the scale of human civilization so far, especially after the pill came around, procreation is not that connected to nature. Same as our other pleasures. What's tasty to eat is largely bad for you. Evolution hasn't adjusted to that. And it probably never will, since we'll invent just-as-tasty-but-healthy before it'll adjust.
And we've learned to trigger dopamine rewards without good behavior too. It's just illegal to consume such chemicals.
Also evolution doesn't demand wanting to procreate. It just demands wanting something that has the effect of procreating (historically), i.e. sex.
Your question is more on point than the other guy who just wanted to call me a nazi. So thanks for that. :-)
The best thing you can do for evolutionary things is to donate all the sperm and eggs that you can. Literally do that as often as you can. I understand why people don't, though, because humans and animals only instinctively connect their will with procreation, even if it's connected, and instinct doesn't do abstraction. It only does connections with what's worked before. Wide hips, health, liking sex, etc... that's what we've evolved to. But who knows, the few mutated humans who give to sperm banks nonstop may become the majority in a thousand generations, and wanting sex may be a trait that'll be phased out.
I want to stay home and eat candy all day, but I don't. There are many things humans don't do that the "reptilian brain" would have them do nonstop.
I don't want to pay into my pension, and realistically my survival post-65 in the west isn't going to affect how my genes live on. Yet I do pay into my pension.
On the scale of human civilization so far, especially after the pill came around, procreation is not that connected to nature. Same as our other pleasures. What's tasty to eat is largely bad for you. Evolution hasn't adjusted to that. And it probably never will, since we'll invent just-as-tasty-but-healthy before it'll adjust.
And we've learned to trigger dopamine rewards without good behavior too. It's just illegal to consume such chemicals.
Also evolution doesn't demand wanting to procreate. It just demands wanting something that has the effect of procreating (historically), i.e. sex.
Your question is more on point than the other guy who just wanted to call me a nazi. So thanks for that. :-)
But then I think of stories like this, and how easily it could have been me with an illness requiring expensive medical treatment and possibly preventing me from working regular jobs.
And so I pay my tax with pleasure, knowing that if something were to happen to me or my fellow citizen, at least there wouldn't be millions of dollars in hospital bills to pay back and there would be aid for a home to avoid ending up on the streets.