Main reason I ask is because Chillindude, a prominent member of the competitive Melee community had a stroke recently and as he’s relatively healthy and works out often, he doesn’t have health insurance, and even though he’s sponsored by Team Liquid, one of the largest e-sports teams out there, because he is classified as an independent contractor, he doesn’t have health insurance through them.
The way he got the stroke was through an infection in his knee that he got misdiagnosed twice, and the hospital was going to throw him out even because he’s been stabilized, but doesn’t have coverage, which to me is actual BS but I’m honestly curious as to why this would be the case, considering strokes need so much recovery done for them.
Situations like this is part of why I couldn’t write my own thing for the ideal society post I made the other day, because I have no clue how healthcare should be handled. I do know however that portions of why healthcare is so expensive is due to the companies that make the equipment being anti-“Right to Repair” and the actual repair costs of the equipment being outrageous (Louis Rossmann made that a video months ago and I can’t find it), but still, this whole situation is really outrageous to me, that the hospital was going to throw him out after he stabilized due to a lack of proper coverage, and that stroke recovery as a whole is as expensive as it is in the US. I’d love to hear from our European people if it’s really any better there or am I being lied to, but still, idk what the solution really is.
Edit: I’m in the US, so this is pretty important for me to know.
The solution is to stop the state from interfering with healthcare. The insurance companies are not real capitalism, they are crony capitalism, and thus there is no real competition or incentive to provide a good service. They form a mafia style oligopoly.
The healthcare system subsidised via taxes, as in Europe, has the same problem. Public employees have no incentive to be good at their job, as their salary does not depend on that, and they are organised in unions (of mostly public employees) which turn the whole system into a mafia. Only worse because there is only one system: a monopoly.
The solution, you ask me, real capitalism, with no state interference at all. No permits, no hurdles to exercise your job. Let the health providers really compete.
THIS. Did you know that prior to about 1920, healthcare in the US was dirt cheap? Required reading!
Medicine is a state monopoly, and to make things worse, the monopolisers are incompetent and corrupt.
god damn it
We just had a massive roll-out of a vaccine which effectively side-stepped all of the regulations that normally are applied to a drug of that sort, and to no one's surprise it has more issues than normally occur with a drug of that sort. That is not a datapoint in favor of the "keep states from interfering" argument.
In my opinion the "keep the state from interfering" analysis misses the part where people do in fact screw up or act maliciously. One of the reasons we have a State is to punish people when they do so.
But I think part of the reason there's so much bureaucracy is that our government is largely incapable of punishing people when they screw up. If you make a drug that kills someone, at best the company gets fined or maybe a CEO gets a stay in Club Fed, but responsibility is so diffuse it's nearly impossible to actually punish to the degree it actually deters bad behavior.
So as a consequence of being unable to punish, instead the State takes a preventative approach where they structure things in a way where it's very difficult or impossible to make the sort of mistakes which they're incapable of punishing. Which is highly inefficient as it treats everyone as if they're incompetent or a bad actor, where the goal should be to treat the competent, good actors quite differently than the incompetent or bad actors. We all intuitively know this and act like this: you give extra scrutiny to the work of less experienced (or trustworthy) people than more experienced/trustworthy people.
Instead of removing the State's involvement completely, if we just changed its role to one of punishment I suspect that would make things much less burdensome. "If you signed off on this drug that injures a bunch of people, we're going to flog you in public. If it kills a bunch of people, we're just going to execute you. We'll let you decide how much risk you're willing to take to avoid those things."
The closest thing we have to that in the medical industry is when people who work in that industry personally use or have family that use the drugs and devices those people are responsible for producing. And those people in my experience take their jobs way more seriously than those who don't, because mistakes become something real and personal instead of statistics in an "adverse events" chart. But even then, sometimes they get overridden by people who don't.
The laws insulating vaccine manufacturers from lawsuits are basically the opposite, though, since they're preventing judicial consequences from reaching manufacturers of faulty goods.
I don't have an answer here really, but the state is actively protecting the producers of the Covid 'Vaccine.' So the base impulse to rip the state out of the equation by the roots is understandable, given present circumstances.
Yes, our State has a lot of bad incentives put in place, those vaccine laws very prominent among them.
And sometimes that impulse is healthy: elsewhere in this thread I mentioned that a main reason the American right opposes nationalized healthcare is that we know it will be run by our enemies.
But ultimately that response should be considered something more akin to a survival tactic instead of a goal unto itself.
Another thing to consider: whenever the right proposes actually punishing someone for doing bad things, its enemies accuse it of "big government". But a government that amounts to "do what you want, but if you harm people we're going to punish you in proportion to how much harm you did, up to taking your life" is going to be much smaller than one that attempts to regulate behavior up-front to minimize the ways you can harm people. Which is what we do now.
Imagine if instead of passing the Pure Food and Drug Act of 1906 -- which created the FDA -- we just tried and executed the heads of the food companies which were poisoning people and left the food companies which weren't alone.
No. State involvement sucks. Criminal charges are one thing but state prosecutors going after medical professionals for perceived errors is insane.
Medical needs two different systems.
There's the emergencies where you don't have the time or wherewithal to choose for yourself and you want licensed doctors that went to medical school, passed the tests, and did the time learning the trade. On the other hand there are slowly developing problems where you have plenty of time and should be able to make informed choices and get potentially deadly medicine from that self-taught guy who hung out a shingle.
There's random things that happen like an asteroid ripping off your arm or defective genes that you shouldn't have to pay for because you had no choice in the matter. There's other problems like from getting fat, not exercising, not brushing teeth that were preventable and you should pay for.
So there's not a single solution because there's two conflicting problems. If the state pays for everything then there's no financial incentive for people not to eat themselves to 500 lbs. If state pays for nothing then people go bankrupt or die from bad luck.
In EU they simply tax unhealthy things, so people can think they're free, while government makes their dietary choices for them.
Recent sugary tax in Poland, that was supposed go towards programs aimed at diabetics and supposedly all it did was cover some costs of needles.
Whether it was needles or if it just got used to get the people in charge richer, at least you can safely say that money went to a bunch of pricks.
I pretty much agree, but then you get the people shouting that you don't care about the poor even though that would be more beneficial for those in a lower income bracket and I know churches and aid organizations can help those in need. My church does a lot in the local area, but it is just one church. Another thing that would be good is catastrophic coverage.
The thing is that the poor are the ones who are most likely not to even know where the more affordable facilities are in the first place.
That is a good point.
Don't forget the other problem which is the horrid copyright system that keep all the meds way overpriced
To start, I'll say he probably should have had health insurance. I presume a guy you say is heavily sponsored so makes a decent living. He had the option to purchase health insurance and chose to not make it a priority. It is totally possible to just buy it and not have to be on an employer plan, and it's not even that crazy priced for a young healthy guy. It would be just like if he didn't buy car insurance and crashed his car or didn't buy house insurance and his house burned down.
I've got a bit of experience with the costs both in and out of insurance. If you're paying cash most regular doctor's office type things will gladly take you. I've gotten a regular doctor visit for $100 and one time I had to go to a dermatologist for an infection it was $175. I mean as a generally healthy person I probably wouldn't spend more than $500/yr on doctors, dentists, etc. for checkups and the odd thing.
Where it gets nuts is the hospital. I had a minor surgery a handful of years ago. The bill from the hospital was just over $10,000. From the time I went in the door to the time I left was no more than three hours. This $10k was not for the doctors, but just for the hospital services. The surgeon's bill was around $1,300, which I thought was totally fine. I mean I'm paying this guy to cut me open, I don't want the budget special. These costs were the insurance costs, so in the end I think I paid out of my own pocket about $2k for the surgery. It's pretty hard to go to the hospital and not get thrown out ASAP if you don't have insurance, because their bill is going to be nuts and they won't get paid.
Otherwise, the other post I see is also totally true, it's a crony capitalism and anti-competitive mess and that's why the costs are so stupid.
I used to do product engineering for medical devices.
One of the reasons equipment is so expensive is that the costs associated with getting the approvals to be able to market/sell equipment. The US Food and Drug Administration has the longest and most difficult approval process for drugs and medical devices in the world, and it's not even close (though the EU is in the process of rolling out some new regulations that may give the US a run for its money). Then beyond the millions you spend on the clinical study, you must have an expensive business infrastructure to meet all the other regulatory requirements related to product design/development, defect tracking, etc... These things are all expensive, and the businesses pass the costs onto the customer.
The other part of it is that, as we all recently saw with the vaccines, the manufacturers try very hard to make it so the "customer" isn't the end user or even the hospital but rather the health insurance companies or the government. So they all try very hard to get a separate billing code, then lobby for that billing code to get reimbursed by the insurer or government. They know that the patient won't care about costs because they're just paying the co-pay, the hospital won't care about costs because they're billing the insurance, and the insurance might care but by the time they get the bill there's nothing they can do about it. So because there's no real cost pressure, the manufacturers know they can charge pretty much whatever they want.
As for "right to repair", that tends to go out the window for medical equipment due to liability. Hospitals generally don't like doing too much maintenance on complex equipment because the liability if it fails might shift onto them. If the manufacturer performs the maintenance using the approved procedures and approved replacement parts, the manufacturer stays liable. And even if a third-party performs the maintenance they will still have to use the manufacturer approved procedures and replacement parts and likely be trained/approved by the manufacturer. Using unapproved parts is a big no-no even if you think they're the same thing.
As for manufacturer markup, some of that is because they can, some of it is that they aren't in the business of selling parts so they may not have very many of them on hand, some of it might be the parts are old/obsolete and may be difficult to source, some of that may be the device manufacturer has specific requirements for the part manufacturers (eg specific part revisions, special firmware versions, etc...), and the part manufacturers pass the costs of meeting those requirements back onto the device manufacturer.
Beyond that, one of the things the FDA requires is that the manufacturer ensure that the end user use the product in the approved manner and make it difficult to use in an unapproved manner. So medical devices generally speaking aren't designed to be modified and in many cases are specifically designed to not be modified. This is why if you ever see a product that has a clinical and non-clinical version, the clinical version is usually a stripped down version of the non-clinical. And manufacturers will often make it so end users aren't able to run software from the non-clinical versions on the clinical hardware.
This is not to say it's all the government's fault: there are plenty of MBA shitheads at these companies who seem to go out of their way to extract as much blood from the boulder that is our healthcare system. But the incentive structure is set up for medical equipment to be expensive, so it tends to be.
I could tell so many stories for each of these items, but then this would become a book; so I won't.
I still appreciate the perspective. Thanks for sharing!
absurdly expensive. Even if you have medical insurance, it can be almost the same as having no insurance in some instances.
This. I dropped mine because it covered nothing, the price cut into my bill money, and the savings was only because the ER could charge my insurance more than if I paid cash. My doctor charges $60 a visit, $10 a visit my insurance covered. Basic labworks were 20% copay, any other labwork was 75% copay. And labs are mass operations now, so they can set their own rates.
Dated a girl decades ago that was a "financial councilor" at a hospital. If you tell them up front you don't have insurance, they'll work something out, usually even better than negotiated rates with insurance companies. The "why" is obvious. Huge charges that can't get paid simply won't, and you can't repossess medical care. So they'd rather get something instead of nothing. And why it's better than contract rates of insurance is because they also routinely line-item deny and the hospital can't balance bill (in our state).
But your overall point is absolutely true. People don't seem to have a problem spending $2K on a giant big screen TV but self-pay for a $130 visit is "Fuck American healthcare!!11!! Communism NAO!!!"
I'd be surprised if he didn't have car insurance since it's legally required to drive in most, if not all states. You certainly can drive a car that's uninsured, but you'll be fucked if you get pulled over or wind up in an accident.
I've lived in both the US and UK, and I have had direct experience, and intimate witness to some of the best and worst of both systems.
In the UK, my slowly dying father's care has been excellent. His pacemaker was installed promptly, his checkups are regular, his medication is provided, he has had two emergency ambulance rides, multiple stays in hospital, and this has cost... Nothing. Not one single penny.
...I, on the other hand, have had to harass doctors for months to have an internal leg injury properly addressed, even despite the fact that at one point, the pain from this injury was bad enough to limit my ability to walk to two miles before literally had lie down on the ground unable to stand. It took six months to get a 20 minute appointment for imaging. Ridiculous. Still, it cost me nothing, and the real reason I waited six months was because I didn't feel like paying approximately $500 to get it done privately.
Now, when I was in the US...
A family member injured himself with a chainsaw and we got a bill of $13000 to sew him up. No ambulance, because we drove him to the hospital ourselves. However... That bill is bullshit. You simply ignore the bill, ignore the phonecalls and mail, and you wait until they magically offer to reduce it.
I don't know what it was haggled down to in the end, but my family weren't pulling their hair out over it and they still went on holiday that year, and the next - and this is a family on around 70k household income.
I didn't enjoy more or less paying a minimum of $100 every time I saw a doctor for anything but I did enjoy that that doctor was almost always rapidly available, and furthermore, seemed to actually care that I was happy with the treatment.
Lastly, a friend of mine tore her ACL, got misdiagnosed twice, spent 8 months unable to stand without crutches. She isn't being bankrupted by this because she's on medicare, but if she wasn't, she'd be staring at a $20k bill to try and haggle down.
...Sooooo if you ask me about healthcare in the US vs healthcare in Europe, I'm going to tell you that things in the US aren't as bad as people tell you, but for anyone who doesn't have a $100k just lying around? You're a brainwashed rube if your reaction to free healthcare is 'IT'S TERRIBLE, GET IT AWAY FROM ME!'
The reason a lot of people on the right are opposed to nationalized healthcare is because we know the same people pushing it also want to give it to everyone in the world that steps foot in this country (and eventually the "step foot in this country" requirement will go away). And extend it to include every medical intervention (like making men look like women and women look like men) they get it in their heads they "need" performed. And then deny it to normal people if they chose to not take a particular medical intervention or call a man a man even if he says he's a woman.
In short, we know it'll be run by children who hate us; and since we're apparently incapable of removing those children from positions of influence, the next best option is to minimize their influence.
How about "It's not actually free, and it's supported by morally unconscionable armed robbery?"
Are the roads also armed robbery?
Believe it or not, there are more miles of privately-built, privately-funded, publicly-accessible roads in these once-United States than several European countries.
The rest of them are privately-built, larceny-funded, publicly-accessible, and generally rougher driving.
Several European countries are ten miles across, so...?
A place where nothing is paid for by taxes is ultimately not possible on the scale (both population and geographic) of most US states.
Taxes go into maintaining everything from the roads to power grid to making sure buildings are built properly, to putting out fires, and they ultimately have to happen. The fact that privately funded roads exist (they exist even in England) doesn't change the fact that ultimately, it's just better for a majority of people if public funds are put to use to for certain things that everyone needs - and at some point, everyone needs healthcare.
This isn't to say I think private healthcare is a bad thing. I think it should exist for those who can afford it, and there are certain treatments that should never be publicly funded - most cosmetic surgeries, for instance.
You're going to be really surprised when you find out we have private power grids as well.
Why would you think that would surprise me? Again, these things exist here also. So private intranets that span tens of miles.
I'm fully aware that yes, these things can be done with private funding. But wide-scale, that's just not desirable or beneficial to most people.
There are lots of ideas that work on limited scales with self-selecting populations. You can even make REAL COMMUNISM work if everyone in your community is on board, and a capitalist state exists around you for you to purchase goods from and gain additional income from.
Does this mean REAL COMMUNISM is viable across a population of millions that includes people who want nothing to do with it? We both know the answer to that one.
The difference (to him probably, just assuming because I’m not him) is that roads are straight up written in the Constitution, while healthcare is assumed to be in the “General Welfare” part.
To actually answer your question, if you don't have insurance you're going bankrupt if you have anything significant go wrong at all even if it's a one-time problem. Only exception is if you are in a car wreck in which case your or their insurance will cover the bills OR it's still not enough and you go bankrupt, maybe they go bankrupt too if they were at fault.
If you have Obamacare insurance it's actual insurance, like for disasters. You get a few free checkups and some free preventive tests, but mostly that you'll pay ~10k out of pocket to be treated by residents and the worst physicians because everybody else doesn't take your plan. There are places who could have their billing done for free by the parent company, but choose not to so they can exclude the riff-raff. In a real emergency you'll probably go out of network against your will and pay an extra $14k on top of that.
If you're on a company plan then most big companies you'll pay nothing more than a co-pay of $100 to see a specialist or something like that. You'll be able to see a good doctor and don't have to worry about going bankrupt from an emergency.
...in other words Obamacare created a lower caste that has pretend healthcare. They're like living cadavers for the medical industry to practice on. Since you're in the US and are subject to this, my advice is get a professional type job with insurance, if you're young get a cheap plan and roll the dice, or if you're older pay through the nose for a good plan while you are looking for a professional job as soon as possible. If you're older and lose your job pay COBRA to stay on the plan for a year even though it'll cost a billion dollars because you're not going to get a good plan by yourself for less money.
He feel for the independent contractor scam and didn't properly protect himself from the consequences of it. He has my sympathy but that's a really stupid idea in a lot of ways.
Unfortunately basically every sponsored e-sports player and every YouTuber is classified as an independent contractor. I’m 99% sure physical athletes are treated as employees of their teams because of the unions that most leagues have, but I’m not certain.
That sounds like a problem with the industry and a good reason to not put all your eggs in one basket. Like, its a horrible position to be in. But that's why you can't just "follow your passion" into markets that treat people like that.
Especially as, which was my point, you know that is the case and then you willingly choose to not cover your bases. If he wasn't making enough money to afford insurances, then he shouldn't have worked in an industry that screws him twice.
He’s been playing Melee since he was like 15, and he’s been involved in competitive Smash for half of his life at this point, so I get why he didn’t get insurance, which I don’t blame him, especially since he lives in the DC area and everything’s more expensive around DC.
I kinda hate the reason why e-sports teams do that, which is so they can drop their MOBA players when they need to, but that trickled down to the rest of the industry, which sucks.
There is no point in your life where you are safe enough to not have insurance. If you cannot guarantee your safety physically (pro tip, you cannot) then you must do so monetarily. We can all hate the system, but at the end of the day that's the way it is.
Esports will never be a real industry as long as it amounts to nothing more than "local tourney setup" but with big names attaching themselves to milk advertising. Constantly settling for being treated like a slave is why its never improved past that.
I'm genuinely curious as to what you think a solution would be. I think unionization akin to what most traditional sports have would be viable, but I have no clue how to even go through with things like that. I've been in and around top FGC players for quite a while now (the majority of colleges have FGC/Smash clubs that host tourneys), but the FGC side of the industry and the MOBA/Shooter side of the industry are two different industries for the most part, mainly because what you can advertise to fighting game players is different to what you can advertise to primarily PC players.
There is no solution. Too many people settled for being treated like cattle, and now no company will pay you right because there are 110000000 desperate names willing to take your spot if you try to get better. The foundation was set on a bad foot and will remain as such until the market collapses.
Its the same problem as illegal immigration. Literally nothing can stop the dehumanization and lowered wages of those jobs because there are zero standards the fresh blood care about besides getting in there.
Short of becoming someone who has Name Draw Power, thereby not as disposable, and then pushing your weight just right, most are SOL. Even if you unionized, the entire union could just be excised and replaced with a handful of college campuses worth of new talent.
Let me just put some numbers in front of you, the average cost for healthcare to adhere to NEW REGULATIONS EACH YEAR IS 20 Billion. That is just on administrative updates each year, starting to get why healthcare is so pricy? What if I told you that Medicare determines benefit rates based off population per zip code? Want to get the actual value you payed into Medicare? Better live in a major city, otherwise you’re fucked.
Combine the cost of healthcare with the discincentization of welfare and you get a situation where it could be easier on my family financially if I just died instead of getting an expensive injury or disease
Medical care is an arms race between what insurance will accept vs what Heath care providers will charge. And health care providers typically always charge first and insurance “adjusts” later. Let this go on for a few decades and there is no realistic price basis for medicine or medical services.
Then when you see an insurance EOB you as the patient are grateful your hospital visit was only $250 instead of the 10k the hospital tried to charge.
It's messed up because everything is aimed at the doctor, and then demands he be competent in everything, while the science is moving away from that. The guy who wrote about the term disruptive innovation wrote about schools and medicine at the same time. In both he said the role of the central figure, the doctor or teacher, would be taken away. He pointed how this was already happening. You need to be checked up by a doctor? How much of it was technicians and nurses? Were you talking to a doctor or a physicians assistant?
He wrote the books in 2008ish, and instead of adapting and changing, the industries went hard against it. We have propped up doctors and teachers so much they can't imagine a world without themselves. They will fight tooth and nail to keep that position, and they honestly think they are helping.
Because of this, both have stagnated both in society and in technology. When all the scanning devices could easily hook up to my phone, why do I need a special appointment? Because the doctor doesn't know how to do that.
It's not new either. Michael Crichton wrote about it in the 1960's, and how technology was changing medicine. He even showed how telemedicine was already happening. Doctors didn't like it, so they made sure it stagnated for literal decades.
I've been nicknaming it Ego Jobs. You recognize it by how they pump it up on the news or meetings. You will also notice how technology acceptance seems to be slow around them.
Journalists, teachers, doctors, and even architects can be described this way.
I feel for you, I had a relative with a rare physical ailment and the doctors had no clue. It took a lot of wikipedia and only research to find out what it could be, and then find a doctor who would approve the tests to see if it was this or that. The entire time Egos got int he way of finding out. Even the people who helped yelled at the relative for thinking it was such and such. I was in the office of one, and he nearly had a sudden facial fracture.