The retail price of my Humalog is $280 a vial. I have insurance so my cost is a fraction of that. Also, I don't know how Novolog compares to Humalog, but $73 a vial is a step in the right direction for diabetes patients who are uninsured or underinsured.
Can't speak to the parent but vials per time can both change per person and between people.
My wife requires quite a bit more insulin while pregnant for example - she had to make changes to her pump's settings while in the hospital to accomodate it.
I was curious about this too. Hopefully someone with firsthand experience will correct me/add on to my comment. I hear about insulin a lot but I’ve never gotten an idea of how dosage works.
What I found:
1 unit of insulin will cover 10g of carbohydrates [1]
Humalog insulin comes in 3 mL (300 units) vials or 10 mL (1000 units) vials. [2]
The list price of a Humalog U-100 10 mL (1,000 units) vial is $274.70 [3]
In type 1 diabetes, most people need a total of 0.5 - 0.8 units of insulin per kilogram of body weight each day. [4]
In patients with type 2 diabetes, marked obesity, and insulin resistance, total daily insulin doses of 200 to 300 units are often required. In this setting, management for most patients includes a total of 1.0 to 2.0 units of insulin per kilogram per day; thus, in very obese patients, a larger total dose is required. [5]
In type 2 diabetes, the average weight is 96.5kg - 98.9kg. [6]
The average American weight in 2020 was 181 lbs. So around 82kg. [7]
With the above details, in type 2, about 100 - 200 units are needed per day. That’s $989 - $1978 per year. In type 1, $494 - $791.
"1 unit of insulin will cover 10g of carbohydrates"
This varies significantly from patient to patient actually. The same goes for basal rates (how much insulin you need to maintain a healthy blood glucose level excluding what you eat). As you mentioned, weight is a big factor but so are other things like age, sex, diet, activity level, stress level, and just how well your body reacts to the insulin. Some people respond very well to artificial insulin while others just don't for some reason. I believe it can also depend on how long you've been using insulin. Your body can slowly stop responding as well as it used to.
The numbers you came up with as an average sound pretty reasonable, but it's important to remember that daily dosage will vary quite a bit between individuals.
It is variable.
But I'm 220, 6'6"
I use ~24 units per day basal rate (continuously pumped, amount programmed over 24 hours)
And 1 unit of insulin per 15 grams carbohydrate.
I usually average ~50 units per day.
Additionally my pump (tandem x2) has a lot of loss due to their loading system. For 300 units loaded, you get 250 deliverable units. Reloads happen about every 5 days.
For use per month, I have 2 vials per month prescribed.
If you are thinking about cost: pump insertion sets and continuous glucose monitoring sensors are all very expensive as well.
I am an unusual case: I am LADA (Latent Autoimmune Diabetes in Adults), sometime called Type 1.5. I am autoimmune (and therefore insulin dependent) but I didn't become symptomatic until my early 40s. Also, my weight hovers around 160 lbs, so my comments do not apply to type 2 diabetes patients who are significantly overweight.
I use Lantus as my long acting insulin, and Humalog as my fast acting insulin. I receive a shipment of three 10ml vials of each every 3 months (so I use 1 a month). I use 30 units of Lantus a day, and a variable number of units of Humalog, averaging 25 units a day. Thus, 1 vial of Lantus lasts me slightly over 30 days, which is how long you should use a vial of insulin before replacing it.
Figuring out how many units of insulin to take can be difficult. This year I got a Freestyle Libre 2 glucose monitor which has alarms which will alert me if my glucose goes above or below preset limits. Fortunately, I am sensitive to hypoglycemia; sensitive enough that I will wake up if I go low while I am sleeping, but I can still get as low as a glucose reading of 40 point before I feel the effects, which upsets me and freaks out my wife. The alarm is set for 80 points, so I can take some carbs before I get seriously hypoglycemic.
I adjust my Humalog injections based on my glucose readings and my carb intake using a formula I have adjusted over long experience. I may take as little as 1 unit (if I just need to bring my glucose reading down) or as much as 12 units with a meal, but most of the time I take about 8 units with a meal.
I've used both Novolog and Humalog (depending on what my insurance likes) and I didn't notice any difference in effectiveness for me. Everyone's different though.
"More than 34 million people in the U.S have diabetes, and about 1.5 million Americans are diagnosed every year, according to the American Diabetes Association."
Wow. That's double the rate of a country like France. An ounce of prevention really is worth a pound of cure.
France has 6% of the population diagnosed with diabetes, contrasted with 8% in the USA. Both countries are estimated to have a total rate (including undiagnosed individuals) of 10-11%.
> An ounce of prevention really is worth a pound of cure.
We have the technology. The cure is cheap. It's criminally insane that the US doesn't make life-saving or life-bettering drugs more available for free.
Yes, but isn't the real 'cure' in modifying our diets so it doesn't happen in the first place? At this point, tax and put warnings on sugar and carb-rich foods. Use the revenue to subsidize healthier foods to offset the regressive effect of a sugar/carb tax. I know about food deserts and fresh food availability, but the real way to fix this issue is upstream from already having diabetes.
You seem to be confusing Type I and Type II diabetes, a pretty common error. Insulin of the sort referenced in this article is used primarily for Type I diabetes, which has little or nothing to do with sugar or carb-rich foods.
The linked article mentions Type I specifically also: "The annual cost of insulin for people with Type 1 diabetes in the U.S. nearly doubled from $2,900 in 2012 to $5,700 in 2016, according to the most recent data available from the Health Care Cost Institute."
Insulin of this type is used primarily to treat Type I diabetes.
How is modifying our diets a "cure" for Type I diabetes?
The only "cure" I know about for Type I diabetes is insulin, the subject of TLA and as far as I can tell, the subject of GP's comment also. Your comment appears to be the first introducing the idea of diet, which suggests that maybe, as I said, you're confusing diet-related Type II diabetes (not the subject of the article) with Type I diabetes (the subject of the article).
Insulin is primarily used to treat Type 1 diabetes, which is related to diet and lifestyle in a far more opaque and unknown way than Type 2 diabetes.
You cannot improve your lifestyle to prevent Type 1. However, it is epidemic across the entire western/developed world -- incidence doubles every ~6-7 years.
U.S Population: 328.2 Million People
France Population: 67.06 Million People
The America bashing on this site really does get tiresome, especially with comments like this one that are just totally meaningless. Especially when America and France have the same percentage of diabetic people: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/E...
France was just an example, but even your link proves my main point. It's not just diabetes. Heart disease is 2x as common in the US as in many other developed countries as well. I don't see how this is "america bashing" (of which I myself have been critical of in the past on this website). What I've presented is useful data that contributes to the discussion over healthcare costs.
If I change the sort order to Price Low->High, I get this really odd captcha telling me to "Press and Hold" a pill shaped button. And I can't solve it, it's in a "Try Again" loop. Weird.
Depends on the type of the diabetes. There's both Type-I and Type-II diabetes. Type-I is an autoimmune disease where your body attacks the insulin producing cells in the body, and can no longer regulate your blood sugars (high or low) and the person must take insulin. Type-II is sometimes caused by obesity, but is also caused by age sometimes. This can be controlled by oral medications, exercise and diet, sometimes, and lower doses of insulin to assist with their blood sugars. It's often referred to as "insulin resistant diabetes".
EDIT:
Forgot to mention. COVID seems to have been causing a rise in Type-I diabetes cases in non-juveniles =/
No, that's a common misconception. Humans are born with different features and flaws.
While one can increase their chances of developing diabetes later in life with poor diet choices (called Type 2), many people are born with diabetes. (Type 1)
It's wild how diabetes is an epidemic in so many places.
I was referring to the relationship between the incidence of Type 2 diabetes and consumption of excess sugars.
Big box stores push refined and processed foods that contain excessive amounts of sugar these days. They have sugary snacks and drinks in the checkout lines. They carry very few products without added sugars; try to find a bread, pasta sauce, or soup without crazy amounts of sugar.
It's not entirely their fault, but Walmart has demonstrated in the last 40 years that they can compel manufacturers to just about whatever they want. If they wanted, they could push for the reduction or elimination of excess sugars in processed foods.
But then again, there wouldn't be as large a market for Walmart brand insulin if they did that.
> But then again, there wouldn't be as large a market for Walmart brand insulin if they did that.
So… you think Walmart sells processed foods because it will increase their insulin sales? Not because they’re extremely popular high margin sales items?
>While one can increase their chances of developing diabetes later in life with poor diet choices (called Type 2), many people are born with diabetes. (Type 1)
90-95% of people who have diabetes are type 2. It's largely a lifestyle disease, even when you include those who have autoimmune issues.
Everyone will have kids one day or knows someone who will. And if that kid is born with type-1 diabetes they will require insulin everyday or else they will die.
The inventor of insulin sold the patent for $1 because the thought that it would not be available to all was unconscionable.
It is absolutely unacceptable that insulin is not free and available to all (including to those who can afford it at the cost of financial stability).
The idea that someone without means should have to pay Walmart $86 for a worse low-budget insulin is disgusting.
I agree that Insulin should be free for everyone, it just makes sense. But you make it sound as if Walmart is making money on this. I would bet it barely covers their cost (Break Even). They did this because they have the power to do this (twist some arms). Don't blame Walmart, blame your government for allowing Big Pharma to charge 80% more in the USA than they do almost anywhere else in the World.
The government never distributes anything for free. They distribute it with money taken forcibly from citizenry. Be careful what you're asking for in begging the government to take care of you. They just may.
wow huh, never thought of that - just learned about "taxes" being a thing from hacker news, thanks for the insight, no one here ever would have made the massive leap to know that governments are funded through taxation
> They distribute it with money taken forcibly from citizenry.
Yes that's exactly the point. I make $150k a year, live very comfortably and pay almost 30% tax (in USA). If the government stops funding endless wars and starts using my tax money to help people get healthcare and education, we wouldn't have this problem.
Agreed on all counts. I make just a touch under 150 and I can afford the taxes. I'd happily pay more if that meant offering better healthcare and education options for everyone.
Take half the DoD budget, add in medicare and medicaid outlays, and throw on what most of us pay for insurance already, and you're most of the way to paying for a decent health care system. It's criminal that Americans in 2021 could die from diabetes complications due to lack of affordable insulin.
Reminded me of my tourist trip to Las Vegas. At some point we got on a bus to travel from one hotel to other.
I asked the driver if that bus was the free one (meaning, if that was the bus in which I didn't have to pay). The driver replied a bit angry that the bus trip was not free, it was complimentary.
Last year, Minnesota passed the Alec Smith Insulin Affordability Act, which requires the major insulin manufacturers to provide 30-day emergency supplies of insulin for no more than $35, and 90-day supplies for no more than $50, for anyone meeting the program guidelines[0].
The law was modelled around the companies’ existing patient assistance programs, and despite assurances from industry reps, PhRMA sued the state anyway just hours before the law was due to take effect[1]. This spring, their lawsuit was dismissed[2].
This law isn’t a great solution if you think that insulin should be free to all, but it is at least something that other states can use as a model to try to help their citizens access to cheaper, high-quality insulin.
This is the weirdest socialized medicine I've ever seen, "offer valid only for COVID tests, COVID vaccines and Insulin (terms and conditions apply)." This kind of targeted quick fix is kind of the epitome of the little patches you put on a leaky kids swimming pool.
Just yesterday my wife and I were watching "last week tonight" episode on US health share orgs. (Like a health insurance, but religious and unregulated).
My impression was: The crazy hoops and loops that Americans will go through for healthcare just to NOT implement a sensible social healthcare program.
I certainly understand that reaction, but I don't think it's crazy.
I just joined one. My primary care physician recommended it. It's about 28% the cost of the regulated ACA plans in my area for my size family. Read that number again. And, it covers everything (except no pre-existing conditions) except for things like cosmetic surgery.
The list of things that the ACA plan didn't cover at all was confusing and pretty lengthy, and it had a $9k deductible (or more, many of the cheaper plans had $15k deductibles) per family member, and double that (two family member's worth) for a max family deductible. To me, that is crazy. And, for the cheaper plans, they required coinsurance, so if I had a disease that would cost $200k, I would owe $67k.
Most amazingly, there's no deductible except for the $400-per-visit deductible. (There's no free maintenance or co-pays or anything like that.) Everything is covered after the $400-per-visit deductible, and there's virtually no maximum. Go to the ER, max of $400. Go for a checkup, probably pay it yourself (unless it exceeds $400).
(One could argue that they should cover an annual checkup, but if it was just a matter of adding $150/year to everyone's plan, what's the point; that's an arbitrary amount that can be budgeted in once you know to expect it. Since it's people of that religion only, some built-in pre-qualification occurs to eliminate people who would just abuse the system.)
These health share non-profit organizations have paid out billions by cooperating and coordinating among their members, and you negotiate with the hospital directly as a cash patient and make your own choice of care and providers.
It's somewhat akin to how a credit union is dissimilar to a bank.
I personally find the idea fascinating and certainly prefer it to forced socialized medicine.
$400 is pretty close to the cost of an office visit, physical exam, metabolic panel, lipid panel, and EKG, which is what a primary care doc is going to order annually on something like 90% of Americans after a certain age.
It shifts the expense of routine care and checkups to the patient. If you view insurance as indemnification against unexpected loss, it shouldn't be paying for expected, routine costs.
> That's also why car insurance pays you to install LoJack and homeowners insurance pays you to install fire alarms.
But this isn't true -- at least for any car insurance or homeowners insurance that I've purchased. You often receive a small discount, but the discount alone doesn't cover the cost of purchase/maintenance.
Those are small discounts against a large premium.
A health insurance analogy would be: Customer A pays $100/mo because he gets an annual checkup and takes the medicines the doctor prescribes. Customer B pays $200/mo because he hasn't seen a doctor since college.
Customer B could reduce his total out of pocket by $800 per year if he paid for the $400 visit.
I watched in one breath a former president explain to a group of AARP members that socialized medicine was evil, medicare was the best, and he'd do whatever it took to preserve medicare. I had a full on shocked pikachu face.
Read the plan very carefully. The reason these plans are cheap is usually because they can and do take advantage of things the ACA specifically outlawed -- rescission, lifetime caps, claim denial, the aforementioned lack of preexisting condition coverage, etc.
So in Canada, while the public system is 'single payer' - private healthcare and coverage isn't illegal. The public system is structured so that it cannot subsidize private care. Turns out, nobody wants private care so it just doesn't exist. I mean, why would they? You get sick, you go to the hospital, you get better and you leave. Bankruptcy not required.
But they are selling both under their store-brand ReliOn. The less effective original formulation for $25, and the analog is the more effective one being sold at $86. Still an absurdly high cost in my opinion, but to get the higher quality analog insulin for like a quarter of the price of the name brands is going to be life saving for a lot of people.
> The inventor of (a specific kind of man-made) insulin sold the patent for $1
Analog insulins are different than the type that the $1 patent is for. They are much more advanced and are much more complex to make. That doesn't speak to whether or not the current prices for insulin are reasonable (they're not)... but you make it sound like "someone invented this and made the patent free, and now people are selling it for $86"... which is not the case.; not even remotely.
But the patent on this, insulin aspart (humalog is insulin lispro, the competitor), is now expired, so the patent isn't a factor in the cost. The fact it costs 10x more than it did when it was introduced to the market in the mid-90's is just absolutely crazy.
Its middlemen. Lilly has been pretty adamant that their revenue per unit has been inline with inflation, despite the sticker price skyrocketing. Presumably that can be fact checked with their financial data. They insist that its PBMs and insurers gaming the rebate system. Unfortunately the rebate system is incredibly opaque and PBMs insist on keeping this way to protect trade secrets.
The only thing wrong here is a bit of silliness in the structure, the people who do have insurance but don't get the good negotiated price, and your made up numbers
My curiosity got the better of me, so I rang up my mother who's had type 1 since childhood.
She said 5x3ml vials of Lispro (or just about any brand) was approx. $40 in the pharmacy.
Once she's spent more than $275-ish in a calendar year, the insulin is free (well, tax funded) until December 31st.
This is in Norway, where the state presumably negotiates good deals with big pharma as they are basically a single customer buying goods for however many of a population of 5.5M need insulin (injected, that is)
> The idea that someone without means should have to pay Walmart $86 for a worse low-budget insulin is disgusting.
The article is talking about the modern formulation for $86. The older-style worse formulation is $25. As I understand it, and I may be mistaken, $86 is very competitive in this space. I don't disagree that maybe insulin should be funded by government at zero cost to the individual, but your description of the $86 formulation described in the article seems inaccurate.
It’s no use expecting moral behaviour from a for-profit pharma corporation, which is an inherently amoral entity.
You have to utilise incentives and regulation to keep prices down. One option is to adjust patent law to enable generic manufacturers to create competition. The downside of this is the generic pharma companies are usually off-shore (more profit that way) and also seem to just pretend to make the actual drug with some regularity (also more profit that way). Another option is for the US government to negotiate drug prices. The US market for medicine is so large that they would have incredible power to cut good deals. The downside to this option is that it will inevitably lead to some form of corruption eg. the drug negotiators don’t try too hard so they can get a cushy job at the drug company next year in their drug negotiating unit.
Anyway, I am fairly sure the latter option will happen soon, perhaps for some group of essential medicines.
So someone who isn't you should pay for its development cost, manufacture, quality control, shipping, storage, and distribution? Or should the people who do those things be conscripted into labor for the glory of these heartfelt convictions?
Prior to 100 years ago, this conditions would have just been fatal. That you can keep yourself alive today for less than the cost of your mobile phone bill is a pretty good value proposition. I just don't understand the outrage.
No, and I agree with your point 100%, but that article does note that part of the increase was due to people changing types of insulin. So it's not as simple as companies charging 2x for the same insulin.
> “Use is pretty flat, and the price changes are occurring in both older and newer products. That surprised me. The exact same products are costing double,” she said.
> The idea that someone without means should have to pay Walmart $86 for a worse low-budget insulin is disgusting.
Its not worse, its significantly better. The version of insulin sold for $1 is human insulin, which has been available at Walmart for $25 for many years. The version being discussed here is human analogue insulin, which was invented by the pharma companies in the past few decades. Its significantly better tolerated, and the rates at which the body can uptake the insulin can be tweaked to be much faster or long-lasting. Its like comparing a Tesla to a Ford Model T.
Honestly, yeah. The quality of life improvement between the two is humongous. I've heard treatment on the older insulin therapies described as "a life ruled by the clock where a mistake means death."
RN with some diabetes education experience here. Some of the ultra lente insulins (degludec, glargine) are q 24h to q 36h dosing, which approaches the convenience of an insulin pump (which are wildly expensive). Insulin pumps requires some maintenance but not as inconvenient as regular injections. This is not the kind of insulin that Walmart is announcing.
What is going on is that big pharma is now charging a premium for the user experience, and not the actual cost of the product or amortizing R&D.
(Of course the caveat here is that a therapy regimen that uses ultra lente insulins exclusively may be suitable for some type II diabetics who hadn’t achieved appropriate glucose control on oral antihyperglycemics, and that insulin dosing with meals using rapid acting insulin on top of a ultra slow acting insulin may follow after a while).
Sounds similar to what happened to Epipens- the drug is long out of patent, but the injector/delivery system gets continual minor tweaks to stay proprietary.
This is a thing somebody like Bill Gates or Buffet should take up, scrap together a company and provide these life saving drugs at rock bottom prices, I feel like alot of their stuff has not been very relevant considering the $$$'s behind their non-profit ventures.
My insulin copay every three months is $100 ($50 for the Novolog fast acting, and $50 for the Tresiba slow acting insulin.) My insurance's portion is closer to $4000 for that 3 months, lst time I looked. Type I Diabetes is expensive, there was a period when I was unemployed and uninsured where I had to pay for type N and type R out of pocket, but the analogs like Novolog and Tresiba is so much easier to control. This is a very good thing.
If they didn't do this, insulin would be fundamentally more expensive. Making a cheap version available at prices that a typical American can afford even without insurance, seems like a BIG step forward.
This was bound to happen, huh? From what I've read the insulin market was/is protected against new competitors with tons of legal red tape someone with enough capital "just" had to get through.
Edit: Wait. Novo Nordisk, their producer, is one of the established insulin vendors. Why are they helping to reduce prices?
Also, does anyone have an estimate of how high the margins still are?
Because there's a push for insulin affordability, and they look really really really terrible when someone brings up a chart of the rise in the price of insulin over the past few decades.
They fear a Congressional inquiry and federal price caps. Normally, you'd expect a new medicine entering the market to get cheaper as the production ramps up, yet it's gone the opposite direction, even after the patent has expired.
> Wait. Novo Nordisk, their producer, is one of the established insulin vendors. Why are they helping to reduce prices?
The big insulin makers like Novo and Lilly have been bearing the brunt of the PR disaster that is drug pricing, but reaping little of the benefit, as, according to them, their revenue per unit has barely budged in decades. Increased costs are to appease the insurance companies/PBM middle men (because due to the rebate system, they don't actually have to pay those increased costs). Both Novo and Lilly have attempted ways to cut out the middle men, with reduced payment programs, like the one mentioned in the article, or through "savings cards". However insurance companies have gone out of their way to combat these, limiting their effectiveness.
I think what's notable here is that Walmart actually has enough corporate muscle to allow a pairing with the pharma companies that the insurance companies will struggle to combat.
It's surprising that not many know about T1D. Also that the inventors gave the patent for free to prevent what we are seeing today in corporate America.
This is huge news. Sure, it's not the end goal of cheap/affordable insulin for all diabetics, but it is a great step in that direction. Walmart should be applauded for taking this step (and I'm usually first in line to hate on Walmart); kudos to them.
And the US does not particularly need to urgently aim for ~$10-$15 as in many other affluent nations. This is a mistake commonly made by those griping about insulin prices, they expect that somehow magically we should just warp to $12 insulin pricing. That desire for step-skipping is never going to happen, that's a great way to never get anywhere. The reality of the giant mess of a healthcare system the US has means it can't work that way, and thinking otherwise is pure fantasy. Instead, $30-$40 would do just fine compared to where we're coming from, it would be tremendous progress. Once we get there, we can target ways to reduce it further to try to get closer to in-line with other nations. As you note, this improvement is welcome, and we should then focus on going after the next step-forward improvement.
It's worth noting that not all states in the United States require a prescription to buy insulin. To me, this raises questions about the statement in the CNBC article:
"Starting this week, the retailer will sell an exclusive private-label version of analog insulin, ReliOn NovoLog, to adults and children who have a prescription."
What's the implication for those who live in a state like Pennsylvania and do not need a prescription to buy insulin, much to the dismay of many in the medical community.
And finally, Wal-Mart has been driving this agenda through low priced insulins for years and deserves praise for that effort to affect change. Can we expect the same from Amazon now that they've chosen to enter the pharmacy business?
Everyone in this thread rightfully outraged by insulin prices needs to look into the rebate system and PBMs in America. Its an absurdly complicated environment, born out of a desire to drive drug costs down, that paradoxically drives them up. There's plenty of approaches to tackling drug prices, but dismantling the rebate system needs to be included.
And frankly, the best way to dismantle the system is through some form of publicly available, universal health insurance. I believe in the power of healthy, free markets as much as anyone, but the current healthcare system is anything but. The lack of a non-profit seeking provider of health care, in a space where customers options are to pay whatever is charged or simply die, is not a functioning market. The rebate system was born out of what was a legislative bandage over this issue. Continuing to try and come up with cute solutions that avoid government provided healthcare for all will see similar results. Its why Americans spend so much more on insulin, and most other forms of healthcare services, than the vast majority of the world.
> ...in a space where customers options are to pay whatever is charged or simply die
Look...I agree with the majority of your point, the majority of healthcare doesn't deal with such an obvious binary...and we aren't going to make progress on this issue unless we're willing to also have the conversation about healthcare within your control - e.g. individual responsibility for your healthcare.
A number of close family members are doctors / surgeons of various kinds, so I've heard so many issues & complaints about the system. And while I would happily pay taxes to fix healthcare issues that are preventative (e.g. cancer screenings,) educational (e.g. nutrition,) and overall unpredictable (e.g. surprise brain aneurysms or the like,) I have no desire in paying for:
- Someone who drank so much and annihilated their liver, requiring significant & expensive surgery
- Someone who couldn't stop eating at McDonald's and hasn't touched a vegetable in a decade now wants lifetime insulin and kidney transplant
- A hypochondriac who wants to see their doctor for every scratch, off-color skin mark, etc.
- Someone voluntarily jumping off planes, doing dangerous sports, etc. without insurance, and expecting someone else will foot the bill
- Someone who wants every and any blood test because they coughed once
etc. etc. etc.
Again...overall I agree with a more central payer system, but you won't get the conversation started with all the groups involved unless you acknowledge that there's some element of individual responsibility that you need to control for as well.
Ultimately the choice will come down to creating a system in which the unfortunate are protected at a cost of also subsidizing the irresponsible, or sacrificing the unfortunate for the sake of punishing the irresponsible.
None of us want to be taken advantage of, but I weigh protecting the most vulnerable and unfortunate, of whom there are many, more heavily.
Ultimately the moral debate is purposeless. Our health care system is designed and run by predators, and propped up by a sentiment that we're willing to pay twice as much to support a system that includes the most vulnerable and unfortunate, and the wealthy, but impoverishes or excludes the working classes.
The easiest way to find out if someone lacks health care access is to ask them if they work with their hands.
So how much money are you willing to spend on doctors who are doing nothing but figuring out which patients were "too irresponsible" versus which ones will get covered?
I think you are in line with how many people feel. The problem is that whether you like it or not, you are footing the bill for all of these people under the current system. My health insurance is $600/month because I'm in a pool of people who are mostly healthy, but the insurance company runs the risk that one or two of us could cost a fortune. In fact, I'd probably pay a lot less towards healthcare if the government was the payer since they can leverage their size for much better prices.
What if paying for all of those things resulted in overall lower health care costs for you? If, theoretically, we all pulled our resources and collectively provided healthcare for everyone and, as a result, your overall health care costs went down (i.e. your share to cover everyone was less than your current expenses to cover yourself + whatever taxes you currently pay) would you be willing to pay for those things in your list?
Why keep your moral condemnation limited to taking health risks? What constitutes healthy behavior is very fuzzy at the edges, I would prefer to condemn people based on who they vote for, or their religion. Why would I want to support the continued lives of people who I think cause health problems in other people?
> - Someone who drank so much and annihilated their liver, requiring significant & expensive surgery
That’s called an addiction. It’s a disease. And that should (and can) be fixed by a doctor.
> - Someone who couldn't stop eating at McDonald's and hasn't touched a vegetable in a decade now wants lifetime insulin and kidney transplant
Same thing + metabolism issues, aggravated by voluntarily aggressive marketing. Can and should be fixed by a doctor.
> - A hypochondriac who wants to see their doctor for every scratch, off-color skin mark, etc.
Psychiatric issue with real psychiatric or physical pain : can and should be fixed by a doctor.
> - Someone voluntarily jumping off planes, doing dangerous sports, etc. without insurance, and expecting someone else will foot the bill
Just make insurance mandatory for extreme sports like in most countries.
> - Someone who wants every and any blood test because they coughed once
Same as above. Hypochondriasis is totally documented as a real suffering and psychiatric issue.
All your examples are situations that can be prevented with preemptive medicine which is the norm in countries where you can see a doctor long before being sick. I’m not saying it’s easy or perfect, but it’s easier for doctors to prevent diabetes if they can follow patients regularly and check their vitals than if they only see them once a year or less because they can’t afford it.
All those people still deserve healthcare. Just about every other developed nation has no problem supporting everyone, so I don't see why things should be so different for us. Treatment of others shouldn't be determined by your personal morals. What if that extended to everything else that is socialized in our system?
From a purely selfish perspective, countries with universal health coverage pay less than Americans do for healthcare, and those countries have better healthcare outcomes, quality of care, shorter wait times and they manage to insure everybody. You'd enjoy not only lower prices, but better care adopting such a model.
But yours isn't even a selfish perspective, but a moralizing one. You don't like the idea of someone getting healthcare that you feel doesn't deserve it, and it seems like you don't care if that means you pay more for healthcare or receive worse healthcare outcomes as long as those people can't see a doctor.
In a largish corporation (5k people) there's pretty good odds at least one or more of your co-workers has a drinking problem, or a significant weight issue, or is a thrill-seeking skydiver on the weekends. If you have healthcare through your employer, and you pay part or all of the premium, then you're already subsidizing those things.
Why this only becomes a problem when done at a state or national level, is not something I can fathom.
There are a number of states where the largest insurer is a not-for-profit organization.
There’s not one simple fix for this. If it’s truly going to be fixed, it’s going to require a lot of very tough fights against entrenched interests to eke out 5% here and 3% there.
It absolutely blows my mind that people are hyped about a Supermarket started selling insulin at low cost.
And I'm writing from Turkey which you would think it would be terrible in managing any public infrastructure including health.
My company pays equivalent to 400 USD per year for private health insurance, gives me unlimited access for surgeries, any treatment that I need to stay at hospital and a check-up per year. The insurance is valid in any private hospital including the ones that look like straight out of Space Odyssey.
You know what's more interesting? If you think this is a good deal, then almost everyone in Turkey thinks this kind of service should be provided by public healthcare system and demand it. Not only for the people that can pay 400 USD per year.
edit: I realized it sounds like you need to pay 400 USD for unlimited healthcare but you don't need to pay anything for the state hospitals. The insurance is for zero-cost treatment at the private hospitals. You do pay a contribution fee around 3-5 USD for every visit plus prescription at the state hospitals though. I believe it is for discouraging unnecessary visits to the hospitals but even that causes a stir.
We could do it in the US too! Convince the Democrats to give up $x billions in $something to do universal healthcare and I bet you could get a bunch of Republicans to support it.
The problem is that neither party wants to make deals. They both want to have their existing programs AND to add extra ones on too.
Everyone follows their incentives. None of them have the incentive to make a deal and get de-elected. They have lots of incentive to grandstand and call the other side bad-guys for being bad and not agreeing to this thing that "we all know is moral and right" that clearly we don't have some kind of 90% super-duper extra majority that all agree it's right. If we did, it would most likely be done already.
> We could do it in the US too! Convince the Democrats to give up $x billions in $something to do universal healthcare and I bet you could get a bunch of Republicans to support it.
Nope.
Leaving aside the the current psychotic break the GQP is experiencing this year, universal health care is not something they've ever wanted.
Why? Well, the insurance companies and for-profit hospitals have big lobbying efforts to ensure that sort of thing absolutely will not get passed. Because it would kill the need for them (insurance) or hurt profits (hospitals).
UHC will not happen until there is serious reform with how politicians get elected, and how lobbying works.
See I can make unfounded assertions too! It's fun.
> Leaving aside the the current psychotic break the GQP is experiencing this year, universal health care is not something they've ever wanted.
There's a difference between "I would never, ever vote for this under any circumstances because NO WAY" and "I'll get voted out if I allow an increase in spending on something that my voting base doesn't want".
In the same way that Democrats couldn't go to their voting bases and say "see we got universal healthcare! " if they had to give up the necessary funding in other places in order to make it budget-neutral, Republicans could only hope to get re-elected if they could go to their voting bases and say "look yeah we compromised, but it was on a thing that was budget-neutral! We didn't get a tax break for you, but we did eliminate all these other $horrible programs!"
I'm not saying that's good or right or what we want. But both sides are playing to their audiences and very much tuned in to what they want. That's what you have to do to get re-elected. That's why neither side is interested in compromising to make a deal. They'll get crucified for "not standing up for what WE believe in" and "compromising with that other side full of awful, evil people"
I don't really like that the US hasn't done much legislatively in the last 20 years. But, I, personally, myself don't get to decide how all this works. And neither does anyone else.
You seem to be under the impression that the large blocks of voters actually understand and care about the issues. Large corporations and their considerable advertising and lobbying efforts are what's really important. Much of this effort is to frame issues to the public in the way they choose.
The "stances" the voting base take are largely shaped by influence campaigns of powerful interest groups. Both major parties (the minor ones too) are affected by this. Though one of the groups has gotten even stupider recently, and they actively vote against their own best interests.
> You seem to be under the impression that the large blocks of voters actually understand and care about the issues. Large corporations and their considerable advertising and lobbying efforts are what's really important. Much of this effort is to frame issues to the public in the way they choose.
The idea that it's the voters that vote is actually true! That's how the system works. Corporations can influence that of course, probably to an enormous degree. But the corporations themselves don't vote. That's the system we've got.
The primary mechanism in our system is people. And people aren't logical, rational, economically-maximizing, or any of it. People are far more narrative-driven than they are rationally-driven.
THAT's what I would say that Republicans would get on board with a universal healthcare bill in which they could claim that they "destroyed" the Democrats by "obliterating" a bunch of "socialist pork". But that's absolutely going to ensure that the Democrats that "caved" in order to get something important done won't be able to get re-elected. And they care more about getting re-elected than they do about doing the right thing! Same on the other side of the isle! This isn't a partisan issue. Everyone wants to get re-elected way, way, way more badly than they want to do the right thing.
I don't like it. I don't think it's right. But it's extremely easy to see that neither party is compromising in any meaningful way these days. Both take hardline stances and don't budge. That's not a bug, it's a feature of American Democracy. It was designed such that if there wasn't wide agreement (or elected officials who would compromise) that things would grind to a halt. That was done so that nobody could run roughshod over the other.
Until we start getting richer such that the increases in spending are coming out of even bigger growth or we somehow manage to convince everyone that paying more and getting less is totally-A-OK this is going to be how it continues to go. Neither side wants to compromise, so their counterparties don't want to either. Deadlock is the name of the game.
> and they actively vote against their own best interests
I can understand how you'd think that. It makes a lot of sense. But it belies a terrible ignorance on your part. Animals don't make decisions on purpose to make their own lives worse in ways in which they KNOW they will end up worse. You can try and project your ethics onto other people all you want and use their relative-to-you irrationality to belittle them. But it doesn't work! Putting people down doesn't change minds. In fact putting people down might be the very thing that got Trump elected (re: deplorables).
I'm not saying Trump is good and Hilary is bad BTW. I'm just using that as an example of how unfortunate it can be to generalize one's personal ethics to the entire country and draw conclusions as a result.
It's just my (underinformed) opinion, but I don't think there is a trade that Democrats could make to get full UHC passed. More than being anti-socialism, Republicans have defined themselves as being the opposite of Democrats.
Democrats could give up everything they hold dear, and I still don't think Mitch would make that deal.
I don't think that's an unreasonable thing to think at all. Were one to try and apply some kind of quasi symmetrical thinking what might one conclude? In what ways have the Dems defined themselves to be the opposite of republicans?
I'm from Canada and we have Universal Health Care which is great.
So when it comes to health care many Canadians like to shit on the US.
On the other hand, Canadians are always complaining about not making enough money, getting taxed high and stuff. And many dream about going to the US where their money making potential is apparently higher.
So to many Canadians, at some point, the potential to make more money outweighs the UHC enough to leave Canada and go to the US to make it big.
So depending on where you are the capitalist nature of the US is a terrible thing and the thing that provides opportunities not afforded by one's own country.
It's not even really a trade-off because at the end of the day both live in the same country. The friction and dysfunction that is caused by this division also shrinks the space of the top 20%, who end up in a golden cage at best.
I'm German from a low income family and I went to school with kids of millionaires and everyone walked through the same streets and went to the same bars. First time i went to the US I noticed what living in a bubble actually means. And the kids of the 'winners' seemed as neurotic as the kids of the 'losers'. There's an entire mindset of "if I not go into college X will I be where my parents are", "is such and such street safe", "should we move to X neighbourhood, is it better than Y". Even the "opportunities" that the people in the top 20% is basically are pure stress.
Yes, but that country is fairly huge. Even in densely populated Central Europe, we tend to make fun of sheltered kids from posh neighbourhoods (how many low income kids are there in schools of Nobelviertel, Hamburg? Perhaps a few well-chosen refugees). This effect is ten times stronger in the U.S.
I am not saying that this is right, just a description of the state.
BTW Unsafe streets are definitely a thing in Germany (or Czechia, for that purpose) as well. No one will, for example, move voluntarily to a neighbourhood with a high percentage of Roma population, regardless of how anti-racist was their education. Or to the proximity of a well-known drug dealing space. European hard drug problem is quite acute in some hotspots.
> So to many Canadians, at some point, the potential to make more money outweighs the UHC enough to leave Canada and go to the US to make it big.
It isn't so cut and dried.
At any point these people can return to Canada and receive free healthcare again after only a year of waiting.
What these people are doing is betting that they won't have any crippling healthcare incidents while they're young and banking on the fact that they can always move back to Canada to receive free healthcare for the chronic health conditions that accrue in old age.
Many of these people are effectively leaches on the Canadian health care system as they do not pay taxes into it and then make use of it in old age when they return to Canada.
You don’t even need to wait in most circumstances. If your family still lives at the same residence, and you remember to keep for health card up to date, you can most likely get service as if you never left.
I can find many many many Canadians that complain about the level of care they get from the Canadian system warning Americans never to allow a system like theirs to happen here..
Long Wait times, inability to see specialists, or get surgeries or MRI's etc
US Care is expensive, and we need to solve that, but I still am not convinced turning it over to our inept worthless corrupt government is the best or only solution to the problems with paying for US healthcare
If you seriously believe the government is that bad, then fixing it should be your top priority. Above all else. You can't have a successful country if the government is corrupt. And you can't just patch and hack around its failings. That shit will eventually catch up.
I believe government is inherently corrupt and can not be fixed. As you consolidate power and authority into a central structure it by nature attracts unscrupulous people that wish to dominate others with that power
The only way to resolve the problem of corruption is distribute and limit the power /authority any group of people has, instead we have slowly over the course of time vested more and more power into a ever growing federal government that continues to become more and more corrupt.
Power corrupts, Absolute Power Corrupts absolutely.
The US Federal government was designed to be very Limited and subservient to the people and the States. Over the last 230 years we in the US have lost sight of that, and instead many now believe the government is our sovereign, is the ruler, is the source of our rights, etc. We have lost sight that we are suppose to be self governing, and that our rights are natural not granted by government.
In my view the government that governs the least governs the best, and giving control over my health to said government transform the relationship between citizen and government in a ways irreparably harm the principle of self governance, and individual liberty.
There's no reason for the federal government to run healthcare, even in a single-payer world. There are other implementations of universal healthcare where it could be run by states or counties.
> On the other hand, Canadians are always complaining about not making enough money, getting taxed high and stuff. And many dream about going to the US where their money making potential is apparently higher.
I bet those Canadians are young and healthy, so they (think they) don't have to worry about healthcare costs. Those who suffer from chronic illnesses or are semi/retired aren't so hyped. In summary, what's good for a certain demography isn't necessarily good for the rest of the citizenry (like friends and family, who don't necessarily factor into the decision on where to work).
Exactly. I know a Canadian that’s in their late 30’s, has children, and mixed health record. Now that the adventures are over, they’re eager to move back. Similar stories for European friends that married and had families with Americans.
I live in Canada, I've also lived and worked in the USA.
I suggest you go and live and work in the USA. Be part of their system. Use their healthcare, send your kids to school, walk through WalMart, live your life.
Sure, when you're in the top 30% or so life is pretty good, as long as you can avoid everyone else in society who are struggling HARD. It doesn't take a rocket scientist to figure out why there is so much violent crime, so many people in prisons and so much violent policing in the USA - tens of millions of people are desperate and struggling for the essentials they need just to live.
You simply don't have that in Canada, the social safety net takes that away.
As a Canadian that’s total bullshit. You obviously don’t hang out in the lower income parts of Canada.
Canada has Walmarts that look suspiciously like the ones I’ve visited in the US. Plenty of poor people who get kicked off welfare or get penalized for getting a job.
The US has Medicaid, free healthcare for the poor?
The claim was "Canada doesn't have a problem with violent crime, violent policing [ask First Nations folks about that!], or people who are desperate or struggling".
> The US has Medicaid, free healthcare for the poor?
That's not the same, as there are tens of millions of people that don't have access to affordable healthcare in the USA. In Canada (and a host of other developed countries) there are none.
> The claim was "Canada doesn't have a problem with x, y & z, or people who are desperate or struggling".
No it wasn't.
The claim very clearly was: "Canada has much less of a problem with x,y & z and far fewer people who are desperate or struggling than the USA does".
Sure, but my dad in Canada can’t seem to get a slot for his knee replacement and has been waiting for 2 years and can’t walk. But hey, he has “universal care” right?
And you said “You simply don't have that in Canada, the social safety net takes that away.” which is BS. Yes you have it. To a lesser degree than the US, but you have it.
And how many people just died in BC from the heat wave? 150+? How many in the US? The Canadian healthcare system might be universal but it’s poorly funded and easily overwhelmed.
You get a whole check-up per year at that rate? Here in the states I had to see a doctor (in network with my health insurance) twice during the pandemic, each visit lasted under 40 minutes in an online video call, combined cost out of pocket: $1000 USD.
How is this sold to Americans as a good option? Is it that you have "choice" of insurance providers? Is it that you might pay less if you are healthy? I don't get it, why do so many American's vote in politicians who advocate for this type of healthcare?!
They aren't voting for their own best interests. They are voting to stop people from killing babies and stop socialism (or whatever else they are told).
The debate in the USA is framed with the implication that if you (the health care consumer) does not have "choice" then you will be forced to only see a really terrible doctor, and get substandard care at a high price. And that, with a little effort on your own part, you will be able to select a better doctor at a affordable price.
Therefore, if you have a bad doctor or expensive care, it is your own damn fault. You just didn't try hard enough to find a good one.
It is the same thing with the debate about school vouchers vs. a standard public education for everyone. A heaping dose of "the free market fixes everything", for all life's problems.
I would rather not have a "choice". I would like to be able to select any nearby doctor, and be assured of getting competent care.
I'm not often in the situation where I have a wacky tropical disease that presents odd and incongruous symptoms, which would take a Dr. House to figure out. I am far more likely to have run-of-the-mill heart disease or a common form of cancer. I just need a doctor with some basic level of competence, who can just listen to me and help me through the common health problems of modern life.
Religious schools aren’t the only use of vouchers either. There are also charter schools. Charter schools can often provide specialized programs. Montessori schools seem awesome as well.
I never understood the concept of vouchers. Taxes are connected from everyone to pay for public schools, which can be used by anyone's children. They're not to pay for the schooling of your own children.
I don't have children at all, and I don't mind paying taxes to fund schools, because when I'm old I want the doctor who is younger than to have gotten a good education. I don't expect any vouchers just because I don't have kids consuming public education.
Vouchers always seemed to me like an obvious scheme to defund public schools and let them rot, thereby punishing kids who were unlucky enough to be born poor.
I guess it depends on what you all vouchers, most people advocate backpack funding. The same amount of money per student is spent, but the parents get to choose the school their kid goes to. Instead of being forced to send their kid to failing schools, new schools can be created to cater to the desires of the parents/children.
So it doesn't defund public schools, but it does break the public school monopoly and allows competition among schools - they can cater to the needs of the community and experiment.
> Instead of being forced to send their kid to failing schools, ...
The real issue is: Why are schools failing?
When I was growing up, the vast majority of kids were educated in public schools. They weren't perfect, but they worked at least decently for the large majority of students, and did so for decades. Across the entire region. And they did that as a monopoly system you seen to despise so much.
So we had a system that worked, was scalable, replicable, and maintainable. What happened?
I don't have all the answers there, but at least once thing is clear, there is now an over-emphasis on testing. We had a system that was designed to give citizens important life skills, and turned it into a system that tries to produce drones that can pass tests.
This is exactly the kind of thing we used to criticize Asian school systems about. And now we are trying to replicate their failings. WTF
That's the thing that frustrates me about this debate. People seem to think that educating children well it's such a difficult problem, that it requires constant innovation. That it requires the "power of the free market" to solve. No, it doesn't. We have known how to do it for a long time. It just requires political will.
And that brings us to another factor, one political party is actively anti-science and actively anti-education. This was definitely not the case 30 - 40 years ago. Back then, they were both pro-public education.
Nobody really has any effective way to evaluate them, or at least, nobody does so on a broad basis or consistently. Some of them can’t pass fizzbuzz. Some of them can churn out CRUD apps, but have no idea what they’re doing when it comes to anything else. Some of them are extremely dogmatic about design patterns and tooling and ignore anything they don’t like. Some of them are inattentive or poor listeners. Some of them assume it’s Problem X they’ve seen a million times, but it’s not. Some of them are assholes. Some of them are really sharp and really engaged, but get overly excited and reinvent the wheel or spend a lot of time doing stuff that’s completely unnecessary and maybe even harmful.
I don’t know how to evaluate doctors until I see them, I have no idea if better doctors cost more or less, I doubt there’s a strong correlation because nobody else can evaluate them either. They either help me or they don’t.
I think it absolutely is necessary that I should be able to have a history and see the same doctor, and that I should be able to see another doctor any time I want for the same condition for a second, third, or fourth opinion. I have seen this be absolutely necessary for myself and others with common conditions that were resolved after seeing a different doctor.
I assume this is still possible in most if not all public health care systems (I live in the US but local doctors and hospitals are all government run, an interesting aside), but I am not sure. I recently had a conversation with a Canadian friend who has debilitating autoimmune disease his specialist is doing basically nothing for and he made it seem like it wasn’t possible, but I didn’t want to press.
Because it’s not the insurance that’s expensive, it’s the medical care, and rooting out the zillion reasons that’s expensive is difficult and involves attacking some sacred cows.
Plus, about a quarter of Americans have “free” care already, via Medicaid and Medicare. Many of the rest have their employer hiding the true cost from them - they think the premium that comes out of their check is the actual cost. Some employers apparently even pay 100% of the premium cost.
So all these people are okay with the status quo, or even want to defend it. It’s the people on (increasingly common) high deductible plans, people with no insurance, or people who experience a catastrophic edge case (out of network provider for example) that hate it.
To be quite honest, most of it is sold by the media, who have mutually beneficial arrangements with the for-profit healthcare/insurance industry. If you’ve ever seen how many advertisements on American TV about prescriptions, health plans, etc, you know what I’m getting at. The debate is kept tightly constrained to make the capitalist system seem more robust and successful than it actually is. So: media propaganda, more or less.
Also want to add: my child’s birth cost $20,000 (with insurance). When I would tell other Americans about this, the response was (usually) “you know you can get on a payment plan, right?”
The high cost of healthcare in the US has very little to do with the structure of insurance. Insurance industry profits only account for 2% of aggregate medical expenditures.
The reason that Turkish healthcare is much cheaper than American healthcare is primarily because Turkish doctors are paid much less than American doctors. (As are Turkish nurses, and Turkish drug and device wholesalers, and so on.) There's a very simple solution to that. All you have to do is let Turkish doctors come to the United States and practice medicine. Or better yet let Turkish hospitals open entire branches in the United States and wholesale import their staff, equipment, and drugs from Turkey.
The reason that doesn't happen is because we have a cartel called the American Medical Association that continuously lobbies for antiquated barriers to foreign competition. Unless a physician does a residency in America (which good luck, if you're a foreigner from a foreign school), you will never be allowed to practice in the US.
There is a shortage of residency slots in general, not just for foreign doctors. That shortage is caused by lack of federal government funding. The AMA has actively lobbied for more residency slots.
Yeah if I were a doctor with insane amounts of debt after training for ten to fifteen years I would support any "cartel" that works to increase my salary too. Cheaper healthcare is not the only thing the US needs. Cheaper college education is important too.
Failed reform after failed reform after failed reform.
The reforms also create a dramatic increase in bureaucracy.
For example, my daughter needs to see a specialist. I call the specialists office. I’m told there are too many patients. The doctor has to chose which to see. I need to call the primary, and have them forward my daughters info. The specialist office says she is not high enough priority and cannot be seen (my daughters condition is crippling, but not fatal as it is for others).
I call up the next specialist on the list. They are overbooked. I need to call up the primary and they a referral. I call primary again. I get referral again. Again the specialist decides not to see my daughter.
I call the next specialist … etc.
Did I mention that for some specialists the insurance info is out of date. They are not in fact in network. So once I get an appointment, I must verify with insurance they are in network.
I’LL PAY THE F*KING MONEY IF YOU GET RID OF THE BUREAUCRACY!!!
Obamacare increased bureaucracy. Clinton HMO increased bureaucracy.
I’m a highly compensated professional. My healthcare is free.
You have the choice of which random areas to gamble on buried in small printing of lengthy contracts.
Medicare isn't public universal healthcare. The prescription plans, Medicare Advantage plans, and medigap plans are run by for-profit companies. $300-500 per month, and many good companies, like Thrivent, are getting out of healthcare completely.
That person’s experience is bizarre. There’s something they aren’t telling us. Americans don’t pay anything like $1k for a checkup or pair of them, especially a virtual one.
I am not sure what you'd mean by whole check-up but I had one last year at this hospital and it was included in the private health insurance for free. It does not list every item but it might give you a rough idea (yes, I had a chest x-ray and a general ultrasound check):
One last thing, probably there is a better English term for this but we have these government institutions in each neighbourhood. They are small and they employ 4-5 doctors and a couple of nurses that provide first level healthcare. (I would say there is a doctor for around 5000 to 10000 people) If you would go to your assigned doctor and ask for it, they do many of the blood tests at the same day and hand the results. This is a common procedure afaik and your doctor would be encouraging to do it every 12 months even if you don't ask for it.
Yes, we don't make too much money and pay about 25-40% income tax but we don't need to shill thousands of dollars for a facetime call with a doctor.
My suggestion would be to visit Turkey and spend those couple thousands USDs on check up and some nice vacation :)
I believe that the person above was using a common english expression to put emphasis on the fact you received a complete medical check up that probably included your doctor's undivided attention for over an hour as well as blood tests and a follow up by your doctor as part of your $400USD annual healthcare costs.
They are contrasting that with their brief online sessions with their doctor that cost them $1000.
The emphasis on whole is to distinguish being the partial check up that they received for more money.
An average person's healthcare costs a few thousand dollars per year in EU. That includes people with innate conditions or other expensive treatments. Most of the countries have zero or only nominal out of pocket expenses.
Were you seeing a specialist of some sort? For comparison I’m in the states and a wellness visit is -mandated- to be free per year and my primary care provider charges $60 for a 30 minute video call outside of that. I use a high deductible plan so this was not my copay or anything it was the full cost after insurance negotiated rates.
Even on a high deductible plan, the most a regular doctor consultation should cost is ~$250, in my experience. But we would need to know what exact codes were charged. The medical coding/charge system is complicated enough for people in the business, outsiders have almost no chance of getting it right at first glance.
I thought in post-ACA America, all health insurance has to cover 100% of the cost of your annual physical? Were your visits explicitly preventative checkups?
I have had healthcare.gov plans on both coasts, and they did include an annual preventative care consultation. I would be surprised if any plan did not. I just schedule it with flu shot. Lab tests may or may not be included, but I have done an annual whatever routine blood test there is showing A1C and lipids and whatnot, and I do not have to pay.
How much does the specialists earn in Turkey? In Australia Surgeons, Anaesthetists and internal medicine specialists top the highest earning professionals chart. Registered Nurses and allied healthcare staff also gets paid quite high. Then there is stupid high cost of prosthesis in a country where we do a lot of knee and hip replacements. Do you have those private space odyssey type hospitals distributed in the whole country or only near Istanbul?
The system in the US is exactly as crazy as it seems. It generates lots of profits and lots of financial hardship for patients. There is just about zero political will for any political party to fix the situation and we all expect it to continue to get worse.
It doesn't make sense to just talk about insurance premiums if you are existing within a system also funded by tax dollars.
Phrases like "you don't need to pay anything for the state hospitals" just means you are ignoring tax contributions, which isn't going to lead to any sort of reasonable comparison with other systems.
I'm not ignoring the tax contributions. You would pay 25-40% income tax for pension plus social security depending on your income. I'm super glad to pay that and willing to pay more if that means parents don't have to go "shopping for insulin at a supermarket" for their children. It's just insane and can't wrap my mind around it.
A typical counter-argument to this is that America does have high prices; but those prices attract the best doctors and innovators in the world, who offer the best healthcare and health-tech in the world.
Each medical appointment visit with Medicare part A (doctors) is $50-300 unless having a Medigap or Medicare Advantage plan run by for-profit corporations for an extra cost.
Medications cost a ridiculous amount of month with Medicare unless you're very upoor to qualify for ExtraHelp to make Part D (medications) costs low.
If you're not disabled or poor, you will soon go bankrupt if you have a chronic condition and do not have a job with benefits that include medications.
We've asked you before not to post in the flamewar style to HN. If you keep doing it we are going to have to ban you, so please review https://news.ycombinator.com/newsguidelines.html and fix this.
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[ 3.7 ms ] story [ 253 ms ] threadMy wife requires quite a bit more insulin while pregnant for example - she had to make changes to her pump's settings while in the hospital to accomodate it.
What I found: 1 unit of insulin will cover 10g of carbohydrates [1]
Humalog insulin comes in 3 mL (300 units) vials or 10 mL (1000 units) vials. [2]
The list price of a Humalog U-100 10 mL (1,000 units) vial is $274.70 [3]
In type 1 diabetes, most people need a total of 0.5 - 0.8 units of insulin per kilogram of body weight each day. [4]
In patients with type 2 diabetes, marked obesity, and insulin resistance, total daily insulin doses of 200 to 300 units are often required. In this setting, management for most patients includes a total of 1.0 to 2.0 units of insulin per kilogram per day; thus, in very obese patients, a larger total dose is required. [5]
In type 2 diabetes, the average weight is 96.5kg - 98.9kg. [6]
The average American weight in 2020 was 181 lbs. So around 82kg. [7]
With the above details, in type 2, about 100 - 200 units are needed per day. That’s $989 - $1978 per year. In type 1, $494 - $791.
1. https://www.medicalhomeportal.org/link/3822
2. https://www.nationwidechildrens.org/family-resources-educati...
3. https://www.lillypricinginfo.com/humalog
4. http://www.diabeticretinopathy.org.uk/prevention/insulindose...
5. https://www.patientcareonline.com/view/insulin-dosing-how-hi...
6. https://care.diabetesjournals.org/content/29/3/493
7. https://news.gallup.com/poll/328241/americans-average-weight...
This varies significantly from patient to patient actually. The same goes for basal rates (how much insulin you need to maintain a healthy blood glucose level excluding what you eat). As you mentioned, weight is a big factor but so are other things like age, sex, diet, activity level, stress level, and just how well your body reacts to the insulin. Some people respond very well to artificial insulin while others just don't for some reason. I believe it can also depend on how long you've been using insulin. Your body can slowly stop responding as well as it used to.
The numbers you came up with as an average sound pretty reasonable, but it's important to remember that daily dosage will vary quite a bit between individuals.
Additionally my pump (tandem x2) has a lot of loss due to their loading system. For 300 units loaded, you get 250 deliverable units. Reloads happen about every 5 days.
For use per month, I have 2 vials per month prescribed.
If you are thinking about cost: pump insertion sets and continuous glucose monitoring sensors are all very expensive as well.
I use Lantus as my long acting insulin, and Humalog as my fast acting insulin. I receive a shipment of three 10ml vials of each every 3 months (so I use 1 a month). I use 30 units of Lantus a day, and a variable number of units of Humalog, averaging 25 units a day. Thus, 1 vial of Lantus lasts me slightly over 30 days, which is how long you should use a vial of insulin before replacing it.
Figuring out how many units of insulin to take can be difficult. This year I got a Freestyle Libre 2 glucose monitor which has alarms which will alert me if my glucose goes above or below preset limits. Fortunately, I am sensitive to hypoglycemia; sensitive enough that I will wake up if I go low while I am sleeping, but I can still get as low as a glucose reading of 40 point before I feel the effects, which upsets me and freaks out my wife. The alarm is set for 80 points, so I can take some carbs before I get seriously hypoglycemic.
I adjust my Humalog injections based on my glucose readings and my carb intake using a formula I have adjusted over long experience. I may take as little as 1 unit (if I just need to bring my glucose reading down) or as much as 12 units with a meal, but most of the time I take about 8 units with a meal.
Wow. That's double the rate of a country like France. An ounce of prevention really is worth a pound of cure.
Looking around, first response on google shows US prevalence is much high higher and increasing while France is lower and decreasing
https://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/c...
We have the technology. The cure is cheap. It's criminally insane that the US doesn't make life-saving or life-bettering drugs more available for free.
Insulin of this type is used primarily to treat Type I diabetes.
The only "cure" I know about for Type I diabetes is insulin, the subject of TLA and as far as I can tell, the subject of GP's comment also. Your comment appears to be the first introducing the idea of diet, which suggests that maybe, as I said, you're confusing diet-related Type II diabetes (not the subject of the article) with Type I diabetes (the subject of the article).
You cannot improve your lifestyle to prevent Type 1. However, it is epidemic across the entire western/developed world -- incidence doubles every ~6-7 years.
The America bashing on this site really does get tiresome, especially with comments like this one that are just totally meaningless. Especially when America and France have the same percentage of diabetic people: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/E...
https://data.worldbank.org/indicator/SH.STA.DIAB.ZS
France was just an example, but even your link proves my main point. It's not just diabetes. Heart disease is 2x as common in the US as in many other developed countries as well. I don't see how this is "america bashing" (of which I myself have been critical of in the past on this website). What I've presented is useful data that contributes to the discussion over healthcare costs.
Your link doesn't show that comparability.
France is the highest rate in EU at 10% for ages 15+, EU average is 6.9.
US average for ages 18+ is 13% [1] West Virginia has the highest adult rate of US states with 15.7% [2]
https://www.cdc.gov/diabetes/data/statistics-report/diagnose...
https://www.americashealthrankings.org/explore/annual/measur...
$879 is the cheapest casket if that's what you're after. The cheapest items were all urns.
EDIT:
Forgot to mention. COVID seems to have been causing a rise in Type-I diabetes cases in non-juveniles =/
While one can increase their chances of developing diabetes later in life with poor diet choices (called Type 2), many people are born with diabetes. (Type 1)
It's wild how diabetes is an epidemic in so many places.
http://main.diabetes.org/dorg/PDFs/Advocacy/burden-of-diabet...
Big box stores push refined and processed foods that contain excessive amounts of sugar these days. They have sugary snacks and drinks in the checkout lines. They carry very few products without added sugars; try to find a bread, pasta sauce, or soup without crazy amounts of sugar.
It's not entirely their fault, but Walmart has demonstrated in the last 40 years that they can compel manufacturers to just about whatever they want. If they wanted, they could push for the reduction or elimination of excess sugars in processed foods.
But then again, there wouldn't be as large a market for Walmart brand insulin if they did that.
So… you think Walmart sells processed foods because it will increase their insulin sales? Not because they’re extremely popular high margin sales items?
90-95% of people who have diabetes are type 2. It's largely a lifestyle disease, even when you include those who have autoimmune issues.
The inventor of insulin sold the patent for $1 because the thought that it would not be available to all was unconscionable.
It is absolutely unacceptable that insulin is not free and available to all (including to those who can afford it at the cost of financial stability).
The idea that someone without means should have to pay Walmart $86 for a worse low-budget insulin is disgusting.
See: https://diabetesstrong.com/walmart-insulin/
Good thing the article is about Walmart now selling 'analog insulin' ie. modern version of insulin
Walmart sucks in a lot of ways, but this article does not demonstrate that.
good thing there are two comments about it!!!
Orwell called it 'Duckspeak'.
Yes that's exactly the point. I make $150k a year, live very comfortably and pay almost 30% tax (in USA). If the government stops funding endless wars and starts using my tax money to help people get healthcare and education, we wouldn't have this problem.
Take half the DoD budget, add in medicare and medicaid outlays, and throw on what most of us pay for insurance already, and you're most of the way to paying for a decent health care system. It's criminal that Americans in 2021 could die from diabetes complications due to lack of affordable insulin.
I asked the driver if that bus was the free one (meaning, if that was the bus in which I didn't have to pay). The driver replied a bit angry that the bus trip was not free, it was complimentary.
The law was modelled around the companies’ existing patient assistance programs, and despite assurances from industry reps, PhRMA sued the state anyway just hours before the law was due to take effect[1]. This spring, their lawsuit was dismissed[2].
This law isn’t a great solution if you think that insulin should be free to all, but it is at least something that other states can use as a model to try to help their citizens access to cheaper, high-quality insulin.
[0] https://www.mninsulin.org/
[1] https://www.minnpost.com/state-government/2020/07/why-so-man...
[2] https://www.twincities.com/2021/03/16/alec-smith-insulin-aff...
My impression was: The crazy hoops and loops that Americans will go through for healthcare just to NOT implement a sensible social healthcare program.
I just joined one. My primary care physician recommended it. It's about 28% the cost of the regulated ACA plans in my area for my size family. Read that number again. And, it covers everything (except no pre-existing conditions) except for things like cosmetic surgery.
The list of things that the ACA plan didn't cover at all was confusing and pretty lengthy, and it had a $9k deductible (or more, many of the cheaper plans had $15k deductibles) per family member, and double that (two family member's worth) for a max family deductible. To me, that is crazy. And, for the cheaper plans, they required coinsurance, so if I had a disease that would cost $200k, I would owe $67k.
Most amazingly, there's no deductible except for the $400-per-visit deductible. (There's no free maintenance or co-pays or anything like that.) Everything is covered after the $400-per-visit deductible, and there's virtually no maximum. Go to the ER, max of $400. Go for a checkup, probably pay it yourself (unless it exceeds $400).
(One could argue that they should cover an annual checkup, but if it was just a matter of adding $150/year to everyone's plan, what's the point; that's an arbitrary amount that can be budgeted in once you know to expect it. Since it's people of that religion only, some built-in pre-qualification occurs to eliminate people who would just abuse the system.)
These health share non-profit organizations have paid out billions by cooperating and coordinating among their members, and you negotiate with the hospital directly as a cash patient and make your own choice of care and providers.
It's somewhat akin to how a credit union is dissimilar to a bank.
I personally find the idea fascinating and certainly prefer it to forced socialized medicine.
$400 is pretty close to the cost of an office visit, physical exam, metabolic panel, lipid panel, and EKG, which is what a primary care doc is going to order annually on something like 90% of Americans after a certain age.
It shifts the expense of routine care and checkups to the patient. If you view insurance as indemnification against unexpected loss, it shouldn't be paying for expected, routine costs.
That's also why car insurance pays you to install LoJack and homeowners insurance pays you to install fire alarms.
But this isn't true -- at least for any car insurance or homeowners insurance that I've purchased. You often receive a small discount, but the discount alone doesn't cover the cost of purchase/maintenance.
A health insurance analogy would be: Customer A pays $100/mo because he gets an annual checkup and takes the medicines the doctor prescribes. Customer B pays $200/mo because he hasn't seen a doctor since college.
Customer B could reduce his total out of pocket by $800 per year if he paid for the $400 visit.
You're foisting the sick and the elderly onto government programs, and patting yourself on the back for pulling yourself by your bootstraps.
They aren't the ones running government.
It's like the stuff we did when we were kids: "I'll do it because I want to, but not because you tell me to".
Things like the NHS or Germany health system (both I've experienced) are pretty good. But hod forbids the US implements those /socialist/ systems.
- "Most people with diabetes need at least 2 insulin shots a day. Some people need 3 or 4 shots for good blood sugar control." (https://www.aafp.org/afp/1999/0801/p649.html)
- "In November last year, Walmart launched the ReliOn Novolin 70-30 insulin pen. The cash price for a pack of five pens is $42.88, compared to $300 for the brand name option." (https://www.wfmynews2.com/article/news/verify-yes-walmart-do...)
So we're talking about $25 for 1-2 days of vital injections. Approx $4,500 - $9,100 annually.
A vial has 1000units and lasts about 2 weeks.
Analog insulins are different than the type that the $1 patent is for. They are much more advanced and are much more complex to make. That doesn't speak to whether or not the current prices for insulin are reasonable (they're not)... but you make it sound like "someone invented this and made the patent free, and now people are selling it for $86"... which is not the case.; not even remotely.
- Lilly wants to set the price at, to pick a random number, $100 per bottle.
- PBM says "I need to tell the insurance company I saved them 50%, so you have to charge _my_ client 50% of list price"
- Lilly wants their business, so changes the list price to $200.
- Then Lilly "graciously" lets people without insurance use a coupon to _only_ pay $100 for it.
Everybody gets to pretend they're the good guy. But the insulin costs $5 to make.. so really, they're not (once again, made up numbers).
My curiosity got the better of me, so I rang up my mother who's had type 1 since childhood.
She said 5x3ml vials of Lispro (or just about any brand) was approx. $40 in the pharmacy.
Once she's spent more than $275-ish in a calendar year, the insulin is free (well, tax funded) until December 31st.
This is in Norway, where the state presumably negotiates good deals with big pharma as they are basically a single customer buying goods for however many of a population of 5.5M need insulin (injected, that is)
> The idea that someone without means should have to pay Walmart $86 for a worse low-budget insulin is disgusting.
The article is talking about the modern formulation for $86. The older-style worse formulation is $25. As I understand it, and I may be mistaken, $86 is very competitive in this space. I don't disagree that maybe insulin should be funded by government at zero cost to the individual, but your description of the $86 formulation described in the article seems inaccurate.
You have to utilise incentives and regulation to keep prices down. One option is to adjust patent law to enable generic manufacturers to create competition. The downside of this is the generic pharma companies are usually off-shore (more profit that way) and also seem to just pretend to make the actual drug with some regularity (also more profit that way). Another option is for the US government to negotiate drug prices. The US market for medicine is so large that they would have incredible power to cut good deals. The downside to this option is that it will inevitably lead to some form of corruption eg. the drug negotiators don’t try too hard so they can get a cushy job at the drug company next year in their drug negotiating unit.
Anyway, I am fairly sure the latter option will happen soon, perhaps for some group of essential medicines.
Prior to 100 years ago, this conditions would have just been fatal. That you can keep yourself alive today for less than the cost of your mobile phone bill is a pretty good value proposition. I just don't understand the outrage.
Did these costs double between 2012 and 2016?
https://www.reuters.com/article/us-usa-healthcare-diabetes-c...
Its not worse, its significantly better. The version of insulin sold for $1 is human insulin, which has been available at Walmart for $25 for many years. The version being discussed here is human analogue insulin, which was invented by the pharma companies in the past few decades. Its significantly better tolerated, and the rates at which the body can uptake the insulin can be tweaked to be much faster or long-lasting. Its like comparing a Tesla to a Ford Model T.
Honestly, yeah. The quality of life improvement between the two is humongous. I've heard treatment on the older insulin therapies described as "a life ruled by the clock where a mistake means death."
What is going on is that big pharma is now charging a premium for the user experience, and not the actual cost of the product or amortizing R&D.
(Of course the caveat here is that a therapy regimen that uses ultra lente insulins exclusively may be suitable for some type II diabetics who hadn’t achieved appropriate glucose control on oral antihyperglycemics, and that insulin dosing with meals using rapid acting insulin on top of a ultra slow acting insulin may follow after a while).
Edit: Wait. Novo Nordisk, their producer, is one of the established insulin vendors. Why are they helping to reduce prices?
Also, does anyone have an estimate of how high the margins still are?
https://divabetic.org/2017/06/08/transparent-pricing-works-h...
They fear a Congressional inquiry and federal price caps. Normally, you'd expect a new medicine entering the market to get cheaper as the production ramps up, yet it's gone the opposite direction, even after the patent has expired.
The big insulin makers like Novo and Lilly have been bearing the brunt of the PR disaster that is drug pricing, but reaping little of the benefit, as, according to them, their revenue per unit has barely budged in decades. Increased costs are to appease the insurance companies/PBM middle men (because due to the rebate system, they don't actually have to pay those increased costs). Both Novo and Lilly have attempted ways to cut out the middle men, with reduced payment programs, like the one mentioned in the article, or through "savings cards". However insurance companies have gone out of their way to combat these, limiting their effectiveness.
I think what's notable here is that Walmart actually has enough corporate muscle to allow a pairing with the pharma companies that the insurance companies will struggle to combat.
source?
"Starting this week, the retailer will sell an exclusive private-label version of analog insulin, ReliOn NovoLog, to adults and children who have a prescription."
What's the implication for those who live in a state like Pennsylvania and do not need a prescription to buy insulin, much to the dismay of many in the medical community.
https://www.researchgate.net/publication/42769372_Murder_by_...
And finally, Wal-Mart has been driving this agenda through low priced insulins for years and deserves praise for that effort to affect change. Can we expect the same from Amazon now that they've chosen to enter the pharmacy business?
And frankly, the best way to dismantle the system is through some form of publicly available, universal health insurance. I believe in the power of healthy, free markets as much as anyone, but the current healthcare system is anything but. The lack of a non-profit seeking provider of health care, in a space where customers options are to pay whatever is charged or simply die, is not a functioning market. The rebate system was born out of what was a legislative bandage over this issue. Continuing to try and come up with cute solutions that avoid government provided healthcare for all will see similar results. Its why Americans spend so much more on insulin, and most other forms of healthcare services, than the vast majority of the world.
Look...I agree with the majority of your point, the majority of healthcare doesn't deal with such an obvious binary...and we aren't going to make progress on this issue unless we're willing to also have the conversation about healthcare within your control - e.g. individual responsibility for your healthcare.
A number of close family members are doctors / surgeons of various kinds, so I've heard so many issues & complaints about the system. And while I would happily pay taxes to fix healthcare issues that are preventative (e.g. cancer screenings,) educational (e.g. nutrition,) and overall unpredictable (e.g. surprise brain aneurysms or the like,) I have no desire in paying for:
- Someone who drank so much and annihilated their liver, requiring significant & expensive surgery
- Someone who couldn't stop eating at McDonald's and hasn't touched a vegetable in a decade now wants lifetime insulin and kidney transplant
- A hypochondriac who wants to see their doctor for every scratch, off-color skin mark, etc.
- Someone voluntarily jumping off planes, doing dangerous sports, etc. without insurance, and expecting someone else will foot the bill
- Someone who wants every and any blood test because they coughed once
etc. etc. etc.
Again...overall I agree with a more central payer system, but you won't get the conversation started with all the groups involved unless you acknowledge that there's some element of individual responsibility that you need to control for as well.
None of us want to be taken advantage of, but I weigh protecting the most vulnerable and unfortunate, of whom there are many, more heavily.
The easiest way to find out if someone lacks health care access is to ask them if they work with their hands.
The classic example is drug testing welfare recipients which was proven to cost more than just giving it out.
Sometimes you have to chalk some of this stuff up to "the cost of doing business."
https://www.dailymotion.com/video/xc3x84
Why keep your moral condemnation limited to taking health risks? What constitutes healthy behavior is very fuzzy at the edges, I would prefer to condemn people based on who they vote for, or their religion. Why would I want to support the continued lives of people who I think cause health problems in other people?
That’s called an addiction. It’s a disease. And that should (and can) be fixed by a doctor.
> - Someone who couldn't stop eating at McDonald's and hasn't touched a vegetable in a decade now wants lifetime insulin and kidney transplant
Same thing + metabolism issues, aggravated by voluntarily aggressive marketing. Can and should be fixed by a doctor.
> - A hypochondriac who wants to see their doctor for every scratch, off-color skin mark, etc.
Psychiatric issue with real psychiatric or physical pain : can and should be fixed by a doctor.
> - Someone voluntarily jumping off planes, doing dangerous sports, etc. without insurance, and expecting someone else will foot the bill
Just make insurance mandatory for extreme sports like in most countries.
> - Someone who wants every and any blood test because they coughed once
Same as above. Hypochondriasis is totally documented as a real suffering and psychiatric issue.
All your examples are situations that can be prevented with preemptive medicine which is the norm in countries where you can see a doctor long before being sick. I’m not saying it’s easy or perfect, but it’s easier for doctors to prevent diabetes if they can follow patients regularly and check their vitals than if they only see them once a year or less because they can’t afford it.
But yours isn't even a selfish perspective, but a moralizing one. You don't like the idea of someone getting healthcare that you feel doesn't deserve it, and it seems like you don't care if that means you pay more for healthcare or receive worse healthcare outcomes as long as those people can't see a doctor.
Why this only becomes a problem when done at a state or national level, is not something I can fathom.
If anything, the larger risk pools would drive costs down.
Public healthcare won’t get rid of it.
There’s not one simple fix for this. If it’s truly going to be fixed, it’s going to require a lot of very tough fights against entrenched interests to eke out 5% here and 3% there.
And I'm writing from Turkey which you would think it would be terrible in managing any public infrastructure including health.
My company pays equivalent to 400 USD per year for private health insurance, gives me unlimited access for surgeries, any treatment that I need to stay at hospital and a check-up per year. The insurance is valid in any private hospital including the ones that look like straight out of Space Odyssey.
You know what's more interesting? If you think this is a good deal, then almost everyone in Turkey thinks this kind of service should be provided by public healthcare system and demand it. Not only for the people that can pay 400 USD per year.
edit: I realized it sounds like you need to pay 400 USD for unlimited healthcare but you don't need to pay anything for the state hospitals. The insurance is for zero-cost treatment at the private hospitals. You do pay a contribution fee around 3-5 USD for every visit plus prescription at the state hospitals though. I believe it is for discouraging unnecessary visits to the hospitals but even that causes a stir.
In virtually all developed countries, it is provided. Hundreds of millions of people around the world live this way, right now.
The problem is that neither party wants to make deals. They both want to have their existing programs AND to add extra ones on too.
Everyone follows their incentives. None of them have the incentive to make a deal and get de-elected. They have lots of incentive to grandstand and call the other side bad-guys for being bad and not agreeing to this thing that "we all know is moral and right" that clearly we don't have some kind of 90% super-duper extra majority that all agree it's right. If we did, it would most likely be done already.
Nope.
Leaving aside the the current psychotic break the GQP is experiencing this year, universal health care is not something they've ever wanted.
Why? Well, the insurance companies and for-profit hospitals have big lobbying efforts to ensure that sort of thing absolutely will not get passed. Because it would kill the need for them (insurance) or hurt profits (hospitals).
UHC will not happen until there is serious reform with how politicians get elected, and how lobbying works.
Nope to that!
See I can make unfounded assertions too! It's fun.
> Leaving aside the the current psychotic break the GQP is experiencing this year, universal health care is not something they've ever wanted.
There's a difference between "I would never, ever vote for this under any circumstances because NO WAY" and "I'll get voted out if I allow an increase in spending on something that my voting base doesn't want".
In the same way that Democrats couldn't go to their voting bases and say "see we got universal healthcare! " if they had to give up the necessary funding in other places in order to make it budget-neutral, Republicans could only hope to get re-elected if they could go to their voting bases and say "look yeah we compromised, but it was on a thing that was budget-neutral! We didn't get a tax break for you, but we did eliminate all these other $horrible programs!"
I'm not saying that's good or right or what we want. But both sides are playing to their audiences and very much tuned in to what they want. That's what you have to do to get re-elected. That's why neither side is interested in compromising to make a deal. They'll get crucified for "not standing up for what WE believe in" and "compromising with that other side full of awful, evil people"
I don't really like that the US hasn't done much legislatively in the last 20 years. But, I, personally, myself don't get to decide how all this works. And neither does anyone else.
The "stances" the voting base take are largely shaped by influence campaigns of powerful interest groups. Both major parties (the minor ones too) are affected by this. Though one of the groups has gotten even stupider recently, and they actively vote against their own best interests.
Edit: grammar.
The idea that it's the voters that vote is actually true! That's how the system works. Corporations can influence that of course, probably to an enormous degree. But the corporations themselves don't vote. That's the system we've got.
The primary mechanism in our system is people. And people aren't logical, rational, economically-maximizing, or any of it. People are far more narrative-driven than they are rationally-driven.
THAT's what I would say that Republicans would get on board with a universal healthcare bill in which they could claim that they "destroyed" the Democrats by "obliterating" a bunch of "socialist pork". But that's absolutely going to ensure that the Democrats that "caved" in order to get something important done won't be able to get re-elected. And they care more about getting re-elected than they do about doing the right thing! Same on the other side of the isle! This isn't a partisan issue. Everyone wants to get re-elected way, way, way more badly than they want to do the right thing.
I don't like it. I don't think it's right. But it's extremely easy to see that neither party is compromising in any meaningful way these days. Both take hardline stances and don't budge. That's not a bug, it's a feature of American Democracy. It was designed such that if there wasn't wide agreement (or elected officials who would compromise) that things would grind to a halt. That was done so that nobody could run roughshod over the other.
Until we start getting richer such that the increases in spending are coming out of even bigger growth or we somehow manage to convince everyone that paying more and getting less is totally-A-OK this is going to be how it continues to go. Neither side wants to compromise, so their counterparties don't want to either. Deadlock is the name of the game.
> and they actively vote against their own best interests
I can understand how you'd think that. It makes a lot of sense. But it belies a terrible ignorance on your part. Animals don't make decisions on purpose to make their own lives worse in ways in which they KNOW they will end up worse. You can try and project your ethics onto other people all you want and use their relative-to-you irrationality to belittle them. But it doesn't work! Putting people down doesn't change minds. In fact putting people down might be the very thing that got Trump elected (re: deplorables).
I'm not saying Trump is good and Hilary is bad BTW. I'm just using that as an example of how unfortunate it can be to generalize one's personal ethics to the entire country and draw conclusions as a result.
Democrats could give up everything they hold dear, and I still don't think Mitch would make that deal.
I'm from Canada and we have Universal Health Care which is great.
So when it comes to health care many Canadians like to shit on the US.
On the other hand, Canadians are always complaining about not making enough money, getting taxed high and stuff. And many dream about going to the US where their money making potential is apparently higher.
So to many Canadians, at some point, the potential to make more money outweighs the UHC enough to leave Canada and go to the US to make it big.
So depending on where you are the capitalist nature of the US is a terrible thing and the thing that provides opportunities not afforded by one's own country.
Being in bottom 20 % of the USA seriously sucks.
That is the tradeoff...
I'm German from a low income family and I went to school with kids of millionaires and everyone walked through the same streets and went to the same bars. First time i went to the US I noticed what living in a bubble actually means. And the kids of the 'winners' seemed as neurotic as the kids of the 'losers'. There's an entire mindset of "if I not go into college X will I be where my parents are", "is such and such street safe", "should we move to X neighbourhood, is it better than Y". Even the "opportunities" that the people in the top 20% is basically are pure stress.
Yes, but that country is fairly huge. Even in densely populated Central Europe, we tend to make fun of sheltered kids from posh neighbourhoods (how many low income kids are there in schools of Nobelviertel, Hamburg? Perhaps a few well-chosen refugees). This effect is ten times stronger in the U.S.
I am not saying that this is right, just a description of the state.
BTW Unsafe streets are definitely a thing in Germany (or Czechia, for that purpose) as well. No one will, for example, move voluntarily to a neighbourhood with a high percentage of Roma population, regardless of how anti-racist was their education. Or to the proximity of a well-known drug dealing space. European hard drug problem is quite acute in some hotspots.
It isn't so cut and dried.
At any point these people can return to Canada and receive free healthcare again after only a year of waiting.
What these people are doing is betting that they won't have any crippling healthcare incidents while they're young and banking on the fact that they can always move back to Canada to receive free healthcare for the chronic health conditions that accrue in old age.
Many of these people are effectively leaches on the Canadian health care system as they do not pay taxes into it and then make use of it in old age when they return to Canada.
Long Wait times, inability to see specialists, or get surgeries or MRI's etc
US Care is expensive, and we need to solve that, but I still am not convinced turning it over to our inept worthless corrupt government is the best or only solution to the problems with paying for US healthcare
If you seriously believe the government is that bad, then fixing it should be your top priority. Above all else. You can't have a successful country if the government is corrupt. And you can't just patch and hack around its failings. That shit will eventually catch up.
The only way to resolve the problem of corruption is distribute and limit the power /authority any group of people has, instead we have slowly over the course of time vested more and more power into a ever growing federal government that continues to become more and more corrupt.
Power corrupts, Absolute Power Corrupts absolutely.
The US Federal government was designed to be very Limited and subservient to the people and the States. Over the last 230 years we in the US have lost sight of that, and instead many now believe the government is our sovereign, is the ruler, is the source of our rights, etc. We have lost sight that we are suppose to be self governing, and that our rights are natural not granted by government.
In my view the government that governs the least governs the best, and giving control over my health to said government transform the relationship between citizen and government in a ways irreparably harm the principle of self governance, and individual liberty.
I bet those Canadians are young and healthy, so they (think they) don't have to worry about healthcare costs. Those who suffer from chronic illnesses or are semi/retired aren't so hyped. In summary, what's good for a certain demography isn't necessarily good for the rest of the citizenry (like friends and family, who don't necessarily factor into the decision on where to work).
Exactly. I know a Canadian that’s in their late 30’s, has children, and mixed health record. Now that the adventures are over, they’re eager to move back. Similar stories for European friends that married and had families with Americans.
I live in Canada, I've also lived and worked in the USA.
I suggest you go and live and work in the USA. Be part of their system. Use their healthcare, send your kids to school, walk through WalMart, live your life.
Sure, when you're in the top 30% or so life is pretty good, as long as you can avoid everyone else in society who are struggling HARD. It doesn't take a rocket scientist to figure out why there is so much violent crime, so many people in prisons and so much violent policing in the USA - tens of millions of people are desperate and struggling for the essentials they need just to live.
You simply don't have that in Canada, the social safety net takes that away.
Canada has Walmarts that look suspiciously like the ones I’ve visited in the US. Plenty of poor people who get kicked off welfare or get penalized for getting a job.
Poverty is far from solved in Canada.
At no point did I say it was. Please don't jump to strawman arguments, it doesn't help anything.
I simply said there is much less poverty in Canada that in the USA. I think that would be very hard to argue against.
> Plenty of poor people who get kicked off welfare or get penalized for getting a job.
Every single one of them has perfectly acceptable heathcare, which is a HUGE step above the USA's poor.
Yes, Canada has poverty, but it's not nearly as severe as in the USA.
The claim was "Canada doesn't have a problem with violent crime, violent policing [ask First Nations folks about that!], or people who are desperate or struggling".
Which I said, is bullshit.
That's not the same, as there are tens of millions of people that don't have access to affordable healthcare in the USA. In Canada (and a host of other developed countries) there are none.
> The claim was "Canada doesn't have a problem with x, y & z, or people who are desperate or struggling".
No it wasn't.
The claim very clearly was: "Canada has much less of a problem with x,y & z and far fewer people who are desperate or struggling than the USA does".
And you said “You simply don't have that in Canada, the social safety net takes that away.” which is BS. Yes you have it. To a lesser degree than the US, but you have it.
And how many people just died in BC from the heat wave? 150+? How many in the US? The Canadian healthcare system might be universal but it’s poorly funded and easily overwhelmed.
Therefore, if you have a bad doctor or expensive care, it is your own damn fault. You just didn't try hard enough to find a good one.
It is the same thing with the debate about school vouchers vs. a standard public education for everyone. A heaping dose of "the free market fixes everything", for all life's problems.
I would rather not have a "choice". I would like to be able to select any nearby doctor, and be assured of getting competent care.
I'm not often in the situation where I have a wacky tropical disease that presents odd and incongruous symptoms, which would take a Dr. House to figure out. I am far more likely to have run-of-the-mill heart disease or a common form of cancer. I just need a doctor with some basic level of competence, who can just listen to me and help me through the common health problems of modern life.
I don't have children at all, and I don't mind paying taxes to fund schools, because when I'm old I want the doctor who is younger than to have gotten a good education. I don't expect any vouchers just because I don't have kids consuming public education.
Vouchers always seemed to me like an obvious scheme to defund public schools and let them rot, thereby punishing kids who were unlucky enough to be born poor.
So it doesn't defund public schools, but it does break the public school monopoly and allows competition among schools - they can cater to the needs of the community and experiment.
The real issue is: Why are schools failing?
When I was growing up, the vast majority of kids were educated in public schools. They weren't perfect, but they worked at least decently for the large majority of students, and did so for decades. Across the entire region. And they did that as a monopoly system you seen to despise so much.
So we had a system that worked, was scalable, replicable, and maintainable. What happened?
I don't have all the answers there, but at least once thing is clear, there is now an over-emphasis on testing. We had a system that was designed to give citizens important life skills, and turned it into a system that tries to produce drones that can pass tests.
This is exactly the kind of thing we used to criticize Asian school systems about. And now we are trying to replicate their failings. WTF
That's the thing that frustrates me about this debate. People seem to think that educating children well it's such a difficult problem, that it requires constant innovation. That it requires the "power of the free market" to solve. No, it doesn't. We have known how to do it for a long time. It just requires political will.
And that brings us to another factor, one political party is actively anti-science and actively anti-education. This was definitely not the case 30 - 40 years ago. Back then, they were both pro-public education.
Nobody really has any effective way to evaluate them, or at least, nobody does so on a broad basis or consistently. Some of them can’t pass fizzbuzz. Some of them can churn out CRUD apps, but have no idea what they’re doing when it comes to anything else. Some of them are extremely dogmatic about design patterns and tooling and ignore anything they don’t like. Some of them are inattentive or poor listeners. Some of them assume it’s Problem X they’ve seen a million times, but it’s not. Some of them are assholes. Some of them are really sharp and really engaged, but get overly excited and reinvent the wheel or spend a lot of time doing stuff that’s completely unnecessary and maybe even harmful.
I don’t know how to evaluate doctors until I see them, I have no idea if better doctors cost more or less, I doubt there’s a strong correlation because nobody else can evaluate them either. They either help me or they don’t.
I think it absolutely is necessary that I should be able to have a history and see the same doctor, and that I should be able to see another doctor any time I want for the same condition for a second, third, or fourth opinion. I have seen this be absolutely necessary for myself and others with common conditions that were resolved after seeing a different doctor.
I assume this is still possible in most if not all public health care systems (I live in the US but local doctors and hospitals are all government run, an interesting aside), but I am not sure. I recently had a conversation with a Canadian friend who has debilitating autoimmune disease his specialist is doing basically nothing for and he made it seem like it wasn’t possible, but I didn’t want to press.
Plus, about a quarter of Americans have “free” care already, via Medicaid and Medicare. Many of the rest have their employer hiding the true cost from them - they think the premium that comes out of their check is the actual cost. Some employers apparently even pay 100% of the premium cost.
So all these people are okay with the status quo, or even want to defend it. It’s the people on (increasingly common) high deductible plans, people with no insurance, or people who experience a catastrophic edge case (out of network provider for example) that hate it.
Also want to add: my child’s birth cost $20,000 (with insurance). When I would tell other Americans about this, the response was (usually) “you know you can get on a payment plan, right?”
The reason that Turkish healthcare is much cheaper than American healthcare is primarily because Turkish doctors are paid much less than American doctors. (As are Turkish nurses, and Turkish drug and device wholesalers, and so on.) There's a very simple solution to that. All you have to do is let Turkish doctors come to the United States and practice medicine. Or better yet let Turkish hospitals open entire branches in the United States and wholesale import their staff, equipment, and drugs from Turkey.
The reason that doesn't happen is because we have a cartel called the American Medical Association that continuously lobbies for antiquated barriers to foreign competition. Unless a physician does a residency in America (which good luck, if you're a foreigner from a foreign school), you will never be allowed to practice in the US.
https://www.ama-assn.org/press-center/press-releases/ama-fun...
The reforms also create a dramatic increase in bureaucracy.
For example, my daughter needs to see a specialist. I call the specialists office. I’m told there are too many patients. The doctor has to chose which to see. I need to call the primary, and have them forward my daughters info. The specialist office says she is not high enough priority and cannot be seen (my daughters condition is crippling, but not fatal as it is for others).
I call up the next specialist on the list. They are overbooked. I need to call up the primary and they a referral. I call primary again. I get referral again. Again the specialist decides not to see my daughter.
I call the next specialist … etc.
Did I mention that for some specialists the insurance info is out of date. They are not in fact in network. So once I get an appointment, I must verify with insurance they are in network.
I’LL PAY THE F*KING MONEY IF YOU GET RID OF THE BUREAUCRACY!!!
Obamacare increased bureaucracy. Clinton HMO increased bureaucracy.
I’m a highly compensated professional. My healthcare is free.
Medicare isn't public universal healthcare. The prescription plans, Medicare Advantage plans, and medigap plans are run by for-profit companies. $300-500 per month, and many good companies, like Thrivent, are getting out of healthcare completely.
https://www.livhospital.com/en/liv-branches/check-up-center
One last thing, probably there is a better English term for this but we have these government institutions in each neighbourhood. They are small and they employ 4-5 doctors and a couple of nurses that provide first level healthcare. (I would say there is a doctor for around 5000 to 10000 people) If you would go to your assigned doctor and ask for it, they do many of the blood tests at the same day and hand the results. This is a common procedure afaik and your doctor would be encouraging to do it every 12 months even if you don't ask for it.
Yes, we don't make too much money and pay about 25-40% income tax but we don't need to shill thousands of dollars for a facetime call with a doctor.
My suggestion would be to visit Turkey and spend those couple thousands USDs on check up and some nice vacation :)
They are contrasting that with their brief online sessions with their doctor that cost them $1000.
The emphasis on whole is to distinguish being the partial check up that they received for more money.
An average person's healthcare costs a few thousand dollars per year in EU. That includes people with innate conditions or other expensive treatments. Most of the countries have zero or only nominal out of pocket expenses.
https://ec.europa.eu/eurostat/statistics-explained/index.php...
https://www.healthcare.gov/coverage/preventive-care-benefits...
Don't do regular checkups, they're cash cows.
http://www.salaryexplorer.com/salary-survey.php?loc=221&loct...
Phrases like "you don't need to pay anything for the state hospitals" just means you are ignoring tax contributions, which isn't going to lead to any sort of reasonable comparison with other systems.
Medications cost a ridiculous amount of month with Medicare unless you're very upoor to qualify for ExtraHelp to make Part D (medications) costs low.
If you're not disabled or poor, you will soon go bankrupt if you have a chronic condition and do not have a job with benefits that include medications.
America is shit.
Your comment would be fine without that last bit.