I saw this when travelling in the US for work. (I am Canadian). Striking up conversations in restaurants I met staff that worked while sick because they couldn't afford to take sick days, or worked with chronic conditions because they couldn't afford a visit to a doctor.
Even worse are the major chronic diseases from our lifestyle (hypertension, diabetes, etc). These are largely preventable or manageable with early care. But, if folks don't see their doctor then the severity of the disease grows until treatment becomes something major like surgery or an ER trip (both much more expensive than preventive care).
In short. Yes, the US healthcare system is broken. Interestingly one political party's solution is to blame a past president and continue to undermine what you have, while the other party is content with the existing for profit model.
s/healthcare//
It’s the middle class who pays their huge bills. Insurance doesn’t cover why these days and deductibles are insanely high. The poor get treated and just skip out on the bill.
For 2018 the individual limit was $7350,
https://obamacarefacts.com/health-insurance/out-of-pocket-ma...
Which granted is a _LOT_ if your making $30k a year, but its not the instant bankruptcy many people discovered themselves in after situations like yours where the out of pocket for "good insurance" could easily go over $100k for fairly limited hospital says.
What's your proposed solution? Just murder the poor to balance the system? Which is, after all, what we already do, we just disguise it as "choice".
Most providers (outside of ERs and the mandate for emergency stabilization therein, and some free clinics operated as charities) won't provide treatment without proof of insurance and any required co-payment upfront, or, for private pay clients upfront payment or fairly strong proof that payment will be collectible.
Why? They're there to keep you healthy. Yeah, sure it can be uncomfortable talking to a doctor about personal health issues, but it's better than waiting until it's too late and finding out that "if only you'd come sooner, we could have helped".
Like Feynman said though, if you are deathly ill in the jungle you would rather go see a witchdoctor than some random person. At least they will have some experience caring for the sick.
>"Do you have a a Do Not Resuscitate order?" - No
>"Would you reject emergency surgery after being shot?" - No
I suspect the real problem here is with your reading comprehension though.
This is probably the issue under contention. I don't like doctors either (or really the entire medical establishment). Some part of that is a belief that they aren't in fact there to keep you healthy. No I'm not trying to argue something like profit motives or whatever driving an unethical effort to make you dependent instead of healthy, or say doctors shouldn't exist, or that I wouldn't go to one if I thought I needed medical care, just that I don't like doctors or the systems and methods they operate under (some by force). nonbel unpacks one aspect of the dislike, The Elephant in the Brain unpacks another aspect (e.g. by the finding that people who receive free healthcare consume a lot more medicine but aren't any healthier, which wasn't actually surprising for me to hear!), and there are other aspects for my dislike too.
Is there any evidence of this? I've seen malpractice litigation similarly cited as one of the reasons behind the the high cost of health care in the US (which is also frequently disputed [1])
[1] https://www.nytimes.com/2014/11/04/upshot/malpractice-reform...
Please, go to the doctor early and regularly. It's not worth it, trust me.
Your story could be helpful to others. According to the doctors:
1) What is the years survived estimate of this vs doing nothing in your fathers situation (age, stage, etc)?
2) What are the side effects (and in general the quality of life) after/during this treatment vs doing nothing?
Also, these should both be some sort of histograms or at least ranges.
Do you understand how insanely expensive healthcare in this country is, especially if you're making minimum wage and have dependents?
What do you suggest they do instead? Die? Let their kids die?
If you do, you (or at least your kids) likely qualify for Medicaid, so you do get treatment. Often preferentially. I have been to providers who have a 6-8 week lead time on appointments for new private insurance patients, but Medicaid patients get in almost immediately.
It's not a matter of forcing that decision on people, but rather having the same expectation of personal choice and responsibility for that choice that we have for other health matters (exercise, diet, smoking, alcohol use).
It's a biological drive so it's tough. But I think we could do better. We're too sensitve that we might be "poor shaming" or such nonsense to even discuss it these days.
That's mostly value indoctrination (both the what they deserve part and the “do not do X if you cannot do Y” part fairly directly,and also the “what they cost” if it focuses on what a preferred approach costs rather than the costs of a spectrum of choices), not education.
> It's a biological drive so it's tough
It's also an economic choice, which is why birthrate declines with strength of social safety nets.
(Which is also why strengthening the social safety net is probably a better approach than trying to shame people into not reproducing.)
Ah, yes. In the US, Twizzlers are a "Low fat snack": https://www.hersheys.com/twizzlers/en_us/products/twizzlers-...
In Canada, just candy: https://www.hersheys.com/twizzlers/en_ca/products/twizzlers-...
It's sad how much this misunderstanding of fat being fattening has permeated the US population to this day. All the false/misleading information in product advertising has definitely played a significant role, it should be made illegal and enforced with stiff fines.
Do you want understand the cause behind the healthcare faillure in the US ?
Just take a look at the chart of the halthcare sector index of US Stock Market.
If I remember well, healthcare was once considered as defensive sector in bear market... Now, it beats, by far, even the financial sector in bull market.
To front-run the complaints, "same quality" does depend on specifics. The USA really does lead the world in breast cancer and diabetes treatment. It is in the middle or back of the pack at nearly everything else, though, including cost, which is >double, even for treatments without quality to match. Most people would not pay >double for this if they had a choice.
They don't. They offer different services at lower overall cost. Cancer survival rates are the highest in the U.S., mostly because people don't like to die, and the U.S. is (by and large) stinking rich. Here in Ontario, I got a double ear infection (from swimming in lake Erie a few days before symptoms started), and was prescribed a combination eardrop. I'm under 25, and do not have private supplemental insurance, but I expected something like this to be covered by OHIP+; turns out they decide not to cover it unless you've been experiencing symptoms for almost a full month.
I ended up paying (it wasn't so bad, honestly) out of pocket for it, since my jaw was almost completely seized up at that point.
Now, you expect something like this to be covered, but these particular drops (I guess the doctor assumed I had supplemental insurance, or knew I would prefer this product [it worked very well and was easy to administer]) are not covered except as a last resort.
In the U.S. system, the majority of people pay for the privilege of at least partial coverage of more convenient/effective (but more expensive) medical products and services. The U.S. market produces high demand for medical products and services, and by-and-large has more disposable income, so prices can be higher.
Absolutely, I saw this when working in the US at age 23 (I'm Australian)
A good friend separated his shoulder while snowboarding and couldn't afford the surgery, so did nothing. To me this was staggering, and I had no idea people in "good" countries lived like that. Growing up in Australia this is unheard of.
His shoulder is still screwed, 15 years later.
I've never seen a commercial for a pain medication or opioid, they're usually for some heart/skin condition, ED, STD treatment, or something related to aging.
This paints a bit of a different picture ... I imagine somebody cracked down on this more recently.
You forgot to mention that the US Gov't also subsides the other side via food stamps, which poor folks use to purchase corn syrup and cheap grain foods, further exasperating the obesity epidemic. It's true insanity.
[0]https://www.jacobinmag.com/2017/01/food-stamps-snap-welfare-... [1]https://www.theatlantic.com/health/archive/2017/05/the-messy...
This is true. It is truly insane that public food benefits can be used to buy soft drinks, sugar cereals and candy:
"Soft drinks, candy, cookies, snack crackers, and ice cream are food items and are therefore eligible items"[1]
Sometimes your kid will only eat sugary cereals for breakfast, because children can be fussy eaters. Or maybe you want to kick back with a can of Coke after a hard day at work (or need the caffeine to wake up for work in the morning, and coffee is too expensive). Or you want some Snickers bars to take on the train or bus to snack on. Policing what kind of food people spend their food stamps on seems like a pointless waste of time and government resources to me.
Obviously it's a bit nurture on both our parts, but sugar for breakfast is crazy, as is being taught that things like soda or snickers should ever be eaten except for in exceptional/celebratory circumstances.
One needs to be taught that those food stuffs are acceptable and gain a palette for them, because foreigners find your food sickly sweet. Clearly this is a policy/cultural thing...
> Obviously it's a bit nurture on both our parts, but sugar for breakfast is crazy, as is being taught that things like soda or snickers should ever be eaten except for in exceptional/celebratory circumstances.
There's always a gap between how things should be done and how they are actually done. I personally don't eat sugary cereals, or drink soda. I like sweets and candy and I'll admit it's a struggle to control sometimes, especially when I'm stressed out. I won't judge someone in far worse circumstances than I for indulging in sugar - it might be the only good thing in their life. And I don't approve of government resources being spent on checking what kind of food people eat - you can get far more bang for your buck elsewhere.
Present healthy food. Vary it day over day in case they really do have some strong dislike for something. If they don't eat it, they weren't very hungry. They will eat cereal every time you give it to them, no matter how hungry they are, which is part of the problem. Do not feed them crap because "that's all they'll eat".
Low-income parents may be hesitant to introduce new, healthy foods to kids because if the kid doesn't like it, it's time and money wasted (assuming the parent can't finish it). They're more likely to buy something the kid is sure to eat.
> If they don't eat it, they weren't very hungry
That's what I think to myself also whenever I see a parent running after a child trying to feed them. But parents can't seem to find peace unless the child finishes their meal. I've also heard children get cranky because they're hungry, but don't eat because they haven't learned that it will make them feel better. Being in that situation as a parent seems horrible. I'm willing to believe that stressed out low-income parents would rather that the kid eats anything, even crap, than face a meltdown.
> Do not feed them crap because "that's all they'll eat".
If I ever have children, this is my plan. But I have also heard that plans don't survive contact with the enemy...
I'm a little sensitive to this one because my wife and several of my friends are teachers and I gather it's really, really common for even fairly well-off kids' breakfast, every day, to be a couple pop-tarts. Which is a dessert, and isn't even on the healthier end of that category. As long as that continues to be as normal as it is, our obesity epidemic's going no-where.
Definitely don't blame low-income folks for doing what they need to do to get through the day, and yeah, food waste can really suck when you're not handing your kids hyper-palatable food for every meal, with the extra kick in the teeth that the hyper-palatable stuff's often easier to prepare. I mostly just weep for the future when I hear about the clearly-middle-class-or-higher folks doing that, or see them feeding their kids snacks (almost always crackers or similar) in the store to keep them docile, or whatever.
> If I ever have children, this is my plan. But I have also heard that plans don't survive contact with the enemy...
It's for sure harder to do it right. Snacks do shut them up, and in that weeks-to-months period when they just won't STFU at the store damn it, you do wanna just shove some crackers in their face so they'll quit making a scene. But if you do you'll have to keep doing it and then you're the parent with the six-year-old still snacking in the store. They will eat crap for any meal at all, or between meals, because it's crap and tastes freakin' amazing. That's the point of it. You just gotta suppress fear of judgement and keep in mind that the (medical) pros say skipping or picking at 50-60% of meals is totally normal for kids, and they will not starve themselves into ill health just because green beans don't trigger the same primal OMG-I-need-more-of-this responses as Doritos do.
The only place this is hard for us is with the grandparents. OMG there's no stopping them short of just cutting them off, which is too harsh for us to stomach. So much junk food. But that's how they eat too—they just don't get it, and that kind of deep cultural difficulty with food is why it's such a pain to do things right on an individual level. And school-provided lunches are pretty bad. The ones around here, at least, are clearly designed to shove as many calories as possible into the poorer kids, damn the nutrition and good eating habits.
Reducing food deserts, increasing healthy food programs for children, and eliminating market distorting subsidies are less paternalistic and more effective.
The winning localities and companies offered $2 billion in rebates to amazon over 10 years, conditional upon job and revenue targets that guarantee the localities and companies are getting multiple times the rebate amount. https://en.wikipedia.org/wiki/Amazon_HQ2
Marketwatch put the local economic contribution at up to $17 billion per year (not per 10 years like the $2 billion). https://www.marketwatch.com/story/amazons-hq2-could-bring-lo...
Sounds like an amazing ROI.
My only question is, how can I give Bezos money for that kind of guaranteed return?
Can you imagine the additional bureaucracy needed to classify (and enforce) the use of food stamps on a more granular level?
And there are "low carb" products that contain an obscene amount of fat.
If people can't count calories, that's their tough luck. It's not rocket science.
High fiber carbs and protein make you feel full too.
> The real problem is they started pairing sugar and corn syrup and grains in general with high fat food.
aka: calorie dense foods. Also, it's the type of grains they use - low fiber, high GI - not grains in general.
Individual bodies' responses to fat/carb ratios, while different, are marginal, and orders of magnitude less important than total calorie consumption - especially when overeating.
If you're eating 3,000 more calories a day than me, it really doesn't matter that your body, for example, stores 10% more fat from carbs than mine does.
Yet there’s no reliable research that proves how all of that works in most people nor how the situation can be solved at large scale. I think it’s a way harder problem than flying rockets.
Educating people, modifying their behavior, and increasing their willpower and persistence is what's difficult - that's a sociological problem and I agree, a hard one. The actual physical mechanism is simple.
Sure. Running faster is also just increasing the power to weight ratio.
You are technically right, but nobody doubts the high level physics of it, it’s the biology part that is complex.
Even leaving aside socio-economic factors and pure behavior issues, it’s not just a “throw things in and you can predict what goes out”. Knowing how different bodies manage food intake, food processing and retention, then come up with a calory burning budget is damn hard. We’re not pipes, a lot of things happen in the body.
I know it’s so much more comfortable to think it’s simple, but I think we need the courage to accept it’s not as straightforward as motivational poster would want us to believe.
Corn syrup isn't really any better or worse for you than cane sugar, it's just a lot cheaper.
This apparently is a risk, even if you have insurance because you are at the mercy of insurers not tossing you out over such whimsical reasons as pre-existing conditions or other bureaucratic tricks they use to kill their customers rather than getting them cured.
There are also these mafia extortion schemes that are completely legal where you have to pay through your nose for insurance in exchange for the privilege of not being charged tens of thousands of dollars for completely routine stuff like broken bones or other things that can and will go wrong for most people at some point. This is not a thing in most modern countries other than the US. Even many third world countries tend to get organized on this front to the best of their abilities.
Then there is the widespread obesity because of corn syrup being a heavily subsidized food ingredient (got to help those poor republican voting farmers). Also it seems there is a whole legislative game around shameless advertising on products where products that contain obscene amounts of corn syrup are advertised as "fat free" instead of "don eat this you stupid fat F*".
The reason for the drug overdoses is decades of shameless attempts by big pharma to coerce the US government on not cracking down on their quite successful attempts at selling heroine disguised as pain medication roughly at the same time when the war on drugs was a big thing. This too is much less of a thing outside of the US where pain medication tends to be very strictly regulated and not advertised every 10 minutes on TV.
In short, the above is the result of decades of misguided policies, failures to regulate, and greedy companies getting away with stuff they shouldn't get away with and lobbying successfully to get away with ever more.