Comment by chime | Hacker News Reader

Comment by chime | Hacker News Reader

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> So, from their perspective, a wheelchair and some pain meds can do the job easily.

And not even a good wheelchair. For my wife recently diagnosed with MS, they would only approve of a basic, featureless, uncomfortable one after I would pay the $3000 deductible plus 20% coinsurance. Instead, I got a light-weight folding electric wheelchair with nearly full-day worth of battery (15 miles), with a spare battery, adjustable headrest for $1300 off Amazon. Add an octopus-tripod fan with 10hr battery, golf-cart umbrella, bendable cane holder, bottle holder, and an A/C fan jacket for a total of $200 and now she is able to spend a few hours out with our kids at museums, aquariums, and zoos.

It was literally cheaper for me to buy all of this cash than try to spend 40+ hours getting insurance approval.

I absolutely love how practical and solid your product is. I cannot comment on the pricing because I have no idea what your costs/market is but if my kid needed $999/mo to walk, I would do literally anything to be able to afford it. Hopefully the costs keep coming down for those with a smaller budget. Good luck!

Great thing it works this way for mechanical tech.

For chemicals, that is, medicines, paying out of pocket is not impossible, but much harder. The $1500 you invested will likely last a number of years. Or it might be a month worth of prescription drugs; cheap generics do not exist for everything (and may sometimes be inferior).

I don't know a good way out of it. The U.S. medical insurance system sucks, but my friends from Germany and Netherlands report that theirs is even worse at providing any remotely advanced treatment.

I’ve only managed to get more advanced treatment in the UK (still nothing ground breaking) by having private medical cover in addition to the national health care. Thankfully as the national health service covers all the basic care it’s possible to get private cover for around £40 per month.

That sounds _really_ good, and kind of blows a big hole in a lot of arguments against universal health care. I pay more than that monthly for relatively basic medication and that's _with_ pretty good employer-funded insurance

It gets better/worse. NHS provides universal cover for a lower per capita cost than Medicare/Medicaid covers the portion of the US population it covers.

Isn’t that a bit unfair of a comparison, since Medicare disproportionately covers the elderly who have higher medical costs, while the NHS serves the whole population?

It's just cheaper by a whole lot, like 2x and that's taking everything into account. The US is way off the scale in medical expenditure.

For example the NHS negotiates drug prices on a national basis, meaning people in the UK pay way less for medicines than in the USA.

I think you misunderstand me.

The cost of Medicare + Medicaid divided by the number of people in the US - not the number of people covered by those services, has tended to be higher than the cost of the NHS divided by the number of people in the UK.

EDIT:

According to CMS[1], Medicare cost $799bn in 2019, and Medicaid cost $613bn in 2019. The Census bureau gave 328 million people in 2019 [3], or ~$4300 per person for Medicare and Medicaid whether or not they are covered.

According to Kings[2], the NHS cost 150bn pounds in 2019, or ~$208bn (I've not taking into account exchange rate changes). ONS gives mid-year estimate of 66.8m for the UK in 2019 [4].

Which gives $3113 for NHS per person, all of whom are covered.

The point is that if Medicare and Medicaid were allowed to work in the same kind of regulatory environment as the NHS (e.g. Medicare is legally prevented from negotiating best prices for some categories of cover), and was equally efficient, then you ought to be able to take the same budget and extend Medicare cover to every citizen of the US without paying more.

In fact, you'd have 33% more per resident to cover e.g. salary gaps without touching the Medicare/Medicaid budgets.

Americans are effectively paying twice, as money paid in private insurance is at least the same amount over again. It's bizarre to me there are no riots in the streets over this - current US healthcare regulation is corporate welfare to insurers and healthcare providers at the cost of regular people.

[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

[2] https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-...

[3] https://www.census.gov/newsroom/press-releases/2019/popest-n...

[4] https://www.ons.gov.uk/peoplepopulationandcommunity/populati...

> Germany and Netherlands report that theirs is even worse at providing any remotely advanced treatment.

It kind of depends on what you'd consider advanced treatment. I know a few people with chronic illnesses that are dependent on getting their (expensive) medications and they never had a problem with that. Besides the prescription fee of 5€ (not 100% sure on that one) they pay nothing out of their pocket.

But I've heard from people that that they often have problems for example with getting approval for new wheelchairs, accessibility adjustments for their cars, etc.

In general it is true that only necessities are covered by public health insurance. This makes sense in most cases for obvious reasons, but in some cases the limits seem totally arbitrary and are not beneficial to the consumer nor the insurer. Luckily I am young and healthy so my confrontations with our healthcare are limited to my bi-yearly dentist appointments, but I can absolutely imagine how there are gigantic bureaucratic hurdles when needing something remotely special.

Generally, getting a wheelchair or similar is a bit of a paper war with the insurance. Once you have it though, the barrier is lower to get a replacement or upgrades.

Can you recommend the specific model of the wheelchair you ordered?

This is the one I bought (not affiliated with them): https://smile.amazon.com/gp/product/B082NN972S

I called up the seller to buy more spare batteries and they said the 2 batteries the chair comes with, are under warranty for 1 year. And they should last another 2-3 years easily even with heavy use. So there's no point in buying spares now since the spares will lose the ability to charge over the same time.

We have been out for 2-3 hours per trip many times this year and not once has even one battery run out.

Thank you, this is something for my grandmother, who finally thinks about swallowing her pride, but gaining some independence again.

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