The global health-care collapse
economist.com
economist.com
When the pandemic began, I left a few comments with home healthcare tips, like how to do lung clearance. People attacked me and accused me of practicing medicine without a license.
At some point, I went looking for an officially recommended list of OTC drugs for covid. I couldn't find any such thing online.
Healthcare shouldn't really be used to mean medical care. I think it's a mistake to treat those as synonyms.
Diet, exercise and lifestyle choices are all part of caring for your health. We could include grocery stores, restaurants and gyms as part of the "Healthcare Industry" though they certainly aren't part of the medical industry.
I think it was a huge missed opportunity that no official health organizations, like the CDC, put together tips of a sort I naively tried to share as someone with a serious condition who therefore has no choice but to do a lot of medical-like healthcare things at home. I was shocked at how hostile people were to that.
Because of that, I've mostly opted to say little about this topic. People are scared, etc and I didn't want to become a target.
But the mistake we made here was relying too heavily on the medical industry and not leveraging the internet as the perfect first line of defense for sharing good info without sharing germs.
You wouldn't expect a home contractor to know everything after visiting a 50-year-old house for 30 minutes. As a homeowner, it is your job too collect information over time and synthesize the advice of experts
There's a reason lots of medical professionals dissuade people from relying on the internet for medical advice, and it's not some vast corporate conspiracy.
If the CDC or NIH had posted established and well-developed protocols for things like lung clearance, then you educate people that "Ivermectin is not being recommended by reliable sources. Here are the home care recommendations from reliable sources."
Lung clearance at home is not some concept I invented. It gets routinely prescribed and taught for patients with serious, incurable lung issues.
Adding to that all communications regarding ivermectin and other crazy people miracle drugs, it should have been communicated that "Ivermectin is generally safe for human consumption. Ivermectin is highly dangerous if taken in single dosages above xxx mg/kg or longer than yyy days. There must be at least zzz hours between individual dosages of Ivermectin. Do not take more than vvv mg/kg a day. If you violate any of the advice given here, side effects might include: x, y, z, allergic shock, death, neurotoxicity."
Instead those hell bent on taking it were ridiculed and ostracized, taking it in secret and an uncontrolled fashion. They could have been both forced and allowed to get in in pharmacies, with the condition of them also taking an information pamphlet or something -instead they went for more difficult to dose formulation directed at large animals.
I'm American. My understanding is that in the US you need a prescription from a licensed healthcare professional to get medication from a pharmacy. This usually means a doctor but in some states a physician's assistant may have the authority to write prescriptions.
In the US, if it doesn't require a prescription, it is sold over the counter, though they may check your ID to see if you are a legal adult for some things.
I have heard anecdotally that in other countries pharmacists can sometimes dispense medication without a prescription.
HN is a very international discussion space. This fairly often leads to people speaking past each other as their comments may well be rooted in a completely different set of assumptions and mental models about how such things work.
Meanwhile people regularly and irreparably blow up their livers with paracetamol and no one gives a damn.
Then there's cocodamol, where in an effort to avoid "addiction" issues the relatively safe opiates are cut with relatively low-LD50 paracetamol.
I don't think an informational campaign would have helped with the ivermectin problem. Underlying that was the conspiracist belief that people were lying to them. Why would they believe a safety leaflet?
However, in theory thats why people have GPs or PCPs, to oversee their treatment. Yes, they were overloaded (as they always are), but if people want to try a treatment, in general we shouldn't say no. We should enroll them in a trial, etc. And we should say no when we have enough data to be sure that it's very unlikely to work, and still, in general fighting scammers/fraudsters and various snakeoil salesfolk should be done through prosecution of those who knowingly make false statements, thereby intentionally defrauding vulnerable people, not through right to sell shit. (And yes, this is a very hairy topic, because everything is fucking expensive when it comes to medicine. But that's one more reason to streamline it instead of having a cottage industry is these trial runners hemorrhage money into a thousand pockets.)
And also afaik the biggest problem with Invermectin wasn't that people were overdosing on it, it's that they were treating it as a prophylactic or potential miracle cure which meant they didn't have to worry about catching or spreading COVID (or get vaccinated, when the vaccines were introduced). "Homeopathy doesn't cure HIV, but here are the dosages of homeopathic remedies which people looking to manage their HIV status with homeopathy rather than antiretroviral drugs and condoms should take", said no public health information campaign ever
Afaik Invermectin has all the safety information regarding its dosages on the packet anyway (at least the packets designed for human use...). Doesn't mean people getting health advice from people shouting about the evils of the medical profession on talk radio or Facebook necessarily acknowledged them.
Can it? We've been trying for 20+ years.
Not to mention that while it used to be purely a literacy problem, nowadays various commercial interests benefit from users being tech-illiterate and are incentivised to perpetuate this lack of literacy, all the way towards dumbing down UIs and removing advanced features so that people can no longer become literate even if they wanted to.
Hell, the spread of medical misinformation benefits the platforms on which it happens as it generates plenty of "engagement" so short of regulation with actual teeth (which won't happen due to government incompetence, regulatory capture or lobbying), I don't see why the situation would ever change.
There was a great paper which I can't find now about the link between the "supplement" industry, whose products range from the ineffective to the actually dangerous, and aren't regulated by the FDA, and the rightwing channels that tend to advertise them.
The polarization affected both ends of the spectrum it seems.
Instead I got the European flavour, where on the left you have a lot of dippy hippies who believe in homeopathy and magic healing crystals.
With that analysis internet literacy becomes a question of showing people that official recommendations are not actively trying to trick you into doing something harmful to yourself. How will that be done when nobody trusts any official authority, be it government, universities, news media or anything else?
This trust will take generations to re-build and currently it doesn't seem like anybody thinks it's even a priority.
The figures above are reasonably educated and should know better but all share a political leaning that the social media recommender ML systems latch on.
If there is a literacy that can be taught, we need to start agreeing on what that literacy looks like
Medical internet literacy absolutely includes educating people that wealth, fame and a willingness to generously and frequently share your personal opinions about everything under the sun, whether you have any expertise or not, does not make you someone people should take medical advice from, especially during a pandemic.
Not only that but HCQ and Ivermectin saved many Indian states from far worse numbers of covid deaths, transmissions and cases (although HCQ eventually became detrimental).
You're thinking of the horse paste idiots who saw Ivermectin working but were denied safe access and the lady who murdered her husband with HCQ aquarium cleaner.
It's correlated with better outcomes in poorer countries for the simple reason that if you dose enough people with an antiparasitic drug in an environment where many people have parasites, overall health improves and a greater percentage of people are better equiped to fight off the worst effects of COVID.
Private health care professionals in the (US|UK) catering to rich internet readers will happily prescribe an antiparasitic to their patients on demand, they keep their customers happy and an antiparasitic won't kill anyone and might even help with any undiagnosed parasites.
Rich people across the world had better outcomes, they were able to isolate more, demand a higher level of hygiene from those that interact with them, afford better doctors, etc.
Properly conducted trials with sufficient ANOVA don't show any benefit for those with no parasites.
Yes correct
> It's correlated with better outcomes in poorer countries for the simple reason that if you dose enough people with an antiparasitic drug in an environment where many people have parasites, overall health improves and a greater percentage of people are better equiped to fight off the worst effects of COVID.
Sounds like a win
> Private health care professionals in the (US|UK) catering to rich internet readers will happily prescribe an antiparasitic to their patients on demand, they keep their customers happy and an
There was a specific medley being prescribed for $3500 with many baulking at the inclusion of ivermectin and refusing to take it but being strongly recommended by the doctor to finish the entire course despite already feeling improved.
> antiparasitic won't kill anyone and might even help with any undiagnosed parasites.
Sounds like a win.
> Properly conducted trials with sufficient ANOVA don't show any benefit for those with no parasites
Big whoop.
> Big whoop.
ie. Essentially pointless waste of time and resources in a first world country with no significant parasitic issues.
Today, we aren't supposed to question or otherwise so much as discuss something if it goes against or strays from any established narratives. At one point, so much as uttering the word "corona" could get you silenced by the powers-that-be regardless of the context.
This is all ridiculous because the foundation of science (protip: medicine is a science) is to always remain skeptical and engage in rich discourse. Blind trust in science is no different from worshipping a religion or cult.
We are the Galileo against the Church's Geocentric Model, but far more precarious and farther gone.
I guesss you are referring to vaccine scepticism.
Comparing anti-vaxxers to galileo is ridiculous.
Obviously not good, but it's not apocalyptic either. (Not bad enough to justify writing off 'freedom' as an awful selfish far-right concept that should be purged from society entirely?)
That's the death count with the measures put in place. If C-19 hadn't been taken as seriously as it was then you might be adding a zero to that death count. Maybe two.
Maybe that was the event that completely broke everybody's sense of proportion. 100ml liquid bottle? Can't take it on a plane. Airborne pathogen? Sure, why not, bring it aboard.
I suspect the same is true of covid, but how do we break the cycle? Is it innate in politics?
Unless you mean obvious a-holes that back then refused to put on masks in shops and public transport and made it a political issue, which it was not, simply a security one.
It was wonderful to see all those slightly weird quiet types suddenly go full blown nuts and dive head first into various redneck conspiracy theories, if they weren't drowning in them before. Reasonable mankind lost those for good probably, but they were never truly part of it so at least now we see situation more clearly and can manage expectations more realistically.
Why the ridiculous straw man?
Up until COVID there was a pretty good social contract going on where we'd all promised never to do the things that the authorities then went and did. 7 million deaths doesn't justify that, WWII alone was 70-80 million people lost trying to promote the opposite of the COVID response. Liberty is important. And might turn out to be a better policy depending on how bad the shock of the COVID response turns out to be (see, for example, the article).
Of course, these interruption were tiny compared to those of life in England or France or other battlefields of the the war. There’s an entire genre of literature and film devoted to lives ripped apart by the interruption of World War II.
The lesson of WWII isn’t that we never need to impose individual sacrifice, but rather that the preservation of our liberty requires deep collective sacrifice on occasion, and to work to protect it not just for ourselves but for our friends who by virtue of luck are in a worse situation than we are.
But that wasn't the point I really wanted to make; what I'm trying to say is that we should be dealing with a substantially bigger emergency before the COVID response was justified. Seriously; how hard is it to just leave people alone to make their own decisions, and pass information to them to try and help them make the best decisions?
Obviously there is a limit - China has recently hit the end of political support for zero-covid restrictions, because they were extremely onerous even in an already totalitarian country.
And most measures and expert driven response were pretty ineffective anyway. People whip out the 6 million number as though it has any bearing on the number of people who might have died or been saved by different responses to COVID which is really pretty disingenuous and emotionally inflammatory. A lot of government particularly health policy involves tradeoffs with lives, you can't just try to put blame on people for deaths if you don't like their position and use that as an argument. Because some extremist can always come in on the other side of your position and make exactly the same argument against your position.
In other words, why would you be the arbiter of exactly what is reasonable and what is "extremely onerous" and when you can and can not allow people to make their own decisions? It's circular logic, you basically justify your position by asserting they are the right decisions.
Because....?
When it comes down to it, you're arguing for a type of society that prioritizes certain values, and those who disagree with those policies are arguing for a society that prioritizes different values. You are not automatically right or morally superior simply because you value safety more than freedom.
It astounds me that people look at the utterly bungled and hare brained government responses to covid (or 9/11 or Katrina or the war on drugs or Vietnam) and can turn around say, "See? We need to give these corrupt greedy nitwits even more power to control our lives."
You can’t speed 65mph through red lights, for instance. In public spaces, or with actions that can’t be contained, many of your choices have consequences for me, so I get to have a say.
The restrictions generally targeted private spaces. In Australia we even went as far as banning friends visiting each other at home.
Driving is a privilege, not a right. You earn that privilege by agreeing to follow certain rules.
Being able to walk in public spaces or associate with whom you wish in private spaces is a right, not a privilege. You don't need to earn your rights. Do you see the difference here?
Governments will overreach and violate civil liberties when the people don't resist (Snowden revelations, anybody?). That's the lesson.
But many other actions, from curfews, to govt planning of the economy, a draft, collective bomb shelters in London, etc, clearly did help preserve life and Liberty in the long term.
Sure, but it makes the point that just because people claim some measure is for the collective good, doesn't mean we should just take that at face value. Power is easily abused and we should be demanding more transparency and accountability from people who want to impose onerous top-down restrictions for speculative reasons. Instead, we get legions of people shouting down and vilifying those who are expecting more.
A literal interpretation of this (comprehensive) text yields a rather bold claim.
I'm sorry but this is ludicrous. WW2 wasn't fought for liberty or freedom - the big 3 Allies were an extremely oppressive dictatorship, a colonial empire and US (which interned it's Japanese citizens in concentration camps and still had bloody segregation as something normal, so while somewhat better than the other two, far from a bastion of liberty). Furthermore, they were only fighting as an alliance of convenience because the war came to them (Axis invading/declaring war), the only exception being the UK deciding to finally stick to it's promises, and not sign a peace treaty (and that was very much thanks to Churchill's perseverance, there were enough people who wanted peace at all costs).
The war was to stop and defeat the Nazis and Imperial Japan, and to a lesser extent Fascist Italy. Liberty and freedom, or saving the Jews/Poles/Greeks/Czechos/Slovaks were never among the goals, or the war would have started much earlier and wouldn't have waited for Axis powers to declare it.
Also, the vast majority of the dead were on the Eastern Front, civilians and soldiers alike, and the people there were highly repressed before, during and after the war.
And in every participant in the war there was extreme censorship and liberty restrictions (like not being allowed to eat whatever one wants, and not being allowed to have lights on at night, curfews, etc.).
Specifically, it was very old and otherwise very sick people.
A large percentage of the deaths were simply pulled forward a couple years. Tragic and awful, yes. But worth 2 years of major disruptions to life and the huge lingering economic impacts?
At this point, I think most would say no. It was absolutely not worth it.
The appropriate amount of skepticism is exactly proportional to the probability that the theory is false.
Since a lot of people are very certain about vaccines, they are very un-skeptical about them. And therefore don't want to spend time on "skepticism".
(Of course if one's prior distributions are very whacky, it's no surprise that they end up with bad posterior distributions after reading/seeing new data/information.)
> and engage in rich discourse.
There's definitely room for improvement. Especially when some folks throw out sentences like "At one point, so much as uttering the word >corona< could get you silenced by the powers-that-be regardless of the context."
And increased amount of skepticism in such a case is completely warranted.
Appropriate amount of skepticism about long-term (5+ years) consequences is still warranted, though as time goes on that amount is seriously decreasing.
What's your point?
If skepticism is warranted, then it's wrong to be pressured to go through with a health procedure.
If phase IV follow up finds problems people who are affected can be notified, funding can be allocated, etc, etc. Also known "potential negative" consequences are much better than unknown ones, because there are likely risk minimization and harm reduction strategies.
Public health is a cruel topic, because there are so many hazards, side-effects for preventative measures, so little resources, etc. It's "great" that COVID was "mild" compared to the extreme possibility of something like Ebola, but it was also much-much-much harder to contain, because it spread by air ... and it killed a lot more people in the end, because people did not take it seriously, did not manage it (inadequate testing), fall prey to the do-everything or do-nothing fallacy (eg. stay at home, meet no one ... or go to work and packed restaurants).
In this regard it's very likely okay that people were pushed, pressured, and persuaded to get the damn jab.
If there is higher uncertainty about the validity of the purported benefits as well as the claimed safety, then it might very well be fine to decide to not participate in something, especially if you don't fall into a demographic that's particularly vulnerable.
The rest of the argument is fine in so far as it goes, but because we already see acute and chronic damage from COVID, the hypothetical undiscovered long term damage from any given vaccine (and there are many fundamentally different ones, they're not all mRNA) would have to be both surprisingly frequent and severe just to get up to a swings-and-roundabouts with the actual illness.
p.s. it's VAERS https://vaers.hhs.gov/
> We are the Galileo against the Church's Geocentric Model, but far more precarious and farther gone.
This sounds far more like the utterances of a cult than even the most dismissive "listen to doctors, they know better than you" media commentary...
How do you illicit a robust world-wide response? By making the potential consequences of not acting abundantly clear, aka "fear-mongering".
For example: yes, the vaccine has side-effects. But here is the data on which we decided to still approve it: a much better aggregate health outcome and lower risk of death.
And in the beginning, there were recommendations NOT to wear masks, because masks were not proven effective for THIS PARTICULAR virus. Which would have been impossible, since it was a month old. But my supposition is that the medical community wanted to buy them first, so I wore a scarf.
They might not even be financially viable without government deals like PRISM.
By this logic almost every corporate out there is a branch of government. Which is trivially provable as being false.
> They might not even be financially viable without government deals like PRISM.
This is just absurd :-)))) Do you think Nike's ad money are funneled through PRISM?
Isn't this the very point of the GGP comment? Social media algorithms do a very poor job of selecting relevant information to present to users.
Has it? Because Pfizer said they needed 75 years to release the vaccine trial data, and that was just a few months ago. Things were not as transparent as you imply.
As for whether my claim was misleading, are you suggesting that the proposed schedule for releasing the vaccine safety data would not have taken 75 years?
The fact that Pfizer released aggregated data based on their own analyses is immaterial if third parties can't analyze the raw data replicate the results.
No, that has no medical, public health or accountability benefit, and you know very well that this isn't the data the scientists are requesting be released.
> The nuisance part of the suit was in data that required painstaking redaction, without a strong argument for benefit.
The strong argument for benefit is that the public deserves to have a independent, public accounting of the processes that led to vaccine approvals. This has significant implications for how public health should be managed going forward, how government mandates surrounding vaccines should be handled, and even how public messaging affects institutional trust and vaccine adoption.
Secretive processes managed by an unaccountable elite/select group whose judgment of the data we must simply trust is not how science works, or even how government should work.
Edit: and to be clear, the documents they were forced to release to date on adverse events during the trial are already raising some eyebrows, and no doubt much more debate is to come.
For vaccines the choice was never about vaccinating everybody or vaccinating nobody and when you only look at aggregate health outcomes you can justify any number of horrific medical practices. E.g. is serving everybody peanut butter good in aggregate because there are more malnourished people in the world than people with peanut allergies?
It's not so easy to find the exact age at which the vaccine becomes "net-positive" even assuming a negative effect can be shown at all. Which would also be very minor, on average. Turns out, "healthy 20yo males" don't generally react purely to vaccines.
There isn't really any data showing a clear net negative outcome for any age group. And even if there had been some doubt, the overall picture, was and is that vaccinating everyone is saving lives and it had to be done as quickly as possible. Waiting for more data would have cost more lives. And the results show that decision was correct.
Yes, the process was not nice looking, but it never is.
The fact that you still call it "fearmongering" with nearly 7 million people dead and how many others with negative long term health conditions from the virus tells you why there is a backlash against anti-intellectualism.
You are certainly not prohibited from challenging the status quo. You know that because there are thousands and thousands of anti-mainstream videos and blogs that tell us viruses aren't real, or covid is just the flu, or vaccinations cause more issues than covid itself, and, and, and....
Engaging in rich discourse happens while scientists are trying to form a consensus. But eventually a consensus is formed and then the outliers who mostly only generate noise tend to get ignored. 1 in 1000000 times then may be correct and successfully challenge the status quo, but mostly they're wrong but convinced beyond any reasonableness that they are not wrong. You cannot argue against all of these people, it is just too tedious, so in the end they just get ignored or stopped from spreading nonsense on certain forums.
A opposed to the fearmongering that vaccines are to be avoided at all costs, and that they only exist to control the masses and further enrich the rich?
Let me translate this: "Blind trust in the best recommended knowledge science has at the current moment in time is no different from worshipping a religion or cult."
No. This is wrong.
Science's recommendation at any given time is based on assembly and analysis of evidence. It evolves over time in the presence of additional evidence.
Religion or cults do not.
OTOH, paying attention to what the "my uncle got COVID, spent a week in only pink lighting, and subsequently recovered!" most recent FB post in your feed is wrong. The internet mob is not following the scientific method. They are posting anecdotes. Those anecdotes are filtered by the mediums for ability to create attention in others; and then those are presented.
I am reminded of the somewhat grim "Facebook COVID researcher" joke: https://i.redd.it/ovumfo3f48ca1.jpg
Engineering and applied science are entire universes removed from the ideal of science that gets painted here in defense of them.
Yes, scientists who pursue science in the way highlighted exist (and they are often not well paid for it) and it is a very respectable and admirable pursuit.
But there is a way larger mass of people and companies who strike a balance between profit and being scientifically backed enough, with incentives to tilt the balance into the direction of profit.
That being said, you should look at things intelligently, but you can’t force people to do that, or you get situations where you can’t question that the Sun revolves around the Earth because that’s not seen as intelligent. The “mRNA vaccines will kill you” crowd are idiots, but censoring them only makes their point seem stronger and goes against the principles of scientific inquiry. Proving them wrong, which is easy, is better
I think you’re confusing science with “The Science”.
The 6 foot rule and mask mandates weren’t science, they were “The Science”.
People aren’t Luddites or anti-science, but they do often know when people (bureaucrats, politicians) are full of shit.
Do you remain skeptical about whether the earth is a mostly roundish ball of rock or a flat disk on the back of some elephants?
How much effort do you put into that scepticism. How often do you re-evaluate your view?
It's as if I yell fire in a crowded theater, then when there is no fire and my speech rightly faces consequences I complain about "the-powers-that-be" limiting my future attempts at yelling "fire".
Scientific skepticism is good, but requires a certain level of being informed. Good, scientific skepticism does not occur on the internet in 99+% of instances. Usually what is actually occurring is politicking and spreading disinformation. Conflating that with the good kind of scientific skepticism is quite dishonest, intellectually speaking.
For you its not a problem, as you are reminded of mortal frailty every day, but for a lot of people that is a scary prospect, they try to yell out there lifes.
Nothing of what you are saying is helpful beyond the official advice given by doctors and public health sources and even the media.
You vastly overestimate your knowledge of the topic.
Lung clearance is something that's been taught to asthmatics and people with chronic pneumonia for a long time. I don't know about its effects on your absolute chances of survival but it could make you significantly less uncomfortable.
I gathered that was the point of GP.
> You vastly overestimate your knowledge of the topic.
This statement can only be made by someone who believes they have more knowledge. I fail to see how you do though, who provided no concrete argument against any of the points in GP.
(formatting compactly to save space)
Suggested approach to prophylaxis and treatment of COVID-19
Prophylaxis
While there is very limited data (and none specific for COVID-19), the following “cocktail” may have a role in the prevention/mitigation of COVID-19 disease, especially amongst the most vulnerable citizens in our community; i.e. those over the age of 60 years and those with medical comorbidities. While there is no high level evidence that this cocktail is effective; it is cheap, safe and should be readily available. So what is there to lose?
• Vitamin C 500 mg BID and Quercetin 250-500 mg BID • Zinc 75-100 mg/day (acetate, gluconate or picolinate). Zinc lozenges are preferred. After 1-2 months, reduce the dose to 30-50 mg/day. • Melatonin (slow release): Begin with 0.3mg and increase as tolerated to 1-2 mg at night • Vitamin D3 1000-4000 u/day (optimal dose unknown). Likely that those with baseline low 25- OH vitamin D levels and those > living at 40o latitude will benefit the most.
Mildly Symptomatic patients (on floor):
• Vitamin C 500mg BID and Quercetin 250-500 mg BID (if available) • Zinc 75-100 mg/day • Melatonin 6-12 mg at night (the optimal dose is unknown) • Vitamin D3 1000-4000 u/day • Enoxaparin 40-60mg day (if not contraindicated; dose adjust with CrCl < 30ml/min) • Optional (and if available): Chloroquine 500 mg PO BID for 5 days or hydroxychloroquine 400mg BID day 1 followed by 200mg BID for 4 days • Observe closely. • N/C 2L /min if required (max 4 L/min; consider early t/f to ICU for escalation of care). • Avoid Nebulization and Respiratory treatments. Use “Spinhaler” or MDI and spacer if required. • Avoid non-invasive ventilation • T/f EARLY to the ICU for increasing respiratory signs/symptoms.
https://srpc.ca/resources/Documents/COVID-19%20Resources/Cli...
Holistic and personalized health-care remains in its infancy, i can forgive skeptics.
I agree with you that diet, exercise and lifestyle choices are all part of caring for your health
Here in Germany there is a general focus on avoiding medical intervention as much as possible unless required. So much so that "Camille tea and hot pack" is a meme for healthcare here.
My wife is from USA-like South Africa and thinks you need some kind of pharmaceutical for everything and us Germans are crazy ;)
Japanese doctors are super adverse to prescribing anything, even painkillers after some type of accident, it's rare they will give you anything, even if your leg is broken.
When I was there I didn't mind it personally, but it's hard to get good drugs if you do require them.
Wow. And people think German doctors are extreme :D
https://en.m.wikipedia.org/wiki/COVID-19_pandemic_on_USS_The...
There's a lot of differences between a navy crew and a luxury cruise ship, but IFR estimates for COVID still vary a lot by nation: 0.2-1.3% around the beginning of the pandemic, and even now the CFR (which is always higher as IFR accounts for unsymptomatic cases) is 1.9% in Brazil, 18%(!) in Yemen, 0.2% in Cyprus, and a bit less than 0.1% in Singapore: https://ourworldindata.org/mortality-risk-covid
Look, I get that old people are more vulnerable than young, and that's still true if I were to add the words "to COVID" to that statement.
But you know what? That's not helpful on either a personal, community, national, nor global level; and saying we had "all the information" on the basis of stuff like that is about as accurate as saying "answers in Genesis" as a response to anything about evolution.
I think COVID is perhaps different than other health and medical topics. The key factor about COVID-19 is that 3 years ago we knew pretty much nothing other than: "People are going to the hospital, not thinking they are starved for oxygen, but are posting horrible O2 numbers. Vents keep them alive a while, but lots of them die."
Seems pretty obvious that "the longer medicine has had to explore something, the more medicine can separate the wheat from the chaff." And even then when incidence is low: Are you sure that exposing the patient to the 24 hour healing property of pink light saved them, or were they one of these folks who would pull through anyway.
Maybe worth a listen: https://radiolab.org/episodes/312245-rodney-versus-death
As to the first "citizen medic" hypothesis, I think this already is in place for lots of established conditions. Perhaps not to the degree it should be, but I can certainly know when to use an ice pack or a heating pad, when to take aspirin, and can go get CPR certified.
As to the "holistic view of heath" perhaps there was a mixed messaging opportunity, but at least here in the US it was hardly the worst missed messaging opportunity. They totally whiffed on masking messaging.
The internet is a fine place to exchange information on understood things. The internet is a horrible place to exchange information on poorly understood things that science is focusing on because the internet mob is not science minded and the mediums we use to have these discussions are monetized for attention. "We don't know yet" is not an interesting answer from the "company gets paid for attention" point of view.
In many places this is free (or dirt cheap) along with "stop the bleed" (in the US), certified first aid courses, etc.
Realistically there is no reason to not take some basic first aid course. You hope you never will need it... But its better than flapping when/if something does happen.
A lot of people I've met are incapable of even cleaning and covering a small wound, so they go clog up the ER.
Is it even? Social media algorithms distort things to such a degree that even "understood things" are not safe.
Was the hostility experienced here on HN? I've come to learn that HN is far more hostile and toxic than I'd first realised.
The best thing for yourself and the country as a whole is sleep, regular cardio, regular lifting, regular sunshine and fresh air, cooking all your meals from scratch with whole (ideally local and in season) ingredients and mostly elimination of all refined products like sugar. But we normalized obesity.
It is unfortunate that you’re having a difficult time but where you live and work is completely up to you.
And layoffs are a reality of the economic cycle, not merely because some “greedy corporation” decided to fire ppl on a whim.
If there is less work than workers or business outlook changes, what would you do? Keep on employees to dig ditches and fill them in out of the goodness of your heart?
At least I have a consistent logic: if the issue is that we have an unhealthy population we should prioritize the health of the population. Give people the time to exercise and cook. Give people the healthcare they need. Give people who fall down a way to get back up without crushing humiliation, debasement, and poverty trauma.
When people say they don't "have time", examine their television, video game, or social media habits. You'll find that 99% of the time they are liars.
We all have plenty of time, it's just a matter of priority. For many, imposing an unnecessary burden on the healthcare system is a small price to pay for having watched plenty of TikTok and knowing the minutiae of Game of Thrones. On their (premature) deathbeds, they'll all wish they'd finished Season 6 of The Expanse and clicked on more heart icons.
That's a patently false statement for a huge number of people now and the vast majority of people throughout history.
There's a kaleidoscope of possibility around people's behavior, station, and life between "Fully Self Actualizing Superman" and "Lazy schmuck who gets what they deserve."
The blanket statement "Where you live and work is completely up to you" is a deeply naive and insulting opinion of the same flavor as "let them eat cake"
That being said, the vaccines worked. The Covid culture war was dumb as fuck
In fact when the prime minister (quite a fat man) at the time caught covid and became quite ill he started talking about how people should lose weight to increase their odds of a quick recovery
Imagine if the same thing happened in the 60s as we started to understand the risks of smoking - all the smokers got together and decided that the science was hateful and they were being discriminated against. To rephrase a line from the article, using that silly hypothetical:
"In the end, says Flegal, defining smoking by number of cigarettes/day promotes anti-nicotine attitudes and tobacco stigma."
One can't navigate conversations about obesity without topics like "attitudes" and "stigma" being part of the conversation, but I don't think the hard biology of the results of excess fat tissue really cares.
I'm aware this is a bit of a goofy tangent, but hopefully it highlights the silliness of the current obesity discourse.
[1] https://conscienhealth.org/2022/04/obesity-how-does-a-diagno...
Abstinence is easier than moderation.
That's part of the reason why we see more (adult) ADHD these days: people used to smoke a lot. (Chain smoking plus guzzling black coffee used to be the stereotype for eg journalists or editors.)
So nobody strictly _needs_ to smoke, but it helps some.
(Before you go and light one up: smoking is one of the worst ways to get nicotine. Use a patch or lozenge or vape instead.)
> The nicotine causes the receptors to release nitric oxide, which slows sensory inhibition causing a suppression of a subsequent stimuli
It seems unlikely that nicotine is the only discovered substance that causes this effect, meaning there should be a healthier method?
There's a lot of discussion on obesity and weight issues on hackernews that show zero shreds of empathy that it's just wild to me and this is not much different. I don't think anyone refutes that diet and exercise are great options to avoid/combat obesity, but statements like yours are as useful as walking up to a smoker and saying "just quit". You may be alienating the audience you are trying to help, given that is the intention
Just about any stimulant will work.
Eg adrenaline/epinephrine works fairly well. Your body produces that itself, especially when exercising or fidgeting. (And now you know one reason why ADHD people often fidget.)
Methylphenidate works, too. It's also known as Ritalin.
Nicotine is a generally safe substance, as long as it's not delivered alongside acrylamide, VOC-carrying particulates, and tar, as it is in cigarettes.
Amazon sells the stuff in lozenge form for only 7 cents per mg.
As a recently diagnosed & medicated ADHD person, who used to chain smoke and drink gallons of coffee daily, so much makes sense all of a sudden.
Thank you for making me aware of this!
Not to dismiss the ADHD connection at all, but I would be hesitant to hang too much of the blame on that given the coffee drinking.
There's just no data ... one day you'll feel a little off, a month later a routine checkup will detect advanced stage cancer, and you've got no time left.
We know much about how exercise and diet plays into long term health in the same way that wearing a seatbelt keeps you safer.
I don't have a citation on hand, but I remember reading a while ago that when it comes to general health outcomes, it was about 70% genetics and 30% personal choices (don't quote me on that, can make that number even 60/40 or 75/25, the point will still stand).
Which makes sense, a lot of people here probably know someone who did everything "right" in terms of their health choices and still got hit with something nasty (e.g., active lifestyle, eating healthy, etc., and still got cancer or covid or something else), as well as someone who did a lot of things wrong and still had a decent outcome (e.g., my grandfather who has been smoking a pack a day since middle school, been doing hard manual labor, and is still kicking in his 80s).
And sure, it seems daunting that your health choices can affect only that 30% (rather than 70%). In blackjack, however, the house edge against an average player is about 2%, and about 0.5% for perfect strategy pro players. People spend countless numbers of hours practicing memorizing (and executing) perfect strategies just to give themselves that extra 1.5%. While with just basics of taking care of your health, you can take charge of the 30%.
That's quite a massive effect that taking care of your health can have on your outcomes (and your life), even though your genetic health predisposition still has the edge.
Car-centric lifestyles and other trends that were not the norm fifty or a hundred years ago have made it nigh impossible for probably most Americans to live the way you describe.
Those lifestyle bits strongly shaped by the public infrastructure, how work gets structured etc are even harder to talk about productively than diet or home healthcare. People feel helpless to change any of it, so saying something like "If America had cycling infrastructure like the Netherlands..." just more or less falls on deaf ears.
The way America used to eat healthy was "wife and mom" (aka homemaker) was the primary role for a lot of women. With two-income couples and other trends, that just isn't a pattern we can rely upon anymore.
There is a proliferation of products, like meal delivery services, to address this widespread crisis but we need to more explicitly recognize and grapple with some of the root causes and we don't seem to doing a great job of that.
Feeling hungry all the time is not a life choice.
Cutting subsidies to factory farming and encouraging plant-based diets would save billions in healthcare reduce pollution and water usage, yet people kick and scream for “mah bacon!”. We will get what we deserve no more nor less.
I bookmarked it at the time, as I was worried about the hospital system collapsing where I lived like it had in northern Italy.
My job is going to destroy my health anyway. Why pretend I have agency here?
> We could include grocery stores, restaurants and gyms as part of the "Healthcare Industry" though they certainly aren't part of the medical industry.
How is this even a controversial opinion?
It's really hard for good basic information on how to take care of yourself and your loved ones to survive in that kind of environment.
Unfortunately in the world we live in today, "truthiness" wins over real truth. "Alternative facts" win over real facts.
And real honest and open discussion of these issues is also dead, thanks to partisanship, Puritanism, and extreme nationalism. Not to mention profiteering.
You can do the rationing through market forces, where people who can't afford it get less care; you can do the rationing through some other allocation system (e.g. priority systems, or long queues, or lottery, or committee allocation) which in effect still mean that not all people get everything.
If you want to say "In our society, everyone gets healthcare" then you have do define "healthcare" narrowly, which includes some services but not everything technically possible - I mean, if we have services that take more than a man-month of labor for each month of prolonged life (and there are some) then that's not possible to provide for everyone always even from a purely mathematical standpoint.
On the other hand, if you want to attempt to provide (nearly) everything to (nearly) everyone and avoid planned rationing of the available healthcare resources (which still comes up to more care for more people than it was 50 or 100 years ago) then the overload catches up to you as described in this article, and you get a collapse of the system.
The thing is, we aren't even doing the simple thing of making sure that the medical care that is delivered is done so somewhere close to the best possible cost. We heavily regulate supply and then pretend that we have a market.
Or like we have laws like EMTALA, which requires stabilizing care, which is expensive, that leads to hospital systems making walk in clinics that aren't subject to the law, and then encouraging their patients to figure what level of treatment the need. Like my PCP has little placards in their rooms explaining the difference. There's no law that the ER can't triage down to a lower level of care, but it would cost them revenue. It's fucked.
They aren't separate to do patients any favors!
Any hospital built in the last 20 years that has a MOB on site probably has a pretty similar setup.
Know what, just turn off the Internet, it was a mistake.
By default, I have to admit that I think that statements like that, without the proper reasoning or maths behind, are among one of the most mysanthropic and lazy things a person can state.
There is nothing misanthropic about stating that we are too many, unless of course you assume that I mean that anything more than zero is too many or a similar ridiculous interpretaron, otherwise it's just a very simple proposition about resource management, and arguing its misanthropic is a emotional response without much through, no reasonable person would call a man who wants the exact opposite -lets say 100 billion human population- a "lover of humanity" or anything remotely similar, then what is the logic to call me a hater of humanity for suggesting humanity itself is better off with less humans living at the same time?
> humanity itself is better off with less humans living at the same time?
Humanity isn't an entity, but each of those humans is. Every single one of them a life as rich and complex and deserving as your own. What path are you suggesting for reducing that number, destroying some of that complexity and richness? This cannot be responsibly debated in the abstract; any concrete policy will result in constraining the self-determination of many of those people. How would you have it done?
Fallacious to say the least. I've explained the reason on why I think it implies that, which is: "people that makes that affirmation with no data or maths to back it up". Which I think is a quite reasonable thing to ask. You reducing it to a "is an emotional response" is a very poor take and bad reading.
Regarding your initial question. I am sorry but I don't see the correlation. The Black Death, for instance, killed between 75 and 200 million people back in 1340-1350 where world population was approx 350,000,000. Following your reasoning, this shouldn't had happened?
Initially, I was expecting from you to give a decent argument like: "There is a strong correlation between wealth, development and low birth rates". Then, based on that, talk perhaps about incentivicing sustainable economic growth. But nope, just talking about reducing humanity by "incentivicing" without being specific or considering the grave implications and then later, talking about your guessing on how covid wouldn't have been a problem.
The most obvious incentive is economic, paying childless people to be sterilized, maybe around $3000.
No point arguing any more, if you ever really want to learn about this there is a book called "Limits to Growth: The 30-Year Update", good riddance.
Great arguments /s.
Anyways, I truly hoped from the beggining a honest exchange of ideas. Instead, I've had you feeling atacked and reacting with condescending attitude. Very dissapointing interaction. Have a good life.
At the moment, we sort of try to reduce medical care to elderly people by trying to get them and their family to agree it would be more humane to let them go naturally, but we still spend an extraordinary amount of money trying to slightly extend the life of nonagenarians, for example.
Unfortunately, something like this is bound to be extremely unpopular and controversial. I think most people probably agree that if you had two people with cancer and could only afford to treat one of them, it would be better to treat the 22 year old and not the 92 year old. However, when you scale that up to an entire country, abstract it all away behind insurance or tax, and it's YOUR grandmother on the line, things get more difficult to reason about in such a utilitarian fashion.
It's probably better for society to withdraw all non-palliative care from over-80s and spend all that money on teenage mental health, but I can't imagine any politician being willing to attack their voter base like that.
Replace the 92-year-old in your hypothetical with a 22-year old blind person in a wheelchair and "most people" would probably withhold treatment in that case. But they would conclude that based on stereotypes and assumptions about what life "must be like" with those disabilities, not on whether or not that person finds their life worth living.
To change this you need to make it so that so that people actively choose, for themselves, less resource-intensive courses. Which is absolutely a thing, most people if well-informed would choose a slightly shorter life with higher quality of life, still part of their families and communities rather than medically segregated from them. There are powerful reasons people don't make these choices right now, and that needs to be addressed, rather than snatching the choice away from them and putting it in the hands of forces that will inevitably use it for atrocities.
At least in my country, healthcare is paid for with taxes, so I don't think there's anything wrong with withdrawing the government funding for the more expensive treatments past a certain age. If someone chooses against that and wants to save up over their life to pay for extraordinary interventions in their later life, I have no issue with that, but I don't think it's a sensible thing for society in general to pay for when we are in a funding constrained situation.
Socialised medicine already makes funding decisions regarding who gets healthcare, for example in the mental health example, that is really poorly funded relative to the amount of benefit it provides compared to cancer care for the elderly. We actually already do incorporate the concept of "quality adjusted life years" into calculating whether to fund a medication, it's just that decision is only made once, at approval time, using the average impacted patient's age/health. However, that has the even worse side effect of causing very effective treatments for diseases that mostly only affect the extremely elderly to not be approved, meaning the odd 35 year old who gets that disease can't get treated without the paperwork of an individual funding request. That is to say, this choice is already in the hands of other forces - and actually in the UK, it's up to the medical team, not the individual or their family to decide whether to withdraw care, but typically (though not always) they do what the family requests.
Few weeks later, you'll receive a financially-crippling bill in the mailbox because the insurers refuse to reimburse your treatment/you were sent out to a out-of-network hospital/because you don't have health insurance in the first place. Oh, don't forget to pay for the ambulance!
Seriously. Excess deaths due to failure to treat are off the charts.
[0] https://www.theguardian.com/politics/2019/sep/12/nhs-hospita...
[1] https://archive.ph/UDtZo/again?url=https://www.ft.com/conten...
[2] https://www.opendemocracy.net/en/nhs-privatisation-health-so...
[3] https://www.gov.uk/government/publications/health-matters-ai...
[4] https://usa.streetsblog.org/2019/05/29/protect-yourself-sepa...
[5] https://digital.nhs.uk/news/2021/one-million-admissions-link...
The problems in the NHS are mostly structural & have been building ever since George Osborne chose austerity in the aftermath of the 2008 financial crash. NHS spending was ringfenced in real terms, but social care wasn’t as that was funded out of local authority expenditure. Social care is now difficult to access & in short supply nearly everywhere as a result. Care homes are closing under the pressure of the difficulties in employing staff & inflation in fuel costs running headlong into the squeeze on LA funding meaning that LAs have been forced to eliminate any/all discretionary expenditures.
For the NHS this has led to two issues that have got progressively worse over time: 1) the UK population is aging & old people need more healthcare, meaning that freezing NHS funding in real terms would inevitably result in a steady increase in healthcare need that couldn’t be met and 2) for those people the NHS did manage to treat the collapse in social care has made it impossible to discharge them from hospital safely in a timely manner.
Some estimates suggest that currently a third of NHS beds are occupied by people who could go home if a care plan was in place for them, but that care is either unavailable due to LA funding cuts (forced on them by a government which cut LA funding to the bone) and can take weeks to arrange as the staff doing the assessments are themselves in extremely short supply.
This bed shortage then has knock on effects that ripple through the rest of the system. Combine with the regular winter flu epidemic & Covid wave spiking demand & you end up with A&E full to the brim with patients dying on the floor whilst every single available ambulance sat queueing outside A&E with patients that cannot be left alone & with no-where for them to go.
All of this has been aggravated by Brexit, but we would still have ended up here without Brexit: the root cause is the intersection of the steady decline in healthcare & social care funding with the increase in demand caused by an aging population & two concurrent epidemics.
All this has been predicted for years, it was obvious from the data that the system was persistently overloaded: waiting times for NHS treatment were steadily increasing at every level, including A&E. The current collapse was entirely predictable, but our current government was either unwilling or incapable of doing anything about it.
Chunks of the left believe that this is a planned collapse - that at least part of the government intended to force the NHS into a state of collapse in order to drive through a US-style privatisation that would enable them to line their own pockets. We know that government ministers have met with representatives of US medical companies numerous times within the last few years, so this isn’t an entirely baseless conspiracy theory sadly.
I’m not personally against private companies being part of a national healthcare service - most of the EU provides healthcare on some kind of partially private basis, with many differences in the details. However the US system is the worst of all possible worlds - it’s extremely expensive whilst giving very poor coverage of the population. It’s impossible not to suspect that US healthcare companies are hoping for an opportunity to carve up the UK healthcare market along similar lines in order to line their own pockets - the cost of bribing government ministers with a few well placed post-government directorships would be a small price to pay.
It's a shallow perspective on a complex problem and I'd encourage you to read something with more depth.
“Scoop and Run” (just get the patient into the ambulance and then the hospital as quickly as possible) vs
“Stay and Play” (emergency doctor starts treatment on site, then transportation to the hospital).
Apparently the former is more associated with the UK and US, the latter with the European continent.
Scoop & Run vs Stay & Play is just a way of describing whether to treat on scene or not. It's used everywhere (at least everywhere that has a modern ambulance service with paramedics) and the boundaries shift depending on scene, patient, skill level on the ground, distance to definitive care, transport options, etc.
The whole world has been migrating over the last ~50 years from a purely Scoop & Run model where ambulance drivers were just that - barely first-aid trained - to a model where more and more care is delivered on-scene, Stay & Play.
> As a swede I’m confused, how does it work where you are from?
I simply described it as how would an ordinary American would experience a potential emergency. Between the "designated doctor" versus "let's be cautious", I'm not sure which is the objectively superior one (although unlike your presumption, I actually like this cautious approach), however I cannot underestimate the fact that your insurance company can just declare your situation as not emergency, despite multiple administrations trying to close loopholes (and even some arguing that the liberalness of insurance companies are not enough). Except for the (rather bitter, I'll be honest) tirade about health insurance, I have tried to not evaluate which system is better, and I'm not sure where did you get the impression that I despise the Anglo-American procedure.
Not saying the system does not work but you do have medical zebras falling through the cracks.
In one case serious consequences were prevented only because the wife of the person, after exhausting all other options, called a special "ambulance on call" service which was part of their healthcare package.
Misdiagnosis is a problem regardless of whether you're talking to a doctor in person or over the phone.
(Though I'm not sure how much cheaper health care is here anyway — we definitely do have a problem with ever-growing health care costs.)
Another issue not widely discussed is that 20% of patents are responsible for 80% of the cost. If you look at said 20% more often than not you'll find consistent failure to intervene early enough while the illness is easy to treat.
But then I believe everyone it entitled to their vice. So please no "forbidding" (as with recreational drugs) but some heavy taxes.
The forbidding lead to smth else becoming very dangerous for public health: US police.
Tax could help a lot but so could choice architecture, putting fatty / sugary foods out of reach and healthy alternatives at eye level could help alot
I dont like too much govt intervention. Taxing something into oblivion, and forbidding ads seems to me the most acceptable things a govt should be able to implement. Bit like smoking (as OP said).
The consumers are not making an informed choice but are being heavily influenced to do something that is bad for them.
Taxing vices makes them proportionally more expensive for the have-nots, without solving any issue. No one gives up smoking or drinking because they don't have the money for it.
I say don't forbid, don't tax, but let there be consequences. It must be very frustrating for medical personal to deal with anti-vaccers and heavy smokers. You buy sigarets? Just sign this waiver. Don't get vaccinated? Don't get a check in the system for future treatment.
I think you are right that some people do take it too far. But from what I've seen a lot of people who do end up chain smoking or overeating processed foods daily have other underlying health-conditions. For example with smoking a lot of ADHD sufferers who are undiagnosed might self medicate with nicotine as it is a stimulant. Some might also have working memory issues and struggle with self control.
Ultimately most individual choices have a societal aspect to them, a lot can be tackled by education, early diagnosis and choice architecture
Rough "napkin" math on this is massively over simplified but the NHS spent roughly £134 billion in 2019/20 (before covid). We have around 67 million people in the UK. That works out at roughly £2000 (~$2500) a year. I ended up spending 4 hours in A&E a few weeks ago trying to get some some antibiotics for a suspected infection because my GP just wouldn't call me back to prescribe them.
I would love to go private (and likely still will), but since I'm forced to pay into our NHS system, I feel like I have already paid for healthcare. I was quoted around £45 a month for private healthcare, which doesn't include the first stage GP visit, but some companies are adding on a handful of video call GP visits as part of the private plan. Bupa charge something like £80 for a 30 min GP visit.
Obviously I'm young and that cost will increase, but at this point I feel like the NHS is just enforced social healthcare thats no better than what can clearly be provided by the private sector. I've only started looking into this recently after my awful experience here in the UK and I'm sure I've missed a ton of factors.
My point is, if I'm forced to pay for healthcare from my tax then I expect healthcare for any issue I have in a reasonable time and to a reasonable quality. Opting out is not really a realistic option.
https://fullfact.org/health/spending-english-nhs/ https://www.ons.gov.uk/peoplepopulationandcommunity/populati...
Don't forget that in both countries public healthcare has to do a lot for the over-65s who don't have spare money for spiralling costs.
A great counter example is Signapore where each individual has a mandatory savings account which can only be used for healthcare. However, catastrophic illnesses and insufficient funds are covered by the gov. Another element of the scheme is that the savings accounts can be used for family members. This incentives people to seek the cheapest care, and keep family members healthy. While the poor, retired etc are still taken care of.
The problem I have with the NHS is that I dont see what my care costs at any point. I dont think that leads to good decision making.
How much extra do you want them to spend on computing this? To what extent do you actually want cost factored into your care?
It almost seems like risk-averse people resent those who take risks for having more fun sometimes. Smoking, drinking, and drugs making you not able to get healthcare at all is next level Puritan shit
yups. and besides that: where to draw the line and how to enforce it? "sugar" for instance...
I was raised christian and was therefore deeply scared of drugs until age 21, luckily for me by the time I was mature enough to enjoy drugs at around 25 my brain had developed fully and I was able to try MDMA & LSD with positive life-altering consequences. Some of my friends who didnt have the same fear ended up trying hard drugs at far too early an age and became addicted. Not all of them, but at least those who had self-control issues and mild ADHD.
Things often come down to a genetical and circumstantial lottery, the more we do to minimise negative consequences of bad luck and level the playing field the more we will benefit from everyones talent collectively
Everybody should be entitled to health-care no matter what their life choices.
If you drive a motorcycle and get in an accident, you should expect the same level of healthcare as someone who drives a car and gets into an accident, despite the vastly different level of injury.
If the system you're living in allows you to buy and consume cigarettes, sugar, marijuana, and you need medical assistance for your diabetes, lung problems, cancer - I'd expect the same level of care as someone who'd abstained from these vices their whole life.
To limit medical care to people based on what they choose to do to their bodies is the exact same as limiting medical care to people based on what they can afford.
It's "Just pull yourself up by the bootstraps and work harder to afford your chemotherapy, you non-smoker!" vs. "Sorry you work 16-hour days to provide for your family so you have a stress outlet of stress-eating, smoking/vaping, etc. - but you made that choice, should have 'pulled yourself up by your bootstraps' and kicked the habit!"
I am guessing japan has more sensible regulations in this respect.
He had to visit a hospital recently, while he never disclosed to me what his medical condition was, at the end he mentioned that his hospital bill was almost $1500... "Only to find out I'm also allergic to penicillin" and that "if I would have taken an ambulance it would have doubled the bill"
That is a kind of "loaded". Joe Average with a crap job, or no job, is not so lucky.
I also have kids and, like most people on HN, have “good” health insurance that comes with a tech job.
But get one family member that needs to see a cardiologist or neurologist every few months and you’re hitting your $6,500 deductible every April.
Do I understand right that this means you might have to pay up to $500 for medical problems?
That seems huge to me, it's higher than what one pays "out of their pocket" here for a childbirth for example and I don't think you can expect a regular person to spend this unexpectedly, that's about a third of the average wage (in Belgium).
I expect to pay at least $200 anytime I receive healthcare, even just for a 5 minute consultation with the doctor. Childbirth is minimum $4k to $6k, assuming vaginal and hospital stay is 2 nights. If C section and 3 nights, then add $2k to $3k. If using epidural, add $3k more. For both of our kids, we reached annual out of pocket maximum of $5k to $7k in the calendar year, for regular, non complicated vaginal births.
Deductible: What you pay before insurance company starts paying. Usually at least $2k, but varies anywhere from $0 to $10k. Could even be as high as the out of pocket maximum.
Out of pocket maximum: The maximum you pay in any calendar year for healthcare. After that, all responsibility falls on insurance company. Legal maximum for 2023 is $9,100 for individuals and $18,200 for families. Usually this is $5k per individual and $10k per family, give or take a few thousand.
The higher the deductible and out of pocket maximum, the lower the insurance premium (like any other insurance).
Insurance premiums are $400 to $1,200 per month per person from age 0 to 64, give it take a few hundred. That means for a family of 4, health insurance will be ~ $400 per month for each kid, and $500 to $900 per month for each parent. So roughly $24k to $36k per year in insurance premiums, plus out of pocket maximum is ~$10k, which means $30k to $45k per year will pay for a family’s (of 4) healthcare in a calendar year.
If receiving health insurance via employer, the employer will usually pay 70% of the insurance premiums. Sometimes more. If not receiving health insurance from employer, and you are lower income, then you can get tax credits (government subsidy). This lower income is usually $100k per year and below, the lower the income, the higher the tax credit.
Age 65+, the federal government starts paying for your hospital emergency healthcare, but you may or may not need to pay for medicines and outpatient (non hospital) healthcare depending on your income/wealth.
https://www.zorgwijzer.nl/zorgvergelijker/english
The lowest deductible on that page is ~$400.
That said, I'm shocked that the average wage in Belgium is only $1500. That sounds very low, do you not have any workers protections for wages?
Well I never lived in the Netherlands and I am not planning on doing so, so their healthcare system isn't really something I have ever had any reason to study. This system strikes me as very different from ours and the costs I see on this page are far higher than those in Belgium, France or Germany. This deductible system also does not exist in these countries.
Average wage in Belgium after tax is 19 000€ from what I can see, so about 1600€ per month, however various sources give different numbers and another number I can find gives 2250€ as median wage. The difference might be that 1600€ per month takes into account the whole population including people who aren't working while the median is calculated on the people who do have a salary, I'm not sure though.
It's not especially low either way when one doesn't have to pay "$30k to $45k per year [...] for a family’s (of 4) healthcare in a calendar year" (according to sibling comment). School and education in general is mostly free as well, which also helps I guess. A family of four in reasonably good health should expect to spend a few hundred euros per year on healthcare here.
It doesn't sound like you know the plight of others very well.
Like almost every professional career from software engineering to law, medicine, engineering, finance, etc. pays 2-4x the same roles outside the US, and usually includes great health insurance.
Whereas almost all public insurance in Europe, etc. doesn't cover preventative screening, so you better hope any disease you get starts with clear symptoms.
I was lucky that I had a good insurance plan, but still, trying to navigate the system when I wasn't unable to was the absolute worst experience.
Which medical system recommends that? And why?
My jurisdiction stopped paying for those because they don't have any evidence of net benefit. It makes more sense to target exams based on your risk of having issues.
https://www.ncbi.nlm.nih.gov/books/NBK82767/
Medicine is often uncertain & going looking for problems can end up being a good way to create new problems where there weren’t any before.
If you propose a universal program to catch diseases early then you need to demonstrate two things: 1) there are people with these diseases that are currently not being picked up and 2) the false positive rate & harm caused is less than the existing harm being caused by missed opportunities to treat real issues.
By way of example, many health services have abandoned screening programs for prostate cancer via PSA tests - the harm done was judged to outweigh any observed benefits. Even in those places that are still screening there will be an age cutoff as, below a given age, the costs are thought to outweigh any possible benefits.
Here's the thing though, it's pretty obvious that early, regular screening and health checkups with a focus on improving health are a net positive. You go to the doctor, do some blood work, a couple x-rays, and they tell you areas where you could be healthier.
Any reasonable person would agree with that. You can come up with arguments for why I'm wrong, and try to put the burden of proof on me, and by doing that you make it such a hassle to try to improve things that I just give up.
This is why nothing gets done in North America anymore. There's always a reason not to change things, not to try anything new. That's how you end up with a stagnant society, crumbling healthcare system, outdated infrastructure, school shootings, global warming, housing crisis, etc.
I don't know mate, I'm sure you have good intentions but it's hard for me to find a net positive outcome of your position.
Is that a worthwhile use of their time? Do we see a net improvement in health outcomes if we do this? Healthcare is littered with treatments that were thought to be helpful but turned out to have negative outcomes.
If you want to introduce something new it really is on you to demonstrate that it represents an improvement to the status quo, because what a “reasonable person” thinks very often turns out to be completely false & ends up doing actual harm.
From my perspective, that's exactly the point of these basic preventative labs - how do you even know what you might be at risk for if you haven't established a baseline? As we saw on the thread about cancer earlier today - early detection has had a greater impact than new treatments.
I had a doctor who was willing to do basic blood tests and he helped me create a plan of sorts about what I needed in the way of long-term awareness, nutrition, etc. And then he retired. Since then, the doctors that I have spoken with have had an attitude in line with yours, IE: call me when you are sick. But that's a core problem with our health care system - the emphasis is entirely on treating symptoms of the disease rather than on prevention. And this to my thinking is why men in particular are statistically low users of health care - because they give up on playing the game.
were you not around for the obamacare debate? i was, and it was made perfectly clear that a majority in the house and senate + the presidency, all in theory working toward the same thing, couldn't really change anything.
without legal intervention, who's iterating and innovating process? and to what end?
If Canada could do it that way, why not US?
“In Canada waiting times have reached an all-time high, with a median delay of half a year between referral and treatment.”
I’ll pass, thanks.
Keep killing those kids
[0] https://www.statista.com/statistics/1240400/maternal-mortali...
https://www.commonwealthfund.org/publications/fund-reports/2....
Humanity is very bad about pre-emptively identifying risks and avoiding them - witness our response to global warming, both world wars, falls of empires, carcinogens, peak oil, the housing crisis, the health care crisis, and so on. Problem is that until a crisis is actually upon people, it's not urgent, which means that everybody has an incentive to focus their attention on things that actually are urgent. A fair number of people may not even agree that a crisis is imminent, or what to do about it, or they may have vested interests in the old system and resist any new change.
People have been manipulated into supporting these bad actors through media. Wanting affordable healthcare is "socialism". Single payer healthcare will kill your grandma with "death panels". The fact is that in most metrics socialised healthcare is fucking the absolute shit out of the US system, which somehow manages to kill twice as many pregnant women as Canada[0]. At this point the only thing that might change the minds of these people is to feel the consequences of their actions.
[0] https://www.reuters.com/article/us-health-pregnancy-idUSKCN0...
Maybe in your country, but not in mine... Our government is sitting on a surplus and won't spend it, and what little we do get goes to executives and all the laptops we had to give out so they could work from home, while all the serfs toil and burnout.
But even within theoretical affordability limits there are tighter limits imposed by political reality. Voters are already strapped by inflation in the cost of daily living. They're going to balk at paying more in taxes or insurance premiums just to maintain healthcare service levels. We might be able to reach a political consensus for a moderate tax increase on high-income people but that would only delay the worst effects by a few years and won't resolve the root problem.
In the meantime there are marginal gains to be made in software to improve productivity. That won't solve the problem either, but it will slow down the decline so that's what I'll continue working on.
Also, it'll be a lot easier politically to let the Trump tax cuts expire than to explicitly raise taxes even though both are basically the same thing.
Here in the US, health care spending (measure $ per GDP) has been nearly twice the level of many other advanced nations while health care been subpar and continues to decline compared to other nations.
The reasons the US spends much and does so badly for its citizens are very complex in overall but one simplification that I think makes the inefficiency obvious is this; we have a full state sponsored system - medicare and etc as well as a full private health care system and they each cost money.
I once read a detailed an convincing argument that the US system had too many layers between sources of health care money (taxes + payments in private insurance) and end point (delivery of health care) with no incentive or structures to keep the middle ground lean and mean.
ie. Way too many people and groups prifiting richly from the pipeline flow of healthcare money with too many lobbyists motivated to keep that status quo.
It's not that the US has dual systems, more that they don't compete on outcomes but that the private system is motivated to increase profit and hamstring the public system.
They basically adjust spending by GDP, then compare the US to other OCED nations, then split spending across a dozen categories of healthcare spending.
The biggest cost driver? Out-patient procedures. It’s not just that it costs more (it does), but volume is way higher than other countries and one of the biggest drivers of the higher spending seen in the US.
For in-hospital care, the US is marginally higher. Drug spending is higher, but it’s 50% more for 10% of spending, so marginal. It’s lower in durable equipment spend. And much higher in R&D spend, though the impact isn’t huge.
Americans get a lot more out-patient procedures than other countries. That’s the biggest cost driver of US healthcare.
Is it cost effective? Not sure that’s been answered yet.
The whole of Europe is on the verge of collapse.
We take in a lot of foreign health care professionals but the borders were closed over covid. Not to mention the govt fired any "heros" who didn't get the vax.
Even before covid my region was staffed by 'locums'. I never saw the same doc twice and one was visiting from California. Now we have a brand new hospital but don't you dare try to use it. It's some kind of neoliberal private/public experiment. You'll be charged for sitting in the ER waiting to be seen, and after 4 hours waiting with a laceration you're too swollen for stitches.
If you have some non obvious sickness, you're only seeing an ED doc so they're just another level of triage so they're not really troubleshooting effectively they just want you out the door. My partner, in incredible amounts of pain (from as it turns out requiring a fucked ovary to be removed) was told to practice mindfulness, until she could see a nurse practitioner of ob/gyn in maybe 3 months.
The GP clinic is inside the hospital but went from serving 1,500 to 12,000 due to the restructures.
No, it's not? Unless you're comparing pre-pandemic to mid-pandemic, rather than the most recent post-pandemic estimates.
Current GDP estimate is within a percentage of what it was in January 2020, and about 6% higher than it was the month before the brexit vote. That's still far from ideal, but it's not 10% down.
Maybe you're thinking of GDP-PPP, but I haven't seen any post-pandemic figures on that, or maybe you're thinking that GDP _growth_ is 10% (not pp) lower than before brexit. That may be the case, but the last three years aren't a good basis for estimating GDP growth as they're very unstable for a whole host of reasons.
We are in a really bad economic situation and are underperforming most developed nations, but our GDP is not down 10%.
Waiting for appointments with publicly funded doctors can now take several months, some doctors refuse adding further people to their wait lists. Many publicly funded positions for doctors stay vacant. Doctors are fleeing into private practices, where they earn significantly more money, have a more pleasant set of patients and less regulations.
I had to wait 2 months for a heart MR at the only institute that does heart MRs in Vienna. Paying privately, I would have gotten it at the day and time of my choice.
We are still getting our brain, heart and lung surgery or organ transplants for free as in 0€, but anything not absolutely necessary is declining, slowing down or starting to cost real money.
E.g. a study "found only one example where there were more covid patients than intensive-care beds". For real? Was it perhaps because of the triage process used during covid? What about the non-covid patients that were left without an IC bed because of IC bed segregation?
It is also reprehensible that everything is pinned down to "productivity" of health workers. Are those the same people hailed as "heroes" a year or so ago?
The peace dividend dying off also doesn't help, you've got to get the a lot more money for the military from somewhere, so it's either from education or healthcare (or from both).
The last reforms, after the Con/Lib coalition came to power, which split the NHS up into clinical commissioning groups is where a lot of blame has to be put (along with not keeping funding to the level required). From centralised purchasing giving economies of scale, to each CCG doing their own purchasing, and lots of duplication of roles across the whole country.
The tone of the article doesn't match that of the title.
- Under-exposure to pathogens due to living in an overly sterile (i.e. artificial) environment. - Over-reliance on medication for the slightest physical discomfort. - Physically inactive life style. - Bad nutrition. - High prevalence of chronic conditions such as obesity, diabetes, circulatory disease, cancer etc.
This has no scientific basis, it has been disproven time and time again.
So in that sense, we’ve come a long way.
But realize that we are the same people we were 3 years ago. We haven’t changed. So what has ?
So spending has ballooned and it's done it in the most inefficient and ineffective areas.
This is the price of "freedom".
This is the main problem in America, at least. Our government loves capitalists but hates people.
Nobody I know has caught the flu... but they all had their flu shot.
Seriously ?
EDIT: found it. Anyway, didn't read the article. I think paywalled submissions should be banned.
Here's what an actual collapse of a health care system would look like to me:
- 95% of a country's health care personnel disappearing
- Hospitals have to close because they no longer have any health personnel. All hospitals, not just rural hospitals. And the closures must be permanent.
Since HN's crowd heavily tilts toward the US West Coast and the Bay Area in particular, I googled a list of all hospitals in San Francisco.[1]
- California Pacific Medical Center - Davies Medical Center - Kaiser San Francisco Medical Center - Friends of Laguna Honda Hospital - Langley Porter Psychiatric Institute - Letterman Army Hospital - Pacific Dispensary for Women and Children - Public Health Service Hospital (San Francisco) - Saint Francis Memorial Hospital - St. Joseph's Hospital (San Francisco) - St. Luke's Hospital (San Francisco, California) - St. Mary's Medical Center (San Francisco) - San Francisco Chinese Hospital - San Francisco General Hospital - San Francisco VA Medical Center - And the UCSF system
A proper collapse of the Bay Area's health care system, to me, would entail the permanent closure of every one of the above. All of them. A "every man for himself" scenario. A scenario where there are no more nurses; no more doctors; no more surgeons. A scenario where health care requiring any kind of advanced equipment is no longer possible, where MRIs become impossible, where cancer treatments become impossible, for rich and poor people alike. A scenario where pregnant women have no choice but to give birth at home. A scenario where no one but the wealthiest billionaires can access any kind of health care that's not a Tylenol or an Advil. That's a collapse.
25% of nurses leaving within a year (and being replaced), or anecdotes of personnel calling out sick, while deeply concerning (as I wrote above, I am very sympathetic), just aren't bad enough to warrant the use of the word "collapse".
[1] https://en.wikipedia.org/wiki/Category:Hospitals_in_San_Fran...
That will be a bad situation that harms many people, but it won't be a collapse.
On top of that, even before COVID, "code zeros" (no available ambulances) were an almost monthly occurance.
So I don’t think the common use of collapse is very useful either.
Please stop being ridiculous.
But I also think a lot of rural communities have had a much more complete failure of the healthcare system, where sometimes there is very little to draw medical professionals who have some pick in where they go. When this results in either primary care doctors or hospitals closing, patients can end up a long way away from care.
It's also worth pointing out that while the SF Bay Area does have a lot of health care institutions, your list includes multiple that are permanently closed (e.g. Letterman Army Hospital, St Joseph's) and some that aren't actually hospitals (Friends of Laguna Honda Hospital is a non-profit for volunteers associated with the Laguna Honda long term care facility, which has its own collapse story).
[1] https://www.merriam-webster.com/dictionary/collapse
[2] https://www.aha.org/news/headline/2022-09-08-aha-report-rura...
In Canada admission to medical schools is not changing with the population growth. Is it the same in California?
That's precisely a collapse. You don't just absorb that many people leaving without issue. You put more strain on the people remaining, and see even more leave next year, and fewer people coming in.
[0] https://www.theguardian.com/society/2022/dec/20/93-year-old-...
Hospitals are a single point of failure as an institution and we should be moving away from centralized medical care in the 21st century. As an aside, I’ve noticed a lot of people are in hospital waiting rooms whereas they could be served with a doctor making a house call. Just my 2c
Lather, rinse, repeat for every medical device. Sleep analysis tools, XRays, surgical tools and instruments, etc etc.
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Furthermore, doctor time is expensive. It makes more sense for patients (who probably make less money than doctors) to spend their time driving. Not for doctors to be driving around making house calls like a maid or milkman.
This is a result of caps on medical school residency positions. The number of doctors per person in the US has actually steadily decreased over the last century, due to measures the AMA lobbied for to restrict the supply of doctors (and hence increase the amount doctors are paid).
You must have forgotten about the sickbay diagnostic bed with the foot-pumping machine in the wall. How's the doctor supposed to carry that around?
Anyway, back to hospitals: they seem to work fine in my country. If you have a problem that's somewhat urgent (needs more than a clinic visit), you just call for an ambulance and go to the hospital. Having doctors spend at least half their day in transit, going from place to place, seems like a massive waste.
When the doctor goes to the patient, travel time is serialize with seeing patient time.
Not really, but I wish we had more urgent cares available so that people without emergencies don't flood hospitals. The reason a lot of them wait until its serious enough is because healthcare is expensive, so people avoid going to PCPs and Urgent Cares.
We need better way of paying funding/paying for healthcare.
Vouchers?
https://www.brookings.edu/research/a-comprehensive-cure-univ...
Ban for-profit health insurance companies?
https://firstquotehealth.com/health-insurance/news/non-profi...
But I honestly believe there is no simple answer. Healthcare systems are built over time and are continually changing, which needs incremental changes and continual tweaks.
Concierge medicine is, cost efficiency aside, more of a replacement for office-based visits (probably doesn’t eliminate the actual office, but lets it downsize) and maybe urgent care and some other outpatient clinics. it’s not a replacement for inpatient hospitalization. I suppose if you include upgrading EMS to include medical flying squads with doctors and nurses as kind of “second responders” in your definition of “concierge medicine” (its not the same thing, but I guess conceptually related enough not to be totally unreasonable to include them together), it might replace some ER use, too, but it would probably be ridiculously inefficient in doing that, even more than concierge medicine generaly.