America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. I emigrated to the U.S. in 2022 but left after a year. Life is plenty hard for citizens there, and despite working in tech, I constantly had this fear of needing healthcare in the back of my mind.
I didn’t want to risk bankruptcy because of an insurance denial, so I left quickly. Aside from the dismal state of transportation, unwalkable cities, and a self-sabotaging healthcare system, I actually kind of enjoyed my time there. Now living in Europe, I’m poorer but happier too.
>but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from
Source? I find this hard to believe given the US leads the OECD in terms of household disposable income[1], never mind whatever "Southeast Asian backwater" country you're talking about. It's unlikely "US healthcare profiteering" would affect this. Healthcare spending in the US is 17.6% of GDP, which provides an upper limit on how much it can eat into income. Even if you assume all that's borne by households and subtract that from income figures, the US would still be in #2.
I'm getting tired of reading this kind of stuff on HN, maybe I should just ignore it but a few friends from other parts of the world, also HN readers, are starting to believe it... So I'll try doing my part.
Yes, the worst-case scenario for health expenses is indeed bad in the US, this is true. However, this is not the average healthcare experience. It's not a matter of time until you're slapped with a bankruptcy-level bill.
My wife and I, both in our 50s, have had our share of insurance annoyances and frustrating phone calls, but we've had multiple surgeries fully covered by insurance. And this is the same with friends and family members, including at least 4 cancer treatments that did not lead to bankruptcy-level or even truly notable bills. This anecdote includes many people who died of "old age".
Worst-case scenario bills can be bad elsewhere too. For instance, a friend in Europe had to do a 250K GoFundMe campaign to pay for a life-saving treatment for his daughter because well, the only place in the world that performed the surgery she needed was... Guess where? The US. He faced bankruptcy for this bill, but friends and strangers were able to help him out to an extent. I think he's still recovering from the expense years later.
Medical bankruptcies and financially crushing bills are a sad possibility in the US, and certainly much more likely than in most other places. We need to keep working on this. But the vast majority of people will not have to face this problem in their lifetimes.
I'm also from a "backwater" place in South America that happens to be richer than most places in Southeast Asia. I've lived decades both in the "backwater" and in the US - I happen to know the US fairly well as a result. I choose to live here for a simple reason: the quality of life in this country is much superior than my comfortable lifestyle in South America.
I know dozens of people from different parts of Asia, and I can only remember a couple, let's say <3%, who went back to Asia after living in the US for a significant period of time. These are not poor Asians, in fact a lot of the Asians you meet in the US were relatively well off as they were able to afford the education in Asia which allowed them to immigrate. Nonetheless, they choose to remain here.
All of this said, there is nothing wrong with wanting to go to a low COL place sometime in our lives. I've done this within the US myself, and I would consider another country for a combination of weather, proximity to friends, desire of early retirement or a large property etc. But not because the US is a bad place to live, in fact its very high quality of life is what keeps me from making such move.
“The place I grew up is nicer than this new different place I’m now in” is very common. I grew up in a small town. I hate big cities. There are people who feel exactly the opposite because they grew up in big cities.
Also you work in tech but weren’t provided or could not buy health insurance? That seems unlikely.
Which backwater? I'm looking for LGBTQ friendly places and there are not many to be had worldwide. Things are okay at the state level for me but federally about to go to hell
Meh. I'm American and also a middle class tech worker. I've never had concerns about insurance denial and also never been denied (or anyone in my immediate family). I feel like the care we've gotten has been excellent and I don't sweat it. My anecdote is worth at least as much as yours.
>America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from.
I think this is a real case of [citation needed]. Many people will, rightly, point at a myriad of statistics to demonstrate how this can't be true, and that's fine. But, I think we can just use some common sense; what are we talking about? There is no way this is true. Why would even need an immigration policy if this was true? This is just some kind anti-Americanism or anti-capitalism nonsense; that is really the only explanation for such an assertion that I can surmise. I'm also not really sure why working in tech you would be "constant fear of needing healthcare". If that is true then if nothing else the placebo of effect of moving to Europe may have been the best treatment psychologically, certainly cheaper than seeing a therapist.
>Nationally, this equates to $38.6 billion each year to comply with the administrative aspects of regulatory compliance in just these nine domains. Looked at in another way, regulatory burden costs $1,200 every time a patient is admitted to a hospital.
> Doctors for United have reported pressure to reduce time spent with patients, and make patients seem as sick as possible through aggressive medical coding tactics.
This is inevitable when government is handing out money. Recipients will always game the bureaucratic rules that specify payouts.
Directly paying for cash-priced surgery has become cheaper than the heavily regulated insured coverage. Not only cheaper when including the overhead of having insurance, but cheaper in real terms of a single surgery event.
Strange list, some of this is flat out crime, not "profiteering". Fly by night companies submitting 2 billion in false Medicare invoices isn't capitalism. It is simple fraud taking advantage of Medicare incompetence. Same for doctors giving giving people chemo for years despite them never actually having cancer.
> In a highly competitive year, the top spot went to Steward Health Care, whose CEO, Ralph de la Torre, is accused of prioritizing private-equity profits over patient care. His financial scheming led to bankruptcy...
This seems inappropriate for an award for "profiteering". I believe that profiteering requires making a profit at some point. What did they want him to do, take the company to bankruptcy faster? And just eyeballing the margins on #2 [0] it looks they don't make that much money either. Those aren't particularly impressive margins. They compare more to Walmart than Google.
This group tore down an institution that took decades of work by extremely smart people to build, and now tens of thousands of people will get less and worse healthcare because of their actions.
rednafi|1 year ago
I didn’t want to risk bankruptcy because of an insurance denial, so I left quickly. Aside from the dismal state of transportation, unwalkable cities, and a self-sabotaging healthcare system, I actually kind of enjoyed my time there. Now living in Europe, I’m poorer but happier too.
gruez|1 year ago
Source? I find this hard to believe given the US leads the OECD in terms of household disposable income[1], never mind whatever "Southeast Asian backwater" country you're talking about. It's unlikely "US healthcare profiteering" would affect this. Healthcare spending in the US is 17.6% of GDP, which provides an upper limit on how much it can eat into income. Even if you assume all that's borne by households and subtract that from income figures, the US would still be in #2.
[1] https://www.oecd.org/en/data/indicators/household-disposable...
breadwinner|1 year ago
Poorer than people in Bangladesh? Unlikely. Bangladesh per capita GDP is 2,529.08. US is $81,695.19.
refurb|1 year ago
This is such a wonderfully HN statement to make because it's so preposterously wrong, yet the author is so confident it's right.
glimshe|1 year ago
Yes, the worst-case scenario for health expenses is indeed bad in the US, this is true. However, this is not the average healthcare experience. It's not a matter of time until you're slapped with a bankruptcy-level bill.
My wife and I, both in our 50s, have had our share of insurance annoyances and frustrating phone calls, but we've had multiple surgeries fully covered by insurance. And this is the same with friends and family members, including at least 4 cancer treatments that did not lead to bankruptcy-level or even truly notable bills. This anecdote includes many people who died of "old age".
Worst-case scenario bills can be bad elsewhere too. For instance, a friend in Europe had to do a 250K GoFundMe campaign to pay for a life-saving treatment for his daughter because well, the only place in the world that performed the surgery she needed was... Guess where? The US. He faced bankruptcy for this bill, but friends and strangers were able to help him out to an extent. I think he's still recovering from the expense years later.
Medical bankruptcies and financially crushing bills are a sad possibility in the US, and certainly much more likely than in most other places. We need to keep working on this. But the vast majority of people will not have to face this problem in their lifetimes.
I'm also from a "backwater" place in South America that happens to be richer than most places in Southeast Asia. I've lived decades both in the "backwater" and in the US - I happen to know the US fairly well as a result. I choose to live here for a simple reason: the quality of life in this country is much superior than my comfortable lifestyle in South America.
I know dozens of people from different parts of Asia, and I can only remember a couple, let's say <3%, who went back to Asia after living in the US for a significant period of time. These are not poor Asians, in fact a lot of the Asians you meet in the US were relatively well off as they were able to afford the education in Asia which allowed them to immigrate. Nonetheless, they choose to remain here.
All of this said, there is nothing wrong with wanting to go to a low COL place sometime in our lives. I've done this within the US myself, and I would consider another country for a combination of weather, proximity to friends, desire of early retirement or a large property etc. But not because the US is a bad place to live, in fact its very high quality of life is what keeps me from making such move.
SoftTalker|1 year ago
Also you work in tech but weren’t provided or could not buy health insurance? That seems unlikely.
dlkf|1 year ago
01HNNWZ0MV43FF|1 year ago
eitally|1 year ago
dinkumthinkum|1 year ago
I think this is a real case of [citation needed]. Many people will, rightly, point at a myriad of statistics to demonstrate how this can't be true, and that's fine. But, I think we can just use some common sense; what are we talking about? There is no way this is true. Why would even need an immigration policy if this was true? This is just some kind anti-Americanism or anti-capitalism nonsense; that is really the only explanation for such an assertion that I can surmise. I'm also not really sure why working in tech you would be "constant fear of needing healthcare". If that is true then if nothing else the placebo of effect of moving to Europe may have been the best treatment psychologically, certainly cheaper than seeing a therapist.
mrbluecoat|1 year ago
Profiting.
palmfacehn|1 year ago
https://www.aha.org/guidesreports/2017-11-03-regulatory-over...
monksy|1 year ago
WalterBright|1 year ago
This is inevitable when government is handing out money. Recipients will always game the bureaucratic rules that specify payouts.
palmfacehn|1 year ago
Directly paying for cash-priced surgery has become cheaper than the heavily regulated insured coverage. Not only cheaper when including the overhead of having insurance, but cheaper in real terms of a single surgery event.
bandrami|1 year ago
ttyprintk|1 year ago
https://news.ycombinator.com/item?id=23764542
s1artibartfast|1 year ago
munificent|1 year ago
roenxi|1 year ago
This seems inappropriate for an award for "profiteering". I believe that profiteering requires making a profit at some point. What did they want him to do, take the company to bankruptcy faster? And just eyeballing the margins on #2 [0] it looks they don't make that much money either. Those aren't particularly impressive margins. They compare more to Walmart than Google.
[0] https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...
lotsofpulp|1 year ago
De la torre led a company that sucked cash out of a hospital by separating it from its real estate, and literally sailed off with a couple yachts.
https://www.wbur.org/news/2024/07/11/steward-health-care-inv...
https://www.wsj.com/business/steward-health-ceo-ralph-de-la-...
https://www.beckershospitalreview.com/finance/as-stewards-fi...
This group tore down an institution that took decades of work by extremely smart people to build, and now tens of thousands of people will get less and worse healthcare because of their actions.
ackbar03|1 year ago