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A good comparison is veterinary medicine in the US. All the functionality is fundamentally the same, but insurance isn't common. Prices are vastly lower, and it
by tlb 6y ago
A good comparison is veterinary medicine in the US. All the functionality is fundamentally the same, but insurance isn't common. Prices are vastly lower, and it's all super-convenient. Typical for an injury requiring stitches: $150, plus $15 for some antibiotics, which they hand you as you walk out.
Every time I go to the doctor I wish I could take myself to the vet instead.
- mc32 6y agoIs it the same for studs or thoroughbreds? What I’m getting at is that for most animals the owner can be compensated for accidental death easily. (How much is a head of cattle at auction?) Not that this explains all the discrepancy, but it may explain a non trivial percentage.
- olyjohn 6y agoAlso your dog probably needs 1/10th the dose that an adult needs.
- philwelch 6y agoLarge dogs can be the same weight as small humans, so I'm not sure what accounts for 1/10th. Even medium-sized dogs like labs are about half the weight of a healthy, average-sized person.
- girvo 6y agoDepends on the drug, but their metabolism isnt identical to ours, and humans can often require significantly higher doses compared to other animals when controlling for dosage per weight unit. But again it depends and there is no hard and fast rule as far as I’m aware.
- mattkrause 6y agoIt's way more complicated than that: there are differences in metabolism as well as size. It varies from drug to drug too, but as a rule of thumb dog needs about twice the human dose (in mg/kg). A 60 lb dog therefore needs about the same as a smallish adult. Here's some FDA guidance on how to translate doses from animals to humans: https://www.fda.gov/media/72309/download https://www.fda.gov/media/72309/download
- tguvot 6y agoEven more than twice. My dogs, despite weighting 5th of me had similar to mine dosages of antibiotics and antihistamines
- deleted 6y ago[deleted]
- giantg2 6y agoJust learn aseptic technique and suture yourself. I generally agree with your sentiment - regulation and insurance overhead are big costs. I do think some people should be able to do the basics at home if they wanted. Basic sutures are a pretty good example, you could even save that $150 that you mentioned.
- dml2135 6y agoWhile I'm usually a DIY kinda guy, giving this advice on a large scale is a perfect recipe for disaster and really encapsulates the dark-ages dystopia that the current US medical system has become.
- giantg2 6y agoIf someone self-studies basic things, it shouldn't be a big problem. Just look at first aid. There are many people who have no idea what to do for minor injuries because they never took the time to learn. Suturing is on the borderline of of falling into first aid. There are people today who learn the basics of it for emergencies or because they live in remote locations.
- chihuahua 6y agoWhile looking for moldable plastic material ("Sugru" and similar) on Amazon, I was a bit taken aback by the reviews for one such substance. Multiple reviewers were stating that they were using this stuff to make their own dental crowns or some other DIY tooth repair because they couldn't afford a dentist. I found this quite shocking and I'm not sure if these people were serious. See the reviews on this product page: https://www.amazon.com/InstaMorph-Moldable-Plastic-6-oz/dp/B004MFLU4Y https://www.amazon.com/InstaMorph-Moldable-Plastic-6-oz/dp/B...
- pseudosavant 6y agoThe teeth reviews on that product are pretty crazy. I kept reading them thinking "they really thought they could do this themselves??"
- 6y ago
- tdfx 6y agoVery similar in developing countries, as well. I've gotten stitches in Mexico and Colombia for less than $40 USD each time which healed comparably or better to the stitches I've paid >$500 for in the US. Consultation for an eye infection along with the antibiotics in Mexico was $23 USD.
- tcbawo 6y agoVeterinary care has been increasing considerably more than core inflation (quick search turned up https://www.in2013dollars.com/Veterinarian-services/price-inflation https://www.in2013dollars.com/Veterinarian-services/price-in...). I'm not sure how that compares to inflation in human healthcare.
- missedthecue 6y agoI feel like the demand for veterinary services has gone up drastically. It shocks me how my millennial friends will spend $5000 without a second thought to keep a dog alive. Older generations often seem to put pets down in that situation.
- cpwright 6y agoI haven't come to that yet, but when our 3 year old GSD went blind, even though it was an elective surgery it wasn't a super difficult choice to spend that much to restore his sight (cataract surgery) given that the same problem basically can't come back. He is six now, and it has really improved his quality of life (he enjoys chasing sticks in the lake again). If he was 10, we would probably not have made the same choice to spend the money; because he would get much less benefit from it. You spend more time with your dog than most people, and I certainly care about him more than any person who is not in my immediate family.
- Jweb_Guru 6y agoOlder generations had a lot more children.
- mNovak 6y agoVet care and pet products generally have been a target of private equity lately. Of course so has private (human) practice.
- jsight 6y agoHmm, I'm not sure how I feel about that comparison. Most vets double up as pharmacies, restrict access to prescriptions, and sell at least some prescription drugs at prices that have been marked up by at least an order of magnitude by the manufacturer. Some of the bills that I've run into have still managed to approach the cost of routine visits at some specialists when billed to my HSA.
- majormajor 6y agoWhatever markups are there are not linear, interestingly. I had to get an MRI from a vet hospital in the past. It was still over a thousand bucks, and in the range of quotes I'd gotten for human MRIs before. I wonder what similar stitches in an urgent care vs a primary care office vs an ER for a human would cost.
- rtkwe 6y agoPart of that is probably the lower volume, so they have to amortize the costs over fewer procedures. Most pet injuries don't need an MRI or if the injury/illness is that bad the euthanasia or palliative only option is more considered.
- dodobirdlord 6y agoHuman MRIs are also pretty expensive, and human MRI machines are generally booked solid. MRI machines cost a lot and also cost a lot to operate.
- Gibbon1 6y agoLast time looked at the costs of imaging I got the impression that there are a monopoly and other captive market effects at work. You'll hear medical professionals claim imaging is expensive because the machines are expensive. Which just says to me that medical professionals aren't accountants. Consider a dental w-ray machine. $15-30k. That's the cost of Prius used as a Taxi. You don't pay a couple dollars for a 15 minute Taxi cab ride. An MRI machine, I forget how much those cost. But whatever, lets compare one with a modern passenger airliner. Cost is about equivalent on a 'per passenger' basis. And an airliner requires highly trained professionals to keep it running.
- s1artibartfast 6y agoA new 787 is 200 million and carries up to 300 people and has a working life of 44,000 flights, for a total of 13 million people trips. A new MRI costs ~3 million, has an operational life of 10 years, performs 5000 scans per year, for a total 50,000 people trips. The people operating the MRI machine are probably payed more than anyone working on the airplane and take vastly more time per passenger.
- mcguire 6y agoIt would work fairly well for minimal routine care and relatively minor trauma, as long as euthanasia is on the table for major long-term care, major trauma, and for those who cannot pay.
- ben_w 6y agoWell that sounds like a Black Mirror episode — “Crowdfund your schoolfriend to not be euthanised”
- celloductor 6y agoIt can be the opposite as well. I work in a vet clinic, but I also am in New Zealand- where there is free/subsidized public healthcare. Thus you get people who go to the vet expecting things to be free or cheap.
- skeeter2020 6y agoIn Canada (at least in my experience) it's the opposite. Vet clinics look a lot like US medical centres, including the state-of-the-art equipment and corresponding prices. Meanwhile the limited for-profit medical services are (mostly) affordable because they do general procedures with relatively low barriers for competitors. Generic drugs are dirt cheap when available; non-generics cost as much as the US. Dental care is all over the map from very affordable to ridiculously overpriced.
- adventured 6y agoVets vary widely in the US. Vet clinics are wildly expensive in many locations here, with veterinarians earning well-paid doctor wages and using modern vet equipment.
- alisonkisk 6y agoDoctor wages and modern equipment are a small portion of human care, though.
- mikepurvis 6y agoAnother Canadian here with a similar experience— friends with dogs even pay for insurance because of the potential for frightfully expensive private surgeries down the road. Though I do wonder if there's a psychological thing there where dogs form stronger bonds and so people go to greater lengths for them, whereas other animals are easier to let go of if circumstances indicate that the time has come. And yes, dental care is all over the map— it feels very much like what I imagine US healthcare to be, with co-pays and mystery charges and having to log into my insurance company's online portal to do stuff. The NDP made a bunch of noise in the last election about a national dental plan, though even that effort would only have covered family incomes up to CAD$90k [1], so it wasn't anything like the universal no-questions coverage we have for core healthcare. 1: https://www.cbc.ca/news/politics/ndp-dental-plan-fact-check-1.5289005 https://www.cbc.ca/news/politics/ndp-dental-plan-fact-check-...
- perardi 6y ago
- SilasX 6y agoNot disagreeing, but one factor that complicates it is that they're allowed to take bigger risks with pets (both with regulations and potential civil liability) than with humans.
- jksmith 6y agoIndeed, treating for cost of liability (insurance) vs best outcomes. Doctor's conflict of interest built into the system.
- Spooky23 6y agoMy PPO pays my GP about $75 for a regular visit. A zpack is $6.50 at my local grocery store, $15 at CVS. The vet always guilts me into some sort of stupid test. Usually I walk out of there $300 lighter.
- alisonkisk 6y ago> For example, in 2011 in America, the average charge for an office visit for an established patient, level 3, requiring approximately 15 minutes with a doctor, was $104. The average total paid was $69. Some more examples: a cholesterol test has an average submitted charge of $72; and a glucose tolerant test (GTT) has a submitted charge of $60. Seems pretty similar to the vet. But that's just an office visit. The expensive stuff is at a hospital when the CYA care shows up.
- throwawayboise 6y ago> My PPO pays my GP about $75 for a regular visit. Which is why they spend 5 minutes on you, 90 minutes after your scheduled appointment time.
- heavyset_go 6y agoMy experience conflicts with your assertion. Costs for veterinary care have sky rocketed over the last 15 years, and costs for procedures without pet insurance are sometimes 75% to nearly the same price as the same procedures on humans. Prices for MRIs, X-rays, surgery and drugs are all very close to human medical care costs.
- poulsbohemian 6y agoFWIW: I wonder if you are in an urban area? When I compare the cost of vet services with my friends in an urban setting relative to what we pay here in rural, small-town America, I'm shocked at the difference. We have a university about a two hour drive away with a noted vet hospital - even their services were priced better than those I've heard anecdotally on the other (more urbanized) side of the state.
- dd_roger 6y agoI'm guessing vets take advantage of the ever growing tendency to consider pets as family members to inflate the price. Especially since (from very anecdotal evidences) it seems to be mostly middle/upper class people who are so invested into their pets. In the countryside people tend to have a more utilitarian view of animals and would simply get a new one rather than wasting money keeping a sick animal alive.
- heavyset_go 6y ago> FWIW: I wonder if you are in an urban area? I'm not.
- alisonkisk 6y agoAn human ACL surgery is $20-$50k, 10x the price for dogs.
- poulsbohemian 6y agoEven more importantly: When you walk into the vet, they can estimate what your options will cost, so that you can make an informed decision. When it was our cat's time too, I was struck by his end of life experience versus that of a human. Whereas a human could have exhausted their life savings on futile treatment or end of life hospice care, Denver cat went quietly into that good night on his favorite blanket surrounded by his loved ones. I'm currently in need of some very common medical treatment, but the maze of providers I need to go through in order to get a referral just ain't worth it. Versus, if I were a cat or dog, I could simply go to the area university veterinary hospital and likely get my answer same day.
- jen20 6y agoThis experience is often available for humans too (even in countries without risk of medical bills bankrupting oneself) - it largely depends on how far the religious right has embedded itself in government. Pieter Hintjens (of ZeroMQ and AMQP fame) chose this option when diagnosed with terminal cancer, and wrote about it extensively at [1] and [2]. [1]: http://hintjens.com/blog:116 http://hintjens.com/blog:116 [2]: http://hintjens.com/blog:115 http://hintjens.com/blog:115
- alisonkisk 6y agoEuthanasia is commonly banned, but palliative hospice (morphine until you die, combined with caloric reduction) is allowed.
- Retric 6y agoStarvation at hospice is a slow and expensive way to go. It’s only appealing in comparison to hospital stays.
- nicoburns 6y agoI'm cautiously optimistic that euthanasia will become widely available by the time I'm old. It seems to preferred over dementia by most people I've spoken to in both my generation (late twenties) and my parents.
- LinuxBender 6y agoMe too. I suspect some of this is regulatory overhead and compliance. I can give pets injections (inoculations and antibiotics) without even talking to a vet. The only exception I ever ran into was antibiotics for a snake, as the feed store didn't carry that. To get those things for myself would require a prescription from a doctor.
- vondur 6y ago"Every time I go to the doctor I wish I could take myself to the vet instead." Kramer thought that in a Seinfeld episode; it was a great episode. Season 8 Episode 10.
- strken 6y agoThe last time I needed stitches, it cost between $70 and $80 AUD (unsubsidised - this is what an international visitor would have paid), and was wholly covered by the government.
- ecommerceguy 6y agoYou can certainly go to Farm and Feeds and get penicillin amongst other pharmaceuticals. Plenty of farmers hours away from metro hospitals and providers commonly use these sources.
- tguvot 6y agoActually pet health insurance is very common. Everybody that I know with a pet has one and even work has discounted pet health insurance as part of employee perks
- josefresco 6y agoHaving just put down two pets with costly late in life medical conditions I'm kicking myself for not getting health insurance. We were able to afford most recommended procedures but not many can. In fact, there are several programs locally for people who can't pay for their vet bills which I've considered contributing to now that I've seen first-hand the anguish people have to face when considering procedures they can't afford for animals they love like children.