6 ms·

It's a crutch around your ancient banking systems. My country never had cobol on mainframes, so bank infra isn't build around daily batches. Also healthcare and

It's a crutch around your ancient banking systems. My country never had cobol on mainframes, so bank infra isn't build around daily batches. Also healthcare and insurance aren't total shit, just a normal level of shit.

rootusrootus 4y ago
Yes, we pay doctors too much in the US. And we spend an irrational amount of money on drug research chasing that long tail. The actual care is great.
- chownie 4y ago
  Is doctor pay much higher in the US than the EU? I had always assumed that healthcare had crazy high costs in the US because they have a middleman who is motivated to refuse payment as much as possible (insurance companies) so healthcare providers have to inflate costs to try and stay even.
  - idontpost 4y ago
  - martinald 4y ago
    Average doctor salary is $300k in the US. Top doctors can make over a million/yr. This is at least 3x what most doctors can expect in western europe.
    - freedom2099 4y ago
      Yes… but doctors in Europe don’t have to pay for expensive health insurances XD
      - sofixa 4y ago
        And don't start with half a million or whatever 6 figure sum student loan debts to reimburse.
        freedom2099 4y ago
        Right… they got their education almost for free
      - KptMarchewa 4y ago
        And no malpractice insurance.
        freedom2099 4y ago
        Also true
  - astrange 4y ago
    It's much higher, there are fewer healthcare providers of all kinds, and Americans use more expensive healthcare services. It's not more expensive because insurance companies are charging you, their costs are passed through from providers. Also, out-of-pocket healthcare spending as % GDP is lower in the US than in the UK. Expensive healthcare in $ doesn't matter when you're paid so much more. https://twitter.com/quantian1/status/1602097888385015811 https://twitter.com/quantian1/status/1602097888385015811
    - TheOtherHobbes 4y ago
      I'm not sure what "out of pocket" is supposed to mean in this context. The UK's NHS has standardised fees paid at relatively standard rates out of taxes. Most care is free at point of service. Prescriptions aren't free, but it's possible to cap the annual amount spent on meds at a very low level. (Last time I looked it was somewhere around £100.) Meanwhile the US has hundreds of thousands of medical bankruptcies every year. https://balancingeverything.com/medical-bankruptcies-statistics https://balancingeverything.com/medical-bankruptcies-statist... Health care is more expensive because most insurance doesn't contribute much to out-of-network costs, and if you have an accident in the middle of nowhere you won't get directed to the nearest in-network facility. Even if you're in-network copays, exclusions, and other scams can turn a medical emergency into a financial catastrophe. It's a completely outrageous, exploitative, inhumane system.
      - astrange 4y ago
        https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm I imagine it covers dentists, specialists, traveling out of country or private coverage because it's faster. I know for a fact my healthcare spending would be higher in Australia than it is in the US despite it having free healthcare. (As in, I’ve paid it.)
      - 0xBDB 4y ago
        "Out of pocket" means what you pay versus what your insurance company pays. By law, the most that can be per year is $18,200 per family in 2023 [1], though it is much lower for almost any employer health plan. My family is very healthy and so I get the crappiest coverage my employer offers for nearly free for my family (because the employer gets a tax break) and mine is $10,000. The limit resets on January 1 and insurance companies can try to weasel on what's covered, though they rarely win those appeals, but on the flip side, most medical expenses are negotiable in that kind of case. The bottom line is that our healthcare system serves several percent of the population (but not the very bottom tier, who have medicaid and public hospitals) incredibly badly and for everyone else is normally just annoying. It's possible for an American software developer with reasonable spending habits to have a medical emergency turn into a financial catastrophe, but it would be really hard. A lot of Europeans seem to believe that their healthcare costs make up for the salary differential. This is not a reasonable belief even before factoring in taxes and cost of living in most cities. [1] https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
  - jandrewrogers 4y ago
    Doctors in the US make FAANG engineer money.
- com2kid 4y ago
  1/3rds of US medical costs go to billing overhead. In any given year of their career, Primary Care doctors earn less than software developers in a coastal city. (e.g. by the time a doctor graduates school and goes through residency, they may be in their 30s, at which point software devs are pulling down more $).
  - chris_va 4y ago
    It used to be that a crazy high number (20%? 30%?) went to the uninsured patient that waited a long time to come in right before you, too. To be honest, it feels like 50-75% goes to overhead, and we just need to figure out a nice system to align incentives to eliminate it.
- SketchySeaBeast 4y ago
  > The actual care is great.[1] [1] Some exceptions apply. Please see your insurance (if you even have any) for details.
- KptMarchewa 4y ago
  I was talking about computer systems - none of the Epic nonsense. But it actually works in a broader sense too. >The actual care is great. Not if you look at actual health outcomes.

rootusrootus 4y ago

Yes, we pay doctors too much in the US. And we spend an irrational amount of money on drug research chasing that long tail. The actual care is great.

chownie 4y ago
Is doctor pay much higher in the US than the EU? I had always assumed that healthcare had crazy high costs in the US because they have a middleman who is motivated to refuse payment as much as possible (insurance companies) so healthcare providers have to inflate costs to try and stay even.
- idontpost 4y ago
- martinald 4y ago
  Average doctor salary is $300k in the US. Top doctors can make over a million/yr. This is at least 3x what most doctors can expect in western europe.
  - freedom2099 4y ago
    Yes… but doctors in Europe don’t have to pay for expensive health insurances XD
    - sofixa 4y ago
      And don't start with half a million or whatever 6 figure sum student loan debts to reimburse.
      - freedom2099 4y ago
        Right… they got their education almost for free
    - KptMarchewa 4y ago
      And no malpractice insurance.
      - freedom2099 4y ago
        Also true
- astrange 4y ago
  It's much higher, there are fewer healthcare providers of all kinds, and Americans use more expensive healthcare services. It's not more expensive because insurance companies are charging you, their costs are passed through from providers. Also, out-of-pocket healthcare spending as % GDP is lower in the US than in the UK. Expensive healthcare in $ doesn't matter when you're paid so much more. https://twitter.com/quantian1/status/1602097888385015811 https://twitter.com/quantian1/status/1602097888385015811
  - TheOtherHobbes 4y ago
    I'm not sure what "out of pocket" is supposed to mean in this context. The UK's NHS has standardised fees paid at relatively standard rates out of taxes. Most care is free at point of service. Prescriptions aren't free, but it's possible to cap the annual amount spent on meds at a very low level. (Last time I looked it was somewhere around £100.) Meanwhile the US has hundreds of thousands of medical bankruptcies every year. https://balancingeverything.com/medical-bankruptcies-statistics https://balancingeverything.com/medical-bankruptcies-statist... Health care is more expensive because most insurance doesn't contribute much to out-of-network costs, and if you have an accident in the middle of nowhere you won't get directed to the nearest in-network facility. Even if you're in-network copays, exclusions, and other scams can turn a medical emergency into a financial catastrophe. It's a completely outrageous, exploitative, inhumane system.
    - astrange 4y ago
      https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm I imagine it covers dentists, specialists, traveling out of country or private coverage because it's faster. I know for a fact my healthcare spending would be higher in Australia than it is in the US despite it having free healthcare. (As in, I’ve paid it.)
    - 0xBDB 4y ago
      "Out of pocket" means what you pay versus what your insurance company pays. By law, the most that can be per year is $18,200 per family in 2023 [1], though it is much lower for almost any employer health plan. My family is very healthy and so I get the crappiest coverage my employer offers for nearly free for my family (because the employer gets a tax break) and mine is $10,000. The limit resets on January 1 and insurance companies can try to weasel on what's covered, though they rarely win those appeals, but on the flip side, most medical expenses are negotiable in that kind of case. The bottom line is that our healthcare system serves several percent of the population (but not the very bottom tier, who have medicaid and public hospitals) incredibly badly and for everyone else is normally just annoying. It's possible for an American software developer with reasonable spending habits to have a medical emergency turn into a financial catastrophe, but it would be really hard. A lot of Europeans seem to believe that their healthcare costs make up for the salary differential. This is not a reasonable belief even before factoring in taxes and cost of living in most cities. [1] https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
- jandrewrogers 4y ago
  Doctors in the US make FAANG engineer money.
com2kid 4y ago
1/3rds of US medical costs go to billing overhead. In any given year of their career, Primary Care doctors earn less than software developers in a coastal city. (e.g. by the time a doctor graduates school and goes through residency, they may be in their 30s, at which point software devs are pulling down more $).
- chris_va 4y ago
  It used to be that a crazy high number (20%? 30%?) went to the uninsured patient that waited a long time to come in right before you, too. To be honest, it feels like 50-75% goes to overhead, and we just need to figure out a nice system to align incentives to eliminate it.
SketchySeaBeast 4y ago
> The actual care is great.[1] [1] Some exceptions apply. Please see your insurance (if you even have any) for details.
KptMarchewa 4y ago
I was talking about computer systems - none of the Epic nonsense. But it actually works in a broader sense too. >The actual care is great. Not if you look at actual health outcomes.