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You don't want to screw around with infected/impacted teeth. One of the leading causes of death up until recently was tooth-related. You'd get a toothache, a fe

You don't want to screw around with infected/impacted teeth. One of the leading causes of death up until recently was tooth-related. You'd get a toothache, a few days later you'd be dead. There's a reason why in all those old westerns people submitted to having their teeth pulled out with pliers without any anesthesia. It was a hundred times better to lose a tooth than die. You get a toothache -- even out on the prairie where the only "doctor" is your friend Gus who dropped out of second grade, and Gus is going to be yanking out your teeth. It was just common sense. As a side note, this will probably sound amazing to many readers, but working both for myself and my startup my family went for over a decade without health insurance. Didn't seem like that big of a deal. Of course we had one rule: if you're really sick, you go to the doctor, no questions asked. In the states they had to see you, and you generally got great service driving up somewhere, even if you didn't have money. The trick was finding out where to go. Over those years, we ran up medical debt at times, yes, but nowhere near the amount we would have paid in health insurance premiums. (Which really shouldn't be a surprise. Basic math, there. We were in a low-risk group.) We had several kids, dental operations, gall bladders removed, vaccinations, ENT surgery -- all kinds of things. And everybody got all the medical attention they needed. It was simply risk management. Yes, things could have turned out differently and we could have ended up hundreds of thousands in debt. But the numbers were on our side. We made the decision just like the insurance companies do -- based on demographic risk. And if you're not making much money you can really only owe so much anyway. After 20 thousand or so, it might as well be 20 million -- you're never going to be able to pay it back. And if you owed 20 million, you'd still be alive and kicking and able to do all the things you love. That beats the alternative. Our downside was limited by the practicalities of medical debt collection. It was a good decision, and I'd make it again. Sorry for the digression. The point in telling the story was that even if you don't have insurance, working in a startup, slaving over the product 80 hours a week, fresh on a team, meeting with VCs -- none of that matters. All those other stresses in your life are silly by comparison. Learn to recognize when you're really sick and then immediately get help.

davidw 15y ago
So basically you planned to spread the costs of any really big debts to society at large...
- DLWormwood 15y ago
  Which is basically what insurance does anyway...
  - glhaynes 15y ago
    True enough. But if you're not paying for insurance, you're not paying into that system. It's not hard to see that as free-loading. (Note: I am NOT advocating that "free-loaders" should be denied medical care. But it does seem like it'd be preferable to not let people freeload.)
    - davidw 15y ago
      Or you could spread the risk pool to the entire population, and pay for the insurance through taxes, or compulsory insurance, or something along those lines. No bankruptcies, lower overall costs, and a hell of a lot less stress, and less incentive for people with families / conditions to stay wedded to one employer.
      - glhaynes 15y ago
        Absolutely, that's just what I mean. Either we should let people die/go bankrupt if they end up in medical trouble and don't have insurance and can't pay (which is obviously morally and societally undesirable and doesn't seem to make practical sense anyway) or we should ensure that everybody is part of the system. I don't really see an alternative and this seems fundamental to the US health care debate.
RyanMcGreal 15y ago
> As a side note, this will probably sound amazing to many readers, but working both for myself and my startup my family went for over a decade without health insurance. It's utterly incomprehensible to me that the United States still hasn't gotten on board with universal health care (the tortured Obamacare plan notwithstanding).
- sp332 15y ago
  There's so much money and bureaucracy in the "health" industry and the insurance industries, that any nationalized system would be corrupt and probably not very effective. Plus, I think it was Thomas Jefferson that pointed out: Any government powerful enough to give you everything you want is powerful enough to take away everything you have. If we let the government think they have control over who gets healthy and who dies, and who has to pay so other people don't die, I don't see that ending well.
  - davidw 15y ago
    > any nationalized system would be corrupt and probably not very effective. You can measure stuff like that, and "it turns out" (to use a celebrated phrase) that even countries like Italy (which does have problems of corruption and being not very effective in terms of the government) can provide care to everyone for a lower price than in the US, in terms of a percentage of GDP. You do have to wait for some stuff, but seeing a doctor is not one of them. My experience in Austria was that it was even better than Italy at providing pretty good care quickly, cheaply, and to pretty much everyone.
  - RyanMcGreal 15y ago
    There are different ways to provide universal health care. Canada, for example, has a single-payer system in which most medical practices are private but they bill the public insurer. The system isn't perfect, obviously, but it is quite efficient at allocating money to actual health care rather than administrative overhead. Whole categories of business expenses (including, ahem, profits) just go away. On the other hand, Britain has a fully nationalized system in which doctors are public employees, and their system is even more efficient than the Canadian system. In fact, across OECD countries, the overall efficiency of the health care system seems to be positively correlated with the extent to which the government directly controls it. In the US, the public parts of the health care system are overall much more efficient at allocating resources to care than the private parts. Sidenote: I will pause here to draw a distinction between allocative efficiency, or the extent to which a system allocates capital where it will maximize ROI, and what we might call outcome efficiency, or the extent to which a system allocates resources where they will maximize effectiveness. Market based systems are better at allocative efficiency, but the evidence is that they are much worse at outcome efficiency. Market-based health care is great business, but it leaves far too many people under- and uninsured. This is because the principal economic imperative for a for-profit insurer is to collect premiums but not pay out benefits.
amadvance 15y ago
I'm glad that it worked for you. But doing risk management with your family health is something I would call irresponsible. Insurance are needed to cover the worst case. You can do such risk management with the car, house, whatever, but really not for health care.

davidw 15y ago

So basically you planned to spread the costs of any really big debts to society at large...

DLWormwood 15y ago
Which is basically what insurance does anyway...
- glhaynes 15y ago
  True enough. But if you're not paying for insurance, you're not paying into that system. It's not hard to see that as free-loading. (Note: I am NOT advocating that "free-loaders" should be denied medical care. But it does seem like it'd be preferable to not let people freeload.)
  - davidw 15y ago
    Or you could spread the risk pool to the entire population, and pay for the insurance through taxes, or compulsory insurance, or something along those lines. No bankruptcies, lower overall costs, and a hell of a lot less stress, and less incentive for people with families / conditions to stay wedded to one employer.
    - glhaynes 15y ago
      Absolutely, that's just what I mean. Either we should let people die/go bankrupt if they end up in medical trouble and don't have insurance and can't pay (which is obviously morally and societally undesirable and doesn't seem to make practical sense anyway) or we should ensure that everybody is part of the system. I don't really see an alternative and this seems fundamental to the US health care debate.

RyanMcGreal 15y ago

> As a side note, this will probably sound amazing to many readers, but working both for myself and my startup my family went for over a decade without health insurance. It's utterly incomprehensible to me that the United States still hasn't gotten on board with universal health care (the tortured Obamacare plan notwithstanding).

sp332 15y ago
There's so much money and bureaucracy in the "health" industry and the insurance industries, that any nationalized system would be corrupt and probably not very effective. Plus, I think it was Thomas Jefferson that pointed out: Any government powerful enough to give you everything you want is powerful enough to take away everything you have. If we let the government think they have control over who gets healthy and who dies, and who has to pay so other people don't die, I don't see that ending well.
- davidw 15y ago
  > any nationalized system would be corrupt and probably not very effective. You can measure stuff like that, and "it turns out" (to use a celebrated phrase) that even countries like Italy (which does have problems of corruption and being not very effective in terms of the government) can provide care to everyone for a lower price than in the US, in terms of a percentage of GDP. You do have to wait for some stuff, but seeing a doctor is not one of them. My experience in Austria was that it was even better than Italy at providing pretty good care quickly, cheaply, and to pretty much everyone.
- RyanMcGreal 15y ago
  There are different ways to provide universal health care. Canada, for example, has a single-payer system in which most medical practices are private but they bill the public insurer. The system isn't perfect, obviously, but it is quite efficient at allocating money to actual health care rather than administrative overhead. Whole categories of business expenses (including, ahem, profits) just go away. On the other hand, Britain has a fully nationalized system in which doctors are public employees, and their system is even more efficient than the Canadian system. In fact, across OECD countries, the overall efficiency of the health care system seems to be positively correlated with the extent to which the government directly controls it. In the US, the public parts of the health care system are overall much more efficient at allocating resources to care than the private parts. Sidenote: I will pause here to draw a distinction between allocative efficiency, or the extent to which a system allocates capital where it will maximize ROI, and what we might call outcome efficiency, or the extent to which a system allocates resources where they will maximize effectiveness. Market based systems are better at allocative efficiency, but the evidence is that they are much worse at outcome efficiency. Market-based health care is great business, but it leaves far too many people under- and uninsured. This is because the principal economic imperative for a for-profit insurer is to collect premiums but not pay out benefits.

amadvance 15y ago

I'm glad that it worked for you. But doing risk management with your family health is something I would call irresponsible. Insurance are needed to cover the worst case. You can do such risk management with the car, house, whatever, but really not for health care.