6 ms·

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.

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.

SoftTalker 2y ago
“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.
gruez 2y ago
>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. [1] https://www.oecd.org/en/data/indicators/household-disposable-income.html?oecdcontrol-7be7d0d9fc-var3=2022 https://www.oecd.org/en/data/indicators/household-disposable...
- betaby 2y ago
  > household disposable income That doesn't matter a slightest if people can't afford housing. Income is indeed disposed, without much to show off.
  - davidgay 2y ago
    Disposable income is measured after housing expenses.
    - insane_dreamer 2y ago
      Incorrect. See below.
  - dralley 2y ago
    Disposable income by definition is post-expenses, which includes housing expenses.
    - smnrchrds 2y ago
      "Disposable income" means income after taxes. The word you are looking for is "discretionary income", which means income after taxes and necessities.
      - deleted 2y ago
        [deleted]
    - insane_dreamer 2y ago
      No, that's not what disposable income means. Disposable income means income after taxes. It does not include any expenses, housing, health care, or otherwise. from the OECD website: > Income includes wages and salaries, mixed income (income from self-employment and unincorporated enterprises), income from pensions and other social benefits, and income from financial investments. It is less taxes on income, wealth, social security contributions paid by employees, the self-employed and the unemployed, interest on financial liabilities, and the change in net equity of households in pension funds. A bit of a clearer explanation here: https://en.wikipedia.org/wiki/Disposable_household_and_per_capita_income https://en.wikipedia.org/wiki/Disposable_household_and_per_c... The reason why the US has such high disposable income is because Americans have to pay for so much more out of pocket than other OECD countries do. Once you factor in health care, education and other social services that are cheap or free elsewhere, Americans are generally worse off than many OECD countries.
- bruce511 2y ago
  Both positions can be true - what you said, and what the parent said. The problem with what you said is that it's a statistic lumping all households together. As such it's largely meaningless because it lumps Elon's household with some person living in a trailer park in Montana. They are unlikely to have similar disposable income. Equally, while health care might represent 17.6% of GDP, this of course provides no limit on any one person or group. Indeed, assuming that most billionaires are not spending 17.6% one can assume the real cost to many I'd much (much) higher than that. No to the parent's statement about "poorer". There are many things to measure here beyond just "cash in the bank". And there are terms like "middle class" and "majority" which are imprecise. Nevertheless the point, as an anecdote stands. While America the country is rich, not all the people in it are. Indeed it seems to be increasingly split into rich and poor - the middle class is shrinking. The good news though is two fold. Firstly most Americans seem happy with this setup (presumably because it maintains the illusion that they can obe day be rich.) Secondly the majority of (not rich) people believe that having rich people in charge will benefit them. No doubt the incoming government of billionaires is something to look forward to. Which is all yo say that each country gets what they want. The US _wants_ for-profit health care. They believe it is the best in the world. Other countries think its bonkers and have other approaches. That's perfectly OK. Indeed this is democracy in action. We vote for people who will best do what we want them to do. Who guide us, not just by their words but their actions. We clearly understand the actions of the incoming guy (he's been there before). He's clearly pro-health-company (not pro health consumer) so this is (quite literally) what people want. The future looks very bright indeed!
  - refurb 2y ago
    > The problem with what you said is that it's a statistic lumping all households together. As such it's largely meaningless because it lumps Elon's household with some person living in a trailer park in Montana. No, because it's a median value, thus outliers are irrelevant.
    - bruce511 2y ago
      Is it a median? The site doesn't say (that I can see) but the text seems to suggest an average, not a median. But even if it's a median, the point stands. At least half the country falls below this standard. Equally the distribution of outliers is not balanced. There are a lot lot more outliers (far from the median) on the up side than the down side.
- ashoeafoot 2y ago
  The us is rich in pride, which if you divide it by baseballstatistic books and multiplicate by the size if the country is the only ritches that matter..
01HNNWZ0MV43FF 2y ago
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
- stronglikedan 2y ago
  > but federally about to go to hell If that were going to happen, then it would have already happened. It hasn't, and it won't. It's not healthy to worry about things you have been conditioned to believe by people that don't have your best interests at heart but will say anything to get your vote.
  - VHRanger 2y ago
    [flagged]
    - dinkumthinkum 2y ago
      [flagged]
    - aiionx 2y ago
      [dead]
  - hooverd 2y ago
    It's happening. Look at Florida or Texas. It's the model that the people soon to be in power want to emulate. They're quite outspoken about it.
    - mvdtnz 2y ago
      Then why didn't they do it 4-8 years ago?
      - ttyprintk 2y ago
        With the Louisiana decision, protections are noticeably, gradually being demolished.
breadwinner 2y ago
> middle-class Americans are poorer than people in the Southeast Asian backwater I’m from Poorer than people in Bangladesh? Unlikely. Bangladesh per capita GDP is 2,529.08. US is $81,695.19.
- wk_end 2y ago
  Your overall point still mostly stands, but per capita GDP isn’t super helpful when talking about middle class Americans because of wealth inequality. The median US income is less than half of that. And the cost of living in Bangladesh is probably something like a quarter of the COL in the US. So while there’s still a pretty stark difference in wealth, it’s not quite as stark as you’re implying.
  - nosefurhairdo 2y ago
    Purchasing Power Parity (PPP): This adjusts for cost of living and inflation rates between countries, giving a more accurate comparison of living standards. In 2023, GDP per capita in terms of PPP for Bangladesh and USA was $8,242 and $74,578 respectively (per World Bank).
    - bruce511 2y ago
      It is hard to compare one country to another because they are different in so many ways. Each has positives and negatives. Clearly the USA and Bangladesh are different. Comparing their GDP is simplistic and doesn't really speak to quality of life in either place. Much less does it take into account that two people in each country may in turn have vastly different quality of lives. In short, using national statistics tells us very little about your life, or my life, or any specific persons life.
      - nosefurhairdo 2y ago
        The person I responded to (correctly) criticized per capita GDP, citing differences in cost of living. I felt that referencing PPP would be helpful since it attempts to factor in cost of living differences. I'm not sure this "comparisons are hard" speech is adding much. Differences in wealth are real, measurable, and meaningful, even if they can't be boiled down to a single number. Obviously there are other factors to quality of life; nobody here stated anything to the contrary.
dlkf 2y ago
What country are you referring to? The American middle class is objectively very wealthy: https://www.noahpinion.blog/p/no-the-us-is-not-a-poor-society-with https://www.noahpinion.blog/p/no-the-us-is-not-a-poor-societ...
- insane_dreamer 2y ago
  That article is based on 1) disposable income, which is the wrong metric to use (because it doesn't account for the fact that the US has much higher expenses in health care and education than places like the EU, Japan, etc.), 2) housing size as a metric -- which is due to population density (Western Europe has nearly 5 times the population density of the USA) and the fact that US cities are built around cars, and 3) vehicle ownership, which is both a cultural hallmark of the US and due to the fact that you can't really live without a car (2 if you're married) in the US due to the way its cities are built. In short, laziest article ever.
dinkumthinkum 2y ago
>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.
- drewrv 2y ago
  Why would working in tech shield someone from our healthcare system? “Most bankruptcies occurred in middle-class citizens with health insurance” https://www.amjmed.com/article/S0002-93430900525-7/fulltext https://www.amjmed.com/article/S0002-93430900525-7/fulltext If you haven’t been harmed by our system, it’s not because you’re immune. It’s because you’re lucky.
- lazyasciiart 2y ago
  > Why would even need an immigration policy if this was true? Do you think Southeast Asian countries don't have an immigration policy?
  - dinkumthinkum 2y ago
    Well, I know HN is pedantic but the issue is why would so many people be trying to flee to the U.S. if it is worse than some "backwater". It makes no sense. I would assert that in extremely impoverished Southeast Asian countries, immigration is not a central concern.
refurb 2y ago
> America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. This is such a wonderfully HN statement to make because it's so preposterously wrong, yet the author is so confident it's right.
- ranger_danger 2y ago
  As a rule, strong feelings about issues do not emerge from deep understanding. -Sloman and Fernbach
- deleted 2y ago
  [deleted]
eitally 2y ago
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.
- mindslight 2y ago
  The pop discourse is myopic and sensationalist. I've never personally dealt with an outright denial. When I've called "insurance" companies, they've been generally helpful. However, this is what I have experienced: Primary care repeatedly rescheduling appointments further down the road, 2-3 months at a time. At one point it got so bad for my elderly aunt that I straight up asked if they were just trying to "run down the clock". Primary care doctors saying they will put in a referral to a specialist. Then a month later just getting a photocopied list of specialists in the mail for us to call directly. Go down the line and most are closed or not accepting new patients. Some were even straight up dead (... like rigor mortis, habeas corpus). One of the two remaining specialists booking 8 months out for an initial consult, the other 5 months. Billing departments that don't feel it necessary to do the work of completing insurance claims, yet feel entitled to still continue sending fraudulent bills to us personally instead. Medical equipment providers outright lying about the validity of their fraudulent bills even when challenged with concrete reimbursement rates, and then doubling down with bullying - aka willful fraud. Needing to put in a bunch of paperwork, then follow up with appeals, merely to see the second geographically closest in-network provider (closer one was having issues) due to living near a state border. And none of this covers the harder-to-capture dynamics of getting shortchanged on time talking to a doctor because the bureaucrats have deemed that 15 minutes is enough time for an appointment, or having to continually make sure the ball doesn't get dropped on care due to the proliferation of different moving pieces. The problem isn't all on insurance companies themselves. The real problem is the entire system is broken due to poor incentives where these gigantic entities have been allowed to pass blame back and forth instead of having to own any responsibility themselves. This puts patients in the middle (often when they're in pressing need of healthcare), to get ground up in an ever-growing runaround, rather than any of these businesses having an incentive to minimize the administrative complexity. The "approval/denial" charade for in network care is just one of the most galling games they've made up, so it gets focused on.
glimshe 2y ago
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.
- gklitz 2y ago

SoftTalker 2y ago

“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.

gruez 2y ago

>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. [1] https://www.oecd.org/en/data/indicators/household-disposable-income.html?oecdcontrol-7be7d0d9fc-var3=2022 https://www.oecd.org/en/data/indicators/household-disposable...

betaby 2y ago
> household disposable income That doesn't matter a slightest if people can't afford housing. Income is indeed disposed, without much to show off.
- davidgay 2y ago
  Disposable income is measured after housing expenses.
  - insane_dreamer 2y ago
    Incorrect. See below.
- dralley 2y ago
  Disposable income by definition is post-expenses, which includes housing expenses.
  - smnrchrds 2y ago
    "Disposable income" means income after taxes. The word you are looking for is "discretionary income", which means income after taxes and necessities.
    - deleted 2y ago
      [deleted]
  - insane_dreamer 2y ago
    No, that's not what disposable income means. Disposable income means income after taxes. It does not include any expenses, housing, health care, or otherwise. from the OECD website: > Income includes wages and salaries, mixed income (income from self-employment and unincorporated enterprises), income from pensions and other social benefits, and income from financial investments. It is less taxes on income, wealth, social security contributions paid by employees, the self-employed and the unemployed, interest on financial liabilities, and the change in net equity of households in pension funds. A bit of a clearer explanation here: https://en.wikipedia.org/wiki/Disposable_household_and_per_capita_income https://en.wikipedia.org/wiki/Disposable_household_and_per_c... The reason why the US has such high disposable income is because Americans have to pay for so much more out of pocket than other OECD countries do. Once you factor in health care, education and other social services that are cheap or free elsewhere, Americans are generally worse off than many OECD countries.
bruce511 2y ago
Both positions can be true - what you said, and what the parent said. The problem with what you said is that it's a statistic lumping all households together. As such it's largely meaningless because it lumps Elon's household with some person living in a trailer park in Montana. They are unlikely to have similar disposable income. Equally, while health care might represent 17.6% of GDP, this of course provides no limit on any one person or group. Indeed, assuming that most billionaires are not spending 17.6% one can assume the real cost to many I'd much (much) higher than that. No to the parent's statement about "poorer". There are many things to measure here beyond just "cash in the bank". And there are terms like "middle class" and "majority" which are imprecise. Nevertheless the point, as an anecdote stands. While America the country is rich, not all the people in it are. Indeed it seems to be increasingly split into rich and poor - the middle class is shrinking. The good news though is two fold. Firstly most Americans seem happy with this setup (presumably because it maintains the illusion that they can obe day be rich.) Secondly the majority of (not rich) people believe that having rich people in charge will benefit them. No doubt the incoming government of billionaires is something to look forward to. Which is all yo say that each country gets what they want. The US _wants_ for-profit health care. They believe it is the best in the world. Other countries think its bonkers and have other approaches. That's perfectly OK. Indeed this is democracy in action. We vote for people who will best do what we want them to do. Who guide us, not just by their words but their actions. We clearly understand the actions of the incoming guy (he's been there before). He's clearly pro-health-company (not pro health consumer) so this is (quite literally) what people want. The future looks very bright indeed!
- refurb 2y ago
  > The problem with what you said is that it's a statistic lumping all households together. As such it's largely meaningless because it lumps Elon's household with some person living in a trailer park in Montana. No, because it's a median value, thus outliers are irrelevant.
  - bruce511 2y ago
    Is it a median? The site doesn't say (that I can see) but the text seems to suggest an average, not a median. But even if it's a median, the point stands. At least half the country falls below this standard. Equally the distribution of outliers is not balanced. There are a lot lot more outliers (far from the median) on the up side than the down side.
ashoeafoot 2y ago
The us is rich in pride, which if you divide it by baseballstatistic books and multiplicate by the size if the country is the only ritches that matter..

01HNNWZ0MV43FF 2y ago

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

stronglikedan 2y ago
> but federally about to go to hell If that were going to happen, then it would have already happened. It hasn't, and it won't. It's not healthy to worry about things you have been conditioned to believe by people that don't have your best interests at heart but will say anything to get your vote.
- VHRanger 2y ago
  [flagged]
  - dinkumthinkum 2y ago
    [flagged]
  - aiionx 2y ago
    [dead]
- hooverd 2y ago
  It's happening. Look at Florida or Texas. It's the model that the people soon to be in power want to emulate. They're quite outspoken about it.
  - mvdtnz 2y ago
    Then why didn't they do it 4-8 years ago?
    - ttyprintk 2y ago
      With the Louisiana decision, protections are noticeably, gradually being demolished.

breadwinner 2y ago

> middle-class Americans are poorer than people in the Southeast Asian backwater I’m from Poorer than people in Bangladesh? Unlikely. Bangladesh per capita GDP is 2,529.08. US is $81,695.19.

wk_end 2y ago
Your overall point still mostly stands, but per capita GDP isn’t super helpful when talking about middle class Americans because of wealth inequality. The median US income is less than half of that. And the cost of living in Bangladesh is probably something like a quarter of the COL in the US. So while there’s still a pretty stark difference in wealth, it’s not quite as stark as you’re implying.
- nosefurhairdo 2y ago
  Purchasing Power Parity (PPP): This adjusts for cost of living and inflation rates between countries, giving a more accurate comparison of living standards. In 2023, GDP per capita in terms of PPP for Bangladesh and USA was $8,242 and $74,578 respectively (per World Bank).
  - bruce511 2y ago
    It is hard to compare one country to another because they are different in so many ways. Each has positives and negatives. Clearly the USA and Bangladesh are different. Comparing their GDP is simplistic and doesn't really speak to quality of life in either place. Much less does it take into account that two people in each country may in turn have vastly different quality of lives. In short, using national statistics tells us very little about your life, or my life, or any specific persons life.
    - nosefurhairdo 2y ago
      The person I responded to (correctly) criticized per capita GDP, citing differences in cost of living. I felt that referencing PPP would be helpful since it attempts to factor in cost of living differences. I'm not sure this "comparisons are hard" speech is adding much. Differences in wealth are real, measurable, and meaningful, even if they can't be boiled down to a single number. Obviously there are other factors to quality of life; nobody here stated anything to the contrary.

dlkf 2y ago

What country are you referring to? The American middle class is objectively very wealthy: https://www.noahpinion.blog/p/no-the-us-is-not-a-poor-society-with https://www.noahpinion.blog/p/no-the-us-is-not-a-poor-societ...

insane_dreamer 2y ago
That article is based on 1) disposable income, which is the wrong metric to use (because it doesn't account for the fact that the US has much higher expenses in health care and education than places like the EU, Japan, etc.), 2) housing size as a metric -- which is due to population density (Western Europe has nearly 5 times the population density of the USA) and the fact that US cities are built around cars, and 3) vehicle ownership, which is both a cultural hallmark of the US and due to the fact that you can't really live without a car (2 if you're married) in the US due to the way its cities are built. In short, laziest article ever.

dinkumthinkum 2y ago

>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.

drewrv 2y ago
Why would working in tech shield someone from our healthcare system? “Most bankruptcies occurred in middle-class citizens with health insurance” https://www.amjmed.com/article/S0002-93430900525-7/fulltext https://www.amjmed.com/article/S0002-93430900525-7/fulltext If you haven’t been harmed by our system, it’s not because you’re immune. It’s because you’re lucky.
lazyasciiart 2y ago
> Why would even need an immigration policy if this was true? Do you think Southeast Asian countries don't have an immigration policy?
- dinkumthinkum 2y ago
  Well, I know HN is pedantic but the issue is why would so many people be trying to flee to the U.S. if it is worse than some "backwater". It makes no sense. I would assert that in extremely impoverished Southeast Asian countries, immigration is not a central concern.

refurb 2y ago

> America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. This is such a wonderfully HN statement to make because it's so preposterously wrong, yet the author is so confident it's right.

ranger_danger 2y ago
As a rule, strong feelings about issues do not emerge from deep understanding. -Sloman and Fernbach
deleted 2y ago
[deleted]

eitally 2y ago

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.

mindslight 2y ago
The pop discourse is myopic and sensationalist. I've never personally dealt with an outright denial. When I've called "insurance" companies, they've been generally helpful. However, this is what I have experienced: Primary care repeatedly rescheduling appointments further down the road, 2-3 months at a time. At one point it got so bad for my elderly aunt that I straight up asked if they were just trying to "run down the clock". Primary care doctors saying they will put in a referral to a specialist. Then a month later just getting a photocopied list of specialists in the mail for us to call directly. Go down the line and most are closed or not accepting new patients. Some were even straight up dead (... like rigor mortis, habeas corpus). One of the two remaining specialists booking 8 months out for an initial consult, the other 5 months. Billing departments that don't feel it necessary to do the work of completing insurance claims, yet feel entitled to still continue sending fraudulent bills to us personally instead. Medical equipment providers outright lying about the validity of their fraudulent bills even when challenged with concrete reimbursement rates, and then doubling down with bullying - aka willful fraud. Needing to put in a bunch of paperwork, then follow up with appeals, merely to see the second geographically closest in-network provider (closer one was having issues) due to living near a state border. And none of this covers the harder-to-capture dynamics of getting shortchanged on time talking to a doctor because the bureaucrats have deemed that 15 minutes is enough time for an appointment, or having to continually make sure the ball doesn't get dropped on care due to the proliferation of different moving pieces. The problem isn't all on insurance companies themselves. The real problem is the entire system is broken due to poor incentives where these gigantic entities have been allowed to pass blame back and forth instead of having to own any responsibility themselves. This puts patients in the middle (often when they're in pressing need of healthcare), to get ground up in an ever-growing runaround, rather than any of these businesses having an incentive to minimize the administrative complexity. The "approval/denial" charade for in network care is just one of the most galling games they've made up, so it gets focused on.

glimshe 2y ago

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.

gklitz 2y ago