[onion2k]

I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?"

The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambulances. Most of the world has accepted that some system to spread the cost among everyone is better than putting people in that situation.

[otherme123]

> Society should find a better way to pay for ambulances

Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.

[x______________]

> Only the US society seems to be unable to find a solution.

Unwilling. It's absolutely feasible to find a solution, as seen everywhere else in the world.

[3D30497420]

Even some parts of the US have found solutions.

From the article:

> In Tulsa and Oklahoma City, meanwhile, the government buys staffed unit-hours from an ambulance operator, while households can prepay a few dollars a month on their utility bill and owe nothing if the ambulance ever comes.

[pornel]

billed for buying unit-hours from an operator... that's very carefully worded to make it sound like a corporation<>customer relationship and not socialism.

[toomuchtodo]

Lots of policy in the US is hacking around the lizard brain idea of "We cannot have nice things because someone who doesn't deserve it might get it."

My favorite example is universal school breakfast and lunch. Without fail, someone will argue that some kids don't deserve it. It doesn't matter that all of the data shows it is more economically efficient and the benefits to kids is overwhelming.

[sleight42]

You essentially described the Republican and Libertarian perspectives in the US.

The Republicans seem to see it as immoral to potentially give a few people support they don't need even if that means that most of the people who need the support actually get it. And, instead, they believe that having an inconsistent array of private interests will somehow be more able to service an enormous population than having an organization (like government...) that is large enough to match that population's needs.

The Libertarians seem to either genuinely not care about the rest of the world or, more often than not, seem to be naive about how life can be for the less privileged.

It's the lie of the "rugged individualist" in America. Most "successful" people come from successful families. Social mobility, in the US, is part of that lie. Here, we celebrate the person who rises from poverty to become wealthy as a member of a sports team, or as an actor, or similar, while disregarding that these massive successes are outliers.

I'm so often disappointed in my own country.

[andrew_lettuce]

Come on, across the world we prepay for the use of things regardless if we do or not. As described in the article it's an option, not a political system.

[red-iron-pine]

only parts of the US are unwilling

they happen to be in the Fortune 50, or top 10.

serious, go look at the F500 list and see how many of the largest, meanest companies in the US (and world) world also happen to be healthcare

if you wanna know why it's never gonna happen -- there is the list. they will spend more money than god on social media, bribes, and whatever else they need to keep the system the way it is

[lotsofpulp]

Why is Fortune the relevant list? Why not market cap, which also happens to correlate with net income, which means more cash to spend on political influence?

https://companiesmarketcap.com/

Mostly only pharmaceutical healthcare in the upper tiers of that, but these businesses still have market caps and net incomes literally one or two orders of magnitude separating them. Grouping top 10, 50, and 500 makes no sense.

[HelloNurse]

Unable to be willing. The combination of not knowing any better, political parties and media that don't care or exert a contrary pressure because they belong to billionaires, and powerful health sector businesses appears to be very effective.

[nkrisc]

The odds are stacked, but everyone still has free will and can choose to question what they’ve been told (especially what they’ve been told conflicts with what they can see with their own eyes).

Many choose ignorance because it’s comfortable.

[wisty]

And the US also pays a TON of tax dollars to a broken, overregulated system.

IIRC if you look at the cost of Medicaide, Medicare, VA, and other federal and state spending it's the same as most other countries per capita or as a percent of GDP. The US taxpayer pays about as much as Canadians to fund their public system, then pays the same amount again for private cover since it's not universal.

No I'm not making a typo. Medicare, Medicaide, and the US system is such a rip off that per capita Americans are paying similar tax dollars to their joke of a public system.

But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.

[refurb]

Canadians don’t get the same care as Americans.

McKinsey did a nice analysis of what is driving US healthcare costs. It compares category spending to OECD then compared price and volume.

Turns out the US pays a bit more for drugs (relative to total spend), a little more for inpatient care and a TON more for outpatient care but half of the increase is volume, not price.

As someone who works in healthcare globally, the difference in US care is stark. Americans get much early and more access to new technology than other countries.

If your lymphoma has returned and you have a 20% of living more than a few years the best care is CAR-T with cure rates close to 60%.

Check out CAR-T rates in the US versus Europe, it’s almost 3x. The US started using it in 2014 and Singapore just started paying for last year (11 years later). Even in Europe adopt only ramped up in the last 5 years.

So yes prices are higher, but a big part is more aggressive care with more expensive treatment.

[wisty]

The US healthcare system just upsells on unnessessary crap. It's junk volume or at best it's heroic high tech solutions mostly making up for the fact that people stay away from hospitals until it's too late.

Life expectancy shows that while the US is the best place to have stage 4 cancer, it's probably not the best place overall. Most places do the 80/20 stuff better.

But yeah, you are right that the US does some stuff well. Just not efficiently.

[refurb]

US care is highly aligned with international guidelines. Saying "it's junk volume" just tells me you're not that close to the data.

Life expectancy doesn't measure quality of healthcare, there are far too many confounding variables like genetics, diet, accidental deaths, etc. No serious study of healthcare quality relies on it.

Look at 5-year cancer survival rates. The US is better (significantly better) in many of them than other countries. A big part of that is access to the latest technology.

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2...

[wisty]

Now do maternal death rate. Like I said, a good place to have cancer but they aren't good at stuff that matters.

The US leans aggressive on tests and heroic end of life care. I doubt you really disagree (except maybe on whether you think it's the right call). That is where the money is, since the insurance company can be forced to pay. It's kind of good for the rest of the world though if the US wants to pay (in both money and other issues) to be early adoptors.

Read "When doctors die", the US is the total opposite - everything goes to the big ticket aggressive (and yes, modern and cutting edge) treatment where it's hitting diminishing returns. https://pmc.ncbi.nlm.nih.gov/articles/PMC6179868/

[dghlsakjg]

A good tell that someone is utterly full of shit on Canadian healthcare is that they generalize all of Canada.

“Canadian health care” is not a thing. Each province administers its own completely independent system.

Someone on PEI is in a healthcare system that has as much to do with Alberta’s healthcare system as it does their neighbours in Maine. As a result, anyone referencing Canadian healthcare is talking about a dozen or so unrelated systems that do things very differently. The closest it comes is that there are interprovincial billing systems so you don’t have to do the paperwork to get covered for an urgent visit out of province, and not all provinces are signed on.

You can safely dismiss anyone that has reduced that complexity, or is completely ignorant of it. It’s a great way to tell when a foreigner is spouting talking points they picked up from an unreliable source and did not do even a minimal fact check on. “Canadian health care” as it is talked about in the US media is frequently fiction for propaganda purposes.

Canadians almost always talk about problems within a province. What's happening in the Maritimes has nothing to do with BC.

The feds set a minimum standard for a province to qualify for federal funding, and that's about the limit of their influence.

No idea if the rest of his statement is poorly sourced propaganda as the first sentence.

[refurb]

You’re ignoring the fact that provinces can’t fund technology that the federal government hasn’t reviewed and negotiated a price for.

So yes there may be differences between provinces in terms of when they fund what restrictions are put on it, the overall trend across Canada is pretty consistent.

And as I said Canadians don’t get the same care as Americans so concluding the higher cost is entirely higher prices for the same thing is false.

[lostglass]

I lived in Ontario for 20 years then I lived in Seattle for the next 17, I assure you that the healthcare I receive and received is pretty much the same - except in Ontario it's way cheaper.

You're talking about cutting edge technologies available to the tiniest sliver of people - I'm not even able to get access to much of them with my private FAANG insurance - and drawing a false comparison.

[nkrisc]

Most doctors and nurses are not overpaid.

Certain specialities probably are overpaid (orthopedics), but others like pediatricians or general practitioners usually aren’t.

And nurses!? From the nurses I know they are underpaid for what they deal with.

The ones making loads of many are willing to travel around the country and uproot their life once or more every year. Not exactly a lifestyle without its drawbacks.

[wisty]

Everyone is gonna say nurses are underpaid. It's a caring, female dominated profession, it's a motherlove sentiment. And they are not paid as well as doctors.

Yeah, most pink / blue collar workers in the US are badly underpaid, but IIRC ones in the health sector are some of the best off, relative to medium salaries.

Compare teachers and nurses. In most countries they make about the same AFAIK (and I'd say nurses do deserve more, telling a parent Billy did badly on a math test has got to be easier than explaining a bad medical test). But in the US it's about 75k vs 95k. There's a huge premium for working in health in the USA, EVEN in the underpaid blue collar end.

Doctors make out even better in the US, and the c suite in health can have salaries that are just insane.

[nkrisc]

I don’t dispute this, but I also don’t think it matters. An underpaid profession being paid more then a severely underpaid profession doesn’t make the former overpaid.

[Sohcahtoa82]

> US doctors are overpaid. US nurses are over paid.

Median pay for a Nurse Practitioner is $132K/yr [0]. I think that's reasonable.

Average pay for physicians ranges from $220-450K depending on specialty. [1]

Personally, I think doctors should be paid more than software engineers, so I think those numbers are all reasonable, especially when you consider what it takes just to enter the field. Nurses require a Master's degree. Physicians need a Bachelor's degree PLUS another 4 years of med school AND THEN a residency program that lasts 3-9 years depending on specialty before they finally earn their medical license.

IMO, the idea that nurses and doctors are overpaid is quite simply ludicrous.

[0] https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-...

[1] https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...

[sgerenser]

You might find those salaries reasonable, but they’re probably double what those same occupations pay in many other (first world) countries with lower healthcare costs. Maybe the trade off is worth it, but it’s not something that can be ignored when people complain about how much more expensive healthcare is in the U.S. compared to Europe (for example).

[Sohcahtoa82]

> but they’re probably double what those same occupations pay in many other (first world) countries with lower healthcare costs

You'll find that salaries across the board are lower in other countries. Software developers in Europe make half of what they do in the USA. In exchange, they get far better benefits.

Also, physician salary only makes up about 8% of total healthcare costs [0]. Cutting salaries in half wouldn't significantly lower our healthcare costs.

[0] https://www.medicaleconomics.com/view/physician-pay-makes-up...

[sgerenser]

No, certainly just cutting physician salaries wouldn’t make a big difference. But cutting salaries for everyone involved, including physicians, nurses, and administration would. I’m not saying we should do that, but just that people seem to ignore how much higher salaries are in the U.S. when they compare healthcare costs to other countries.

[master-lincoln]

That's what a government would be for. You vote neo-liberal, you get it... (I consider both the US democrats and republicans neo-liberal)

[bestouff]

I think only the US consider the US Democrats as leftists.

[opo]

This is a common claim, but it is a misleading simplification of US politics and European politics. (In simple terms, many of the economic positions taken by the Democratic Party would be considered centrist in Europe, but if you include positions that have been taken on immigration, identity politics, criminal justice, reproductive rights, etc. it would not.)

[refurb]

The Democratic Party spans from slightly right to ragging left that even European leftists look at with confusion.

[Symbiote]

What's the name of the far left grouping?

[natebc]

Only the rightists do and among them really only the loud redfaced ones.

[cucumber3732842]

>But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.

17% of GDP is healthcare. So between 1:10 and 2:10 people in this country are making more than they otherwise would (note I did not say wealthier) because the system is screwed up and hoovers up more of everyone else's wealth than it ought to.

Slavery was 12% and (while obviously geographic concentration of industry plays a lot into it) it took a war for them to take a haircut.

[uoaei]

Earnings represented by GDP are not distributed evenly across a given population. That 17% of extra earnings goes to relatively few people in the States (I'm putting this very mildly, the concentration in reality is insanely lopsided).

[cucumber3732842]

The US healthcare industry is ~10% of the workforce. More if you include people affected by the supply distortions thereof (all those techbros working for agentic penis pump startups).

The fact that that pie is not sliced evenly does not change the fact that is an integer multiple larger than it ought to be.

[pjc50]

Possibly reasonable point about labour supply ruined by an absurd analogy with slavery.

[nekusar]

Not at all.

Systemic inertia is unimaginably strong.

I easily see that changing the USA to be more socialist, especially in areas where game theory indicates its the best solution, will likely take a civil war.

That also aligns with Marx's writings, that the capitalists will not acquiesce without a fight, and a big fight at that.

The slavery and Civil War connection is a comparison of similar economic magnitudes.

[refurb]

Canada doesn’t pay for ambulances unless it’s truly an emergency. Think you’re having a heart attack but you’re not? Time to pony up hundreds of dollars

[LtWorf]

You see, it's better to die than to help the coloured neighbour who lives across the highway. I don't believe in this but that's USA society.

[frenchman_in_ny]

I've been there before. I had a high deductible health plan, it was December & I hadn't used any of my premiums... I had a heart attack (I didn't know it at the time). And my mind went to "but my premium! I know, I'll walk myself to urgent care instead of taking an ambulance to the hospital"

[grogenaut]

Is this the common cost or is this an outlier blog story that hit it off. Talk real data to me. I don't get excited about any individual anecdote (unless it's me personally of course).

No people shouldn't be bankrupted for a short cab ride that's not needed. I'm not arguing that.

[lazide]

Well over a decade ago, it was $6500 for a couple mile ride to the nearest hospital, no emergency medical care necessary (just supervision). This was in the Bay Area, in California.

I can’t imagine it’s gotten cheaper.

[WJW]

That's wild. According to the website of my local ambulance organisation, a full on ambulance ride with all medical supervision etc runs between 400 and 900 euros. Typically this would be reimbursed by the (mandatory in this country) health insurance. This is in a large city in western Europe, I would expect it's cheaper in places with lower cost of living.

EDIT: their own website states "If the ambulance only comes and stabilizes you on the spot but you don’t need to be transported, there are no costs." https://ambulanceamsterdam.nl/information-in-english/

[culopatin]

Yeah my mom got billed 9k a few months ago from SFO to one of the south sf hospitals. Neck brace and supervision was all that was needed. Basically an expensive uber ride.

[Esophagus4]

He covered that in the article fairly thoroughly. Did you read it?

The anecdote illustrates the issue then he dives into the analysis.

[ChrisMarshallNY]

It’s pretty common.

I know that John Oliver is a bit of a “lightning rod,” for many folks, but he (or his staff, really) does his homework. He did a segment on it, some time ago: https://youtube.com/watch?v=Ezv8sdTLxKo

[master_crab]

He’s a lightning rod only because some people get unnecessarily triggered by facts that don’t fit their world view.

[mananaysiempre]

There’s a thin line between satire, which can convince, and sneering, which can only turn off. John Oliver, unfortunately, does end up on the wrong side of it from time to time, and can (together with his core audience) be something of a bully when he does.

I’d also be careful about his facts: they’re usually well-researched, but by the nature of the format he only ever presents those which fit his argument, and that’s just not good epistemology. I can think of a few times when the show made me feel safer about my beliefs than I should have been feeling.

[ajuc]

The time for this debate was 100 years ago. Now only people who can't be convinced aren't convinced, so there's no point convincing.

So why not make fun of them? There's no downside.

[gruez]

>So why not make fun of them? There's no downside.

...except the populist right backlash, triggered in part by their resentment at coastal "elites" (think yuppies, not people who fly to davos annually) sneering at them.

[refurb]

He’s a comedian that some people take too seriously.

You’re not supposed to shape your political views from entertainment.

[PearlRiver]

I remember this came up during COVID. The government was worried that homeless people and illegals would be afraid to report symptoms. GPs are specifically free and don't have to ask for papers or insurance to combat these health crises.