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.
Even 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.
I had to get medical attention in Thailand and it was wonderful. I walked into the hospital, explained my symptoms to the nurse, got wheeled to a private waiting room, met with a specialist 10 minutes later, got some scans done on state of the art equipment (newer than what you would find in an American hospital), had a consultation, prescription, settled up for ~$90 and I was out of there in just under an hour.
I plan to go back if I ever need a major medical procedure.
The major difference is what happens when something goes wrong - you really want to be in a situation where you can be transferred to a research hospital that has the guy who has handled the three other times X has happened before.
I've always opted to be treated locally when needed - but I also pay for an emergency evacuation service that puts my butt on a jet back to the states if things go pear shaped.
This 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].
I'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.
Anecdotally - it seems like a non-trivial percentage of my mom's trips to the vet end in euthanasia.
I suspect there is an order of magnitude in the difference in level of care that goes into the average person vs dog. I mean, for one, it is very common to hear things like - "well, you have to remember, their lifespan is short. They only have a year or so left to live." This just isn't a discussion that is had with people.
I'm with them. I have no desire to transfer my assets to an already-wealthy bunch of doctors and healthcare conglomerates in exchange for dragging out the inevitable.
You are currently thinking with the rational part of your brain.
Find a 4-5 story parking garage and stand up on the edge. That part of your brain that kicks in and tells you to get back down to safety will also tell you to pour every cent you have in to buying a few more weeks.
> Find a 4-5 story parking garage and stand up on the edge. That part of your brain that kicks in and tells you to get back down to safety will also tell you to pour every cent you have in to buying a few more weeks.
This can change when there is no "back to normal" available. When your quality of life is shot and you know that tomorrow won't be better than today.
In a suicidal person who jumps off that building we consider this a tragedy because there's usually no physical reason that those feelings couldn't have passed, why their life couldn't have been normal again.
But in someone with a terminal condition and a body that's just done... and especially if they're well informed about the realities of their medical condition... yes, there can be things you care about more than throwing every cent you have into extending the pain.
I'm pretty sure you're wrong, but time will tell I guess. I've already watched both my parents die of the inevitable effects of getting old, and I have pretty firm ideas about what parts of that process I want to avoid for myself.
That is the sort of discussion that happens around old or terminally ill people. Some people prolong things as long as they possibly can, but in my observations this generally only seems to cause misery to everyone involved.
> Anecdotally - it seems like a non-trivial percentage of my mom's trips to the vet end in euthanasia.
Part of this could be that pets are limited in their ability to communicate details of their feelings to humans, making it harder for humans to tell the difference between a pet that is acting off because of something that they will recover from without a trip to the vet and one that is acting that way because of something that is serious and is going to go downhill fast if you don't take them to a vet soon.
This leads to vets first going to the vet for a given illness later into that illness than a human with a similar illness would have went to the doctor, hence a greater chance of it being too late.
I’m not a religious or spiritual person, but I assure you my cat told me when he wanted to fight, and when he was ready to go. I’ve never seen a cat so happy as when he saw me again after that long week in the hospital, and likewise when he was on the floor of the bedroom in pain, his face and his little weak voice told me he was ready to go the same as each person I’ve been with in their last moments.
Maybe that’s part of the problem? I mean - my grandmother lived to be 96, was “healthy” nearly to the end, but realistically was ready to go a good decade before that.
With my cat (and this would likely be the case with any of my cats...) we took a reasoned look at the medical options and the quality of life choices. It wasn’t exactly cheap, but we basically bought him a year of life. If it had been a human family member, we would have gone through exactly the same decision, IE: do you want to keep fighting and do you want to go through this procedure or not?
In 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.
Another 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.
> And yes, dental care is all over the map— it feels very much like what I imagine US healthcare to be,
Funny enough, dental insurance in the US is very straight forward. I have always gotten quotes up front with very clearly explained charges. The way it has worked is dentist talks over with me what they want done, billing person runs the numbers and gives me paper with estimates, and if I agree I pay whatever balance I owe on the way out.
Amazingly straight forward, kind of like how everything else should work...
FWIW Eye doctors and insurance on glasses works just as well.
Ha, I mean that's basically what it is in Canada as well— it's just so much more than going to the doctor, where you never even see a bill.
An example of my frustration with dental: I went to my usual dentist for a checkup, but then he referred me to a specialist. The specialist appointment wasn't going to be for a month, but then they call suddenly and have a cancellation the next day. I end up having to pay full price for the specialist appointment because my insurance doesn't like that I had two "assessment" appointments back to back.
On another occasion, I was quoted a procedure, and my decision for when I wanted to have it done was driven entirely by which insurance-year it was going to fall under, rather than by my convenience or how urgent it was, or anything else.
I know these are fundamentally "insurance issues" and I suppose better supplemental insurance could make them go away, but at the end of the day, just like with Americans, my insurance is chosen by my employer and I have basically no control over it.
It's uncommon here in Norway, unheard of in fact as far as I am concerned. I have a checkup once a year that includes a really thorough cleaning procedure and x-rays. That costs about 120 USD. If I need a filling that will probably add about 100 USD at the most and the two crowns (milled ceramic done on site, on demand) that I have cost about 500 USD each so over the last thirty years I have spent about 6000 USD on dentistry, so an average of 200 USD per year.
Do people in the States not pay for pet insurance?
We sure did go for it in Toronto. Vets seem to charge by the pound (wait, sorry, kilogram, immigrant…). Large dogs seem to come with large medical bills, and we were strongly advised by friends and family to go for pet insurance.
Now, I am not actually sure that pet insurance, versus setting up a dedicated savings account that we sock money into, was the best idea. If anything, we went for it because I am from the States, and I assume any non-trivial medical issue will be cripplingly expensive.
I don't. Part of the reason is I'm ok with a small chance of a few thousands dollars bill, but a bigger reason is I don't trust insurers: their standard contract would first explain how I have no rights and then add that if I have a problem with that, I can go to their pocket court (arbitration) to learn that I really have no rights.
It's available, and some people pay for it. I would be very careful to read all the fine print though.
For me, the cost of routine care, spay/neuter, and a certain amount of unforseen expenses should be part of what you plan for when you get a pet. Beyond that, it's a judgment call as to whether the cost of some treatment is worth it. I know people who have spent thousands of dollars treating cancer in an old dog, and others who have euthanized younger pets who developed expensive but in theory treatable health problems. I don't think either approach is wrong, it's up to the owner.
My dog just had major knee surgery (TPLO). Its cost will be total of about $5k when we have some x-rays in a few weeks. I don't have pet insurance, however, most companies don't cover it. There are tons of loopholes, like human insurance.
Vets 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.
They can, but they vary. I'm a citizen of both countries and there's one allergy medicine I take where the generic price in the US is the same as the name brand price in Canada. The name brand in the US is 7x higher than the name brand in Canada.
Not 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.
As the other reply mentioned, I wonder if this is just the human cost insanity infecting veterinary costs -- MRI tech could be used for humans, so the machine is absurdly expensive, and vets have to charge more to justify the cost of having a dedicated pet MRI.
True, but in my experience getting a few MRIs, the price from various imaging centers nearby varied (for the exact same MRI) from $500 to $2000.
The $2000 place is associated with a local hospital chain that is well regarded. I guess that is how they could negotiate $2000 for an MRI with insurance and the other place (that I went to) was only able to negotiate $500.
Honestly, the price for health care in the US is all funny money. I've gotten a single shot, of a very common drug, that was billed at $20k, knocked down to $10k with the "insurance discount", so my 10% co-pay ended up $1000, with insurance!
I had a surgery that was billied at $250k where the "discount" was over $150k. That $250k price is clearly not real.
And theae kinda of prices are why I'll probably never choose to live in the US. How do people live with the possibility that a freak accident could completely and permanently finacially ruin them.
The highest medical bill I've ever paid is £8.50. Of course I pay National Insurance to cover the costs of the healthcare system. But as far as I can tell that's no more expensive than what people in the US pay despite their insurance having not nearly the same coverage.
Do you sell all your assets, like realty where you live in, personal possessions, car, tickets to vacation you happen to buy beforehand? Or declaring bancrupcy is really harmless and easy?
It varies by state. There's a list at https://www.nolo.com/legal-encyclopedia/bankruptcy-exemption.... Basically you can keep stuff like the house you live in, your not-flashy car, household goods, tools of your trade, a small amount of personal property (if you own, say, a nice musical instrument or some jewelry worth $2k or whatever). As a general rule, anyone rich enough to have to sell property in a bankruptcy already has health insurance.
And please don't take any of this as a defense of the current abominable US system. I lost my dad to complications of untreated diabetes because he didn't have health insurance. What I'm saying is that people who should declare bankruptcy often don't, because they think bankruptcy will ruin their life. It won't. It protects you from predatory lenders and gives you a fresh start.
> As a general rule, anyone rich enough to have to sell property in a bankruptcy already has health insurance.
Isn't the issue that health insurance often doesn't cover everything. And that it's very difficult to get health insurance at all if you have pre-existing or chronic conditions (exactly the people who need it the most).
Pets tend to be smaller than humans, so manufacturers could ensure that pet MRIs don't drag down human MRI prices by making smaller MRI machines that only work for pets. They probably do.
There are "small animal" MRI machines, which are mostly intended for research.
The bores are really small: 55mm or so is not uncommon, so a mouse would fit, but nothing much bigger. Other animals are usually scanned on a machine meant for humans (sometimes even the exact same ones, very early in the morning or late at night).
My dad, a radiologist once had patient that was so large that they couldn't fit them on a conventional CT scanner. Luckily this was a university town, so they were able to access the vet's large animal scanner.
Part 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.
Last 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.
My dog had MRIs and ultrasound recently. Each event was $700-$900 a pop.
I take my dog for routine full checkup that includes MRI and Ultrasound whenever I travel to south america. They use the same machine brand as in the US, with same diagnostics. I pay $50-$85 over there for the same tests.
Vets over in SA (not business owners) make about $500-$1000 USD per month.
It would seem the huge cost is not from the machine. Its the labor. I think these are the 2 key differences:
a) Based on my understanding, getting licensed in this SA country is a nonissue. There is in fact an oversupply of vets because its easy to practice.
b) The price for the vet studies is on the 2k-5k year for a private U. Compare with US Colleges.
Regarding quality: Our vet in SA diagnosed my dog after seeing the US diagnostic test reports , over whatsapp. She was correct on her diagnosis from the start.
It took 4 different US vets, 3 separate facilities, 4 days of hospital bills ($5000) to arrive at the same conclusion that I got from a whatsapp.
It is not the machine problem. It is a captive market with huge costs related to labor.
MRIs are principally taken by technicians then a doctor will interpret them but the bulk of the operation isn't done by doctors and the techs are well paid but are paid less than a first year commercial airline pilot. IF you include all the maintenance and support around in airplane and around an MRI machine I think the airplane will be even further ahead.
Thanks, I learned something today. I think the point still stands if you include the time of the radiologist and tech, capital and employment costs for MRI in the US are substantial.
I agree that it is a very strange comparison between MRI and a plane, I was just chiming in on the capital and employment cost for each could be comparable on a per trip basis, not that MRI prices are where they should be.
In my personal opinion, a major problem with US healthcare is a race to the top, where the newest and best care is sought irrespective of the price. A judgement call needs to made somewhere on cost/marginal benefit, and post-procedure reimbursement debates is the worst way to do it. CT machines can cost between 250K and 14 million, as I mentioned in a sibling post. Similarly, MRI costs can range from $170-$5,500 [1]. In the current system, almost nobody is incentivized to keep costs down. Doctors and insured patients want the best care, as costs are externalized to the insurance pool. Insurance companies want to maximize costs, because their profit margin is limited by a % of spending.
I was quoting the number for a modern 3 tesla MRI machines, which would fall into the 500k+ range on your link. These are high end but not necessarily rare. For example, UCSF has 4 of these machines. These can easily be on the order of 3 million+ with installation
3 T machines are not necessarily better, it depends on what they're trying to look at, getter a sharper image of noise is not useful.
Anyway, your estimate seems to be way off, basing it on a 6 year old puff piece for a cutting edge model that was deployed in a lab. The cost for a typical new MRI is more like $500k.
I never said I was talking about averages ct machines any more than a brand new 787-9 is the average plane. You can get a 20 year 737 for a lot less than 200mil, and is probably closer to the average.
If your point is that MRIs less than 3T exist, I agree. If your point is that cheaper MRI exist, I agree. If your point is that nobody has spent 3 mil on a CT, then I disagree. A link showing the price of used machines 10-15 years old isn’t going to change that.
Very 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.
"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.
I 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.
I 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.
It 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.
> 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.
Hmm, 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.
My 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.
FWIW: 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.
I'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.
It'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.
Large 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.
Depends 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.
Having 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.
Me 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.
It 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.
You 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.
The 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.
Actually 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
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.
While 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.
While 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.
If 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.
Specialization of labour is what's primarily responsible for the industrial revolution - while this is a hyperbolic comparison, is the only reasonable way to fix healthcare to throw away all specialization and go back to "do it at home"?
The service needs to be available in some form at least for folks like me that have an essential tremour or otherwise are limited in fine motor skills.
I'm not saying do everything at home for everyone. But if some people did minor things (first aid type stuff) at home, that would free up the system for more important cases. Just think of all the people that fo to the doctor with a cold. A little education could go a long way.
People keep talking about patients going to the doctor for frivolous reasons, but what I see is that it is much more common for patients to ignore symptoms or take some over-the-counter medicine, and take too long to see a doctor.
This, I think, is a natural result of the US insurance system. Being sick is quite expensive and not being sick but being proven to not be sick is also rather expensive so people will naturally tend to avoid formal treatment longer in the hope that everything just magically goes away.
This also contributes to the amount of emergency room treatments that could have been trivially handled with earlier intervention. A boil that has gone septic is a very serious medical condition, but nearly all boils can be trivially resolved with a short regimen of antibiotics.
You could end up with a brain infection, very easily.
If you cannot afford US dental care, and you are not super poor, get a 1 way ticket via Kiwi.com to a more “eastern” European Union country like Croatia or Poland. If you use scripts from GitHub or are very good at searching you can get such tickets for $200-$250. You can find extremely excellent dentists with great qualifications and reviews in countries like that, and many have amazing reviews and are super cheap.
A lot of people from EU countries, that do not have “socialized dental care” go to countries like that a couple times a year to get dental care.
> If you use scripts from GitHub or are very good at searching you can get such tickets for $200-$250.
This is the average cost, per tooth, of the work I had done here 2 years ago, in the US, at a dentist where I paid cash.
> You can find extremely excellent dentists with great qualifications and reviews in countries like that, and many have amazing reviews and are super cheap.
I’m wondering how cheap they have to be in order to make it cheaper to fly to europe. How much would be an extraction or a filling replacement?
Well, I am a dual US|EU citizen, currently living in Croatia. So, I do travel abroad a lot.
When I lived in the US, I had an individual plan through Costco (Delta Dental) that was quite a good deal. It was a Dental HMO plan, though. Really, the only thing I noticed that it did not cover was implants. However, Costco only offers it in a handful of states: https://www.costco.com/dental-insurance-services.html
In both cases above, if you get the Dental HMO, it has no annual or lifetime maximum dollar limits, no waiting periods, or pre-existing condition clauses.
Anyways, I used my American dental insurance to get cleanings, X-Rays, and fillings. I go to Europe a couple times a year at minimum anyways, so I use that to my advantage by getting more advanced dental care there.
Dental implants, especially Swiss implants, can be 8 times cheaper than what some dentists charge in the US. A Swiss implant, when all said and done, costs about $1000 USD in the more eastern EU countries.
I would stick to European Union countries, as the quality of materials is very high. There is some website like the link I posted above, that has implant success rates posted, by dentist. I just do not remember the website's name. Anyways, you take your time and do extensive research before you choose your dentist.
Anyways, I have a very rare immune-mediated disease affecting my autonomic nervous system, which affects salivation, so my teeth are totally jacked up, even though they look really nice. I also have type 1 diabetes, and it makes my teeth naturally more prone to infections. So, cost-wise, I am screwed when it comes to dental care. I know somebody with the rare disease I have, that has about 20 implants in her mouth.
But, if your teeth are really jacked up, and especially if you need implants (of course it is better than dentures), it is way cheaper to go to European Union countries. This is even for 1 implant. If you may need thousands of dollars in dental care, you may be better off going to the European Union to get that care.
If you really want to be frugal, why not go all John Rambo style and just cauterize the wound with some gunpowder? It's probably <$2 for enough to make sure you don't bleed out.
Every time I go to the doctor I wish I could take myself to the vet instead.