No One Goes There Anymore

https://news.ycombinator.com/item?id=23206784

I saw the "No One Goes There Anymore" post last night while trawling through the "new posts" page, read it, realized it was from DoreenMichele, and, having read and resonated with the aforementioned comment, upvoted it just to make DM feel better.

YMMV

Fixed; thanks!

This is a special case of what is in fact the biggest challenge on HN. If you try to interpret individual data points, given that so little information is available, you'll end up curve-fitting the worst picture from your own imagination. It is a sort of demonic connect-the-dots game where, given a few dots, we end up recreating our own shadow: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so.... It's we who are doing it, not the data, which is what makes it so frustrating: only we know where our own buttons are, so only we can push them so reliably, over and over. But since we don't know we're doing it, it feels like the other person is doing it, or the community is doing it, and that feeling is intensely convincing! It's crazy-making.

There are lots of statistical clouds like that on HN—the opinions of commenters are another. This is why users frequently post angry theories about how awful the commenters are, but the angry theories are all contradictory. Each user is recreating their own shadow from the data points they happen to notice and dislike (https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor...), and since we have different shadows, we end up with different theories.

Even among people who file for bankruptcy, most have little medical debt: https://www.forbes.com/sites/aparnamathur/2018/04/09/exposin...

> Department of Justice did a similar survey of bankruptcy filers between 2000 and 2002, which included a much larger sample of 5,203 filers, and found that 90 percent of filers had medical debts less than $5,000, and 54 percent had no medical debt.

We’re talking about 10% of 1% of people that file for bankrupt y and have more than $5,000 in medical debt.

The other thing people don’t mention is the aggressive cost controls in other countries. In the U.K., the NHS will pay $30k on average for treatment that is expected to increase life by one quality-adjusted year: https://www.kingsfund.org.uk/publications/articles/ministers.... For cancer, etc., it’s double that.

> NICE has on occasion approved treatments that cost more than £30,000 per QALY. In addition, since 2009, there has been a higher threshold of £50,000 per QALY for end-of-life care, which in practice has applied chiefly, although again not exclusively, to cancer drugs.

In the pre-Obamacare days when there were lifetime limits, you’d see stories of people blowing through a $1 million limit, and then dying a couple of years later $500,000 in debt. Tragic yes, but in the U.K. or Germany these people would have been counseled into hospice instead.

https://www.politico.eu/article/cancer-europe-america-compar...

> Speedy access to cutting-edge treatments cuts deep into America’s national purse. One study, summarized in the New York Times, determined that the U.S. averted 265,000 more deaths of colorectal cancer compared to Western Europe between 1982 and 2010. Each year of healthy life gained cost $110,000. The costs for gains in prostate and breast cancers were even more dramatic.

The incremental lives we saved in the US for these cancers came at a cost double that of what would have been approved by the U.K. NHS.

Finally, the other thing most people don’t mention is that Americans have vastly more money in their pockets due to higher incomes and lower taxes: https://images.app.goo.gl/n8Qs8eBa84yuo3by7

There is a small chance that, in the US, you’ll get cancer or have a heart attack, and fall through the cracks of health insurance, Medicaid, and Medicare. But you pay a significant price for reducing that risk.