This exact scenario happened to me a few years back. I had just jumped onto a team in the middle of an enormous shift in product and put the nagging, on-and-off pain on the back burner with some aspirin and made a dentist's appointment a few days out.
After I woke up on Wednesday with the worst headache of my life looking just like that first photo, I went to my oral surgeon, who sent me in for emergency surgery immediately. I spent a night in the ICU and three days recovering. He explained that I had developed a serious abscess that had spilled into my palate and threatened to close my windpipe completely, and that if I hadn't come in I probably wouldn't have made it to the weekend.
It was an extremely sobering look at my priorities and good luck. I was young, and health insurance hadn't been a priority - had I been bootstrapping or freelancing instead of a part of a team with the good sense to get a group health insurance policy, I might have dug myself into about $40,000 in debt, or worse - hesitated to go to the doctor's for even longer.
Don't fuck around with your health. I dodged a bullet. It's tempting to push these responsibilities off like any other, but like other commentors said, it runs directly contrary to your duty to be healthy and present for your team. Dead entrepreneurs make no products.
My friend, who is a serial entrepreneur/CTO/founder, was on his first big company back in the late 90s. He was brought in by a friend/consulting partner and was very jazzed to be working on an exciting predictive analytics application to detect churn in mobile subscribers.
So much so, that he lived the company. He ate poorly, didn't exercise, was grossly overweight, drank excessively and worked obsessively. His gallbladder couldn't take it and nearly burst. It was so swollen by the time he went to the doctor, they were scared it would go any minute.
He had emergency surgery and could have easily died. That was as big as wakeup call as they get. He got the message loud and clear, lost weight, started exercising, ate better. Got much healthier and recovered shortly thereafter.
Living for the startup is stupid. As byrne said, "Dead entrepreneurs make no products".
I had an uncle who was just a normal guy, not overweight, didn't drink excessively, etc. He complained of occasional stomach pain, but didn't feel like going to the doctor. Eventually it got worse and he saw a doctor. Turns out he had stage 4 cancer and was dead in two weeks.
Not to derail this thread, but out of curiosity why did you choose to take aspirin for the pain? Given that there are more effective OTC pain medications out there.
Throughout my life, my parents have drilled into me:
If you lose your money, you lose a little.
If you lose your friends, you lose a lot.
If you lose your health, you lose everything.
No one is going to write you a beautiful eulogy if you collapse at work because you were so loyal to your paymasters. If you're feeling sick, then you need to take a break and get it looked at, end of story.
As an entrepreneur still trying to make it I don’t the extra cash for insurance right now so I just pushed it off thinking it would take care of itself. -
...and that's why i can't support candidates who want to repeal universal healthcare in the US, most of whom are Republicans, and ironically, in their opposition to reasonable universal healthcare are adopting a policy that is incredibly anti-small-business.
Individual dental plans typically aren't available. Even with insurance, the co-pay on wisdom tooth extraction is typically 50%, because such procedures are typically (not always) preventable by proper dental care.
So even with insurance, he'd be paying 50% (and probably could negotiate 20% off with a cash payment without insurance, so insurance only costs 30% less). Did he have 50%, or would he still have put it off due to the expense. Is asking him to pay for it a "failing" of society? If so, consider the cost of dental insurance that provides 100% coverage for procedures that are generally preventable.
Insurance is about math. Because truly catastrophic dental care is rare, dental self-insurance is generally a matter of cash management, and you usually can come out ahead, even with an issue like this during a year.
Context: I am an entrepreneur "still trying to make it". I have a wife and 2 kids. We don't have some magic source of easy income. Planning for the cost of insurance was part of planning to start a company. So was planning to self-insure dental. It is possible. I don't understand why any of this planning should be anyone's responsibility other than my own. I don't believe I should be asking someone else to pay for my insurance as some sort of societal debt, and I wish the feds would quit adding mandatory coverages and regulatory overhead that makes buying insurance more expensive.
If either party REALLY cared about small business, they would have taken the simple, obvious step of making individually purchased health insurance tax-deductible long ago. But that didn't fit their agenda.
"Even with insurance, the co-pay on wisdom tooth extraction is typically 50%, because such procedures are typically (not always) preventable by proper dental care."
Wait, what? It's true that under most dental coverage you pay a percentage (and not a flat co-pay) on oral surgery, but for the life of me, I don't understand the idea that the need for wisdom tooth extraction is ever preventable by proper dental care. No amount of brushing and flossing is going to prevent your body from throwing extra teeth in your mouth in your late 20s.
If anything, proper dental care means none of your teeth will have fallen out, so when your wisdom teeth come in they have nowhere to go and get impacted and then decayed and then infected.
I said "not always". Although it seems possible that scheduled wisdom tooth extraction may have been possible with proper care, regular x-rays, etc, that's not really the point.
In my recollection, scheduled wisdom tooth extraction has usually been on the same 50% co-pay as emergency wisdom tooth extraction. And I don't think the "emergency" part has the cost implications in dental that it does in other medical realms.
Neither is pleasant, but the cost would probably be the same either way. I don't try to justify the tiering of the co-pay, but recognize that moving it down to the 20% co-pay range just means the actuaries factor that change into everyone's premium.
You said "typically (not always)" and I say pretty close to never.
I don't try to justify the tiering of the co-pay
You said the co-pay was tiered "because such procedures are typically (not always) preventable" (emphasis mine).
(i'm note 100% sure that by 'tiered' you mean that you pay 50% for this instead of the flat or 0 co-pay most dental coverage has for checkups and the like)
Sure, you can micro-parse the language, and yes, I mean it's at the 50% co-pay or whatever.
If I were trying to explain the rationale in this case, I'd theorize it's because this is typically something that happens once in a lifetime (if at all). I'd expect once one wisdom tooth gets cranky, they'd yank the rest at the same time. So, in this case, the thought would be that people partially pay for it when it happens rather than making everyone in the insurance pool pay for that risk every month, especially people with no wisdom teeth.
But I am not an actuary or insurer, so I don't know for sure.
It's not always a 50% co-pay. That will vary by state and by plan. I have pretty cheap & awful dental insurance, but wisdom teeth extraction was 100% covered. I think my only cost was the copay for anesthesia.
Dental insurance is pretty cheap -- there are a limited number of high-dollar procedures that happen infrequently. Plus, major costs like anesthesia are usually part of medical coverage. So while the insurance pool is more likely to pay for a wisdom extraction for many folks between 18 and 30, that's a one time event.
Medical insurance, on the other hand, needs to cover a broad array of overpriced procedures with nearly unlimited liability. I had a back surgery that cost my insurance company about $75k. The recent birth of my child cost nearly $25k!
some people dont have space for wisdom teeth, and in such cases they need to be removed - whether it can bedone simply with some freezing or some more complex surgery depends..... but uf you dont haveenoughspace, as many dont, they gotta come out.
I'd go with a business rational over the theory of distributive just over lifespans. It's an adverse-selection problem. Wisdom-tooth extraction is usually not an emergency (Nick's case excepted!)-- they have to come out sooner or later, but often you've got some time. And it's a big cost compared to most dental work. If the insurer covered all or most of it, you'd have people signing up for dental coverage, getting their teeth pulled, and dropping out.
Very commonly, a person's jaw/mouth is too small for the wistom teeth to fit. Case in point, I (25-year old guy) had a wisdom tooth which grew sideways (into the next tooth) and _would_ have destroyed the next tooth and caused an infection like the one linked in the article. I have a second one which might do the same.
These things are not preventable, you were just born lucky. Remember, humans didn't usually live to become 50 years old.
> Very commonly, a person's jaw/mouth is too small for the wistom teeth to fit.
Exactly this. I had something similar (identical?): A horizontal impaction of my bottom right molar. Had I left it longer, it would've destroyed the roots to the molar in front of it, and I would've lost that tooth, too.
I suspect it's largely genetic. My mum has all her wisdom teeth, and she's never had an issue; my father had all of his removed because they didn't come in straight. My situation played out identically to his. Hence, I don't believe that simply taking pristine care of the teeth will magically help--if they don't erupt from the gums properly or come in crooked, there isn't much else that can be done save an extraction if they're problematic. In many cases, you're better off having them removed to prevent issues precisely like this one.
I'm missing two upper teeth [0], which resulted in my having enough room in my mouth for my upper wisdom teeth to fit comfortably. It's evidently of genetic origin in my case, as I have relatives who are missing the same teeth, which I think from that source are called the upper lateral incisors. Were I not missing those teeth I expect I'd have needed the upper wisdom teeth removed to make room.
(On a tangent, there's a great article [1] about how bulldogs have been bread to have massive jaws and a very short face and that results in all kinds of breathing difficulties.)
Interesting. I know of at least two other people with that condition who were missing a number of adult teeth that never came in. Though, I think their example is somewhat more extreme (and according to Wikipedia, I guess it would be classified as oligodontia), because at least one of them required extensive dental surgery for implants since they quite literally lacked 6+ (maybe more?) teeth.
> (On a tangent, there's a great article [1] about how bulldogs have been bread to have massive jaws and a very short face and that results in all kinds of breathing difficulties.)
I bet that applies to persian cats, too, since they're bred with extensively concave faces (something that seems cruel, IMO).
Very interesting reply--thanks for sharing that, because I had completely forgotten that one of my friends has a similar condition. Can't believe I completely forgot he had implantation done, too...
"Remember, humans didn't usually live to become 50 years old."
This. Also, humans used to lose a lot of teeth. Modern dental hygiene is a very recent development within the ~200,000 year span of H. sapiens sapiens. Throughout most of human history, wisdom teeth served as reserves, of a sort, to fill in what were likely to have been more than a few gaps.
These days, proper dental hygiene means you've more likely than not been able to keep all of your adult teeth, ergo, it's highly likely than your wisdom teeth will become impacted. The assertion that proper dental care will prevent wisdom tooth impaction is ludicrous.
It is true, however, that extraction of wisdom teeth can be managed to an extent. Almost everyone gets them at some point, and impaction is very common, and all of this is well known. So a proper dental regimen should include x-rays to search for wisdom teeth well before they become problematic. If this is what the OP intended to say, then fine. But his phrasing makes it sound as if he implied that proper brushing and flossing will obviate the need for wisdom tooth removal. Last I checked, brushing and flossing do not alter the shape of one's jaw.
To defend myself here (a day later), I was not assigning the causality in that direction. The "Because I took care of them" clause goes with the "I get to keep them", as in "I made sure to clean them and not let them get cavities, so there aren't any problems with them staying around". I thought the English was clear enough as I wrote it, but I guess parse errors are more common than I thought.
"obvious step of making individually purchased health insurance tax-deductible long ago."
I deduct my health insurance premiums as tax-deductible.
I'd like disability insurance to be deductible too. Seems that's kind of a no-brainer, as I'd be able to rely on disability insurance rather than hitting up social security if I didn't need it.
This is probably true for dental, for a lot of reasons, including the routinization of dental care, the degree to which dental expenses are preventable, the fact that fewer people have dental insurance than health insurance (and so the market for dental care is less distorted), and the extent to which dental care can be cosmetic.
The same isn't true of health care. The health care market is totally distorted by insurers, who collude with providers to set prices. Services fall into two buckets: routine "checkup" type stuff that costs so little it's not worth arguing about, and hospital/specialist services for which there is no pricing transparency and which, purchased by anyone other than an insurance company, is catastrophically expensive.
It is perfectly reasonable to advocate for single-payer health care even if one believes firmly in moral hazard. There are other interventions one could advocate for instead. But any way you slice it, the "market" we currently have is busted.
Health also has significant variance in outcomes, much more than the variance in dental costs, so it makes sense to pool risk. However, the fact that events aren't uncorrelated like a lightning strike makes it hard to deal with as an "insurance", the usual risk-pooling strategy, because in many cases the event has already happened, so no sane insurer would insure against it (how is it insurance if it has an 100% chance of occurring?).
For example, an American friend of mine has a congenital heart defect which will over his lifetime cost probably $1m or so; I had better luck and was not born with one. It seems sort of problematic imo that this sort of thing isn't risk-pooled across the population. It's already bad enough that he has to have surgeries/etc. for it, but due to our health system it also impacts areas of his life that shouldn't be affected, like choice of career. For example, he can never start a startup or do freelance/consulting work, because he wouldn't be able to buy individual health insurance; so he has to work at a large company with a good group-health plan, and can never be unemployed for longer than the 18-month COBRA limit.
Sure, people can't be the same, but I see paying for major healthcare problems as just one of the basic "civilized society" baselines. I mean, in most of those other cases you have other choices: can't be an air force pilot, do something else. And we do make some baseline effort to ensure that you have some ability to choose a career, by providing free public education. But if you have a heart that doesn't work without medical treatment, you don't have an alternative to "get medical treatment".
I guess I don't at all mind paying an equal share of those kinds of expenses, either. To me, not having heart defects, leukemia, down syndrome, or any of a number of things I might've had is its own reward, because my quality of life is better and I don't have to get surgeries and whatnot. I don't see a need to also come out financially ahead of those who had the misfortune to need the surgeries, so I win the health lottery twice and they lose it twice.
The moral-hazard problem also seems pretty weak, at least when it comes to major things like surgeries; I doubt there are many people who would've avoided getting cancer if they had to pay for it, but if it was free decided hey what the heck (that is, the suckiness of major illnesses is already a bigger disincentive than the expense of treatment). Moral hazard might come into it more with things like overprescription of antibiotics for routine/minor illnesses.
Sorry, deleted not realizing you had replied. For reference:
It's not Kosher, but the thing that always pops into my mind is- you've got the body you were given. Are we now also in the business of equity across our mortal coils?
Plenty of people can never be air force pilots; they need glasses, or are too tall/short, etc. The same goes for athletes, and so on.
There was single payer before the tax code subsidy for insurance came along. It was called "cash".
The subsidy is responsible for a lot of distortion. It has separated cost and benefit in the minds of employees.
And it hands more of a subsidy to people who make more money. Taking insurance from your employer is a bad deal if you don't make enough. Which is why many employers of lower paying jobs don't offer it.
I don't disagree with you, but I wonder if this situation would be covered by the law as AFAIK dental coverage isn't part of the plan. It boggles my mind that medical conditions that arise your teeth and gums (which, as this anecdote illustrates, are fully capable of killing you) are treated as an entirely different thing as diseases that happen elsewhere in the body.
That sounds just silly. Here in Finland, we can actually choose to either use free public dental care, or go to a more expensive private doctor and pay the difference.
Dental care is essential. Even if you don't have pain, constant inflammation can cause you all sorts of problems.
Oddly enough, here in Denmark, which otherwise has very strong social services, dentists for adults aren't covered, though their cost is partly subsidized (dental care for children is covered).
Same in Sweden. There's even been some scandals about local governments refusing to pay for (more expensive) treatments for people who cannot afford them and are on welfare, instead having their teeth pulled out. Rather sad for a country with a 45-50% total tax burden. :/
Yeah, I always thought it was odd that I had to get a special insurance for dental work. This is supposed to be a socialist land of milk & honey, not cold-hearted America :p
Sweden used to be all about reaping the benefits of both capitalism and socialism, but now our gov't seems to take a perverse joy in making it a "worst of both worlds" type of country.
I would be curious to know what countries today offer what Sweden used to offer. New Zeeland? Canada? Denmark?
Same in New Zealand. Free for under 18, but after that you have to pay. However, if you have an accident and need medical care, it's covered under the government. If it's due to negligence, then, well, you're responsible.
When I was a child (8 or 9, can't remember) I chipped my front tooth on a trampoline. All my checkups, x-rays, caps, etc., and eventually a root canal and crown were covered, even 10 years afterwards.
Same goes for america if you are on medicaid. They only cover up to 21 years and then they drop you, as if dentist work is merely cosmetic. And even with private insurance, across the board, only 50% is covered, so that root canal is still going to cost you about $750 out of pocket. It's a total joke.
Healthcare, at least where I'm from, doesn't cover preventative dentistry, but it does include anything life threatening which includes the situation from the article. I would sincerely hope the US system would behave similarly.
US health insurance tends to distinguish based on the location whether it's "dental" or "medical": if an infection sends you to the hospital, then it's medical, but if you go to the dentist to get it fixed, then it's dental. Typically the latter wouldn't get covered by health insurance regardless of severity.
There are some miscellaneous oddities; for example, if you visit a dentist and have antibiotics prescribed, typically the visit won't be covered (it's a dentist so counts as dental), but the antibiotics will be covered (they're a medical prescription).
The problem is, the average person can't tell whether a toothache is a minor, non-covered issue, or a life-threatening problem that would be eligible for coverage - without going to see a dentist out-of-pocket, that is.
That's not too hard. Having a minor or even a somewhat annoying toothache for a day won't kill you. As can be seen in the article, such infections don't develop overnight. Just wait a few days, and if you still need to use ibuprofen or what have you to make it go away, then you can be sure you need to go visit a dentist. Making it a habit to use painkillers to deal with toothache = bad.
most people with impacted, rotting, painful wisdom teeth know damn well they need to have it taken out. some just decide not to because nobody likes the dentist and they think it will just go away.
Truth be told, in most cases, it will 'just go away'. (Read: said tooth will fall out, and it will HURT.) Though it's better not to take these kind of chances.
Health insurance doesn't normally cover dental work. Dental plans are generally a separate offering, and typically aren't a good deal for younger people who take decent care of their teeth. Even Medicare doesn't pay for dental work.
Indeed. I avoided dental work a while back when I didn't have dental insurance. Instead of getting a cavity filled for $150, I ended up needing a $1000 root canal. But even then, not that expensive. Dental procedures are generally simpler than medical procedures, and cost less as a result.
(Getting three wisdom teeth removed did not appear to cost that much either, but my insurance paid for that.)
What bothers me is that many of the so-called dental "insurance" plans I've seen in the U.S. have quite low caps. Essentially, they work out more as a kind of "payment plan" against average expenses when measured over multiple years.
I'd rather pay for those, myself, but have "real" dental insurance for the quite expensive, unexpected stuff. Infections. Complications from non-routine extractions (particularly notable with some wisdom tooth extractions). Etc. Things where a $1000 or $2500 cap may hardly make a dent in the final expense.
When I was looking at individual dental plans (actually, "group plans" from the ACM or IEEE), it seemed to me that it was basically the cost of two dental visits amortized out over 12 months, with a small discount on other procedures.
With a "real" group plan, the only things I've had to pay was a $300 deductible on the wisdom teeth removal and $25 for a flouride treatment that insurance doesn't cover. (Presumably because most adults don't have braces.)
How much exactly does health insurance cost now in the US?
In Germany, I have to pay 65 Euros (87 Dollars) for health insurance as a university student if I earn more than ~400 Euros a month. It's not free here either, it's just mandatory.
I pay $370/month to cover my wife and I, and that's on a company-subsidized plan. The actual cost is at least twice that much on a group plan. If you try to buy insurance as an individual, the cost is even higher. And my plan requires me to spend $10-$75 for prescription medicine, and doesn't cover more than basic care from eye doctors or dentists.
I am 27, so my case might not apply to older people. However, for me in the US, I pay approximately $85/month for a high deductible plan as an individual. I am stuck with the first $5,000/year of medical expenses, of which in most years I only spend around $100-$200 for a checkup and labs, but I am covered 100% after that.
However, I can put $3,100/year into a HSA account. I immediately get to deduct the amount I put in from my taxes (which for someone with an income just about pays for the insurance), and I can grow it in the HSA and not pay any taxes on withdrawal if I use it for medical expenses (works kind of like a super IRA).
Is your employer covering part of the cost? My insurance for just myself is 70-80 a month, while my employer covers another 250 a month. If I had a full family plan it would be 250 a month for me and 750 for the company. This is for a relatively standard 2000(individual)/4000(family) high deductible plan.
I wouldn't think our different deductibles would save you that much money, but perhaps.
No, I don't have an employer covering my cost. The full cost for my $5000 high deductible individual plan is $85/month.
Perhaps the difference is that my plan was purchased in Illinois (Blue Cross Blue Shield of Illinois). I know state mandates can significantly change the cost of insurance.
I pay about $1500/month for a family of four. Admittedly this is an HMO group plan in NY as opposed to a high deductible plan since we have some pre-existing conditions that preclude a non-group plan.
Certain segments of the USA have universal health care. As part of the treaties one of these groups is Native Americans through IHS. Google "don't get sick after June" for how the USA approaches universal health care. I support any candidate that would repeal what was passed and try to come up with something different. If they cannot get it right for 7 million then they won't for the rest.
A story that ties both together. My dad was visiting me. He was going to go golfing with my brother, but had too painful of a headache and was just going to lay down then drive the 7 hours home. It was so painful that we convinced him to go to a hospital. I just happened to pick one that had a neurologist in emergency. He was bleeding from the brain because of poorly prescribed blood pressure meds. The doctor in the ER was not happy. He was in surgery that day and took a week in the hospital.
> If they cannot get it right for 7 million then they won't for the rest.
That's a pretty bullshit example. Native American services are an entirely different planet within the government.* The lost billions of dollars in indian trust funds, etc. Pretty much every service for native Americans is monumentally dysfunctional, yet the equivalent services for non-Indians often work quite adequately.
*) This state of affairs is the product of a lack of political will to do better (who cares about the poorest constituency in the country?) and certain Constitutional insulation from the rest of the government.
I don't think it is a "bullshit" example. Past performance of an entity tends to predicate future performance. The equivalent service is also provided to our veterans. The VA is also a failure. Just because white people will be serviced doesn't mean it will be any better. The legislation sets up the same pattern of control. The currently passed bill fits all of the fiscal and regulatory issues of IHS.
I would love to see the statistical change on that. They did a lot of damage to vets around here (miss diagnosing, etc). The hospitals they own are not great and need some serious changes. Never mind the fun policy of just moving problem staff.
Exactly. Nothing about Obamacare absolves him of his responsibility to purchase health insurance; it only adds a penalty if he doesn't (and tries to make it cheaper/easier to do so if he does). You still have the responsibility to purchase/maintain it.
As someone who has had an infection requiring dental care: dental surgery is covered by the Canadian provinces if it is medically necessary. On the other hand, preventative care and cosmetic surgeries are not covered.
They have dental setups in the hospitals here for emergencies but generally it's not taken seriously enough. Poor dental care can have a tremendous impact on a persons physical and mental health.
As someone form a country with a working, good, universal health care system, the notion that many Americans have that it somehow can't work in reality is very puzzling to me. How can that be true when it plainly does work in many places?
The argument that a private insurance based system could be better, fairer, or more efficient can be made (although not if you hold up the current US system as a positive example...), but any argument that it's the only thing
that will work is frankly ludicrous.
Healthcare in the US, even in its incredibly broken state, still "does work". We can compare anecdotes all day long, but that tells us nothing, anecdotes are not data.
I believe it's generally known to be true that health care in the UK, where I live now (I have also lived in the USA in the past), whether measured by % of GDP or by monetary cost, is much cheaper per capita than health care in the USA[1]. Life expectancy, probably a good measure of the efficacy of a health care system, is very close, perhaps with the UK having a small lead, if anything[2].
If we were to allow anecdotes, I'd also say (and I find this to be a good thing) that people in the UK don't avoid going to the dentist or doctor because it's too expensive. I'm sure that there must be studies that show this to be true.
Even if we're not allowing the anecdotal argument, however, if you're prepared to say that the system in the USA 'does work', you're surely prepared to say that the British system also works? Personally, I have a hard time not believing that, since it seems to produce comparable, if not better outcomes, for less cost, it's the better of the two systems.
Note that I'm /not/ arguing at all that a private health insurance system could not be devised that also worked as well - perhaps better. I'm also not arguing that any public system will be perfect. To argue that a public system /can't work/ though is, as I said, ludicrous.
Until we have a cure for the metabolic syndrome, I'd say that comparison of health care quality by life expectancy doesn't actually do what you think it does. America is incredibly obese, and this is a lifestyle choice that makes comparisons of the quality of care quite difficult.
I wouldn't even try to make the argument that public healthcare doesn't work. Comparing across systems and cultures (again, obese vs the rest of the world) is tough to do well. I was thinking perhaps some measure of in-hospital mortality would be useful, but even that would be confounded. Perhaps the Massachusetts model might work for in-US comparison to other states, but MA is not really comparable to single payer systems in the rest of the world.
It's a really interesting topic and I wish I weren't at work so I could brainstorm more with you about how to get a clean comparison.
It is a talking point from our country's politicians (who already have what would be offered under a real universal healthcare bill) who are in the pocket of private insurance companies, big pharma, and the like.
Call me a cynic if you like, but that is the only real argument I can think of. There is no data to back the claim up, only anecdotes about what it's like in other countries.
The data points to universal healthcare being better.
Healthcare is a scarce resource but what you say isn't all that universal healthcare provides. All healthcare systems must ration care. The goal is to ration care in the most ethical/moral way. The present system in the U.S. rationalizes care in a more unethical way that Finland and other similar healthcare systems.
This sort of hyper-simplistic modeling of real world problems is a pretty common trait among real academics, not just HN posters. In my own field of interest (spectrum management) the papers written by ostensibly reputable people are shockingly bad in their reductionist thinking and plain glossing-over of important caveats and assumptions in the applied theories.
If healthcare is an inelastic resource, the private sector won't make any more if you throw more money at it, and will just re-allocate it to those who can pay the most.
Scarce doesn't mean inelastic and health care -- especially basic one including antibiotics, vaccines, etc. -- is not inelastic, you can get more, as much as you like, really, if you divert resources from other pursuits.
The only way in which you're correct is that the supply of skilled practitioners (doctors, nurses, etc.) may well be inelastic, in that only so many of them will be born in a given timeframe and it requires a certain length of time to take a potentially good practitioner all the way up to actually being a good practitioner.
After almost dying in Thailand to an infected scrape, I recommend keeping a round of standard antibiotics accessible.
I never expecting that the bumps near the scrape would progress to intense pain, waves of nausea, and blackness underneath the skin, or that those symptoms left me maybe a day to live had I not taken antibiotics supplied by a fellow traveller.
A year later, I got an infected gum/tooth situation and the dentist was closed for the weekend. Although I could have freaked out and figured out an emergency situation and a different dentist (that I may not have been covered for), I just looked up the reasonable dosage for a tooth infection and treated myself accordingly. It went away overnight, and I followed up with my dentist that week.
Note that I do not recommend self medication for anything out of the ordinary or with possible interaction effects. But for infected flesh, which is a common and dangerous medical issue, I think knowledgable self-administered use of antibiotics can be as valuable as a similar use of bandages or CPR.
Bacteria are incredibly diverse. Antibiotics are not effective against every strain.. not just because some have become resistant, but because they they usually target a specific enzyme or pathway that may not be present.
A round of antibiotics is a nice thing to have if you are traveling and don't have access to hospital, but if you have a serious infection and try to treat yourself, you are taking a stupid risk with your life.
Also make sure to do the full round of antibiotics -- not being officially prescribed them by a doctor is no excuse for not using them correctly. Antibiotic resistance is terrifying, and assisting it does a huge disservice to the world.
When I went to Mexico almost a decade ago to do some missionary work, my doctor gave my dad and I each a full round of antibiotics with instructions to start taking them immediately if we started feeling sick.
yeH, better to let peopledoing missionary work, far from any reasonable healthcare just die, is that it?
Overuse of antibiotics is a global problem, for sure, but once you get into thelower latitudes of the planet, infections get a hell of a lot more dangerous. more bacteria, more types, and they move fast.
Most people spending significant time in thetropics learneventually that small infections or even just cuts you would ignoreup north require mich more caution, attention, and respect if you want to stay out of the hospital, or, you know, just not die.
The advice is more “start taking these and get to the hospital”.
Keeping some antibiotics on hand isn't a terrible idea when there's a scenario that delays medical care for more than a day (and no, the weekend doesn't count in a city).
I had open heart surgery just over 4 years ago, from a bacteria infection that is typically caused 50% of the time by bad teeth. This bacteria, literally ate my hart valve (they have no blood so cannot defend themselves). As a consequence I now have a titanium prosthetic Aortic heart valve. In a very quiet room, if you stand beside me, you can hear it click every time my heart beats. I had a fever for 4 weeks lost 25 pounds of weight. Serious stuff. Teeth infections can cause Endocarditis (heat valve deterioration)or in some cases meningitis.
When you get told by the heart surgeon that there's a % chance you can die in surgery, you start to evaluate differently. Whether you believe vin things beyond death, or not, I believe we are here to learn, develop, experience and make a contribution to humanity. Ultimately the way we treat ourselves is tied with how we treat others. respect yourself, respect others...
Focusing on my health has been my best productivity boost.
For a few months, I didn't exercise and ate lots of cheap, unhealthy food, thinking that I was too busy and could work more with that stuff. The result? Great progress with work and horribly diminishing productivity. My overall output increased but I got far less done every hour. And I felt like shit all the time.
So last week I started to eat healthy foods and exercise. Nothing fancy - I just stick to simple meals that I know are good for me, so it doesn't consume extra time. And I keep workouts to 20 minutes every other day (not much at all).
It's worked wonders. I have far more energy now and have been getting 20-30% more done per day, probably at higher quality.
Taking time for yourself also gives your brain a break. How often does a solution to a problem or a new idea present itself when you simply take a break?
Doesn't this strike anyone as, I don't know, maybe a little bit melodramatic? Not trying to discount or in any way disrespect the author or the people that read him, but I think these kind of posts, as much of a guilty pleasure as it may be to waste the little bits you have of your life begging the question on various sophomoric questions, are indicative of the declining quality of HN as the most social or active people fail to upvote genuinely compelling technical news and insights and instead let demagogic writings slide that range from The Enquirer to Readers Digest for smart people (or at least for people that like to pretend to be smart people, as the case may be).
Ludwig's angina is life-threatening (not that one can reliably diagnose it from a scant blog post). Whether or not it had progressed that far, tooth abscesses are serious business because their sequelae are nasty.
The connection between the illness and the post's overall message is perhaps strained, and I could see not wanting to see the message on HN.
Sounded like a real serious health issue to me actually, and it was 100% relevant to me since my life pretty much revolves around technology projects and trying to deal with my health issue without insurance.
Similarly, I had a cracked tooth in Jan 2011 (or maybe a bit earlier) that started to hurt in jan/feb. i put off dealing with - just taking aspirin and such. it got worse. i finally got to a dentist and they said I needed a root canal procedure and a cap. The nerve was exposed and that's what was hurting so much. Cost? $2400. I paid for their x-rays, said 'thanks', then got a second price from someone down the road. That was ~$1400 (plus the $100+ for the initial x-rays) so that was about $1500. Not pocket change for me, but still saved $1k with a couple phone calls.
I wanted to be knocked out for the whole thing, but I had no one to drive me home at the time, so they wouldn't let me be knocked out - I had to be awake. In lieu of being sedated, I amused myself with some pics and videos:
Having a significant other who happens to be a dentist this is more commonplace than most probably think. When pain in your mouth is approaching the 6-10 range you're playing with borrowed time at that point. It's far cheaper, pain-free and healthier to:
* Invest in a great tooth brush.
* See your dentist at least once a year - and there are a lot of bad dentists (just as there are bad doctors) out there, so do some homework and avoid the "chop shops" of the dental world.
* Eat healthy. We juice every day (once or twice) and greens like parsley, kale and spinach do a fantastic job of promoting a healthy mouth - the parsley does a great job of controlling bad-breath-bacteria as well.
* Avoid amalgam - ask your dentist to do composites. The amalgam filings require much more tooth structure to be removed compared to the same filing using composite. Plus, no mercury (amalgams have been banned all over the world already, but for some reason the ADA still has their head shoved in ass state side).
Avoid amalgam - ask your dentist to do composites.
I had a fairly large composite filling in one of my molars, and it would never last more than a year because of the extreme pressures that molars are routinely subjected to. Composites are getting better, but they're still weaker than amalgam. Also, when a composite filling fails, a microscopic gap emerges between the filling and the tooth, letting bacteria seep in and cause cavities deep inside the tooth that goes undetected for a long time.
A while ago, the dentist asked me whether I'd like to try amalgam, so I said yes after doing a bit of research myself. I haven't had it long enough to see if it actually lasts longer, but the doc tells me a well-placed amalgam filling can last a lifetime.
While that was generally true it's generally not the case anymore. This isn't a knock on older dentists but the fact is - you're good at what you practice. Younger dentists (and better/more progressive dentists) do composites without the downside you're sharing. If a composite is structured correctly it should last over 10 years I've been told. Sure, an amalgam may last your lifetime, but I for one will never allow mercury to be in my mouth long term. Mercury changes significantly to insignificant amounts of heat (i.e. thermometer) - and while the ADA will tell you it's "sealed" it's considered a toxic substance, which has been disputed by many researchers. This is why amalgam is banned in most developed countries.
I asked about the failing of a composite as you've described and was told that what you stated is not true. Any filing can fail and leak as described, this is generally a result of bad dentistry or trauma to the filing that impacted it's seating and is why you have annual X-rays done. ANY filing can fail regardless of compound leading to shadowing as described.
So you have a choice. Mercury or safer materials that, when used properly, are a safer / healthier alternative.
In closing - keep in mind one thing: not every doctor is as skilled or cognizant as the next. They're humans as well and there are fantastic doctors and there are greedy and poor skilled doctors. The fact is you should understand your doctor's core competency and skills as best you can. Unfortunately most doctors know who the bad doctors are in regions, but the status quo is to not throw any other doctor under the bus. The consumer loses because it's hard to get at that information. If in doubt, get a second opinion - if there's a big derivation in prognosis, get a third. It's your health at stake.
Fair points. Surely a lot depends on the dentist's skills. Several dentists have been in my mouth, and some of them were definitely better than others.
However,
amalgam is banned in most developed countries
This is only true if you think that developed countries == Scandinavia. Which, admittedly, is a reasonable view to take.
And chew xylitol gum. It kills bacteria. But it won't cure an impacted wisdom tooth. There are places that will put you out to remove them so stop putting it off.
I've been working on a startup and on a day job for the past 8 months. In the past month or 2, I've experienced a couple of fevers, and beginning to get anxiety/panic attacks, and feeling sore all over from sitting all day at work + home. A few months ago, I had a severe panic attack on the train, where it felt like my brain cells were fighting each other. I thought I was going to have a heart attack.
I think I'm very close to reaching a breaking point, and am not sure how long this can last. But the thing is.. I know I will feel miserable if I have to work at a day job for the rest of my life, so that makes me want to work even HARDER at my own gig so that that never happens.
It's a truly vicious cycle.. I work harder, get less sleep, become more grouchy/irritated at work, which makes me motivated work even HARDER when I get home.. which makes more sleepy at work, more irritated.. repeat...
You need to take a break. You are putting way too much pressure on yourself, and your body can no longer take it. Don't take it as a sign of weakness. You don't have to give up on your goals, but definitely take a 3 month break and get your life back together. You're breaking apart at the seams, you need to take a mental break otherwise you're seriously headed for a bad fall.
Rescue workers have a rule that their own safety comes first --- because if they don't act that way, they risk becoming yet another victim that their colleagues have to go in and save. Similar logic applies here. One of the risk factors for your startup is you falling apart. Neglecting that risk doesn't serve you or the business well.
You're already past your breaking point, what do you think those symptoms are for? If it's a typical startup, you're going to get screwed in any event, so you might as well start looking to get a better job now.
You should go to the gym a few times a week. A couple of months ago, I went back to the gym for the first time in six months. The next morning, a lot of my background stress disappeared.
Dude. I think you need some serious help, because I think you are suicidal. I'm not kidding. Or, the way you think, you might as well be.
You don't believe that life is worth living unless you achieve $STARTUP_RICHES. And you are okay with death as the alternative.
There are lots of ways to achieve wealth and security. In fact, doing an internet-based startup is statistically one of the lower-probability ways of doing that, compared to say, a job in finance.
Try transitioning to becoming a highly paid contractor/consultant so you can turn down your hours and do the startup thing with a healthier schedule. Kind of like Jeff LaMarche
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.
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.)
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.
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.
> 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).
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.
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.
> 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.
In my view, one of the reasons for runaway healthcare cost may the way that insurance coverage distances the patient / consumer from the true costs involved. (e.g. "My statin costs $5 a month because that's how much my co-pay is." No.)
Insurance is necessary and useful for catastrophic events like the OP's. By contrast, for routine, predictable health care expenditures, insurance spreads the cost among policyholders / taxpayers to the extent that there is no conception of the actual cost of care. It's like having insurance to put gas in your car, or to pay your utility bill. Every time the money changes hands, you can bet the insurance company takes it's share.
This model will allow (or even cause) drug companies and hospitals to keep costs high to protect reimbursements, all via back-room deals with huge insurance companies. Expensive, government-mandated (or provided) insurance coverage for routine health expenditures will get in between doctors and patients and will drain employers and taxpayers while the insurance companies get richer.
We bootstrapped our company as well and did not get (couldn't afford) health insurance for the founders until about 1.5 years in. By that time I was too embarrassed to go to the dentist and put it off for another 2 years. Worst decision ever. By the time I did go last year, it had been over 5 years since my last dental visit. I needed a root canal and I'm still getting my cavities I piled up in that time period filled (though I'm almost done).
Our insurance plan is not cheap, (we live in Hawaii and pay about $500/month each) but its essential. You worry about so many things when choosing the startup life, your health shouldn't be another thing on your mind.
I think there's a broader point to be made here: don't deal with issues by ignoring them. This is just as true for technological, social or finanical issues as it is with your health.
Grab the bull by the horns, deal with it, and you'll almost always come out better.
Pain is a message. A serious message. Don't make it go away, FIX THE PROBLEM. Only take painkillers when you KNOW what the problem is AND ARE FIXING IT.
After gallbladder removal, they gave me a big bottle of Vicodin and sent me home. Figuring that much of that strong stuff meant I should expect pain, I took it. Other indicators later I went back to the ER, realizing the pain was telling me something was very wrong. They didn't let me eat for two weeks waiting for the problem to heal.
Before the paranoia starts - I just deleted a comment that I made about a current YC startup where I know of a founder who's ignoring some health issues.
I think it's better if I reach YC people privately about it.
I'd be interested to know if the OP has a significant other. I know that there are challenges to being an entrepreneur with a SO, but I think one of the big benefits of having an SO is that they look after your health. I know if I were in this situation my fiancee would have kicked my butt and dragged me to the dentist's office.
Have there been any essays out there comparing being an entrepreneur with and without a SO? I'd love to read them.
Neglect your health and your start-up company will outlive you! If your body gives you any type of warning sign, it's imperative that you take care of it! For your company to remain healthy, you need to be healthy. Eat well, exercise, and do your physical exams annually. Your start-up company will thank you for it.
Yeah, scary stuff. Last year I had constant, nagging pain in my stomach muscles (always felt like I'd worked out my abs hard the night before) for a few months. I finally started having pain so severe that I could not just take painkillers and suffer through. I go see a doctor, and they diagnose me with pancreatitis and place me in the hospital immediately.
Apparently my pancreas had not been particularly useful for a few months, as they thought I had diabetes (untrue) based on my A1C. Ended up spending 7 of the following 8 weeks either hospitalized or in my bed with a feeding tube in. Fun stuff (note: sarcasm).
Anyway, I waited so long to see a doctor because running a business takes all of your time. If I'd been an employee, wouldn't have even questioned taking a day off to go see one. So meh, have to learn to do better / realize I'm still a person.
Never mind that conflating "health care" with "health insurance" is silly in the first place; or that we could focus on lowering the cost of health-care, enabling people to afford health-care without having to resort to the corrupt, ridiculous system we have today.
But never mind the libertarians... just keep telling yourself that if we just pass enough laws and regulations and implement enough subsidies, kickbacks, programs, and create enough forms and bureaucracy that everything will be OK. I mean, that's worked so well up to this point, why not pile on more of it. These knobs go to 11, right?
I think moments like this define what should take priority. It is a wake up call but we all push it anyway don't we.
I think this case is the most extreme where it is directly about one's health and is very critical. You have to be alive and kicking to do what you want.
However what about the more grey areas like a loved one being sick, not getting time to see your child grow up, or even pushing the possibility of having a child or marriage - these are as irreversible. Just that these are a sacrifice of a feeling vs sacrifice of self. But you never know if the feelings are bigger than self.
He must really like himself to put two portrait pictures of himself in a single blog post. I'm not saying its bad taste. I would do it too if I was better looking :)
Similar thing happened to me, I was out of the country and was having serious tooth pains, before I returned I made an appointment and went the first day I was back. The dentist said 'Your lucky you came, this infection is pretty bad and almost spread to your brain'... scary shit, especially seeing as I was in another country for the previous 4 month and wouldn't have been able to get dental work done there.
Due to life being overwhelming for a while (moved twice, two new jobs, new baby, etc.) I missed a cardiology appointment. At the next one, the new doctor checked me out, he got oddly quiet and asked in a restrained tone "are you sure you don't have any other symptoms?" Two major urgent surgeries later, he admitted that question really meant "why are you still alive?"
OK, this apparently needs to be spelled out clearly to all you hipster founder hacker types out there:
Pain is bad.
Yes, that is right, your body is trying to tell you that something is wrong. Taking pain meds does not fix anything. Ignore it at your own peril, because it is hard to found the next social media empire when you are dead.
What's tragic is that there are some folks who can't afford to have badly needed dental work done. Hard to believe, because the pain of my recent toothache hit these incredible high notes that literally buckled my knees.
Great post. Thanks for reminding me of such a serious(ly overlooked) issue.
If anything ever reaches "11 out of 10 on the pain scale," your body is probably telling you something.
For those of you in San Francisco or New York, I highly recommend One Medical - you can make same day appointments and they are super efficient and timely. It's a beacon of sanity in the absurdity of American medicine.
COUNT RUGEN
Ah. Are you coming down into the pit? Westley's got his strength back. I'm
starting him on the machine tonight.
PRINCE HUMPERDINCK
(sincerely)
Tyrone, you know how much I love watching you work, but I've got my country's
500th anniversary to plan, my wedding to arrange, my wife to murder, and
Guilder to frame for it. I'm swamped!
COUNT RUGEN
Get some rest. If you haven't got your health, then you haven't got anything.
I've never been more surprised by downvotes on HN. This is a quote from a beloved movie that expresses (in a lighthearted way) the exact point made in the OP. I'm very disappointed by the result.
Sorry to be so blunt, but you are not a very good founder/entrepreneur.
One of your major responsibilities is to your cofounders; it has been said many times that starting a start-up is like being married to your cofounders. We wouldn't hesitate to condemn a husband who was so negligent towards his own health that he left a widow with unpaid bills behind; under that same logic, no one who makes an idol out of, as you call it, "the all out pursuit for your dream" and is negligent towards their health can be considered a responsible teammate/businessman.
After I woke up on Wednesday with the worst headache of my life looking just like that first photo, I went to my oral surgeon, who sent me in for emergency surgery immediately. I spent a night in the ICU and three days recovering. He explained that I had developed a serious abscess that had spilled into my palate and threatened to close my windpipe completely, and that if I hadn't come in I probably wouldn't have made it to the weekend.
It was an extremely sobering look at my priorities and good luck. I was young, and health insurance hadn't been a priority - had I been bootstrapping or freelancing instead of a part of a team with the good sense to get a group health insurance policy, I might have dug myself into about $40,000 in debt, or worse - hesitated to go to the doctor's for even longer.
Don't fuck around with your health. I dodged a bullet. It's tempting to push these responsibilities off like any other, but like other commentors said, it runs directly contrary to your duty to be healthy and present for your team. Dead entrepreneurs make no products.