Seems pretty clear that it was worth it. The actual bill was closer to $250,000 -- $618,000 was without any discounts.
We work and save and pay premiums for decades specifically so that we CAN have someone pay $250,000 to extend our lives by 17 months. That is the PURPOSE of a health insurance policy.
It's hard to see this one as an example of our (admittedly terrible) healthcare costs.
Also, the money that was spent didn't just go to extending his life. A lot of that money was spent on pharmaceuticals where he was an "early adopter". People like him covering the massive costs of developing those pharmaceuticals are paving the road for the day when they can be available as cheaply as the vaccinations the article talks about.
Right, but her point is that had they (the author and her late husband) actually understood the costs at the time that they were making treatment decisions they might have made different ones. On the other hand, as you note, in a very real sense they'd already paid for the treatment in the form of decades of premiums.
It's of relevance to anyone in the US who is considering working for startups, since anyone who does so runs the (admittedly low-probability) risk of being murdered due to unaffordable or inadequate health coverage.
I think steveplace covered that when he wrote 'we can find ways to view the US healthcare issue as "Hacker News"'.
In that sense, almost any political news can be made to be "relevant" to HN. The California budget deficit, Iraq, the tax code, the next elections, you name it.
And when the topic is politics, even though people here tend to remain civil, the level of discourse inevitably goes down.
For instance, consider your superlative usage of "murder". This sort of thing practically precludes any further fruitful discussion: anyone who disagrees with you is automatically in the uncomfortable position of "abetting murder".
I think a partial solution to this is to require some small portion of health care costs to be covered by the patient. Would she have spent 5% of $40,000 if he was probably going to die overnight? If if she could afford it she probably wouldn't have. What about the previous two times when there was more hope? Probably so.
Alternatively, she paid higher premiums under the assumption that some extreme end of life dollars would be nearly wasted by some policy members, but that's okay because that's what they chose to pay for so that they would never have to make a cost benefit analysis in their own care. I don't think she needs to wring her hands about it, that's what she bought.
Would she have spent 5% of $40,000 if he was probably going to die overnight?
There are unintended consequences, of course. If a patient had invested hundreds of thousands of dollars in care that ultimately failed, the incentive for his family to sue for malpractice is much greater. This raises the price of malpractice insurance, which makes medical care more expensive for people that aren't at the end of their life; people with routine problems that are easily treatable.
Also, you could agree to pay and just not pay. If I was going to die in an hour, and someone asked, "will you pay us a million dollars to use a new treatment", I would easily answer yes. I won't be needing the money if I die, and if I live, I can just change my name and not pay it. When you're broke, there are ways out. When you're dead, you're dead. That's it. Forever.
"The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 became $254,176 when the insurers paid their share and imposed their discounts. Of that, Terence and I were responsible for $9,468 -- less than 4 percent."
>> "I think a partial solution to this is to require some small portion of health care costs to be covered by the patient."
What the hell??? Health care should be a right. Something you don't have to ever worry about. If my kid is lying in hospital sick, I'm not going to make a decision based on money, because I'd always say "Yes take all my money", and that puts me in a very vulnerable position indeed. One that could be exploited by evil companies if given the chance.
Health should always be far far far more important than money, but to prevent evil companies making a ton of money out of desperate people, it should be provided by the government.
Why is there such a disconnect in America between socialized war mongering, and socialized health care?
Free speech is a right. When I speak freely, I don't diminish your ability to do so. Healthcare can never be a "right" in the same way because it is bounded by scarcity. There is some point at which when I consume more, it leaves less for everyone else.
We can decide to ration what we have fairly. (How to do this is a matter of great debate). I'd argue that facing this problem in a clear-eyed, rational manner is almost a rite of passage for civilization, but calling it a "right" clouds the issue considerably.
Yeah sorry, the choice of words wasn't correct. It's not a right to demand every treatment under the sun etc.
But I believe it is a right to have some level of basic healthcare provided by government. I simply couldn't live in a country without it :/
I guess the issue is that you can spin that as "Death panels" if you wish - the government/NHS/etc get to decide who gets treatment, and who doesn't. It's a great shame it's been spun that way though.
First world European countries use a quality-of-life-year or disability-adjusted life-year metric. If resource X will give patient A an expected 20 years of life as a vegetable (Q = 0.1) vs. patient B 10 fully-healthy years (Q = 1), patient B gets it. The goal is to maximize total life-years. Obviously, these numbers are estimates, the quality multiplier is subjective, and the optimization problem is very difficult, but the goal is fair and noble, and I think most people would agree with it. When I'm 90, if we haven't made any anti-aging progress, I would want the 20-year-old to get the heart transplant instead of me.
I would want myself to want the 20-year-old to get the transplant instead of me. Whether or not I would make that decision while lying on my death bed is another matter.
Assuming no anti-aging progress, me being 90 implies that I've got 15 years left of life, tops... and most likely 2-4 given that I've just had a transplant. I'd be willing to give that up in order for someone else to live, as long as I can die a decent death. I believe that there are benefits to doing the right thing, both in the here and the hereafter.
It'd be a harder decision if I was 50 and had children who depended on me, and if the 20-year-old didn't have good odds anyway (or had done something incredibly stupid). Then I might be tempted to do make the "selfish" decision if it were mine to make. But not if I am 90 and decrepit.
There are absolute and relative rights. Absolute rights are based on absolute ethical frameworks, while relative rights are constrained by the resources available.
For example, I don't have the absolute right to life, but only a relative one. No one can provide for that. In fact, I am guaranteed to die someday. I do have the absolute right not to be murdered (and to expect society to punish those who deprive that right).
People in a society have a relative right to food, shelther, and medical care. If the resources exist, they have a right to them. If they don't, then that "right" is meaningless. Every American has the right to adequate medical care without the life-destroying mess of individual medical billing (as opposed to the taxpayer-funded system that First World countries use) but not every American has the right to a liver transplant, because livers are scarce.
> Every American has the right to adequate medical care without the life-destroying mess of individual medical billing
Bullshit. Someone has to pay for the adequate medical care - and it should be the person receiving it. If you want protection against "individual medical billing", you can always buy insurance - if you don't do that, you should be willing to face the consequences.
To put another way: the only way of ensuring "adequate medical care" to someone without the means or unwilling to pay for it is to force other people to pay for it. Do you think this makes sense? Let's say I eat healthy food (which most people don't), make exercise every single day (most people don't) and pay (insurance) for proper medical care (most people don't).
Why, exactly, should I be forced to pay when someone that eats crap every day, spends 4 hours a day on Television, does no exercise at all, etc, etc, gets sick?
And even that is besides the point - even if a perfectly healthy person gets hit by a car - why should I be forced to pay for it?
It can't be a "right". You might ask for it to be a "limited" right, but medical care is expensive and a constant struggle between cost and benefit.
The tough part is admitting that either some disinterested third party should specify what's worth doing, or people should be responsible for their own care. My personal belief is that a properly functioning market (ie: something vastly different than what we have now in the US) allows for more nuanced and personal decisions regarding what's worth paying for than a blanket set of policies. I also happen to think that letting people allocate their own resources between competitive providers is the best way to find that lovely equilibrium where prices are as low as they can be for a reasonable level of quality.
Assuming you disagree with me, you still can't consider unlimited healthcare an achievable human right. If your kid is sitting in a hospital, someone is making a decision based on money. I'd rather I be in control at that point. I also assume that in such a happy fairytale of a free market, I'd have planned for such an occurrence and purchased a reasonable level of medical insurance to cover that sort of event.
Be careful not to paint America with such a broad brush. Most of us are "victims" of fearmongering and policies that are well outside of our control. It's a sad byproduct of a dysfunctional system that's grown well outside the bounds of what it was originally designed for.
What do you consider a "properly functioning market"? People who espouse free market views of health insurance believe that it can work like other insurances (such as car and home insurance). But this ignores the fact that health insurance is fundamentally different. With other types of insurance, the max value of the insured is fixed (to basically its replacement cost). However, since we can't replace ourselves, we have to resort to fixing the problem with medicine, and the cost of this is dependent on the type and severity of the illness. The free market approach is exactly what you see with today's dysfunctional system. Health insurance companies charge healthy people and drop them when they get sick. Or healthy people decide not to insure themselves, and so the rolls are left with sick people who have higher insurance premiums. Of course, sometimes the healthy people get sick, go to the ER, and raise everybody's costs.
Health insurance companies would love to purge their rolls of all unhealthy people, and only charge premiums to healthy people. The free market cannot fix this.
I never said unlimited, and I disagree @ "I'd rather I be in control at that point". I'm not a doctor, and I'll leave it to them to decide the best course of action.
The problem I have though is that most Americans seem to think pretty much unlimited socialised military spending is fine.
> Health should always be far far far more important than money,
I'm pretty sure that your own behavior proves otherwise. (I'm not claiming that your choices are wrong, but they do show that health isn't always your highest priority.)
> but to prevent evil companies making a ton of money out of desperate people, it should be provided by the government.
In what universe can govts provide unlimited healthcare?
The current US healthcare "reform" includes significant cuts in Medicare spending on certain conditions. Folks who have those conditions will get less care. You know, pre-existing conditions....
Feel free to provide a checkable citation to any govt healthcare system that doesn't limit the amount of care.
I just believe that in this day and age, the US should join other first world countries in valuing life above military.
>> "I'm pretty sure that your own behavior proves otherwise. (I'm not claiming that your choices are wrong, but they do show that health isn't always your highest priority.)"
You said that it was wrong to limit healthcare access. If there aren't limits, it's unlimited.
> I just believe that in this day and age, the US should join other first world countries in valuing life above military.
What makes you think that it doesn't? The US spends far more on health care than it does on the military.
Yes, that's true of the federal govt. Note that state and local govts also spend money on health, and they spend very little on the military. And then there's private spending.
In fact, one of the big arguments by folks arguing for more govt healthcare is that they claim that it will cost less than the current system.
> Care to elaborate?
If I observe your life, I'm pretty sure that I'll find several things that you do that are not as good for your health as they could be. (Here are easy ones - is your weight ideal? Do you exercise enough? How about sleep?) Their existence proves that health isn't your highest priority.
I'm not saying that you're wrong to have priorities other that health, but it is absurd to criticize others for doing the same.
> I think we should become a First World country, which means universal healthcare.
The US has univeral healthcare. As I've pointed out, most people opt out, in part because it's a lot like the DMV. It's unclear why making it bigger would change that.
The US has a lot of experience with govt healthcare and it's mostly bad. (The Indian Health Service is especially bad.) It's unclear why we'd go for more before demonstrating that we could do it well.
In other words, as long as Medicare and Medicaid are disasters, why would we want more?
And yes, you can fix Medicare/Medicaid without increasing their scope. If they're fixable. And if they're not, increasing their scope won't fix them either.
Medicare is a "disaster" because of the funding cuts, which are a direct result of our tendency to elect assholes to represent us.
In many areas, government can do a great job when it's not being kicked around by bunch of asshole politicians who think government fails at everything (I include almost all Republicans and at least a third of Democrats) and are therefore invested in proving that point by making it fail.
> Medicare is a "disaster" because of the funding cuts, which are a direct result of our tendency to elect assholes to represent us.
Whatever the cause, we're going to continue electing the same kind of people, so if the result of doing so is broken govt healthcare ....
I am curious about the argument that medicare would be less of a disaster with more money. Govt healthcare advocates claim that govt healthcare would make medicare cheaper. That claim is inconsistent with medicare needs more money.
Medicare with more money might well produce better outcomes, but that's not cheaper.
FWIW, Obama's cost numbers assume significant additional medicare cuts. Those cuts aren't likely to happen, but ....
As I've written before, I'm perfectly willing to give Obama free rein over everyone currently covered by govt healthcare (not just IHS, VA, and medicare/medicaid, but govt employees, including state and local govt employees, and maybe the beltway bandits too) to see what happens. Part of the deal is a 5%/covered-person-year cut in years 3-6, which is a bit over 20% total, which should be a slam dunk given the claims of 30% cheaper with better outcomes. (That's starting from what they're spending now to cover those people.)
If he wants to spend the savings on convering more people, great. I'm also open to letting other folks buy in at cost. The only non-negotiables are "all govt employees" and the per-covered-person budget cuts.
If the claims are correct, that experiment will be a huge success. If the claims are wrong, govt employees will revolt. Either way, we'd know.
"American exceptionalism". We are too good to get free stuff that is good for us, and we are too good to not impose our views on the rest of the world. I don't think this, of course, but that's why I am not elected to a public office.
> Health should always be far far far more important than money,
Currently, I've got mild damage in my left elbow, both knees, and one of my teeth is very slightly chipped from a martial arts match. I could afford treatments to all of these, but I choose not to because there's other stuff I value more with my money. I like that I can make that choice for myself.
I also like that no one has any say in what I do with my life - I can eat horrible fried foods, or not, I can drink loaded-with-fructose beverages, or not, I can smoke cigarettes and drink vodka, or not, and so on - and no one else has a say, because I pay for my own medicine and medical treatment. If everyone had to pay for my medicine, then logically they'd want a say in how I lived my life. I don't want to pay for someone who gets a preventable disease because of lifestyle choices, and I don't want someone to pay for mine. I'm happy that I get choice over my own life, and others don't get a say in how I live it, and I don't want a say in how others live their lives.
Until you get a heart attack, or some other critical medical condition. Are you willing to pay the $1000-$3000+ a night for your hospital stay? Or are you willing to stay home so those of us who do pay for insurance don't have to cover your expenses, since you will most likely not be able to pay them without bankrupting yourself.
Since the article is talking about examining the detailed costs of the long, drawn-out process of his slow decline, it is important to note that she says he was an overweight ex-smoker, which made him (she says) a prime candidate for kidney cancer.
The biggest cost in western-style health care is not end of life care, it is lifestyle-induced illness that leads to an explosion of totally preventable terminal diseases.
Even oncologist question their utility today when they can offer the average cancer patient only meager life extension, and those are often pain-filled years at that.
But it's a good business model: people will often spend their net worth to extend the life of themselves or their child a few months. But in the end they almost always die the same miserable death. So I expect even more "childrens' cancer centers" to open and rake in millions.
This is an emotionally charged issue for me, I lost my mom to ovarian cancer. My bet is that you, quite frankly, have no damn idea what your talking about.
My mom was supposed to live 6 months longer (at best). Instead she made it more than 2 years. Where they difficult years? Yep. However, they where still valuable ones. She got to see me marry. She met the future mother of her grandchildren. She got to see and do things she always wanted to do. She saw her estranged family again.
The value of those oncologists simply can't be discounted. It's an incredibly difficult profession, one in which most of your patients die. However, the ability to extend lives...even by a few months... and manage to make those last days as painless and productive as possible makes them angels in my book. Not profiteers.
It was interesting getting to know her oncologist. He clearly struggled with the emotions of his job. In the wake of her death he couldn't bring himself to attend her funeral (understandable). There was hardly a human being who knew her better in those last two years... and for that I'll be eternally grateful to him.
Your anger is misguided. I have weathered the deaths by cancer of several whom I care about very much. I found it grueling, relentless and painful for everyone. In every case much money changed hands in a very short period of time, always to the benefit of the oncologist and associated institution.
Your wishes aside, most doctors are profiteers. Take the profit out and most would find another professions. Don't you remember the attitude of hopeul medical-school bound students in college? Very few go to medical school for noble causes.
Your mom's oncologist likely attended very few, if any, of his patients' funerals.
As for:
"It was interesting getting to know her oncologist. He clearly struggled with the emotions of his job. In the wake of her death he couldn't bring himself to attend her funeral (understandable).There was hardly a human being who knew her better in those last two years... and for that I'll be eternally grateful to him."
I must call you on your claims. Oncologists necessarily don't spend much time with each patient and it is very unlikely that
- you "got to know her oncologist",
- he "struggled with the emotions",
- he "knew her better" than anyone else .
The only way the last could be true is that your mother had no friends. Was she wealthy also? Oncologists do make exceptions for wealthy patrons.
Yes, but an oncologist is unnecessary for this. Pain management becomes the single most important thing to the patient until, finally, they reach the level where no legal painkiller can do anything for them. Then they lapse into a drug-induced coma-like state and die an excruciating death.
But before this, the patient is negotiating for something, anything, that will relieve his suffering. And money ceases to become an object.
People don't see it as spending their net worth. The article opened with that, in fact. People expect that the insurance their companies provide pay for anything under the sun, and they sometimes get it at the expense of everyone else in the group.
Some friends lived with me for a few months while their daughter was in the NICU because she was born extremely prematurely. I don't know the final tally, but at some point the calculated the total cost to be just north of $2,000,000. I don't think it is possible for me to rationally discuss if is worth it because I'm emotionally involved (they now have a beautiful, healthy little girl), but it's easy to see that it doesn't take many cases like hers to jack insurance premiums up pretty high.
As our medical skills are improving we can keep people alive that used to die. Unfortunately our medical skill isn't advanced enough to do it cheaply. Perhaps the luxuries of time and money will get us there one day.
the same 2 million dollar treatment probably costs 3-5 grand in Mexico or India. Personally I think health tourism is going to be much more popular soon, since the healthcare costs in the states are getting less and less affordable.
Are you honestly suggesting that someone would travel to Mexico or India to put their premie in newborn intensive care unit there? Really; that seems remotely reasonable (or even possible) to you?
It seems unlikely that medical technology will not continue to advance. As such, there will always be new techniques which are, by their very nature, expensive relative to older proven means. So, yes, we'll be able to provide today's state of the art medical care "cheaply" in the not too distant future... but that will no longer be the standard by which emotionally-involved people judge "good enough" care.
The real problems start not when "end of life" becomes very expensive (which it has) but when technology advances to the point where it is possible to keep someone alive indefinitely but at geometrically increasing costs. We've set it up so that everyone will feel entitled to that one extra week, no matter what the cost.
I doubt that costs can increase geometrically for any significant period of time. The technological ramp would have to be enormous. Unless your belief is that current technologies will remain at their current prices and new technologies will be built at exclusively higher prices.
Its not about any particular technology, per se. It was cheap to die in 1600 no matter what killed you simply because there was very little that could be done.
Each year we add more and more expensive interventions from ECMO machines to artificial hearts. Put this together with the "if it can be done, it should be done, damn the cost" attitude we've trained ourselves to expect and we could find ourselves in for a severe reality check.
Medical technology seems strangely resistant to Moore's law (witness the price of a CT scan over time), but even if it weren't, the improvements in individual areas might not be enough to offset the growth of intervention technology in general.
That's unlikely to happen. If nanotech and anti-aging succeed, they'll push back the costs. If they don't, there's going to be a lot of scaling back on things that don't work or aren't proven.
If nanotech and anti-aging succeed, they'll push back the costs.
Yes, anti-aging is the best possible research we could be funding. Unfortunately most people shut down when it's brought up, because thinking about your own decline and death isn't pleasant.
If they don't, there's going to be a lot of scaling back on things that don't work or aren't proven.
How will the "scaling back" be accomplished? Governments can and should stop paying large amounts for treatments that don't do much, but unless private services are banned, lots people will spend whatever they have to try to keep themselves or their loved ones alive.
The 17 months he lived could have taken him 17 months closer to a breakthrough cure - holding on to hope is often times what people attribute this insane struggle to, and I dont blame them.
Will you be this cold when you are dying? What about when your wife and kids are dying?
Maybe I am just a hopeless optimist, but personally, if my wife/kid is dying, I am probably not going to say "BAI!1!", rip the cord out of the electrical outlet, and grin as I watch his/her eyes close for the last time. Ever. Instead, I am going to spend a lot of money to hopefully avoid ever seeing that. Because while you can always make more money, we can't clone people yet.
He fought cancer over the course of 7 years, and it sounds like his quality of life was reasonable for most of that time.
I think pretty much everyone would rather die than linger on in a hospital bed without hope. At a certain point, utility of future life becomes negative and returning to a positive state is not possible. The problem is that it's not so clear cut and obvious at the time that this is the case. A big part of this is that doctors often want to save the patient at all costs, and often deceive themselves as to the patient's prospects. So often even the patient has no idea how bad the situation is.
but you're talking about spending your own money, not mine! euthanize you, and donate the money to a charity helping starving 3rd world kids get a chance at a whole life.
My own death doesn't scare or disturb me. It might happen suddenly tomorrow, or in 50 years, or in a million (if anti-aging succeeds). I'm sufficiently curious about what happens next not to be upset about the concept. (Although death is weird; I've never done it before.)
On the other hand, I'd fight for a child or a (healthy, not doomed to die soon) relative with everything I've got. Which is why it surprises the hell out of me that health insurance companies aren't getting the Joseph Stack treatment all over the place over rescissions and life caps.
You're genetically programmed to protect children. Doctors and hospitals know this and exploit it. Unfortunately children with cancer or birth defects are money sinkholes.
Spartan parents would kill children with defects. In contrast we keep physically and genetically damaged children alive (or on life-support in the case of cancer) at much cost to ourselves and at peril to our offspring. Would you want your daughter to marry a man who carried a life-threatening gene? Did she? That's what we're doing. Maybe someday we'll be able to fix these problems, but today we cannot.
From the article it seems he was teaching for a lot of the time after the initial diagnosis... Also, he took the chance to complete some of his lifelong dreams (visiting Pompeii). And the bill was actually 250k after negotiations.
i'm all for giving a dying man his dreams, but we spend comparatively zero on dying kids in 3rd world countries. that much dough could allow a bunch of children a chance at a whole life.
The difference here is that had he not spent that money on living, the money saved could have gone to saving dying kids in third-world countries, but probably would not have done so. It would have just been more profit in the bottom-line of some insurance company and less revenue for some doctors/hospitals, that's it.
We work and save and pay premiums for decades specifically so that we CAN have someone pay $250,000 to extend our lives by 17 months. That is the PURPOSE of a health insurance policy.
It's hard to see this one as an example of our (admittedly terrible) healthcare costs.