Um, you're a millionaire. Why don't you put up the money? Someone is paying for it. This is literally an ultra-wealthy person complaining that someone else won't pay for her friend's million dollar medical treatment.
It's fine if you want to argue for single payer healthcare. But where do you get off berating a non-charitable institution about covering their costs? They have their longevity to think about. If they simply gave everyone infinite treatment for free they wouldn't exist anymore.
Yes, if someone should be paying for random medical tragedy, that's a discussion that should happen at government-scale such as with subsidized insurance, not something pushed around like an externality or hot potato.
Stanford is a non-profit. It is also charitable. It sounds like this guy wasn't given his options properly. Clearly he found insurance and was treated. I actually think that the social workers and financial workers at Stanford do a very poor job and this is from experience. I am sure that goes all the way up the executive chain. Imagine if you are a poor immigrant. Imagine if you don't have a rich friend to advocate for you.
Yp! Why should the hospital bear the entire cost of his treatment? People will die, others will go hungry, others sleep under the bridge and so on. But these problems need to be solved by the society in general, i can't berate e restaurant because they serve food and many people around it go hungry. If hospitals cured people for free they'd close their doors within months.
Anne: >>What kind of morals are reflected in our society when you know you can save someone’s life but refuse to do so bc of payment?!
Anne Wojcicki should put her money where her mouth is...she is worth, what hundreds of millions or a few billion (was married to Sergey) and has 123and me. What kind of morals does she have when she could help thousands and thousands of people with her money, yet she doesn't. Shame on her...
You are defending the position that we should let someone die because they don't have enough money to pay for medical treatment.
Are you really sure you want to go there?
Now, if you want to argue I would argue that why is this CEO letting a "friend" go without healthcare when CoveredCA has platinum plans at about $7000/year for an individual?
> You are defending the position that we should let someone die because they don't have enough money to pay for medical treatment.
> Are you really sure you want to go there?
Yes, I absolutely am. Grown-ups in the adult world have to make choices. We have limited resources and time, and yes, sometimes that means that we can't give life saving treatments to every person that needs it.
Occasionally that is true, but often if you look more deeply into the pricing of these things, that's really not the case. Pharmaceutical companies are businesses, and they invested hundreds of millions, sometimes billions of dollars of their own money to discover these treatments. They have to be able to recoup that cost in the market place. If you do not allow them to do that, they simply won't invest in finding the treatments anymore.
There are alternative funding models, of course. We could have the government fund all pharmaceutical research. But that has a whole host of other problems. It's really actually a difficult problem without a simple solution. You might say "well, maybe we should do a mixed public/private model of some kind", and if you said that, you'd probably arrive at about what we have now in the US.
Yes, that is true, but irrelevant. A purchasing entity can price the drug fairly, and an entity doing original research can price the drug unfairly. Whether or not the IP was bought and sold is a non-sequitur.
What actually matters is that we have two problems:
1. How do we incentivize drug discovery?
2. How do we treat all the people that need treatment?
Right now our answer to #1 is that we allow people to charge the people that need treatment, for a limited time. This system works ok, but there may be better ones. If you have any, i'd love to hear them.
One approach would be to place an upper limit on the price of each drug or medical procedure based on the expected gain in Quality Adjusted Life Years (QALY) for an average patient. Although it's uncomfortable to discuss, we already place a dollar value on human life in civil wrongful death lawsuits. So we know roughly what an extra year of life is worth. And that value can be adjusted based on whether the patient is able to live a normal life or will still be bedridden (or other limitations) even with the treatment.
Ya, but the effect of that will be to diminish investment in treatments. If you can charge a million dollars per pill for a cancer cure, then you'd be willing to invest an enormous sum to find that cure. If your price is capped at $1000/pill, you will be willing to invest considerably less.
This isn't out of any malice or malfeasance, i'd like to add. This is just a rational calculation. A real person at the top somewhere is investing their own money in this, in the hopes that they'll be able to recover that in the marketplace, and presumably make a profit.
Skimming it, it doesn't really explain the means by which pharmaceutical companies succeed under weak or absent patent laws, it just says that they do. It seems to leave open the explanation, "Chemical and pharmaceutical companies in countries with weak or no patent laws make most of their money by selling into countries that have such laws." I haven't read it too carefully, though. It does say that they exaggerate their costs (presumably so as to argue for patent laws); that lots of those costs are perverse (e.g. bribing doctors); and that the patent laws inhibit innovation in lots of ways.
Meanwhile, I vaguely remember reading someone's proposal: Health insurance companies, at least in theory, basically make a bet that their customers will have good health. Let's suppose a health insurance company has 100k customers, and it's expected that 0.1% of them (let's say there's no way to tell who) will develop disease X sometime during the term of their insurance plan, and the treatment for disease X costs $50k. Then the expected total cost per customer is .001 * $50k = $50. The insurance company would therefore be fine agreeing to cover all costs of treating X for any insurance premium exceeding $50 over the term of the plan. Let's say they charge $70 to cover that particular item, and risk-averse customers agree to it. This is the classical notion of health insurance (I think in practice it's diverged significantly from that).
Once these plans are agreed to, the insurance company stands to bear an expected $50 * 100k = $5m of costs (for $7m in revenue). Now, if the insurance company has some way of, say, spending $2m to fund medical research that cuts the cost of treating X from $50k to $25k, then that would save them $2.5m in costs. (Making no reference to patenting or even selling the drug.)
Now, research is almost never guaranteed to produce the results you expect (arguably it wouldn't be called "research", merely "implementation"), and furthermore it takes time, perhaps longer than the term of the insurance plans. The uncertainty might be handled with a research consultant who makes "educated guesses" as to the expected value of different research paths. As for the time taken, (a) you could project how many insurance plans of this type you expect to have at the time the research completes, and (b) you could work something out with other insurance companies that provide similar plans. Which brings me to the biggest point:
I chose the figure of 100k customers. What if we imagine either a very large health insurance provider, or a joint effort by multiple insurance companies? Company A expects to have 5m insurance plans covering disease X when the research completes; company B expects 10m; company A will contribute $z and B will contribute $2z, or perhaps they'll just commit to funding the research and then find out how many plans they have when the research completes and divide the costs at that point. With a total of 15m customers, the research is now profitable if it costs anything less than 15m * $25 = $375m. The wider the consortium can be, the wider the range of treatments it will now become profitable to research.
> It does say that they exaggerate their costs (presumably so as to argue for patent laws); that lots of those costs are perverse (e.g. bribing doctors); and that the patent laws inhibit innovation in lots of ways.
That's certainly true. Pharma companies spend enormous sums of money on bribing doctors, so to speak (usually it's slightly indirect, because direct bribery is illegal). However, there's an interesting economics point here, which is that: A company should only spend a dollar on advertising it if expects to make 1 + epsilon dollars in return. Which is to say that each dollar of advertising spend shouldn't really be factored into the cost profile of the drug, since each marginal advertising dollar exists only to generate > 1 dollar of profit in return. This is a little bit difficult to wrap your head around, but it's true.
One way to summarize this is that while advertising dollars may cause prices to be higher than they otherwise would be, they don't impact what companies ought to be willing to invest in. Although, that's of course only if you assume that all drugs are equally marketable. Which is almost certainly false. Hmm...will have to think about this a bit.
> Now, if the insurance company has some way of, say, spending $2m to fund medical research that cuts the cost of treating X from $50k to $25k, then that would save them $2.5m in costs. (Making no reference to patenting or even selling the drug.)
This is an interesting idea, but one problem I see here is that it would incentivize insurance companies to silo and keep secret their medical research, because better treatment would be a competitive advantage for them, and cheaper treatment would allow them to charge lower premiums, which is also a big competitive advantage.
> The uncertainty might be handled with a research consultant who makes "educated guesses" as to the expected value of different research paths.
That's exactly what pharmaceutical companies do :).
No it does not. There are treatments that are deemed to expensive and will not be provided. Typically it will be a trade off between how effective the treatment is and how expensive it is. European healtcare systems does not have infinite money.
And she is defending that effectively tax money should pay for medical treatment. ANY medical treatment, with the only limitation that it prolongs life.
It is already the case that millions people lost ~20% of their disposable income because of insurance increases. In many cases it is lower a LOT of people who would normally be comfortably above the poverty line back down to the poverty line (those are the people losing the most in the individual mandate and subsidy system). And we all know that anything less than 2x the poverty line definitely feels like poverty and already cannot be escaped through savings and/or good financial sense.
So there is a choice to be made. A choice between the cost of the individual mandate and coverage on families and the fact that we want everyone to be "saved" from health problems.
This is further complicated by the fact that anyone saved from a health problem increases healthcare demands both linearly (very few health treatment really fixes things, so future demands on healthcare by the same patient will on average be higher), and exponential (a LOT of health problems are inheritable), because people demand the genetics of their kids be "respected" even when known problems exist. Afterwards, of course, it is unfair to blame the kids or the parents, even in entirely predictable problem cases. And then you have 5 kid families, where the parents were warned long before anything happened, which all have severe genetic problems resulting in brain defects. 2 cannot survive a single day without medical care and only 1 will ever live independently. But 3 would like to marry and have kids themselves (I don't blame the kids, however the parents should have known better, also we need to figure out the very sane policy of 100% refund of fertility treatments for couples without fertility problems for this reason) ... At what point is it not reasonable anymore ?
The larger point of this article is about the need to advocate for your own medical care. It really hit me hard, due to my own and family experiences with hospitals and doctors who simply didn't care or recognize the effect of their everyday behaviors on the lives of others.
The example given in the article is Valley Med requiring 5-10 days to serve patient medical records. These 5-10 days can be the the difference between LIFE and DEATH when it comes to medical care. There exists an inefficiency, which can lead to wrongful death, and there is a clear path to remove the inefficiency. Why is nothing done and why does society accept it, despite paying ridiculous amounts for healthcare?
The fact is that doctors are perfectly adept at handling 95% of cases which they see often, but outside of that they seem to lack the drive to 'connect the dots.'
When I go to the doctor, I do my research before I step foot into the office and I tell them what I am thinking. Sometimes I am wrong and cede to the doctor's explanation, other times it results in different tests taken/treatment paths.
There's one problem with this.. for emergent care, the records can be faxed over immediately. At least PAMF does that. They can also get the doctor on the phone. Always remember your doctor's name. It's on the discharge sheet.
Requests for medical records should not take 5-10 business days period. When someone requests medical records it is for some purpose related to health. A hospital taking 5-10 business days to make medical records available can only hurt patients.
Perhaps the problem is more that there exists expensive treatments. As long as they exist, people will be upset at not getting them. When they don't exist, people won't blame anyone for their death. Imagine if some miracle cancer cure is discovered but it genuinely costs a million dollars (not just due to patents). There'll be no option but to let uninsured poor people die. There might not be enough money in the country to actually save them all.
Considering that the USA spent $1.9 trillion on the Iraq war, something that was quite literally not needed by anyone, I wouldn't be so sure that money couldn't be found to provide lifesaving treatment and research technological advancements to bring its cost down in the long term.
In this scenario, that $2 trillion would prevent about a quarter of the deaths from cancer in one year, except that spending was over a decade, so assuming that we could spend at that same rate perpetually, replacing Iraq War spending with million dollar cancer cures would prevent about 2% of cancer deaths.
Do you have a source for that $2 trillion/ quarter of all deaths figure? I understand healthcare in the US costs far more than in the rest of the developed world, but those calculations seem quite wrong.
> In the EU in 2012 the estimated cancer incidence was 2.6 million cases. The estimated cancer mortality was 1.3 million deaths, accounting for 26% of all deaths. DHCC (direct health cost of cancer) in the whole EU increased from €79 to €86 billion during 2005-2014 (in 2014 prices)
The population of the EU is over 500 million people. The annual taxation needed to afford this level of care ranges from 50-270 euros per person across the region.
It's not just expensive treatments unfortunately. A very significant proportion of healthcare expenditure comes from caring for patients that can't take care of themselves (in fact that's 90% of the reason hospitals exist at all).
You obviously don't need to know the CEO just "to get healthcare" - her friend was already being treated. It only seems to be necessary as a means of getting access to expensive private treatments that were otherwise unaffordable.
"Such assertiveness came in handy when Wojcicki was visiting her grandmother in a Palm Springs care home several years ago and couldn’t find a doctor in the building."
The nursing homes I'm familiar with have nurses and a doctor who comes in one day a week, and takes calls from staff. If anything significant comes up the resident is taken to the ER.
A care home with a doctor on staff full time (let alone 24 hours) would likely be significantly more expensive.
I suspect Wojcicki's grandmother couldn't afford that. And it's probably overkill.
It's standard of care to send a patient to the ER from the nursing home... We may not "know" this but it's also fine to call 911 and get an ambulance especially if the staff on hand is not cooperative. Some nursing homes have a clinic attached to them for daily and urgent care but even if you had a hospital next door they would still have to be wheeled or taken by ambulance. So this specific part of the article is overly sensational.
If the issue was really urgent enough for an ambulance, then "a doctor" probably wasn't what was needed. The doctor would just call for an ambulance - they probably wouldn't have much in the way of emergency treatment equipment on hand anyway.
If the issue wasn't urgent enough for an ambulance, and she just wanted to escalate the issue because she didn't trust the nurses or wasn't happy with the quality of service she felt she was getting, then it would be irresponsible to call 911. 911 is not for the use of impatient rich people.
She could have just called her grandmother's doctor.
Glad Anne Wojcicki, CoveredCA and Legal Aid were able to step in and help. There are some specific problems highlighted in the article that could be fixed by software startups:
1) Problem: Difficulty to identify a Doctor for a second opinion.
a) Possible solution: software that allows you to input the medical term (or possibly the medicare code for a disease or combos of diseases?) and find all the second opinion doctors located near you. The software needs things like sort by reputation or reviews, price estimates, speed to get second opinion, time window (with a button to click for life-threatening emergency). Also, why be local? Through telemedicine you could video chat with your second opinion after digitally transferring records.
2) Problem: Too long to transfer medical records 5-10 days instead of 10mins.
a) Possible solution: HIPAA and GDPR compliant digital medical health platform that works with all hospitals. (Very difficult to solve this because of non-standardization.)
b) Secondary solution: Biometric authorization (fingerprint and voiceprint ID or DNA scan) and quick digital download of medical record in plain text. Must complete in less than 10mins even with slower bandwidth.
3) Problem: Didn't have health insurance. Hospital was looking at a potentially very large unpaid bill.
a) Single payer government health insurance is the best solution.
b) SW Tech company solution is quick instant insurance signup with government or charity guarantee for some percentage of bill. The rest of the bill is dumped into CoveredCA or something else. And the patient is enrolled for 1 year after the fact and must pay premiums. ? There are probably better solutions.
4) Problem: Must rely on humans.
a) IBM Watson for disease diagnosis and treatment recommendations combined with additional neural net or machine learning technologies could be used to created automated second opinions. Feed all the raw data into the system to determine the outcomes and probability of recovery for all treatment options.
The problem is that when you have a hammer (a software startup), everything looks like a nail:
1. There may be a shortage of Doctors to provide a 2nd opinion. The cost of a medical education is quite high, and the pay has been going down these past few years. This can't be solved by a software startup.
2. Hospitals have less funding than ever, and are trying to do more with less. So there may already be software out there, but they can't afford it (or the staff to to maintain it, never mind the staff to distribute it). This can't be solved by a software startup.
3. This is really a political problem, and again that can't be solved by a software startup.
4. A medical opinion may not be a binary option, and it could be a moving target where data changes by the day, and it could be a suggestion to collect more data, or even to talk to someone else. Opinions by definition are arbitrary, as where something like IBM Watson may just give you options based on probability (but that probability is only as good as the data you collect, which may not be all inclusive, and may be a moving target). So a startup might even make things worse as people base their options on incomplete data or dated options.
The depressing reality is that there is a great deal of economic inequality in our society, and that's reflected in the quality of healthcare that many people receive. It should also be noted that poverty can prevent access to preventative healthcare strategies which include everything from diet to access to basic medication.
There are already standard protocols and data formats for transferring patient charts between providers within seconds. The standards actually work pretty well now and are supported by most major EMR applications. But many providers still haven't fully configured those features or linked their systems to existing nationwide health information exchange networks.
> b) SW Tech company solution is quick instant insurance signup with government or charity guarantee for some percentage of bill. The rest of the bill is dumped into CoveredCA or something else. And the patient is enrolled for 1 year after the fact and must pay premiums. ? There are probably better solutions.
CoveredCA kinda sorta does this already where if you get pulled into the system via a catastrophic diagnosis they will kick in and help spread the cost. However, I think that the hospital still winds up eating some chunk of the cost as well. The problem is that a doctor has to kick the process off and none of the doctors associated with the hospitals were going to do this.
It's fine if you want to argue for single payer healthcare. But where do you get off berating a non-charitable institution about covering their costs? They have their longevity to think about. If they simply gave everyone infinite treatment for free they wouldn't exist anymore.