Lessons of a $618,616 Death

theodp writes "Two years after her husband's death, Amanda Bennett examines the costs and complex questions of keeping one man alive. The bills for his seven-year battle with cancer totaled $618,616, almost two-thirds of which was for his final 24 months. No one can say for sure if the treatments helped extend his life, and she's left with a question she still can't answer: When is it time to quit?"

Comments

Mixing up advice

[Anonymous Coward]

Fail early, Fail often

Re:Mixing up advice

[mrcaseyj]

Though it may not have done much for him, the same treatments may have better results on others on average, and therefore be worth it. Or maybe not. Also, medical bills tend to be grossly inflated, so the real cost may have only been something like $150,000. It's a quadruple the price and give the insurance company 75% off scam (but still charge the cash customer the over inflated price, partly to make up for cash customers who don't pay).

Re:Mixing up advice

[Fluffeh]

I would ask at what point did HE stop wanting to go through all the medicines and procedures?

If you ask me, that's when it should have stopped.

Re:Mixing up advice

[Anonymous Coward]

Some diseases come result in a shorttime depression, which means that you can't just let people die because they don't want to live for a day or two. They c

Re:Mixing up advice

[Anonymous Coward]

This is why you wan't free healthcare, dumdidum... I know, kill the socialists for being privileged!

Re:Mixing up advice

[Anonymous Coward]

God speed, lad. His suffering was so great, he couldn't bear to finish his post before pulling the plug. :(

Re:Mixing up advice

[dominious]

Sometimes the patient might want to stop, because they feel they are causing you trouble and wasting your money (i.e. the patient is your mother or father or husband).

You however must show them you love them and keep on trying. This will make it worth in the end.

Re:Mixing up advice

[carlhaagen]

Even $150k for this treatment is far more than we "socialist" Europeans pay for equivalent healthcare via our higher taxes. Your system is broken.

Re:Mixing up advice

[Nutria]

Did you RTFA? It was longish, but very enlightening.

Re:Mixing up advice

[Anonymous Coward]

We like it broken, JACKASS!

Re:Mixing up advice

[10101001 10101001]

Sometimes the patient might want to stop, because they feel they are causing you trouble and wasting your money (i.e. the patient is your mother or father or husband).

Yes, this is a problem with any sort of expensive care, especially the long-term kind.

You however must show them you love them...

Yes, that's always important.

...and keep on trying. This will make it worth in the end.

I'm going to have to go with no. In the end, it is not your position, my position, or the loved one's position to choose how or if a patient should continue treatment. It is the patient who will have to live with the consequences of their choices and to take away those choices with a mantra that one must "keep on trying" regardless of the futility of the action condemns people to situations where they are forced to endure needless suffering to placate the wishes of others. If it is wrong to coerce or steer people to give up, it is certainly as wrong to coerce or steer people to keep on trying.

Re:Mixing up advice

[pookemon]

What the HELL are you doing on Slashdot. You don't belong here! Your well thought out, concise post, that takes into consideration the feelings of the dying person is just not heard of!

You're OUT there - way OUT there. There's something wrong...

And your sig almost makes it seem like you CARE about OTHER PEOPLE. Be careful, you might impress someone! Like me...

Re:Mixing up advice

[Fluffeh]

Okay, how about this then...

Are you like hot.. and stuff?

That make you feel more at home on slashdot, or should I just start spewing out random car analogies, math solutions and have a crack about privacy/microsoft/overlord?

Re:Mixing up advice

[JustOK]

It might just have been his computer that got up and left, seeking greener pastures

Re:Mixing up advice

[JustOK]

doing nothing does something too

Re:Mixing up advice

[JustOK]

hehehe you said crack

Re:Mixing up advice

[Anonymous Coward]

your a moran.

Re:Mixing up advice

[MrMr]

You're actually willing to torture your victim indefinitely to please your sense of righteousness?

Re:Mixing up advice

[tburkhol]

You however must show them you love them and keep on trying. This will make it worth in the end.

So, they know you're wasting money and time for no medical benefit, you know you're wasting money and time, yet you have a compulsion to continue putting on a charade to demonstrate your love? Seems pretty shallow to me, in the sense of "If you loved me, you'd buy me a Lexus." ie: "if you loved me, you'd buy me four weeks of morphine coma."

End of life medical expenses are a deeply personal choice. Many people fear being locked into a dysfunctional shell of a body. Many people have faith that there are seemingly miraculous recoveries from even the worst conditions. You ought to talk about your feelings with whomever might be called upon to make life-or-death decisions for you, so you can find a compromise that balances your wishes, their guilt, and everyone's interests.

Re:Mixing up advice

[cptdondo]

It's a quadruple the price and give the insurance company 75% off scam

I thought one of the things that came out in the debate was that there was a federal law prohibiting discounts to cash customers, so the poorest, uninsured *has* to pay the full price. The doctor cannot discount unless it's an insurance company.

Re:Mixing up advice

[MobyDisk]

I've heard of a law forbidding discounts when compared to cash. But I don't think that applies to medical costs. I've paid cash for dental visits and gotten significant discounts. It makes sense for two reasons: 1) They don't have to do any complex billing and wait months to get paid 2) They insurance companies discount the bill anyway - so the doctors never get paid in full anyway.

Re:Mixing up advice

[Rich0]

Ok, time to sacrifice some karma I guess...

You suggest that the desires of the patient are the ONLY thing that should be considered when deciding on treatment plans.

However, there are others who have a legitimate stake in the matter. In particular is whoever is paying for it.

Suppose that for a cost of one billion dollars I could extend somebody's life for one year, completely devoid of any pain or suffering. It would be a very fulfilling year, one that anybody would want to live.

Who wouldn't want that? One more year with their family, one more year to accomplish whatever it is that makes somebody feel happy about living. If left up only to the recipient of such care, everybody would elect to have this treatment.

However, at a cost of one billion dollars each the entire human race would essentially be enslaved to providing for the care of maybe a few thousand or tens of thousands of people who manage to receive the treatment before the entire planet runs out of resources.

Obviously a billion dollars is a contrived example. The opposite contrived example would be ten dollars - I think virtually everybody could agree that for taxpayers to balk at spending ten dollars to extend somebody's life for a year sounds very stingy (although one could debate that we do this all the time when we ignore starving people in poor nations).

So, at this point we're just haggling over price. At what point do those actually paying for care get to say "enough is enough?" That is exactly what this article is about. Talking about putting a price on life sounds barbaric, but the fact is that everybody does this every day - they just don't talk about it.

Here is something else to think about - if you really do consider my life to be worth a million dollars per year, or whatever, can I elect just to receive the cash for two years of life right now and then thirty years from now you can just let me die in peace?

Re:Mixing up advice

[dcavanaugh]

I think the REAL reason why the cash customers are gouged has little to do with collections. It's the 75%+ discounts that the insurance industry and the government require. They keep the beds full, with the system running near capacity, but only because of huge discounts. After all the paperwork and nonsense, the providers are probably running at a loss because of the discounts -- but a manageable loss AND the capacity is predictable. That leaves cash customers to pick up the rest. Meanwhile, the insurance industry and government LOVE this arrangement, because cash customers are severely punished and dragged back to the captivity of insurance and government dependence.

If cash customers could pay the same heavily-discounted rates as the insurance industry and the government, the collections problem would be greatly reduced. And with medical expenses paid directly "out of pocket", patients would shop more diligently on price and try harder to avoid seeking unnecessary treatment. Notice how the problem of uncollectible accounts is never subsidized by the insurers or the government, presumably because they are not part of the collections problem. If I offer to pay on the spot, I am not part of the collections problem either. Why should I subsidize the uncollectible accounts or (even worse) the wildly expensive "claims management" process? By offering cash on the spot, I should pay a rate LOWER THAN INSURERS, GOVERNMENT, OR TRADITIONAL CUSTOMERS. Notice how it doesn't work that way, thanks to insurers and their allies in government. Notice how the proposed healthcare reform leaves the problem intact.

Re:Mixing up advice

[cptdondo]

IIRC you can pay cash at the time of service and get a discount, or you can pay the full price. But hte doctor has to bill you the full price if you get billed. I'd really like to know the details of the law. No, I haven't researched it and (shocking for /.) I don't pretend to know it.

Re:Mixing up advice

[MobyDisk]

Okay, that makes sense. When I paid cash it was at the time of service.

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[scarboni888]

Yes we should always force people to live no matter what. Because even if death & dying are natural parts of life we just can't bear it & so must fanatically impose life at all costs.

Re:Mixing up advice

[hairyfeet]

I'd say when the person is suffering 24/7, and the odds of them ever getting any better are pretty much zero, it is time to seriously consider letting them make their peace and just letting them go. Look at it this way, if it was a dog suffering that bad, would you put them out of their suffering? Then why the hell subject someone you love to that much pain?

When my sister passed away last year they probably could have kept her around for another 4, maybe 5 years, first by hooking her to a vent followed by an iron lung. But her nervous system was already shot, her bones were as brittle as twigs, she hurt pretty much 24/7, and if they would have continued she would have ended up unable to speak, move or even communicate. What kind of "life" is that? In the end we were lucky that sis had a compassionate doctor, who gave her enough morphine she just drifted away in her sleep. A hell of a lot nicer death than the slow suffocation or being nothing but a slab of meat wired to machines, unable to even speak.

So I would say when there is no hope and they are suffering it is time to seriously think about just letting them go. Forcing them to soldier on with nothing to look forward to but more pain is simply cruel. And I know they are talking about an economic standpoint here, but I wonder how many of those were the choice of the patients, or the NOMW (not on my watch) docs? Before my mom retired as a nurse she worked a NOMW case, where a doc kept a 22 year old girl "alive" for 9 days because he refused to give up and told the family there might still be hope. This poor girl hit a guard rail with her head at nearly 70 and my mom had to put towels around her head when the family visited so they would see her brains slowly leaking out from the swelling.

So I would say someone needs to step in when it is obvious we are at 0% hope and have everyone seriously look at what the future holds. with technology we can keep a human body often going long past the point of failure, but not only is it expensive as hell, it is seldom a pleasant or an easy way to go.

Re:Mixing up advice

[Nidi62]

No, you are still paying for it. You are paying for it your entire lives, even when you are perfectly healthy, through your higher taxes.

Re:Mixing up advice

[tacocat]

The way it's presented as a single concept that We (meaning the Federal Government and not yourself) have to Do Something (meaning pay for all of this and never let people die) or make life & death a financial decision which people don't want to equate. I do not agree with this.

First, the question of life & death being expressed in financial terms is actually quite accurate. Money is the result of your productive activity and allows you to employ others to be productive on your behalf. There's always a limit to how much you can pay.

The moral aspect of this is understanding at what point you are spending money not for a cure, but for extension of life and at what quality. If you have ever had to put a pet to sleep you understand the question. If you have ever been a client of Doctor Kivorkian you also understand the question. If you have done neither then you have no perspective on this very personal matter. And not everyone who is going to die would elect to leave their successors with $600,000 of unpaid bills. That's a tragedy in itself.

Healthcare is expensive because we allow it to be expensive. We bury the costs behind corporate write-offs, subsidies, shelters. Only when you are purchasing services without insurance do you understand how expensive it has become. The system is broken. But the solution is not to have more people pay for my insurance but for me to pay for my insurance and you for yours.

Car insurance is much less than health insurance. And I'm much more likely to have a payout from car insurance than health insurance. Why? Because if car insurance is too much you can switch. But when the company pays for 80% of your insurance as part of a tax write-off incentive, you won't walk. You remain in their system because the immediate effect is that it's cheaper for you.

There is no scam here. The economics allow everyone to do this because there is no free market competition between doctors and insurance companies when most everyone gets their insurance through their work. This is where the system is broken.

Remove the tax incentive from companies and they will stop providing you health insurance. You will have to compete freely for the best price for insurance and healthcare. And only this will drive the prices back down to a reasonable level. Initially it will look pretty bad, but markets will correct themselves in a few years.

You want proof? Uninsured medical procedures fall in price while insured medical procedures climb in price. Free Market versus Socialist Market.

Is it affordable for everyone to have unlimited cancer treatment? No. Never will be. It's very possible that it shouldn't be. People don't make good decisions with other peoples money.

Re:Mixing up advice

[trout007]

One thing that makes this much more difficult to understand is feedback. Anyone with experiences in control systems or other nonlinear systems knows how difficult and sometimes counter intuitive things are. Take your example of feeding a poor person in another nation. That sounds good. But the feedback you forget is that by giving that person free food you put the farmers in that country out of business. What would happen in this country if China gave us all the free rice we could eat? It would put all of our rice farmers and many other farmers out of business as people switched to rice. And as those farmers lose their jobs they can no longer afford to feed themselves or their employees. The same goes for healthcare. Price is a very important thing in the real world. It works as a signal between producers and consumers so that resources can be used most efficiently. For instance I just got a quote from a dentist saying I needed a cavity filled. But during the procedure I may need a crown. The cavity filling will cost me $120 but the crown $900. With this information I decided to call around to find out prices for crowns. My insurance doesn't cover crowns so I have to find the best deal. The only difference is emergency medicine. I think that should be socialized on a county level like fire rescue, emt, and police are now. The reason is when you have a heart attack you can't call up hospitals to shop around. But in order to do this you have to treat emergency rooms like the police and emt. You can's sure them for messing up. It's an emergency and they don't have time or all the information. If the results of them doing nothing is you dying then whatever happens when they try to help you should be covered under the good Samaritan laws. Also anyone going to an emergency room for non emergencies should not only be turned away but fined just like calling 9-11 because you didn't get cheese with your quarter pounder. Once a person is stabilized and can be moved then they are back in the paying system where they should have to shop around for the best service they can afford.

Re:Mixing up advice

[Anonymous Coward]

People get sick more than once in their lifetime, and, I am willing to bet you that we Americans are sicker than the Europeans. And, are you implying they should switch to paying with a game of roulette with their lives as bet? Because that's sort of what it's like here in the states with our current healthcare model; it's truly a "your money or your life" situation, while in the Scandinavian countries, you have the exact same healthcare when being flat-ass broke on the street, as when you are wealthy.

Re:Mixing up advice

[Fotherington]

Here in the UK there's a Government body, the National Institute of Health and Clinical Excellence, which makes judgements on how cost-effective treatments are. According to their website if it costs more than £20 000 - £30 000 to provide an extra year of healthy life, then the treatment is likely to be held not to be cost-effective and won't be offered via the National Health System.

Before anyone piles in, it's a bit more complicated than that (different parts of the UK follow different rules, for instance) but that's the essence of it. Private insurance of course isn't affected.

Re:Mixing up advice

[Kral_Blbec]

Stop spouting off numbers you have no idea about. I work in the medical field. There is NOT a gross markup. It is expensive to the manufacturers, it is expensive to the practitioners, it is expensive to you.

Re:Mixing up advice

[toomanyairmiles]

If you had the experience I've had, watching my father die from cancer, you would understand that after a certain point the patient is no longer able to make rational decisions. The long term effects of the morphine, chemo drugs, and the metastases of the cancer often render the sufferer distressingly incompetent.

Re:Mixing up advice

[Anonymous Coward]

Oh dear god. This is the hardest I've laughed at slashdot in months. Maybe I'm just stoned. Fuck it! Jager, here I come. Goodbye cruel world...

Re:Mixing up advice

[dgatwood]

I'm assuming by "brain leaking out", you mean that they performed a decompressive craniectomy. With such treatment, even someone with a severe head injury has some chance of survival without serious damage. What the doctor did in this case might not be at all unreasonable, depending in large part on a lot of subtle considerations like whether the patient had good pupil response on admission, the age of the patient (which in this case leads to a much better prognosis than with an older person), etc.

In one (admittedly small) study of severe head injury cases (all of which, AFAIK, would likely have been described in much the way you described this case), fully half of the people who underwent such surgery survived, and a third survived with no or minor disability.

In other words, the outcome is not always clear from outward appearance or even from the severity of impact. The doctor might well have legitimately thought the girl had a reasonable chance of recovery. Nine days is not really unreasonable. Brain swelling can easily continue for a couple of weeks, and I actually had a teacher once who was in a coma for many months (or was it years, I forget). I'd have to know a lot more than you've given me before I would agree that the case was hopeless.

Re:Mixing up advice

[uglyduckling]

What you're talking about it exactly what is done in healthcare rationing. It's also been used as a football in the US healthcare debate (I think some idiot called the UK system that decides this 'death panels'). They way it's done is to ask a representative sample of the population to rate the value of a year in a certain condition. It's based on QALYs - Quality Adjusted Life Years. So, for instance, someone might say that 1 year in a wheelchair has the same ' value' as 2 years able to walk unaided, so you would say that a year in a wheelchair has 0.5 QALYs. Bear in mind, this isn't done by a panel but by survey of the population.

What a group of experts / managers / politicians / etc. does do is decide how much the health service is prepared to spend per QALY. So, a certain type of cancer treatment might buy 0.01 QALY per treatment, at a thousand pounds a treatment. A cutoff can then be set over the whole population, for every type of treatment, to say that as a society we agree not to pay more than e.g. GBP 500,000 per 1 QALY.

The whole idea is of course terrible, grotesque, but also elegant and necessary in the job it does. Of course, people with enough money can buy whatever health insurance and private healthcare for whatever treatments they desire. Every so often, there's a big media storm about a certain treatment (usually for a cancer) that has been deemed too expensive, and you get lots of protests over putting a price on life. Of course, if there's a cap on public healthcare spending then to provide that expansive treatment, something else would have to go.

Re:Mixing up advice

[Anonymous Coward]

Silence is another way of saying what I want to say
Lying is another way of hoping it will go away
You were always my mistake...

Re:Mixing up advice

[uglyduckling]

Replying to my own post, I've realised that I think it's more like 30,000 per QALY but the rest is the same.

Re:Mixing up advice

[blackest_k]

The real problem with the American healthcare system is that the cost of treatment often has to be met by the family of the sick patient.

Should people be made to face the choice of continuing treatment or costing their families future. Should your wife be forced into living in a trailer park as your widow your children forced to withdraw from college in order to maintain your life for a few more years?

Essentially it becomes a choice of suicide or putting the people you love most through intense hardship, probably worse than that since suicide would invalidate any life insurance so you need to bare the pain of cancer for as long as your body holds out.

I'm lucky I live in a country where most of my medical needs are taken care of some options will be limited due to cost and the benefit they provide. However I will get treatment and my family will be ok.

Health care is the number one reason for not wanting to live in the usa.

Re:Mixing up advice

[daveime]

The real problem with the American healthcare system is that the cost of treatment often has to be met by the family of the sick patient

As opposed to N random people paying into a system to finance your family's problems ? You do know what a Pyramid Scheme is ? If you're still paying into a Government Pension Scheme, possibly the penny will have dropped.

Re:Mixing up advice

[daveime]

He's a Masai warrior from Kenya ?

Re:Mixing up advice

[daveime]

So at what point does "being wealthy" have any further benefit ?

Having come from a country with excessive taxes, seeing people enjoying free 4 bedroom houses and all the benefits under the sun, and collecting bi-weekly expenses cheques from the Government, while myself being on minimum wage and paying through the nose for everything, who exactly is "better off" ?

Re:Mixing up advice

[Anonymous Coward]

Do you know the difference between insurance and a "pyramid scheme"? Do some math and come back to us.

Re:Mixing up advice

[Anonymous Coward]

It would put all of our rice farmers and many other farmers out of business as people switched to rice. And as those farmers lose their jobs they can no longer afford to feed themselves or their employees.

You're missing something. These American rice farmers can eat free Chinese rice, just like the rest of us. And they can get new jobs for the rest of their money. Just like the rest of us.

The Chinese would hypothetically be getting screwed. Farming rice is labor intensive. Which is why farmers everywhere are paid for it. Every bit of rice that we imported, for free, would be added to our GDP, specifically because the American farmers' labor is a resource that has been freed. They can move on to do something else, possibly even more productive. America would be significantly better off if China did something like that. Of course, they won't.

It might suck to see macroeconomics in these terms. Recessions are ultimately caused by poor capital allocation or risk management. Industries recede to sustainable levels -- because the capital allocation before then was unsustainable (or was sustainable but has become unsustainable through circumstance). This isn't "laziness", but poor planning. The "victims" of poor planning were like hogs at a trough before their unnecessary jobs were eliminated.

Re:Mixing up advice

[Kral_Blbec]

I agree with some of your first points, but you digress at the end.

Car insurance is much less than health insurance.

Well, sure. A nice car costs 20k. Insurance covers damage to that car, and another similar car, in the event of a crash. Some plans cover limited property damage, maybe a little medical too, but those plans are a steep step up from basic liability. Compare that to health care, I've worked in rooms where one piece of equipment the doctor is using costs more than that. Now instead of covering a 20k car, we are paying not only for some very very expensive equipment, but also the wages of a dozen people to give exclusive attention to a single person for several hours/days/weeks. Medical care costs exponentially more than a new car, hence insurance for one is much higher than the other.

You want proof? Uninsured medical procedures fall in price while insured medical procedures climb in price.

In all the operating rooms I've worked in, all the surgical procedures I've done, and in all my career, I've never known the insurance status of the guy on the bed. Nobody talks about it. What I have heard is doctors debating with themselves if they are going to need the $2000 sterile package that I have on hand and if I should open it or not. I've seen them try very very hard to avoid opening supplies because they know how much it costs, and don't want to have to charge the patient for it if they dont have too, irrespective of insurance status.

Re:Mixing up advice

[poopdeville]

So at what point does "being wealthy" have any further benefit ?

Look up things called "marginal cost" and "marginal gain". That will answer your question about "being wealthy" and "being wealthier".

Re:Mixing up advice

[b4upoo]

There are a lot of factors involved in deciding when all is lost. Obviously a patient with a large number of lethal issues or issues that make life wretched confounded by a condition which will ultimately kill call for physician assisted suicide or homicide. But there are other situations where a cure may be coming in a reasonable amount of time for the lethal illness and the lesser medical problems may be quite tolerable when the worst condition is eliminated. In situations like that the patient may want to toss in the towel way to early. For example heart disease may be quite painful and keep a person bed ridden and helpless. Yet a fix may be in the works. That same patient may suffer from acute depression and something like arthritis that causes a lot of pain. But a repaired heart may lift that depression along with a bit of medication and a new found ability to exercise may keep the arthritis at bay enough to make life enjoyable.
                  Therefore as much as I am against social intervention over riding a persons self determination end of life decisions should not be left to the patient or family alone. Emotion and false knowledge come in to play far too easily when death is hovering around a person.

Re:Mixing up advice

[sjames]

However, at a cost of one billion dollars each the entire human race would essentially be enslaved to providing for the care of maybe a few thousand or tens of thousands of people who manage to receive the treatment before the entire planet runs out of resources.

Sounds like our current economy.

Re:Mixing up advice

[Anonymous Coward]

AFAIK you can negotiate whatever payment terms you'd like. You have the most power when you're offering cash up front, but I've successfully negotiated 6-month terms at a significant discount as well. There's maybe some insurance contract they have the prevents them from offering good non-cash terms -- though given the amount of regulation around insurance I find that a little hard to believe -- but I'm not aware of any such law, and it would clearly be against the public interest if it did exist.

Re:Mixing up advice

[Diagoras]

Actually, you just mentioned one of the things I like the most about the American system. The choice is mine. In societies with socialized healthcare, some government bureaucrat is the person who decides how much to spend on my dying wife. In America, she and I decide. It's horrible either way, but I'd prefer for that choice to be in my hands than someone else's.

Re:Mixing up advice

[glitch23]

Look at it this way, if it was a dog suffering that bad, would you put them out of their suffering? Then why the hell subject someone you love to that much pain?

The problem with that logic is that who defines the quality of life and whether it is bad or good? This is the same issue with abortion and assisted suicide. The excuse is frequently something along the lines that person A wanting to get rid of person B does it based on stating their *opinion* about person B's quality of life. It isn't person A's responsibility to state what is or is not an acceptable quality of life for anyone. Only person B can really decide that. If they are incapacitated (e.g. Terri Schiavo) then it becomes a problem because that person cannot speak for themselves (much like a baby about to be aborted). We shouldn't be essentially killing people because it is convenient. If a person is going to die due to the cancer and they don't want to live anymore because of what the treatment does to them then we aren't killing them. They will die of natural causes. But aren't we supposed to save people you ask? Obviously humans are always supposed to save someone's life if that person is in danger but there are some things we can't save people from, especially all the time.

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[OeLeWaPpErKe]

It really depends. If the company does their homework and goes for long term planning, insurance is, well, insurance. This means, obviously, savings, savings, savings. Some insurances do this.

If the company spent or gave dividend with what should have been future investments, often done, then insurance becomes a pyramid scheme. If the company only even attempts to cover the cost of current expenses, not saving for the future, that company is a pyramid scheme.

And for the political war, imho : what Obama is proposing falls squarely in the second category : it's forcing everyone to underscribe a singular option that MAY cover today's needs. Let's say it does cover actually cover the needs of today's patients, and that the CBO is wrong. Nothing is saved for tomorrow's needs, for when the patient becomes old. Instead it is assumed that when patients grow old, enough new productive citizens (ie. current children) will be paying enough taxes to make up for it, or taxes can be raised to cover the cost. Obviously this is not true, unless the pool of new citizens is necessarily always bigger than before. So it seems to me the system Obama proposes is one baby boom (with dropoff afterwards) removed from collapse.

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[hairyfeet]

Dude the back of her head was the size of a basketball and we aren't talking spinal fluid here, we are talking brain matter. But the doc had a serious God complex and was a total NOMW (Not on my watch) and refused to accept her brains were splattered. I mean Good Lord man, she was thrown from a jeep and it drug her head along a concrete divider at 70MPH!

To me the saddest part is there was all those healthy organs that could have saved actual living people, but thanks to Dr NOMW and all the drugs he had to pump her full of trying to keep the poor mangled mess alive by the time the heart gave out 9 days later all the organs were worthless. No telling how many lives could have been saved if Dr NOMW wouldn't have been such a self righteous prick. But according to mom the swelling was so damned bad her actual brains were coming out the back of her head and oozing out her ears, only the machines and later drugs + machines Dr NOMW ordered kept the corpse functioning as long as it did.

And it was a corpse, according to her by that last 48 hours the thing had already started to smell like a rotting corpse thanks to all the failures. in the end it was a heart and lungs, nothing more. To me this is the perfect example of why they need someone with medical knowledge not affiliated or personally involved to talk to everyone and point out the odds are pretty much nil. If they would have done that on day 2 when her head became a basketball and brains started leaking they could have at least saved the organs, not to mention God knows how much money Dr NOMW spent keeping that corpse going.

Re:Mixing up advice

[Swave An deBwoner]

I thought one of the things that came out in the debate was that there was a federal law prohibiting discounts to cash customers, so the poorest, uninsured *has* to pay the full price. The doctor cannot discount unless it's an insurance company.

I think that this is in fact correct. It applies, however, to patients who are insured through Medicare (and maybe also Medicaid), not to the "cash" paying patient.

In the past, doctors would often accept what Medicare paid for treatment and tell the patient for whom any additional cost would be a burden to forget the balance. That's what we ordinarily think of as "compassion". The Federal government decided, however, that since Medicare was paying 80% of the bill, if the physician told the patient to forget about the remaining 20%, then Medicare was overpaying and should have paid only 80% of 80%. Of course, if they did that, and the remaining 20% was forgiven, then Medicare would want to pay 80% of 80% of 80%, and so on ad absurdum.

Another wonderful bookkeeping insight into the problem on the part of those who fund Medicare. So the upshot was that Medicare requires that the physician make a "good faith" attempt to collect the remaining 20% even from the little old lady (or gentleman) who will have to go without supper for a few months to pay it, or else face being paid even less for the physician's services (or, in some cases, perhaps be accused of Medicare fraud).

Re:Mixing up advice

[OeLeWaPpErKe]

What do you consider "medical benefit", because if you interpret the Hippocratic oath version of "medical benefit", even a second's life extension would count as medical benefit.

And according to that same Hippocratic oath, both euthanasia and abortion fall in the category of criminal, and should exclude anyone performing these from any and all forms of medical profession.

As for your other claims :

Many people fear being locked into a dysfunctional shell of a body.

And others would prefer being alive, even if only to see the world move around them, even if it meant pain.

Many people have faith that there are seemingly miraculous recoveries from even the worst conditions.

As any docter with a few years under his belt will tell you : that's absolutely true. People come back from the most dreadful diseases, seemingly without reason at all. The other side of the coin is also a fact, some people come in with mild coughing, then drop dead 10 minutes after the docter declares them hypochondric and "prescribes" cough syrup.

Which is, of course, why just about any disease's survivability is a bell curve : you can be the one at the top, that still lives 100 years after being diagnosed. Of course, the chances of this depend on the disease.

Re:Mixing up advice

[OeLeWaPpErKe]

So instead of punishing them, murderers should get a bonus from gaia for "services rendered" and continue on, after an interview on live television ?

Re:Mixing up advice

[OeLeWaPpErKe]

It might suck to see macroeconomics in these terms. Recessions are ultimately caused by poor capital allocation or risk management. Industries recede to sustainable levels -- because the capital allocation before then was unsustainable (or was sustainable but has become unsustainable through circumstance). This isn't "laziness", but poor planning. The "victims" of poor planning were like hogs at a trough before their unnecessary jobs were eliminated.

Yes but you leave out something very important : WHY is capital poorly allocated ? WHY is risk management screwed up ? After all, especially in agricultural matters, we've got close to 5000 years experience with it. Surely we'd have found a way to deal with the risk and surely we know what capital to allocate ?

Yet we regularly hear about famines, even huge ones. What is going on ?

The simple truth is that the world changes. It changes the conditions of agriculture : a new plant disease, ground erosion, water changes. Despite the constant barrage of propaganda to the contrary, land does not have constant productivity if we were to just do things the natural way. In fact, that would cause much more massive fluctuations in the food supply. Fluctuations that would kill millions.

The problem with allocating resources, wether capital, or redundancy (to avoid risk), is that finding a good resource allocation involves predicting a huge number of variables into the future. Nobody knows the future, and nobody knows the consequences of a particular allocation of finite resources. Especially the downsides tend to come as a surprise. And when it comes to resource allocation, small mistakes cost dearly, mistakes cause recessions and big mistakes cause famines, civil war, and worse.

Recessions are caused by wrong capital allocations or risk management issues, yes, absolutely true. But one wrong prediction about the future pretty much guarantees wrong capital allocation and mistakes in risk management. In other words, every failed prediction brings us closer to recession. Of course that's for a capitalist system, where many actors have variances in how risk is spread. If we had a single entity doing that, whether said entity is the government, or monsanto, we'd be one wrong prediction from close to zero available food.

Re:Mixing up advice

[icebraining]

If you have health insurance and you don't get sick, you're doing exactly the same. Everyone that has an insurance with that company is paying for those few that actually require expensive treatment. If you sum all the money you've paid every month for your insurance contract, and them subtract the money the insurance company has paid for your treatments, you'll probably see (unless you're one of the few misfortuned people) that you've paid much more than they have.

The only difference is that you're also paying for the shareholder's profit.

Re:Mixing up advice

[OeLeWaPpErKe]

So which handicaps and genetic diseases are death sentences under this system ? Death sentences in the sense that the government will do something between denying you critical care and outright kill you.

Re:Mixing up advice

[OeLeWaPpErKe]

Don't worry about that, every European government would have let that guy die in the first year of treatment.

You get what you pay for. Except you pay more, and get less. Furthermore, you have zero choice in the matter.

Re:Mixing up advice

[icebraining]

And if you have private insurance, you only pay when you're sick, right? Oh, wait...

What you fail to realize is that the "public health system" is simple insurance. The only difference is that you're forced to have it, but since nobody everybody effectively needs insurance, it's the same.

The only difference is that even people who were too poor to pay for insurance actually get it, but if your only objection is that you want to live better by enslaving poor people, you're a terrible person.

Re:Mixing up advice

[Anonymous Cowpat]

and there's a (slightly) more realistic chance of the fund going bankrupt and nobody getting anything.

In an NHS-type system you have the buffer of the whole of the rest of the national budget that COULD be eaten into before the money actually runs out.

Re:Mixing up advice

[blackest_k]

So heres a situation my niece has junior rheumatoid arthritis. It takes her from being a typically healthy teenager to one thats in constant pain and in a wheel chair. There are injections which she has which bring her back to normal health.

The cost of these injections is more than twice my sisters take home pay but its paid for by the NHS through everybody's National Insurance contributions. You are looked after by this system from before you are born and through to your last breath and you contribute to this system throughout your working life. There is a maximum contribution so its never totally unreasonable.

but put this in your situation and its your son or daughter with this illness and it costs twice your salary to keep him or her normal. In the UK that government bureaucrat actually pays out more than you could pay for.

so your welcome to a system where you have to accept and see the pain of your family suffering because you can't afford it.
ah but you have insurance part of your work package but hey you are almost certainly not immune to redundancy even with a solid company like IBM. HR doesn't care about you and your family especially so if your raising premiums. If your selfemployed and you lose a major contract you can end up unable to pay to keep your family safe and well.

so tell me how you manage to pay more than you earn to look after the medical needs of your family and while currently your a major bread winner a small clot of blood can stop the flow of blood to your heart or worse still to your brain and recovering from this stroke and the brain damage it caused your now caught in a world of pain and debt and misery. Even if your in perfect health someone could hit your car on your way into work tomorrow and change your life forever are you really prepared for that?

http://en.wikipedia.org/wiki/History_of_the_National_Health_Service_(England)

the above link gives a little of the history of the founding of the NHS and why it was done

Re:Mixing up advice

[pookemon]

That's more like it! You just need to start with "1st Post" even if you are replying to someone elses post.

We'll make a /.er out of you yet. :P

Oh yeah I forgot... 1st post!!!

Re:Mixing up advice

[ben_white]

RTFA, she states the real dollar cost was ~250K of which they were personally responsible for about 10K.

Re:Mixing up advice

[JustOK]

mom?

Re:Mixing up advice

[drsmithy]

In societies with socialized healthcare, some government bureaucrat is the person who decides how much to spend on my dying wife.

You really shouldn't talk about things you know nothing about.

Re:Mixing up advice

[Rich0]

Well, being hit by lightning probably counts - I doubt the government will do anything to save your life in that case since 99% of the time you're fried to a crisp.

Having a massive heart attack probably counts - again, while most would actually consider intervention in this case cost effective it probably is not possible.

There are TONS of things that could kill you that the government isn't able to do something about.

Most socialized nations set a standard cost per year of life at some level of quality - if treatment costs more than this amount then you are written off. It sounds bad, and I'd hate to be the guy making the calls. However, any other choice actually costs more lives than it saves.

Why is this? Simple - opportunity cost. A hospital has $x to spend. If they spend it all on terminal patients, then there is that much less to spend on other things, like people with a much better prognosis, or on preventative care. Oh, you can argue that the health care budget should just be raised. Ok, where do you draw the line? If you taxed everybody at 90% and put every dollar into health care the fact is that there would STILL be people that you could save if you only spent a little more.

Ultimately, duration of life is not the only thing that matters in this world. At some point most people would be willing to trade some duration of life for quality of life. Now. that isn't a decision that most would make on their death bed, but it is a decision that most would make when they are healthy.

Just ask anybody on the street what they think the government should spend to keep them alive for an extra year when they are 85 and in the hospital. Let's say they come up with $10M. Then, ask them whether they'd rather just have that money now, but at the cost of not receiving heroic care when they are older. I bet you 95% of anybody actually offered that kind of cash would take it now, and they wouldn't just sock it away until they're on their death bed.

Sure, you can say that people are short-sighted, but that applies no less than somebody spending the money now as spending the money on their deathbed. Ultimately the question of whether a year of life in one's elderly years is worth more or less than a WHOLE lot of fun today is a question that has no clear absolute answer. We have to choose as a society which we value more - the prosperity of the living, or the dying.

Re:Mixing up advice

[dgatwood]

Just to be clear, I'm not saying it wasn't hopeless. It probably was. I'm just saying that I wouldn't automatically assume that her prognosis was obvious nearly as early as you think it was, assuming they treated her correctly. The questions you didn't provide the answers for (e.g. are the pupils blown, is there EEG activity, does an MRI show hematomas, does an fMRI show dead areas, is part of her head physically missing, etc.) are far more important for determining prognosis than the amount of swelling, IMHO.

The amount of swelling of the brain is not always a good indication of the level of damage. There are many causes of swelling, some of which are pretty much guaranteed to indicate serious damage (e.g. a hematoma caused by severe hemorrhaging) and some of which aren't (e.g. edema that might not cause too much permanent damage if the skull is opened up and the brain is allowed to expand temporarily until it can heal). A lot of the more serious damage in traumatic brain injuries occurs well after the initial impact, due to edema compressing the brain against the skull, causing further bruising and cell death. And a lot of damage due to the initial bruising can be headed off by prompt administration of the right medications (steroids, anti-inflammatory drugs, possibly blue dye #1...).

In other words, a lot of the things you saw as signs of hopelessness were actually part of the normal course of treating such an severe head injury and might or might not have been sufficient to consider her prognosis poor. Her prognosis probably was poor, but it wasn't poor for those reasons....

That said, IANAMD, so take this with a grain of salt.

Re:Mixing up advice

[shutdown -p now]

In societies with socialized healthcare, some government bureaucrat is the person who decides how much to spend on my dying wife. In America, she and I decide.

You missed the other important part of that equation - namely, that, in America, you can decide for yourself, but only within the limit of the money that you have - and for vast majority of people, that amount is actually less than what would be allocated to them in a country with socialized healthcare. So the actual freedom is mostly theoretical.

Re:Mixing up advice

[Fotherington]

In a perfect world, healthcare would be free. Because funding for healthcare is limited (UK: something like 9% of GDP) you then have to decide how to spend it in the fairest way you can. This means making hard decisions, like "We can medicate your condition for £10 000 per year, and can cure it for £1 000 000. Curing you means that 99 people this year would go untreated, so we'll have to give you medication instead." If the alternative is dying because your condition isn't covered by your health insurance, I'll take the medication!

Re:Mixing up advice

[Novae D'Arx]

Oh, don't worry, I can tell you're not a physician, and almost definitely not associated with any medical field in any way. Not to be insulting, but that patient had obvious massive intercranial pressure causing severe hemorrhage and compression injury to the cerebral tissue. I don't know where you're getting your information, but da-yum. We're not talking about how she looked on admission, we're talking about the continuous process of testing, assessment and evaluation that should have told the MD in question that his patient. Was. Brain. Dead. Didn't matter if she had a craniotomy; while you're right that initial amount of swelling is not really an indicator of actual damage, there's a poing at which the brain just crushes itself, cranial window or not. Sorry; and yeah, brain tissue can damn well hemorrhage out the ears if there's enough intercranial pressure. It's gross, and an indicator of a pretty piss-poor prognosis *eyeroll*. Anyway, I get what you're getting at, but that patient was just plain gone. Finito. Meat on a vent. And that doc needed a serious cockpunch. But please, be careful about giving out medical advice when you don't really know what you're talking about, especially with brain-injured patients. Way too many people get false hope that way, and needlessly put themselves through years of suffering and grief because of magical thinking about how the brain works and heals itself.

Re:Mixing up advice

[hairyfeet]

Well according to mom all the nurses were seriously PO'ed that Dr NOMW kept pumping up this poor family with false hope when it was obvious by 36 hours she was totaled. According to her this girl, which was ejected out of a jeep at 70MPH+ and had her right skull hit the concrete dividing wall full force, literally hit with such an incredible force that pieces of her skull were slung through her brain matter like a shotgun blast. She said one look at the Xray and even a first year LPN could tell you that girl had no chance of being anything but a body on a vent, but NOMW cared only about the age and not the injury. And yeah, when someone's actual brains start oozing out their ears? I think hope is pretty much lost.

What is sad is if someone besides Dr NOMW would have just sat down with that girl's parents and told them the truth instead of blowing hope up their ass those organs could have saved who knows how many. Mom said her body wasn't hardly damaged at all with the exception of a broken leg. But her head was just a mess, with her entire right side of the skull just powdered from the force of the trauma.

But in the end Dr NOMW got his way, and not only did that girl's parents have to cling to lies and pointless hope for 9 days, not only did all those healthy organs get wasted thanks to all the drugs and machines he used to keep that corpse alive, which yes it was a corpse, but countless amounts of money in ICU was blown for what was basically a meat sack. She said Dr NOMW insisted on continuing even after day 7 when she began to smell of decay. And while I agree one can't just judge a brain injury by swelling in the first 24 hours, according to mom that spent nearly 20 years as charge nurse in one of the largest ICUs in the south, you really know by the 36th hour. By then either the swelling will begin to subside or like this girl the pressure will get so high that even with multiple drains the brain simply crushes itself.

Just think, that poor girl's family could have least taken comfort that their daughter's passing wasn't just a waste, that she had lived on in others thanks to organ transplants, if it wasn't for Dr NOMW. She said he was a total self absorbed prick with a serious God complex, and I agree if anybody deserved a cock punch it was that asshole. All that waste for nothing, just nothing. How sad.

Re:Mixing up advice

[tacocat]

Car insurance covers something different, but the normalized increase of car insurance against what it's covering, when compared to health insurance, is much lower

I never said the client was involved but procedures like cosmetic surgery, which is never covered, has consistently fallen year over year while procedures which are covered by most insurance has risen year over year. And I do not believe what you describe in the operating rooms is rare. But the point of the costs are not all realized on the table. Rather than debating on where that cost is and what to do about it, it's far simpler for competition to sort it out rather than trying to regulate it. More effective, more efficient, and no risk of regulators getting it wrong. If a business can't manage their costs correctly they lose at the bottom line. Regulators don't lose.

Re:Mixing up advice

[Anonymous Coward]

So it stopped to install Ubuntu?

Re:Mixing up advice

[jecblackpepper]

This also has the advantage that the drug companies know what the limit is, so if they want to sell a drug to the NHS then it had better be cheap enough to fit under the bar, otherwise the NHS doesn't buy it and the drug company loses their biggest potential customer in the UK. If there is no limit other than individuals deciding what they can afford or insurance company representatives deciding whether your policy would cover the treatment then the drug company will raise the price as high as they are able to - almost regardless of how effective it is.

Re:Mixing up advice

[OeLeWaPpErKe]

And how much of that 9% is actually spent on patients and docters, and how much on administration, rule-checking and general bureaucracy ?

Is it 50/50 ? Do tell.

Furthermore, I would contend that this is not the deal your government promised the baby boomers if they created the NHS. It is not that deal *at all*.

Do you think government will still respect this, much more limited, deal when you finally need it ? I somehow doubt it.

Re:Mixing up advice

[Kral_Blbec]

Costs have fallen for cosmetics mostly because there aren't a whole lot of new procedures and research being done for them. A face lift today is the same as a face lift 20 years ago. There is little to no room for improvement other than what is common to all surgery procedures. Compare a laparoscopic appendectomy today to an open procedure 3 years ago and they are very different.

My time is worth $15 an hour

[DreamsAreOkToo]

My time is worth $15 an hour (plus benefits). My time alive is priceless. (But I haven't lived while suffering cancer, either)

Re:My time is worth $15 an hour

[BigSlowTarget]

Your time alive is worth more than your family's home, education and future? You would give the children to the state because all of your income above the barest essentials goes to pay current and back medical bills that cannot go away because bankruptcy only works once? You would transform 20 years of your spouse's retirement into 20 years of working at Walmart so they can eat for another week of life?

If you don't have a family then I agree, your life is worth everything you have and everything more you can borrow or talk out of someone. Unfortunately although it's true you can't take it with you its also true you can take other people down before you go. "My life is priceless" makes sense when the decision is between not buying a nice car or a new video game vs. dying but that's not the amount at stake when you pay for medical care. To choose imposing financial ruin and associated suffering on people you presumably love to put off for a few months something that we all must eventually do is simply selfish.

It's not until you consider these implications that you can really say "I would pay any price for one more day of my life."

Happiness

[mr_zorg]

It is only time to quit when the patient ceases to be happy. As long as they are still in good spirits and enjoying their life, keep trying...

Re:Happiness

[Anonymous Coward]

It is only time to quit when the patient ceases to be happy. As long as they are still in good spirits and enjoying their life, keep trying...

Euthanize the depressive!!! Yay! Better be in good spirit, suckers!

Re:Happiness

[sys.stdout.write]

Euthanize the depressive!!!

I'm pretty sure he's restricting his proposition to the terminally (or likely terminally) ill.

Re:Happiness

[Anonymous Coward]

So, you are not allowed to be in bad mood about being terminally ill?

Depression is one of the most common psychological conditions cancer
patients have.

Might as well stop treating all of them.

Re:Happiness

[Anonymous Coward]

If you are gonna die anyway, what's the point in keeping you alive if you don't want to? It's stupid to artificially extent the life of a terminal patient just for him to be miserable a little bit more time. Just stupid.

Re:Happiness

[Anonymous Coward]

Everyone is terminal.

You won't get out of life alive.

LIFE is the leading cause of death. We should stop it.

edit:
Ok... thats creepy......
Captcha: embalm

Re:Happiness

[Anonymous Coward]

If you are gonna die anyway, what's the point in keeping you alive if you don't want to?

You know that there's a difference between depression and suicidal tendencies?

The original poster basically said that you should stop treating people when they are not
happy anymore. What would condemn most of them to an exceptionally agonizing
death, by the way. Care of terminal patients is mostly palliative.

Just go somewhere where they treat cancer or a hospice and ask patients wether
they are good spirited and enjoy their life. Expect to be thrown at with filled urine bottles.

Ask them wether they want to die and only a tiny minority will say yes. You can actually
see the fear for their life in their eyes. When you are confronted with your own death,
you will do anything for another few days. Especially when painkillers are effective.

Most of those who want to die are actually not untreatable yet. That is why they have to
endure painful procedures to prolong their life.

By the way, what makes you think the patient will still be suicidal a few days down the
road? It's not necessarily a permanent condition.

Re:Happiness

[Anonymous Coward]

Being happy is a small and IMHO sometimes a petty or selfish reason. I AM dying from liver failure. I do not want to have a transplant or go through the expenses. I don't want my wife to struggle through the remainder of her life because I love her too much to see her suffer by being poor again.

I'm very happy even with everything that is happening to me. I'd rather live a good life of quality than a long one without.

Re:Happiness

[ookabooka]

What if someone is bipolar and terminally ill?

Re:Happiness

[Dalambertian]

Euthanize the depressive!!!

I'm pretty sure he's restricting his proposition to the terminally (or likely terminally) ill.

Aren't we all terminally ill? Some of us just haven't been diagnosed yet.

Re:Happiness

[coolsnowmen]

Sometimes it is extremely hard to determine how "miserable" a patient is. When they are in pain, they are prescribed pain killers which can put people in a chemically induced "happy" state. And then because of the sickness and the drugs they sleep/nap 18 hours a day anyways.

Re:Happiness

[Anonymous Coward]

And if he's not, allowing a depressive to choose when to stop is no less compassionate than allowing a cancer patient the same choice.

Depression, even when medicated, can last for decades, it can be physically exhausting for the patient, the meds have awful side effects for some and, as a depressive friend once said to me, it's like living with the pain of bereavement every day, even when taking meds.

Euthenasia should always be the patient's choice, not a choice based on their illness.

Re:Happiness

[Dalambertian]

I'd just like to say good luck to you, other douchebags notwithstanding.

Re:Happiness

[Anonymous Coward]

:(

Re:Happiness

[Anonymous Coward]

>I'm very happy even with everything that is happening to me.
Well in that case you'll be unhappy if the transplant will ever be done, and from QOL point of view such operation should not be performed.
let's hope there would be new more happier way, life's not end till your heart stop beating, and that's it.

easy

[zerojoker]

try to estimate cost vs. life expectancy in a function and derive the local maximum.

After all, when it comes to health we should never forget what a life is worth... in terms of hard currency.

Re:easy

[sys.stdout.write]

It's easy to attack an economic analysis of health care as cold and calculating, but at some point we need to admit that it's not worth spending half a million dollars to keep an 80 year-old-man alive for an additional month.

Admittedly, it's harder in some situations (like in the article where the person is 67) than in others.

Re:Easy

[Anonymous Coward]

But who pays the bills? The average cost of health care per family is about $14k, that means at least 44 family-years of payments went into extending his life for perhaps 18 months.

Re:easy

[Anonymous Coward]

Where I live, we have a saying among the population:

"You can afford to die, you cannot afford to fall sick."

After glancing at the article, I can't stand to read it. I don't think I can hold back my tears. So, no RTFA for me.

Re:Easy

[dominious]

Listen, the point is that the patient will want to stop because they are causing you trouble and waste your money.

Your reaction should be not to stop and keep on trying to show them you love them. In the end that's the only thing that will remain.

Life is more than money.

Re:Easy

[jonadab]

Yeah, that works as long as the patient is conscious.

The question becomes somewhat more difficult when the patient doesn't look, medically speaking, like he's ever going to wake up ever again.

Re:easy

[Anonymous Coward]

"try to estimate cost vs. life expectancy in a function and derive the local maximum. "

Obama's death panels will do that only for Republicans.

Re:easy

[Anonymous Coward]

Actually, in the US, dying is expensive. My ex-wife's father passed away about 15 years ago at the age of 61 from a long-term battle with heart disease. The death benefit paid to his widow by social security: ~ $250.00. That's right, 250 _DOLLARS_. He had a decent job and paid SS tax his whole life. That payout barely covers the cost of a couple flower arrangements at the funeral. Total cost of the funeral, which was relatively small and FAR from extravagant, was in the order of $15-20k USD.

Only in the US.

Re:easy

[john.r.strohm]

Try saying that when the man in question is your father.

Try saying that after watching your father's last week of life on hospice protocol.

Intellectually, you know there's nothing more that can be done but make him comfortable.

At gut level, it isn't the same.

(And in case you're wondering, the above is not hypothetical. I wish to God it was.)

Re:easy

[Anonymous Coward]

That's why you'd need impartial people to make those kind of decisions, not relatives or children.

Making healthcare efficient is NOT nice. Before every procedure, you will need to consider if the benefits outweigh the cost. Making a 65 year old, who isn't working anymore, live two years longer has no benefit to society. If he wants to spend his own money to do so, great - but if we're talking about public funds, there clearly needs to be a benefit for society.

Treating the broken arm of a 25 year old worker makes sense - he will earn much more money and pay in taxes & insurance than the procedure cost. However, if you have a 25 year old drug addict that has been living on welfare since forever, it gets harder again.

People need to talk about this, and we need to reach a consensus to where the line is.

Re:easy

[hedwards]

And the justification for that when those that still have decades of productive life left, were they to be able to access affordable healthcare, is? If it's your own money that's your business, but as soon as it robs those with a better chance of survival and producing the resources necessary to provide help for others you'd have to be a pretty bad person to even consider the proposition seriously.

Re:easy

[corbettw]

No one said the decision is easy. That's why it's so important to have living wills, so that your loved ones know what you expect and can be freed from making gut wrenching decisions when the time comes.

Re:easy

[MobyDisk]

This is so weird to me. At a gut level, I want people to end their suffering. What bizarre torturous form of "love" demands that you keep dying (sometimes zombified) people in struggling in pain until their last breath?

Re:easy

[Rich0]

I dunno.

If everybody got $15k handed to them when a loved one died, then the average funeral would be held in Maui and would cost $30k. Services and costs rise to meet the amount of money available - just look at college tuition and oil prices. When parents became willing to dump their retirement funds into tuition colleges obliged by raising prices. When investors were willing to give billions of dollars to hedge funds money managers were happy to trade oil futures until the credit crunch took all their money away.

Ultimately, what is the purpose of a funeral, and why is it that it cannot be accomplished without spending $10-15k? Disposal of a body is pretty cheap. A family gathering in somebody's house is pretty cheap. Renting a church doesn't really have to be all that expensive either. I doubt that 100 years ago they managed to spend $15k (inflation-adjusted) to do all of this.

Re:easy

[sunking2]

oh please. its around 3-5k

Re:easy

[AGMW]

People need to talk about this, and we need to reach a consensus to where the line is.

Actually, first we need to agree that there is, and has to be, a line!

No health care setup can be fully funded, whether private or public, as there will always come a time when someone needs something new and leading edge and they tend to be expensive. Not that money can always be thrown at the problem - I remember feeling particularly sorry for Paul McCartney when Linda died because I think I would have been looking for any and all treatments regardless of cost ... and yet she died!
So assuming we can agree that any health system has a budget we need people to administer that budget and that involves wieghing up the relative merits of treatment A for one (very sick) person vs treatment B for several (not so sick) people: eg Heart Swap vs Hip Replacement.

The people making those decisions HAVE to be cold and calculating about it. This means none of the (now normal!) "how does it feel" style reporting we're now too often saddled with by lazy reporters. The argument of "what if it was your father" is a ridiculous argument - of course you want the best for you and yours but that isn't necessarily the best for 'society' - in much the same way with kidnapping/hostages. As an individual I would say pay them what they ask for to buy my freedom, but as part of 'society' I would say you should NOT pay for my release because I recognise that paying them off encourages more kidnappings!

Re:easy

[Cassini2]

What bizarre torturous form of "love" demands that you keep dying (sometimes zombified) people in struggling in pain until their last breath?

It is hope. People hope to see their relative healthy again. They remember seeing a person healthy. They miss it, and they want to see it again.

Unfortunately, some of the treatments are ineffective. They might extend life, but they will never restore health. Medical procedures are graded by mortality rate over periods of time. Ex: 50% survival at 5 years. The goal needs to be different. Effectiveness should be judged by time outside the hospital without extensive medical intervention. 50% of the time, this procedure gets you 3 more years with your family. A subtle and significant improvement.

Re:easy

[QuantumRiff]

A co-worker was an ER nurse.. She would tell me stories of people that insisted that they revive grandma, even though she had signed DNR letters. If there is any question or argument, their legal team says to always revive.. So they would get someone that wanted grandma revived, which the process of CPR would usually break ribs, and lots of other bad stuff to a frail 80 year old.. She got really frustrated trying to explain that yes, they could revive her, but she was going to die in the next week or possibly 2, and that she was going to need so much pain medicine that she wouldn't be able to talk to them anyways...

People just can't cope with death very well.

Re:Easy

[Anonymous Coward]

Yes, if the patient is the one paying for it.

Re:Easy

[SydShamino]

Yeah, but language in health care legislation to encourage people to create living wills (when they are neither demented nor unconscious and can still make such rational decision on their own) was eliminated because people referred to such discussions as "death panels".

So, instead, more people have made no such indications until they have severe dementia or are in a coma, and then next of kin (spouse usually) have to make the choices, because otherwise the doctors would be making them on their own.

Re:Easy

[nedlohs]

Assholes get sick too you know.

Re:Easy

[Anonymous Coward]

It's not about a spouse just pulling the plug (that's not how it works anyway) it's about having the discussion about what the patient wants. Do you know how hard it is to tell your parents that you'd rather not suffer anymore and just enjoy a few more months? And yes, chemotherapy is suffering. It has nothing to do with someone else deciding, it's about letting the patient decided and respecting their wishes. You almost never see that.

Re:easy

[Anonymous Coward]

Been there, done that myself, glad it was over quick, without a lot of time being wasted trying to fight the inevitable.

Re:easy

[nitehawk214]

The problem is, your life is worth a lot less to me then it is to you. (Sorry, not trying to be an ass, but I don't even know you.) I can probably guess our lives are worth whatever we pay in taxes to a bureaucrat (if that).

I think this is more of a cultural problem. After taking care of a parent with a terminal disease, I can sympathies with anyone in that situation. Furthermore, in many cases the patient's life is worth less to them, then it is to their family.

Re:Easy

[Anonymous Coward]

What happens when the patient can't decide any longer?

Re:easy

[shoehornjob]

just my 2 cents here but I watched my father (who suffered from a massive stroke and should not have made it to the hospital) become a vegetable and waste away for several months before he fianally died. My mother, who was already suffering from clinical depression, suffered on for another two years before she killed herself. From my perspective quality of life is everything. It's never an easy decision to let someone pass but the medical profession needs to be more respectful of the family's wishes.

Re:easy

[hedwards]

Hmm, so I'm a troll for pointing out what people with an actual intellect all realize. Making cannon fodder of the young to prolong the lives of the elderly by what might be as much as a few months is stupid. Perhaps we can turn the youth of the world into a soylent green paste so that the elderly don't have to chew while we're at it.

Re:easy

[Anonymous Coward]

That hope, though, is selfish.

They want their life the way it used to be, with this person alive and healthy. Sure, they might love them, which is why they want them around. At the same time, though, that love is not what is forcing them to stay alive in constant pain with the aid of machines. They aren't actually concerned with the well-being of this other person beyond how it affects them personally. Thus, selfish decisions like keeping this person in a tortured state for as long as possible, so that they don't have to deal with the loss yet. They have to get over themselves and fucking grow some balls.

I just went through this with my grandfather, who was the bedrock of the family. He was dying of lung cancer that spread to his brain. Our only concern for him was to make him comfortable. If you suggested to my mother or grandmother that we should hook him up to machines to keep him going, you would probably have been slapped.

This great man who did so much for our country, who was more of a man than anyone I have ever seen or met, deserved a death in comfort around loved ones, not a prolonged and agonizing death connected to cold machines.

Re:easy

[RAMMS EIN]

When will you be running for president? I'll support your health care reform.

Re:easy

[owlstead]

The one thing I can remember of my father dying was the useless suffering of brain cancer in the last two months. Even when he cried out that he wanted to die doctors said he was not "able to decide". This even though he did in fact already put this on paper, and had the support of everybody around him.

My mother died two years after that, struggling with the same disease fortunately in a different spot. After a while she stopped the normal medical treatment and decided against a second surgery. She died peacefully after having taken time to say goodbye to everybody she loved. It did take a long time for her to accept her fate though, and choosing to end your life that way is certainly not for the weak of heart.

If anything is wrong with the current medical system is that it tries way too hard to safe lives. It should focus on the quality of life instead. It should certainly be able to make hard choices in this matter. And most certainly it should allow patients to make their own decisions (and stop religious groups interfering with such matters.) With the savings we can make the life of a whole lot of persons a lot better.

Re:Easy

[Anonymous Coward]

the church has no say in it either way. stop putting spin on this shit by bashing religion. if the church has so much influence in the medical arena then explain to me how abortion is still legal?
 
you're just another slashdork with a hair up his/her ass. get over it and be real.

Re:Easy

[igny]

It's time to quit when the patient says it's time, and it's not the business of the spouse, the church, or the government to decide otherwise.

But later he may change his mind and be pissed at his wife for listening to him.

Re:easy

[shermo]

I remember feeling particularly sorry for Paul McCartney when Linda died because I think I would have been looking for any and all treatments regardless of cost ... and yet she died!

I'd find it much more tragic if there was treatment available and I wasn't able to afford it. At least in his case there really was nothing he could do about it.

Re:easy

[roystgnr]

No health care setup can be fully funded, whether private or public, as there will always come a time when someone needs something new and leading edge and they tend to be expensive.

Expensive for a while, anyway. My thanks go out to everyone who paid $50K each for flat bigscreen HDTVs; while I was just drooling over them, you were subsidizing the R&D on the model I got for $1500 years later. And to those people who held out until today, when prices for that quality are under $800, I'm happy I did my part.

It's a good thing people don't actually care as much about TV as they do about healthcare. We'd either be using CRTs or $5 trillion further in the hole, depending on whether the better models had been categorized as "excessive" or "a human right".

Re:easy

[PeterAitch]

You have to experience this with a loved one to understand it. I'm in the midst of it right now with my Dad (although, mercifully, in the UK the financial aspect is much less burdensome to the individuals concerned). Intellect is ultimately not enough: indeed a truly rational or analytical approach can lead to guilt and depression because you try to follow a course which you think to be "right" but which feels "wrong". The whole thing is an emotional, ethical and (potentially) financial minefield.

Re:easy

[jmactacular]

I really wish America would at least have this conversation. A discussion of the hard choices. Rather than an irrational frenzy over "death panels".

Re:easy

[Anonymous Coward]

This is the question of "death panels", restated.

Re:Easy

[RightSaidFred99]

Huh? Certainly if the patient can pay the bills this is the case. What if someone else (insurance company, tax payers) are footing the bill?

Re:easy

[Anonymous Coward]

One of the key distinctions I think missing in the health care reform debate, is that just like your health insurer now (if you have one) decides what it will and won't pay for, often excluding elective or experimental treatments, is that gov't health care would do the EXACT SAME THING your insurance company is doing right now.

And a public option doesn't mean that you can't have your own supplemental insurance that covers more treatments. There's plenty of that in markets around the world.

It baffles me that we have made the health care reform debate so confusing when it doesn't need to be.

Re:Easy

[ben_white]

It's time to quit when the patient says it's time, and it's not the business of the spouse, the church, or the government to decide otherwise.

Who pays the bill in your scenario? It is easy to say it's the patients choice, and if the patient is paying the bill no problem. The problem becomes when we socialize the financial risk of serious medical illness (either through government run programs like Medicare and Medicaid, or through premiums paid to private insurance corporations). Now other people are fitting the bill! That is what this whole article is about. Patients often make different decisions on proceeding with care based on whether they or some third party is fitting the bill. I've seen it first hand more times that I can count. Treatment A has a 10% chance of giving you 6 more months but costs $10,000. If a third party is paying 80-90% of patients jump at the chance. If it is out of their pockets (even in patients who can afford that kind of money) this rate drops significantly.

Re:Easy

[LatencyKills]

Well, that's of course the problem with a publicly financed health care system. It's also furthermore a problem of a health care system where apparently only people who can afford medical care get medical care. The reality of the current health care system in America is in fact the worst of both worlds - everyone is paying for the medical care of those who can't afford it, but the only way people who can't afford it manage to get it is through emergency rooms - far from the most efficient or cost effective way for it to happen. And to sort of go offtopic for a moment if I might, I'll add that from a societal spending money standpoint, if you gave the average citizen the choice to either spend their money on someone else's medical care or cable for death row inmates, which do you think the average person would choose? We have this enormous wasteful government, and I think wasting money on health care would be among the least offensive holes they could dump it down, at least for me.

Re:easy

[Anonymous Coward]

Seriously, one of the best posts (analogies) ever. Do we want a "right" to a CRT or an opportunity to buy a light weight, flat, crisp $700 HDTV-1020i 42" 120hz (last week - : ) - for me).

Re:easy

[FlyHelicopters]

Yes, and sometimes hard decisions have to be made that you won't like.

For example, if your house is on fire, you get out, the fire engines show up, and you then realize that your kid is still inside, you WILL try to run back in and save him/her, and the firemen WILL tackle you and stop you, because it serves no purpose in having you die in the fire, or worse they then have to try and save both of you. You won't be very happy about that decision either, even more so if your kid dies, but it will have been the right one.

You're right, when it is your father, any amount of money is acceptable, and if you personally have it to spend, go for it. The problem is when people want "other people's money" to be spent in such a case. I don't want half a million tax payer dollars spent to give an 80 year old another month, however you're more than welcome to spend your own money on your dad, if you have it.

Cold decision, but cold decisions have to be made when demand is unlimited and resources are limited.

Re:Easy

[Anonymous Coward]

...and when the patient is in a persistive vegetative state? what then?

Re:easy

[Eivind]

No it wouldn't. It's true that if everyone had more money, the average funeral would cost more. Because -some- people are money-constrainted. But most aren't. Most people don't opt to make a funeral that costs the maximum amount they could possibly pay. Indeed doing so would be monumentally stupid, it's hard to think of something STUPIDER to do with your money than spend it all on celebrating that somebody died.

It's cost-benefit like everything. Most people would want to spend some money, both as a token of respect to the dead, and also to provide a nice funeral for those still living. But spending twice the money does not give twice the benefit. No, it's more like, if everyone got $15K when a loved one died, the average funeral-price would rice by $5K.

Re:easy

[Ihlosi]

Seriously, one of the best posts (analogies) ever.

It's one of the worst false dichotomies ever, if anything.

Do we want a "right" to a CRT or an opportunity to buy a light weight, flat, crisp $700 HDTV-1020i 42" 120hz (last week - : ) - for me).

You can also have both, you know.

Re:Easy

[Anonymous Coward]

Do you deny the "to each according to his need" you're implying to be inherently Marxist?

Re:easy

[Anonymous Coward]

+1 Uncomfortable Truth

Re:easy

[Rich0]

Most people would want to spend some money, both as a token of respect to the dead, and also to provide a nice funeral for those still living. But spending twice the money does not give twice the benefit.

Agreed in general, but let's think about what motivates people.

Why is it that somebody would consider it too little to just bury the body in a wooden cask and have a brief ceremony at the grave site? Why is it that somebody would consider a 3-week vacation in Maui excessive?

I think the answer is general community expectations. Most people hold funerals in the same way that everybody else does, just as they do with weddings. 100 years ago both weddings and funerals were much simpler affairs than they are today.

The year after those $15k checks were mailed the cost of funerals would only rise a little. However, year after year the complexity of funerals would rise, and costs would rise with them. Eventually people will be having funerals in 5-star hotels because "that's just what you do."

Re:easy

[ResidentSourcerer]

I disagree.

After my mom's first heart surgery, she said never again.
She lived 3 more years. The last 6 months were in an extended care facility doing a balancing act between her failing lungs (emphysema, from 60 years of smoking) failing heart (overweight, diabetic) failing kidneys (diabetes, diaretics to keep her lungs from filling up.)

I said my good-byes and left her with my sister.

****

When I was 14 my father had open heart surgery. they replaced 3 valves that had been damaged by rheumatic fever when he was a young man. The hours on the heart lung machine, coupled with vastly improved heart action after, caused a series of micro strokes. The strong vibrant man who was my father was replaced with this hollow shell that could no longer help me with my math, no longer could follow the plot of a TV show. Worse, he knew what he had been and no longer was.

****

My grandmother Zelia was in a car accident at age 75. She recovered consciousness in the hospital, her kids had time to see her. Most of the grand kids came by, and some of the great grand kids. She died that night. Good way to go.

****

My other grandmother broke her hip in the old folks home she was in, and never got out of bed again. It took 6 months for her to finish dying.

****

The father of a friend was a heavy smoker. Early in his 60's he was diagnosed with lung cancer. He refused the lung transplant offered, opting for paliative care. He lived at home with his wife. The kids and grandkids came by frequently, and he would play with them, less and less actively as lung function deteriorated. I think only the last 2-3 weeks were in a hospice. He had courage.

My wife and I have living wills. Neither of us are to keep the other alive once there is little chance of recovery.

My sister has deliberately chosen to live on an island. It's half an hour to the ferry terminal, an hour plus ferry ride, and another hour drive to the nearest hospital.

***

My best answers:

* Once I go to bed for the last time, try to keep me alive until I've said good-bye to my people. After that, just paliative care.

Our culture has become morbidly fearful about death. As a practitioner and teacher of backcountry travel I have come close to death a few times. Events such that I was certain I was not going to live more than another minute or two.

I discovered that death is not to be feared. I had regrets of things not done, did not like the pain I was in, but death itself was just there.

Do not project your own fears onto other people. Have courage. Face your death when it's time.

Re:easy

[Anonymous Coward]

You cannot compare a heart swap and a hip replacement. Replacing someone's heart is fundamentally different than a hip swap. One is saving someone's LIFE - one is not. Sure, the hip swap is improving a person's quality of life, but they have life either way.

If the people were making the decisions were completely cold and calculating - then it would be easy - just die already! Kill babies that have birth defects or chronic illnesses. Don't bother with heart or lung or liver transplants. But then where do you draw that line? How do you determine how much is too much to spend on saving my life?

The point is that you can't calculate the value of a human life based on any emperical measurements. You can't base it off of what a person contributes to society. You can't base it off of anything other than the fact that there is intrinsic, infinite value to human life.

Re:easy

[Eivind]

Nah. Seriously not. It's true that the average cost of funerals has risen with standard of living. That makes perfect sense, because the benefit of a nicer funeral is the same whereas the cost is less and less.

Put more simply, if a nicer funeral would cost a years salary, and you where living on the bare essentials, you'd make do without, whereas if the same nicer funeral would cost you a weeks salary, and could be covered by shortening your bahamas-vacation from 14 to 10 days, you might do it.

Giving people $15K makes them sligthly richer, agreed. It's completely unreasonably however, to suppose they'd want to spend 100% of this increased richness for funerals. Why would they ?

Yes, generally if people have more money, they'll spend more for everything, including funerals. Someone who is richer will have a tendency to have a sligthly more expensive house, a sligthly more expensive car, a sligthly more expensive vacation, and yes, a sligthly more expensive funeral. No argument with that.

But you seemed to be saying that additional money would get distributed 100% to funerals, 0% to all other spendings. I don't see any rationale for that at all.

Maybe she can answer in hindsight

[tsotha]

Maybe she can decide at this point "hey, we should have stopped fighting here and just put him in hospice care", because she knows when he finally succumbed. But sometimes people beat cancer (rarely or often, depending on the cancer). Let's say early on they decided to go the hospice route, and he died. What is she going to think when she opens up the paper and find a story about a guy with the same cancer who lasted another 20 years?

It's really easy to draw a line on a chart and say "anybody on the right side of this line has such a bad prognosis it's just not worth the money to treat them. It's a lot harder when it's your mom.

Re:Maybe she can answer in hindsight

[Anonymous Coward]

It's a lot harder when it's your mom.

Re:Maybe she can answer in hindsight

[dominious]

so from all this you picked the last sentence to make a joke. How old are you, 10?

Re:Maybe she can answer in hindsight

[kramulous]

I read somewhere just recently that apparently Americans have the worst survival rate with cancer because they believe god will help them more than what science will. That has a big effect on outcome.

Listen to your doctor.

Re:Maybe she can answer in hindsight

[JordanL]

I read somewhere recently that unsourced claims and statistics rarely convince anyone who doesn't already agree with you.

Re:Maybe she can answer in hindsight

[cedars]

In fairness, the fact that someone can crack a "your mum" joke in this discussion scares me a lot less than some of the other posts here that suggest "your life = your salary."

The truth is your life is worth more than your salary. For starters, even if you only wanted to focus on money, it's not just your salary that matters but your potential future salary. However this thinking is still severely flawed, humans do a lot of activities that aren't costed. They care for people, fall in love, contribute to the cultural and political life of society, write open source software, complete volunteer work and provide social engagement for others.

We should never underestimate the value of surviving, surviving is what humans do, everything else (including sex) is just a footnote.

Re:Maybe she can answer in hindsight

[Kijori]

The studies I have seen put American and European survival rates at about the same level, with normally a slight advantage to the Americans, although critics point out that reporting differences (for example, in Great Britain anyone diagnosed with cancer is included in the survival figures, while in America deaths that may not be related are not counted, plus many American hospitals publish only estimated survival percentages rather than actual counts), differing access to treatment (if you don't go to the hospital you won't get counted, which could stack the deck against socialised healthcare) and uncontrolled variables (incidence of cancers is lower across much of Europe, possibly because of differences in the health care systems) make comparisons contrived at best.

Re:Maybe she can answer in hindsight

[kramulous]

I understand you don't like the result, don't worry, it only affects those who are religious. The American slant was what appears to be 'African American Women' and breast cancer. I need to be at work to do a much better check and get the exact papers.

http://scholar.google.com.au/scholar?q=health+outcomes+cancer+god&hl=en

Re:Maybe she can answer in hindsight

[Malakhay]

You just made my day. Every once in a while there are these gems of wisdom on slashdot. This is one of them.

Re:Maybe she can answer in hindsight

[Anonymous Coward]

What scares me is that it was an incredibly good your mum joke. It was achieved by merely by removing a few sentences and fit perfectly with the post title as well. Simple. Elegant. Beautiful.

Re:Maybe she can answer in hindsight

[dominious]

yes, but GP was talking about cancer. Is any joke appropriate?

Re:Maybe she can answer in hindsight

[Bluesman]

The funny thing is about the socialist health care method is that now we're all forced to care about these things and decide what's fair for other people, and put a value on their love, volunteer work, etc.

This isn't an issue when people pay for themselves.

Re:Maybe she can answer in hindsight

[nacturation]

yes, but GP was talking about cancer. Is any joke appropriate?

Of course. A very widely observed human response to tragedy is to make jokes. It's a coping mechanism for many people, whether they're personally involved or not. It's cathartic and relieves the tension of an otherwise uncomfortable topic.

Re:Maybe she can answer in hindsight

[nacturation]

Closely related: http://www.theonion.com/content/video/courageous_man_refuses_to_believe

Re:Maybe she can answer in hindsight

[fbjon]

All jokes are appropriate. Some are just badly made.

Re:Maybe she can answer in hindsight

[AGMW]

yes, but GP was talking about cancer. Is any joke appropriate?

Do what now? Are you saying there's some law forbidding jokes about cancer? Are there any other diseases on that list or are safe to joke about menstrual cramps, MS (the disease not the software company ... actually on this w/s that doesn't necessarily disambiguate!), D&V?
I used to wonder whether doctors should have a "Fuck me! Cancer" form they could just sign and hand to patients instead of all that hand wringing sad face crap!
We'd learn to dread the doctor pressing the intercom button and saying "Nurse, could you get me the FMC pad please".

IMHO laughing at cancer is the way forward. We should do all we can to diminish the general conception that cancer is a death sentence. Obviously, some cancers are bad - REALLY BAD - but a lot aren't, and something's got to get us in the end. There may even be some mileage in the perception that "being happy" is better for you than "being sad" so what better medicine than a book of cancer jokes, to be taken twice a day before meals.

Re:Maybe she can answer in hindsight

[CrimsonAvenger]

yes, but GP was talking about cancer. Is any joke appropriate?

Speaking as someone who has cancer, yes. If you can't joke about it, your life probably isn't worth living.

My wife, on the other hand, seems to think my jokes about my cancer are in poor taste. Go figure...

Re:Maybe she can answer in hindsight

[AGMW]

This isn't an issue when people pay for themselves.

No indeed! Screw the poor people who are ill - hell, let's screw all the poor people anyway! We could probably get a posse together and drive those low-life middle income people out of town too!

Oddly, we pay less for our Social Healthcare in the UK than those who can pay pay in the US for their private health care, and this includes the safety net for the poorer people in the UK who are otherwise unprovided for in the US. I'm not saying the NHS is perfect (or actually that it even could be perfect) but it sure as hell beats the alternative!

Re:Maybe she can answer in hindsight

[ColdWetDog]

This isn't an issue when people pay for themselves.

Total and complete bullshit - unless you live in some Spartan fairyland that doesn't exist.

Do you think that hospitals get to stop treatment when bills mount up? You get to stop going to the ER? We get to say "oops, no bucks, so sorry".

It gets done. It gets billed out. It doesn't get paid. That's why Miami, Florida is about to shut down 1/3 of it's public hospital facility.

Get it out of your Rush Limbaugh addled brain that the free market actually works in Medicine. Unless you're willing to go the full Monty of showing your Visa card at the door and having the IV stop when you reach the credit limit - and, while we're at it - dismantle the majority of Federal and State regulations pertaining to the delivery of health care - you and Sarah Palin are so utterly wrong about this that it's amusing.

Re:Maybe she can answer in hindsight

[roman_mir]

care for people, fall in love, contribute to the cultural and political life of society, write open source software, complete volunteer work and provide social engagement for others

- I can have a script for that ready by the next week.

Re:Maybe she can answer in hindsight

[Anonymous Coward]

Do you think that hospitals get to stop treatment when bills mount up?

Actually, in some cases, yes.

You get to stop going to the ER? We get to say "oops, no bucks, so sorry".

It gets done. It gets billed out. It doesn't get paid. That's why Miami, Florida is about to shut down 1/3 of it's public hospital facility.

Yes and no. If you show up at an emergency room (with an emergent condition) at a hospital that takes medicare/medicaid, then they have to treat you first and send you the bill later under EMTALA.

For everything else, the health care provider is fully entitled to establish that you have the ability to pay, and is under no obligation to treat you if you are unable to pay.

As a side effect, EMTALA doesn't apply if the hospital doesn't have an emergency department, so many hospitals are closing them since they lose so much money in the ER.

You're also starting to see independent ER facilities that don't take medicare/medicaid and therefore don't fall under EMTALA.

And while at the University of Chicago Medical Center, Michelle Obama started a program to encourage poor patients who arrived at the ER to turn around and go to other hospitals.

Re:Maybe she can answer in hindsight

[Anonymous Coward]

"We should never underestimate the value of surviving, surviving is what humans do, everything else (including sex) is just a footnote. " Close, but (sometimes no cigar is just) no cigar.

Dying is what humans do. All people die. The only survival lies in sex and procreation. When I die, the only thing really left of me will be my two daughters, and their chances to have their own families. When I look at them, I see, along with their differences, some aspects of myself, renewed in a child's body. That is why I'd go to my grave early for either one. They are my survival. My own grave, now, has little to do with it.

Re:Maybe she can answer in hindsight

[navyjeff]

A man in his 60s goes to the doctor for a physical. The doctor says, "I've got some bad news for you. First, you've got Alzheimer's. Also, you have cancer."

The man replies, "Well, at least I don't have Alzheimer's."

Re:Maybe she can answer in hindsight

[dominious]

ok not any jokes, but if someone's mother dies from cancer you don't go and say to the person "It's a lot harder when it's your mom" and laugh out loud because you just said a joke do you?

Re:Maybe she can answer in hindsight

[owlstead]

Living is what people do and surviving is a large part of that. It's a large part, but it is certainly not the whole pie.

Re:Maybe she can answer in hindsight

[The Slashdot 8Ball]

say to the person "It's a lot harder when it's your mom" and laugh out loud because you just said a joke do you?

The error is in laughing at your own jokes.

Re:Maybe she can answer in hindsight

[bvankuik]

We should never underestimate the value of surviving, surviving is what humans do, everything else (including sex) is just a footnote.

Recent theories suggest that sex is actually more important than survival. Read "The Selfish Gene". An example can be found in birds, where the males have very distinguishing colors. These colors are easier to spot by predators. But they also tell the females, look how nice my colors are -- I can execute my mating dance in the open field and not get caught by predators.

Re:Maybe she can answer in hindsight

[Anonymous Coward]

I have a different view. A particular life might be worth a lot to family and friends, but it is not and can not be that valuable to society and humankind at large. The fact is, EVERYONE is going to die. Period. If a life would be that valuable to society then society is in deep risk, but it isn't because someone can always fill the shoes of people before them.

In the context of health care, fine, let the family spend as much as they desire to keep someone alive. But please do not put that on the insurance system and make everyone else pay for it because that life just is not that valuable to others. There has to be a line drawn.

In the context of the planet earth and the environment, the planet just will not be able to tolerate an ever increasing population. There are already pressures on the resources and decreasing quality of the environment.

I'm sure there are other contexts that can be argued from a societal point of view, but I think that will only end up pitting one's life against another and who's to say which is more valuable?

Re:Maybe she can answer in hindsight

[Anonymous Coward]

Well, of course they picked the last sentence.

The rest of it isn't funny.

Wrong question

[DNS-and-BIND]

She shouldn't be deciding at all. How the hell is she qualified to discuss such matters? These things need to be left in the hands of experts. The common people have all sorts of crazy ideas when it comes to health care, and it would be a lot better for everyone if the right choices were made for them.

Re:Wrong question

[AmazinglySmooth]

I think your premise is wrong. People make decision all the time without full knowledge of all of the underlying facts. So called "experts" who know enough to know the outcome rarely exist. Another thing to consider is that it is my life. I would never want to give up freedom to some "expert". I may listen to the "expert's" advice, but I still may choose to want to try to win despite the odds. Tim Tebow's mom was told that she should abort him by a so-called expert, but she didn't. Look at him now. If I want to go for it, and it is my money, then I should. If it is someone else's money, then they should be able to decide. That is why you should never let the government run your money for you--you give up your freedom to decide.

Re:Wrong question

[Anonymous Coward]

At some level, it is a personal choice of the patient whether or not to continue to seek treatment. Should the patient be incapacitated, the choice devolves to the next of kin or whoever has power of attorney. I had a great uncle that decided he'd rather die than live without his tongue (some form of cancer) and a grandfather who made it quite clear that he never wanted to visit a hospital ever again, regardless of the consequences. That is their choice, not a doctor's.

Re:Wrong question

[__aasqbs9791]

My sarcasm detector is on the fritz, did you drop this /s? I honestly can't tell.

Re:Wrong question

[scalarscience]

Funny, I read the parent post as sarcasm.

Re:Wrong question

[tburkhol]

If I want to go for it, and it is my money, then I should. If it is someone else's money, then they should be able to decide. That is why you should never let the government run your money for you--you give up your freedom to decide.

And if it's the insurance company's money? I mean, that's why people get insurance, right? On the belief that the insurance company will pay out more than they have paid in, while that is clearly at odds with the continued operation of one of the most profitable industries in the country. They have to pay out less than you pay in. On average, you have to get less care than you pay for.

Almost every argument against government healthcare is an argument against the insurance industry.

Re:Wrong question

[Anonymous Coward]

Wow.

Just like we're supposed to listen to the global-warming "experts" who've been exposed as frauds?

No thanks. I'll educate myself and make my own decisions.

Re:Wrong question

[Homburg]

These things need to be left in the hands of experts.

Absolutely. I know I'm not qualified to make all kinds of decisions about my healthcare, and so I don't want to be in a position where I'm forced to make them. And I suspect I may well be incapable of making a rational decision about end-of-life care for someone I love (thank god, I've never yet been in that position), and I don't want to be in a position where I have to decide something incredibly important, where I know I'm incapable of making a good decision in this instance.

Just $200 more...

[throwaway85]

...and he could have at least said his death was palindromic.

Re:Just $200 more...

[Anonymous Coward]

...and he could have at least said his death was palindromic.

You insensitive clod!

Re:Just $200 more...

[Anonymous Coward]

They can give me the $200, if they want...

Re:Just $200 more...

[Subm]

Or $2,000 less. Or they could charge an extra 616,816 cents.

Or $618,616 less would have given a palindrome and rotational and reflection symmetry.

Re:Just $200 more...

[Anonymous Coward]

Don't you consider that maybe he was shooting for that specific palindrome?! $200 more in medications, and he ould have had it! You insensitive clod!

Definitely not priceless.

[elucido]

If you only make $15 an hour this should be an indication as to your worth. But if you really want to know how much your life is worth, find out how much it would cost to have someone take your life and you'll receive an answer.

Re:Definitely not priceless.

[annex1]

Only make $15/hour? I'll assume that you make considerably more than that. If that's the case, you become a bigger loser for trolling around on /. for what "you're worth" versus what "he's worth". He's wasting $15/hour and you are wasting considerably more. When did hourly income become the value of an individual?

Re:Definitely not priceless.

[digitig]

If you only make $15 an hour this should be an indication as to your worth.

You don't know what the benefits are. Maybe he gets to bone supermodels. Many men would accept a negative hourly rate for that.

Re:Definitely not priceless.

[Idiomatick]

Reagan era?

Re:Definitely not priceless.

[Anonymous Coward]

When did hourly income become the value of an individual?

Since we are talking about hours of your life time. $15 one hour (of your life), that's pretty straightforward, no euphemisms.

Re:Definitely not priceless.

[Ogi_UnixNut]

In which case the average life is worth between 800-1600 Euros? I disagree. I'd argue your life can't be measured in worth. The best you can do is see what has been invested in it, both in time, and money (education, feeding etc...), and what is the value of that which you can contribute back to the world.

Re:Definitely not priceless.

[Anonymous Coward]

See, now, if only companies offered benefits such as those instead of "spending an extra two years of life in a vegetative coma taking cancer drugs".

Re:Definitely not priceless.

[JustOK]

More like four-score and and 1 year ago.

Re:Definitely not priceless.

[lukas84]

Suicide by supermodel. I like it. Not sure if the wife's too happy about it, but everything has it's disadvantages.

Re:Definitely not priceless.

[danceswithtrees]

Suicide by supermodel.

How does that work?
1. You are with supermodel
2. Wife finds you with supermodel
3. Wife not happy
4. Wife expresses her unhappiness on your head with blunt instrument
5. Profit?

Re:Definitely not priceless.

[AGMW]

Maybe he gets to bone supermodels.

Strewth, they're all skin and bone anyway! If you took away the bones I guess they'd be a bit more comfortable to lie on, but it's really not going to help their self esteem problems now is it!

Re:Definitely not priceless.

[lukas84]

Nah, i was thinking about older men with a weak heart.

Re:Definitely not priceless.

[Anonymous Coward]

You don't know what the benefits are. Maybe he gets to bone supermodels. Many men would accept a negative hourly rate for that.

Nice assumption on the gender.

Re:Definitely not priceless.

[phoenix321]

You don't know what the benefits are. Maybe he gets to bone supermodels. Many men would accept a negative hourly rate for that.

Nice assumption on the gender.

Male supermodels are usually men who have sex with men. And there are definitely men who would pay to have sex with them.

So, nice (and wrong) assumption on the sexual orientation, pal.

Re:Definitely not priceless.

[shentino]

Life can be worth infinity and you'd still need to take into account the cost.

In particular, opportunity cost of NOT spending that money on someone else, perhaps in a more efficient manner.

Bear in mind that resources devoted to keeping one person alive are resources that cannot be devoted to keeping other people alive.

Withholding services can kill a terminal patient just as easily as withholding comparatively much cheaper food and water from healthy people can get them starved to death, or worse into a bed right next to that terminal patient.

Respect for human life aside, I think money is better spent on prevention, and on keeping that "patient" from winding up in an expensive hospital bed in the first place. That saves their life, and to boot lets them live happily, and with enough money left over to similiarly save a dozen other people as well.

Lives versus dollars will never make a good comparison. However, lives versus lives might.

Re:Definitely not priceless.

[MaskedSlacker]

1919? Try again?

Re:Definitely not priceless.

[MaskedSlacker]

Many men accept a negative hourly rate for meth-addicts on the street corner. It's called prostitution.

Re:Definitely not priceless.

[unknownroad]

Death by snu snu.

Re:Definitely not priceless.

[JustOK]

um...1929?

Re:Definitely not priceless.

[gmhowell]

Considering how infrequently my ex and I had sex and the amount I have paid, am paying, and will pay, I could easily have afforded a group orgy at Eliot Spitzer's whorehouse of choice and still come away ahead.

Re:Definitely not priceless.

[mjwx]

When did hourly income become the value of an individual?

About 10 minutes after they were no longer permitted to sell us on the open market.

Re:Definitely not priceless.

[MaskedSlacker]

Lesson learned my friend. Lesson learned.

Re:Definitely not priceless.

[MaskedSlacker]

2010...carry the one....fuck me. My bad.

Though I still don't see how that year is when hourly wage became the measure of the individual. What the hell does a stock market crash and the ensuing depression have to do with that? People were crass and greedy and materialistic all through the 1920s. And the 1910s. And the 1900s. And the 1890s. And the 1880s. I could keep going, but I won't.

Re:Definitely not priceless.

[elucido]

You might want to convince yourself that your life cannot be valued in dollars but I can assure you that it can be. There are no priceless lives except in the hearts of the immediate family and friends who care if they live or die. That's probably a handful of people.

So how much was for actual medical care?

[dbIII]

There is a HUGE amount of overhead in US health care starting with a massive markup on medicine which isn't seen elsewhere and ending with the support of a lot of middlemen.
It doesn't matter if it's private or public - what matters is removing the leeches and profiteers from the system and turning it back into medicine instead of a protection racket pretending to be insurance and hospitals where care is an afterthought. The doctors are not the ones getting rich and if you want to see a nurse laugh ask them if they are rich.
I doubt that the same amount of care elsewhere with the same treatments under a public system would have cost the taxpayer anywhere near one fifth of that. Remember folks, it's still a drain on the economy even if rich sick people are the ones getting ripped off instead of the taxpayer - it still hurts everyone to an extent.

Re:So how much was for actual medical care?

[rolfwind]

It's not just insurance, which is why I don't understand the current debate as making insurance the only bad guys.

I know someone who broke their leg. While in the waiting room, they asked the staff for a blanket because they were cold. They got an equivalent of an airline blanket in size and quality. The hospital charged him $395 for it plus labor.

Someone else I know needed aspirin. The staff got him one and charged $725.

I went to the hospital for stiches. Got an X-ray to check for metal parts. Had no insurance. Got charged $3500 or so. They didn't even stich, just stapled 20 staples.

There's a lot wrong with the picture.

Re:So how much was for actual medical care?

[Anonymous Coward]

The "massive markup" on medicine pays for R&D on new drugs. Without that, there would not be nearly the level of R&D that we see today. It's not that we pay too much. It's that other countries pay too little.

No one will invest in R&D if the return on their investment will be controlled by the government. As it stands now, the US market is the only reason there is any investment in health R&D. Canada has price controls. Most of europe has single payer (monopsony pricing ftl).

If the US implements price caps or single payer, it will be the death of private R&D in the health sector. And the government will *never* be able to make up for the loss.

There are problems with our health system, but price caps and/or single payer are not the answer.

Re:So how much was for actual medical care?

[Anonymous Coward]

Assuming you are not exaggerating, I wonder if a court would call this profiteering? For that kind of money, I would definitely attempt to make the case.

Re:So how much was for actual medical care?

[Anonymous Coward]

I live in Finland. Despite being a small country with socialized medicine we have a world-renowned pharmaceutical industry. The companies' return on investment is certainly not controlled by government since the government has nothing to do with running private companies in a country with socialized medicine. Maybe you assume that socialized medicine means that everything is socialized, but it isn't. In Western European countries the only thing which is socialized in addition to what you have socialized, is health care. You do know that you have a socialized fire department, police force and public schools? IMNSHO, those and health care are such basic necessities that they should be guaranteed to be available for every citizen.

Now, I do not know how the Canadian system works but you don't seem to know how single payer systems in Europe work. For instance, I suffer from a chronic condition, which requires quite expensive medication and every three months when I visit the pharmacy the receipts say:

pills that are none of you business (but made by Pfizer): 1 698 €
public insurance subsidy 100 %: -1 698 €
customer fee: 3 €
total: 3 €

How does Pfizer make less profits when the public health care system pays instead of me, who as a student simply couldn't afford that?

Now, I'm not telling you to adopt our system since it's none of my business but it's annoying when you have misconceptions about European systems and frankly insulting to imply that we "pay too little" since I know very well where the 100 % subsidy comes from. However, something you might think about is that the money going to insurance company employees (not to mention executive compensation) and their shareholders, is money paid by citizens that might need care and for what, exactly? Deciding what care you can or cannot get? Not a single person working for a health insurance company has your best interests in mind yet you pay them. In European systems, there's no middle man deciding what to cover and what not to, which does save a lot of costs. Nobody disagrees that capitalism works in most cases since the private sector is more efficient than the public one but do you honestly believe that socialized medicine is run so inefficiently that more money can be spent on actual care when there's a private insurance industry grabbing money between patients and health care providers. More money than in our system where doctors decide what treatments or medications patients need?

Re:So how much was for actual medical care?

[throbbingbrain.com]

First, an aspirin costs $500 when they dispense to 500 people and only one person pays for it.

Second, I remember a time when, if someone needed stitches or a cast, they went to their doctor's office. The ER was where the ambulance took you if your brains were hanging out of your skull.

Re:So how much was for actual medical care?

[cnaumann]

Medical costs really don't mean anything. There is no rational or justification for any of it. They are just made-up numbers. It would be difficult enough to make judgement calls on real numbers, but it is impossible with fake numbers.

It is also very reasonable to spend a lot of money fighting the condition that will/does kill you. Where else are you going to spend it?

Re:So how much was for actual medical care?

[FooAtWFU]

Ask yourself, "If they charged me less, who would benefit?"

Now find some way to make "the hospital" part of that answer.

Pretty hard, isn't it?

Re:So how much was for actual medical care?

[dbIII]

Unfortunately that is bullshit fed to you by expensive PR.
An example demonstrating it very clearly is the cervical cancer vaccine developed with Australian taxpayers money, certified to US standards by the Australian taxpayer (similar to Australian standards so not a lot more) and licenced to US manufacturers for a very low fee. Guess what - it costs more than twice as much as anywhere else in the USA with the "R&D" excuse without a single dollar spent on research and development by those jacking up the price..
Most US commercial medical "R&D" is finding loopholes in patents or slight refinements in research paid for by taxpayers somewhere, often US taxpayers. There are exceptions but the markup seems to be an order of magnitude more. It's really just a way to lie about profit instead of being up front about it. Since there is very little competition in that market there is a lot of room to gouge money about of people instead of just making a comfortable living.

Re:So how much was for actual medical care?

[Rich0]

Second, I remember a time when, if someone needed stitches or a cast, they went to their doctor's office. The ER was where the ambulance took you if your brains were hanging out of your skull.

Yup, but then again I remember a time that if you got a minor infection after this happened you couldn't have sued the doctor for a few hundred thousand dollars for not performing the treatment in accordance with the general standards of care, which generally translates into the best possible manner of rendering the treatment generally available.

Or, another illustration:

Suppose an oncologist advises a patient that it might make sense to just make the most of their last few weeks on earth and not suffer with chemotherapy. The patient dies in a few weeks. The family talks to a lawyer and a bunch of experts second-guess that decision and the doctor could easily end up paying a fortune for prematurely ending a life.

Suppose instead the oncologist just tells the family what the best care available is, and discloses the side effects. The patient goes through agony and dies in a few weeks. Well, what do you expect from chemotherapy, the doctor has given the patient the best care available and that's just how things go. Family's insurance pays the $100k bill and no lawyers are involved. Doctor gets paid more for administering the treatment.

And then we wonder why healthcare is so expensive... NPR had a really great two-part program on these sorts of situations a few months ago.

Re:So how much was for actual medical care?

[Anonymous Coward]

A question I've long had - is insurance part of the problem for those costs - or more specifically, are HMOs the problem?

Are those costs inflated, since the KNOWS they will have to discount their rates, and at varying discounts, for various insurance companies. So, they "artificially" inflate their rates, so when they discount it, they get more what they were actually expecting? In other words, if I know I will have to discount my rate 40%, and I normally charge $60 for a certain procedure, I raise my rate for doing that procedure to $100, so when I give the discount the insurance is demanding, I still get my $60 (or close to it).

If you don't have insurance, you get hit with ridiculous rates, and even if you do, you see ridiculous rates, along with the discount. I've tried to find some more solid info, but it seems to me that rates really started major increases year over year - right after HMOs became "legalized" in the US. HMOs were the ones who really started the major "cost-cutting/discounts" with healthcare providers in this country.

Re:So how much was for actual medical care?

[Anonymous Coward]

"what matters is removing the leeches and profiteers from the system and turning it back into medicine instead of a protection racket pretending to be insurance and hospitals where care is an afterthought."

It really is not as simple as that.

  -- Research is expensive

If drug companies did not have incentive to invest, research wouldn't happen, so there goes the medicine.
Take it a step further and just say that the government should fund this -- government does not have the wealth nor imagination to fund things like this, that is why the private sector is more efficient.
If the government were funding research for new drugs, I'm fairly certain we would still be trying to determine the benefits of ibuprofen -- but we would sure have a ton of paperwork to file.

  -- Insurance is expensive

Doctors pay a lot of money, put in a lot of hours, sacrifice like crazy, so that they can get through medical school and then into an internship, and finally to a place where they can actually make some money.
The funny thing is, while everyone thinks that doctors make a ton of money, they honestly don't make *that* much money.

Technology does cost money - if a hospital wants to stay in business, which benefits everyone, they have to stay current.
A fancy MRI machine may cost several million dollars -- that has to be payed for by revenue.
People will go where they believe they are getting the best care, and they don't want someone to wave a dead chicken over them to decide their prognosis.
For the same reasons as drug companies are funded, so insurance companies exist.
You are saying to someone who has the money you want, "I want to pay you a small amount of money each month, and then when something causes me to get sick, I want you to pay the huge medical bills -- or else you are a profiteer"
Sure, I would help one person who needs help, but when people start lining up, well, I'm not sure that is sustainable.

  -- Care is an afterthought

Hmm... Well, I'm sure that some people have wear their hearts on their sleeves, and make every decision in life based on some bigger purpose ( I like to think I am one of those people ).
For the majority of people though, they are trying to make a living. Hospitals are not all the I am talking about.
I am a network engineer - I am very concerned with work that I do, and I very much want to make sure I do it correctly.
My co-workers, management, and I think most of the company I work for, feel the same way about our company as a whole and the work that each individual does.
Part of doing that is offering me incentives on a regular basis, for reaching out to our clients in a way that makes them feel that they have received the best possible "care".
Healthcare is a business as well, and while there are good businesses, and poorly run businesses, I would dare say that they feel the same way.

I don't know why anyone would want to be a direct care giver - I would find it very depressing -- just being honest.

My bottom line, and point, is this:

We need people to invest freely in health care, or it is going to get worse.
If people feel that their money is going out of their pocket with no return on the investment, then they will stop investing.
"Don't muzzle the ox while it is treading the field"

The private sector is much more imaginative in how it can come up with finances to deal with issues.
Doctors already turn away medicare / medicaid -- they can't spend their time working on so many cases, and then not get paid.
Those are great examples of taxpayer funded programs that ensure that people get worse care than if they were in the private sector.

Re:So how much was for actual medical care?

[ScentCone]

Medical costs really don't mean anything. There is no rational or justification for any of it. They are just made-up numbers

Really? Do they just make up the price they pay for materials, for electricty, for oxygen deliveries, for all of the lab tests they have to run so that sleazeballs like John Edwards can't get rich suing them into oblivion? Do they just make up the dollar amounts that they have to pay orderlies, nurses, electricians, radiological equipment maintenance people, and the costs of HIPPA compliance in all of their record keeping? Does the hospital just make up the numbers involved in paying for the cable TV they run to rooms, the backup generators and fuel that allow a patient to survive through an appendectomy during a thunderstorm? Do they just make up the costs of incinerating medical waste? Of the bandwidth they use? Of emergency preparedness, for mass casualty events like train wrecks? Do they just make up the numbers involved in paying their IT staff? I see.

Here's another thing they don't make up: that huge numbers of people who walk into their emergency rooms get the full-time attention of highly skilled professionals, consume lots of sterile supplies and drugs, occupy expensive space, present the risk of lawsuit in case the doctors aren't omniscient, and then: never pay for any of it, ever. So of course they people paying for all of this (the hospitals) have to pass those costs along to the few customers who can pay.

It is also very reasonable to spend a lot of money fighting the condition that will/does kill you. Where else are you going to spend it?

But is it reasonable to spend someone else's money? Because that's usually how it goes. Have you put half a million dollars into your own health care? Even a tenth of that? I see. Most people won't, can't, and never will. But they can sure spend it when someone else is forced to fund it. And now we're looking at the government getting ready to borrow trillions of more dollars from the future (and from China) to do even more of it. Horrific.

Re:So how much was for actual medical care?

[Fnkmaster]

Very simple - make medicare reimbursement legally dependent on eliminating the disgusting practice of overbilling uninsured patients. Legally mandate the same price for a procedure for everybody. The problem is right now they bill a theoretical price of $3000 for an X-ray, as somebody else just posted in this thread, but an insured patient gets $2200 of that price "waived by agreement" on their insurance statement, the hospital gets a $700 reimbursement from the insurance company, and ends up with a $100 bill to pay out of pocket.

A medicare or medicaid patient will be billed whatever the legally reimburseable and billable amount for the procedure under those programs.

The amazing part is only the uninsured patient, who is likely either young or poor or simply unlucky, is the only yutz who ever gets billed $3000. That is a made-up number. NOBODY else pays $3000. I promise you. My mother was hospitalized for a long period of time and I used to get these bills all the time for $2k-$5k procedures done while she was there. Reimbursement was generally between 20% and 40% of the theoretical billed amount. Even when a procedure was not reimbursed at all by the insurance company, they often would waive 60-70% of that theoretical cost "by agreement with insurance company" so I'd end up owing 500-600 bucks instead of thousands.

This practice should be made illegal. It's really despicable and punitive to the uninsured. If the hospital knew that medicare would immediate cease all reimbursements if they discovered this practice occurring, they'd suddenly find a way to bill a true, common price for the same procedure, not a hypothetical maximum which represents the most they think they could ever extort from any insurance provider or individual payer.

Re:So how much was for actual medical care?

[nanoakron]

I know I'm responding to an AC, so I'll keep it brief.

Your answer is littered with so much misinformation that I wonder whether you keep yourself wilfully misinformed about the realities of the healthcare economy, and in particular that of nations with socialised healthcare services.

Governments pay a large proportions of R&D in terms of university labs and the like. Much of the money spent by big pharma is in marketing.

Insurance is only expensive in countries where healthcare is expensive. No Frenchman or Japanese person goes broke just to pay for healthcare, and their systems are insurance-based.

Careas an afterthough is just plain insulting to the individuals working in the system. In no other developed nation (and I mean literally 'no other') does a doctor turn someone away because of financial considerations.

Your healthcare system is broken, but what's worse is you show no intention of educating yourself as to the alternatives.

To everyone out there who thinks this way...PLEASE do some reading before perpetuating this misinformed nonsense.

Re:So how much was for actual medical care?

[AGMW]

There is a HUGE amount of overhead in US health care starting with a massive markup on medicine which isn't seen elsewhere and ending with the support of a lot of middlemen. It doesn't matter if it's private or public - what matters is removing the leeches and profiteers from the system and turning it back into medicine instead of a protection racket pretending to be insurance and hospitals where care is an afterthought. The doctors are not the ones getting rich and if you want to see a nurse laugh ask them if they are rich. I doubt that the same amount of care elsewhere with the same treatments under a public system would have cost the taxpayer anywhere near one fifth of that. Remember folks, it's still a drain on the economy even if rich sick people are the ones getting ripped off instead of the taxpayer - it still hurts everyone to an extent.

My Dad was a doctor - a GP - in the UK and back in the 80's I remember him telling me about "medical insurance" for Drs, in case you get sued. He told me that Drs in the US paid more in insurance premiums than he earned per year! Who's benefiting from that and who's paying the cost!

Re:So how much was for actual medical care?

[Anonymous Coward]

First, an aspirin costs $500 when they dispense to 500 people and only one person pays for it.

Aspirin doesn't cost $1 each. Even if it did, I'd be number 500 that didn't pay for it. The hospital could then add the cost of fraud litigation to the price of their next aspirin.

Re:So how much was for actual medical care?

[Anonymous Coward]

Under the current system those who can't afford emergency care don't pay for it. The hospital has to make its money somehow. Hence the exorbitant insurance premiums for the insured and the ridiculous fees for the uninsured. In the end, it very much can be traced back to the insurance model we have here in the US.

Re:So how much was for actual medical care?

[AGMW]

Ask yourself, "If they charged me less, who would benefit?"

Now find some way to make "the hospital" part of that answer.

Pretty hard, isn't it?

Somewhat disingenuous, but I can fix that for you ...

Ask yourself, "If they could charge me less, who would benefit?" Now find some way to make "the hospital would be no worse off" part of that answer.

A few individuals are unlucky enough to have medical procedures go wrong and sue the hospitals/doctors/anyone and get large settlements.
The hospitals/doctors/everyone has to pay large premiums to the insurance companies and therefore have to put their prices up accordingly.
So actually you had it the wrong way around ...:

If the hospitals could spend more of their money on providing health care and less on insuring against court cases they could offer better and cheaper services!

Re:So how much was for actual medical care?

[FriendlyPrimate]

I just had to pay $1300 in out-of-pocket expenses for my daughter to get a single stitch (emergency room visit because it was after hours). And the doctor was on the fence as to whether nor not she needed one. Had I known it was going to cost me $1300, I would have used a band-aid.

There is a HUGE disconnect between medical services and pricing. How many of us ask doctors about how much something is going to cost? How many doctors tell us this information up-front?

That's why I think there should be a law that hospitals/doctors MUST present you with a bill BEFORE they do anything (except in the case of an emergency). i.e. they're not allowed to charge you for anything unless you've signed the bill for it first.

Re:So how much was for actual medical care?

[Anonymous Coward]

Thats INSANE!
40 euros here no more for a xray...

Re:So how much was for actual medical care?

[locallyunscene]

You're right there are a lot of problems with healthcare, but it sounds like you're trying to lay a lot of blame on hospitals doorsteps. In reality they're just dealing with the bad decisions made by a lot of people.

The prices in a hospital bill to the uninsured are more or less based on two things: the price medicare sets for a procedure(because insurance companies base their reimbursements on that number), and the difference between the medicare reimbursement and the actual cost of care. This is why the busiest hospitals are the ones that fail to stay open. Most uninsured simply can't pay their hospital bills and emergency rooms are the "catch all" in our current "system". You cannot legally be turned away from an emergency room even if you don't have a life-threatening condition. As a result, a lot of the poor who can't afford health-services use that to get their basic healthcare needs met.

You also have to realize that the cost of care in an emergency room is going to be a lot higher than pretty much any other way to get care due to the cases you just described. Triage is at play- SICK people go to an emergency room, and they need services RIGHT AWAY. You're paying for lifesaving convenience and expertise with limited and in-demand resources. If you go to the emergency room to get aspirin for your headache you're potentially diverting it from someone who needs it for a heart attack, so that aspirin must be restocked right away.

Re:So how much was for actual medical care?

[Anonymous Coward]

If you RTFA (long, I know), the actual amount of money paid to the hospitals was $254,176.

Re:So how much was for actual medical care?

[CodeBuster]

starting with a massive markup on medicine which isn't seen elsewhere

It isn't seen elsewhere because most other countries have slapped price controls on prescription drugs. However, before you wax poetic about how wonderful those crafty Canadians and Europeans and their health care systems are, it might be interesting to consider where better than 90% of new drug research and development occurs. If you guessed 'the United States' then you were right. Other countries have been free riding off the benefits of US research and development in cutting edge drugs; financed by high prices for American consumers. It will be very interesting to see what happens when and if the United States also slaps priced controls on prescription drugs. If nobody is left to pay premium drug prices to support new research then these drugs simply won't be developed unless the governments of the world step in to make up the difference currently being funded by the generosity of US health care consumers. I doubt that the various socialized health care systems around the world would be successful at that; even if they tried.

Re:So how much was for actual medical care?

[Alinabi]

Family's insurance pays the $100k bill and no lawyers are involved.

My landlord had a car accident and needed about $7,000 worth of physical therapy. The insurance company refused to pay that until the lawyers got involved. I seriously doubt they would even consider paying $100k without going to court first.

Re:So how much was for actual medical care?

[frank_adrian314159]

Legally mandate the same price for a procedure for everybody.

Stop the government takeover of health care!!!

Yes, I'm being sarcastic. At this point the best thing we could is have the government take over the other 50% of what it doesn't already control via Medicare, Medicaid, and the VA system.

Re:So how much was for actual medical care?

[Wildclaw]

it might be interesting to consider where better than 90% of new drug research and development occurs. If you guessed 'the United States' then you were right.

If you guessed that this was a made up statistic, you guessed right.

Re:So how much was for actual medical care?

[Dalambertian]

I couldn't agree more, after watching this TedMedd talk, you get the sense that the medical industry makes a lot more money on a terminally ill patient than they would on a patient whose cancer was detected early. This would explain why so little research goes into the detection of cancer, which can apparently be done in a lab the size of a postage stamp (and at a fraction of the cost of a postage stamp): http://www.youtube.com/watch#!v=-ew0bn8mGAA&feature=related

Re:So how much was for actual medical care?

[sjames]

That's what happens when we allow "the market" a free reign when the conditions for a healthy free market don't exist. Were there ACTUALLY a market, the hospital would benefit from charging less because then they might actually have patients rather than being a big empty for exactly the same reason no grocery store charges $100/pound for ground beef. Since there is nothing like a healthy market, the outrageous prices are the natural result of applying an inappropriate economic system.

Re:So how much was for actual medical care?

[Anonymous Coward]

Very simple - make medicare reimbursement legally dependent on eliminating the disgusting practice of overbilling uninsured patients. Legally mandate the same price for a procedure for everybody. The problem is right now they bill a theoretical price of $3000 for an X-ray, as somebody else just posted in this thread, but an insured patient gets $2200 of that price "waived by agreement" on their insurance statement, the hospital gets a $700 reimbursement from the insurance company, and ends up with a $100 bill to pay out of pocket.

A medicare or medicaid patient will be billed whatever the legally reimburseable and billable amount for the procedure under those programs.

The amazing part is only the uninsured patient, who is likely either young or poor or simply unlucky, is the only yutz who ever gets billed $3000. That is a made-up number. NOBODY else pays $3000. I promise you. My mother was hospitalized for a long period of time and I used to get these bills all the time for $2k-$5k procedures done while she was there. Reimbursement was generally between 20% and 40% of the theoretical billed amount. Even when a procedure was not reimbursed at all by the insurance company, they often would waive 60-70% of that theoretical cost "by agreement with insurance company" so I'd end up owing 500-600 bucks instead of thousands.

This practice should be made illegal. It's really despicable and punitive to the uninsured. If the hospital knew that medicare would immediate cease all reimbursements if they discovered this practice occurring, they'd suddenly find a way to bill a true, common price for the same procedure, not a hypothetical maximum which represents the most they think they could ever extort from any insurance provider or individual payer.

Um, the reason for this apparent "overcharging" of medicare patients, is because "medicare" does NOT pay the entire bill. They only pay a small percentage of that bill. This keeps costs HIGH for the private insurance as they have to subsidize the treatment of the medicare patients. I work at a hospital so I see this all the time. These artificial medicare costs have to be so at least some of the overhead of the treatment could be recovered.

Re:So how much was for actual medical care?

[phantomfive]

This will never happen (at least, not by an act of congress) because it means medicaid would have to pay a fair value. Currently medicaid does not pay enough to even cover the cost of treatment, thus hospitals and doctors pass the cost on to other patients. Some doctors won't accept medicaid patients.

However, if congress made it fair, they would have to start paying a lot more. Congress isn't willing to do that.

Re:So how much was for actual medical care?

[Fnkmaster]

I never said that medicare patients were overcharged. *All* patients are overcharged, and portions of bills are waived for all *insured* patients, whether they are covered by Medicare or private insurance.

You basically make my point for me. Certain classes of patients shouldn't be billed excessively to make up for other classes of patients. There should be one, true fair price. Which should be what Medicare and private insurers reimburse, and what an uninsured patient would have to pay. Having every patient incur different charges for the same procedure, with the highest charges accruing to an uninsured patient (who is not indigent or bankrupt), is absurd. And frankly, having private insured patients subsidize Medicare patients and uninsured patients subsidize everybody (until they go bankrupt, in which case they are getting subsidized) is just ridiculous.

If you force fair billing practices along the lines I suggest, you certainly don't fix all or even a majority of the problems with hospitals or with our healthcare system in general, you just reduce the penalties for the uninsured, force some transparency into the system, and provide strong incentives for cost containment and make possible better alignment of agency (i.e. principal-agent problem) issues than is currently possible.

Re:So how much was for actual medical care?

[debrisslider]

I'd say MOST people have paid more than a tenth of their own health care. Medicare taxes on every dollar earned (the majority of workers earning far less than the cutoff) is probably half of it right there, and (inflation adjusted) health insurance benefits/premiums (if your employer didn't have to pay them, you'd get a higher wage, after all) more than makes up for the rest. And as for 'other peoples' money', well, insurance is a shared risk pool of other peoples' money, so you paid for the right to have access to money in excess of your own contribution if the circumstances ever called for it. How much you should be allowed to spend is a fair point of contention, but don't pretend people are making out like bandits for a service they paid what the insurance companies themselves considered a fair amount for.

Re:So how much was for actual medical care?

[Anonymous Coward]

As a Doctor in New Zealand I find these prices ludicrous. Even in the the Private Health Care sector an Xray will cost you NZD$50-100 (~USD$35-70). This includes the reporting by a Radiologist. In the public sector it is completely free.

I don't know how they justify a price anywhere near USD$3000, even the USD$1000 insurance "agreement" price seems excessive.

Re:So how much was for actual medical care?

[ImOnlySleeping]

Since you didn't read the article, the insurance company argued the cost down to 247k of the original bill of 618k.

Re:So how much was for actual medical care?

[DerekLyons]

I just had to pay $1300 in out-of-pocket expenses for my daughter to get a single stitch (emergency room visit because it was after hours). And the doctor was on the fence as to whether nor not she needed one. Had I known it was going to cost me $1300, I would have used a band-aid.

Let me get this straight - you took your daughter to the ER for an injury that could have been handled with a band aid? (And even wosre, you haven't the common sense to recognize this?)
 
Christ, I'm glad you're paying out-of-pocket and don't use the same insurance company I do.
 

There is a HUGE disconnect between medical services and pricing.

Yes, there's a huge disconnect - and it's between your ears. But in typical fashion, you blame anyone but yourself.

Re:So how much was for actual medical care?

[ScentCone]

don't pretend people are making out like bandits for a service they paid what the insurance companies themselves considered a fair amount for

No, you're missing the point. I'm talking about the huge numbers of people who don't pay at all, but still get the use of the million-dollar imaging machines in the hospital, can still sue for malpractice, and still take up the time and resources of expensive professionals and the facilities in which they operate.

Re:So how much was for actual medical care?

[iphinome]

This is why we need a -1 astroturfing.

Re:So how much was for actual medical care?

[Anonymous Coward]

That's why I think there should be a law that hospitals/doctors MUST present you with a bill BEFORE they do anything (except in the case of an emergency). i.e. they're not allowed to charge you for anything unless you've signed the bill for it first.

That's cute, FP. Let's get serious. How about a bill restricting the amount you can collect from an individual paying cash to the medicare/medicaid reimbursement amount? Why does the government get to negotiate really hard on behalf of its favored citizens and pay the fucking bill to boot? I would apply this law to any practicioner who accepts medicare or medicaid. This will cause those rates to go up somewhat. Boo hoo. The rest of us would get honest, reasonable, cash-up-front pricing. It would make health insurance less important. See this post for a good explanation - in thread - if you haven't already.

Re:So how much was for actual medical care?

[pivot_enabled]

Right On! You have hit the nail on the head.

I had a situation in which my insurance had recently lapsed. They requested this absurd amount of money from me. I said "Well, how much would this bill be under my former insurance's negotiated rates?" they quoted me an amount that was less than one third. I said "OK, I'll pay that amount right now, if you agree to waive the remainder". They agreed, and I paid.

I am not saying that this approach will work all the time, but I think that everyone should demand to receive the same "discounts" as the insurance company's are getting. The fact of the matter is that the hospitals never really expect to get the "list" price. It's really just a scam.

These ridiculous bills handed out to uninsured patients are not just high, they are fraudulent!

Re:So how much was for actual medical care?

[AEC216]

I was in between jobs five months ago. Cut my figure on a can lid. Couldn't get it to stop bleeding after 3 hours.

3 stitches and a tetanus shot. $900 for the ER visit. $700 for the doctor.

My new health insurance kicked in 1 week later.....

That was the most expensive chicken pot pie I ever made.

Re:So how much was for actual medical care?

[rolfwind]

Second, I remember a time when, if someone needed stitches or a cast, they went to their doctor's office. The ER was where the ambulance took you if your brains were hanging out of your skull.

Yeah, but it was after hours and I shredded my leg cutting down some trees and was afraid I got metal splinters in the wound as well. I also didn't have a tetanus shot in years.

I'd rather pay an inflated hospital bill for stiches than pay an inflated bill for gangrene later on.

Re:So how much was for actual medical care?

[wurble]

Interestingly enough, there are already laws on the books which call for this but they aren't being enforced. The Clayton and Sherman anti-trust acts make it illegal to bill different amounts to different groups for the same product or service in such a way as to give one group a serious competitive advantage. Since the difference between what a private insurance company pays and what an uninsured person pays is usually an order of magnitude, I'd say that qualifies.

Too bad anti-trust laws haven't been enforced seriously in decades.

Sometimes the answer isn't more laws or more regulation. Sometimes the answer is simply enforcing the laws you already have.

Re:So how much was for actual medical care?

[compro01]

I don't know how they justify a price anywhere near USD$3000, even the USD$1000 insurance "agreement" price seems excessive.

IMO, it's mostly the end result of a positive feedback loop.

Of the X people who get a procedure, Y of them cannot/do not pay for it (500,000+ medical-related bankruptcies per year is an oft quoted estimate) and the hospital writes it off. To compensate for that loss and maintain profitability, the price of the procedure (and/or other procedures/consumables/etc.) is increased, resulting in Y increasing.

Keep this running for a few decades and add in other factors such as litigation, masking of costs, inappropriate money distribution, and more, and you find the current situation.

What is that for a question?

[Gernot]

You should _not even have to_ ask yourself this question - healthcare should never put such responsibility into an affected person's hand!

The US seriously needs to fix its healthcare system.

Re:What is that for a question?

[Anonymous Coward]

The US needs to fix its healthcare system? I could mention ideas, which may or may not lead to a long thread of comments. But, it is so sad that our idiot members of Congress probably wouldn't act on any intelligent ideas put forth.

Remove the public option? Make it mandatory that people have health insurance? They're kidding, right? They remove potential competition against the insurance companies, then mandate that most everyone have coverage or face like a 2.5% income tax "fine"? Why don't we just send the poor directly to jail, or perhaps forced labour camps?

About the article, which I barely briefly skimmed: What about a living will, asking the person's wishes before he or she is hospitalized? Money shouldn't be an issue to these sorts of questions. Personally, I'm toying with the idea that if I'm ever in a coma, that if I'm not out in one month (31 days), to pull the plug. But maybe it's my belief system.

Re:What is that for a question?

[Anonymous Coward]

Remove the public option? Make it mandatory that people have health insurance? They're kidding, right?

They're not kidding. They're bankrupt, intellectually, morally, and literally. Americans should expect nothing more than to be gouged to pay for a long string of government failures.

They remove potential competition against the insurance companies, then mandate that most everyone have coverage or face like a 2.5% income tax "fine"?

Stealth tax increase: creating a monopoly and forcing you to purchase a product that you don't want, which the US then recoups via 'progressive' taxes on the companies in question.

Why don't we just send the poor directly to jail, or perhaps forced labour camps?

Because we like sending the poor off to get injured in unnecessary wars instead. It's kind of the reason we're bankrupt, and we suddenly have a lot of extra health costs to pay for.

Re:What is that for a question?

[Anonymous Coward]

You should _not even have to_ ask yourself this question - healthcare should never put such responsibility into an affected person's hand!

The US seriously needs to fix its healthcare system.

You're looking at it from a strictly dollars and cents point of view.

Even if the patient has a billion dollars, making the cost of treatment not a factor, at what point does the patient say "I'm done with the treatment. My quality of life has gone down the tubes."

We are not supposed to live forever. We didn't evolve to live beyond the age of 30, hence why we start to fall apart after that age and why women have an exponential increase in difficulty in conceiving after that age. In Western society and especially in America, we have this terror of death - we deny its existence which makes it all the more terrifying. Compare it to this attitude: when the Dalai Lama was asked when he reached 60 what he was going to do, he responded "prepare to die". He didn't mean that he was going to start his funeral pyre but that he was realizing that he was at the end of his life and he was going to live like it and prepare his emotional and mental state. Here in the States, you see 80 year olds acting like they've got another 30 years.

I'm not saying people should roll over and die when they have any health issue, but there's a point when we need to face reality - which is something we Americans are horrible at.

Re:What is that for a question?

[killkillkill]

Right, decisions of ones life are too much a responsibility. Clearly, the call should be made by enlightened doctors, administrator, and politicians. That will be a relief when they tell me that I am just going to have to quite now. I know I would be much happier if I didn't have to put up with the stress of making the decision and knew I was going to die based of the decision of a comity who calculated the value of my life.

Re:What is that for a question?

[TheLink]

> I know I would be much happier if I didn't have to put up with the stress of making the decision

Some may not believe it, but that can actually be true.

It's part of human psychology. When you make decisions, you often wonder whether you made the right decision etc. And that reduces your happiness and satisfaction.

Watch the following:

Barry Schwartz: The paradox of choice

http://www.youtube.com/watch?v=VO6XEQIsCoM
(esp see 3:41 onwards in this context)

Dan Gilbert: Why are we happy? Why aren't we happy?
http://www.youtube.com/watch?v=LTO_dZUvbJA

Re:What is that for a question?

[Anonymous Coward]

I agree. But it is still a legitimate question to ask in some ways. Here (Canada) doctors have to ask it every time they consider treatment. However, they go about it in a very specific way: will this treatment improve/prolong this person's life and is it what the patient wants? If not, it doesn't happen.

I'm facing a rather similar situation with an 85-year-old close family member. They have terminal cancer and they've beaten the odds for 2 years now. The doctors were not expecting that length of time, but any treatment this person needed they got, and it has paid off. I'm sure they would have died a couple of years ago otherwise. Judging by degradation in their condition recently, it won't be much longer now, but I haven't had to worry about the financial aspects of treatment. The doctors have just done what is needed and what my relative wanted (my relative rejected some treatment options).

I've heard the rhetoric in the U.S. about "death panels". It's pathetic propaganda. These are honest doctors that are trying their best for the patient. They don't make these kind of decisions on their own. They consult the patient, they consult the family, and they weigh the medical options. Their job is to know the best medical treatment and what the likely effects are. They won't put patients through the misery of some invasive treatment or test with no hope of actual success. They will pick the cheaper/more efficient technique over the more expensive one if the outcome is the same (it's common sense). They explain the procedures, the risks and the potential benefits, and the patient makes the call -- every time, for as long as they are able to do so. After that the wishes they recorded beforehand apply, or the family steps in.

It is hard enough to make these decisions under the current circumstances, but to go through all of that *plus* having to wonder "Can I afford this? Is it covered by insurance?" is ... truly horrible to think about. And yet that's an aspect that families in the U.S. face all the time. I don't know how they do it. It must be hell on top of hell.

Re:What is that for a question?

[Anonymous Coward]

Clearly, the call should be made by enlightened doctors, administrator, and politicians.

Those enlightened doctors, administrators, and politicians already make that call. They define every single aspect of the cost of treatments that are made available to you (and what treatments aren't available to you). You are constantly calling on their expertise to protect you from your own ignorance.

Not to mention your choices aren't made in a vacuum. There is forever only going to be a limited amount of care to go round. While the capitalist/individualist model works well for things that aren't necessary for life, it is murder for things that are. Every choice you make is externalized to some extent, and there is no way for you to bear complete responsibility for that cost.

We already have rationing of care. We are trying to do it more intelligently.

Re:What is that for a question?

[Hurricane78]

In what dream world do you live?
Yes, we should care for our people.
But every minute of health care and every resource still costs. Which is never ever free. But always a loss for the community as a whole.
Resources are limited. So at some point it will cause so much bad, that you won’t be able to keep someone else alive.

So would you really throw so much resources at one person, that you risk the survival of another one?
Or the health of another 100 people?
Where do you draw the line?

Since you are suggesting to never draw the line, you would essentially at some point kill others.
Now in what way is that fair??

The reason we care for our community, is because of the huge benefits of having one. And because they will do the same for us. Together we are strong!
Also: Stop your arrogance. Our galaxy is not special! Our solar system is not special! Earth is not special! Humans are not special! Human life is not special! Your race is not special! (See where I’m going?) You are not special! We all aren’t!

Re:What is that for a question?

[Macrat]

You should _not even have to_ ask yourself this question - healthcare should never put such responsibility into an affected person's hand!

How about the question when keeping someone "alive" is really about greed and not value of life for the patient?

Re:What is that for a question?

[Anonymous Coward]

You should _not even have to_ ask yourself this question - healthcare should never put such responsibility into an affected person's hand!

The US seriously needs to fix its healthcare system.

Remind the "Grandiose Obstructionist Party" of this.

Re:What is that for a question?

[Anonymous Coward]

Everybody everywhere should be asking this question: What if that last $400,000 was instead put towards preventative medicine, or a gym membership, or spending less time at work, or fewer processed foods in their diet?

We're all for spending tons of money doing heroic low-odds procedures, whether it's trying to cure people in the late stages of cancer, or making rescue attempts (that sometimes cost more lives than we were attempting to save), and yet we completely ignore the many small things that could be done to extend people's lives or improve their quality of life for most of their life. Instead, we save it all up for the end, when much of the time it makes the patient's lives worse and extends them relatively briefly. Actually, "save it all up" is too kind: it's more correct to say we burden ourselves for most of our lives with those end-of-life healthcare costs. It's like we're all buying hugely expensive tickets to a lottery where most of the winners will die while they're receiving the prize.

Re:What is that for a question?

[Anonymous Coward]

WRONG. Ultimately YOUR life is YOUR responsibllity, regardless of YOUR contidition.

Yes you do need to ask yourself that question, otherwise you make yourself a sheeple of others, nothing more than a slave to a system.

If you don't consider these possibility while you are healthy. That is your fault.

Re:What is that for a question?

[kilodelta]

No kidding. When I saw the estimate that 31% was paperwork the first thing that popped into my head was "single payer".

Back in 2001 I worked at the state AG's office. It was there that I got a glimpse into the medical billing and insurance systems side. It lead me to the conclusion that not only are the insurance companies being enriched at our expense, the billing companies are making a fair amount of money too.

Go single payer and you cut out those two layers. Imagine that.

Re:What is that for a question?

[Anonymous Coward]

You should _not even have to_ ask yourself this question - healthcare should never put such responsibility into an affected person's hand!

Absolutely. You should never have a say in something directly impacting you. God forbid. Let the government make all the decisions about everything that directly impacts you. Sheep. F'ing sheep...

Everyone believes their life is priceless.

[elucido]

The truth is sometimes the exact opposite and usually somewhere in between.

Re:Everyone believes their life is priceless.

[Aranykai]

That pretty much covers all the bases doesn't it? You aren't in consulting are you?

Re:Everyone believes their life is priceless.

[__aasqbs9791]

My guess would be politics.

Re:Everyone believes their life is priceless.

[BikeHelmet]

He's obviously a philosopher.

Re:Everyone believes their life is priceless.

[Rockoon]

Exactly.

I want the entire worlds population to exist for the express purposes of keeping me alive and well for as long as imaginably possible.

Period.

The sad reality of the American situation is that if YOU break your leg and then have it mended, thats going to cost thousands upon thousands of dollars, but if YOUR DOG breaks its leg and then you pay to have it mended, the cost will be under a grand. The reason for this is that SO MANY PEOPLE HAVE HEALTH INSURANCE FOR THEMSELVES, BUT NONE FOR THEIR DOG.

Its all fun and games when someone else pays.

Re:Everyone believes their life is priceless.

[Bryan3000000]

You've got it partially right. Someone else paying is only a part of it - the part that means we consume a lot. The other part is how much we pay for each bit we consume. We don't pay 30 administrators, medical coders, bureaucrats, claim adjusters, insurance reimbursement specialists, medical transcriptionists, etc. when we take the dog to the vet. And that's not even counting the cost of prime real estate, years of medical device and drug approval reviews (which still don't prevent problems any better than our European counterparts which do it radically more cheaply and around a decade faster), healthcare lobbyists, IT infrastructure and software that doesn't actually work (and there are cheaper alternatives that do actually work), and, of course, someone has to make a profit on top of supporting all of these parts that are, at the end of the day, pretty much expendable. And don't forget the profit that must be made on each of the supporting parts as well. (and don't forget the lawyers, settlements, and insurance company overhead and profits on malpractice premiums either) Basically, we've built up our healthcare system as a super-massive employment program over the past few decades. Nurses with many years of experience will tell you that twenty years ago, they took care of far more patients at a radically lower cost, because so much overhead and procedural/bureaucratic make-work has been added. It's actually only a few dollars cheaper to have an office visit with a nurse practitioner than with a doctor (this was supposed to be a revolutionary cost-savings). All of this is because of the massive overhead we've included in healthcare. And yet regulators, politicians, and advocates are continually screaming for even more regulation (with the resulting overhead). It's completely unsustainable, and it has very little to do with the amount of healthcare people consume, or the number of MRIs they have. We could make all of that stuff cheap. It's the four layers of bureaucracy to support - government oversight, health insurance, reimbursement, and institutional bureaucracy - plus the malpractice insurance industry to support. You want to know why we can't do healthcare reform? It's because it would cost a very VERY large percentage of our workforce their jobs if we were to make things more efficient. Insurance companies have already massively raised rates so that they can continue supporting this huge system with fewer people actually purchasing insurance these days. And since this is all so completely unsustainable, it also means there is a real estate and business equity bubble in this area that could do every bit as much damage as the financial sector already did to our economy. Come up with a solution to that catch-22. We could have healthcare as cheap as it is for our dogs, but doing so would mean that we'd have to give up the whole concept of health insurance. And with it, the livelihoods of many millions of Americans. That's why the only solutions being considered are containment measures that continue to support the current ecosystem. Literally nobody has the guts to publicly admit the full measure of this, unfortunately.

Health Insurance in Germany

[koinu]

When you look at my taxes, I pay each month, you'll also find the amount of mandatory health insurance. It's about 300 euro a month and the employer has to pay an additional 300 euro (50%/50%).

So remember when I warned you that your social system is better than ours in the "oh-so-great-EU". You'll pay in ONE month more than you pay for actually being ill for 2 years.

Re:Health Insurance in Germany

[Shimbo]

So remember when I warned you that your social system is better than ours in the "oh-so-great-EU". You'll pay in ONE month more than you pay for actually being ill for 2 years.

If you used the comma as a decimal separator, you could reduce your medical costs by a factor of a thousand!

Re:Health Insurance in Germany

[thasmudyan]

In your case it's 300 €, but keep in mind that the amount you pay for insurance is directly linked to your income, not to how much you've been sick last year. You could argue it's unfair that you have to subsidize a bunch of students and old people for a while, but it sure beats any other system I've seen. I agree it's not fun to pay the insane amount of insurance and taxes here in Europe, and yes, a huge part of it is going to be wasted on government pork and mismanagement. We need to address that. I'd speculate we could cut those insurance premiums in half if we abolished all the profiteering, corruption and misappropriation. But all in all, it's the price we pay for a pretty decent attempt at social equality.

Re:Health Insurance in Germany

[koinu]

The real problem is, because it does not cost much to see a doctor, people go there when they have a pimple. The average German goes to see a doctor over 20 times a year for nothing. Wtf? I have to pay for this. And when I am sick, I still to have pay for medicine that soothes my pain. Even vaccines are not free, I paid about 80 euro for Hepatitis protection, because I went on holidays to an affected country. Because it's all not free. All you get for free is antibiotics and how much does this stuff cost? 600 euro? Maybe during 40 years of being ill regularly, yes.

Re:Health Insurance in Germany

[Anonymous Coward]

All you get for free is antibiotics ...

Sounds like a wonderful way of breeding antibiotic resistant bacteria.

Re:Health Insurance in Germany

[Anonymous Coward]

The average German goes to see a doctor over 20 times a year for nothing. Wtf? I have to pay for this. And when I am sick, I still to have pay for medicine that soothes my pain. Even vaccines are not free, I paid about 80 euro for Hepatitis protection, because I went on holidays to an affected country. Because it's all not free. All you get for free is antibiotics and how much does this stuff cost?

You do know that a doctor gets _one_ quarterly amount of money by the insurance company for appointments with a
single patient, irrespective of how often the patient visits him, as long as he visits once? You "subsidize" patients who visit
the doctor 20 times a year with the same amount of money as someone who visits him 4 times a year.

Vaccines required for holidays no one forces you to take are one of the very few kinds of commonly needed medicine
that you have to pay for yourself if you have public insurance.

Fancy looking tooth replacements in places others would not see when you smile are another. Cosmetic stuff costs extra.

EVERYTHING ELSE is paid for by the insurance company. If a doctor prescribed it, of course. Saying that only antibiotics
are paid for is a blatant fucking lie.

By the way, you certainly know that here in Germany, we _do_ have private insurance companies. Paying 300€ a month
for health insurance, you certainly earn enough to go with them. What is holding you back? You won't have to subsidize
anyone! Their rates are actually way cheaper in your case, as you seem to be healthy. Go with them and stop complaining.

They won't take people with pre-conditions though.

Re:Health Insurance in Germany

[koinu]

Vaccines required for holidays no one forces you to take are one of the very few kinds of commonly needed medicine that you have to pay for yourself if you have public insurance.

This is wrong thinking. I vaccine myself not only because I want to stay healthy, but the insurance has a decreased risk to pay high costs when being ill. One day in hospital there costs a private person about $100, just the bed without medicine. The insurance should support this and they usually do. And when I'm paying a visit to my family on my holidays (that was the purpose), I cannot really say "no one forces me".

EVERYTHING ELSE is paid for by the insurance company. If a doctor prescribed it, of course. Saying that only antibiotics are paid for is a blatant fucking lie.

This is actually a lie. I paid about 60 euro for pain medicine after 3 of my teeth were pulled. This is NOT COVERED by insurance. And tell me... where do you get pain drugs from? YOU HAVE TO HAVE THEM PRESCRIBED! And I remind you... you don't even get a fucking piece of prescibed(!) Aspirine here.

Re:Health Insurance in Germany

[TapeCutter]

For an Australian family on $100K/yr UHC costs $1,500/yr. I told that to an American a little while ago and he called me a liar...

Re:Health Insurance in Germany

[Anonymous Coward]

Yes, it is. That's why goodies like MRSA are rampant in Germany and other industrial nations.

Re:Health Insurance in Germany

[thebian]

On my own, my health insurance choice is a limited $1,500 a month plan and an average $2,500. Those are different companies, and the only ones selling insurance in my state (in the U.S.). I'd say Germany's plan looks OK to me.

Luckily there is a group for freelancers in my state, but keep in mind:

• You have to be relatively successfully every year in order to qualify.
• You have to do one of several types of job.

If you have no income (say 10% in the U.S.) or low income, you are screwed.

It's not a political problem here because 70% or so of the people are covered by employer plans that more or less support the entire wasteful system.

Again, the 30% are screwed.

Re:Health Insurance in Germany

[denzacar]

This is actually a lie. I paid about 60 euro for pain medicine after 3 of my teeth were pulled. This is NOT COVERED by insurance.

You have paid 60 Euros for analgesic - AFTER you had the procedure.

How much did you pay for the procedure itself? How about for the anesthetic they gave you for while they were pulling your teeth out?
Or did you decide to "take it like a man", without drugs?

And tell me... where do you get pain drugs from? YOU HAVE TO HAVE THEM PRESCRIBED!

You have to have them prescribed cause they are NARCOTICS. Vodka is also a great painkiller. It can be bought for much less than 60 Euro.
Oh, wait... you want something that won't fuck up your liver, nor get you hooked, but strong enough so you don't feel pain radiating from right at edge of your major CNS-point (umm... brain?).

Aaaand - is not a part of standard procedure.
Most people just get that one shot before they have their tooth pulled - and they deal with it as the wound is closed and already healing as the anesthetic lets go.

And I remind you... you don't even get a fucking piece of prescibed(!) Aspirine here.

Didn't you just say that you get free antibiotics?
You don't get prescription for Aspirin cause it is over-the-counter dirt-cheap drug.
It costs less than a pack of gum and it has almost no harmful effects - why subsidize or control that?
You wouldn't expect to have vitamin C prescribed if you had a cold, right?

Re:Health Insurance in Germany

[Anonymous Coward]

This is wrong thinking. I vaccine myself not only because I want to stay healthy, but the insurance has a decreased risk to pay high costs when being ill. One day in hospital there costs a private person about $100, just the bed without medicine. The insurance should support this and they usually do.

And when I'm paying a visit to my family on my holidays (that was the purpose), I cannot really say "no one forces me".

Well. What can I say. Public insurance is not perfect, and obviously does not fulfill your use-case. But here in Germany we have
the freedom to choose. There are private insurers that may pay for this.

Hepatitis vaccination is only paid for for under 18 year olds and those who's work brings them near infected people. That may be
good, that may be bad. Most people take this vaccination for holidays. Something the rest of us would have to subsidise. And
subsidising others seems to bother you when it comes to doctor's visits.

This is actually a lie. I paid about 60 euro for pain medicine after 3 of my teeth were pulled. This is NOT COVERED by insurance. And tell me... where do you get pain drugs from? YOU HAVE TO HAVE THEM PRESCRIBED!

Well, I think emotions went overboard with me here. Sorry. I read your post as though you said no medication but antibiotics was paid for by insurers, which is not true, as most medications are insured.

Some painkillers are not insured anymore since 2005, but that doesn't mean all painkillers are not insured.

I had a tooth extraction and three root channel treatments at the beginning of the year and had to pay 30€ for all, including lots of painkillers and strong antibiotic treatment. 20€ being Praxisgebuehr. But I just asked others and found out that I was simply lucky, and that a lot of dentists try to screw you over with stuff you would usually get insured. Mine did not.

BTW, insurance won't pay for aspirin, but ASS ratiopharm costs 3€ and you do not need a prescription for it. I mean. Come on. Just go to an apotheke and ask for an aspirin genericum. No prescription needed.

Re:Health Insurance in Germany

[TheLink]

> It's not a political problem here because 70% or so of the people are covered by employer plans that more or less support the entire wasteful system. Again, the 30% are screwed.

Actually a significant proportion of those 70% are screwed too, they just don't know it yet... Having your healthcare tied to your employer is not a good thing ( http://www.health.com/health/money-article/0,,20223203_1,00.html ). Overall you have to deal with all sorts of crap (much not present in other systems), which is not good if you are actually very sick.

A lot of US people yell at the Europeans/Canadians and say "YOUR HEALTHCARE ISN'T FREE OR CHEAP, OTHER PEOPLE ARE PAYING FOR IT". The thing is, those other people are paying less on average than they would be if they were in the US system. Just look at the statistics - per capita spending on health care.

If you are very rich, the US healthcare is good for you, since you can really get the best and afford it.

If the majority who are not very rich want to stick with their current broken system where people are clogging up ER rooms just to get treatment (and thus indirectly increasing costs and decreasing quality of healthcare, and don't forget that taxpayers are still paying for those non-emergency ER patients), then perhaps they should get what they deserve. Representative democracy and all that...

Re:Health Insurance in Germany

[dunkelfalke]

It is not a flat fee in Germany but currently at 14.9% of the gross wage. The employee pays 7.9% of it, the employer 7%. The fee is capped at the gross wage of EUR 3750 per month, making the maximum fee EUR 290 for the employee and EUR 257 for the employer.

Re:Health Insurance in Germany

[dunkelfalke]

It is better to go to the doctor before a problem gets really bad. It is also cheaper.
And no, you don't pay for that. You pay for your own insurance.

Also you are a liar.
Twinrix costs EUR 65.60 per shot, Havrix 1440 costs EUR 47.25 per shot. For just holidays one shot is enough and often the insurance companies pay for the vaccine if vaccination is recommended for that country by the Federal Foreign Office.

And by the way, antibiotics are quite expensive. The price of a box of generic amoxicillin is around EUR 70.

Easy

[LatencyKills]

It's time to quit when the patient says it's time, and it's not the business of the spouse, the church, or the government to decide otherwise.

Individual Cases

[RAMMS EIN]

I think this sort of thing cannot be decided in general. You would have to consider the individual case.

As far as I am concerned, I believe interpersonal relations should be mutually beneficial. I wouldn't keep someone else alive just because _I_ want them to live; they have to want it as well. Similarly, I wouldn't want others to keep me alive just because I want to live. The last thing I want is for my loved ones to spend all their time, energy, and money so they can watch me suffer longer, when they could instead let me pass away and find happiness with the billions of people still alive.

Get a better health care system

[kramulous]

My mum suffered a seven year death with cancer. It certainly didn't cost anywhere near that. Dad has just retired this week, I shit you not, with his new wife (of one year, mum died 2001) and is very healthy with money. Mum would have died in that first year without the excellent public health care system that Australia has (or rather, used to have).

You really need to focus on the important things and stop bitching about the little, meaningless crap.

Time to quit? I never got to have the 'now I'm older, what made you the person you are?' talk with my mum. Dad focuses on the future and won't talk about what used to be. Kids will eventually want to know.

Quit when you are sick of fighting or when your kids are ready for you to go.

Money might not be the first question

[houghi]

Was there at any moment a point where it was said that whatever they would do, it would not help or the chances of helping where minimal? And how successful would a recovery be at that moment? Would they be living the same live they did before, or would they be clustered to their bed for the rest of their life?

The chances of success could be a big indicator as well. If you pay $10.000 for treatment and that treatment is 100% it a no-brainer. You go for it. If the success rate is 50% then you might still risk it. If it is 1% success rate, some will still risk it. What if it is 0.001% Then the money factor might become important. If you have it, you pay. At that point people will pay the money for snake oil and it becomes a question if the treatment is really a treatment or just a way to get more money from you and/or do experiments on you.

Each individual will answer those questions differently. If the knowledge would go to the public, I would not have an issue. If the knowledge goes into some patented medicine from some company sueing everybody else who found a cure of what I have, I am not sure. Unfortunately they will say "Either we give you this medicine that might save you live for free and we take your soul or we let you rot."

You, free choice can be a bitch.

Re:How much is your life worth?

[RAMMS EIN]

``Your life is worth your salary.''

Actually, my life is worth a lot more than that. The boss only pays for what I give him, but there is a lot more I do in life.

Re:How much is your life worth?

[kramulous]

Dude, the work you do is not anywhere near as important as what you think it is.

Take a holiday!

Tis a sad day

[bguiz]

It is a sad day when one decides to value the dollar worth of a human life.

Re:Tis a sad day

[Sowelu]

Yeah, it's even sadder for the people who are forced to make that decision. They don't LIKE to. But SOMEONE has to, to save more lives.

Re:Tis a sad day

[kripkenstein]

It is a sad day when one decides to value the dollar worth of a human life.

It is indeed sad, but life is sad that way. If you don't think about the dollar worth, more human lives are lost. As she said in the article, the deceased himself, had he known the costs of his care could be used to vaccinate a tremendous amount of third-world children - he would have preferred the money be spent that way.

It's important to realize, as you do, that human life is not equal to any monetary amount. But it's also important to realize that we have a limited amount of resources, and we need to think about how to utilize them, to have the best possible effect on people, including saving their lives. That includes calculating how much it costs to keep a person alive.

Re:Tis a sad day

[maxume]

If there was no way to exchange dollars for human life, he likely would have died 5 or 6 years sooner.

I can't imagine how that makes you sad. I suppose you might not have thought through that health care costs money no matter what, there are just some systems that hide the costs from the patient.

Re:Tis a sad day

[Ma8thew]

Unfortunately no matter what health care system is used there is a dollar value on life. Would you say that it is value for money to spend the entire revenue of Microsoft for one year to extend someone's life for six months? One month? One week? Because at some point pretty much everyone will draw the line, and then you are putting a value on human life.

Re:Tis a sad day

[AmazinglySmooth]

There really isn't a better way--maybe Yuan?

Re:Tis a sad day

[yabos]

Just because the money COULD have been used for something else, doesn't mean it actually WOULD. The insurance company wouldn't have taken the $620K and sent it elsewhere, they'd keep it.

Re:Tis a sad day

[FooAtWFU]

Statistically, the economists say, the value of a human life is about $1 million. At least, if you can do something for safety (e.g. install a railing somewhere, put a better crumple zone in your car) and there's a 1% chance it will save a life, people are willing to spend up to $10,000, give or take.

That's in the aggregate, mind you. It's a bit harder when it's an individual person.

Re:Tis a sad day

[Anonymous Coward]

It is a sad day when one decides to value the dollar worth of a human life.

Then don't think like that. $600k might possibly have extended this guy's life by 20 months. With something less than 25% prospective benefit. Malaria treatment costs $3.50 with greater than 90% efficacy. Now, the death rate from malaria is only about 1 in 120, but $600k could cure more than 150,000 cases of malaria and prevent the death of 1500 children. If you've got a 70 year old man in one hand, and 1500 children under the age of five in the other, does it still seem so hard to decide?

Re:Tis a sad day

[Rich0]

True, but if everybody made these kinds of decisions then insurance premiums would be that much lower, and then everybody gets to decide how to spend that money. Maybe they just spend it on vacations. Maybe they spend it on building hospitals in Uganda.

Is it immoral for anybody on the planet to own a TV when one child is staving anywhere else on the planet?

If not, then we're just haggling over the price of life. How many children need to starve before we consider selling our TV sets? Every human being makes these kinds of decisions every day without thinking about it. The same people are the first to line up and condemn anybody who actually wants to talk about putting a price on life. It is the epitome of hypocrisy.

Re:Tis a sad day

[Hurricane78]

You are falling for the broken window fallacy.
Every dollar that you throw at that single human life (which is not special), is then missing for other human life.

So if you, by your suggestion, throw infinite dollars at that one life, then what you think happens to the other life?
Hunger, disease and death.

It’s not the dollar that is worth more than human life. The dollar is only a piece of paper. It’s the other human life that we value more at some point, that the dollar can buy.

Of course you are free to choose whichever life you value the most, and give it all for the person who is about to die, because that person gave you so much in the past. Nothing wrong about that.
But is there really no other life that at some point could use the money in a better way to survive, than that person?

If I’m about to die, I rather have my daughter or son improve their own chance of survival, than mine.
After all one could say that if my strain survives, then so do I. I’m not dying. Most of me lives on right there.
Children are humanity’s way of immortality. :)

Re:Tis a sad day

[nedlohs]

You make decision every time you buy a coke instead of spending the money to vaccinate a child in Africa.

And the answer you come up with is: a life is worth less than consuming something with negative nutritional value.

Re:Tis a sad day

[rogerz]

It is a sad day when one decides to value the dollar worth of a human life.

Well, if you decided to spend $0 dollars on saving your own life, you wouldn't need to decide its dollar value. However, somehow what I think you mean is that you think that *I* should not care about how much money I am forced to spend on saving your life.

Re:Tis a sad day

[cervo]

You sure are naive. It is not unusual for agencies to put a dollar value on human life to figure stuff out. The book "Flying Blind, Fly Safe" http://www.amazon.com/Flying-Blind-Fly-Safe-Schiavo/dp/038079330X mentions that there is a dollar value on human life in the FAA. The loss of life and dollar value determines when the FAA steps in and when the economic cost to the industry versus the economic loss of human life is not worth the effort of say forcing some type of safety change/inspection. I guarantee they are not the only agency that does it.

If you really think people don't put a cost on human life (particularly companies selling products that may hurt people) then you certainly aren't familiar with the greed of men. I would bet that tobacco companies computed some type of financial model from lawsuits resulting from the deaths/illnesses of consumers and decided that economically rather than trying to find ways to make their products not kill you, it is better to keep selling and fight the lawsuits....

Oh welcome to earth :)

Re:Tis a sad day

[cervo]

Well I see an awful lot of doctors driving Bentleys/porsches. They work hard it's true. But still what's the cost in human life that could be saved from those good things? I also see awful high premiums on mal practice insurance.

I also can't see not suing a doctor either. I mean if a doctor causes brain damage and you can no longer work for the rest of your life, then you need to sue for the money to live. If a doctor causes an expensive mistake that requires millions in medical treatment to repair or so you can live somewhat pain free, then you need compensation. Now if a doctor adjusts a bone and it hurts, but it heals and you sue for "pain and suffering" then you shouldn't get a dime. If it can be proven that the doctor did it wrong and should have done it another well known way to save you pain, then his license should be revoked.

IF a doctor is leaving his surgical instruments in many of his patients, he should be fired. Once or twice is an honest mistake, over and over again is carelessness. And if he leaves his surgical instruments in then you should be able to sue for medical bills. If his instrument ruins your life and makes you unable to work or causes chronic illness/pain then you should sue and not have to pay the treatment. If it just requires a quick surgery/recovery then you should sue only for the lost days of work, and the medical costs. No need for 100 million because a pair of scissors was left in your stomach.

Re:Tis a sad day

[roman_mir]

Seriously, you'd deny a dying person some care even though they do have insurance or money to pay for it? Why don't you instead go after the politicians and the bankers that just stole 2 trillion from the people of your country and use that money instead?

Re:Tis a sad day

[roman_mir]

sorry, I meant to say those politicians and bankers that stole 2 trillion just in the past 18 months.

Re:Tis a sad day

[MartinSchou]

Of course it isn't reasonable to spend a billion dollars to keep someone alive for another six months. Unless they pay it themselves. But it's still an obscene amount of money to spend on one person.

What the billion dollars buys is another question entirely. For example, I'm pretty sure that my sister could have been kept alive for another six months for a lot less than that, but it wouldn't have been any kind of useful life. She'd have to be kept in a sterile room at the hospital, as the ECMO procedure itself has a high risk of killing you off due to infections and bleeding complications. I'm sure having five banana bags provide IV fluids into each hand isn't healthy either.

She'd likely have to remain in the artificial coma, which doesn't exactly make a good argument for quality of life. And even if she was kept alive for another six months as a piece of meat, it wouldn't really get her any closer to survivign, as Sharp's syndrome doesn't have a cure, and while I don't know the transplant rules, I don't think they'll give new lung, heart and kidneys to people with that kind of auto immune disease, and without those, she'd never get off the ECMO.

So ... spend a billion dollars to keep my sister alive for another six months? Not worth it. A million dollars? Still not worth it. Ten thousand dollars? Impossible at that price, but I still don't think it'd be worth it. There'd be nothing in it for her, and I don't think either of her kids nor her husband would get anything from it. It was murder on my dad, who already saw both his parents die while hooked up to machines, and mom, and it wasn't exactly a dance of roses for my other sister. It's difficult enough watching someone you love die. Making it last longer won't help. To be honest, I suspect it makes it worse. The first couple of days you can sort of put of work, but the longer it lasts, the more you need to get a bit of normality back in your life.

I'd rather see that billion dollars or million or ten thousand be spent on working on a cure for the next person who is afflicted by this. My sister, her husband and her son (the daughter is five, so not much say) all felt the same way, which is why her body was given over to science to get a better understanding of how that particular disease works. Sharp's syndrome is quite rare, affecting less than 2.7 patients out of 100,000 according to a Japanese study. Basic research is better way to spend the money than trying to keep people alive beyond the point of no return.

Re:Tis a sad day

[Anonymous Coward]

>It is a sad day when one decides to value the dollar worth of a human life.
Really? When I'm terminally ill, will you give every penny you have to extend my life or are you a lying hypocrite?

I'm tired of hearing this empty mantra of people with more heart than brains. The amount of money we can afford to spend is finite. The sooner you people grow up and accept that the better off we all will be.

Re:Tis a sad day

[Anonymous Coward]

You're an idiot. You want to go vaccinate some third-world children? go send them all your money. It is not up to your small mind to decide what and how another person should use his money on. I wish he knew that his wife was thinking of this, he should have cut her out of his will.

Re:Tis a sad day

[greensasquatch]

How about we don't look at it in terms of dollars. How about we look at it in terms of resources and man power. $630,000 is about 10 man/years worth of work. So that's 10 people working for a whole year to save one man (truthfully it's a whole lot more than ten people working less than a year each but lets just break it down real simple). Now if these 10 people were used in another way in the medical system, how many lives could they have saved? When you stop looking at as simply dollars and put people and resources behind it you can't just say "save one life at any cost" anymore. Because the dollar amount and the resources that back it up are not infinite.

Re:Tis a sad day

[Blakey Rat]

Could be worse.

In history, there have been many times in many places where life has no value whatsoever. "Noble"men frequently tested the quality of their swords by killing peasants with them. Think of the millions killed by Pol Pot, Stalin, Mao Zedong, Adolf Hitler-- that was just recently!

Look, the fact that you're alive in the 21st century at all? It's not a sad day, it's an awesome joyous day and better than any other time in history. Be happy that he lived in a society well-off enough to be able to diagnose cancer as an illness, instead of thinking the cause was a curse, or bad humors, or demonic possession.

Re:Tis a sad day

[Mendy]

It is indeed sad, but life is sad that way. If you don't think about the dollar worth, more human lives are lost. As she said in the article, the deceased himself, had he known the costs of his care could be used to vaccinate a tremendous amount of third-world children - he would have preferred the money be spent that way.

Or thinking less altrustically, a person might have a better life if instead of the money being spent to prolong their life at the end if was given to them in the prime of their life to have experiences that wouldn't otherwise have been open to them.

Re:Tis a sad day

[Anonymous Coward]

Yeah, it's even sadder for the people who are forced to make that decision. They don't LIKE to. But SOMEONE has to, to save more lives.

*cough*Bullshit*cough*

Forgive me if I don't feel sympathetic toward people who charge the family of terminal patients half a million dollars for 2 years of hospital care. I bet they cry themselves to sleep in their mansions.

Re:Tis a sad day

[iphinome]

Problem is insurance premiums will never get lower, as the parent posted that extra money would just be considered profit, there's little or no competition for health insurance in the US, monopolies don't lower their prices.

After just watching The Matrix again ...

[erroneus]

I can only use words like "inevitable." I've lost loved ones in various ways... the inevitable grandparents, a parent, a son, friends... It's just another ending among many types of endings just as there are many types of beginnings. I'm neither happy nor sad about either. I just can't think in those terms any longer. Have I grown up or have I simply grown numb or indifferent. As I still enjoy life in general and can't help but smile at the antics of my youngest son, I doubt numb is what I have become. I think I have learned better than many how to let go and say goodbye. That lesson came easy when my mother died after a long agonizing time of waiting... for the inevitable. When I got word she died, the first word that came to mind was "finally" and I was happy... well, relieved is a better word. I didn't want her to die, but it was better than the suffering she endured for several years.

I think it would be good for everyone to get it through their heads that life always ends. It is merely a matter of time and circumstance.

The parties wanting more than half a million dollars from all of that will likely never see all of it. Insurance may cover some of it, but who knows what manner of weaseling they will muster up to lighten their own damages. The wife will not be able to cover the difference unless they were particularly loaded and I don't really care. I think the money could have been better spent on happier things. My favorite gifts are the ones I give to others and that are truly appreciated and enjoyed. I can't imagine someone spending that much money prolonging my own suffering.

Re:After just watching The Matrix again ...

[Anonymous Coward]

Let me enlighten you on medicine. I was diagnosed with stage 4 colon cancer in 2001. It had spread into my lymph nodes. I was a goner. I was given 3 years to live. I had the surgery to remove what cancer they could fine and then went on Chemo. I was offered a place in a chemotherapy to run along side normal treatment. It was experimental. Of course I said yes. I was doing 8 hours 1 day a week. Four hours for normal chemo followed by the experimental chemo. I had extreme nerve damage from the treatment. Reaching into the refrigerator felt like reaching into an oven. I asked for a week off of treatment and was told I could quit or continue, no breaks. I quit. They learned from the trials that the dose, at least the dose I was receiving, was far too high. My quitting early didn't hurt my chance of survival. It's now 9 years later and I am still not dead. Remember, my doctor, whom I really think is a good doctor, was honest with me and told me in her best estimation I had three years at best. Was it the new experimental drug? Was it just a fluke? Is it that in a lot of cases we simply know how the majority end up but we really don't know? The money was spent on something I cherish the most, my life. My family agrees, best gift to them in the world.

  When doctors can absolutely state that something is not going to help, and are 100% sure, then I agree with calling it quits. When they say "most likely" won't help then I think it is up to the person to make that decision. It isn't like the money is being destroyed, it is being paid to doctors, nurses, and ll other people who support their families with it. Everyone always looks at the money in a project as being wasted when the end isn't realized in a successful manner. If you build a 6 billion dollar satellite and it blows up on launch you didn't lose 6 billion dollars, you paid for kids to eat, families to buy cars and houses, for people to live. Yes, the company got no return on their money but the money did go for a good cause. To say that money would have been better spent on vaccinating third world children is, in my opinion, short sighted to say the least. And who knows, perhaps there are more people walking around who would be dead had they just went off figuring they had no chance.

Re:After just watching The Matrix again ...

[Anonymous Coward]

Yeah, that's a fine logical point of view.
You've got no right to spout it, though, until YOU have had to stare the grim reaper in the face every remaining day of your life as a fact of reality that simply will not go away.

It's one thing to know that "someday I will day", and entirely different thing to know "I'm dying right now unless something changes".

As others have stated here, the choice to continue (or not) should be *entirely* up to the affected person.
Nobody else should get a say.

Re:After just watching The Matrix again ...

[MattskEE]

RTFA.

When it came to the insurance companies, the sticker price meant little since they had negotiated their own deals with the hospital. Neither the hospital nor the insurance companies would elaborate. The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 was lowered to $254,176 when the insurers paid their share and imposed their discounts. The portion of the charges that were not covered for the most part vaporized. Terence and I were responsible for and paid $9,468--less than 4%.

Ironically if they were uninsured, they would be on the hook for the entire $618,616 instead of what the insurance companies paid.

Re:How much is your life worth?

[Anonymous Coward]

Yes! because people getting huge bonuses for shuffling around imaginary money are worth so much more than say scientists or volunteers.

For instance the CEO of Goldman Sachs has clearly been a 1000x more useful to society than say Einstein, or Bohr, or Turing, yes, a 1000x more useful than all of them combined.

Isn't slashdot for cutting edge IT news?

[Anonymous Coward]

Like a lot of slashdot stories lately, why is this even on slashdot?

Healthcare costs during lifespan

[sciencewatcher]

The amount of money spent on healthcare during the lifespan of a person in Europa is normally divided as follows. 50% for the last year of someone's life and 50% for all years up to the last year. The problem is trying to determine when the last year of someone's life starts.

Re:How much is your life worth?

[Anonymous Coward]

...1000x more useful than all of them combined.

Well, yeah.

exploitation

[Anonymous Coward]

1. patent drug treatments.
2. suppress cures.
3. ???
4. profit

Free healthcare (Scandinavia etc.)

[carlhaagen]

In f.e. Sweden, the cost for this case, over 7 years, would've been a staggering whole lot less in the shape of the extra taxes we pay here for our free healthcare (yes, I do consider it free after all). Over here, everyone helps to pay for everyone, and people get the care they need without being subjected to "pay lots, or get out". Over there, people die, or go broke in the process of staying alive.

Re:Free healthcare (Scandinavia etc.)

[Attila Dimedici]

Based on the studies I have seen of prognosis after being diagnosed with cancer, in Sweden it would have been a lot less than 7 years.

Re:Free healthcare (Scandinavia etc.)

[mindstormpt]

Which studies?

Because Sweden's health system is ranked much higher, life expectancy is much higher, and preventable deaths are much fewer.

Re:Free healthcare (Scandinavia etc.)

[Anonymous Coward]

Source please?

And you might also want to know that our country is so small that no private hospital would have any financial incentive to provide certain special cancer treatments since demand is so small among nine million people. Therefore we have a cooperation agreement with Finland through which they provide that specialist radiation treatment and in return we provide them with certain heart transplant treatments, which they have so little demand for in a country of five million. I don't know the (medical) details better since I found out about this through a TV program about one of our airports and in it they had a brief segment about such a patient flight that day (and I don't think it's cheap for our healthcare system to rent a private jet and equip it suitably for transporting a patient but I think it's worth it).

Re:Free healthcare (Scandinavia etc.)

[matsoo]

I wonder how you can draw that conclusion, since the figures I have seen says that the survival rate after 5 years of people who get cancer treatment are only marginally lower in Sweden compared to the US. As far as I know the only really good study comparing cancer survival rates was led by british MD Michael Coleman in 2008 and is not available (for free) on the net.

The overall death rate from cancer is also much higher in the US compared to Sweden, presumably because many more people get little or no treatment in the US. Another significant difference is that when to stop treating a patient is a purely medical decision in Sweden, and is made by doctors involved in the treatment, so you never get to make this decision as a relative.

Re:Free healthcare (Scandinavia etc.)

[Rich0]

Because Sweden's health system is ranked much higher [photius.com], life expectancy is much higher [photius.com], and preventable deaths are much fewer [allcountries.org]

It all depends on how you make your measurements.

If you look only at people with insurance in both nations I bet the US patients would do a LOT better. However, US stats are skewed by large numbers of people with very little care at all.

Now, whether that is morally acceptable is certainly open to debate. However, simply looking at averages doesn't really tell the whole story. Why do you think that so many Americans opposed some of the recent healthcare legislation? The fact is that many Americans actually receive fairly good care (at exorbitant cost), and so the issue is how to not throw the baby out with the bathwater.

Re:Free healthcare (Scandinavia etc.)

[nedlohs]

Generally when comparing countries you compare *all* the people.

You don't declare that Zimbabwe is wealthier than the US because we are only going to count Robert Mugabe in Zimbabwe and compare that with the average of everyone in the US.

You can't just exclude a huge chunk of the population because they make the numbers worse.

Given the number of people with private health insurance in Sweden number in the low thousands, any comparison you do with them will be overwhelmed by noise.

Re:Free healthcare (Scandinavia etc.)

[Rich0]

Generally when comparing countries you compare *all* the people.

Hence the reason I said those statistics are misleading. After all, if you live in the US and have insurance which matters more to you - the healthcare of all people who live in the US or the healthcare of all people who live in the US and have insurance?

I did clearly state that there is a legitimate moral question around whether such a have/have-not system is acceptable.

I think that a move towards universal care in the US is inevitable. That will invariably raise the overall life expectancy figures. Whether it improves care at all for those who already have good care is a very open question.

Re:Free healthcare (Scandinavia etc.)

[Anonymous Coward]

And they don't count infant deaths that happen in the first 6 months, where the US is the ONLY country that does. Considering that, if the US is anywhere close on those expectancies, that would make the US much higher if they counted the same way.

Re:Free healthcare (Scandinavia etc.)

[sourcerror]

If you cover less people with the same budget, the few can have better quality care, big surprise!

Re:Free healthcare (Scandinavia etc.)

[Anonymous Coward]

Yes, its pretty much the same all over the Europe.

Austria herewhere it is supposed to be private - though its covered by the government if you are unemployed, subsidised for students etc.

The stories of US healthcare system are quite disturbing.

Correct me if I am wrong, but I think the problem could be that many people in US think country is moving towards socialism when even remotely close ideas about a universal healthcare system are proposed

Re:Free healthcare (Scandinavia etc.)

[RightSaidFred99]

The US has the best health care available, if not the best "system". I'm tired of seeing the same old lies about e.g. infant mortality where the US measures them differently than other countries. We have the best medicine. I have access to that medicine, as do a majority of Americans.

Where the US falls short is that not all Americans have access to that system, and it can place a financial burden on some people.

Re:Free healthcare (Scandinavia etc.)

[nedlohs]

I live in the US and have insurance. What matters to me is the healthcare of all the people in the US (regardless of insurance).

And whether it improves care for those people isn't important - what matters is does is make it worse.

Now the government always does find a way to amaze me on these matters and hence likely will again, but I can't see how you come up with a worse system than the US currently has.

Ridiculous tax rules tying employment and health insurance together? What idiot thought that was a good idea?

Re:Free healthcare (Scandinavia etc.)

[ben_white]

It is not free!!!!!! Repeat after me, "quality health care is not free." Even though you want to think it is and it appears so from your (and most other citizens') point of view. The economic costs of providing medical care are real, and cost benefit trade offs do have to be made. In a truly socialized system such as in Sweden those trade off decisions are made by government agencies establishing what care will and won't be paid for. The basis is usually a balance between compassionate availability of care for the sickest patients and wise use of funds to wring the maximum population benefit per dollar (or krona) spent. In the US system we make those decisions based on less rational criteria; for non-emergent care it is based on whether or not you can pay, in emergency situations hospitals and doctors are required by law to deliver care without regard for ability to pay until the emergent problem is resolved. This perverse system provides crazy incentives for the way care is provided and our current mess. But I digress. The point is that health care is expensive, even in systems where it has the appearance of being free, there are complex decisions being made on how to muster economic resources so that you can get care.

Re:Free healthcare (Scandinavia etc.)

[Rich0]

Couldn't agree with you more on all of your points.

However, everything I've read about the current health proposals in the US is really a worst of both worlds system. Sure, it will lead to universal coverage, which I think is a good thing. However, in the desire to not tick anybody off they're basically going to be printing money to propagate the current mess as long as they can. NOBODY wants to tell ANYBODY that they might make a little less money in the future as a result of the changes.

Re:Free healthcare (Scandinavia etc.)

[compro01]

Ridiculous tax rules tying employment and health insurance together? What idiot thought that was a good idea?

A nice case of "It was a good idea at the time", namely during WW2 when wages were fixed (keeping inflation stable), resulting in companies competing for employees working around that by offering extra money in the form of things like health coverage and pensions, which didn't legally count as wages. Follow up with a "don't rock the boat" mentality and other factors occurring in the background (a positive feedback loop in medical costs, for example), and you end up with today.

Re:Free healthcare (Scandinavia etc.)

[nedlohs]

Which I'd also count as "what idiot thought that was a good idea" in and of themselves. Price controls always cause your problems than they solve.

Price controls with a nudge-nudge-wink-wink official way to set go over them anyway are even more insane.

Just sick?

[Arkan]

This is like putting a price on one's life. Even asking such a question is disgusting, and shows a complete lack of humanity.

I can't even imagine the mindset that can push someone to formulate such a question.

I think this is an huge hint that our society as a whole as gone south. Prove me wrong, please prove me wrong.

Re:Just sick?

[benjamindees]

It is not putting a price on life.

It's merely deciding whether you value quality of life over quantity.

Re:Just sick?

[Vector7]

The inability of some people to put kneejerk emotional reactions aside and rationally consider whether it's reasonable to spend a considerable fraction of many people's total lifetime earnings for the sake of extending the life of a very sick person for a few months or years is disconcerting. It's fine and good to pretend money is no object when you aren't the one paying for it, nor the one suffering bedridden and perhaps barely conscious. When you consider your typical middle class American spends most of their life working to pay off a few hundred thousand dollar mortgage, burning through that much or more on a person with a terminal illness is in some sense like throwing the life's work of another person away. Unless you're willing to be that person, pipe down.

Re:Just sick?

[crazedartist]

Exactly. And there's also the factor of leaving your entire family in insurmountable debt and poverty. It's not about putting a price on a life, it's about comparing the sick person (or family's) two priorities: keep living no matter what, vs. ruining their family's lives for many years even after death. Yes, OP, it's disgustingly tragic -- but so is the alternative, in extreme cases like this. Such is the way of things in a resource-limited life. (resources = health care and money.) Arguably, spending every last cent of your family's money on your own health care is the economic (and moral?) equivalent of ditching your penniless spouse and family. Of course in reality, we aren't often presented with such an extreme case, and hindsight is always 20/20.

Re:Just sick?

[nacturation]

This is like putting a price on one's life. Even asking such a question is disgusting, and shows a complete lack of humanity.

For $1,000,000,000,000 we can extend the life of this 97 year old person who lives in chronic pain by 24 hours. By your logic, we should do it because it's disgusting and shows a complete lack of humanity to not go ahead with the treatment.

Re:Just sick?

[RightSaidFred99]

Wow, how positively dramatic of you. If you were at a podium would you pound on it and have tears (for effect, of course) streaming down your face?

The fact that you are typing on SlashDot on a computer right now shows you are putting a price on life, you fucking hypocrite. You could be working your fingers to the bone donating money to feed starving children, or to pay for research into a cure for Malaria or some other disease.

I love the holier than thou brigade. They're always so completely full of shit.

You sir, are an idiot.

[Anonymous Coward]

Value is subjective for absolutely everything. Even paper with absolute numbers printed on them.
Your example about hiring someone to commit murder is over-simplified. Murder is illegal and has stiff penalties, including life imprisonment or capital punishment, which is trading one life for another.

To your group of family and friends, your value approaches inf. whilst the state might glom you up into it's statistics, and assign you a value of around $15.00 per hour

And if you were to threaten my life, I would kill you for free. Free as in beer, and free as in freedom.

Selfish?

[ebonum]

If I was in his position, I would have let it go. When the odds of a successful outcome are low, I would consider it a hugely selfish act to blow hundreds of thousands of dollars on my own treatment. If I was really rich, perhaps I would spend more of my own money on a few last ditch attempts and continue the treatment. Even then, when I reach the point that I can no longer be active enough to enjoy simple pleasures outside without assistance, I'd let it go and leave the rest to family or donate to a good cause. I completely fail to understand why anyone should be forced to pay for my personal expenses.

Enjoy life while you can when you are active and healthy. All good things do end. When you are bed ridden and on the way out, let nature take its course.

Re:Selfish?

[Ma8thew]

It's pretty easy to say that when you're not facing a terminal illness. No one can truthfully say how they will react to a very difficult decision like that until it actually happens. We can say how we would hope to react, but to suppose we would make a better choice than someone else is dishonest and arrogant.

Re:Selfish?

[Urkki]

It's pretty easy to say that when you're not facing a terminal illness. No one can truthfully say how they will react to a very difficult decision like that until it actually happens. We can say how we would hope to react, but to suppose we would make a better choice than someone else is dishonest and arrogant.

Of course, if you're not especially rich (to some degree even in countries with "socialist" health care, more so in countries like USA, and especially in developing/3rd world countries), it doesn't matter much how you react, 'cos you can't afford the treatment anyway...

Re:Selfish?

[Ma8thew]

In the West people many people undergoing cancer treatment will at some point decide to stop chemo or radiation therapy because they want to spend their last few months feeling somewhat healthy. That's the kind of situation I'm discussing.

Re:Selfish?

[Anonymous Coward]

Amen to that. GP is an asshole.

Re:Selfish?

[SydShamino]

Have you taken the time to create a living will that says this? Your slashdot post doesn't count, and with nothing else your parents (or spouse or children) may end up making the decisions based on their emotions, not yours, if you are unable to communication your wishes.

Re:Selfish?

[Anonymous Coward]

The issue is that the costs are over inflated. His treatments in all likelihood would be completely reasonable as an attempt to beat the cancer... if it were not for the fact that in the United States, Tylenol pills cost $140 when handed to you by a nurse, $120 for a bit of gauze, $1000 for a toothbrush, $102 for an IV bag (and they'll bill you for 40 they didn't even use on you to the tune of over $4000), $765 for laying on a gurney in the hallway of the ER...

In the United States, it can cost thousands of dollars just to go to the ER, get an X-Ray and get a few stitches. $618k for one person for cancer is probably on the low end now so it's not selfish to expect that treatment because it absolutely shouldn't cost that much to begin with.

Re:Selfish?

[cervo]

I would say you would look at it different when dying. Maybe you let it go and then a year after you die they find a cure for your disease. Or even worse, you let it go and then a few months before you die they find a cure....but it is too late to apply it. I would rather live than have the $1 million go towards bonuses to pharmaceutical executives or medical device maker executives or insurance executives.... e2fsck them.....

Re:Selfish?

[Anonymous Coward]

When my life is at stake, money is no concern to me.

Re:Selfish?

[owlstead]

You nailed it. It is important that we have been build by evolution to safe our lives. Doing away with our own life is very hard. My mother did stop her own life, but even after months of planning it in advance, only in the last week I had the feeling she was really ready to let go (shortening her bed ridden suffering maybe for weeks/months). I can only hope that I am that strong when my time comes - hopefully a heart attack or similar will end my life in a less dramatic way. But I will never ever accuse someone of hanging on to life, it's really really hard and maybe even unnatural*1 to let go.

*1 Something not being not natural is no reason not to do things, as some persons may lead you to believe (I hear the sound of an urn turning half a round after hearing four negatives in one sentence :)

How many other lives could that money save?

[Sowelu]

Yeah, it sucks for him, but I bet I could find ten other people who could live six years longer on average with just $60,000 to spend on their health care. Medication they couldn't afford, living conditions that are toxic, not having enough food, being in need of rehab, hell, just finding cancer early so it can be treated. Not to mention what impact that money would have in third-world countries. $600,000 kept him alive for seven years...That could be two reasonably-paid people working full-time on HIM ALONE, for seven years straight. Think of what else they could do, what other benefits they could bring to the world. Or hell, that money could pick a smart but poor high-school graduate out of Wal-Mart and put him through medical school to become a doctor. Yes, there's a point where the money ought to be spent on someone else...especially when it's public money.

Anonymous Coward

[Anonymous Coward]

Money doesn't come out of thin air (as much as the US government might think otherwise). We all are paying this $618k bill.

Stories like this happen every day. Over a year, this is many millions of dollars which you and I are somehow paying for.

How much of your money are you willing to spend to prolong a total stranger's life?

$1? $10? $100? $1000000.

IMO, America needs to start being realistic about money and the fact there are limited resources available.

You're Sick!

[Putr]

How twisted have you Americans become that you even ask yourselfe this question! When a mans(or womans) life is at stake, money has no value! That's why we have Universal helth care, so that you dont have to care! (I'm pissed but I'm going to stop now.)

Re:You're Sick!

[benjamindees]

If you're really pissed about this, then you haven't really thought it through.

Natural resources are finite. The supply of human labor is finite. It is impossible to expend infinite amounts of resources extending human life. You've been lied to if you believe you don't have to care about these truths. And if your government is the one who has told you this lie, that just means that they will take on the responsibility of reconciling any disconnect between your perception and reality, by force, whenever necessary.

Re:You're Sick!

[cbope]

The sad part is that his life was likely extended a bit, only by the fact that the family could AFFORD it. An unemployed or uninsured person would very likely have died much sooner from lack of treatment or medication due to the fact that they could not pay for their care. This is just wrong and healthcare in the US really needs a reboot. When insurance companies have near-total control over your treatment, what drugs they will pay for and for how long, etc., the system is TOTALLY BROKEN. Doctors and care providers should be the ones responsible for determining the best methods of care for their patients. The costs for healthcare in the US are at the opposite end of the spectrum compared to most other civilized countries, even those with universal or socialized systems. It's not the doctors or care providers getting rich off the sick American, it's the middlemen: insurance companies (and health care "plan" providers).

Fix the system, it's terribly broken. And get over the fact that some of your tax money will be spent HELPING OTHERS who cannot afford care. It's something you have to accept to fix the system. I live in a country with socialized healthcare and yes we pay taxes for it. But my healthcare is basically free or very low cost. I do not need to worry about getting sick, losing my job and consequently losing my right to healthcare. It's in the benefit of society as a whole to have a healthy population with adequate healthcare. A population with adequate healthcare at reasonable cost (much less than in the US currently) is much less expensive over time than the current healthcare system in the US.

Re:You're Sick!

[cbope]

I should add that the privatization of many hospitals in the US is also a huge part of the problem. Private hospitals operate to generate a PROFIT. They have no real interest in the healthcare they provide, beyond the profit they generate for their shareholders.

This does not mean there are not caring doctors and staff at these hospitals, just that operating cost (and resulting profit) of the hospital drives most decisions made in patient care. Decisions are not made in the best interests of the patient, they are made in the best interest of preserving a level of profit for the hospital as a whole.

Hospitals should not be run as private businesses. They should not operate "for profit", like a normal business. They are there to provide a service to the population, who in turn have paid taxes to be able to benefit from such care. It's not wrong for a hospital to make a profit, but the expectations of a profit margin like a normal non-healthcare related business are absurd.

I speak from experience, as I saw the privatization of a formerly good, non-profit regional hospital. Patient care went out the window when it became privatized and practically all decisions related to patient care were based solely on a cost/profit basis. The level of care dropped severely and the hospital even started to turn away uninsured patients who needed immediate care. It was sickening to say the least.

Re:You're Sick!

[Vector7]

You're an idiot.

Re:You're Sick!

[corbettw]

Should doctors work for free? Should drug companies not be compensated for the work they put into making their products? Should a construction company build a new hospital, from scratch, with no reimbursement?

Health care has a dollar value because the things which comprise are not free. How twisted are you Europeans because you think, just because you don't pay for these things directly, that no one has to pay for them at all?

Re:You're Sick!

[Rich0]

Doctors and care providers should be the ones responsible for determining the best methods of care for their patients.

Why is it then that the nation that you live in sets guidelines about what kinds of care that doctors can provide? Why is it that in your nation the legislature decides how many doctors will be hired, and not the doctors themselves? Why is it that in your nation the government decides how much to pay doctors, and the doctors don't just set their own wages? I can say this having no idea where you live, as in EVERY nation on earth the people paying for healthcare set these kinds of guidelines, whether we're talking about private insurers in the US or nationalized health systems in Europe.

The fact is that your government has decided that it is NOT only the job of a doctor or care provider to decide what the best methods of care are for patients. They have placed a price on life.

And this is a good thing!

A population with adequate healthcare at reasonable cost (much less than in the US currently) is much less expensive over time than the current healthcare system in the US.

This is absolutely true. The US has a horribly inefficient healthcare system. However, make no mistake in thinking that in making the system much more effective and efficient that a price on life will not be set.

Any healthcare system can trade more money for increased health outcomes. Now, in the case of efficient systems like in Europe we could be talking about a LOT of money in exchange for a tiny amount of additional health. However, the fact that 100% of a nation's GDP doesn't go towards healthcare and yet people are still dying indicates that at some point every nation is willing to draw a line.

The only difference is how openly people are willing to talk about it.

Re:You're Sick!

[chowdahhead]

This is not true. A large percentage of hospitals are non-profit and rely on philanthropy to balance their budget. Furthermore, you underestimate the amount of care provided that is under-reimbursed. It's not a coincidence that hospitals are leaving their independence to join healthcare networks, allowing them to combine resources and remain afloat. When looking at the US healthcare crisis, the outlook for hospitals is actually pretty bleak.

Re:You're Sick!

[Fnkmaster]

You do realize that in your country, somebody asks this question too. Assuming you live in a country with a single payer system, the people who run your single payer system have already decided what they are willing to pay and for which procedures. The way they do that is generally looking at dollars spent vs. quality-adjusted-life-years purchased for their taxpayer citizens, and similar health economics measures. I agree that the system in the US is fucked up in many many ways, but having to consider costs in medical treatment is a reality of finite resources and it happens everywhere.

Re:You're Sick!

[RightSaidFred99]

We'll see how that universal health care works out for you in the long term, dude. When the life expectancy has gone up to about 95, and your birth rate is even further in the shitter you tell me how that's working out for you, ok? You think the US is imploding economically, wait until you see what happens to the EU with it's simply unsustainable social policies. It's not going to be pretty.

Re:Maybe we can just take the right away from her.

[Kijori]

Having private health insurance and then not letting people make use of it seems to be the worst of both worlds...

Re:Maybe we can just take the right away from her.

[cedars]

I'm guessing from that comment you're fairly young because the truth is there's a lot people do after 45. Many people (including CEOs, judges and surgeons) reach the peak of their career after 45. If you had kids at 28, they still wouldn't be adults by the time you turn 45.

keep someone alive if they can recover

[distantbody]

How about 'Keep a long-term poor prognosis patient alive with your own resources'. It's a tough approach, but keeping someone with a bad diagnosis alive when they would have died a long time ago is cruel and unnatural, and stretches the 'public healthcare' mission a bit too far.

Economists' approach

[Anonymous Coward]

There actually is a mathematical approach to determining the monetary value that a person associates with their own life by measuring the price they are willing to pay to reduce their risk of dying. Economists use it by comparing job safety to salaries, people's willingness to buy certain automotive safety features, etc.

Here's a very crude approximation. (IANA economist, so feel free to correct me.) Suppose a demon comes up to you and says that he's about to push a button on a magic box. When he pushes the button, there's a 99% probability that nothing will happen, but a 1% probability that the box will kill you. However, he offers not to push the button at all if you pay him a monetary bribe of a certain size. (If demon accepts your bribe, he takes the money 100% of the time, regardless of what the outcome of the button-press would have been. Assume that you can trust the demon's honesty and that there are no externalities, such as "paying him will only encourage this sort of behavior.") If you think you can't put on a monetary price on a human life, consider: you'd be an idiot not to pay a mere $1 to reduce a 1% chance of dying to zero, but if the price is your entire net worth, you're certainly better off taking the 99% chance that you'll be able to continue your life tomorrow without being a penniless beggar. Hence, there must be a number between those two extremes such that paying less is a good idea but paying more is a bad idea. Suppose you rationally decide where that boundary is. Multiply that number by 100, and you have the cash value of your life.

Stupid argument - money wasted elsewhere

[dbIII]

Since it's less than the price of Carly Flonina's stupid Devil Sheep advertisement who are we to say it's more of a waste of money?
There must be quite a few health care executives with no medical training or medical experience at all that get paid far more annually than that. There's a vast industry and only a tiny proportion of it is focused on health care, most of it is about carving out monopolies to maximise profit - you can forget about the "free market" because it does not apply.

Re:Stupid argument - money wasted elsewhere

[Rich0]

Since it's less than the price of Carly Flonina's stupid Devil Sheep advertisement who are we to say it's more of a waste of money?

Well, as a taxpayer being asked to potentially foot the bill for socialized medicine, I certainly get a say in this. I didn't pay a dime for that ad, so I could care less how much it cost. When I buy a product I pick the best product I can get for the money I'm spending, and as a result I could care less whether it might have cost 0.1 cents less if some particular corporate decision were made differently.

There's a vast industry and only a tiny proportion of it is focused on health care, most of it is about carving out monopolies to maximise profit.

I'll certainly agree that quite a bit of money goes into satellite industries, although the majority are focused to some extent on providing care. They all have overhead, but that is true of all industries.

When you look at healthcare there really isn't any single "evil" industry or factor you can point to as being responsible for all the cost. Insurers do create overhead and take profits, but they are only a component of the cost. Tort law certainly creates overhead and takes profits, but they're only a component as well. Doctors create overhead and take profit, and they're a component of the costs (and if doctors were perfect you wouldn't need all the overhead in the insurers and lawyers to catch them when they make mistakes or try to overcharge). Patients crave treatments that aren't cost-effective, and that drives up costs. There are a ton of factors that drive up healthcare costs.

you can forget about the "free market" because it does not apply

On that, we can agree. I'd go further and say that healthcare will NEVER be a truly free market, due to the nature of the bargaining positions of providers, payers, and patients. However, I do think that regardless of whether care is socialized or not that some reforms should be enacted to at least make the market a little more functional. There will always be a need for heavy regulation in this area, but the more effective the market can be made the more money whoever is paying for care can save, whether that ends up being patients or taxpayers.

Re:Stupid argument - money wasted elsewhere

[dbIII]

I didn't pay a dime for that ad

It's part of the process of making a government so it will come out of your wallet indirectly at some time.
My point however is there are plenty of things we spend money on that are far more trivial than if somebody lives or dies.
Personally I think that a large proportion of those costs were artificially inflated for completely non-medical reasons.

Re:Stupid argument - money wasted elsewhere

[Rich0]

Personally I think that a large proportion of those costs were artificially inflated for completely non-medical reasons.

Well, anybody who knows anything about medicine can tell you that.

"Medical devices" are highly regulated, which means low competition and very high prices (even where there is competition a lot of non-value-add money gets spent to satisfy lawyers/regulators). I saw an article that indicated that stroke patients had better outcomes regaining balance with a $100 Wii balance board as compared to a $18k medical device. Sure, maybe 1/100k Wii controllers ships defective, but what is the impact of that? (I'm sure if somebody falls off of one the doctor that suggested using will be sued, however.)

There is overhead at every part of the process. Half of it amounts to "don't buck the system" since those who do tend to get sued.

Then throw in consumers who are all too happy to spend money if somebody suggests that a procedure will help them.

If you can try to dig up a copy of an NPR show from last year I think that talked about medical costs. It was amazing how much the whole system is biased towards spending money without much regard to whether doing so is likely to actually provide real benefit.

There is no time to quit

[egnop]

Allthough I agree a little bit with fluffeh:
- I would ask at what point did HE stop wanting to go through all the medicines and procedures?
- If you ask me, that's when it should have stopped.

I've been through that process with several people that eventually died,

The main thing that keep hopes up is that they will find a cure for the problem within the time frame.

Yes, I know, it sounds like irrational, but missing the one you love is keeping up taking the effort of holding someone alive

And that point, that very fine point is the point where you just keep going, and don't quit.

There is no time to quit until reality and rationality wins in your hopes...

OT question

[Anonymous Coward]

"Take a holiday!"

The clocks at Slashdot seem to be on holiday... Anyone else notice the one-hour shift in time stamps? Bizarre. We don't Spring Forward for another week...

Lessons of a $618,616 Death

[AHuxley]

This is why most of the rest of the world has gov pay if you want/need it.
If you can afford it you go private, great, for others you have the gov option.
The only question then is personal and medical - are the drugs working, are the complications worse than the treatment with no positive long or short term result.
Does the person want to continue with the meds or pass away at home?
Costs should not come into into healthcare -
Why spread the cost over young healthy people and non sick people ?
Think of 1 loss of a sick person - net loss to the tax system is one sick person.
Think of 1 loss of a sick person and the debt of a family in the $618,616 world?
The stress and loss of 1,2,3 + tax paying productive workers as they feel the long term $618,616 stress?

Why make the choice?

[Bartab]

Taxpayer bankrolled (what some call, "free") healthcare means never having to decide when spending the money isn't worth the value anymore. Spend millions on the last week of life? NO problem! Everybody -else- will pay for it, and you can still pass on your financial portfolio to your kids! Win win! Well, except for all the people paying. They're losing.

Re:Why make the choice?

[nevurthls]

I don't have any numbers to back this up, but the way I've heard it end of life care cost is much higher in the US than in Europe or elsewhere. Not just absolute but also relative to total health care cost. You're wrong.
The amount of people in the US that state they want doctors to do everything they can to stay alive a few more days is staggering. Even if it will make them miserable, and success of treatment is measured in adding days to the cancer patient's life, by slowing the progression (while getting the patient more and more sick), not in how it cures them of anything.
Ask any cancer doctor: there is a rather large very religious group of US residents that doesn't care about suffering and just does not want to die. So millions are wasted to add suffering and paradoxically postpone their trip to heaven, wasting money that can save other people's live in the process.
I believe, like many others have stated, that the time to pull the plug on a terminally ill patient is when they don't want life anymore. Now this won't affect cost here in the US much unless that terribly large religious subset (please, I'm not talking all religious people, don't get me wrong) stops fearing death so much. http://en.wikipedia.org/wiki/Terror_management_theory

Re:Why make the choice?

[Fnkmaster]

Ummm, nobody has ever suggested or run a system like that. Single payer systems that are taxpayer bankrolled in other countries simply don't do that. They have a finite budget to cover the population of their country and they have to allocate care as efficiently and cost-effectively as they can. In most cases they do a better job than the US at that, in the sense that they provide comparable outcomes at much lower cost. I've never heard of a government-funded healthcare system that freely lets physicians spend millions of dollars on a terminal patient's last weeks of life - they'd drive their system bankrupt in no time that way.

I mean, I'm happy to have a debate about the merit of different systems for funding healthcare, but you have to at least make a sensible argument for people to take you seriously.

Questionable Source

[Lord Byron II]

Why is it when we have health care discussions, the media tends to quote widows and widowers? They are not experts in health care and they are not unbiased. Sure, her story is interesting and compelling, but does it tell us anything useful about medicine in the US?

Re:Questionable Source

[Bluesman]

The media and politics in general are based on emotional appeals, because most people don't understand logical arguments.

It's governance by irate mom, and ludicrous, but off we go.

Re:Questionable Source

[CodeBuster]

but does it tell us anything useful about medicine in the US?

No, but it does generate higher ratings, more viewers and more advertising dollars by appealing to viewers' emotions. Besides, the broadcast and cable "news" is mostly just for entertainment anymore here in the United States; what did you expect, real journalism? Maybe in some parallel reality, but not in this one.

Re:Questionable Source

[ben_white]

Why is it when we have health care discussions, the media tends to quote widows and widowers? They are not experts in health care and they are not unbiased. Sure, her story is interesting and compelling, but does it tell us anything useful about medicine in the US?

Yes it does. This article is excellent. This widow asks more probing questions about the economic underpinnings of our broken medical system than our leaders do while trying to overhaul it. RTFA-A(gain).

The cost of Healthcare

[Guru Jim]

I worked in ICU for a while and the statistic that gets through around there is that often 75% of a person entire healthcare bill is spent on their last stay in ICU. Dealing with palliative care is a little different, but based on my experience with death and dying, it is up to the patient. When they think it is time to go. A lot of the therapies are pretty invasive/painful/make you feel really bad, so a lot of it comes down to a kind of risk/reward. You also get the healthcare system you pay for. In from Australia, and healthcare is a lot cheaper here than in the US, but the US has a lot more aggressive interventions that save more lives. If you want to cut the cost of healthcare, sure doctors wash their hands!

what? why?

[user138]

As someone who as dealt with this issue... If it were your family, would you pay the cost? It's up to the patient. F the bills... it's about being alive. Why is this on slashdot... ya.. making money on sick people is (as far as i can figure) wrong. and contrary to being a caring human (and yes i understand the capital consequences of this argument). j.

600K is quite low

[140Mandak262Jamuna]

The cancer must have been one of the aggressive ones. I see the 600K billed is on the low side. The actual payments to the providers would have been less 125K. Typically the terminal patients generate 1M$ in bills in their last 24 months. And generate about 300K in actual payments if they die in a hospital.

easy enough

[Anonymous Coward]

it's time to quit when he doesn't want to extend his life or when you *are* sure that the treatments wont help extend his life.

I think that it's pretty much always worth it

[vadim_t]

True, it's horrendously expensive. But that money pays for research, and that research will allow people to stay alive or even get cured a lot cheaper later.

People aren't going to pay half a million for battling cancer forever. At some point it'll be understood and become curable with a few of the right pills and injections. But for that to happen, somebody needs to try the less understood or experimental treatments and see if it works out.

Incidentally, I believe that paying for the "vaccine for nearly a quarter million children in developing countries" is on the long term a rather pointless thing. Doing it that way we'll just be shipping vaccines over there forever. Instead, money should be invested on infrastructure in those countries that need it, so that they can manufacture their own vaccines. Also, actually allowing those countries to manufacture them by eliminating the need to obey the patents would do a whole lot more of good.

Re:I think that it's pretty much always worth it

[crazedartist]

How do you figure that money pays for research? The insurance company / hospital is plowing all their profit into research, you figure? I somehow doubt that. If contributing to research is your primary motive, just donate it to a research grant organization directly.

Re:I think that it's pretty much always worth it

[vadim_t]

Of course not all of it. Not even a large part of it probably.

But, if when people got cancer they decided to just take pain relief medication and die quietly, nobody would do any research. Somebody has to fight until the bitter end. And those people are precisely those who try the experimental medicine, in case it helps. Even if research was entirely funded by donations, somebody still has to volunteer to try it.

The first heart transplants were a desperate gamble, but now thanks to all the attempts many people can actually enjoy a normal life afterwards, and some even manage to climb mountains.

Re:I think that it's pretty much always worth it

[Vellmont]

True, it's horrendously expensive. But that money pays for research, and that research will allow people to stay alive or even get cured a lot cheaper later.

Some of it pays for research. More of it goes to marketing though. How much is pure profit? I'd rather not try to address the complexities of public funded drugs vs "free market" funded drugs, but suffice it to say the picture is far more complicated, and has many more options than what you're saying.

Incidentally, I believe that paying for the "vaccine for nearly a quarter million children in developing countries" is on the long term a rather pointless thing.

Infra-structure doesn't help so much when everyone is dying of some easily preventable disease. Infra-structure is important, but you have to start with getting people relatively healthy first. Sick people ain't so productive, and are obviously very expensive. Is it really smart to build a factory, educate the workers, train them.. and then have a large portion of the people you just spent a lot of money on dying of malaria, or some other cheap to prevent disease? A healthy society is the base of productivity. In a very real sense it IS infra-structure.

Re:I think that it's pretty much always worth it

[vadim_t]

Infra-structure doesn't help so much when everyone is dying of some easily preventable disease. Infra-structure is important, but you have to start with getting people relatively healthy first. Sick people ain't so productive, and are obviously very expensive. Is it really smart to build a factory, educate the workers, train them.. and then have a large portion of the people you just spent a lot of money on dying of malaria, or some other cheap to prevent disease? A healthy society is the base of productivity. In a very real sense it IS infra-structure.

I agree, but why is it that year after year people keep talking of that for $X dollars we could feed/clothe/vaccinate $Y millions in the third world? If we have to feed $Y millions this year, and 1.1 * $Y millions the next, and so on, we're not making any progress. We're even actually making things worse. For instance, the massive amount of donated clothes destroys the clothing industry in those places. Instead of helping what we do is screwing up their situation even more, and making them dependent on donations.

The "feed $Y millions" stuff should have ended decades ago, except for mass disasters. Feed people once, then make sure they can keep feeding themselves without further intervention.

Re:I think that it's pretty much always worth it

[Vellmont]

If we have to feed $Y millions this year, and 1.1 * $Y millions the next, and so on, we're not making any progress.

If population growth is the only thing that improves, I might agree with you. Is that really the case though? What about measuring the amount of sick people that need treatment? You act as if people is merely a burden rather than a resource.

For instance, the massive amount of donated clothes destroys the clothing industry in those places.

Only if all the following conditions exist:

There actually IS a clothing industry in whatever place we're talking about.
The clothing is actually donated rather than someone just buying clothing locally.
The people who can't afford clothing would have somehow went out and bought it rather than continue to wear rags.
A significant portion of the clothing in the theoretical clothing industry is sold internally rather than exported

Given that we're talking about economically depressed region, I'd say at least one of those conditions isn't going to apply.

Feed people once, then make sure they can keep feeding themselves without further intervention.

How long is once? And what makes you think progress hasn't been made? The world is a big place, and expecting everything everywhere to just turn around in a few decades isn't realistic. If you really think no progress has been made in these countries, I'd suggest taking a look over at gap minder

Re:I think that it's pretty much always worth it

[vadim_t]

If population growth is the only thing that improves, I might agree with you. Is that really the case though? What about measuring the amount of sick people that need treatment?

I'm not talking about the population, but about the amount of people to feed.

If you have to feed 10 million hungry people today, and 12 million next year, there is a problem. That can be either that the population grew, or that people are overall worse off and in more need of help. In the first case, the increased population is still failing to produce enough food, in the second, the food isn't really helpful. In any case something is wrong that isn't getting fixed by just sending free food to the population.

You act as if people is merely a burden rather than a resource.

If those people were a resource then next year there would be less people to feed, as those extra people would be growing food, for instance.

Only if all the following conditions exist:
There actually IS a clothing industry in whatever place we're talking about.

Making clothes is easy. I'm not talking about designer clothes here. Some cloth, thread and a sewing machine can go a long way. Your grandma didn't need a room full of machinery to knit a sweater.

But, even that goes nowhere when you ship truckloads of your old stuff and dump it on those people for free. What little industry was there dies, then they start needing those donations because you just drove the producers out of business.

The clothing is actually donated rather than someone just buying clothing locally.

Lots of it is. I've seen many notices in many places along the lines of "Leave your old clothes here, we'll pick them up and send where needed". Apparently more than enough to screw up the industry as per the above article.

The people who can't afford clothing would have somehow went out and bought it rather than continue to wear rags.

Yes, but that's not a sustainable economy. Short term, somebody gets old designer jeans from the US. Long term, that means they don't need to buy locally, so the local maker goes out of business. In turn, that local merchant now isn't earning money to spend in the local economy. If they try to grow food, well, you dump truckloads of that for free in there as well.

Re:I think that it's pretty much always worth it

[Anonymous Coward]

How do you figure that it doesn't? If you're going to make an argument like this the least you can do is to back it up.
 
I know the largest medical company in my area does a ton of research and most of it is far reaching research. Where do they get the funding? They're also the owner of most of the hospitals in my medium sized metropolitan area. Oh, and before you flap your gums some more? They also do a ton of work within the community with no reimbursement. Most of that shit goes largely unnoticed by naysayers like yourself tho, since there are so many bitches who feel entitled to a free living without having to pay into the system.
 
It outrages me to see fuckers who think that resources are being shit out of asses everywhere and that bills should magically take care of themselves.
 
Learn a little about R&D in medicine and you'll see that it's far from a government subsidized free ride for the groups doing it altho most slashdorks would have you think otherwise.

Re:I think that it's pretty much always worth it

[Alinabi]

True, it's horrendously expensive. But that money pays for research, and that research will allow people to stay alive or even get cured a lot cheaper later.

So, you are saying that the only people who should pay for cancer research are the ones unfortunate enough to get it? Nice.

Re:I think that it's pretty much always worth it

[Anonymous Coward]

"At some point it'll be understood".

Here's the "secret" you seem to have missed out on in biology class. Cancer is not one illness, any more than "my car broke down" is a specific fault in your vehicle.

Cancer is the label for the set of illnesses characterised by cells in the patient's own body growing uncontrollably and in the wrong place because their DNA programming has been damaged. There are many cancers as there are types of cell to damage and ways to damage them. Curing one cancer tells you almost nothing about how to cure the next, and there are an unlimited supply of possible cancers.

So we aren't going to ever have a "cure for cancer" any more than you're going to buy a car that can never break down.

There are some rules of thumb, some parts of the body are more vulnerable to cancer than others, some lifestyles or activities increase your chances of cancer developing (most famously, smoking, ie inhaling tobacco smoke). But there are no certainties and we've picked the low hanging fruit. There have been plenty of rich, famous people with lung cancer (often from smoking) but we don't have anything resembling a cure, and not for want of trying.

Ultimately cancer is the curse of DNA based life forms. If we escape it, it won't be from improvements in medical care, but from something far more radical and most distant in our future.

Re:I think that it's pretty much always worth it

[Anonymous Coward]

“Incidentally, I believe that paying for the "vaccine for nearly a quarter million children in developing countries" is on the long term a rather pointless thing.”

How? It works. We vaccinate, eradicate the disease, nobody has it any more. There is no more smallpox, and, unless either Russian or the US decides to try to use it as a weapon, there never will be again.

Very often for an individual poorer country, eradication is a low priority, they can't justify spending extra money to have 1000 less sick people next year, when they could spend that money on building a road or a school or something. So when a disease seems "under control" (which often means it is limited to poorer or rural districts) they abandon efforts to eradicate it.

But the international community is able to take a longer view - to drive to true zero and eradication of the disease, not hide it in slums and mountainous regions. This costs a lot of money, but you only have to spend that money once. When the last guinea worm dies, there won't be any more of them. When the polio virus is eradicated no more children will be crippled by it.

Before scaremongering idiots wrecked it, the vaccination programs in North America and Europe were on the verge of eliminating measles from those regions. The cost saving from (a) no children in those countries developing this illness and (b) not needing to vaccinate people unless they went to another region would have been enormous and ongoing. But no, someone had to make up a scare story and fuck it up...

Re:I think that it's pretty much always worth it

[vadim_t]

No. I'm saying, somebody has to fight until the end, trying everything they can, for science to advance.

To put an extreme example, if people went "fuck, I'm screwed, might as well die now", popped a cyanide pill and died right there, it would be pretty hard to do any useful research done, if only because of the lack of test subjects.

Those people who spend those huge amounts of money trying to stay alive participate in medical trials, try the newest medication and newest techniques. It is in a big part thanks to them that science advances, some treatments are found to work, and people are able to live a normal life despite having a condition formerly terminal in 3 months. That's why I think all that money isn't wasted.

Re:I think that it's pretty much always worth it

[Alinabi]

And I am saying that since they are already doing us a favor, by acting as human lab rats, they should not have to pay a dime and society (the rest of us) should pick up the tab.

Re:I think that it's pretty much always worth it

[vadim_t]

Well, I think the experimental drugs are given out for free. But you don't get to that point without trying the current non-free approaches first.

Billing and Payments

[gordguide]

I was struck by the information provided in TFA about the billed prices and the negotiated payments.

(If you didn't bother reading it) several times she mentions that her insurer paid a negotiated rate for a procedure or drug, and that negotiated rate varied when she switched jobs and changed insurers. Discounts she mentions varied roughly from perhaps 20% to sometimes far more than 50%; individual insurers would negotiate what they were willing to pay for something and the hospital would agree to consider that amount to be paid in full, regardless of the hospital's standard billed amount for that "something".

It led me to wonder whom, actually, pays the full amount? Then it struck me. The uninsured do.

Re:Billing and Payments

[Ma8thew]

No, you're wrong. The full amount is not the actual cost of the treatment. In the USA hospitals are run as businesses so the cost of treatment is what the market will bear. In other words, how much the insurance company (or individual) is willing or able to pay. In general, I think (and IANAA (I am not an American)) uninsured people pay less for treatments than an insurance company would.

Re:Billing and Payments

[barzok]

The uninsured may pay less. Obviously the hospital can still operate when the full billed price is negotiated way down (I see this regularly on the statements from my insurance company). The hospital bills high rates because they know it'll get negotiated down, but it'll still be higher than their actual costs. They know the insurance company will pay most of the time anyway.

IOW, they bill ridiculously high rates because they can get away with it.

Re:Billing and Payments

[Bluesman]

The most accurate thing you can say about medical prices in the US is that they have little relation to what actually gets paid. This is part of the problem.

Re:Billing and Payments

[the eric conspiracy]

It's actually the exact opposite. One of the issues with the American health care system is that uninsured people are not in a good negotiation position so they end up paying more for the same procedure than the insurer pays.

Re:Billing and Payments

[Rich0]

Actually, from what I've been able to glean, the uninsured pay much more.

Here is the problem - you don't get the bill until AFTER services are rendered. For kicks, go ahead and ask your doctor what a procedure he is recommending will cost. He'll look at you like you're an alien.

So, you get a bill. The problem is that now you've already incurred the service, so you can't decide to shop around. You can try to barter, but bartering after the sale is not very effective. You're relying purely on the hospital's generosity. However, if the hospital really were generous, why would they be mailing you a bill for $100k knowing that most insurance companies would only give them $20k?

Most likely you'll talk that $100k bill down to $30k and then talk to your friends about how nice the hospital was to you. What you don't realize is that they give a better deal to every insurance company on the planet. Nobody pays sticker price.

If I were running US healthcare one of the first laws I'd pass was that hospitals would need to publicize a full price list, and that EVERYBODY pays the same price. Since the hospital doesn't want to be dropped from every insurance plan in the country they'll publish a fair price, and then there is no penalty for not having insurance, or for having an insurance company without a lot of patients in the local area. Note, I am under no illusions that this would fix US healthcare entirely - it is a huge mess that needs MANY changes. This would just be one of the first I'd pass, since it saves money regardless of whether taxpayers or private insurers are paying for care.

Re:Billing and Payments

[Ma8thew]

OK, I wish I hadn't said anything about costs for the uninsured since it's tangental to my point, but from what I've read (admittedly on Slashdot) if you call up a hospital before you have a procedure done you can negotiate the price down. That's just what I've read, and I don't really want to argue the point since it's kind of irrelevant and I'm probably wrong anyway.

Re:Billing and Payments

[Fnkmaster]

You are 100% absolutely correct. I have no idea why such a law hasn't already been passed. The practice of negotiated billing is there strictly because hospitals think they can extract more from insurance companies that way, but the net result is to completely fuck over uninsured and underinsured patients, and result in general unfairness and disparity and dishonest billing practices.

Medicare reimbursement should be contingent on a hospitals *overall* billing practices. Medicare should reimburse the lesser of their reimbursement rate or the published price of a procedure. Any remainder MUST be paid for by a patient or insurance company and cannot legally be waived. And if a hospital is caught billing other patients unfairly, all medicare reimbursement should cease for the hospital, driving it out of business to be seized and placed under new management.

Re:Billing and Payments

[chowdahhead]

The billing in hospitals is very complicated but is based on J codes, which are developed by CMS, the branch of the Fed that deals with Medicare and Medicaid. I don't understand it well myself but the idea is that you're not paying the actual cost of a treatment, but the suggested cost of treating a patient based on a billable unit. If a hospital or MD's office uses the wrong code, the treatment will be under-reimbursed or not reimbursed altogether. A medical secretary or someone working in a hospital billing department could explain this better, but you should understand that hospitals don't always get reimbursed above their costs, and often the write off heavy losses because we treat patients without regard to ability to pay.

Re:Billing and Payments

[Anonymous Coward]

Only emergency rooms charge the uninsured more, since patients may not have a choice at that point. My normal doctors charge 20% to 40% less if I don't use insurance due to the lack of administrative costs.

Re:Billing and Payments

[locallyunscene]

And if the uninsured can't than either we all do(gov't subsidies) or no one does and the hospital goes out of business.

Re:Billing and Payments

[Anonymous Coward]

You and gp are great at telling other folks how to run their businesses. Are you prepared to do the same with yours?

I agree, the numbers are way out of whack,... part of the problem is *we're using numbers/dollars* instead of carrots, chickens, and cows.

I really want to explain what's going on here, but I'd have to sit still long enough to find out what I'm doing wrong in this system,... and I'm not sure I'm prepared to deal with that,... so it must be everyone else causin' the problem.

regards,
not your uncle gerry

Re:Billing and Payments

[sjames]

Exactly, the people with the least ability to pay get billed for the maximum.

Re:Billing and Payments

[Anonymous Coward]

The law would have to include a provision whereby the insurance company can negotiate a lower price, but that new lower price become what everyone pays.

Re:Billing and Payments

[Rich0]

The prices could be changed at any time for any reason, but would require some kind of advance disclosure so that insurers/etc can decide whether to drop the hospital.

So, hospitals could negotiate higher or lower prices any time they want to. All they need to do is publish a new price.

And yes, whatever the price is, everybody pays...

Re:Billing and Payments

[TehZorroness]

Many people are uninsured simply because they cannot afford it. If your job doesn't provide health insurance for you, you are left to pay for it yourself. When you're living on a low income, you have more important things to cover first, before you can even dream of health insurance. Rent, food for your family, ect. Both of my parents work in a hospital and deal with this every day. People without insurance avoid seeing a doctor until their condition declines so much that they must go to the emergency room (where they cannot be denied service). Instead of taking preemptive measures to health care, they must wait until they are walking the line of death to be treated. After they are treated, they will disappear (without paying the outrageous bill which they can't afford). This is a very inefficient model of health care.

The way I see it, If we can spend so much money starting war with a couple countries which did not threaten us, why can't our government cover health care? Health care would be the absolute best thing to spend our tax dollars on. Why don't we invest in healing people instead of maiming and killing them?

Re:Billing and Payments

[Fnkmaster]

A) Your post is incoherent. B) You posted as an anonymous coward making an ad hominem instead of addressing any issues of relevance. C) I have worked as a health care investor and my family owns several health care related businesses. I am 100% certain I have more skin in the industry than any 100 anonymous cowards on Slashdot do. D) Everybody in the United States agrees that the health care industry is fucked up, from the richest industrialist to the poorest McDonald's worker. E) Hospitals aren't arbitrary businesses, they serve a critical role in our nation's health care system and the stuff that goes on in hospitals accounts for a huge portion of our nation's GDP, with an awful fucking lot of it already coming from taxpayer money. I'm just happy to suggest ideas when our elected representatives shit out absolute garbage bills that apparently have had no input from ANYBODY with a background in economics as to how to contain costs. F) There is regulation in every business. Suck it up and deal with it - capitalism is a good organizing principle for many industries but unfettered capitalism ain't what we practice in the US. And our healthcare industry is already way, way far from it and thank god for that.

Re:Billing and Payments

[ben_white]

If I were running US healthcare one of the first laws I'd pass was that hospitals would need to publicize a full price list, and that EVERYBODY pays the same price.

This is naive. Do we also apply this rationale to auto mechanics, window cleaners, lawyers and all other corners of our economy? Hospital and physicians often offer lower prices to certain insurers who can guarantee a certain volume of business. An example: If I run a surgery center and I know that an insurer will bring me 200 cholecystecomies (gall bladder removal) a year to be done in my center I can buy supplies in bulk (less cost, except in your world where everyone pays the same all the time), I can hire the appropriate extra personnel to be available to do the procedures and I can schedule time in advance in the operating rooms. All of this saves significant money. I then pass some (if not most) of those savings on to the insurer who is guaranteeing me a minimum level of business. The price I give the insurer is less than the cost of providing the procedure on an ad-hoc basis, so if I was required to bill every one the same, I would lose money on many of the procedures. Now, I am a fan of medical cost transparency, but eliminating the ability of providers to negotiate their fee structures with payers is lose-lose scenario.

Re:Billing and Payments

[Rich0]

Do we also apply this rationale to auto mechanics, window cleaners, lawyers and all other corners of our economy?

Nope, and we don't have to. Those industries all have fairly efficient markets where prices are very transparent and people are able to effectively shop around and compare prices and services. Also, almost all of those items are bought by individuals, which means that the market treats individuals fairly.

Hospitals are a VERY different beast. In most areas you can't comparison shop 25 different hospitals the way you can shop 25 different garages for an oil change. You have very little leverage. Also, 99% of the paying market is represented by insurers, which makes the 1% almost powerless to negotiate. While I'm sure the individual caregivers do care about the uninsured as a business most hospitals would probably prefer they just went away - they create FAR more work than they are worth.

You do make a good argument in general about being able to plan and save money, but the fact is that all kinds of industries manage to do business with individuals where they have to try to predict how much business they'll have. I'm also fine with having fees based on notice/etc - so 4 weeks notice for a procedure gets you a discount compared to emergency walk-ins, and so on.

I think the benefits will greatly outweigh the downside. One way or another there will be measures put in place to control costs - fixed but freely set pricing has to be preferable to a single payer system where you're told what you'll collect and your 4-bed clinic has to compete at the same price with the 1000 bed megahospital across town under all the same constraints you listed.

Personally, I'd rather take small steps towards a solution than to go to a command economy. I'd hope that most providers would tend to agree.

Re:Billing and Payments

[Anonymous Coward]

So, you get a bill. The problem is that now you've already incurred the service, so you can't decide to shop around. You can try to barter, but bartering after the sale is not very effective. You're relying purely on the hospital's generosity. However, if the hospital really were generous, why would they be mailing you a bill for $100k knowing that most insurance companies would only give them $20k?

Actually, in the situation you describe, it is the hospital who is in the position of weakness. The patient has already got the angioplasty (or whatever) that he needed. He can just walk away. Whether he is poor as a church mouse or stinking rich makes no difference... there is no legal way in the US for the hospital or a collection agency to force him to pay the bill. (Nor should there be!) All that they can do is to harass him and to report the bill as an uncollected debt to the credit reporting agencies.

This is a bad situation for the healthcare provider, even if they did not charge a ridiculously inflated price. This illustrates some of the major motivations to charge high prices for uninsured people: 1) To discourage uninsured people from visiting in the first place; 2) As a scare tactic and better bargaining position for negotiated settlements of unpaid bills; 3) To compensate for the rate at which people decide to ignore their bills.

I hope that requiring people to carry health insurance may help to alleviate this problem. Unfortunately, it doesn't seem to have helped much in Massachusetts. The number of uninsured people has dramatically decreased, but it doesn't seem to have slowed the rate of price increase... This does not bode well for Obamacare in its current form.

Re:Billing and Payments

[Sinical]

It led me to wonder whom, actually, pays the full amount? Then it struck me. The uninsured do.

I don't know that that's true. I worked with someone who told me that, when she was uninsured, she could get huge discounts by paying cash at the time of the appointment: doctors were very happy not to have to go through an insurance company, etc. etc. I think the discounts she quoted were 50-60%. So presumably doctors inflate everything knowing they're going to discount.

No, only people who put a value on life lose

[SmallFurryCreature]

What Americans and right wingers don't get, is that some people prefer a humane society over low taxes in a hellish environment were there is a dollar amount for every human life.

Some of us value humans more then money. You clearly do not. To bad. Maybe one day you will decide to join the human race. Usually about the time when it is your life that is being represented by a dollar amount.

Re:No, only people who put a value on life lose

[Stray7Xi]

What Americans and right wingers don't get, is that some people prefer a humane society over low taxes in a hellish environment were there is a dollar amount for every human life.

The dollar amount isn't completely arbitrary (although quite inflated). It takes time and resources to provide healthcare. You can spend arbitrarily large amounts on healthcare to keep people alive that are further out into that bell curve. But eventually you have to draw a line or bankruptcy will draw it for you. Let's face it, ultimately a whole team of people (including all the people in the background) working fulltime to keep a person alive but bedridden is a waste.

I'm for government health care but not one that goes in with the mindset of "Life is priceless." Because they will have a budget, and I don't want them blowing huge amounts on people that will not only never contribute again to society but will never even be without pain when there will be plenty of people with need. The republican fear-mongering on death panels is amusing, because no one wants to acknowledge it's an inevitability (and it's better then what we have now).

Re:No, only people who put a value on life lose

[Anonymous Coward]

You're right. My life is worth a fortune. Yours is not. Yours is worth the same as everyone else's, including the other 7 billion people in the world. If we have to spend half a million dollars to give you a few months of extra life why shouldn't we be spending that much on some African kid? Or even some kid from the Ozarks that can't get a decent education? It makes way more sense to be spending money on the first part of a person's life than the end. If someone wants to spend their own money on end-of-life care that's their business, but don't expect the rest of us to fund it just so you can have another holiday together. Spend your half million dollars having holidays with your family when you're young and healthy.

Re:No, only people who put a value on life lose

[nedlohs]

And some of us realise that money is just a proxy for society's resources. And those resources are limited.

Sure you could spend $1,000,000 keeping one person alive for an extra few years (with an extremely low quality of life), or you could spend that $1,000,000 treating a thousand children who will go on to live another 60 years at full quality of life.

Pretending you don't have to choose and have unlimited resources is just dumb and you end up not being able to do either.

Re:No, only people who put a value on life lose

[Persol]

It's nice that you imply the person isn't human simply because you disagree.

The problem is that resources are limited. We 'could' have doctors spend lots of time keeping you alive, but that means we are going to have a ton of doctors, and not much else. The whole purpose of money is to distribute/use our resources in a somewhat sane way. With bailouts and built in inflation we may have deviated from the path a bit, but that's still what money at it's route is.

So you can say "do whatever it takes to keep people alive" and then have millions of living people without basic necessities... or you can realize that, in reality, you can't save everyone... and difficult choices need to be made. Putting a dollar value on a life is likely one of the most fair ways to do it.

Re:No, only people who put a value on life lose

[Anonymous Coward]

Pro Abortion
Pro Gay

These things don't move the human race forward.
Nice try though.

Re:No, only people who put a value on life lose

[Anonymous Coward]

What Americans and right wingers don't get, is that some people prefer a humane society over low taxes in a hellish environment were there is a dollar amount for every human life.

Some of us value humans more then money. You clearly do not. To bad. Maybe one day you will decide to join the human race. Usually about the time when it is your life that is being represented by a dollar amount.

So why don't you pay for health care for Mexicans? (since you're such a humanitarian.) Are they not worthy of your virtuous benevolence?

Re:No, only people who put a value on life lose

[Anonymous Coward]

Sure, and we kept Bob (or was his name Charlie) alive for six more days at the cost of 18,000 meals on wheels...

Re:No, only people who put a value on life lose

[ErikZ]

What Americans and right wingers don't get, is that some people prefer a humane society...

There's no such thing. You're simply paying for your "humane society" by enslaving others. You satisfy your conscious by only enslaving the most productive and telling yourself it's for the good of society.

Re:No, only people who put a value on life lose

[Anonymous Coward]

WTF are you talking about? "Right wingers" think that if you can pay for it yourself you should be allowed to. Its the "Left wingers" that are deciding at what amount of money the public should be responsible for some one elses healthcare.

The ONLY time you have to assign a dollar amount to someone's life is in a socialist society. In a free society, your ability to take care of yourself is the only determination of what you receive.

Don't come on here and put the "death panel" idea on what you say is "right wingers" when it is clearly "right wingers" using your same argument against socialism.

Liberals are nothing but whiny bitches that can't form a reasonable argument and blame the other side for problems with their "ideals"

Re:No, only people who put a value on life lose

[Anonymous Coward]

Medical expenses are about extending life beyond naturally imposed limits. It is hardly someone's life represented as a dollar amount.
There is no fairness to the distribution of life spans. Some people catch fatal diseases young. Some people are born with fatal genetic flaws. Some truly undeserving people will live long lives without any significant malady. Absent any medical expertise, the unfortunate will die from their maladies. The fortunate will never need it. Medical resources are limited. If you don't distribute them on some cost efficiency evaluation, then you distribute them by saying some people are better than others. Because you will have to forgo some level of treatment to somebody in order to fully treat someone else. Socialized health care systems make the decision for you, so that you can make some righteous claim that you value humans more than money. Which isn't true.

Your claim isn't even true on an individual, let alone societal, level. How do I know? Because you're posting on /.
If you truly valued humans more than money, you'd sell your computer and donate the money to some charity. You'd have no hobbies, because they cost money. And you value humans more than the money, right? There are starving and ill people everywhere. Yet somehow your luxuries aren't being disposed of or avoided so that you can pay for food and medication for them. But you value humans more than money. Right...

Re:No, only people who put a value on life lose

[Anonymous Coward]

Some of us value humans more then money.

Ha! Unless you've already donated all of your excess income to save the life of someone you don't know, that's just a cheap sound bite pandering to people with soft hearts and softer minds. In all likelihood, you've hardly ever matched your actions to your words and we all know it.

Re:No, only people who put a value on life lose

[Kral_Blbec]

+5

Re:No, only people who put a value on life lose

[Anonymous Coward]

You are already putting a value on a human life if you are paying into a healthcare system. Why not put all of your money towards healthcare? What I really hear you saying, is "I can't afford the costs of health care on my own, so therefore I accept a system where I might be able to get more out of it than I put in."

Re:No, only people who put a value on life lose

[Anonymous Coward]

What Americans and right wingers don't get, is that some people prefer a humane society over low taxes in a hellish environment were there is a dollar amount for every human life.

Some of us value humans more then money. You clearly do not. To bad. Maybe one day you will decide to join the human race. Usually about the time when it is your life that is being represented by a dollar amount.

You're saying everyone should get the same treatment, so $618,616 * 330M people (US only) = $204,143,280,000,000. I don't have that kind of money under my mattress. How about you? That's more the the GDP of the world. Even when it's only 30M people, you could pay for it, but what don't you pay for instead? It's fine for a 12 year old to say that everyone should have ice cream, mansions, cars, cable TV, food, and $100k per year, but it's another thing to come up with the money to make it happen.

Money isn't the issue -- really it's just a measure of allocation for limited resources. There are only so many doctors (especially top-of-the-field ones), nurses, newly developed drugs, etc. Is first come first served fairer than giving it to the person who planned, sacrificed, and saved instead of having fun and being frivolous, especially since the people with money would be paying in either case. You can "value" human life all you want, but, at some point, there comes a limit to the resources to keep everyone alive. When two people are stuck in a snowstorm, the person who planned ahead and brought a coat and sandwich deserved to stay warm and eat. He could voluntarily share and "donate" his items to the other person, but the other person don't have the right to take them, either himself or through the force of government.

Re:No, only people who put a value on life lose

[Anonymous Coward]

Pro Abortion
Pro Gay

These things don't move the human race forward.
Nice try though.

If you think more people automatically == good, you have obviously never lived in Utah.

end of life medicine is expensive

[meander]

In Australia, the last time I looked, around 90% of the lifetime medical expenses is spent on the last year of life. This has been true for decades.

You think you are doing good stuff, but all too many suffer and die. As a GP, my role is to keep folk alive. If I was a complete rationalist, I would work out some way of stopping useless treatments, but unfortunately that is usually only obvious in retrospect.

I counsel folk on the pros & cons of cancer treatments.

Sometimes it is obvious you are flogging a dead horse, and really they should pull out and enjoy their last days in comparative health, without the misery of chemotherapy et al, with the horrible side effects, and before you recover, the cancer catches up to you & you die in continued misery. I kept one of my mates out of lung cancer chemotherapy (in this case there really was no chance), and he enjoyed his last few good months without being stuffed by chemo. His family still thank me years later.

Then there are the less obvious cases, where the therapy may help, but usually just adds to life's burden of misery, worst just before they die.

Then there are the successes. They are wonderful, but not that common.

Sure, some guys making chemo drugs make a lot of dollars, but what drives most medicos is that we care, and we are not very good at pulling back when things are hopeless, because sometimes we succeed.

Re:end of life medicine is expensive

[FooAtWFU]

Sure, some guys making chemo drugs make a lot of dollars, but what drives most medicos is that we care, and we are not very good at pulling back when things are hopeless, because sometimes we succeed.

Ah, the good old variable-reinforcement technique. Works every time.

Re:end of life medicine is expensive

[chowdahhead]

To add to this, the goal of cancer treatment isn't only remission. We treat patients to make them more comfortable as well. Excision of the primary tumor and using chemo and radiation to shrink inoperable sites prolong life to an extent, and we have good data on this, and reduce their symptoms but also have the tertiary benefit of improving the quality of life remaining. I don't think many critics understand how excruciatingly and inescapably painful cancer can be. A comment on cost: the older and more well-established chemo agents are actually surprisingly cheap. But, there is a significant cost associated with administering the drug parenterally and disposal of all waste. Many of the newer treatments are monoclonal in nature, which don't have market competition to drive the costs down. Until the FDA develops a method to evaluate and approve generic biologicals, our most expensive drugs will make universal affordable heathcare unobtainable.

Re:end of life medicine is expensive

[roman_mir]

Ah, so you are the socialist death paneler then? Sarah Palin knows all about you.

(but she misses something similar about the private insurance, who also do this kind of 'counseling', except that it's a bit different in that it tries hard not to pay out on the insurance that they were collecting payment on).

Re:end of life medicine is expensive

[2obvious4u]

Then there are the successes. They are wonderful, but not that common.

Most cancers now have treatment rates in the upper 90%'s, there are few cancers which can't be successfully treated. The biggest issue when treating cancer is when it is diagnosed.

Re:end of life medicine is expensive

[Anonymous Coward]

In Australia, the last time I looked, around 90% of the lifetime medical expenses is spent on the last year of life. This has been true for decades.

For what age group? For the elderly this may be true. For ages where accident and violence are the major causes.. Well, these things tend to kill you instantly leaving no major bills. This is a worthless statistic.

Death cult

[Anonymous Coward]

No one can say for sure if the treatments helped extend his life

And it doesn't seem to be about that; there is rather a sort of ritual of "having done everything possible".

The ancient Egyptians embalmed and mummified their dead, and built elaborate stone tombs (the wealthier, the grander); we hook people up to IVs and give them expensive but questionable treatments (the wealthier, the more intensive).

But we still die alone.

$600,000, or $70,000?

[Anonymous Coward]

$600,000? No. That was the 'nominal' bill. She says that after negotiating, the insurance companies only paid around $250,000. And if every insurance company had negotiated like Blue Cross it would have probably been around $100,000. Now lop off the 31% of costs that is just paperwork, and it gets you to $70,000.

The problem with end of life treatment is the health care system, not people's desire to live and see their loved ones survive.

Btw, of course the most expensive part of treatment is the last year of life. You don't need health care when you're healthy!

The value of a life

[ebonum]

Some of the comments refer to a life as "invaluable". Money has no meaning, etc.

People in Africa get AIDS, and we all sit at home watch them die. We do nothing. The people who post these types of comments could send all their money to save as many people as possible, but they don't. The US government has the resources to save these people, but the US government withholds the money and watches them die.

The reality is that resources are finite. A society could devote all its resources to health care and do everything possible for everyone, but where does this leave the rest of us?

I could not buy anything for the next 20 years and save up an extra 500K USD ( this is above and beyond normal retirement saving ). This way, when I eventually get to my last year or two, I will have the money on hand to handle my own "spare no expense" end of life care. What impact does this have on the economy and my quality of life when I'm healthy? One needs to multiply this number by 300M people to get the scope of the entire US health care problem. These are real problems with a huge impact on both the living and the dying.

Finally, Europe is no panacea. For instance, England deems many new cancer drugs as too expensive. Cancer survival rates suffer due to England's cost cutting.

Re:The value of a life

[Bluesman]

Amen.

What most people don't realize is that the decisions you make now with your money are a choice between what you want now and all possible future uses of that money. Do you have a DVD collection, and a TV? You've chosen that your enjoyment of those things now is more important than saving that money and using it to extend your life later. Seems reasonable, but when you don't have that money when you're older and the inevitable medical expenses arrive, is it a good decision?

This isn't a serious problem until other people are paying for your care, and you decide that their DVD's and TV's aren't more important than helping an 80 year old woman live another year or two. Surely we'd all give up most or all of our entertainment expenses to save lives, right? And well, in all honesty, you don't really NEED that second car, and you don't really NEED to heat your house to over 60 degrees F to live...

But nobody thinks about things in these terms, even though this is the exact decision you have to make when talking about health care.

For a more detailed discussion, see here.

Re:The value of a life

[Ma8thew]

The kind of cancer drugs that NICE (the body which decides which treatments are covered by the NHS in England and Wales) rejects are not exactly 'life saving'. The most recent examples tend to extend life by a few months, but are extremely expensive. NICE uses a formula to calculate whether a treatment is value for money, and they actually made an exemption for life prolonging cancer drugs to allow some of the more expensive ones to be used. Make no mistake, NICE does not reject cancer curing treatments.

Re:The value of a life

[shermo]

Your final sentance is completely at odds with the rest of your post.

Re:The value of a life

[Ma8thew]

Did you not pick up on the distinction between cancer curing and life prolonging treatments? The GGP referred to cancer survival rates.

Re:The value of a life

[shermo]

In New Zealand it's all on the cost vs QALYs (Quality adjust life years) curve. I imagine it's similar in England.

'Cure' an 80 year old of cancer and they're going to live another ten years maybe (10 QALYs). Extend their life by 5 years with very expensive drugs and you've maybe given them another 3 QALYs. If the first drug is four times more expensive than the second one then the second one will get approved over the first one.

Distinguishing between 'curing' the disease and providing someone with another 5 years is rather meaningless. This is what QALYs vs cost attempts to solve.

Incidentally, from memory I think we draw the line at about $100k/QALY.

Re:The value of a life

[Ma8thew]

That's exactly the way it works in the UK (at least England and Wales). NICE's threshold is £30,000 per QALY, although there is leeway for more expensive 'end-of-life' treatments.

Re:The value of a life

[Sockatume]

"Cancer survival rates suffer due to England's cost cutting." Empirically, they do not.

if i ever catch a terminal illness

[FudRucker]

rather than slowly dieing in a hospital while the doctors tally up the profits i would rather stay home and wash down a bottle of pills with a fifth of whiskey and drift off to sleep and never wake up.

Re:if i ever catch a terminal illness

[Greyfox]

That's pretty easy to fuck up. I suppose it's somewhat more likely to work if you do your research well. You don't get much of an exit strategy in the USA, either. "Slow, Lingering Death" is pretty much the only official option on the table.

Re:if i ever catch a terminal illness

[cts5678]

I agree, except I'd probably opt for a massive overdose of heroin.

Palliative Care

[Puff_Of_Hot_Air]

Another question to ask is when should doctors admit "hey we can't save you, your better off in palliative care". This is an issue that has been raised in Australia recently, and it makes a good point. We in the west, are too often affraid to confront death, even talk about it with acceptance. Palliative care allows one to die a good death (as is frequently not the case in hospital; just ask any nurse). Doctors do not want to say "there is nothing we can do". For them this is failure. They are looking for ways to extend life, or that outside one in a million chance that just might work. The thing is, if I had to choose between extended suffering, or a peaceful death, I'd rather the peaceful death. We need more doctors who are able to recognize that a good death may be the best thing they can offer.

Re:Palliative Care

[postbigbang]

There's also profit in being valliant. And there are some tasty assets out there to suck away from an ostensibly terminal patient.

Oh, wait-- we're all terminal, aren't we?

Medical ethicisists have been wrestling with this question since Plato. It boils down to the patientl and their family/friends, and their desires. I've carried the pall of many family members, friends, colleagues. Some believed they needed to anything possible and feared death, others were different in their grace and accepted what's inevitable for all of us. I hope I have their courage and style when I go.... and not the Hunter S Thompson method.

Re:Palliative Care

[__aasqbs9791]

Depends on who your doctors are, I guess. My grandfather just died last Valentines day. Almost a year ago he had a heart attack that put him into the hospital and they said he needed a quadruple bypass, but that he lungs were too damaged (from emphysema) and he would be on life support the rest of his life (if he even survived at all). They said they'd do it if he wanted, but they recommended against it. So he went home and prepared to die. A few more heart attacks and months later, he seemed to be doing a bit better (he was able to walk around the block occasionally), and then about a week before Valentine's Day he suddenly got much worse and died.

Re:Palliative Care

[Saint Stephen]

Doctors are wrong all the time. He might have been much better otherwise, or maybe the doctors could have been right. The point is, they aren't infallible, so don't base reasoning on that implicit assumption.

Re:Palliative Care

[OeLeWaPpErKe]

Do you really have illusions that people "outside of the west" do not want to extend life at all costs ?

You should better distinguish between not having the means to do something and not wanting to do something. If it's a dictator, every few months there's a newspaper article about some "non-west" dictator paying some "western" docter millions for the off chance of extending his life even a few years, despite him having passed the average life expectancy of the country he rules by a factor of 3 or so.

Lots of people don't have 5 jacuzzi's with 70 inch oled tv screens in their house. This is, at least in my case, not for lack of want.

Euthanasia

[MrKaos]

Some people who want to live are executed whilst some people who want to die are sentenced to suffering.

The whole medical establishment needs an acid bath

[Anonymous Coward]

The whole medical establishment has positioned itself to take full advantage of the sick and its cosy ties with the never ending government funding $$$ machine. They have their claws into everything and they scratch each others back i.e the doctors and big drug companies.
It's going to take a lot of work but the whole system needs dismantling, the large medical corporations need to be put in their place and made non profit, the specialists and doctors need to be taught how to care for their patients instead their bank accounts. The whole establishment needs an acid bath and a new beginning. We need to start at the medical schools to ensure the future doctors are in it for the right reasons.

And the point is?

[BinBoy]

Well I made it about halfway through the article before my eyes glazed over. He worked for companies with great health insurance plans, he got cancer and they provided health care that kept him alive several years longer than expected. What's the problem? Would she be happier if the insurance company kept his money and told him to die?

Re:And the point is?

[MITguy21]

No one has mentioned health care proxy yet. Here in New York State, this is the way to specify, in advance, who will make decisions if you become unable. It also lets you make, in advance, decisions on life extending treatment. Here's one link: http://www.health.state.ny.us/professionals/patients/health_care_proxy/about.htm

My uncle named me his proxy. When he suddenly was hospitalized, we followed his wishes. Not easy, but much easier than trying to figure out what he wanted after he wasn't able to communicate.

Re:And the point is?

[Anonymous Coward]

"She worked for companies with great health insurance plans, he got cancer and they provided health care that kept him alive several years longer than expected. What's the problem? Would she be happier if the insurance company kept her money and told him to die?"

There, fixed it for ya.

Re:And the point is?

[cts5678]

The point is, people need to figure out what they want before they get in the situation, and then communicate their desires to their next-of-kin. The problem is, this lady and her husband never apparently did that, and left it to the docs, hospitals and insurance companies to call the shots.

Money is not real

[cruelworld]

Money is not real. It is a concept we invented. Life is real. To value an imaginary groupthink like money over a loved ones life is very sad.

Re:Money is not real

[Anonymous Coward]

Agreed. Reality (and thus biological realities) supercede virtual matters (money) by far. Only the capitalists think money is reality... Sad... I guess they'll be buried in gold coffin they will NEVER enjoy anyway...

Re:Money is not real

[RightSaidFred99]

That's a truly stupid comment. Money is real, it represents the work one person is willing to do for another.

I'll tell you what. How about you quit your job and go work in hospice care for free. After all, money's not real and those people need you.

"Money's not real". Seriously, how fucking facile can one be?

What's humane?

[Anonymous Coward]

...that some people prefer a humane society...

What's humane? Keeping someone alive for the sake of keeping one alive - living in pain and suffering, probably drugged out of his gourd because it's the "right thing" or allowing one to die with dignity when their time is up?

People on this thread is making it a dollars and cents thing and NOT thinking of the quality of life.

Some of us value humans more then money. You clearly do not. To bad. Maybe one day you will decide to join the human race. Usually about the time when it is your life that is being represented by a dollar amount.

Money can be used as an input by the dieing as to whether they're fighting a lost cause. If they realize that they're dumping hundreds of thousands of dollars into their recovery and not seeing results that will extend their life or just extending their life for one month, maybe they'll use that input to decide that it's time to go.

I have a parent dieing right now from cancer and it's painful to see him suffer. Vomiting, being exhausted, unable to eat and in complete misery. The doctor thinks that he has a snowballs chance but unfortunately, other members of the family is pushing him along - he wants to go. The savings are gone. I don't know what's going to happen after he's gone. Welfare?

Our medical science is at the point where they can do too much and give false hope.

Patients don't care about cost

[markdavis]

One of the big breakdown factors in end-of-life care is that extremely rarely does the patient or their family pay any of that HUGE amount of money (or they pay very little). It is either private or government insurance footing the bills. Of course life has value, and it would suck to be denied coverage, but most people DON'T CARE about the cost and will sign ANY form to extend life, regardless. I see it all the time. If they had to give up their family home, or sell their cars, or wipe their retirement plans to extend someone's life by a few weeks or months, I doubt the decisions would be the same.

It is an impossible situation to be in with no real solution.

$9,468

[Anonymous Coward]

From TFA:
The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 was lowered to $254,176 when the insurers paid their share and imposed their discounts. The portion of the charges that were not covered for the most part vaporized. Terence and I were responsible for and paid $9,468less than 4%.

The total overall cost of treatment was $600k. They 'only' had to pay $10k, thanks to circumstances. That actually makes me happy for the author.

Not a financial decision, unless you're out of $$$

[syousef]

If it was me it would not be a financial decision unless I had run out of money.

But then I'm not sure I'd hang around either.

Not so much the point though

[TheLink]

I think the big question is not so much whether you think your life is priceless.

If you're going to pay for all the treatments etc yourself, hardly anyone else will care.

It's how much should other people pay for you, to keep you alive for X years longer.

And that includes total strangers - assuming your country has some sort of health care system.

Some may say ZERO, but in my opinion, if we want to pretend that we are living in this human construct called civilized society, then yes we SHOULD pay more than zero to help keep others (even total strangers) alive. Not doing so would be uncivilized.

But beyond a certain point it becomes unreasonable and unfair to expect others to keep paying for you. And I think this should be related to how rich the country is and how rich the average person in that country is. There just won't be enough money/resources to go around.

The issue is as technology improves, there will be more and more advanced treatments, and many of those will be more and more expensive. The billionaires of this world might be able to pay for replacement body parts (say a whole leg) to be custom made for them (in fact maybe 1000 could be made and the best one used), but you can't provide this to everyone who wants it. If they want others to pay for it they'll have to make do with a cheaper prosthetic. Of course if that "organ printing" stuff becomes affordable, then OK.

To me a fair healthcare system would give everyone a quota, say USD500K/lifetime (or maybe something else per time period, let the economists and actuarists work it out). Once you've used that all up, no more automatic help from strangers. Sure it's unfair to let you die/suffer, but past that point, it is even more unfair to make others keep paying for you. What makes you so much more important than them?

So beyond that point you have to pay for yourself or convince others to help pay for you. Perhaps others can donate some of their quota to you (subject to regulations and approval - otherwise there'll be too much swindling).

FWIW, I don't think it's fair to have other people to pay USD600K to keep me alive for a few more years or decades. I live in a 3rd world country and earn a 3rd world wage, so USD600K is a lot here, maybe if I live in a rich country it'll be different.

Nor should they pay USD600K even if it'll keep me alive indefinitely. Given a long enough time, the odds are I'll become a nuisance (since I am imperfect) ;).

Re:Not so much the point though

[SomeKDEUser]

Actually, you are wrong. What you are suggesting is a lifetime cap.

But really what matters is the average cost of health for the whole population, over their lifetime. Which is hard to predict, because of technological and societal evolution.

On the other hand, if you have a global budget for health, because of socialised medicine, then the problem is simply one of doing stats and updating the costs every year.

Controlling the total budget becomes a question of setting priorities and investing in the right things -- doctors and nurse education, fundamental research, as well as using your clout as a sole provider to negotiate good prices for medicines with the big pharma.

Swindling is not an issue: the issue is the ethics of the care providers, and that is a matter for regulation and training.

Re:Not so much the point though

[TheLink]

> Actually, you are wrong. What you are suggesting is a lifetime cap.

1) I did say it could be an amount/period too - I'm no economist or actuarist, they can figure out the details.
2) The lifetime cap could be adjusted depending on the country's economic status.

The advantage of a cap (even if it can change) is that it sets some expectations up front. Think of it as a personal budget for spending.

> On the other hand, if you have a global budget for health, because of socialised medicine, then the problem is simply one of doing stats and updating the costs every year.

That's like not giving departments a budget but allowing them to draw directly what they want/need from the entire company's budget. That's not good. Yes you can still control spending, but it's usually better to just allocate separate budgets first.

Having no explicit limits up front would also mean voters expectations might be higher than what the country could afford in the long term. And when that happens politicians may find it easier to spend the money of future generations, for votes today. They're not going to be around 30 years later, or at least not going to be blamed by most for the disaster.

The entire medical establishment needs an acidbath

[m_number4]

The whole medical establishment has positioned itself to take full advantage of the sick and its cosy ties with the never ending government funding $$$ machine. They have their claws into everything and they scratch each others back i.e the doctors and big drug companies. It's going to take a lot of work but the whole system needs dismantling, the large medical corporations need to be put in their place and made non profit, the specialists and doctors need to be taught how to care for their patients instead their bank accounts. The whole establishment needs an acid bath and a new beginning. We need to start at the medical schools to ensure the future doctors are in it for the right reasons.

An extra $22K would have solved the problem...

[Anonymous Coward]

640K should be enough for anyone.

solution: Support the Mprize!!!

[Anonymous Coward]

Why are we constantlly fussing over getting OLD and dying, when, if we spend 100 million - 1 billion on projects like the Mprize, we could get a handle on the aging process in about 10 or less years. We waste billions and trillions on wars and old 20th century medial tech, when we could be developing stem cells out of our own cells, developing nanobots to go in and fix every cell in our bodies and hence make every cell in our bodies YOUNG again.

We are supposed to be in one of the fastest moving times in the whole time humans have been on this planet and we still waste resources on bling, endless wars and with every industrialzied country in the world supporting huge military budgets...its simply insane. Perhaps china will be the next country to take advantage of high tech nanotech, after all, their culture tends to appreciate more the possibility of life extension technology and AI, unlike the west with it's christian dislike of AI (see: frankenstien) and christian dying and going to heaven dogma.

Europa?

[denzacar]

Weren't we warned to "attempt no landings there"?

I'd but that for a dollar...

[denzacar]

How much of your money are you willing to spend to prolong a total stranger's life?

I have 1$ folded into a origami ring in my "junk bowl" on the desk.
I'd be perfectly OK to give it away to save Anonymous Coward's life - but I am not an American, so I'm not sure how to go about that...

Mind you, I mean some OTHER "Anonymous Coward", not the parent poster - cause he is a selfish son of a bitch that could do a favor to the world by getting off of it.

Only if she were paying

[Chemisor]

It's really easy to decide to spend more on health care when you are not the one paying the bill.

Health care costs, reform

[MobyDisk]

The article points out some of the absurdities in are system, some of which might be easy to fix:

The documents revealed an economic system in which the sellers don't set the prices and the buyers don't know what they are

Imagine you walk into a grocery store and buy some beans. At the checkout counter, they take down your information and let you leave, but don't tell you how much the beans cost. Actually, they don't know. The food share you are in doesn't tell them what they pay for the beans. And the price varies based on the food share you use.

Would this grocery store stay in business? Only if all the grocery stores do it!

This is our medical system. The medical providers don't reveal the actual costs of their products and services, and the insurers hide their fee schedules. There's no way to actually know what something will cost ahead of time. If we want health-care reform, THIS is what we must fix. This isn't capitalism. It isn't socialism. It's bureaucracy.

be brave at the end and let the living live!

[computerchimp]

The 2/3rds of the bill being spent for 2 months of life is too much.
Yes, it is about the money. money=time money=food "money can"= quality of life I am talking about the ones that will continue to live.
Money does not matter directly but it does matter. The money resource could be used for other important things.

The man had several years to prepare for death and get his affairs in order; he had a responsibility to prepare. If he had the choice I would hope he would suck it up and move on; we all die, it is a part of life. And yes, ultimately the dying ones decision....I hope my relatives are brave at the end. I intend to be prepared and brave.

CC

Re:be brave at the end and let the living live!

[cdrguru]

Bet you don't live in the US.

This is an extremely common opinion outside of the US and almost unheard of in the US. Which is why medical care costs are so different in the US and why 90% of the spending is done in the last year of life.

Everyone wants that last change heroic rescue from dying and are willing to go to almost unbelievable lengths to get it.

Re:Uh, FUCK no!

[the eric conspiracy]

A friend of mine who read the Obama bill said they DEFINITELY had tiered levels of coverage by age - older people won't get the same level of care.

That is true under the current system as well. As you get over age 80 a lot of procedures become unavailable because they just don't make sense and your insurance won't pay for them.

Alternative Care Options

[mim]

Dear Mrs. Bennett, my deepest condolences on your loss. I know that this is more than a day late and a dollar short (no pun intended), and some find this to be quite controversial, but there are alternative options for cancer patients including palliative care when the patients themselves are ready. In states where it is legal patients can seek medical marijuana not only for cancer treatment but for treatment of the pain and debilitating side-effects of chemotherapy and other (extremely costly) synthetic pharmaceutical medications. One site to check out for more information is: http://norml.org/index.cfm?Group_ID=3376 Living in WI, US, we are currently lobbying to become the 15th state to pass legislation to this effect. Anyone interested in helping further this cause can visit: http://www.jrmma.org/ or: http://immly.org/

US Healthcare

[Whatchamacallit]

I just recently had to pull the plug on my father. He suffered a major heart attack that was unrepairable. He went in for a routine operation and two days after, he had the heart attack. He was rushed from one hospital to another and was given the best medical care possible. He was on an external pacemaker, respirator, liquid cooling blanket (high fever from an infection caused by the surgery), and about 30 different IV medications. He was being kept alive by the machines and drugs. The staff at the Cardiac ICU were outstanding, they revived him 12 times! They were compassionate and explained that every time they revived him they were doing more damage and causing him a great deal of pain. They explained that they would continue until the family said to stop. His outlook was bad, he was not going to survive nor recover. As family members arrived, we were granted access against the visitation rules. We were allowed to have him revived so we could say our peace and to pray with him. We also received his blessing on our decision. As a family we made the decision to not prolong his suffering and after discussing the options, the hospital staff advised turning off the external pacemaker and slowly stopping the heart medications while keeping him sedated and comfortable. They continued some drugs that enhanced his breathing. We waited about five hours until he left this world for the next.

The decision should ALWAYS be with the afflicted or the family. In some nationalized healthcare systems the government performs a financial calculation and then refuses payment or even treatment! In America, you decide how far you want to go to extend life. It is a personal decision. It is your FREEDOM! Even if you don't have insurance in America, you will still be treated and you will still receive the best treatment in the world. You just have to pay for it.

Yes, insurance companies negotiate prices with affiliated hospitals and doctors. When you receive an insurance statement it clearly shows what the doctor or hospital charged you and what the insurance company actually pays them as well as what you owe depending on your coverage. If you work for a large company or state or federal government, you will see a better negotiated price because of the sheer number of employees being covered. Insurance companies make money based on the premiums you and your employer pay into the program. They then bet that most people won't get sick. This is how the insurance company makes money. Same goes for fire insurance, etc.

We are all going to die someday. Most of us will get sick and need healthcare at some point in our lives. The government does not owe you free healthcare! The government is not responsible for your health. All insurance does is protect you from losing everything if you get sick or if your home is destroyed or if you cause a fatal car accident, etc.

I do not want the government to have the power to deny me or my family healthcare because it costs too much. I don't want to go on a waiting list because the government does not have the resources to provide care. I don't want the government to tell me I can't have a knee or hip replacement because I am too old or it costs too much. I don't want the government to tell me they can't at least try to save my father's life because it's hopeless. That is my decision and no one else's! I do not want the government to seize more then half my income to pay for those who should be working and buying their own insurance. I don't want to pay for Joe crack heads habit and treatment. One only needs to look at the legal immigrants entering the USA to understand that they see the opportunity this country provides it's citizens to succeed and that through hard work they can make it too! There are countless success stories of immigrants coming here with nothing and in a generation or two making it really big! I know a Polish family that arrived in the 1960's and the husband and wife worked 2-4 jobs for years to make it possible for their so

Re-tooling

[sycodon]

Ever notice that all the "fixes" proposed in Washington revolve around getting more people into this failed economic model and accommodating the costs? No one asks why a scan costs some $3000 or why a drugs costs $750 per dose.

It's time to just re-tool the whole thing from the ground up, focusing on having prices that reflect the actual costs or services. A probably not so far fetched example, a one million dollar MRI machine. Amortized over 5 years, 8 scans a day, that comes out to about $68. Add on the technician's fees and misc. for power and space in the hospital and your scans should not cost more than a couple hundred dollars sans the radiologist's fees to read them.

Health care reform should be 100% about bringing transparency and predictability to the costs. Only then can you look at how to cover more people.

Re:Re-tooling

[I'm just joshin]

Mod parent up. Awesome and concise.

Re:Re-tooling

[Anonymous Coward]

Please, mod parent up. Good comment!

Re:Re-tooling

[nanoakron]

Here in the UK, that's exactly what MRI scans do cost - the NHS 'pays' between £300-£600 per scan. Every scan. Across the whole country.

Private scans work out slightly more, but that's because there is a profit motive involved.

Re:Re-tooling

[Stormy Dragon]

The problem is that the vast majority of healthcare is paid for by someone other than the patient, so even if costs were transparent there's no incentive for them to bother paying attention.

Re:Re-tooling

[martinX]

I work in a publicly funded tertiary hospital in Australia. I'm not medical (I used to be a medical scientist) so I don't have the hands-on, day-to-day experiences of the clinical side of the hospital, but I do get to have glimpses of a 'big picture' view of it.

The head of radiology recently told me that the Uni was willing to "donate" a big expensive machine. Poisoned chalice, he said. They get all the kudos (and access to it for research), the hospital gets the bills. And no funding. Things like:
- floor space (and these are big mofos, some machines require vibration-proof rooms, or shielded rooms etc)
- installation (cranes and shit)
- power, both getting massive amounts of power to it and paying for massive amounts of power.
- operators
- maintenance (that's a biggy it seems)

None of these costs fit under "misc. expenses" I'm afraid.

Plus there's things like the PACS system to store all this data. Radiology has an IT storage system a little bigger than the rest of the hospital.

Buying the machine is small potatoes.

Re:Re-tooling

[OeLeWaPpErKe]

And, pray tell, is the waiting time for a "publicly funded" scan ?

And what is the waiting time for a "private" scan ?

What if you don't have 8 months time ? How many deaths could have been prevented by allowing the cost of NHS scans to increase to 1200 pounds ? Thousand ? Ten thousand ? A million ? Nobody knows, but it certainly is a positive number.

Re:Re-tooling

[Archangel Michael]

What most people don't realize is that the cost of doing medicine in the US today isn't just the cost of doing medicine. It includes other costs for things like The Uninsured (still gets treatment), Legal (Malpractice), Defensive Medicine, Insurance Overhead, lack of competition, artificial scarcity of services.

I have three simple steps to fix this mess.

1) Tort Reform. Limit Pain and suffering so that it is no longer a "get rich quick" scheme. Punitive damages don't go to victim, but rather goes into a fund for medical care grants.

2) Pricing stabilization. No negotiated pricing for insurance companies. EVERYONE pays the same. Period. Negotiated pricing is nothing short of price fixing.

3) Make insurance cover emergency and substantial care only. Have high deductible and medical savings accounts.

Having more Nurse Practitioners and other skilled people doing routine care instead of doctors would also help lower costs.

Re:Re-tooling

[ben_white]

Health care reform should be 100% about bringing transparency and predictability to the costs. Only then can you look at how to cover more people.

This is why you could never be elected; for the love of god, man, how 'bout those death panels! ;-)

Re:Re-tooling

[drsmithy]

What if you don't have 8 months time ? How many deaths could have been prevented by allowing the cost of NHS scans to increase to 1200 pounds ? Thousand ? Ten thousand ? A million ? Nobody knows, but it certainly is a positive number.

Perhaps you can elaborate on why you think a higher price would result in the machine being able to perform scans faster ?

Do you also think that more expensive shoes will make you run faster ?

Re:Re-tooling

[characterZer0]

Why does a CD and a piece of paper from Oracle cost $100,000? Because a lot of research and development went in to developing it.

Why does a few ounces of platinum cost hundreds of dollars? Because there is not very much of it and it is expensive to find and process.

Re:Re-tooling

[sycodon]

Except if you want Oracle and you call and ask them how much, 99% of the time they will say $100,000, and you won't get it until you pay for it.

Why are diamonds so expensive? Because they artificially reduce availability.

I also remember a 60 Minutes episode showing literally piles and piles of them waiting in vaults for economic conditions to change and reduce oversupply.

Re:Re-tooling

[OeLeWaPpErKe]

No but serving 1000 people with 1 machine takes 1000*$scan_time

Serving 1000 people with 2 machines (and crew) takes 2000*$scan_time.

The problem being of course, that for a number of diseases a scan is adviced, because it can detect complications or alter the diagnosis. But if you have to wait 8 months for a scan, the patient will be long dead in the case of complications.

In order to guarantee prompt service delivery in emergency you'll need to have extra capacity, that will sit unused some of the time.

E.g. in order to be ready you'll have to have full-on flu research and treatment facilities going on 24/7/365 despite the chances of getting new infectees during e.g. early summer is tiny.

Re:Re-tooling

[Carnildo]

3) Make insurance cover emergency and substantial care only. Have high deductible and medical savings accounts.

You would get a higher standard of health and better value for your money by having insurance only cover preventive medicine. If insurance only covers substantial and emergency care, people will put off treatment until it falls into one of those categories.

(Which costs more: a MMR vaccine, or a month in the quarantine ward of a hospital being treated for severe measles? Under your plan, which is cheaper for the patient?)

Re:Re-tooling

[Anonymous Coward]

Okay, then lets lock up everyone who has highly infectious diseases like Aids and Tuberculosis with long (or impossible) cure rates. In the name of the system of course.

And while we're at it, lets stop treating Pancreatic and other low survivability cancers because all it does is delay the inevitable at huge expense. I mean in the name of the system of course.

And anyone over the age of 75 doesn't get any treatment for any care for high mortality diseases like heart, diabetes, lung diseases (pneumonia) and kidney dialysis. I mean in the name of the system of course.

We'd be able to have TRULY affordable health care in this country if the old, and very sick are just allowed to die. I mean in the name of the system of course.

Perhaps we should just force everyone to take BMI and charge extra for fat people, who drink too much and so on. I mean in the name of the system of course.

Aligning interests...

[Fished]

The problem is that the best interests of the doctor are not aligned with the best interests of the patient. Instead, we've got a situation where the best interests of the doctor are to "play it safe, spend as much as necessary, preserve life at ALL costs (because that won't get me sued)". The tail is wagging the dog, in the form of a very small percentage of patients who will someday sue their doctors.

However, the solution is not tort reform--in the sense of limiting verdicts--because the problem is not the size of verdicts. The problem is the things that doctors do in over-the-top efforts to avoid really frivolous lawsuits. (Believe it or not, many doctors are devastated when they lose a patient, and to then be sued by the patient's family just makes it worse. So, to defend their own self-image, they of course do *everything* they can to avoid being sued. Which is very expensive.) I think something more akin to the "good samaritan" laws, where the nature of a doctor's obligations are spelled out, would be a better choice.

Re:Aligning interests...

[WCguru42]

I think something more akin to the "good samaritan" laws, where the nature of a doctor's obligations are spelled out, would be a better choice.

I completely agree with you. If I could, I would sign a form before a surgery (or any other dangerous procedure) indicating that I would not sue the doctor for malpractice unless they come to the surgery drunk (or anything else in gross negligence). The problem with this, as mentioned in an earlier post, what happens when a doctor tells a cancer patient that they would be better off living the last few weeks of their lives off chemo. It's a lot harder to tell if the doctor was right or was being lazy/ negligent. Certain negligence is obvious (drunkenness) while others are not so simple.

the eol question is the biggest issue we face...

[airdrummer]

the whole healthcare issue hinges not only on how do we pay for it, but how much do we pay for? last week's lawNorder:svu ep http://www.aceshowbiz.com/tv/episodeguide/law_order_special_victims_unit_s11_e13/ dealt directly with treating a 4mo-premie that _could_ be saved but _probably_ would be a blind vegetable...and unfortunately beliefs don't deal well with probabilities:-(

just because we have the technology, does that mean we _must_ use it? who pays? the religious right objects to paying for abortions, but demands that all life must be preserved @ all cost:-{sounds ironically like "from each.../to each..." don't it?-}

i think sjg's noma is inaccurate: _politics_ is the intersection of religion & science...

One More Data Point

[The_Steel_General]

I'm going to repeat a point one other person made, just to make it again: In addition to the direct societal costs (which, I realize, can't even be easily quantified based on TFA: 600K? 400K? The amount charged, the amount paid, the amount paid less the patient's insurance premiums, divided by the number of people paying into policies for the two insurance companies?) and benefits (a few more years for 2 kids to have their dad around, an article investigating health care costs, a discussion on Slashdot on healthcare economics) there is also the advantage of having one more data point.

Because this guy was willing to keep trying, going through significant suffering for the benefit of his wife, his children, and a few more months of life, the medical community knows that a given group of drugs can extend the life of a kidney cancer patient by up to 17 months. The next kidney cancer patient, and the next cancer patient, and the next doctor looking for a way to treat this person who just walked in,and the next researcher investigating how these drugs work, all have a bit more information than they did before. They may decide that it's a goal to shoot for, or they may decide that the regimen is not quite useful. Either way, it's more than they knew before.

Of course, we can't determine the value of that, any better than we can determine whether the rest of the money spent was worth it. It's still a benefit we all get and should consider.

TSG

Re:One More Data Point

[astar]

I RTFA and I looked at all the high-modded comments and the last one is yours and it is pointing to an aspect that I think is critical. Remember that he was part of a clinical trial. So if you value concepts like progress, as the patient might well have, then his suffering had purpose. On the other hand, if you are a zero-sum accountant type, long-term benefits are necessarily ignored.

A little politics: the one non-negoiatable feature of obama care has always been the N.I.C.E. modeled independent cost control panel. It was originally called IMAC, but the name always changes, and now it is publicly nameless. I suppose that makes it harder to talk about. In his health push last week, he put some numbers on this. It is to cut out the one-third cost that is waste in medicare, according to Obama.

On the other hand, in my area we are short several hundred docs, and, per the newspaper, if you are on medicare it is a real trick to find a general practice doc that will take you. It seems to be fair to say that you cannot find one.

But during the bush and the obama admins we spent 23.4 trillion dollars in speculator bailouts. and if you pay attention to such concepts, you cannot figure Iraq was a "just" war, even ignoring the intelligence frauds, like the yellow-cake forgeries. i expect we spent and still spend some significant treasury there.

Not that simple...

[Oxford_Comma_Lover]

> the same treatments may have better results on others on average, and therefore be worth it.

Even assuming all the relevant context, sometimes it doesn't make sense to pay for treatment with better results. Doctors always want you to do the best thing--and if money were no object you might want it--but I'm unlikely to trade a 2% increase in my likelihood of survival for all of my life savings if those are what my family has to live on when I'm dead. There are exceptions--when the second-"best" option leaves you less productive, or you're young and very likely to recover and have time to build a new nest egg, etc...; but there isn't really a system in place for someone to (1) get a realistic portrayal of the facts, and (2) make a decision based on those facts. Doctors will give you some information, but they pretty much never tell you to get your affairs in order (no matter how bad it is), and why on earth aren't we told "with your insurance, this will cost X" as soon as we walk in the door and for every procedure, or at least after we are told what the procedure is and maybe what our options are before they perform it? In a life-threatening situation, you need experience with the way medicine works, you need to understand the politics of hospitals, you need to get opinions from multiple professionals and decide which one to trust, you need to do so much more than we ever teach in schools. And you need an in, somewhere, that lets you know who the good surgeons are. That may be the hardest part, because you have to penetrate the veil of the profession. Does the money take a back seat to all of that? Yes. But it shouldn't disappear completely. And the reality of a 70% chance of death, for example, shouldn't disappear completely either. I can be told I'm likely to die, but that doesn't mean that I'm already dead or that I'm not going to fight; but I should know if my fight is going to cost my family everything it has.

it doesn't have to be that way

[snooo53]

This is not an either/or choice, and to say it's due to lack of resources is disingenuous at best. There is more than enough food in the world to feed everyone. More than enough manufacturing capacity to vaccinate everyone. And in short order there could be more than enough hospitals and doctors to treat everyone who is sick. The reasons we can't vaccinate/feed/cure the world are not because we can't due to lack of resources, but because WE CHOOSE NOT TO as a society. (either directly or indirectly by supporting the particular political or economic systems of the world)

anonymous coward

[Anonymous Coward]

Amazing that we value the dollar so much when it comes to healthcare. We didn't even blink when we spent>$1trillion to save banks from financial mass destruction. (Isnt that scare tactic getting a little thin?) There is still no inflation with all those greenbacks printed.

RTFA - she only had to pay $9500

[spineboy]

Wow, so she uses the hospital billing rate, which NO HOSPITAL gets, nor does any insurance company pay. People who don't have insurance are also given a steeply discounted rate. She neglects to say that the Medicare rates that she compared costs to, are usually low enough, so that the hospital often can lose money on the patient.
So lets put that in perspective - that would be about the same if her husband stayed in a 4 star hotel room for about 30 days, excluding room service. Most new cars cost about 2x as much. How much does cableTV +an iPhone cost? around $200/month for less than 5 years -the 7 year treatment of his cancer would cost them about the same.
So what exactly is she complaining about?

Re:RTFA - she only had to pay $9500

[Kral_Blbec]

Dude, are you are saying we should expect people to cancel cable in order to pay their bills... thats just downright un-American!

So you've never lost anybody?

[fantomas]

"So, at this point we're just haggling over price."

I'm guessing you've not lost any close relatives (say your mother or father) through a painful illness.

Re:So you've never lost anybody?

[Rich0]

I am sure that I might feel differently if I were personally involved in such a decision. Perhaps this is why I feel that the time for such decisions to be made is when we aren't personally involved in them.

If we leave the size of the national health care budget up to only those who have loved ones with terminal illnesses, we won't be able to afford anything but medicine.

Resources are finite. I don't like it, but that's just the way it is...

Re:So you've never lost anybody?

[Anonymous Coward]

using the government to force me to spend hundreds or thousands of dollars to keep alive thousands of people i don't even know? fuck you all.

"Force" is relative. You would pay cash for that service if an insurance company promised to pay for your health care if/when the time came. The insurance industry is one of the few where a monopoly can benefit the consumer. Insurance companies pool risk, and pay their claims from that pool. The need to pool risk is so great that they issue credit default and cash flow swaps to each other, to homogenize their pools of risk -- every major insurance company in American basically shares the same pool of risk, constructed by default swaps between insurance companies. But that layer of indirection makes accounting for risk a terrible pain. They can't do it. They are effectively incentivizing fraud. The doctors and hospitals know that insurance companies will settle debts with each other with better credit default swap terms next quarter. So there's an arms race to raise CDS interest rates.

Competition is causing poorer, more expensive service.

You might want some competition in this case, but that desire is irrational. You might want some choice. But that desire is irrational. Totally and utterly.

She only had to pay $9450

[spineboy]

the actual bill was inflated, so that when the insurance company pays at a steeply discounted rate, the hospital doesn't get raped. Her insurance only paid about 250,000, of which she only had to pay 4%

Pretty damn good actually

Re:She only had to pay $9450

[Anonymous Coward]

You have trouble comprehending the situation. The rest of the insured people payed the cost!!! The cost of insurance for everyone goes way up because of this broken system. This makes cost of insurance prohibitively expensive.
A lot of people suffer and die because they can't afford treatment, while useless but expensive treatments are routinely administered.

Without ANY exaggeration, our health care system is a racket. A legal racket of proportions which make Al Capone look like a mosquito.

Re:She only had to pay $9450

[poopdeville]

You have trouble comprehending the situation. The rest of the insured people payed the cost!!!

Excellent deduction. I'm glad you understand how insurance has always worked.

Make no mistake

[Trip6]

How good care you receive and how much is spent while you are dying is a result of caste and privilege. Do you think children in Laos are getting this kind of care?

I decided for myself.

[Hurricane78]

When I’m old enough that life stops being fun, I’ll cut all ties to everyone (so they can’t get to them for liability questions), take the largest loan I can get, book a parachute drop, and jump without an actual parachute.
I plan to land head-first on the biggest asshole on the planet. Be it some dictator or something alike. Oh, and if I can manage, I’ll strap something to me that will guarantee his death.

Human missile FTW! What better way to go, than to do something good, like making a “god king” bleed (or rather burst into gibs). ^^

Well

[ShooterNeo]

It costs about $50k-$100k to have a person's brain cryogenically frozen. For those of us who believe in the laws of physics, the chances of eventually reviving a dead mind or at least recovering all of the memories and personality information is excellent. This would be a much better alternative than a year or two of excruciating suffering ending in a permanent death, and would be cheaper as well. I'm hoping reversible cryogenic freezing can be developed in my lifetime, so that we can definitely show that cryo patients are not actually dead, and make this procedure available to all. ("reversible" freezing would be a method using enough cryo-protectants that you could theoretically thaw out the brain and it would work. You wouldn't actually plan to do this for a century or two, but you could convince the general public that these patients were still alive)

One idea I've thought of to improve the method : how about blasting the frozen heads into space, and putting them into an orbit that keeps a planet between the space capsule and the sun? Then you wouldn't need to keep refilling the liquid nitrogen, or worry about something happening to the patients. Each frozen head would weigh about 5 kilograms : at today's $10,000/kilogram launch prices, that would be about $50,000 a patient.

I agree!

[fuego451]

I believe you hit on the most important point; Quality of Life. In my wife's fight with cancer, this is what was most important to her. She battled courageously to the point she felt she had done all she could, then made the conscious decision to let fate take its course. She didn't just 'give up', purse, she just realized the cancer was very aggressive, nothing was working and she had had enough. From that point on, she serenely and calmly ordered her remaining life the way she wanted it to proceed.

I am glad that she was able to make this decision for herself. If she had been incapacitated in any way and unable to do this, the burden of the last decision would have fallen on me and that would have been an extremely difficult situation to be in. At the first sign of a life threatening illness, a 'Living Will' is probably the most important document you can execute.

     

Re:I agree!

[bluefoxlucid]

I have never had a girlfriend but I have my eye on a girl at the moment...seems every few years I fall in love, need to stop that. I can say though that if things worked out, and one day I'd reached that point... I don't know how I'd let her go. I think I'd die right along with her. Watching her suffer would be just as bad; it would be all I could do just to be by her side, but... there'd be nothing I could do.

I spend a great deal of my life trying to stay single. The above explains some of the possible consequences of actually falling in love with someone. Face it, one of you eventually has to watch the other one die; I'd rather survive her than make her go through that, but I'd prefer it be my last act of defiance against the pain the universe intends to burden me with. After that I don't think I could really continue living.

It's immaterial, anyway; this one probably won't take me as her own, so I will continue to be single forever.

Re:I agree!

[fuego451]

I can't say it any better than this:

From Alfred Lord Tennyson's poem In Memoriam:27, 1850: I hold it true, whate'er befall; I feel it, when I sorrow most; 'Tis better to have loved and lost Than never to have loved at all.

You must not let fear of the unknown keep you from living your life. Pursue this woman you fancy; see if you fit.

Re:I agree!

[bluefoxlucid]

She's engaged. Granted, it's a fuzzy situation. A long relationship from since when she was very young... it could be a comfort/security thing she's not happy with but has convinced herself of; or perhaps she is really in love. She knows what I want. She seems apt to keep me at hand, but is resisting... the fact that she protests when I tell her I'll back down makes me question her true feelings. Perhaps even she isn't sure.

Still, I am in a position where I have to destroy everything she's worked for in life to obtain what I want. Now how am I to justify this? I'm being very careful; I persist, gently, but I'll leave it up to her to take the bigger step, and I will catch her before she falls. It is all I can do, and even that makes me question my worth...

I hate being a hopeless romantic. This happens every time I fall in love. Which happens every few years, and in the interim I'm totally disinterested in relationships.

Thoughts of a Middle Aged Geek

[sybarite]

I rarely post to Slashdot, but feel the need to weigh in on this topic. At 40, I am at an age where I increasingly am confronted with the end-of-life issues of loved ones. I have a dear friend who at 72 has been battling cancer for a few years. I cherish the fact that he is still with us for whatever time he has left. This man is more active than I am and is a real world character from the movie "The Bucket List".

There are some gut-wrenching decisions that need to be made about when to let the inevitable take its course. I do believe this is best left to the patient and their families. I do think that it is to be expected (and okay) that the majority of health care spending is at the end of one's life. Those who choose to battle on against odds do benefit society by providing subjects for the experimental. They are the pioneers whose treatment may one day lead to either a cure or successful management of the disease. Perhaps not for themselves, but for those on down the line.

I think that this article was also an indictment of the US healthcare system. The overhead and markup is horrendous. The system engineer in me dislikes inefficiency and believes strongly in process improvement. I think we can and should do better for all of us. The challenge is obviously that there are too many constituencies and stakeholders that are unwilling to work together toward a common good as they profit mightily from the status quo. They spread fear, uncertainty, and doubt when anyone tries to change the current system. This article illustrates again to me that medical care is not market driven service, so a market-based approach to health care delivery might not be effective.

Hmmm

[jav1231]

If you ask yourself this question then apparently you can put a price on life. Such is life in the collective thinking of the day. At what point do we consider paying $1200 mth to keep grandma in assisted living is too much of a burden?

It would be different if say the husband said, "I don't want to keep trying things if it's not likely to help" or something. My Dad was offered several different treatments but several nurses came to us privately and said, essentially, "None of these treatments are likely to help him and while they may extend his life he'll be very sick most of the time and have no quality of life." Considering that and his overall poor health he likely wouldn't have survived such treatment. We opted for no treatment.

But had they said, "For $600K we got a good shot at beating this thing" we'd have said "Do it" in a heartbeat.

Re:Hmmm

[Kral_Blbec]

Very good points, but you're skipping one important factor. Often times terminally ill patients do not have the mental capabilities to speak for themselves, such as with Alzheimer's or coma patients. Remember Terry from Florida a few years ago?

money better spent elsewhere..

[zcold]

the time to quite is when you cant afford it... The money would have been better spent getting him a canadian citizenship, legally or illegally and having him die peacefully.. or even buying that a ton weed and diloteds...

Do you REALLY believe or are you just saying so

[presidenteloco]

I hasten to add that this post would not be a troll in a rational world.

Perhaps a way the health care system could save money is if religious believers
were offered the option to sign a "Let God's will take its course" declaration,
which says that any time the person's health is getting really critical, the
doctors and hospitals should lay off and let God's will take its course.

Re:Do you REALLY believe or are you just saying so

[Kral_Blbec]

Actually there is, and typically religious people are more likely to end treatment and let themselves die. I don't remember the reference, but we talked about it in my "Ethics for Healthcare Workers" class.

It depends on your own ability to pay.

[Kral_Blbec]

A terminally ill patient should not impose such medical bills that chase the surviving family for the rest of their life. You got the means to pay for last ditch treatment that has a 1% chance of doing anything? That's your money, go ahead. Make 20k a year and you have lung cancer from smoking 2 packs since you were 16? Sorry. (Extreme example i know) The simple fact of the matter is that we cannot support everyone like that. Its not a matter of charity or benevolence or cruelty to strangers. There simply is not enough personnel, supplies, space, nor funding.
Another way to look at. This guy took 600k to sit in a bed for two years in pain. Most of that was funded by insurance. Other people with that insurance paid for it in their premiums. That means premiums, as a whole, were just a bit higher. That made them too expensive for John Doe and Jane Doe to pay for. John Doe broke his leg and didn't have insurance, so the tax payers covered his emergency room visit. Jane Doe got sit with strep throat but couldnt afford to see a doctor. She died of rheumatic fever. You really want to make insurance accessible for everyone, then people need to realize that terminally ill patients are probably going to die soon no matter what you do.

Re:It depends on your own ability to pay.

[mikefocke]

In the case in the original article, the man's family was quite able to pay the out of pocket costs. Some of the drugs were experimental, some of the combinations of drugs were also in trials. And the choices being made given the descriptions of the man's state at the time the decisions were made were seemingly rational and an end treatment decision was made.

I've been in the room when life ending/extending choices of treatment were made by a patient. Been in the room to hear the Cancer diagnosis too many times. My son is alive for having had a treatment that hadn't been tried often on someone his age...and now is a new data point for someone with the same diagnosis. And I'm a Cancer survivor. In my case, the treatments cost about $50k. Simpler cancer, not nearly as near term fatal a diagnosis. Personal costs were near zero. Thank goodness for great health insurance (I had been paying for more than I used for 40 years), good doctors who had been experimenting for 20 years to document the right doses and thanks to the many people who had been their patients who didn't make it in the early days when their cure rates were awful but whose treatment enabled them to ultimately learn how to treat successfully.

Read the whole article, not just the headline. It sounds more reasonable the more you read...until you get to the estimate that 31% of the health care costs are administrative. Ask you congressman what they are doing to reduce that layer of costs.

Re:It depends on your own ability to pay.

[Kral_Blbec]

I'm actually not that surprised about 31% administrative overhead. There are a LOT of people employed in healthcare besides doctors (I'm one of them). There is an immense amount of paperwork done for everything that has been implemented for several reasons, such as quality control, liability, and research. It's not just bureaucracy for the sake of bureaucracy (most of the time). If you want to cut those costs then you are going to have to accept either more frequent errors, less malpractice lawsuits (yes please!), or slower research.

Re:It depends on your own ability to pay.

[cdrguru]

So you believe that medical treatment is only for people that can pay? I think you will find yourself in a rather small minority in the world. Most people seem to believe that care should be available for all without considering ability to pay.

Obviously, we can't spend infinite amounts of money. So the end result is like Canada where everyone gets the same treatment and money can't be used to get more or better. This generally means that end-of-life sorts of stuff just doesn't happen. At all, for anyone.

What most people haven't figured out is if the US is going to go to a system where insurance is mandated and can't be managed - everyone gets the same coverage without regard to risk - we are going to have to have some strong limits on end-of-life care or the costs will be impossible. Since around 90% of all US medical costs come in the last year of life, this means a savings of around 80-90% immediately.

Of course, if you don't happen to agree that it is time for you to go it will kinda suck. But this too will be a decision that you will have help with. Modern living through chemistry - there are certainly drugs that will make the idea that it is your time a lot easier to take.

No Karma sacrificed!

[Anonymous Coward]

While everyone needs to make their own personal choice, why is it that so many are afraid of death? I watched both my grandmother and my great-aunt face death head on. It was beautiful. When my time comes I hope I am courageous enough to let go.

Should we mortgage the future so that we can live a little longer? "Screw the children, screw the future, screw everyone else: I don't want to die" is what I'm hearing. I wish you all luck with that...

Living with more dignity, not just living more

[GNUALMAFUERTE]

If you have to die, die. Don't try to extend your life at all costs, while making your family go through hell.
You just found out you have a terminal disease? You have 6 months left? Live 5 happy months with your family, and when you start to deteriorate, jump off a bridge.

It's not about the money. It's about your dignity (and your family's).

If you happen to be a simple minded person, and so, you believe in religion, then go happily thinking you'll get an afterlife.

If you are smart enough to be an atheist, you should be smart enough to die when it's time.

Easy question, easy answer

[cts5678]

The time to quit is when the patient, in counsel with his/her loved ones, decides it's time to quit. I didn't read TFA because I prefer to go off half-cocked when offering my opinions, but if the widow is now wondering if it was worth it, she and her husband obviously had a failure to communicate before he was stricken.

our story, maybe this can help

[Anonymous Coward]

at the age of 26 my wife was at a doctor trying to figure out why her hearing was failing in her right ear. that was the first time we heard about http://en.wikipedia.org/wiki/Neurofibromatosis_type_II and the last time our lives didnt revolve around it. by 28 she had her first brain surgery. by 30 she had another. this is all sad, but not intended for sympathy... the rest of this however should scare the piss out of you.

we realized that her quality of life would degrade and there would be a point where we would be on 'the down hill fight'. knowing that, we decided to change our lives drastically. we already had great insurance but we will lose it forever if our coverage drops for even a single day. we refocused our lives to 'retire' early so she could at least get something enjoyable out of life and not just be a slave to a corporate job for the insurance until disability. we didnt ask for help, we didnt ask for handouts... and the progress we have made is simply amazing.... and ultimately pointless.

by 30 we were making 6 figures a year and living in a 350sq/ft apt. we save/invest over 50% of our income and we are on track to financial independence at 45. this includes the $10k/y it would (currently) cost us for private coverage. wait, let me put that in a better perspective, at 45 years old our ROIs will pass the amount required to continue living as though we were still working, maintaining our nest egg and continuing to pay the insurance premiums, property taxes, bills, etc. but again... this is pointless - at this rate she will hit her lifetime maximum coverage before we cross the finish line. and when that happens everything we have saved and work for will dry up in a few years. all that work and we are likely to end up broke and on medicaid. the system has failed.

we need the health care reform. we need people to remove this bullshit notion that human life has a price tag. and we have no hope that any of this will happen in a country full of people that think 'that will never happen to me'. well... you had better hope it doesnt, because i doubt anyone else reading this has dedicated their lives to this game like we have. we put more money a year into this than the average american salary and we cant win. there is no outpacing this industry. not unless you win the lotto. it boggles the mind to see people talk about health care reform in such a way that suggests they are magically immune to getting sick, or that everyone that wants universal health care is a bum. i guess those people must make 7 figures a year. then i can see how we are bums with our sad little 6 figures. if we cant win this race... what makes them think they can?

--signed AC because the only karma this needs is the karma from voting FOR healthcare reform

One Word - Hospice

[Penicillus]

Hospice is a loving and caring way for helping the dying, and once an individual is admitted, many of the costs are absorbed by grants and government assistance there.

The answer is food.

[Anonymous Coward]

The problem is simple, the problem is food. See the film titled "The Beautiful Trith". Cancer is nothing more than a symptom of an underlying dietary deficiency. People in the western world do not understand what _real_ food is anymore. And it is a tragedy that modern _corporate_ allopathic medicine has no motivation to pursue. Which will make more money? (1) patented biochemical toxins or (2) telling people to eat real food. ("Let food be thy medicine and medicine be thy food.")

A third path

[bradbury]

After 250+ comments I am surprised that there is no discussion of a 3rd path, e.g. cryonic suspension. Ralph Merkle often presents a 2x2 decision matrix with "cryonics works / doesn't work" on one axis and "choose / don't choose cryonics" on the other axis. In only one of those boxes does one come out surviving. Yes, in one box, one comes out as "stupid" (cryonics doesn't work + choose cryonics) -- but asserting the negative (cryonics doesn't work) is a very hard thing to prove (esp. when asserting the alternatives -- disassembly by cremation or microbes are fairly certain to "not work").

Given that current prices (which I haven't checked lately) were of the order of $30-$50K for head/brain preservation and $130-$150K for whole body preservation it looks like the costs are 4+x cheaper for allowing a hospice path "death" followed by immediate cryonic suspension vs. the current medical paradigm of pulling out all the stops (no restrictions on costs) end-of-life care for people who are certain to die (and have presumably a low quality of life during that period).

I would request that you not even think about responding to this post in a "cryonics won't work" vein unless you really know what you are speaking about (meaning you really understand nanotechnology and nanomedicine and have a good working knowledge of cell biology and current cryonic suspension (vitrification) processes -- the information is out there on the WWW if one bothers to educate oneself). By and large I consider the current medical community to be guilty of malpractice if they only present the two "standard" paths (hospice care vs. full medical intervention) and leave out cryonic suspension. It is interesting that in the current debate regarding controlling health care costs that cryonic suspension has not come up in the discussion as an alternative.

Re:A third path

[Anonymous Coward]

(meaning you really understand nanotechnology and nanomedicine
I know enough about them to know that people who believe magic nanobots are going to fix everything have an understanding of physics and biochemistry roughly on par with amoeba.

Re:A third path

[Sockatume]

Empirically, cryonics doesn't work. There's not a human being in the world who has ever survived a course of treatment involving sustained cryonic suspension. That's not to say it won't work, but the survival-rate-per-buck has to get pretty low for the option with a hard-zero survival rate to become preferable. When cryonics starts saving some lives, then it'll be something worth choosing for more than intellectual curiosity. Right now it's empirically as viable as trying to reincarnate someone's mind in a clone using their Livejournal entries.

Re:A third path

[bradbury]

Granted. But the atomic bomb was empirically impossible before July 16, 1945. Walking on the moon was impossible before July 20, 1969. And look at the effort into making those realities! Basing what you do on what is empirically known is highly problematic, esp. if one has any perspective on The Singularity.

However recognizing that one could shift costs on the order of $500,000 per person for end-of-life care to $150K - $50K for cryonic suspension and realizing that this probably involves 1-2 million people per year (U.S.) [1] one is probably talking a savings of *several hundred billion dollars per year* if people would simply accept cryonic suspension as valid path [2]. Yes, the people have to be allowed to die sooner. But dying later may significantly reduce the chances of recovery in the case that cryonics works out (due to cancer destroying tissues, strokes or heart attacks destroying brain tissue, etc.) with some highly questionable benefit in those "borrowed time" weeks/months/years.

1. Current U.S. deaths per year is 2.4+ million [CDC | CIA Worldfactbook]
2. Indeed one has to wonder why insurance companies and the government do not have active programs encouraging people to select the cryonic suspension path vs. the life extension with poor quality and high expenses path? [The examples cited previously are cases where there was no empirical "proof" that a path would work. But at least in the cryonic suspension case one can cite examples where the path could be much better than the one we are currently following.]

The UK model (the QALY)

[Anonymous Coward]

How much is one year worth? about £30,000 (in perfect health, about £20000 if that extra year is spent in hospital). http://www.nice.org.uk/newsroom/features/measuringeffectivenessandcosteffectivenesstheqaly.jsp

Simes that by about 3 for end of life conditions so thats about £90,000 per extra year. Of course if the treatments may cure someone, then you get eg 20 years extra life, then the allownce would be £600,000. So it all comes down to calculating how likely the treatment is to save someone, which is REALLY HARD.

If the patient wants to die, they should die.

[moxley]

If the patient is terminal and wants to die, they should die when they wish to; by whatever means are necessary...The fact that the government prosecutes people in some places for euthanasia is disgusting.

To reuse a phrase

[Anonymous Coward]

You can have my life when you pry my cold dead hands off of it. I'm sorry to who it offend and who thinks it's not worth the money but you are wrong, once you are dead you can't come back to life, game over (unless you believe in reincarnation and even then you don't remember your former life so it's the same as dying). If I am sick I want it all, I don't care how much it costs or if you have to suck the brains out of aborted fetuses and stick them in me, I will do anything to survive and millions of years of evolution have made sure that I am really good at surviving.

When is it time to quit?

[Anonymous Coward]

When Obama says so.

Fisrt hand experience

[ooshna]

Well I actually have a lot to say about this but I am not going to do it. I got to watch my mom die screaming in pain b/c of cancer. We only knew she had it when she went to the hospital .She was in the hospital only 3 weeks. She died at 42 the day before her 43rd birthday. She didn't go out peacefully she was afraid. The doctors wanted her to go to hospice she wouldn't because she couldn't handle the fact that she was dying and nothing was going to stop the cancer in the 7 different organs it spread too. After she died I had to drop out of high school to take care of my disabled father and two underage brothers. If she would have went to hospice the bills would have been much lower. But if she did that I think she would have lost the little hope she still had left. I'm not sure what the best choice was even now but when someone is in so much pain that you pray to a god your not even sure exists to end there suffering even through death it kinda clouds your judgment. I could get into it alot more give all the details but hopefully you understand those decisions are ones you have to live with the rest of your life. The kind that will haunt you in your daydreams and dreams.

Re:Maybe we can just take the right away from her.

[FleaPlus]

Your comment gave me a random thought: Why aren't there any sellers of combined health+life insurance? The health payments could deduct from the life insurance amount, and the insurer would also have an extra incentive to keep you alive so that they don't have to immediately pay the life insurance amount.

Reminds me a bit of Robin Hanson's "Buy Health, Not Health Care" proposal: http://hanson.gmu.edu/buyhealth.html

This is wrong

[TRRosen]

Sorry but my Lord and Savior Sarah Palin has determined that talking about end of life health care options is a "death panel" and is evil so you should all be ashamed.

Learn from vets

[Moof123]

The ability to put a suffering animal down lies in stark contrast to how inhumanely we treat suffering humans.

Having to just "make her comfortable" while she swore at god, and asked to just end the pain solidified my views on the subject. We all need control over our own off switch (or reset switch, if that's your faith). I'd rather die under my own power while still alert and not in drastic pain.

If however you want to fight, and have the money to fight, then by all means have the conversation with the relevant family members and go into the whole process with everyone understanding the game plan.

Hmmm...

[Anonymous Coward]

$27.48

Re:Uh, FUCK no!

[Kral_Blbec]

As your body ages, it responds to surgery differently and heals much slower. Its not just that insurance wont pay for them, often its the case that surgery would do more harm than good.

look at how people value their own lives

[doug141]

It is a sad day when one decides to value the dollar worth of a human life.

We routinely do things that reduce our life expectancy by marginal amounts in return for rather minor conveniences and pleasures. We often stay up too late, eat and drink too much, fail to get enough exercise, and drive too fast. When we do so, we are putting a price on our lives, and a pretty low price. Just how much is it worth to eat that extra cream puff or drink that extra beer? You would probably forgo the cream puff for $10, but not to avoid reducing your life expectancy by a marginal amount. If so, the implication is clear--the marginal value, or price, you place on your life is no more than $10.

Re:Maybe she can answer in hindsight - NCI

[thms]

The studies I have seen put American and European survival rates at about the same level, with normally a slight advantage to the Americans [..]

Yes, I read about the "inexplicable" advantage wrt. cancer as well. Since currently everything seems to gravitate around the Healthcare debate I found the claim that this was due to the government funded National Cancer Institute centers which provide excellent treatment.

Don't Understand the Question

[loox]

AFAIK, the cost of keeping Mr. Bennett alive even if ill could be more advantageous for the community than the cost of keeping his wife alive even if healthy.

What about the cost of keeping Stephen Hawking alive? Let's terminate Mrs. Bennett and make better use of her money.

Re:Uh, FUCK no!

[Saint Stephen]

i can't believe my own personal wishes about what I want done with my own body get modded troll - speaks volumes

Not a third path?

[JSBiff]

I'm not sure I really see that as a third path. That's just another way of saying 'let the patient die instead of continuing to treat them'. Maybe it opens a possibility that at some time in the future, someone both figures out how to treat what was killing you, and how to reverse the cryonic death, but in the here and now, cryonic suspension basically equals death, from most people's standpoint.

Re:Not a third path?

[bradbury]

Agreed with respect to "letting the patient die", since in order to undergo cryonic suspension one has to be pronounced clinically "dead". However clinically "dead" is a moving target. Once, several decades ago, you were dead if your heart stopped. That is no longer true. And while there are cases currently where one is *really* dead, e.g. incineration in a fire (cooking the brain) or skull being crushed in an earthquake (scrambling the brain), but between where we are now ("dead" subject to "brain death beyond hope of recovery") and where we may someday be, e.g. brain death due to irrecoverable loss of information, there is a *lot* of room which is highly dependent on the technologies available to restore or extract information. I am a hard core computer scientist in that if I still have the information and can effectively run it (now or someday) -- I am not dead. Substrates are important to some but not to me -- which points out another area where there is a lack of discussion -- would you give up your body and/or appearance if you could continue living? Not enough discussion about that in the realm of "how much should we, as a society, be willing to spend to keep someone alive" [1]?

1. It is worth noting that to have a serious discussion in this area one has to debate the ethics of the value of a human life -- and be willing to defend the value of an 90 y.o. individual with Alzheimer's vs. the value of an Olympic Gold Medal winner. One has to begin to wrestle not with "all men are created equal" but whether or not the value of a life has an expiration date.

The insurance/medical industry is...

[okmijnuhb]

The insurance/medical industry is to the terminally ill, as a pride of lions is to a weak antelope.
they survive and thrive by devouring you.

Re:The insurance/medical industry is...

[John_Yossarian]

Completely agree with you. The problem with insurance companies is that they distort the natural market for healthcare through collusion. If we eliminated health insurance completely, individual consumers would be much better off.

Payments first

[hackingbear]

That's not my experience. In one time period, I went without insurance. The first thing the doctor and hospital asked for was the check. When I went to the radiologist to do an X-ray. They told me it would cost me $1500 incl. radiologist's fees; I turned them down and waited until I got insurer when I landed on a job.

They asked payment first because many people simply do not have the money to collect from.

So unless you are in the ER, they will tell you the price and collect ahead.

Legalize euthanasia

[melted]

Legalize euthanasia for terminally ill patients. It would make so many of these edge cases go away that the rest would not matter.

Lessons of a $950,000 death...

[Anonymous Coward]

Lessons learned by my mother after father diagnosed with Stage 4 metastasized colon cancer, later to spread to liver...her insurance paid about 950,000 along the way. This, after right at the start, the doctor gave him at best a 10-15% chance for 5-year survival.

$950,000 goes a long way. It gave him about three years. Three years bought for almost a million dollars.

Year 1, he stopped working. She took him to every chemo and experimental treatment, cried every day at the thought of losing him.

Year 2, he started dreaming. Spent money on a couple of trips, since he met someone else. Started sending all their [meager] savings to the other woman, hoping to return to his home country and live out his last years.

Year 3, he filed for divorce. Became truly psychiatric, started accusing mother of being the one of cheating on him, all the while telling everyone he met (never mind family, telling the mailman, the neighbors, the police who would come visit when called regularly about his illness and craziness) about his girlfriend. Conversations with him were difficult, to put it tactfully. At one point he said to me, "what if I told you [the other woman] was really your sister?" Quite an amazing experience, to see mental illness take over.

End of year 3, he collapsed alone at home. Mother found him while checking in on him occasionally (they had separated at this point) and called ambulance. He died in hospital a day later, refusing to speak a word to her, but did manage to tell the ambulance medics on the way about his girlfriend.

I called the hospital when I heard he collapsed, and found out he had just died, had to call and tell her (I live 3,000 miles away). Her exact response: "God forgive him. Life goes on." She is retiring shortly, house unpaid (he refinanced, and spent it) and with no savings. Her insurer paid a million dollars to a lost cause, and meanwhile she was left with nothing.

Still, the money went a long way. It lets us have no regrets, and she had no more tears. Others should be so lucky.

Medical Costs 40% more in USA

[Dan667]

When comparing medical costs in the US to other developed countries, they are about 40% more. So if the care had been in another country it could have cost $400k instead of $618k. Something else that should be discussed, examined.

If a band-aid would have sufficed...

[Petersko]

"I just had to pay $1300 in out-of-pocket expenses for my daughter to get a single stitch (emergency room visit because it was after hours). And the doctor was on the fence as to whether nor not she needed one. Had I known it was going to cost me $1300, I would have used a band-aid."

Maybe the reason the health care system is overburdened is because some people bring their kid to the freaking emergency room for a single stitch.

Re:If a band-aid would have sufficed...

[ameoba]

Emergency rooms are for -emergencies-. 9 times out of 10, you're better off calling up some local walk-in clinic and/or urgent-care facility. Hell, the odds are good that your regular Dr could squeeze you into his schedule on short-notice - cancellations happen all the time.

Adequate vitamin D can help prevent some cancer...

[Paul Fernhout]

Just to note that curing vitamin D deficiency (very inexpensive, either from sunlight or supplements) can prevent many cases of cancer:
http://www.vitamindcouncil.org/cancerMain.shtml
as well as many cases of heart disease, stroke, hypertension, autoimmune diseases, diabetes, depression, chronic pain, osteoarthritis, osteoporosis, muscle weakness, muscle wasting, birth defects, periodontal disease, influenza, autism, and more (there are different degrees of scientific evidence for those). See:
http://www.vitamindcouncil.org/

But vitamin D supplements or sunbathing is so cheap, there is not profit in telling people about this...
"Treating Disease With Vitamin D"
http://www.vitamindcouncil.org/treatment.shtml
"Why Michelle Obama is More Likely to Die From Breast Cancer than Hillary Clinton"
http://curtisduncan.blogspot.com/2009/10/why-michelle-obama-is-more-likely-to.html

There are other inexpensive treatments to prevent or cure cancer with various degrees of anecdotal evidence (like IV vitamin C as a cancer treatment),
http://www.medpagetoday.com/HematologyOncology/OtherCancers/2938
but curing vitamin D deficiency (now widespread as we all spend more time indoors at computers) has lots of scientific evidence about its value in relation to cancer and a wide variety of other things because vitamin D is essential to regulating the expression of thousands of gene. That is why being vitamin D deficient has such widespread negative effects -- sort of like deleting thousands of files at random on your hard drive... What's amazing is that humans survive at all with so little sunlight... So big is this effect of vitamin D deficiency on health that for Western Europe alone it has been suggested:
"A Decade Of Vitamin D Supplementation Would Save $4.4 Trillion Over A Decade; Would Save $1346 Per Person Per Annum"
http://www.lewrockwell.com/sardi/sardi111.html

Where are the US CDC, FDA, AMA, and other acronyms doing about all this? Good question...

Essentially, the US RDA for vitamin D is about ten times too low, as it was set decades ago for healthy bones, not a healthy heart, a healthy brain, a healthy immune system, or a healthy weight. The toxicity fears have also been overblown (vitamin A is much more toxic, and according to Dr. Cannell who runs the vitamin D council website, many people through supplements have too much vitamin A which interferes with vitamin D.)
http://www.vitamindcouncil.org/vitaminDToxicity.shtml
http://www.vitamindcouncil.org/newsletter/2008-december.shtml

Although just how much vitamin D as supplements you need depends on things like your weight, your skin color, your behavior outdoors, your latitude, your personal biochemestry, and so on, so regular blood tests are important (even though people still disagree over what the optimum level should be). Example:
http://heartscanblog.blogspot.com/2009/01/why-rda-for-vitamin-d.html

The average light skinned human adult in a bathing suit at moderate latitudes under noonday summer sun will make 10,000 to 20,000 IUs of vitamin D in twenty minutes or so in their skin, and up to 50,000 units before their skin turns pink (sunburns are of course bad for you). The reaction is self

Subsidised costs.

[Bill, Shooter of Bul]

You also have to keep in mind that with any cost that is paid by a patient with insurance, it is always higher than the actual cost in order to compensate for those that cannot pay at all. People with out insurance also get sick, and require expensive medical procedures, drugs, surgeries and care. If those same patients were allowed to enter the healthcare system when their illnesses were lest severe and less costly we could save a bundle on everyone's care. Also, if we could get some of those to pay into an insurance plan as well, then the costs would also go down.

So basically, I think its the other way around,

Once we cover more people, then we can get transparency and predictability in the costs.

Re:Subsidised costs.

[sycodon]

Chicken or the egg eh?

Could be. But I would suspect that until there is a complete understanding of costs, including treating those not covered, nothing can really be done. It's just rearranging the desk chairs on the Titanic.

Properly pricing services and prohibiting the charging of different amounts to different customers will clearly expose the biggest piggy sucking at the public teat. It all comes down to the idea that you can't fix something until you truly know what is wrong.

If doctors practiced medicine like the health care "reformers" are practicing reform, they would lose their licenses and be put in jail.

Exponential Growth of Health Care Costs

[urusan]

I'd like to point out that health care costs are growing exponentially in almost all developed nations, and in fact faster than GDP which is already exponential. The US simply started higher than most and has grown more strongly than the others that started out near the same level. http://www.kff.org/insurance/snapshot/chcm010307oth.cfm http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

In the long run, socialized medicine in other countries will begin to encounter the same expense problems as the US if they cannot curb the growth of their own health care expenses.

By the way, from that second article: I wonder why US health care spending surged during the 70's oil crisis, the late 80's-early 90's recession, and just after the tech bubble burst. There's probably an important relation there.

Re:Uh, FUCK no!

[Saint Stephen]

It's safe to say at least some of the people who modded you up won't feel that way when they're 80.

It's a very relevant question.

[Anonymous Coward]

Otherwise the responsibility of a person's life (a loved one's life) will be in the caring hands of bureaucrats. Who, let me tell you, take very little time to develop the attitude of "there are too many of you and just one of me, get lost". Ultimately, there is NO ONE who should be assuming responsibility for a free man's affairs -- unless you enjoy spending time in lines to get your papers stamped "reject".

society isn't benefiting

[r00t]

Might she now produce children who have a tendency to get this problem? Unless she has something extreme to make up for this problem (like Einstein), she really isn't good for the gene pool.

I'm OK with providing morphine so she doesn't suffer.

Again, if she's busy unlocking the secrets of the universe or finding cures for cancer, I have no problem paying for the fancy drugs. I doubt that's the case.

Re:society isn't benefiting

[Taevin]

Wow, let me see if I'm getting this right. She's bad for the gene pool (as well all know, given our physically intensive modern life, strong and healthy athletic children are what we need most going forward), so we shouldn't let her reproduce. As long as she's helping now though, doing something that genetically superior humans can't, we'll let her live--for now.

This all sounds very familiar...

Re:society isn't benefiting

[r00t]

Mental abilities are largely genetic. The environment can make you dumb, but it can't ensure you will be smart.

If she's busy unlocking the secrets of the universe or finding cures for cancer, then she is genetically superior in at least one way. That can make up for her defects.

helping them can be a loss for society

[r00t]

You forget to account for two things:

1. Everybody reaches the expensive stage at some point. All you can hope to do is delay the inevitable.

2. Every year of life is costing money for the rest of us. Remember you're talking about people who offer little of value to the economy. Many offer negative value! (crime, welfare, etc.)

It definitely isn't a sure thing that providing free non-emergency care is good for the economy.

Re:helping them can be a loss for society

[Bill, Shooter of Bul]

Point number one is wrong, with many obvious counter examples.

Point number two is a valid, albeit disturbing point. Are you really suggesting we through our inaction let people die because they aren't valuable members of society? Wouldn't surprise me if you were. There are a lot of psychopaths here on slashdot.

If you are, you should consider moving to Bogata Columbia, where private citizens hire out death squads to kill the homeless. There, true libertarian capitalism reigns free.

Re:helping them can be a loss for society

[r00t]

Point number two is a valid, albeit disturbing point. Are you really suggesting we through our inaction let people die because they aren't valuable members of society? Wouldn't surprise me if you were.

Sure.

This is more-or-less a feature of the current US health care system. People seldom admit that they like this feature, but there is clearly a reason why so many people don't want to change healthcare much. They don't want to lose this feature in the upgrade.

The feature isn't well-implemented. It isn't based on predicted value, and it doesn't count certain non-monetary things like child raising. Still, it more-or-less works: useless people tend to die faster than useful people.

Also, as viewed from the perspective of poor republicans, it is insulting and shameful to get a handout. It feels shitty to be taking something you didn't earn.

There are a lot of psychopaths here on slashdot.

I think "psychopath" is far from accurate. That would involve saying nice things to you while backstabbing you and internally mocking you.

Better: brutally honest, fair, and coldly rational

Note that it isn't fair to treat useful people as badly as we treat useless people.

Re:helping them can be a loss for society

[Bill, Shooter of Bul]

This is more-or-less a feature of the current US health care system.

No, it isn't. If you are a dying homeless man who has never worked a day in your life, you can stumble into an ER and they, by law have to treat you regardless of your ability to pay, usefulness to society, or overall cost. They have to subsidize that lost cost by charging paying patients more.

You can't see the logical conclusion of what you are proposing. It ends up with us like Columbia, minus the cheap cocaine and beautiful women. You don't want what you think you want. To be fair though, most people don't. I shouldn't pick just on the slashdot variant of morality. Its just an odd, disturbing one. Fairness is unfortunately, a relative term in our society, dependent on one's hierarchy of values.

Re:helping them can be a loss for society

[r00t]

you can stumble into an ER and they, by law have to treat you regardless of your ability to pay, usefulness to society, or overall cost.

Right, that's why I say "more-or-less".

It is true that the useless people tend to die faster than useful people. To pull some numbers out of my ass, perhaps life expectancy is 45 for useless people and 90 for useful people. We're forced to accept that a few useless people will make it past 100, and a few useful people will die at 20.

The ER isn't everything. Lack of early cancer detection and lack of early heart surgery are among the many things that play a role in killing off the useless.

Depending on one's hierarchy of values, one can redefine fairness to mean enforced equality at the expense of others. That's hardly fair by any reasonable definition. Fairness rightly means that you get the share that you deserve, no more and no less.

$500000 for everybody?

[r00t]

Consider 30-year-old men, each having used up 10 percent ($50000) of their $500000.

One has started a company and is an irreplacable part of that business. He employs a dozen people, mostly engineers. It's a bit beyond a start-up, operating on profit and growing, but he's not yet rich. He has six kids with ages 0, 3, 3, 7, 8, and 11. His wife died last year.

One is in prison for the second time. He raped a woman, then burned her clitoris with a cigarette. The previous time in prison involved keeping a woman in an RV for a week while repeatedly raping her. He's a highschool dropout. When not in prison he lives by begging, digging in restaurant dumpsters, and visiting soup kitchens.

Re:$500000 for everybody?

[TheLink]

Yes. The same for everybody. And why not? (It's not like they get the money upfront in their bank accounts - it's like insurance).

Everyone gets an equal chance to show how deserving or how undeserving they are. That's called being civilized. Everyone gets given a base level of "civility".

And that way they have fewer and fewer excuses for their behaviour if we ever have to justify punishing them for whatever they do, and even the form of punishment.

No: "I desperately needed the money to pay for medical bills".

If you think 500K is too high for everyone, then make it something lower.

Re:$500000 for everybody?

[r00t]

Yes. The same for everybody. And why not?

IMHO, this is completely unfair. It's revolting. It's as disgusting as anything could ever be.

Try reading my examples if you haven't yet. It's obvious that one person is deserving and the other is not. (me: WTF???) I suspect you're just being stubborn; you know that one of those people deserves better than the other.

Everyone gets an equal chance to show how deserving or how undeserving they are.

It looks like you disagree with yourself. I thought you wanted to ignore how deserving or undeserving somebody might be.

Given that one man has shown himself to be deserving, let's spend $millions on him. For the undeserving, we spend $0.

Re:$500000 for everybody?

[TheLink]

I have read your examples. I was already well aware of the implications of what I was saying. So your examples don't change my mind at all, and it's not because I'm being stubborn.

Are you saying the police shouldn't save "bad people" from others? Or if they are in a building on fire, the firemen shouldn't save them?[1]
And that "bad people" should not be able to borrow books from a public library?
And that "bad people" shouldn't be allowed to vote[2]? Or have freedom of speech?

You really think freedom of speech and the right to vote is worth less than a "medical insurance package worth up to USD500K"?

This is part of the civilization thing I was talking about. When you live in a civilized society with rule of law, everyone gets certain protections, certain freedoms, even free access to various resources.

Whether or not you, I or anyone else likes it or not.

Even a murderer on deathrow is not supposed to be killed by anyone else except the State.

If you still don't get it, you do not understand what civilization is and why it really is a good thing for us.

I'm not being stubborn. I understand very well the consequences. I prefer living in a civilized world. If it means some of my taxes go to keeping some "bad person" alive (hospital etc), that's fine with me.

My taxes already go towards keeping a bunch of "bad people" (e.g. certain politicians and their cronies) filthy rich. Which to me is even worse - that's not necessary for a civilized society - in fact those are symptoms of a corrupt society.

[1] Yes if they know, who to save, maybe they should save someone else first ;), but firemen normally don't have time for such things - they just do what they can.

BTW having a law which says firemen should only save the good people first, would be uncivilized and impede them in their work.

Should they save a stinking murderer who has killed only one person, and who might at most kill only 5 more other people in his lifetime? Or should they save a well-heeled politician who has lied and thus caused the death of tens of thousands of people for the benefit of himself and his friends (and not the nation)?

To me they shouldn't have to think about such stuff. I'm fine if a fireman's reasons for saving one _first_ and not the other was: he looked lighter :).

[2] I am well aware that in the USA it is common for convicted felons to not be able to vote. This to me is wrong. Even prisoners should be allowed to vote (and do it freely without coercion or compulsion). This is part of reintegrating them back to society.

Re:$500000 for everybody?

[r00t]

Are you saying the police shouldn't save "bad people" from others?

It was done in the American west. The sheriff/judge would declare somebody to be an outlaw. Once that happened, he was no longer protected by the law. You could cook and eat him if you wanted to.

It's not safe to do this because of mistaken identity, but otherwise it's appropriate for the most severe crimes. Lots of people would enjoy killing a pedophile.

Or if they are in a building on fire, the firemen shouldn't save them?

There are neighborhoods where firemen are shot at. I expect that many fire departments quietly give priority to places where that doesn't happen. This can be done when deciding where to locate a firehouse and/or when prioritizing where to send the trucks.

When you live in a civilized society with rule of law, everyone gets certain protections, certain freedoms, even free access to various resources.

No, that's uncivilized. Civilization exists to protect the useful from the useless. If we didn't need police/military to protect us, we'd have never accepted the loss of freedom required to form a civilization. Civilization is all about stopping the useless people from taking our resources; it's not about handing over our resources to the useless.

Or should they save a well-heeled politician who has lied and thus caused the death of tens of thousands of people for the benefit of himself and his friends (and not the nation)?

That's the inevitable imperfection. It's like autoimmune disease: we have an immune system to protect our body, but sometimes it attacks us.

Re:$500000 for everybody?

[elucido]

Nobody is entitled to anything, not a penny, not a hug, and not time.

Now that this is settled, every human life born costs the rest of us. Whether we put that human in prison, or we give that human welfare, we will be paying for that human one way or another.

Since most humans are functionally useless, we should strive to create less of them.

Re:$500000 for everybody?

[elucido]

Are you saying the police shouldn't save "bad people" from others?

It was done in the American west. The sheriff/judge would declare somebody to be an outlaw. Once that happened, he was no longer protected by the law. You could cook and eat him if you wanted to.

It's not safe to do this because of mistaken identity, but otherwise it's appropriate for the most severe crimes. Lots of people would enjoy killing a pedophile.

Or if they are in a building on fire, the firemen shouldn't save them?

There are neighborhoods where firemen are shot at. I expect that many fire departments quietly give priority to places where that doesn't happen. This can be done when deciding where to locate a firehouse and/or when prioritizing where to send the trucks.

When you live in a civilized society with rule of law, everyone gets certain protections, certain freedoms, even free access to various resources.

No, that's uncivilized. Civilization exists to protect the useful from the useless. If we didn't need police/military to protect us, we'd have never accepted the loss of freedom required to form a civilization. Civilization is all about stopping the useless people from taking our resources; it's not about handing over our resources to the useless.

Or should they save a well-heeled politician who has lied and thus caused the death of tens of thousands of people for the benefit of himself and his friends (and not the nation)?

That's the inevitable imperfection. It's like autoimmune disease: we have an immune system to protect our body, but sometimes it attacks us.

There is a huge difference between a pedophile and a child molester. The fact that you cannot distinguish a difference is why we should not have these sorts of witch hunts. If we are going to murder serial rapists you have to think of the consequences beyond the obvious protecting of children. You murder the rapist, the rapist might have people who love him and her who might murder some of your "bad" people, now you have a civil war.

It's better to put the bad people in prison, and let the system chew them up and spit them out. It's always better to side with the law than to let the mob rule. The reason is because mob rule is anarchy.

Re:$500000 for everybody?

[Anonymous Coward]

> Civilization is all about stopping the useless people from taking our resources; it's not about handing over our resources to the useless.

Is that all civilization is about? If that's it, it's pretty useless too.

Possibly the wrong question

[jandersen]

Do we all have the right to live? Well, of course, and in my opinion it shouldn't be a question of money, really. Most hospital treatments are obscenenly expensive because medical companies are maximizing their profit, not because it really is that expensive to develop the drugs or treatments concerned.

But sometimes we see that this "right to life" becomes a duty to keep living, even when you don't want to; to me, that is the real question.

Re:How much is your life worth?

[DarthVain]

Also the time I give him is the time I do not want. Usually when I am unproductive and cranky.

An Exquisite Piece of Narrative Journalism

[nightcats]

I'd prefer that we focus on the quality of the writing: Bennett's work is Pulitzer-quality journalism, the kind of stuff that would have transformed last year's debate and pulled Washington out of the sewer of shrill innuendo and insanity which it still calls home. Incidentally, the editors here deserve praise for bringing a sterling piece like this to a large audience.

Well, thanks for describing insurance industry.

[jotaeleemeese]

Look, let me let you into a secret, insurance is "N random people paying into a system to finance your family's problems ".

H-e-l-l-o-o-o-o ! Anybody there?

The difference with socialized medicine is that the aim of the system is to get best outcomes for the most patients.

With the sorry excuse of a system in the US the aim of the system is to make rich the insurance companies and ancillary businesses (hospitals, doctors) at the expense of the US people, who pay way above the odds for care that is often denied on the flimsiest of excuses.

Think: how it comes Cuba, one very poor country, which has been prosecuted mercilessly by old U.S. of A. , can boast several health indicators (life expectancy, child mortality) which are pretty similar to the US's in s shoestring of a budget?

But whatever, if you think it is a good idea to be at the entire mercy of for profit organizations when it comes to health care be our guest. The rest of the civilized word knows better (the brand of Ayatolic capitalism espoused by half of the US population is frankly illogical and stupid, but that is what happens when blind faith clouds sound judgement).

Interesting.

[jotaeleemeese]

That is what it costs (more less) in the UK if you have elective private health insurance (normally a perk from some big companies, of course it would be free in the "Communist", by US derided political standards, National Health Service).

You are being conned in the US, but half of you chose to believe the nonsense that the the interested parties (insurance companies) chose to publish.

Private is faster of course.

[jotaeleemeese]

You are paying for it after all (from your own pocket or your private insurance).

The NHS will prioritize treatment, so if you need it tomorrow you most likely will have it tomorrow, if it is not so urgent, yeah, it will take a while.

One has to grant that the waiting queues have been tackled up front by the current government (one of the reasons they have remained in power for so long) and the system is far from perfect, but is it really annoying this minute nit picking about a system that in general terms works reasonably well for far less money.

The previous Conservative government (Republicans Light, very Light, they don't remotely approach the right wing US political spectrum, but still, they are to the right of UK politics) of course forgot about the NHS and during their last tenure in power service got worst,

The current Conservative leader has made a cornerstone of his political manifesto to keep current levels of spending on the NHS in real terms.

In the UK the party of Margaret Thatcher has come to the conclusion that Socialized Medicine is the best solution for the provision of Health Care for the general population.

People opposing Health Care Reform in the US should really take some time to think about the above...

Re:Private is faster of course.

[OeLeWaPpErKe]

The NHS will prioritize treatment, so if you need it tomorrow you most likely will have it tomorrow, if it is not so urgent, yeah, it will take a while.

That is, of course, the propaganda statement. What will, in reality happen is that the NHS will put a price on your survival, and deduct the cost of the potential outcomes. If any of those numbers go below 0, you ... well ... you are left without treatment.

It sorts patients based on what amounts to least cost for the government, not based on medical necessity. And yes, after that it will make manual adjustments on the most idiotic decisions made by this algorithm (thank God for those adjustments).

The NHS is the best possible example illustrating the blatant falsehood that with the government in charge profit motive will disappear from medicine. In fact it will become worse : you are forced to buy from a monopolist AND said monopolist has a profit motive (spending as little as possible on you for the maximum benefit (in this case, tax-wise)).

So with the govt in charge you have all the disadvantages of government, like easy fraud, massive bureaucracy, practical unaccountability of the "do we treat this guy" decision makers, and the constant addition of new, ever more idiotic rules due to changing guard in the parliament. And then you combine these disadvantages with the disadvantages that someone who wishes to spend as little as possible on your life, the so-called "profit motive".

Re:Private is faster of course.

[Anonymous Coward]

It sorts patients based on what amounts to least cost for the government, not based on medical necessity

Utter horseshit, straight from Fox News itself.

If that were true, why would the NHS treat people who have retired? They get a state pension (Ill give you a minute to scream "communism". Done? Ok, good.), so letting them die early by denying them any medical care would "amount to the least cost for the government".

Also, you are not forced to buy from a monopolist. Yet another Foxism. BUPA is one of the private UK health care schemes you can join. It is offered at a discount in many companies here. Furthermore, the NHS does not have a profit motive, it follows the government funding model - if a department underspends, it gets that taken away from its budget next year). I dont have to go to the NHS. Oh, and whats this "buy" thing? My taxes help pay for NHS treatment. Doesnt matter if its a heart bypass or an x-ray, it cost me the same when I walk into a hospital - nothing, as Ive already paid for it.

Oh please.

[jotaeleemeese]

"Take your example of feeding a poor person in another nation. That sounds good. But the feedback you forget is that by giving that person free food you put the farmers in that country out of business."

Which business is that exactly?

In countries where people are starving there is not enough food being produced. THat is the problem (drought, wars, you name it).

Or do please provide examples.

In any case, if saving thousands of people from starvation means that a few farmers have to make a living doing something else, so be it.

Re:Oh please.

[compro01]

In countries where people are starving there is not enough food being produced. THat is the problem (drought, wars, you name it).

Other possible reason : price of food crops is too low (inexpensive food is desirable for society in general) to make a living off of with a reasonable amount of land, so they grow non-food cash crops instead, often for export.

Food being imported for free/cheap lowers price further and results in a feedback loop of the above.

Typical solution to this issue is to decouple the crop sale price from the food purchase price via subsidies, but this doesn't work if the government of the country in question doesn't have things together enough to implement that or isn't interested in doing so for whatever reason.

A theoretical all-terms solution to this problem is fairly easy to come up with, but successfully implementing one is decidedly non-trivial or potentially impossible depending on various factors.

Healthcare should be free for everyone.

[christianmartel]

Healthcare should be free for everyone. Here, in Canada, taxes are expensives for everyone, but no one has to choose between life and money.

What is your point?

[Anonymous Coward]

My brother wanted me to "lend him" more money to treat a cancer that by all accounts was incurable.

I refused, and that is a decision that still hurts me today, but there was absolutely no way that he was going to get better.

My mother in the other hand, understandably but irrationally, got heavily into debt to help him.

Guess who had to pay her bills in order to make sure she didn't lose her house?

(Mexico has some degree of socialized medicine, but my brother decided to take no cover, neither socialized nor private, the blissful ignorance of somebody young).

It is only fair to all the people staying behind that you at some point make a judgement call and atop throwing money away.

It is painful, but it is also necessary.

Very few.

[jotaeleemeese]

Only cases in which it is terribly expensive to provide treatment, or the quality of life is barely increased, or life expectancy does not change.

The cases of this happening are so rare that it becomes national news when they are discussed.

And it is not like those choices are not done in the private sphere, health insurance companies deciding somebody is "uninsurable" are making exactly the same call, the difference is that the panel in the UK is taking in consideration what is in the best interests of patients (they are and independent body, not linked to the Health Service as such) while insurance companies are only looking at they actuarial tables and their balance sheets.

Another "nerds are not sexist" joke.

[jotaeleemeese]

keep bringing them on...

Re:Another "nerds are not sexist" joke.

[digitig]

Oh, I'm sure there's an equivalent benefit for str8 females. I just don't know what it is. Something involving chocolate, perhaps, or having the men of the local fire service do their housework for them naked? See, I have no idea, so I thought it best to stay out of that territory.

That is why we need listen more to our intellect.

[jotaeleemeese]

So when the time comes to take difficult decisions we are mentlly prepared to take the rational, logical one.

Unfortunately in today's society there are lot of people that allow themselves to be guided by magical thinking and sentimentalism.

Love has its place, a very important one, but it should never ever be the only determining factor of matters of practical consequence.

Balance of probabilites.

[jotaeleemeese]

She should think that no reasonable person should gamble with the wellbeing of a loved person, specially if the odds are against you.

You are missing the point entirely.

[jotaeleemeese]

That amount of money is used to pay for people in old age.

When you become old there will be young people wondering why they should pay 300 euros a month for health care they don't use while you receive civilized health care that you may not have been able to afford otherwise.

Golly ....

[jotaeleemeese]

"If you look only at people with insurance in both nations I bet the US patients would do a LOT better. However, US stats are skewed by large numbers of people with very little care at all."

That is kind of the frigging point Batman...

Re:Golly ....

[Rich0]

That is kind of the frigging point Batman...

Yes, that was my point. What is yours? :)

Here is a another way of putting it:

1. In the US, people who pay the most for healthcare are healthier than they would be in Europe.
2. In Europe, people who pay the least for healthcare are healthier than they would be in the US.

Some argue #1 is morally superior, and some argue that #2 is morally superior. Most likely this will have a great deal to do with one's opinion of socialism in general. Of course, the correct answer is so obvious to everybody that I won't bother to state it here. ;)

The US system also has the additional attribute of being wildly inefficient, so potentially either the poor or the rich or both could do better if that were fixed. We of course don't bother to fix this, as fixing the cost problem is difficult to divorce from fixing the socialism problem, and since nobody can agree on the latter the industry in general cashes in on the former.

Argh please, grow up.

[jotaeleemeese]

We put price on human life every day.

It is called insurance.

People that become "uninsurable" are considered too costly for society.

At a much basic level, more primitive societies just left the unable behind, or the old people would separate from the main group to die on their own.

We have always made those judgements of value, I resent you don't invite us to your planet where such decisions are not quantified and taken.

Dishonest? Check Wikipedia for bunnies sakes.

[jotaeleemeese]

AI will not even comment more on that.

As for arrogant, well, gee, what a surprise, people believing that they may be better placed to judge personal situations.

Did you get a degree on stating the obvious or it is just a natural talent?

England situation.

[jotaeleemeese]

You are incorrect.

England does not pay for drugs that don't demonstrate any obvious benefits.

Any drugs that are obviously working are not stopped in general terms, unless they are outrageously expensive (I have not heard about such a situation yet).

Same in the US

[tivoKlr]

MR is a very popular modality where I work due to the high incidence of soft tissue injuries that occur on the slopes above us.

Just as jotaeleemeese mentioned above, if your case is critical you'll get bumped to the head of the line, but otherwise, you're gonna wait for your MR. It's not magic, just because we live in the US and are straddled by this broken profit driven model of healthcare doesn't mean that you're going to get instant diagnostic tests done or a miracle cure TODAY.

MR's take time. Lots of time, and when there is only one machine (well now we have two but one is privately owned) there's gonna be a wait.

Right.

[tivoKlr]

if your only objection is that you want to live better by enslaving poor people, you're a terrible person.

This is what defines the American right. Personal wealth made on the backs of other poor people, here at home and abroad.

what a stupid article

[Anonymous Coward]

I started reading it. Nevermind. Too long.

deadbeat husbands should be dropped!!!

[Nyder]

Dude isn't earning an income and is costing her?

Damn straight she should of pulled the plug.

what, too soon?

Selfless!

[psithurism]

I was actually thinking: Wow! Hundreds of millions pumped into a really hard medical case, I bet doctors learned a whole lot! I bet they'll be better with patients in the future after this. The hospital probably has tons of equipment it couldn't previously afford.

Really, I think the more rich dying people are willing spend keeping themselves alive, the more we will later be able to keep people alive and happy with less money.

Re:Uh, FUCK no!

[Tim C]

Hence the OP said "they just don't make sense" as well as "and your insurance won't pay for them".

Good, give the billionaires treatment.

[elucido]

And charge them hundreds of millions, or even billions. This will create jobs for the rest of us while we nurse and doctor the sickly billionaires.

Sounds like a good plan to me. Do you have a better plan?

Pathetic that this question even has to be asked

[Baloo Uriza]

How heartless are we that we even have to ask this question, rather than move to a universal access system?