Slashdot Mirror
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?"
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).
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.
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.
Moved to http://soylentnews.org/. You are invited to join us too!
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.
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.
The truth is sometimes the exact opposite and usually somewhere in between.
``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.
Please correct me if I got my facts wrong.
Dude, the work you do is not anywhere near as important as what you think it is.
Take a holiday!
.
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?
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.
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.
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.
Yes, this is a problem with any sort of expensive care, especially the long-term kind.
Yes, that's always important.
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.
Eurohacker European paranoia, gun rights, and h
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.
"I assumed blithely that there were no elves out there in the darkness"
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.
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.)
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.
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.
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.
Which studies?
Because Sweden's health system is ranked much higher, life expectancy is much higher, and preventable deaths are much fewer.
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?
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?
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.
ACs don't waste your time replying, your posts are never seen by me.
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!
Eclectic beats from Leeds, UK
handmadehands.co.uk
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.
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."
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.