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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?"
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.
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.
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.
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.