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?"
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...
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.
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!
...and he could have at least said his death was palindromic.
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.
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.
Jealously hoarding mod points since 2007.
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
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!
``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.
God speed, lad. His suffering was so great, he couldn't bear to finish his post before pulling the plug. :(
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.
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 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.
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.
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.
Quidnam Latine loqui modo coepi?
Reagan era?
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.
Having private health insurance and then not letting people make use of it seems to be the worst of both worlds...
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
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...
dnuof eruc rof aixelsid
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"
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?
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.
sed -e 's/Chuck Norris/Rajnikant/g' joke > fact
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.
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.
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.
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.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
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.
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.
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:
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.
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.
You're actually willing to torture your victim indefinitely to please your sense of righteousness?
640K should be enough for anyone.
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?
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.
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.
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.
When Fascism comes to America, it will call itself Anti-Fascism, and tell you to give up your guns.
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.
"He who would learn astronomy, and other recondite arts, let him go elsewhere. " -- John Calvin, commenting on Genesis 1
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."
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
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.
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.
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.
Check out my sci-fi/humor trilogy at PatriotsBooks.
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.
Blarney Quality Restaurant, Plants
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.
"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.