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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?"
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).
...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.
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
``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.
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.
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 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.
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
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.
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 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.
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.
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.
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?
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
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.
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.
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.
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.