End-of-Life Warning at $618,616 Makes Me Wonder Was It Worth It
bloomberg.com
Solid long-format article about the costs of healthcare for a dying husband.
bloomberg.com
We work and save and pay premiums for decades specifically so that we CAN have someone pay $250,000 to extend our lives by 17 months. That is the PURPOSE of a health insurance policy.
It's hard to see this one as an example of our (admittedly terrible) healthcare costs.
You mean people like us, the ones that pay the premiums, subsidizing the research of pharmaceutical companies?
In that sense, almost any political news can be made to be "relevant" to HN. The California budget deficit, Iraq, the tax code, the next elections, you name it.
And when the topic is politics, even though people here tend to remain civil, the level of discourse inevitably goes down.
For instance, consider your superlative usage of "murder". This sort of thing practically precludes any further fruitful discussion: anyone who disagrees with you is automatically in the uncomfortable position of "abetting murder".
I would never startup in the US, and one of the reasons would be lack of public healthcare.
Alternatively, she paid higher premiums under the assumption that some extreme end of life dollars would be nearly wasted by some policy members, but that's okay because that's what they chose to pay for so that they would never have to make a cost benefit analysis in their own care. I don't think she needs to wring her hands about it, that's what she bought.
What the hell??? Health care should be a right. Something you don't have to ever worry about. If my kid is lying in hospital sick, I'm not going to make a decision based on money, because I'd always say "Yes take all my money", and that puts me in a very vulnerable position indeed. One that could be exploited by evil companies if given the chance.
Health should always be far far far more important than money, but to prevent evil companies making a ton of money out of desperate people, it should be provided by the government.
Why is there such a disconnect in America between socialized war mongering, and socialized health care?
Relevant painting: http://en.wikipedia.org/wiki/File:Progress_of_America,_by_Do...
We can decide to ration what we have fairly. (How to do this is a matter of great debate). I'd argue that facing this problem in a clear-eyed, rational manner is almost a rite of passage for civilization, but calling it a "right" clouds the issue considerably.
But I believe it is a right to have some level of basic healthcare provided by government. I simply couldn't live in a country without it :/
I guess the issue is that you can spin that as "Death panels" if you wish - the government/NHS/etc get to decide who gets treatment, and who doesn't. It's a great shame it's been spun that way though.
It'd be a harder decision if I was 50 and had children who depended on me, and if the 20-year-old didn't have good odds anyway (or had done something incredibly stupid). Then I might be tempted to do make the "selfish" decision if it were mine to make. But not if I am 90 and decrepit.
For example, I don't have the absolute right to life, but only a relative one. No one can provide for that. In fact, I am guaranteed to die someday. I do have the absolute right not to be murdered (and to expect society to punish those who deprive that right).
People in a society have a relative right to food, shelther, and medical care. If the resources exist, they have a right to them. If they don't, then that "right" is meaningless. Every American has the right to adequate medical care without the life-destroying mess of individual medical billing (as opposed to the taxpayer-funded system that First World countries use) but not every American has the right to a liver transplant, because livers are scarce.
Bullshit. Someone has to pay for the adequate medical care - and it should be the person receiving it. If you want protection against "individual medical billing", you can always buy insurance - if you don't do that, you should be willing to face the consequences.
To put another way: the only way of ensuring "adequate medical care" to someone without the means or unwilling to pay for it is to force other people to pay for it. Do you think this makes sense? Let's say I eat healthy food (which most people don't), make exercise every single day (most people don't) and pay (insurance) for proper medical care (most people don't).
Why, exactly, should I be forced to pay when someone that eats crap every day, spends 4 hours a day on Television, does no exercise at all, etc, etc, gets sick?
And even that is besides the point - even if a perfectly healthy person gets hit by a car - why should I be forced to pay for it?
I'm pretty sure that your own behavior proves otherwise. (I'm not claiming that your choices are wrong, but they do show that health isn't always your highest priority.)
> but to prevent evil companies making a ton of money out of desperate people, it should be provided by the government.
In what universe can govts provide unlimited healthcare?
The current US healthcare "reform" includes significant cuts in Medicare spending on certain conditions. Folks who have those conditions will get less care. You know, pre-existing conditions....
Feel free to provide a checkable citation to any govt healthcare system that doesn't limit the amount of care.
Your most important asset is your ability to produce income.
By that definition, your health is very, very important.
I think we should become a First World country, which means universal healthcare.
The US has univeral healthcare. As I've pointed out, most people opt out, in part because it's a lot like the DMV. It's unclear why making it bigger would change that.
The US has a lot of experience with govt healthcare and it's mostly bad. (The Indian Health Service is especially bad.) It's unclear why we'd go for more before demonstrating that we could do it well.
In other words, as long as Medicare and Medicaid are disasters, why would we want more?
And yes, you can fix Medicare/Medicaid without increasing their scope. If they're fixable. And if they're not, increasing their scope won't fix them either.
In many areas, government can do a great job when it's not being kicked around by bunch of asshole politicians who think government fails at everything (I include almost all Republicans and at least a third of Democrats) and are therefore invested in proving that point by making it fail.
Whatever the cause, we're going to continue electing the same kind of people, so if the result of doing so is broken govt healthcare ....
I am curious about the argument that medicare would be less of a disaster with more money. Govt healthcare advocates claim that govt healthcare would make medicare cheaper. That claim is inconsistent with medicare needs more money.
Medicare with more money might well produce better outcomes, but that's not cheaper.
FWIW, Obama's cost numbers assume significant additional medicare cuts. Those cuts aren't likely to happen, but ....
As I've written before, I'm perfectly willing to give Obama free rein over everyone currently covered by govt healthcare (not just IHS, VA, and medicare/medicaid, but govt employees, including state and local govt employees, and maybe the beltway bandits too) to see what happens. Part of the deal is a 5%/covered-person-year cut in years 3-6, which is a bit over 20% total, which should be a slam dunk given the claims of 30% cheaper with better outcomes. (That's starting from what they're spending now to cover those people.)
If he wants to spend the savings on convering more people, great. I'm also open to letting other folks buy in at cost. The only non-negotiables are "all govt employees" and the per-covered-person budget cuts.
If the claims are correct, that experiment will be a huge success. If the claims are wrong, govt employees will revolt. Either way, we'd know.
I just believe that in this day and age, the US should join other first world countries in valuing life above military.
>> "I'm pretty sure that your own behavior proves otherwise. (I'm not claiming that your choices are wrong, but they do show that health isn't always your highest priority.)"
Care to elaborate?
You said that it was wrong to limit healthcare access. If there aren't limits, it's unlimited.
> I just believe that in this day and age, the US should join other first world countries in valuing life above military.
What makes you think that it doesn't? The US spends far more on health care than it does on the military.
Yes, that's true of the federal govt. Note that state and local govts also spend money on health, and they spend very little on the military. And then there's private spending.
In fact, one of the big arguments by folks arguing for more govt healthcare is that they claim that it will cost less than the current system.
> Care to elaborate?
If I observe your life, I'm pretty sure that I'll find several things that you do that are not as good for your health as they could be. (Here are easy ones - is your weight ideal? Do you exercise enough? How about sleep?) Their existence proves that health isn't your highest priority.
I'm not saying that you're wrong to have priorities other that health, but it is absurd to criticize others for doing the same.
The tough part is admitting that either some disinterested third party should specify what's worth doing, or people should be responsible for their own care. My personal belief is that a properly functioning market (ie: something vastly different than what we have now in the US) allows for more nuanced and personal decisions regarding what's worth paying for than a blanket set of policies. I also happen to think that letting people allocate their own resources between competitive providers is the best way to find that lovely equilibrium where prices are as low as they can be for a reasonable level of quality.
Assuming you disagree with me, you still can't consider unlimited healthcare an achievable human right. If your kid is sitting in a hospital, someone is making a decision based on money. I'd rather I be in control at that point. I also assume that in such a happy fairytale of a free market, I'd have planned for such an occurrence and purchased a reasonable level of medical insurance to cover that sort of event.
Be careful not to paint America with such a broad brush. Most of us are "victims" of fearmongering and policies that are well outside of our control. It's a sad byproduct of a dysfunctional system that's grown well outside the bounds of what it was originally designed for.
The problem I have though is that most Americans seem to think pretty much unlimited socialised military spending is fine.
Health insurance companies would love to purge their rolls of all unhealthy people, and only charge premiums to healthy people. The free market cannot fix this.
Currently, I've got mild damage in my left elbow, both knees, and one of my teeth is very slightly chipped from a martial arts match. I could afford treatments to all of these, but I choose not to because there's other stuff I value more with my money. I like that I can make that choice for myself.
I also like that no one has any say in what I do with my life - I can eat horrible fried foods, or not, I can drink loaded-with-fructose beverages, or not, I can smoke cigarettes and drink vodka, or not, and so on - and no one else has a say, because I pay for my own medicine and medical treatment. If everyone had to pay for my medicine, then logically they'd want a say in how I lived my life. I don't want to pay for someone who gets a preventable disease because of lifestyle choices, and I don't want someone to pay for mine. I'm happy that I get choice over my own life, and others don't get a say in how I live it, and I don't want a say in how others live their lives.
There are unintended consequences, of course. If a patient had invested hundreds of thousands of dollars in care that ultimately failed, the incentive for his family to sue for malpractice is much greater. This raises the price of malpractice insurance, which makes medical care more expensive for people that aren't at the end of their life; people with routine problems that are easily treatable.
Also, you could agree to pay and just not pay. If I was going to die in an hour, and someone asked, "will you pay us a million dollars to use a new treatment", I would easily answer yes. I won't be needing the money if I die, and if I live, I can just change my name and not pay it. When you're broke, there are ways out. When you're dead, you're dead. That's it. Forever.
"The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 became $254,176 when the insurers paid their share and imposed their discounts. Of that, Terence and I were responsible for $9,468 -- less than 4 percent."
The biggest cost in western-style health care is not end of life care, it is lifestyle-induced illness that leads to an explosion of totally preventable terminal diseases.
But it's a good business model: people will often spend their net worth to extend the life of themselves or their child a few months. But in the end they almost always die the same miserable death. So I expect even more "childrens' cancer centers" to open and rake in millions.
But before this, the patient is negotiating for something, anything, that will relieve his suffering. And money ceases to become an object.
Skip the oncologist, pass the drugs.
My mom was supposed to live 6 months longer (at best). Instead she made it more than 2 years. Where they difficult years? Yep. However, they where still valuable ones. She got to see me marry. She met the future mother of her grandchildren. She got to see and do things she always wanted to do. She saw her estranged family again.
The value of those oncologists simply can't be discounted. It's an incredibly difficult profession, one in which most of your patients die. However, the ability to extend lives...even by a few months... and manage to make those last days as painless and productive as possible makes them angels in my book. Not profiteers.
It was interesting getting to know her oncologist. He clearly struggled with the emotions of his job. In the wake of her death he couldn't bring himself to attend her funeral (understandable). There was hardly a human being who knew her better in those last two years... and for that I'll be eternally grateful to him.
Your wishes aside, most doctors are profiteers. Take the profit out and most would find another professions. Don't you remember the attitude of hopeul medical-school bound students in college? Very few go to medical school for noble causes.
Your mom's oncologist likely attended very few, if any, of his patients' funerals.
As for: "It was interesting getting to know her oncologist. He clearly struggled with the emotions of his job. In the wake of her death he couldn't bring himself to attend her funeral (understandable).There was hardly a human being who knew her better in those last two years... and for that I'll be eternally grateful to him."
I must call you on your claims. Oncologists necessarily don't spend much time with each patient and it is very unlikely that
- you "got to know her oncologist",
- he "struggled with the emotions",
- he "knew her better" than anyone else .
The only way the last could be true is that your mother had no friends. Was she wealthy also? Oncologists do make exceptions for wealthy patrons.
As our medical skills are improving we can keep people alive that used to die. Unfortunately our medical skill isn't advanced enough to do it cheaply. Perhaps the luxuries of time and money will get us there one day.
Each year we add more and more expensive interventions from ECMO machines to artificial hearts. Put this together with the "if it can be done, it should be done, damn the cost" attitude we've trained ourselves to expect and we could find ourselves in for a severe reality check.
Medical technology seems strangely resistant to Moore's law (witness the price of a CT scan over time), but even if it weren't, the improvements in individual areas might not be enough to offset the growth of intervention technology in general.
Yes, anti-aging is the best possible research we could be funding. Unfortunately most people shut down when it's brought up, because thinking about your own decline and death isn't pleasant.
If they don't, there's going to be a lot of scaling back on things that don't work or aren't proven.
How will the "scaling back" be accomplished? Governments can and should stop paying large amounts for treatments that don't do much, but unless private services are banned, lots people will spend whatever they have to try to keep themselves or their loved ones alive.
what was gained by keeping him alive, in a bed, not creating value, for 400k? the family suffered with him while he died.
let him die, grieve, get on with your lives.
and save the rest of us the 400k.
Maybe I am just a hopeless optimist, but personally, if my wife/kid is dying, I am probably not going to say "BAI!1!", rip the cord out of the electrical outlet, and grin as I watch his/her eyes close for the last time. Ever. Instead, I am going to spend a lot of money to hopefully avoid ever seeing that. Because while you can always make more money, we can't clone people yet.
On the other hand, I'd fight for a child or a (healthy, not doomed to die soon) relative with everything I've got. Which is why it surprises the hell out of me that health insurance companies aren't getting the Joseph Stack treatment all over the place over rescissions and life caps.
Spartan parents would kill children with defects. In contrast we keep physically and genetically damaged children alive (or on life-support in the case of cancer) at much cost to ourselves and at peril to our offspring. Would you want your daughter to marry a man who carried a life-threatening gene? Did she? That's what we're doing. Maybe someday we'll be able to fix these problems, but today we cannot.
Living in a hospital bed is not living.
I think pretty much everyone would rather die than linger on in a hospital bed without hope. At a certain point, utility of future life becomes negative and returning to a positive state is not possible. The problem is that it's not so clear cut and obvious at the time that this is the case. A big part of this is that doctors often want to save the patient at all costs, and often deceive themselves as to the patient's prospects. So often even the patient has no idea how bad the situation is.