I was given new hands for Christmas | Hacker News Reader

I was given new hands for Christmas

theguardian.com

I think it's incredible that her health insurance didn't cover electronic prosthetics.

The hook prosthetic is just a simple open/close grabber tool. Imagine trying to navigate through life with two grabbers. The modern myoelectric prosthetics offer way more functionality and freedom. You can use a computer, dress yourself, drive a car, and feed yourself (of course the author can't do all these yet, it does take time to learn). You can't do this at all with hooks.

I fractured/dislocated multiple wrist bones two years ago and it wasn't life threatening but I would have had diminished functionality without surgery -- insurance covered it no problem. My hand is great.

How the hell does it make sense to fix a wrist in order to allow someone to do the activities of daily living but it doesn't make sense to give them a common commercial prosthetic in order to do the same thing?

This is why the entire health insurance market doesn't make sense. Right now, as a healthy person, how am I supposed to weigh the impact of every potential health issue in my life? I'm sure she could've purchased some cadillac plan to cover it, but without experiencing that and with such a minute chance of an accident like that occurring as a teacher of all things, why should she ever buy it? Or even know to look for that kind of coverage? Who can price the repercussions of going without some medical procedure or medicine without ever having experienced that situation? I can understand car, boat, our house insurance and can easily replace those tangible items, but how should I price the risk to my health?

Healthcare is heavily rationed in socialized medicine systems. That's why wait times are so extreme in Canada, and doubled from ~1990 to 2015.

Rationing is the same exact thing as what you're talking about. They're choosing who gets what medical access and when. If you're 92 years old and you want an extremely expensive surgery or treatment in Canada, and it's only going to prolong your life by 18 months, you are not going to get that treatment, period. The same applies in France and Britain. Rationing is a required tenet of socialized healthcare. I'm not saying all rationing is bad, however pretending that under socialized healthcare it's just a free-for-all, is flat out wrong.

A very recent example of the rationing squeeze:

"N.H.S. Overwhelmed in Britain, Leaving Patients to Wait"

"Cuts to the National Health Service budget in Britain have left hospitals stretched over the winter for years, but this time a flu outbreak, colder weather and high levels of respiratory illnesses have put the N.H.S. under the highest strain in decades. The situation has become so dire that the head of the health service is warning that the system is overwhelmed."

"Some doctors took to Twitter to vent their frustrations publicly. One complained of having to practice “battlefield medicine,” while another apologized for the “3rd world conditions” caused by overcrowding."

https://www.nytimes.com/2018/01/03/world/europe/uk-national-...

>That's why wait times are so extreme in Canada, and doubled from ~1990 to 2015.

what are wait times for 30M uninsured in the US? Infinity? Or even for underinsured :

http://www.commonwealthfund.org/publications/issue-briefs/20...

"Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. "

Who said the US system was better? You're attempting to stand up a strawman counter.

I said socialized medicine requires heavy rationing of care. The comment I replied to was implying that somehow the selection of and or limitation of care is wrong (eg under the US health insurance system): all socialized systems depend on that exact approach, aka rationing. They limit access, they restrict types of therapies based on age or expected outcomes due to cost, they extend wait times dramatically based on what they decide is more or less important, and so on. Socialized medicine would collapse instantly without such aggressive rationing.

And nowhere in the above paragraph did I say the current US system is superior to alternatives in the developed world.

you must be kidding. You brought up the socialized medicine as a strawman counter in your first comment in this thread.

I didn't do that in any manner. I brought up the fact that socialized medicine depends on restrictive filtering systems - rationing - to strictly control for costs. It can't function otherwise.

The argument in favor of socialized medicine isn't that it enables any care you need at any time you need it. It's that it's supposed to be a morally superior distribution of resources.

The US is better, and it's worse.

Poster anecdote describes vet who has more leg prostheses than he is able to use. Article anecdote describes cost-cutting to the point that prostheses which adequately replace the function of hands for a quadruple amputee are considered a luxury. Compassion is a cost; cut it.

That makes a pretty wide range of outcomes. We even have a dolphin that has a state-of-the-art tail fluke prosthetic. I doubt it had insurance. If it did, I doubt it would pay out without a 3 tuna deductible, a 40 sardine co-pay, and a 15 sailfish lifetime maximum.

Do these insurance companies think we're paying just for our own sakes? Do they think we should breathe a sign of relief for not having to pay that $260k in increased premiums? Every one of us that's not a sociopath can empathize with the woman who got shot twice in the chest and as a result woke up one day not even able to pick her nose by herself. That could have been me! I, for one, love picking my nose by myself. And I am super pissed that the sole reasonable outcome to this story was achieved only through the wish-granting generosity of a passing fairy godparent.

Good for that guy in private life, but his day job is actually making more difficult several of the more reasonable paths to that outcome. What about all the people who will never get a fairy wish?

Nobody is ever going to take $260k worth of pity on people like me. I really need all this to be a matter of enforceable contracts or laws, rather than what charity may grow in the human heart. Any safety net based on that sort of goodwill simply has me-sized holes in it everywhere.

Canadian wait times are a bit of an aberration according to a recent survey[0]. According to the same survey, which also includes other developed countries, the US isn't doing better at all on other fields, and significantly worse on things like cost barriers.

The existence of socialized healthcare doesn't preclude privatized healthcare. That 92 year old can get their treatment in the private sector in any developed country, and hope their insurance will cover it.

I'm not sure what that anecdotal evidence means. Just today I drove my mother to the ED after a fall that left the bone peeking through the skin, and we were in and out in an hour. The fact that the NHS has problems now doesn't prove anything.

0: https://www.cihi.ca/sites/default/files/document/commonwealt...

>> "N.H.S. Overwhelmed in Britain, Leaving Patients to Wait"

The next line in your comment explains why this is the case: "Cuts to the National Health Service budget". The NHS was a unique jewel of a public health system (from which I myself and members of my family have benefited, as well as contributed to btw). This was until successive Tory governments took a knife to its budget and started making plans to sell it all off.

The fact that the NHS is ailing supports the exact opposite of what you are trying to say: a health system supported by public funds takes good care of its citizens. One that is privatised and whose budget is slashed, does not.

Agreed, especially for a person that needs two. You could perhaps rationalize the insurance position in the case of only one hand.

I fail to see how it's a luxury for someone that needs two.

Over the next few weeks, I watched my hands turn black and shrivel up.

As a software developer and musician, but especially as a human, this is my nightmare.

This should the worst nightmare of any human. It completely removes any ability to be a productive member of society with the loss of both hands. It ruins them and just completely removes any possibility of a good quality of life without a prosthesis.

It is totally awful, but I wouldn't say you can't be productive. Speech-to-text is good enough now that you could substitute it for typing. It won't be as fast, obviously, but that's not an insurmountable obstacle.

This is not true at all. This is just a pessimistic exaggeration.

I don't think it's overly pessimistic. How about you try to open a doorknob with your fingers taped together.

He didn't say it was easy. He said it's overly pessimistic.

I would tend to agree that "It completely removes any ability to be a productive member of society" is not only quite a stretch, but pretty insulting.

Amazing generosity, and an incredible story.

I've always been quite fascinated by prosthetics and cybernetics.

I would be willing to trade most of my biological body parts that have limited lifespans for self-healing synthetic replacements.

The unfortunate thing is currently prosthetics are much less nimble than real hands. I'd want to see a lot of improvements in that tech before I'd see them as a replacement.

In the article she mentions she's had them for a year and is still learning to use them and struggles to do some things.

Absolutely. I’d reckon you can do a lot of gross motor skills with existing prosthetic, but fine motor skills are a long ways off.

I haven’t been keeping up with self-healing materials either, but I am certain they are also in a nascent state.

It should be noted that we are still a very long way from creating a useful replacement for our olfactory system, our digestive system, our circulatory system and our reproductive system, among other things that make life worth living.

Anyone know what was the reason her hands died? Inadequate oxygen supply? Couldn't they have just oxygenated her blood in the hands?

It wasn't necessarily inadequate as much as it was inconstant. There was a dip due to the lung damage, but then there was reperfusion afterward as a result of medical treatment.

Sometimes, when tissues are deprived of oxygen, they undergo apoptosis when the oxygen is restored, not when they are deprived. This is why people who undergo heart attacks are sometimes rapidly chilled to core hypothermia. The cold discourages their tissues from committing suicide when their power comes back on.

Her extremities might have been saved by putting them in ice baths, but it is very unlikely her physicians would have been aware of the potential problem and quick enough to respond appropriately. Their primary concern was likely maintaining sufficient oxygen to her brain and vital organs.

Okay, time to add another entry to the list of terrifying trauma complications. Adding it to the subgroup that includes compartment syndrome.

https://en.wikipedia.org/wiki/Compartment_syndrome

As a transwoman I haven't been able to afford any surgery. I'm hopeful that eventually society realizes luxury & cosmetic are just added terms to discriminate against people suffering.

There is a bit of a difference between being transsexual and having your limbs amputated as the result of an armed robbery.

She never claimed that they were equivalent. The disparity in quality of health care for transgender people in this country is well-documented and stems from many of the same reasons as the situation described in this article.

The problem with that logic is where does it end? Should anyone who wants anything from anyone be able to claim it?

The same could be said of any medical treatment. I've known people that believe drug addicts deserve zero treatment because it's all their fault. Same with people that did something stupid and got severely injured.

'Where does it end' isn't much of an argument. Instead we should be asking how should we determine where the line is and I believe the answer is simple: If it can be determined that it would result in a significant QoL increase then it should be covered in most cases. A transgender person receiving hormone therapy or reassignment therapy is an example. A victim who lost their nose in an accident and wants to mend their face is another.

> If it can be determined that it would result in a significant QoL increase then it should be covered in most cases.

I don't argue that there shouldn't be a line. It's just a very fine one with lots of edge cases.

It should end at treating medical conditions. Gender dysphoria is a medical condition.

So, if some company creates a really really expensive medical treatment, are they all of a sudden on the hook to providing it to the whole nation?

Yes? In an ideal society the company would create the treatment and the government would foot the bill for the citizens, followed by costs lowering over time as new advancements are made.

There are already a bunch of extremely expensive treatments for diseases and afflictions that affect a small portion of the population. Some of which are fatal if not treated. Should they be expected to just die because the treatment is as you said 'really really expensive'?

The first country that does that, I'm going to move to and make a $1,000,000 treatment that doesn't work and wait for the first idiot to get the government to pay for it.

People need to appreciate how hard fraud is to circumvent in anything where government largesse is involved.

A large amount of countries already exist that do that. Cancer treatments can easily cost that amount depending on the cancer, never mind some of the more esoteric diseases. You argue that it's easy to 'fraud' the government in this case, ignoring the amount of regulation and steps that have to be taken in order for a treatment to actually be put into practice.

And you conveniently ignored my point on how what you suggested is essentially advocating for people to die if a treatment is too expensive.

You're not getting my point. I never said governments shouldn't pay for medical care. I'm saying there's a line where it needs to stop, and asking where it should be drawn. Sure, let's pay for cancer treatments. How much, exactly?

I posited a hypothetical scenario, which can get extremely real if we start looking at real situations of benefits fraud, and asked you how we should deal with that. Are you really saying that the government should just pay whatever I want to charge for my service that doesn't work? If it does work, can I charge the government whatever I want to provide it?

What you're not understanding here is that this, and every other example of asking the government to do things, is manipulable by humans and thus is an adversarial process. Because the government isn't God, it doesn't have truly unlimited resources.

Your question posits a scenario that is fairly rare, and assumes that it's common enough that it's an issue. You again ignored my direct rebuttal in the parent comment as well, which was that there is large amounts of regulation that goes into making sure that a treatment actually works and is effective.

The original argument was never about 'should the government pay for fringe treatment that is not confirmed to work' but rather 'should the government pay for people who have fringe diseases or issues'. Your hypothetical scenarios and arguments have been drifting from the latter and into the former.

That's one of the challenges countries with public healthcare have been facing recently, along with generally skyrocketing medication costs, when medication is covered by the system (Canada has haphazard coverage, from Québec which has total coverage to many provinces which have none). New treatments are opt-in, so once in a while someone with a rare disease will be denied coverage due to the expensive nature of their treatment, or its unavailability in the jurisdiction. Until 2017, there was only one clinic in Canada which did sex re-assignment surgery, in Montréal, so out-of-province patients who want the procedure have to go jump through a lot of hoops to get covered by their own province and have the whole trip covered by their provincial healthcare system.

I guess it's not really the point, but I'm intrigued to know how a lawyer can spend $260,000 on a gift for someone they don't know.

This also reminds me of reading a story about the olympics style event organised for disabled veterans. The article included a conversation between an Afghani amputee and a british counterpart:

" One day at the games, Azimi, whose lost hand was replaced by a 25-year-old hook, saw a British athlete with a prosthetic leg and asked him what it cost. The British athlete didn’t know.

“You have that leg and you don’t know how much that costs?” Azimi asked him. “Maybe $50,000 or $60,000,’’ the British athlete responded. “Our government pays for that.”

Asked about the disparity between the first- and third-world teams, U.S. team captain, retired Army Capt. Will Reynolds, said he was appalled.

“I’ve got eight (artificial) legs — more than I need,” said Reynolds, a leg amputee who was enjoying a moment’s rest with his son watching the U.S. team practice wheelchair volleyball, after winning medals in cycling, track and field. “Some of the legs I can’t even wear. And to know there are other servicemembers out there wearing stuff that’s not serviceable is unacceptable.”

https://www.stripes.com/news/no-coach-training-or-prosthetic...

The attorney, Mark Holden, is apparently Chief Legal Officer for Koch Industries, so I'd imagine he's quite well compensated. That doesn't diminish the generosity of the gift, mind you, but it's not as if he was a solo tax attorney or something.

I'd be surprised if he paid the rack rate either, but that does not diminish the generosity of his gift. This is how all people should act. Making the world better one stop at a time.

I think it goes beyond generosity. I think it's natural for people to care about what happens to each other, even between strangers. And it's just as natural to want to do something about it. The story you quote exemplifies this- it's only uman for the US team captain to be upset in the situation.

The reason why these natural tendencies to stand by each other are being eroded left and right in western societies, is probably too big a conversation for now, but my concern with that is what moved me to post this. So, you know, I apologise for a bit of subtle socialist propaganda :)

And for very poor people there is the soda bottle prosthetic:

https://www.youtube.com/watch?v=Yvev6shNvSg

https://makezine.com/2009/02/05/plastic-soda-bottle-prosthes...

Unpleasant as this is, it's worth pointing out that the superlawyer who bought the hands for her, Mark Holden, is almost certainly the same Mark Holden who sits on the board of directors for Americans For Prosperity and runs the public sector legal division for Koch Industries.

It's generous indeed for him to spend $200,000 on prosthetics for a stranger, but this story would be more heartwarming if he wasn't at the same time working to strip millions of people of their health insurance, which is what AFP is zealously trying to do.

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