High cost of cancer care in the U.S. doesn’t reduce mortality rates

Part of the reason why it’s a thing in the US is that a huge number of people do have/have had a serious illness in the past: heart disease, diabetes, obesity, etc. Part of the reason they have those illnesses is because they neglected their health due to the cost of prevention.

Just FYI, annual checkups are recommended, but certainly something that a lot of young people skip. A quick google shows that only around 60% of Americans see a doctor yearly.

The checkup also isn’t a battery of tests unless you are at an age or condition for that. For a healthy 20 something that goes it’s basically the doctor checking your blood pressure and asking if anything has changed.

Not to defend anything about the American model (I personally hate it and think it's broken) but the annual checkup is a very cheap way of dealing with a possibly expensive condition.

The checkup is non-intrusive and for presumably healthy people consists of a physical, basic blood tests (glucose and some metabolic indicators + infection markers) and a blood pressure check. As an example, it's way cheaper to find out you have pre-diabetes this way, than to go to the doctor with symptoms when you have full on diabetes. This is mainly the reason why insurances pay for these in full, as they're part of 'preventive care'.

> How much more would it cost our health-care system, if everyone took advantage of

Annual checkups are definitely not the reason healthcare costs are sky-high in the US.

Wait a sec: mammograms, postate exams, colonoscopies? You don't have these regular screenings when you hit a certain age? AFAIK, the data is very good on the early detection power of these exams.

> I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.

The US is outstanding at taking money from sick people, just not any better at getting them well.

> It's not like we have "death panels" or awful long wait time here, but I know patients that have gone to the US to get treatment - on their own bill - for cancers that were deemed too advanced for treatment, here in Norway.)

This sounds like the right way to go, but I want you to understand this is exactly what people mean when they say “death panels”.

It's also a Japanese concept. Regular low-cost health screenings can catch big problems early.

You don't get annual bloodwork performed? Does your cat/dog?

Well, overdiagnosis/overtreatment is an issue

Both approaches have pros and cons, because while an early diagnostic of some diseases can make a huge difference, there are also false-positives and needless invasive procedures

(And I guess the people that are the most oblivious about their health are the ones that are more prone to have lifestyle related conditions - some people have never measured their blood pressure or blood glucose)

If you are male, your life will probably be wrecked at some point by a heart attack/stroke or prostate/bowel cancer. The risk of cardiovascular disease can be reduced in various ways. You also might have rarer but more significant risk factors for premature death from cardiovascular disease (eg Lp(a)). There is still an unacceptably high rate of death or severe disability from the primary cardiovascular event ie. you don't get a second chance, as the first sign of the disease can be fatal or disable you permanently. The screening tests one has in an annual checkup are not 'extensive' really, it is asking questions about lifestyle and family history, checking lipids, routine bloods, blood pressure and doing cancer screening after certain ages. The chance of an incidental finding resulting in harm is very low with this kind of thing.

Has a proactive, annual checkup model been properly compared to doing nothing on a population level? No. But on an individual level, it makes a lot of sense.

I would say it is not useful to compare mortality rates between countries. Norway has the highest GDP per capita anywhere for example, and is quite culuturally, geographically and genetically homogeneous. How would you make a useful comparison to the USA?

Since we spend twice as much as anyone else on healthcare but rank somewhere around 50th in lifespan, it would be weird if we were getting better outcomes in any area due to greater spending.

Healthcare is notoriously slow with adoption of new technology. IMO this is because healthcare is fee-for-service, which is basically incompatible with prevention. A movement to value-based care would vastly improve adoption of preventive and personalized healthcare.

how can people take action themselves here

Is this something private labs offer?

Very true. The headline is misleading though. The actual article is framed as the inverse: "does spending more on cancer care give the US better outcomes?" and the answer is no. We're on par with other wealthy countries that spend half as much per person on cancer care.

So yeah, the exorbitant costs of US healthcare do not correlate with better health outcomes. Just worse financial outcomes.

My Mum was diagnosed with stage 4 lung cancer - had 2.5 years of radiation, chemo and monthly doctor visits. Saw many specialists, etc. etc.

Never saw a single bill, and in fact was paid actual money for the inconvenience of having to drive 3.5 hours to a bigger facility that had equipment the local small-town hospital did not. Also got a free apartment to stay in for those out of town appointments, meal allowance, etc.

Mum had never paid a cent in insurance premiums in her life, etc.

>each chemo infusion cost $65k to her insurance company. Her surgery to remove her left breast cost $165k. 5k going to the surgeon fee while the rest was a facility fee. It's been less than a year now and the insurance has paid out almost a million dollars.

Do you know that your insurance paid that, or is it what you have been quoted?

US hospitals are notorious for overcharging by factors of ~10x when looking at their charge master, but the insurance companies will get a much better price after negotiating with the hospital, which is one of the reasons why the hospitals will blow-up charges in the first place, to get paid despite the insurance companies not paying everything.

It's a broken system because you need an insurance agent as a "lawyer" to get the real rates.

Instead what is necessary is price competition and transparency. You should be able to look up online the cost of chemotherapy for a certain type of cancer in the whole US, then you can filter by distance, reviews and price. The price on the sticker has to include everything. Whether you have insurance or not should not factor into the price at all.

The free market is maybe not a solution to the social problem here, but it could at least drive down costs.

Do you have any data to backup your claim? For example Cuban healthcare/treatment/outcome is excellent based on its own research. Roche(Swiss) nor Merck ( German, not related to US Merck) don't benefit much (if at all) from US subsidies.

You'd really need to show some numbers to back this up.

Is the cost of funding the "research complex" included in the expenditure on health care?

At least some of this cost is born by the Federal government, foundations etc, is this counted as general health care expenditure (I doubt it)

Some of the research is funded by companies - since they sell globally this funding cannot be counted as purely of US origin.

Other countries also have significant health research - e.g. UK, France, Germany - your point would also apply to them.

Overall your point is dubious, and vague - you'd need to present some solid numbers to back it up.

on the research side, this would tend to reduce prices, right? clinical trials usually aren't charging (per [1]).

this 2017 article[2] claims that the US pharma $ premium is more than R&D spending for 13 of 15 top pharma cos. (Note: this isn't even talking about profit, it's talking about the excess profit from higher US prices). Maybe you can make an argument that R&D is lockstep to margins, and would shrink if margins went down?

1. https://www.hhs.gov/ohrp/sachrp-committee/recommendations/no...

2. https://www.healthaffairs.org/do/10.1377/forefront.20170307....

This mirrors my personal experience. To make a treatment decision, against the advice of my local doctors, that was key to survival I relied on US research.

To compare costs: For an extremely rare cancer, total cost of treatment was 100k EUR in Germany, whereas US patients report case costs of >2m USD.

Part of these savings stem from the public healthcare system not providing adequate treatment, while strictly necessary for a reasonable chance of survival in this case. What happens in Germany then is the amazing doctors do stuff anyway (if you can convince them), bill whatever they can, and write off the remainder. Profits from privately insured patients make up for this shortfall here.

Public healthcare being adequate is somewhat of a myth, for Germany at least.

Having dealt with end of life Healthcare for a family member who dies of cancer, I'm curious how you can see it any other way. It is purely wealth extraction at end of life.

When you lose you job and insurance due to health, you can not qualify for state aid if you have any assets at all. you you must spend until you are broke before you get any help. Then there is the issue of nursing homes. If you end up in one, they have the ability to unwind any asset transfers in the previous 5 years, so if you thought you can transfer your house to your children before you die, you can not. The nursing home and the hospitals will suck every penny out of an estate and the only way to prevent it is to die quickly.

But this is adjusting for the baseline illness, remember. This isn't just age-standardised mortality rates. It's disease-standardised mortality. Hopefully they've adjusted for confounders...

While your premise may not be wrong, I'm not so sure that COVID statistics can tell us much between countries. There are a great deal of countries that are either wholly inadequate, or purposefully misleading when it comes to their true COVID numbers.

For example, India has an official COVID death count of around 500k. The WHO has made their own estimates and believe their death count to be closer to 5 million, ten times the official number.

> The relatively poor average quality of healthcare was made apparent in covid pandemic where US had among the highest mortality rates and deaths per capita in the developed world

This has nothing to do with healthcare quality.

Do you have the numbers to back these claims? Is the extravagant money spend on healthcare in US actually drives everything ahead? Do countries like UK, Germany, Switzerland and Japan lag behind due to the smaller amounts spent?

I don't believe that there is any research backing this.

Do you have any articles, papers etc from reputable sources to back this up? Or is this just personal speculation?

I work in the drug development industry, its a shame this has been downvoted, it's largely true - at least for new drug innovation. The fact that routine procedures are expensive in the US is unrelated.

The US is ~35% of the global pharmaceutical industry, which is the topline driver of new drug development.

When the US pays top dollar for new drugs, it does effectively subsidize European access to the new research.

>Do you have any data to backup your claim?

I would suggest https://www.rand.org/pubs/research_briefs/RB9412.html

or the Great American Drug Deal, by Peter Kolchinsky.

> they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement

Drug prices are far from the leading cause of the high cost of US healthcare.

The whole system is deeply dysfunctional with massive perverse incentives.

> One route to fixing things in the US, if we really wish to do so, is to create by law a "most favored" status for the US such that if a US drug company sells outside the country, they must sell the drug in the US for the same price as the lowest price they sell it to any other country. This would largely fix our expensive healthcare, but would also harm the world heavily in advancement.

Then you'd end up bankrupting most healthcare and pharmaceutical companies, that is if most of them don't leave the country. If the current scenario is a "tragedy of the commons" a la Guns or Butter, then the US's domestic medical policy is the biggest contributor. A "most favored nation" policy as such just allows the government to pick winners and losers by creating a de facto price control. It's not a solution and would do more harm than good.

The ultimate reason why it's expensive to sell a drug in the United States is because the FDA makes it illegal to import competing drugs. The solution is to let the market determine the "real" prices.