Hacker News Reader

Comment by kerkeslager | Hacker News Reader

> Didn't read the article

Then don't comment. It's not complicated.

> There's lots of articles here on hacker news about how the vast majority of medical expenses come at the end of life and how we do too much to keep people alive against their wishes.

Jesus Christ.

Let me get this straight: you're saying the solution to medical expenses is "let old people die, they don't want to live anyway"?

There are certainly cases where people are kept alive beyond what's compassionate, but that's a pretty separate cultural problem from the situation at hand, which is people who need basic care and can't get it because of capitalism being involved where it shouldn't be.

View on HN

> Jesus Christ. Let me get this straight: you're saying the solution to medical expenses is "let old people die, they don't want to live anyway"?

That’s quite an uncharitable take, and plainly not what they meant to express.

Well, I don't hear you offering an alternative interpretation that sounds plausible.

And critically, the person I was responding to, responded back to me, and didn't disagree with my interpretation, so...

Startup culture's brand of charitable interpretation glosses over a lot of anarcho-capitalistic sociopathy and I'm not interested in participating in that. Perhaps if you were more interested in actual charitable action such as making sure seniors' medical expenses are paid rather than charitable interpretation, this place would be a bit less toxic.

Your interpretation is too off the mark require an explicit response.

If you don't want to participate in a discussion you don't have to respond.

If you think my interprepation is wrong, feel free to explain, otherwise we can only conclude that it wasn't wrong, and you just don't want to have to defend your indefensible idea.

My take: many people spend $$$ at the end of their life to receive aggressive treatment that ultimately doesn't do much. Palliative care is underutilized -- it's lower cost and results in a higher quality of life [1].

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/

Other interesting articles: https://www.nursing.upenn.edu/details/news.php?id=848

https://med.stanford.edu/news/all-news/2014/05/most-physicia...

I mean yes, the original "How Doctors Die" study came out over 10 years ago (I read it in college, but now I can't find it). So as I've said a few times now, I'm well aware that some people spend too much on life-extending treatments that don't work.

But that is about what is best for the patient, not what costs less. It is is unconscionable to consider that as a systemic solution to medical costs. Profit motivated sociopaths cannot be given another excuse to deny people needed care. The profit incentives here are to literally murder people. And that can't be fixed, because keeping people alive costs money. The only solution I can see is that money is completely eliminated from the conversation.

The fact is, some people pursue life-extending treatments in cases where it is effective and does result in better outcomes. But from a cost-cutting perspective that's no different. The incentives don't change because the life-extending treatment actually works. If you let money-hungry people near this, they'll still cut the cost.

As I have said elsewhere: the decision to pursue life-extending treatment should be between the patient, their loved ones, and their doctor. Not "society" or government, as some sort of cost-cutting measure. The patient. Their loved ones. Their doctor. No one else.

Let me reiterate: end of life discussions are about patient outcomes. Not about money.

If you want to know why people don't like corporate types, this is it. If you literally can't tear yourself away from your obsession with money to have a human discussion about how to let people die with dignity, you're one of the bad guys.

Come on, we can't be children. I'm saying we need a conversation as a society about how we are going to handle end of life. We can't lurch form unthinking outrage to unthinking outrage.

True, but I'm not interested in hearing the opinion of companies in that conversation. When I and my loved ones are reaching end of life, what decisions we make should be a conversation between me, my loved ones, and my doctor. Whether it's humane to pursue life-extension should be a part of that conversation, sure, but I trust my doctor to present that viewpoint: people who profit from that viewpoint and don't know anything else about the situation (such as Medicare Advantage providers) are welcome to fuck right off.

The reason our society keeps lurching from unthinking outrage to unthinking outrage is that people like you who can't be arsed to read an article and respond on topic keep proposing outrageous changes to our society. If you don't like unthinking outrage, maybe be more thoughtful and stop saying outrageous things.

I agree that medical care should be run by the state. I would prefer that to our current system. I don't think its worth us talking any more since we don't seem to be learning from each other.

> I agree that medical care should be run by the state.

...which is largely irrelevant, because the state should also not be involved in the conversation about whether pursuing life-extending care is humane.

> I don't think its worth us talking any more since we don't seem to be learning from each other.

Nobody involved in internet disagreements learns from each other typically. I approach internet disagreements with the idea that non-participants reading the disagreement can learn from it. That is, outrageous viewpoints like yours should not go unchallenged because that normalizes them.

If you want to stop representing your viewpoint to readers, you're welcome to, but you can drop the smug superiority about it. If you want conversations to learn and educate, you might start by reading the articles you're responding to.

Before we have this conversation, let's first agree on one thing. Let's all agree on the fact that health care is not actually exorbitantly expensive. That "health care costs" are not what's out of control in the US, what are out of control are health care PRICES. And that those prices lost virtually all relationship to the cost of providing services DECADES ago.

Americans already use fewer health services than most other industrialized countries, but we still spend way more than anybody else. Will using fewer health services at end of life make a serious dent in health expenditures? Maybe temporarily, but rest assured the hospitals, big pharma, insurance companies and others will raise prices until all those savings are eaten away, and more.

Make no mistake, I am totally for end of life planning, but I believe it is a completely separate question entirely.

That's a useful distinction. I've never been able to understand where the prices come from, and my sister is an ER doctor. I'm surprised that these basic facts are so hard to come by. I read articles that say, well, healthcare prices aren't high because of X, where X is just about anything I can think of.

This article is a good place to start: https://time.com/198/bitter-pill-why-medical-bills-are-killi...

When it came out 10 years ago, it answered questions that I'd had for the previous 15 years.

Don't agree. Americans recieve an absurd amount of end of life care. In many, many case outcomes would be improved by putting people in hospice instead of invasive surgery that increase their lifespan by maybe a year. Our medical system discourages preventative care which is much more cost effective, but in the end we need to say no to many more end of life procedures.

Improving preventative care will no doubt improve outcomes. Improving end of life planning will no doubt improve quality of life for those nearing the end. However, believing that either of these things will lower health care prices is purely magical thinking.

Reply on news.ycombinator.com