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Comment by puchatek | Hacker News Reader

I would like to know whose stands to benefit from this the most. Is it about improving quality of life for patients? Or to save costs for health insurers who won't have to pay for treatment of the side effects of the more aggressive options?

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The standard treatment of cancer forty years ago meant very aggressive chemotherapy, radiation, and radical surgery. Many have reduced quality of life afterwards, think having to walk with help or having brain fog for the rest of your life when for all intents and purposes, you were okay a few months before. Not being able to do strenuous chores like lifting a box off the floor. That is the nature of treatment after early detection, usually when cancer is discovered during an infection or with symptoms, it's too late. In the cases discussed above, early detection of mild cancers usually don't mean the patient has a poor quality of life at that time and would actually experience a drop in their QoL from the treatment itself.

Cancer treatment to this day is not magic, it's not like taking a pill other than in extremely rare cases. You should spend time looking at cancer statistics, the oft mentioned statistics state death rates are a result of "cancer or cancer treatments" because the treatments take a toll on your body and leave you disabled or infirmed for the rest of your life. Until we have better treatments, which are coming, yes if a tumor will go away on its own you best believe it this is better for the quality of life for patients. In fact, the people who stand to lose the most from such a re-diagnosis would be drug manufacturers or even hospitals who can charge a lot for radical surgery and hospices who care for patients undergoing chemo.

For unfortunate personal reasons I have been reading studies on rectal cancer. Rectal cancer is terminal if untreated and curable if treated, but still 20-30% of patients don't even complete radiation and chemo treatment. Standard of care is localized radiation, poison in pill and IV form, and hope the cancer dies before the patient. At 40, this is rough. At 80, I might decide to call it game over. Only in the last decade, they have downplayed surgery with ~40% dodging it altogether when chemo-radiation provides total response. Surgery typically means at least a temporary colostomy and is high risk for older patients so the incentive was there to avoid it. Modern medicine is very pro-treatment and it takes a lot of 5 year studies to get them to dial things back.

I had colorectal surgery for a 5cm tumor at 41. I had two very young kids and wife, so opting out wasn't really a serious option. I'm pretty glad how things turned out, all things considered but knowing how tough those years of treatment and surgery were, there's no chance in hell I'd go through it at 80. I lost my father to lung cancer at 85, and his last year of fighting it really hit hard on his quality of life. He thought he was going to beat it though.

The former. Something like 75% of men in their 80s probably have some sort of mild prostate cancer. It’s just extremely prevalent but most of the time they are rather non-aggressive so you will die of something else years before you’d even think of worrying about the cancer killing you.

In a competitive market, insurers don't really care one way or another whether something should be covered or not: they just adjust premiums accordingly.

(Ideally, as a customer you'd have a choice between plans that do and do not cover a particular treatment.)

Insurers are incentivized to set standards for spending as much money as possible on all health care.

They have maximum profit rates, as a percentage of revenue. So the two ways to grow the revenue, and therefore profit, are to 1) capture a larger percentage of patients, and 2) make sure that all patients, including competitors, start using more expensive care options all together.

System-wide cost savings do not increase insurance company profits. This could be considered a good thing or a bad thing, depending on your point of view, I guess.

I had always considered it a bad thing, but given the thrust of your comment, perhaps it's good that there's no incentive for health care companies to push cost-savings measures as an industry.

And this is why having government funded basic healthcare isn't as inefficient as so many people claim.

For the government the only thing that matters is net tax revenue. Healthy people pay more taxes and unhealthy people cost money.

So the solution is obvious: invest in effective low cost preventative treatments and cures. That maximizes net tax revenue.

Meanwhile private insurers only care about your health to the extent that they get paid. Healthy people bring in less money than the chronically ill.

This isn’t true. Insurers are incentivized by lowering healthcare costs as well. All you have to do is look at all the preventative care that they pay for - often with smaller or no copay (although no copay was mandated by Obamacare).

You’re missing the part where insurers have to big for coverage. Companies will say “we want a plan that includes X” then get a bunch of proposals from insurers.

Cost is a big factor in which one you go with. So while insurers do make more money by paying higher and more claims, that’s offset by customers wanting a low price.

That might be true in some regions but there also many regions in the US with very little health insurance competition.[1][2]

[1] https://www.ama-assn.org/delivering-care/patient-support-adv...

[2] https://www.ama-assn.org/delivering-care/patient-support-adv...

I was talking about standard changes to what is deemed medically necessary, and the best medical course of action.

Individual companies wanting particular things covered is quite different. And the topic of this thread is why is the entire field shifting in their care in terms of what's thought to be medically best.

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