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Comment by spiderfarmer | Hacker News Reader

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My experience with advanced cancer is that it is not. I routinely see people from the UK and Canada raising funds for legitimate treatments my insurance will cover because their governments won’t. To be fair, those treatments are paid for by the government in Nordic countries and France, so it isn’t universal that governments fail their sickest when treatments get expensive.

There is ultimately a monetary value of extended life.

In single payer systems, that’s determined by a body whose responsibility is to provide the most effective healthcare to all its citizens given a limited budget.

In the US, the monetary value of extending your life is proportional to the amount of money you spend on your health insurance (and appropriate actuarial tables).

Both systems have flaws.

Both systems have flaws? True, but it’s a false equivalence. There’s a reason why there’s only one country in the world where insurance company CEO’s have to hire security to walk around in public.

Not really. At the end of the day, in both systems, the person paying for the healthcare decides what healthcare options are available to the patient. In the US, the patient themselves (or their insurer) is paying.

In other countries, it’s often the health service itself that is paying.

Don’t get me wrong, I believe the single payer system is infinitely better, but for a small number of people, it will lead to worse healthcare outcomes.

It's not "both" systems, it's at least four. Canada is private doctors, public insurance. In the UK, the public system includes the doctors as well. France is not single-payer but has a system somewhat similar to the ACA, with private but nonprofit insurance, an effective mandate, a national price list for health services, and a prohibition of claim denials for anything on the list.

A great book comparing eight national systems in The Healing of America by T.R. Reid. It references stats showing the French-style systems get the highest quality results, with reasonable cost. Japan and Germany have similar systems.

Exceptions don’t make the rule.

It's fairly common for governments to provide a basic level of care for free or heavily subsidized, but not cover more expensive treatments. It's certainly not exclusive to the US.

At least in Europe and the Nordic systems I have experience with, that typically applies to the very expensive novel treatments. There are gene therapies which can cost $2-3 million per patient and those aren't covered by any public healthcare system, AFAIK.

But it's not like there is some kind of upper limit on coverage. If you have cancer, you will get treatment regardless of how much your care has already cost.

It depends. At some point often it switches to palliative care, rather than treatment. That point is not “there’s literally nothing else we can try”, it’s “the remaining options are inadequately proven, too expensive, high risk, or not effective enough (won’t extend life by long enough or improve quality of life enough)”.

Every single one of those criteria is subjective, which is why you see these fundraising campaigns for kids with cancer to go and a get a multimillion dollar treatment in the US, because as a parent, accepting that there’s more you COULD do if you just don’t give up is hard.

In most of the places I've been in SE Asia and South America, there are separate government hospitals that are the only affordable option for the poor. If you have cancer, they're not going to do much for you.

In Canada, while the hospital care is covered, the additional supplies and treatment are often paid for by the patient.

https://www.cbc.ca/news/health/cancer-costs-report-1.7404064

"During more than two years of treatment, which included surgery to remove part of the colon as well as 12 rounds of chemotherapy, Percoco paid more than $4,000 out of pocket for prescription drugs, including medications to cope with the side-effects and complications. On top of that, there were costs for colostomy bags, which she had to restock every four days, bandages, physiotherapy sessions and osteopathic consultations, as well as travel and parking."

That's a normal fact of life.

The underlying cause is that there is an almost infinite demand for medical costs - well beyond the economic capacity of any country.

Unfortunately facts are difficult, and politicians can't fix the facts regardless of how much they tax everybody.

In The Netherlands you can get cancer treatment even if you're homeless. And I don't mind paying extra insurance costs if it means I'm not running into inhumane and desperate go fund me campaigns everywhere I go.

I wouldn't mind paying into it if there was some kind of balance.

If we broke healthcare spending down by person a small percentage of the population is probably consuming a huge percentage of healthcare. The average person just goes to the doctor once or twice a year and has a few large surgeries during their lifetime.

I would be ok with that if there was some kind of guarantee for those of us who didn't abuse the system and did our best to manage our own health. If I haven't gone to the doctor for 2 years and I need to wait 3 months to get an appointment that doesn't feel right.

At the risk of sounding sarcastic: the small percentage of the population consuming a huge percentage of healthcare is the older segment, and those with several comorbidities.

Live healthy, live long, die fast.

Live unhealthy, live short, die slow.

Throw in accidents and unexpected life events and boom, you can transistion from health to unhealthy quickly.

Same in New Zealand.

But our public health system has to use a variety of techniques to limit the total healthcare expenses - such as waiting lists. Drug budgets are restricted which means that many expensive anti-cancer drugs are not available to the public.

Would you be happy to pay 100% of your income in taxes? That is the logical outcome of ever-increasing healthcare and nursing costs. Some wealth tax suggestions here in NZ approach 100% taxation over a lifetime (2% of wealth per year certainly crimps a 4% drawdown on retirement savings).

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