The root cause of the problem is that parents and children need to raise funds for cancer treatment in the first place.
Local man embezzles $20,000 meant to keep 200 orphans from being crushed in the orphan-crushing machine.Also, the scale seems much larger than $20k.
I mean almost the entirety of the US healthcare system is a industrialized scam engineered by middlemen
The incentives are there. Our economy runs on incentives. Create a vulnerable group and the sharks smell blood in the water.
For example, families forced to publicly beg for money to provide their sick children with treatment. What societal structures enable this situation to occur? Who is profiting off of this structure?
Involuntary, progressive crowdfunding through government threat of violence (taxes) seems to work better than the other methods and most consider it humane. Americans have shown little interest historically in doing the humane thing, unfortunately.
To put another way, if I were facing some terminal illness I would want to have full control of picking the service even if it costs money. Sure, I would want "the best" specific to me and have someone else pick up the tab, but that's a fantasy, because no system or third party has as much skin in the game as me. That's why things like elective surgery are so cheap and competitive.
The problem is why do these treatments cost so much? What prevents competition and innovation. And my argument it's largely due to regulation and third party payer system
Collusion and cartels never work on the long run. It's an unstable equilibrium, the incentive to reduce prices to capture more market is too great.
> What is it that still makes you believe
Competition. It's the only force keeping humans honest. That's why we must treat any barriers of entry in a market with extreme care. The only "failed" or "captured" market is a strongly regulated one.
For example, while the Phoebus cartel only really lasted from 1925 through to 1939, 1000hr incandescent light bulbs remain the standard offering till present day. Profitable market manipulations are sticky.
The whole notion that markets are efficient is just a mathematical construct that has become very dogmatic for people. But if you look into the details, markets are efficient under the assumptions of perfect information and infinite time. Neither of those conditions are present in the real world: we neither have perfect information nor infinite time.
> 1000hr incandescent light bulbs remain the standard offering till present day
This proves in fact that all the cartel did was establish a standard, an optimal average between various tradeoffs when building an incandescent lightbulb: brightness, cost, efficiency and life span. Yes, the cartel behaved anti-competitively. The effect on the market? Nil.
> perfect information and infinite time
There is absolutely no requirement for this for markets to work. Markets work just fine with partial information and just-in time. When new information and new market participants appear, markets will self-correct. The only way to prevent markets from working is through government intervention.
In facts, free markets are the only system we have that works with incomplete info and reacts in real-time. Central planning will happily decide on incomplete info then never adapt. We saw that during communism when the Party decided allocate X resources for production of Y and it always resulted in a glut or shortages. Central planning doesn't work.
Pure misanthropic fantasy pretending to be sophisticated economics.
It's the obvious reality around me here in Eastern Europe. We were starving under communism before 1990 but are now enjoying the amazing wealth capitalism brought.
Define "long run" - they have been already proven to have worked for years and in some cases even decades.
This is basically a religious belief at this point. It's how a perfectly ideal free market might work, but we don't have any of these, especially in healthcare.
Probably 99% of what I consume comes from private companies and the services generally get better over time, with some exceptions. Compare that to an experience with the TSA.
The general public doesn’t have enough information to make informed decisions when it comes to healthcare. This alone completely removes the usual market forces from providing any benefit when it comes to healthcare.
Cancer treatments don’t inherently cost that much money, the systems to ensure people are actually getting useful treatments are expensive. You can’t trust companies selling cures. You can’t trust every doctor when they have financial incentives to offer treatments. Insurance companies are in an adversarial relationship with providing treatments, which doesn’t result in efficient supervision here. Lawsuits offer some protection, but at extreme cost to everyone involved. Etc etc.
The net result of all these poor incentives is single payer systems end up being way more efficient, resulting in people living longer and spending less on healthcare.
Why is it always "the general public" and not "I". Do you have enough information about decisions? Can I take away some of your rights? No, of course not. Everyone else is dumb except me.
I'm sorry but I refuse to believe some unelected, anonymous bureaucrat has my best interests in mind or can even know me anything about me such that I want to allow them to make health decisions for me.
Me personally, No.
I don’t have enough information to make informed decisions here and you don’t either. Off the top of your head, how well educated is your dentist? You after all made an informed decision picking them. So how well did their background compare to others in your area. What where your concerns about their dental programs weaknesses and how was that offset by… Except no let me guess that never entered your mind did it.
My dentist cleans my teeth. If it's painful every time I come or I keep getting cavities I consider changing dentists. If they suggest I replace my teeth with veneers or something extreme, I consider someone else. And I'll do a few google searches.
It seems pretty normal. You don't do this?
So you don’t need to continue, you just proved my point.
I trust government staff far more than the decision of unregulated, greedy corporations who literally exist to extract the most money from whatever process they're trying to sell you.
I have trouble believing empowering people who have no risk of losing their job and no one knows they exist is the best model for making decisions for other people.
EDIT: Also the whole VA system.
You mean like the (non-medical doctors) third-parties contracted by my private insurance provider who routinely deny important care[0] and even reject pre-approvals for antibiotics for MRSA infections even after multiple interactions with several medical doctors confirming both the diagnosis (with accompanying pathology) and the appropriate course of treatment.
Yeah, you keep that rolled up newspaper handy so you can "Gub'mint bad! Bad Gub'mint!"
I hope you never have to deal with a life-threatening situation where your insurer flatly refuses to cover treatment until after you're dead or have body parts amputated.
Every single product and service I am using in my life is made by a corporation. The clothes I wear, the food I eat, the car I drive, the PC I am making my living on.
Government?! Decaying infrastructure, lines at the DMV, crappy schools and killer hospitals.
You may trust the government if you want, but I will never. However, you are the only one pushing your choice onto me and reducing my options. I am fine with you using private or governmental services but you won't allow me this freedom of choice.
I'm sorry to tell you that this is, but unelected bureaucrats are constantly making health decisions on your behalf. You may not want government bureaucrats, but bureaucrats already work in your employer's HR department, deciding on which insurer to partner with, and with what benefits. They are at your insurance company, doctors office, and hospital administration, negotiating and deciding which procedures and drugs are available to you without ever asking for your opinion. Bureaucrats you didn't vote for infest drug company's research and finance offices, determining the availability and cost of your present and future care. None of these even pretend to act in your interests.
I'd rather have some government bureaucrat preside over all the other predatory bureaucrats. I sure as hell wouldn't be make well-informed decisions in the ER, or after getting a cancer diagnosis. Further, it is impossible to compare provider quality and final costs for elective, cosmetic procedures when I'm under no time pressure or stress.
I have no problem with bureaucrats. I want a choice. If I come in one day to find the shelves empty, I go somewhere else. If they make it difficult for me to check out, or are too expensive, I change. I just want choice.
You can choose to listen to the same unelected anonymous bureaucrats. Just log on to FDA or whatever, and follow their advice (e.g. follow the food pyramid). Only one of us wants to remove choice from the other, and that's the difference.
This is simply not true. Healthcare in the US is comparatively much more expensive than countries offering subsidized healthcare with comparable or better outcomes(1).
> it's largely due to regulation and third party payer system
Capitalism can't work in a market that's completely consolidated, and where people can't offer to not buy your service. Healthcare in publicly subsidized countries is much less expensive because it's regulated. Compare the price of simple drugs like insulin or asthma medicine if you need an easy example. Pharma companies still happily sell there, which is to say that the difference is pure profit on the back of sick people who don't have a choice.
My biggest grief against this individual payment system is moral though. I don't see the virtue in a system where kids have to put on a show to receive care. Or anyone for that matter, you'll give to a kid because they're cute and generate empathy, does it make someone ugly with no family less deserving of getting cured from cancer?
1: https://www.healthsystemtracker.org/chart-collection/health-...
So it is a highly asymmetric bargaining situation where all the incentives are poorly aligned. Of course it is exploitative.
And now your death will have a meaningful change to the career bureaucrat or politician that made the decision that led to your death.
Because power of an individual vote is much more powerful than the power to take your business elsewhere. That's if you can find out the responsible party that makes these decisions and they're not appointed but elected, otherwise you'd have to mount an influence campaign on the politicians with 90% re-election rate to change said bureaucratic leader.
Makes a lot of sense.
But seems some prefer to believe a theoretical argument with no evidence to back it up.
“The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.”
Agreed. Also, all empirical evidence shows that free-markets work better, producing far better outcomes at lower cost than either. Just look around at any less-regulated and thus free-er markets. Or just "reject the evidence" - your choice.
> die
I am middle-aged so I used plenty of health services in my life. I always had choices when in came to price and level of care and treatment. None of them were for the "dying" case. But I do have an insurance specifically for that case. I am a rational being so I plan in advance. No need for a government bureaucrat to decide my health care for me just in case some day I may be incapacitated.
Same with education. I am more than happy to pay taxes for an education system, even if I do not personally have children.
Public health systems vary with country. Private advocates say public sucks, until it is their turn to be scammed.
Public education is largely a scam to put 'original sin' of debt of children to society so when they grow up there is some plausible explanation that "we're a society" and they must feed into the pyramid scheme.
I'm not sure what nation you're from, but here, in the US, we pay a fairly significant part of our wages towards something called "Social Security."
If we pay a lot, during our working time, we can draw more, after retirement (and it is nowhere near a living wage -it was never meant to be).
In my country, we pay for education with property taxes.
Kids are not only getting classroom time. They inherit a whole baseline that previous taxpayers built: safer streets, clean water, courts that mostly function, vaccines, roads, libraries, stable money, and the accumulated tech and culture that makes modern jobs even possible. That bundle is huge, and it starts paying out long before anyone is old enough to “owe” anything.
Also, adults are not literally trapped. People can move, downshift, opt out of a lot, or choose different communities. Most don’t, even when they complain loudly, and to me that’s a pretty strong signal the deal is at least somewhat reasonable. Not perfect. Not fair for everyone. But not a cartoon pyramid scheme either.
If there’s a real fight worth having, it’s making the burdens and benefits less lopsided across generations, not pretending the whole social investment in kids is fake.
We’re not billiard balls. We have agency. Nothing causes a human being to choose to commit immoral acts vs. immoral acts. A human being may be put in a situation that may entice that person’s corrupt desires (we used to call this temptation), and responsibility while mitigating culpability is possible when someone’s rational faculties are overwhelmed, but the choice remains.
Blaming systems for theft is scapegoating and an evasion of responsibility. (To make this clearer by distinction: a starving man taking bread from an overstocked warehouse during a famine is not choosing to commit an immoral act; he isn’t stealing in the first place, as some share of that bread is his).
This is neither here nor there. As I said, temptations can arise that make things more attractive to certain people given their conditioning and the habituation of their desires. But ultimately, at the end of the day, we can refuse to indulge even strong desires. To the degree that we are in possession of our wits, we are culpable.
> If what you said was true then rule of law would have been the standard throughout history
I have no idea how this is supposed to follow, or even what this means.
Money goes in, and good feelings come out. It certainly serves a purpose, but not the intended one.
To put it in HN terms, this is what people here like to use to shit on Mozilla for how much they pay their executives while having zero insight into how much Firefox's for-profit competitors pay their executives.
Is the bottom line roughly:
Money received: 1000
Money used for good: 800
Labor: 200
Is that it?
Because I can assure you, that will not turn out well.
The same people that audit your taxes, roughly with the same consequences for lying. Except the IRS is far more likely to send unannounced auditors to NGOs than they are to send them to for-profit companies or individuals. It's more of a hassle to get/retain tax-free status than it is to simply pay your taxes like everyone else (as it should be).
> Is that it?
Let me guess: you haven't clicked on "view filing", which leads to a roughly 20-pages-long document.
It's dubious to say Google "competes" with Mozilla, because they pay Mozilla to develop Firefox to avoid antitrust issues, but it's easy enough to find CEO compensation for public companies.
https://www.sec.gov/answers/execcomp.htm
Of course people have published the numbers for well known companies:
https://www.jagranjosh.com/general-knowledge/highest-paid-ce...
Also, "Other companies pay their CEOs ridiculous amounts, so we're going to," is a poor justification, and just shows Mozilla execs are there to enrich themselves, and don't really care about the browser or community. But I guess they can't spend all of the money on Pocket and AI.
* by real, I mean large societies that aren't propped up by some bizarre economic quirk...eg maybe the sultan of brunei can personally pay for everyone bruneian citizen to get the best cancer treatment. But that's not a scalable solution
Parents had enough problems to think about.
In a similar way we can say that every shop in Amazon can create own digital shop themselves, but marketing, sales channels and distribution is not easy to acquire.
It's all very well and dandy that you can say "actually, there is a larger structural problem underlying it all" when meeting something bad, but it doesn't make that particular bad disappear.
You're absolutely right.
Also we don't need "pre-auth" and other Bullshit before we start standard treatments.
The real death panels are sitting in your Insurance Companies Offices as seen by the news coverage around United Healthcare et al lately
For comparison, the New York City public transport system (MTA) runs a deficit of about $3 billion. Six billion for universal healthcare in a country of 83.5 million people seems like a total bargain.
The German Healthcare System also has some historically developed peculiarities that don't make much sense in today's age, but they are difficult to address without pissing people off (The duality of Private and Public Health Insurance, allowing the first one to get rich and very healthy people out of the risk pool, and then loopholes to switch back into the public system when they grow older and don't want to pay the then high prices in private insurance)
The Hospital Reform is already working to reduce costs by reducing the number of small hospitals, and concentrate them into bigger ones. (As a side effect, quality of care will increase too, since outcomes are correlated with experience)
Also more care will be shifted to outpatient setting.
Otherwise we are fighting with the demographic change. But these problems are also hurting all other developed nations including the US, where funding problems in Medicaid are also expected in the next decades
tl:dr We have problems due to the demographic change, but these are in line with other developed nations. There are some efforts to address them, but politicians are hesitant to do real reforms, because old people have the most voting power
Yes.
To help you think a bit more clearly: the health insurance system is not a for-profit system, even though some people mistakenly hold on to the idea that it should be. It is a risk spreading mechanism.
I live under a system where even very expensive treatments are covered by the state using taxpayer money, and I'm not starving. Sometimes you need to optimize for human dignity.
Governments-paid treatments are god-sent but many times the funds are limited so they only cover older, cheaper treatments. Approval and funds for newer ones come so late, sometimes too late.
Germany has one of the most developed economies on the planet so naturally has more spend on healthcare. But that can change and when the money is tight, tough choices have to be made. I'd make those choices for myself rather than trust the State to do it for me.
Slovakia?
We can't really know, since only free markets can determine the price of a good or service (it's driven by supply and demand) and health care market is tightly regulated.
> Why is American insulin
Because of the regulatory barriers not allowing other providers to enter and sell insulin on the US market.
Is it so hard to believe in today's day and age that somebody tries to learn and understand how the world around works using observation, published facts and deduction from as close to first principles as possible?
I have three second-hand cancer experiences from family here in Australia (Dad, Mum and my half-sister - under 35/yo). All three were detected early thanks to regular checkups and screening (covered under Medicare), treated in major hospitals (Dad was in a rural hospital, Mum and half-sister in Metro major city hospitals) and are all alive and certainly not in debt. The biggest cost was parking at the hospital, drinks from the vending machine and the PBS medication (all PBS medicine costs $31.60 for adults, and $7.70 for concessions).
Any PBS medication has the full-cost price printed on the label for reference, more often than not the printed prices go from $300 - $2,000, but I remember that these aren't the full price anyway since our government collectively bargains for cheaper prices on OS medication).
I can't imagine having to pay for treatment AND the insane full price of medications, it must be so much more stressful for families going through cancer treatment.
Americans, don't let the media and your government tell you otherwise. Universal healthcare is cheaper [0] and more effective than whatever archaic system you have now.
I am so god damn proud of our system in Australia, it's not perfect, but damn it's so efficient for critical care, thank heavens for Medicare and the PBS.
Oh and for those that say "well doctors aren't paid very well"... they are. My brother-in-law is a surgeon and he's doing pretty well for himself, bought a new Audi last month for his wife, heading to Europe for a month-long holiday with his family and just moved into a new house.
[0] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?most_...
Boy are you in for a ride. France will be first and Germany is on a good track for it within the next two decades.
So then you would expect life expectancy in the US to be higher than in Germany, France, UK?
It is not.
Pretty soon, actually. EU countries are falling further and further behind economically. Health care costs are increasing, taking up an ever increasing slice of the government budget. Labor force participation rate is decreasing due to generous welfare and high taxes. Natality is plummeting. Attempts to increase retirement age are met with riots.
We're a technological backwater. AI research is done in USA and China - the benefits will mainly go there too. We can't even cool our cities: we're losing more people every year to heatwaves than the USA to gun violence. We're closing down nuclear power plants after years of shamelessly funding the Russian war machine for cheap energy.
Years of redirecting defense spending into social programs are coming back to bite us. Russia is hungry and aggressive, while the US is not protecting us anymore. What do you think will be the life expectancy under drone and rocket attacks?
American life expectancy compares extremely unfavourably with the UK. The English seaside town of Blackpool has been synonymous with deep-rooted social decline for much of the past decade. It has England’s lowest life expectancy, highest rates of relationship breakdown and some of the highest rates of antidepressant prescribing. But as of 2019, that health-adjusted life expectancy of 65 (the number of years someone can be expected to live without a disability) was the same as the average for the entire US.
https://www.ft.com/content/653bbb26-8a22-4db3-b43d-c34a0b774...
Also what you conveniently forget to mention, all European countries still spend less on Healthcare than the US, as a percentage of their GDP. In absolute numbers this comparison would look even worse
So this isn't Defense Spending redirected to Healthcare
As we all know, American insurance companies never deny coverage, nor do you ever have to wait in an American hospital. /s
Even with waiting lists, people get healthcare. They get better health outcomes per $ spent. America can provide excellent cutting edge healthcare, which is especially great if you can afford it. At some point, you have to decide whether having most of the bell curve taken care of, is more / less important in terms of rhetoric and priority.
Yes, there is quite a bit to improve in the German system. No doubt there. But if I compare it to the abysmal situation in the richest country on this planet, I am left standing awestruck asking myself why. I really, genuinely cannot wrap my head around.
[1]https://d3nkl3psvxxpe9.cloudfront.net/documents/econTabRepor... via https://truthout.org/articles/6-in-10-americans-back-medicar...
Your vote has consequences, and republicans have been voting for people who objectively and loudly tell their voters that they have no intention of doing those things.
It's time for people who vote republican to own that they suck at picking who to vote for.
Tons of them also say they want recreational weed, but it's only republicans working to prevent that in most states, often literally ignoring citizen's initiatives and court cases to accomplish that.
Now maybe when I stop working that may be a different comparison. And its not like there is a choice, voting for a D doesn't magically get German healthcare.
You need to show that it has a chance of working (literature etc...) and it will be reviewed by a doctor from the "Medical Service" which is independent from the Health Insurers.
If they decide it should be paid, it will be paid (which is most of the time the case).
Otherwise you can go through the social courts. (No court costs for the insured person. You can get a lawyer reimbursed if you're poor)
Especially within the University Hospitals who administer these treatments they already have the experience how to write these applications and know their counterparts
If the US were to shift to that model today, a country already heavily in debt would have to either take on more debt PR increase revenues in a manner that they wouldn't have been willing to in order to fund our already growing debts.
The debate over whether public or private healthcare is better is all well and good, but first we should be debating how the US would pay for it in the first place.
Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
The healthcare industry in the US is massive and already full of corruption and inefficiency. Even if we are to assume giving politicians and bureaucracy more control over the system will reduce both issues, we can't predict how successful that will be.
Similar claims were made regarding the hopes for ACA reducing costs and here we are.
No, this is not Medicare Advantage, in which Medicare just directly pays private health insurance premiums for enrollees.
Other public systems vary between 1-4%
Plus the phrase "cure" does a lot of heavy lifting. People seem to see a win here as being "here's a tablet, all cancer is gone."
So yes, we have spent an insane amount of money that can be ascribed to "cancer". (We've Also spent a lot on heart disease, diabetes and so on.)
But yes, we have got an extraordinary return on money spent. Treatments and survivability of common cancers (breast, prostate etc) have gone through the roof. Better screening, better education and much better Treatments lead to much (much) better outcomes.
Not all cancers are the same though. Some are harder to treat. Some rare ones are hard to investigate (simply because the pool is too small) but even rare cancers get spill-over benefits from common ones.
In terms of "cure" - that's not a word medicals use a lot anyway. Generally speaking we "manage" medical conditions, not cure them. "Remission" is a preferred word to an absence of the disease, not "cure".
In truth, we all die of something. Cancer is usually (not always) correlated with age, and living longer gives more opportunities to get cancer in the first place. So it's not like we can eradicate it like polio.
Just one example, prostate cancer today has a 90+% 10 year survival rate, in 1970 that was 25%
That’s not utterly transformative but I wouldn’t call it negligible either.