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Edit: It has been (correctly) pointed out downthread that I have helped hijacking a very personal post for political point scoring - which I think is fair. However we lack a decent history function in HN so I leave it here otherwise the thread will read strangely.

Thank you - as a Brit I read this too. I cycled through emotions - fear and sympathy for the diagnosis, hope as some of our best professionals consider new options, and then.

WTF describes it best.

Americas attitude toward health care is odd from our perspective - not mismatched socks odd but like a Collegue suddenly announcing that aliens are real, they look very talk and thin and one is living in his attic

That kind of odd

(I am glad that the OP has recovered, heartened by every success medicine has against this disease. Just ... It's odd how nearly this was a different story)

May you have a long and happy life.

So long as you're not poor, health care in the US is good. If you live in a major city and are diligent about who takes care of you, it is great.

I've had three MRIs. All were scheduled the same day they were prescribed. I've routinely scheduled appointments with renown specialists and waited less than 2 days to get in. My double hernia surgery was performed by the same guy who treats the Chicago Bears. My old chiropractor/kinesiologist used to be Andre Agassi's.

To clarify: "not poor" != "rich". At the time of these expenses, I was making a good salary, but nothing unattainable by HN definitions.

However, if you're on Medicaid... you. are. fucked.

"So long as you're not poor..."

I had a kidney stone a few weeks ago. All told, the bills for dealing with that hit $34,000.

For a kidney stone.

That's not about being poor or not, that's highway robbery.

Have you considered traveling abroad to get your surgery? For that kind of money, it seems it would have been cheaper to get the surgery in another country even after factoring in the cost of the trip.

I had a near miss with MS 8 years ago. Several MRIs, spinal taps, blood work, etc. Before insurance: about $25k. After insurance: $3k.

Double hernia surgery was a couple grand out of pocket.

Not all insurance is the same.$34k is robbery.

Let's put it this way:

34 k would pay for the original poster's trip to my country (Uruguay), the best treatment available, and he'd have money left over - heck, 34 k would probably pay the doctor's wages on that hospital for a year.

There are very dodgy and shady costs with US healthcare.

I have the very best healthcare available in my country (Hospital Británico). It costs U$ 150 per month. A kidney stone would probably run me in the hundreds of dollars. 3k would probably bankrupt me.

http://www.hospitalbritanico.org.uy

Some differences are that doctors in the U.S. are paid an order of magnitude more, and I've heard hospitals have legions of well-paid administrators doing paperwork for insurance companies, which will have legions of people doing paperwork on their side, and government doing its bit, and lawyers doing their thing. All that money is obviously not going directly into healthcare, it's basically bureaucracy friction. I suspect "real" healthcare costs, even factoring expensive U.S. doctors, would be shockingly cheap.

I don't disagree.

Tell me something: Suppose you go in to get your left kidney removed, but the doc removes the right one by accident. What are your options? Law suit? What would you expect to get in settlement?

I'd expect in most places you'd get damages, and most likely the costs for the ensuing transplant (after all, you were needing to remove the left kidney for a reason, so now you have no other option).

Your doctors only earn 34k a year?

That's per hospital, and for a non-surgeon, a doctor on average works on 3 or 4 hospitals, so he would make about 140k per year (among the highest paid in my country).

Surgeons and anesthetists are on a class of their own, they make upwards of 60k per hospital.

Have you been able to negotiate a reduction in your bills?

woo! fellow kidney stone sufferer here. I had a 9mm stone i had to have busted up ~18 months ago (and a few 5mm ones i didnt). Ended up owing a few grand on it even with insurance. still paying it down (owe only like $400 on it now, thank God).

yes. health reform (and lots of others) is/are needed.

Really? Medicaid outcomes are actually pretty dam good considering the population that is being treated!

Wait time for an MRI can be months (at least that was the case back in 2008 when they compared Medicare/Medicaid to Canada's system).

I think you are far worse off if you make too much to be on Medicaid, but don't get health insurance through work and can't afford it. Everyone I know on Medicaid can go pretty much anywhere they want to receive treatment. I know very few doctors that don't accept Medicaid. (Dentistry is the exception, for those who are covered, it can be difficult to find a dentist.) (This is in Missouri- it may vary depending on your state). Even if you don't have insurance, you can still get a great deal of medical care- you will just be billed exorbitant amounts of money.

I cannot believe that the #1 comment responding to his thanks is basically a political one to raise awareness of the "broken" U.S. healthcare system, so I'll respond in-kind.

What was broken in this case was described by his statement: "I had no medical insurance and the few benefits I had with the VA would take months of paperwork to get me in." You can blame that on Ted Kennedy, btw. He is the one that made health insurance an institution in the U.S. The best chance we have at good healthcare here has nothing to do with government or health insurance, it was to do with doctors that are willing to say F.U. to the system and provide healthcare directly to paitents without middlemen. So, that's the other side of the politics. Now back to what we really should be talking about...

I think it is wonderful that his cancer was treated and that people here helped. Cancer really fucking sucks. I hate Cancer with a deep passion that some of you out there understand. Others of you like to think of how great your resume looks and how you are going to land a fat house on the beach. I used to also.

The UK has notoriously poor cancer outcomes.

http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-sur...

You understand we've done a lot since 2007, right?

EDIT: specifically, "survival rate" is just "how many people lived for 5 years after diagnosis". Thus, you detect a lot of slow growing prostate cancer and your survival rates go up, even though nothing has been done to reduce the incidence of cancer, or stop any more people from dying of cancer.

When you look at US cancer mortality rates they look pretty good, until you restrict the numbers to the under-65s, when suddenly the numbers look pretty average. This might be because poor americans don't get access to treatment until they're 65 and qualify for some aid.

I'd like to add to this that the US recommended screening PSA screeening for prostate cancer, whereas there's no screening program in the UK because the medical evidence suggests it does more harm than good. A huge proportion of older men have prostate cancer (30% of men over 50, apparently) but in most of them even without treatment it never progresses to the point of affecting them in any way before they die of something unrelated.

Similarly, the US screened women for breast cancer and cervical cancer earlier and more frequently than the UK, which again does more harm than good but improves the 5-year survival stats.

The US Preventative Screening Task Force has since recommended that screening should basically fall in line with what the UK's doing, but that happened well after that article was published.

Dan I am not challenging your statement I am just curious if you have seen any figures about the new outcomes. I did a quick look at the UK Cancer research page and it does not look like many of the statistics have been updated recently.

That being said it would be nice if the disparity in survival percentages on this side of the pond looked more like the stats from your side:

http://www.cancerresearchuk.org/cancer-info/cancerstats/surv...

Can you provide a link to a study that shows UK cancer outcomes exceeding those of US outcomes in populations under 65?

http://jama.jamanetwork.com/article.aspx?articleID=1710486

This appears to say that incidence of cancer is worse in the US, but that outcomes are better.

OK, I'm starting to think you're right about that. Here's another source that agrees with you.

http://www.nap.edu/openbook.php?record_id=13497&page=3

Hi, I believe that's wrong. I don't know why there is conflict in the technical literature, but I believe the consensus is that US healthcare outcomes lag behind most industrialized nations, including the UK. See e.g.

http://politix.topix.com/homepage/7019-us-is-27th-in-the-wor...

and the paper from which the figure is taken

http://jama.jamanetwork.com/article.aspx?articleID=1710486

Those data show that the USA ranks far below the UK on Years of Life Lost due to several cancers. I don't see how that's consistent with your claim. [Edit: actually, YLL is an incidence statistic, whereas parent's claim is that survival statistics are higher in the US, which the sources I've found agree with.]

The Telegraph is a right-leaning paper and is well known to be anti-NHS. Please; being economically laissez-faire as people are on HN are is not incompatible with supporting state provision of healthcare, along with the other things a state provides. It's sad to see libertarians / laissez-faire economics people bashing the NHS by quoting stories cherry-picked by right wing media sources. It's just not something we need disagree about.

From those top tens for females and males, five out of ten are countries with populations less than 12 million each. It would be interesting to see the US statistics by state.

Smaller networks (small population of a country, or by state) could be a factor here.

Could you find the original study?

Is it this one?

(http://www.ncbi.nlm.nih.gov/pubmed/18639491)

I wondered for a moment, "why is this relevant?" until I saw that you're responding to the parent's nationality.

On cancer outcomes, the US outranks many (most?) of the countries that beat it on life expectancy. And, as pointed out downthread, life expectancy is a dodgy stat; it's heavily weighted by infant mortality, which isn't uniformly measured, and by accidental and violent deaths which, while tragic and perhaps symptomatic of other US problems, don't implicate our health care system.

You have to be careful about cancer statistics, because in many cases the US diagnoses early-stage cancers that would never get recorded in other countries. Some of those cancers never progress to the point of being life-threatening, making the survival stats misleading. Others do but because they're recorded earlier US patients are recorded as surviving for longe when in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries.

>" in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries."

That's hard to tell, you can also say that because those patient were treated earlier they have a longer life expectancy. But I am agreed, those stats have to be looked very carefully.

Absolutely. It's called lead time bias, and there's a great illustration on Wikipedia:

http://en.wikipedia.org/wiki/Lead_time_bias

Gil Welch at Dartmouth is one of the experts in unnecessary medical screening and lead time bias. He's written numerous academic and media articles, especially regarding lung, breast, and prostate cancer screening. Also an amazing public speaker:

http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph

You can use a table like this to see that US life expectancy doesn't get much better if you calculate it at age 10 or 20 instead of at birth and US ranking is not much different (actually the US drops a few places): http://www.worldlifeexpectancy.com/your-life-expectancy-by-a... For 'first world' countries with low infant mortality rate life expectancy at birth and at age 10 is nearly the same.

It would also be interesting to see the stats weighted to account for the much higher levels of obesity in the U.S., which has to bump heart disease and cancer deaths significantly.

Damn lies and statistics - it's very difficult to compare countries on Infant Mortality because they have different definitions of alive.

From wikipedia:

The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[24] In Germany and Australia, requirements for live birth are even higher.[25][26]

https://en.wikipedia.org/wiki/Infant_mortality

Not to say there aren't problems with the US healthcare system, but we need to stop these comparisons that are just not relevant.

In addition, if you limit the data to single child births, eliminating twins and other multiple births, the US actually ranks number one for child mortality. Multiple child births are inherently more risky, as are births to women over the age of 30. Due to wealth, cultural, and lifestyle factors the number of multiple-child pregnancies in the US is much much higher than in other countries. More American women choose to have children later in life and sometimes this includes fertility drugs which results in more riskier twin pregnancies.

When you remove car accidents and suicides from the death rates, factors that are largely independent from the health care system, the US actually has the highest life expectancy in the world.

A good source of info on this is the work of Scott Atlas. This econtalk includes a good look at the statistical biases in the micro rankings that get so much undue attention in the media.

http://www.econtalk.org/archives/2012/07/scott_atlas_on.html

I am not sure that suicide rates are particularly independent of health care provision, especially suicides in the elderly, which is where there has been a massive increase.

From your article:

"However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[34][35][dead link][36] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[36]"

Your argument, will perhaps partially correct, fails to properly explain the disparity in infant mortality (mostly due to unnecessary premature births) between the US and similar industrial countries.

Yes it doesn't explain it away, there are other problems too that aren't related to health care: More teenage pregnancies (higher likely hood of low birth weight), more single mother pregnancies, more obese pregnancies). These are underlying cultural issues that while related to healthcare are different.

In no way am I trying to blame the victim or excuse a bad system. I'm only pointing out that these comparisons are very hard to do correctly and can be misleading. We have an urge to compare so that we can make better decisions, but it can be tough to do this. From the stats originally posted it could be argued that we need to spend more money on the healthcare system, when in reality we just need to educate people to wait to have kids.

  Researchers from the NCHS found that low birthweight 
  and short gestational age births—a leading cause of 
  infant death internationally were more common in the 
  United States than in Europe.  Although outcomes for 
  these births were similar, they found that the U.S. 
  rate of low birthweight and short gestational age births
  was double that of Finland and Sweden.29 After adjusting
  for potential recording differences by excluding very 
  short gestational age births, they found that the U.S. 
  IMR would be 3.9 if the United States had the same rate 
  of low birthweight and short gestational age births as 
  Sweden. 

  https://www.fas.org/sgp/crs/misc/R41378.pdf

I know I must sound like a broken record, but life expectancy is a poor proxy for quality of healthcare. There are many factors which impact life expectancy which have nothing to do with healthcare. For example, if you correct for the number of car accidents (which is high in the US due to the number of cars on the road), the US comes out near the top in terms of life expectancy.

The other thing is that to say that the US ranks 50th in life expectancy is useless without showing numbers. From what I've seen, the #1 country and the #50 country difference by less than 3 years. So is the number 50 ranked country really that much worse than the #1 country.

I just copied the first paragraph from the Wikipedia article, which happpened to be about life expectancy which is often seen as a proxy for quality of healthcare. Fair or not.

Here are some other excerpts from the article:

- The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population.

- lack of health insurance causes roughly 48,000 unnecessary deaths every year in the United States

- In 2007, 62.1% of filers for bankruptcies claimed high medical expenses.

- A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.

These quotes are just from the first paragraph of the article... There are many more if you read it through.

For an outside observer it's blatantly obvious that you have a broken system, and it's inexlicable why you keep defending it.

You won't get any argument from me that the US healthcare system is broken (both the private and public systems).

However, using flimsy statistical arguememts to make the arguememt isn't helping anyone.

Btw, the 62% of bankruptcies stat is also misleading. Whether the person had $10 or $100k medical debt is included. It's not surprising that if someone went bankrupt due to a failed business they wouldn't pay their medical bills either. Thus for many of those 62%, medical expenses had nothing to do with their bankruptcies.