

End-of-Life Warning at $618,616 Makes Me Wonder Was It Worth It - AdamN
http://www.bloomberg.com/apps/news?pid=20601087&sid=avRFGNF6Qw_w
Solid long-format article about the costs of healthcare for a dying husband.
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hapless
Seems pretty clear that it was worth it. The actual bill was closer to
$250,000 -- $618,000 was without any discounts.

We work and save and pay premiums for decades specifically so that we CAN have
someone pay $250,000 to extend our lives by 17 months. That is the PURPOSE of
a health insurance policy.

It's hard to see this one as an example of our (admittedly terrible)
healthcare costs.

~~~
bobbyi
Also, the money that was spent didn't just go to extending his life. A lot of
that money was spent on pharmaceuticals where he was an "early adopter".
People like him covering the massive costs of developing those pharmaceuticals
are paving the road for the day when they can be available as cheaply as the
vaccinations the article talks about.

~~~
Confusion
_People like him covering the massive costs_

You mean people like us, the ones that pay the premiums, subsidizing the
research of pharmaceutical companies?

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steveplace
I'm sure we can find ways to view the US healthcare issue as "Hacker News,"
but please let me have some sanctuary.

~~~
pw0ncakes
It's of relevance to anyone in the US who is considering working for startups,
since anyone who does so runs the (admittedly low-probability) risk of being
murdered due to unaffordable or inadequate health coverage.

~~~
nandemo
I think steveplace covered that when he wrote 'we can find ways to view the US
healthcare issue as "Hacker News"'.

In that sense, almost any political news can be made to be "relevant" to HN.
The California budget deficit, Iraq, the tax code, the next elections, you
name it.

And when the topic is politics, even though people here tend to remain civil,
the level of discourse inevitably goes down.

For instance, consider your superlative usage of "murder". This sort of thing
practically precludes any further fruitful discussion: anyone who disagrees
with you is automatically in the uncomfortable position of "abetting murder".

~~~
axod
I think it's fairly relevant. For example as relevant as all the startup visa
stuff.

I would never startup in the US, and one of the reasons would be lack of
public healthcare.

------
danteembermage
I think a partial solution to this is to require some small portion of health
care costs to be covered by the patient. Would she have spent 5% of $40,000 if
he was probably going to die overnight? If if she could afford it she probably
wouldn't have. What about the previous two times when there was more hope?
Probably so.

Alternatively, she paid higher premiums under the assumption that some extreme
end of life dollars would be nearly wasted by some policy members, but that's
okay because that's what they chose to pay for so that they would never have
to make a cost benefit analysis in their own care. I don't think she needs to
wring her hands about it, that's what she bought.

~~~
axod
>> "I think a partial solution to this is to require some small portion of
health care costs to be covered by the patient."

What the hell??? Health care should be a right. Something you don't have to
ever worry about. If my kid is lying in hospital sick, I'm not going to make a
decision based on money, because I'd always say "Yes take all my money", and
that puts me in a very vulnerable position indeed. One that could be exploited
by evil companies if given the chance.

Health should always be far far far more important than money, but to prevent
evil companies making a ton of money out of desperate people, it should be
provided by the government.

Why is there such a disconnect in America between socialized war mongering,
and socialized health care?

~~~
anamax
> Health should always be far far far more important than money,

I'm pretty sure that your own behavior proves otherwise. (I'm not claiming
that your choices are wrong, but they do show that health isn't always your
highest priority.)

> but to prevent evil companies making a ton of money out of desperate people,
> it should be provided by the government.

In what universe can govts provide unlimited healthcare?

The current US healthcare "reform" includes significant cuts in Medicare
spending on certain conditions. Folks who have those conditions will get less
care. You know, pre-existing conditions....

Feel free to provide a checkable citation to any govt healthcare system that
doesn't limit the amount of care.

~~~
axod
I didn't say "unlimited" health care, anywhere.

I just believe that in this day and age, the US should join other first world
countries in valuing life above military.

>> "I'm pretty sure that your own behavior proves otherwise. (I'm not claiming
that your choices are wrong, but they do show that health isn't always your
highest priority.)"

Care to elaborate?

~~~
anamax
> I didn't say "unlimited" health care, anywhere.

You said that it was wrong to limit healthcare access. If there aren't limits,
it's unlimited.

> I just believe that in this day and age, the US should join other first
> world countries in valuing life above military.

What makes you think that it doesn't? The US spends far more on health care
than it does on the military.

Yes, that's true of the federal govt. Note that state and local govts also
spend money on health, and they spend very little on the military. And then
there's private spending.

In fact, one of the big arguments by folks arguing for more govt healthcare is
that they claim that it will cost less than the current system.

> Care to elaborate?

If I observe your life, I'm pretty sure that I'll find several things that you
do that are not as good for your health as they could be. (Here are easy ones
- is your weight ideal? Do you exercise enough? How about sleep?) Their
existence proves that health isn't your highest priority.

I'm not saying that you're wrong to have priorities other that health, but it
is absurd to criticize others for doing the same.

------
delackner
Since the article is talking about examining the detailed costs of the long,
drawn-out process of his slow decline, it is important to note that she says
he was an overweight ex-smoker, which made him (she says) a prime candidate
for kidney cancer.

The biggest cost in western-style health care is not end of life care, it is
lifestyle-induced illness that leads to an explosion of totally preventable
terminal diseases.

~~~
pw0ncakes
Cancer is not "totally preventable". Non-smokers die of lung cancer (and other
cancers) too.

------
giardini
Even oncologist question their utility today when they can offer the average
cancer patient only meager life extension, and those are often pain-filled
years at that.

But it's a good business model: people will often spend their net worth to
extend the life of themselves or their child a few months. But in the end they
almost always die the same miserable death. So I expect even more "childrens'
cancer centers" to open and rake in millions.

~~~
enjo
This is an emotionally charged issue for me, I lost my mom to ovarian cancer.
My bet is that you, quite frankly, have no damn idea what your talking about.

My mom was supposed to live 6 months longer (at best). Instead she made it
more than 2 years. Where they difficult years? Yep. However, they where still
valuable ones. She got to see me marry. She met the future mother of her
grandchildren. She got to see and do things she always wanted to do. She saw
her estranged family again.

The value of those oncologists simply can't be discounted. It's an incredibly
difficult profession, one in which most of your patients die. However, the
ability to extend lives...even by a few months... and manage to make those
last days as painless and productive as possible makes them angels in my book.
Not profiteers.

It was interesting getting to know her oncologist. He clearly struggled with
the emotions of his job. In the wake of her death he couldn't bring himself to
attend her funeral (understandable). There was hardly a human being who knew
her better in those last two years... and for that I'll be eternally grateful
to him.

~~~
giardini
Your anger is misguided. I have weathered the deaths by cancer of several whom
I care about very much. I found it grueling, relentless and painful for
everyone. In every case much money changed hands in a very short period of
time, always to the benefit of the oncologist and associated institution.

Your wishes aside, most doctors are profiteers. Take the profit out and most
would find another professions. Don't you remember the attitude of hopeul
medical-school bound students in college? Very few go to medical school for
noble causes.

Your mom's oncologist likely attended very few, if any, of his patients'
funerals.

As for: "It was interesting getting to know her oncologist. He clearly
struggled with the emotions of his job. In the wake of her death he couldn't
bring himself to attend her funeral (understandable).There was hardly a human
being who knew her better in those last two years... and for that I'll be
eternally grateful to him."

I must call you on your claims. Oncologists necessarily don't spend much time
with each patient and it is very unlikely that

\- you "got to know her oncologist",

\- he "struggled with the emotions",

\- he "knew her better" than anyone else .

The only way the last could be true is that your mother had no friends. Was
she wealthy also? Oncologists do make exceptions for wealthy patrons.

------
dhyasama
Some friends lived with me for a few months while their daughter was in the
NICU because she was born extremely prematurely. I don't know the final tally,
but at some point the calculated the total cost to be just north of
$2,000,000. I don't think it is possible for me to rationally discuss if is
worth it because I'm emotionally involved (they now have a beautiful, healthy
little girl), but it's easy to see that it doesn't take many cases like hers
to jack insurance premiums up pretty high.

As our medical skills are improving we can keep people alive that used to die.
Unfortunately our medical skill isn't advanced enough to do it cheaply.
Perhaps the luxuries of time and money will get us there one day.

~~~
vaksel
the same 2 million dollar treatment probably costs 3-5 grand in Mexico or
India. Personally I think health tourism is going to be much more popular
soon, since the healthcare costs in the states are getting less and less
affordable.

~~~
sokoloff
Are you honestly suggesting that someone would travel to Mexico or India to
put their premie in newborn intensive care unit there? Really; that seems
remotely reasonable (or even possible) to you?

------
noonespecial
The real problems start not when "end of life" becomes very expensive (which
it has) but when technology advances to the point where it is possible to keep
someone alive indefinitely but at geometrically increasing costs. We've set it
up so that everyone will feel entitled to that one extra week, no matter what
the cost.

~~~
houseabsolute
I doubt that costs can increase geometrically for any significant period of
time. The technological ramp would have to be enormous. Unless your belief is
that current technologies will remain at their current prices and new
technologies will be built at exclusively higher prices.

~~~
noonespecial
Its not about any particular technology, per se. It was cheap to die in 1600
no matter what killed you simply because there was very little that could be
done.

Each year we add more and more expensive interventions from ECMO machines to
artificial hearts. Put this together with the "if it can be done, it should be
done, damn the cost" attitude we've trained ourselves to expect and we could
find ourselves in for a severe reality check.

Medical technology seems strangely resistant to Moore's law (witness the price
of a CT scan over time), but even if it weren't, the improvements in
individual areas might not be enough to offset the growth of intervention
technology in general.

------
dustingetz
ice cold alert.

what was gained by keeping him alive, in a bed, not creating value, for 400k?
the family suffered with him while he died.

let him die, grieve, get on with your lives.

and save the rest of us the 400k.

~~~
jrockway
Will you be this cold when you are dying? What about when your wife and kids
are dying?

Maybe I am just a hopeless optimist, but personally, if my wife/kid is dying,
I am probably not going to say "BAI!1!", rip the cord out of the electrical
outlet, and grin as I watch his/her eyes close for the last time. Ever.
Instead, I am going to spend a lot of money to hopefully avoid ever seeing
that. Because while you can always make more money, we can't clone people yet.

~~~
steveklabnik
Some people are different. If I was that dude, I would have hoped my wife
would have just pulled the plug and saved everyone the money.

Living in a hospital bed is not living.

~~~
pw0ncakes
He fought cancer over the course of 7 years, and it sounds like his quality of
life was reasonable for most of that time.

I think pretty much everyone would rather die than linger on in a hospital bed
without hope. At a certain point, utility of future life becomes negative and
returning to a positive state is not possible. The problem is that it's not so
clear cut and obvious at the time that this is the case. A big part of this is
that doctors often want to save the patient at all costs, and often deceive
themselves as to the patient's prospects. So often even the patient has no
idea how bad the situation is.

~~~
steveklabnik
Of course. By reading a blog post, I have no idea what the situation was truly
like. I should have probably qualified my response with that.

------
AdamN
I like the “That moron Bush” quote when he can't remember anything but the
response to who the president is.

