
This is how you healthcare: American Death in London - DanBC
http://nsfwcorp.co/afboza
======
oneandoneis2
I was in America, in LA, a few years back (I'm British), when the whole
Obamacare thing was being debated everywhere.

The one thing I noticed, and it was a rule that didn't have a single
exception, was that everyone I talked to could give at least one example of a
time when either they or somebody they personally knew had been faced with a
ruinous bill for healthcare. People who'd been bankrupted, people who'd fled
to another state or even left the country to get away from a hospital bill.

And yet even after seeing whole families' lives literally torn apart, first-
hand, they still were against any healthcare reform.

I tried then, and I've tried in the years since, but I simply cannot
understand where they're coming from. How anyone can support a healthcare
system in this day & age that can, and does, bankrupt or refuse to treat
people.. I just can't understand it.

~~~
rdouble
The system does bankrupt people, but it doesn't refuse to treat people. That
is why people go bankrupt - the hospital has to treat everyone, then hands
them an immense bill.

~~~
bunderbunder
Actually, it does refuse to treat people quite regularly. Aside from emergency
department, health care providers are generally free to refuse care for
patients they believe cannot pay except in the case of a life-threatening
emergency.

What this means is that in the USA it's common for people to have to allow
earlier-stage, less expensive to treat problems develop into serious problems
before finally going into the ED to seek treatment. Which increases all of our
health care costs overall. Not only does the problem that eventually gets
treated end up being more expensive than it needed to be, but the place where
the care is provided is also the most expensive option. And since they don't
pay, health care providers are forced to raise everyone else's rates to cover
the cost of this unnecessarily expensive care that they had to provide.

Long story short, the range of things that health care providers have to treat
is much wider in countries with more socialized systems than it is in the USA.
And that is yet another reason why the USA has such enormously high health
care costs despite providing poorer quality of care.

~~~
carbocation
> Actually, it does refuse to treat people quite regularly.

Let's not play with words like that. People in the US get treatment—you even
say so later, despite your ominous lead sentence. They just get it later, via
the ED, after prevention goes un-performed. That's abominable enough, and
that's what we should talk about, not the (false) specter of non-treatment.

~~~
potatolicious
> _"They just get it later, via the ED, after prevention goes un-performed.
> That's abominable enough, and that's what we should talk about"_

You two aren't disagreeing.

You say we should talk about the epidemic of people unable to afford primary
care, pushing treatment later and later, eventually into the ER where they may
not even be able to be saved - and even if they do, suffer long-term health
effects due to the delay in treatment.

And he's saying that this is because the system _does_ refuse to treat people
- especially at the primary care level.

These two topics seem to line up just fine.

~~~
carbocation
Yes, that's why my point was to ask that we refrain from falsely hyperbolic
statements (people don't get treatment) so we can focus on the myriad true
problems that most agree exist, some of which you pointed out.

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newbie12
The author's father, Bill, around age 76, never paid taxes while living for
decades in the UK, but was still treated, and died there. The author assumes
he wouldn't have had care in the U.S. That's wrong. Even though he never held
a recognized job (and probably was a tax cheat), as a senior citizen he would
probably receive Medicare and as a poor person he would also potentially be
supported by Medicaid for any shortfall. Further, his situation is hardly a
model for national policy-- why should someone who never worked, yet
apparently has well-off, internationally traveling family, be completely
subsidized by taxpayers? Why shouldn't Bill or his family face some of the
costs for his care?

~~~
27182818284
>or his family

For the same reason that you don't go to jail just because your brother robs a
bank? Hey it is nice when family helps out, but they shouldn't have the legal
obligation.

~~~
newbie12
They should if he leaves them an inheritance.

~~~
27182818284
That's an interesting idea. Directly I'd still say no, they shouldn't, but
indirectly via an inheritance tax I'm OK with as I'm OK with inheritance tax
in general.

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flexie
When my wife gave birth in Europe the 11 hour procedure, which apart from the
traditional medical stuff, included massage and acupunture for relaxation,
involved a handful of nurses, 3 midwives, 2 doctors, an anesthesiologist etc.
After the birth our little family stayed in the 300 square foot private room
at the hospital for two days. We never saw any papers except the booklets the
hospital gave us about having an infant. It was great and it was free.

Two years later my wife's sister gave birth in a top notch Manhattan hospital
and my wife was there for support. Man, the stories she tells about how every
part of the procedure was initiated with waivers being signed and questions
asked about insurance to her sister who was squirming in pain and was several
hours into labour. And how the impatient doctors tried to upsell her sister to
a C-section... After that her sister shared a tiny room for a night with some
other woman and was then sent home. Luckily, most of the 40,000 dollar bill
was covered by her insurance.

~~~
newbie12
This is an indictment of the U.S. legal system, not the U.S. healthcare
system.

~~~
flexie
Yes, it's kind of related, though, isn't it?

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mikekij
\- I'm really sorry to hear about the author's father's passing.

\- While it's heart-warming, it is unrealistic to think that a public program
can spend infinite amounts of money on citizens who a) have paid "little or
no" taxes and b) "throat cancer suffers who quit smoking four years
afterwards". The math just doesn't add up.

\- The fact that the US has a pseudo market-based healthcare system is what
allows drug / device companies to make money on innovations that ultimately
save lives in other countries (like the UK) where these drugs / devices may
not even break even. If you create a system in the US where it's impossible to
make money in healthcare innovation, we'll see far fewer technological
developments in healthcare, which will lead to worldwide increases in infant
mortality / decreases in life expectancy.

That said, we should have a way in the US to provide basic healthcare for the
uninsured. The answer is not, however, a single-payer system.

~~~
maethorechannen
Anyone who is a throat cancer sufferer who has only recently quit smoking has
paid quite a bit of tax, at least in the UK.

~~~
mikekij
True. My point, however, was that the author was highlighting the fact that
this particular patient did not contribute much to the financial pool from
which he was now drawing.

------
carsongross
'who lived entirely on his own terms.'

Not really. He was fine with other people paying for his hip replacements.

~~~
sageikosa
Apparently those _were_ his terms.

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ntrepid8
I enjoyed reading this article and I think the choice about how healthcare
should be delivered in the U.S. boils down to how we as a society want to
spend our (limited) resources. Part of the reason that we spend more in the
U.S. than in the E.U. is because in many cases we go to greater lengths to
extend someone's life.

I'm not sure that culturally people are willing to accept the idea that we
aren't going to do "everything we can" for someone because it isn't worth it
to society (the payer). In the case described here, we might have implanted an
electronic device to resynchronize the patient's heart and prevent the CHF
from trashing the rest of his organs for a few more months (or years) at the
cost of $200k.

Are we at a place where people in the U.S. will accept not doing that that?

I think that a single payer with a base level of free care is the right thing
for society to do, but the possibility of making private insurance illegal (as
it is in some places and some groups in the U.S. are advocating for) is
terrifying to me.

The affordable care act basically ensures that we will arrive at a single
payer system sooner or later, but how do we change our culture to be more
accepting of our own mortality and the limitations placed on extreme measures
to extend life?

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sageikosa
All this noise about the problems of the American "system", ignores the fact
that America doesn't have a health-care system _yet_. If the problem in the
United States is high-cost, the solution is tort-reform, so that GPs can
comfortably practice general medicine and afford their insurance premiums
again.

Unless a central "system" is going to indemnify GPs, there won't be a flood of
them entering the pool, since their rates will be fixed by central rate tables
(maybe, if they are lucky, adjusted for regional cost-of-living) even if only
indirectly by maximum benefits needed to maintain minimal legal coverage
levels; if they are to remain privately run and thus administratively
independent.

------
danso
Some excerpts:

 _He was a charming, damaged, charismatic, fiercely intelligent, dissolute
individual, who lived entirely on his own terms. As a professional gambler, it
is unlikely he paid much if any tax in 37 years. He had no will, no funeral
plan. He never did fill out the forms necessary to vote in the last election,
or the one before that, as I discovered. He just hated forms. I could
sympathise. Had he stayed in the US, it is – how you say – dollars to
doughnuts he wouldn’t have got it together to fill out the forms, and would
have had no health insurance. He considered the US system “absolutely
unmanageable”._

 _However long this goes on for, they'll continue throwing resources at this
individual and never show a single sheet of figures to any of his relatives.
Not because they'll get anything back, but because this is what the NHS does.
It’s free care for throat cancer sufferers who only gave up smoking four years
afterwards, for drinkers who were told 35 years ago that if they didn’t quit
drinking they’d die. Free care for American immigrants, for jerks and gents.
Free care for parents whether they showed up or not. Free care for guys who
tried to try. Free care for the only father I will ever have._

So here comes the TANSTAAFL argument: I don't think anyone argues that what
the OP describes is a "bad thing"...in fact, I think it's probably the dream
scenario that people optimistically assume is the case before they have their
first encounter with an emergency room.

But the reason why it doesn't happen is because of cost, plain and simple. And
to be concerned about cost is not just the domain of greedy insurers and fat
cat cost cutters, but of reasonable people who understand that preventive care
is less dramatic than end-of-life care, but is surely as deserving of
resources and attention. And both types of care rely on the same limited pot
of funding.

It's easy to be emotionally invested in the personal case of a man who is
lucky enough to have a loved one so eloquent with words. But what about the
hundreds, thousands of routine cases that are treated by NHS with a protocol
governed by cost limitations, limitations that will inevitably be imposed by
the decision to give blue-chip treatment to the untreatable?

These routine cases don't pull at the heart strings because it is the nature
of the human mind not to realize/dwell on how an exam/procedure not scheduled
two years ago is the main factor in the chronic disease one suffers today. And
yet these people are just as deserving of optimal treatment as OP's Bill. The
way that OP judges the value of healthcare, though, means that the Bill's will
get a greater share of a finite set of resources. Is this really the way an
optimal healthcare system should work?

This is not to say that the U.S. or any other system is currently better than
the NHS. It's just to point out that fashion in which the OP (positively)
judges the NHS is susceptible to being ignorant of the problems that occur
earlier in the pipeline of health.

~~~
ahi
The problem with the TANSTAAFL argument in this case is that the NHS is far
cheaper than the American alternative. It is also far superior at providing
preventative care than the American alternative.

~~~
btilly
Indeed. The US private sector and the US federal government EACH spend more
per capita on health care than the UK does. And yet we rank behind the UK on
virtually every health statistic that they bother to track.

In 1993 Republicans did an interesting analysis. They found that Clinton's
health care plan would work, and would be popular. If it passed, they believed
that Republicans would be losing national elections for a generation. But they
also figured out that if they derailed it, then they could turn fears about it
into a potent election issue. They did, and it was. They tried the same thing
with Obama's plan. Whether the other half of their prediction comes true is
yet to be decided.

For the actual Republican analysis from 1993, see
[http://delong.typepad.com/egregious_moderation/2009/03/willi...](http://delong.typepad.com/egregious_moderation/2009/03/william-
kristol-defeating-president-clintons-health-care-proposal.html).

~~~
gruseom
Not only that, but as Dean Baker never tires of pointing out, if the US only
spent as much as other rich countries do on health care (countries that get
better health outcomes), it would have huge budget surpluses rather than
deficits.

------
AndrewKemendo
So the healthcare system - as described here - is largely benefiting the
living members of the dying by helping them cope and transition into death.

That is what I took away from this article.

------
philwelch
For what it's worth, my father spent a lot of time in hospitals towards the
end of his life, died, and the only consideration made towards payment or
insurance was when he was first admitted. I honestly don't even remember the
details that well, though I vividly remember a lot of other things about it. I
also received reams of "explanation of benefits" papers afterwards in the
mail, but we never had to pay a dime.

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a_c_s
I'm not clicking on any link with nsfw in the url.

~~~
kami8845
Thanks for your feedback. The next time we will simply post the link with the
domain removed.

~~~
hospadam
I'm not sure if you're being snarky or not... but nsfw in the domain is a good
reason to give caution while at work, right? There are a lot of terms that, if
in a domain name, I would choose not to read at work.

~~~
lostlogin
If only NSFW had appeared in the URL of a few things I've clicked at work.

------
jgrahamc
"As a professional gambler, it is unlikely he paid much if any tax in 37
years"

There's no tax on winnings while gambling in the UK anyway.

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ctdonath
The article deifies government. _By now I am convinced that the NHS – and I
hyperbolise, but only slightly – is the greatest achievement of humankind, the
nearest we get to a benevolent deity, a goddamn superhero._ Such worship of
the state never ends well, starting with large-scale confiscation of private
earnings (where do you think the money for this incident came from?) and
veiling of failings (having delivered soothing words and relaxed settings for
the patient's death, no mention of what life-saving options were available and
why not administered). All delivered with non-sequitur jabs at another
healthcare system. "I love Big Brother" - Winston Smith

As someone who should be dead four times over, I find the American health care
system quite functional, effective, and satisfactory. No worship thereof
necessary.

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JackFr
[http://www.dailymail.co.uk/news/article-2279984/NHS-
pays-1mi...](http://www.dailymail.co.uk/news/article-2279984/NHS-
pays-1million-compensation-men-wrong-TESTICLE-removed.html)

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sageikosa
Anyone who gives up a little health liberty for a little health security will
obtain neither. Instead they'll get another sprawling centrally-run
bureaucracy (in people and rules) managing the health "system" equivalent of
"no-child left behind".

