
Hacker News Folks Get Long Overdue Thanks - reactor
http://linuxlock.blogspot.sg/2013/07/hacker-news-gets-long-overdue-thanks.html
======
mixmax
While this is a great and heartbreaking story that makes me proud to be an
active member of HN it's also a symptom of the totally broken US healthcare
system.

From wikipedia:

The United States life expectancy of 78.4 years at birth, up from 75.2 years
in 1990, ranks it 50th among 221 nations, and 27th out of the 34
industrialized OECD countries, down from 20th in 1990. Of 17 high-income
countries studied by the National Institutes of Health in 2013, the United
States had the highest or near-highest prevalence of infant mortality, heart
and lung disease, sexually transmitted infections, adolescent pregnancies,
injuries, homicides, and disability. Together, such issues place the U.S. at
the bottom of the list for life expectancy. On average, a U.S. male can be
expected to live almost four fewer years than those in the top-ranked country.

According to the World Health Organization (WHO), the United States spent more
on health care per capita ($8,608), and more on health care as percentage of
its GDP (17.9%), than any other nation in 2011. The Commonwealth Fund ranked
the United States last in the quality of health care among similar countries,
and notes U.S. care costs the most.

[http://en.wikipedia.org/wiki/Health_care_in_the_United_State...](http://en.wikipedia.org/wiki/Health_care_in_the_United_States)

~~~
lifeisstillgood
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.

~~~
tptacek
The UK has notoriously poor cancer outcomes.

[http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-
sur...](http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-
rate-lowest-in-Europe.html)

~~~
DanBC
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.

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

~~~
Myrmornis
[http://jama.jamanetwork.com/article.aspx?articleID=1710486](http://jama.jamanetwork.com/article.aspx?articleID=1710486)

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

~~~
Myrmornis
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](http://www.nap.edu/openbook.php?record_id=13497&page=3)

------
nwenzel
Great story of compassion and triumph. So... How do we make it scale?

Is it mandatory insurance? Insurance doesn't make everything affordable, but
it probably wild have been helpful. Though maybe the co-pay would have been
$50k.

Universal tax-payer funded insurance? The term "tax payer" is interesting
because politicians and pundits forget that we're all tax payers in one form
or another. Granted some pay more, some are net consumers of govt services.
But tax payers mean us, and those with more earned income more than those with
less. I think the main difference between taxes and donation is choice.

Single-payer or government provided healthcare? Pretty sure that no one would
identify the government as the picture perfect example of efficiency. Plus,
putting elected officials or their appointees in charge of handing out goods
and services doesnt seem to be sustainable. Not that putting profit seeking
entities in charge has yielded the ideal result.

Making drug providers, healthcare providers and everyone else in that supply
chain non-profit? Profit has enormous motivational powers. Not always for
good. But it is pretty amazing what can be accomplished by organizations setup
to create wealth.

Big Data? Sorry, I couldn't resist. Well, lets use that as a proxy for
innovation. It would seem that greater opportunity for innovation would help.
Lower barriers to trying new drugs, procedures, diet, treatments would allow
for potentially lower cost solutions to be created.

Separating health care from your job? Of your insurer only needs you to be
healthy until you find a new job, there's not much in incentive for long-term
healthcare and preventative screenings to identify tumors and other problems
before they become an expensive problem. Though that would seem to be an
arguement in favor of a single payer system.

Sorry, I don't have an answer. Hopefully, great stories like the OP continue.
But if we don't make it scale then we haven't really done all we possibly can
do.

~~~
raganwald
_Single-payer or government provided healthcare? Pretty sure that no one would
identify the government as the picture perfect example of efficiency. Plus,
putting elected officials or their appointees in charge of handing out goods
and services doesnt seem to be sustainable._

It seems odd to me that so many Americans seem pessimistic about their own
government. I could understand if the attitude was, "We could make universal,
socialized healthcare work. We could make it cheaper than Canada's. We could
make it better than Sweden's. We just don't want to for ideological reasons."

But how can it be that the attitude is, "It would never work here?" You're the
greatest empire in the history of civilization. What is this word "can't" and
why is it in your vocabulary?

~~~
Symmetry
Well, we do already spend more than the UK on providing health insurance
(divided by total population), but we're just providing it to seniors and poor
people.

The problem is the morass of laws we've accumulated around healthcare over the
years for various reasons that now interact in complex ways that nobody
foresaw. Like the law designed to make Medicare or Medicaid (I forget which)
drugs cheaper that ended up making it illegal to give free birth control to
college students.

We also have the laws from when people believed that competition increased
costs and so tried to ban competition between hospitals. Or the committee that
sets doctor's reimbursement rates for Medicare procedures based on the *$%@#
labor theory of value. And the laws designed to prevent people from
overcharging Medicare that means that everybody has to worry about those rates
across the industry. Or the way that the makeup of that committee means that
primary care physicians gets shafted.

And the fact that we allow so few schools to teach medicine means that they
can charge an arm and a leg, which means that those poor shafted PCPs need the
kickbacks they get for assigning specialist care in order to pay off their
student loans and malpractice insurance.

And I could go on.

And now we have this system that's incomprehensibly complex. So Congress has
no way of figuring how to fix it on their own. There are people who've spent
years figuring out how all of this works, but that's their job and if the
system was actually fixed their job would be gone and that understanding they
spent years acquiring would be useless.

Which isn't to say that this is entirely hopeless. There have been some
efforts at the hospital level like Kaiser Permanente's to ameliorate the
perverse incentives in the system and capture some of the value unlocked by
that. And there are some laws that could be changes or repealed (like the one
against hospital competition) without really breaking anything. So I think
that gradual reform might be possible, but it's going to be a long road that
doesn't particularly involve the issues that people tend to talk about around
healthcare.

~~~
jarek
In slightly less words and with slightly less accuracy, you're unwilling or
unable to wipe the slate clean and start from scratch.

To an extent I wonder how much of that is due to lack of recent experience
with starting from scratch. The United States hasn't had a revolution, a war
on its territory, or a regime collapse in a long time.

~~~
Wingman4l7
What first-world country has?

~~~
jarek
Germany and Japan were rebuilt from the ground up after 1945, France is now on
the fifth republic, Spain, Portugal, and Greece shed dictatorships in the
1970s, some of Eastern Bloc now qualify as first world and have undergone a
major change in 1989-91...

------
twstws
This is truly a wonderful story. But it makes you wonder how many others in a
similar situation weren't so fortunate.

I lived in the US for two years, and I never understood the aversion to
government healthcare. The Canadian system is far from perfect, and I know
there are failures. But it's still a lot better than soliciting for online
charity on a case by case basis.

I'm impressed and humbled that it worked in this case. Just a little disturbed
that it was necessary at all.

~~~
Klinky
I am not sure this story is really about the need for socialized medicine.
This is more about the need of specialist care and second opinions. If most
doctors he saw determined that he most likely would not survive treatment, a
socialized medical program may have very well denied payment for such
treatments, and he would have had to resort to fundraising anyways.

Maybe if the system was flexible, nimble and could make judgement calls on the
side of compassion, it might work, but this is difficult in both public or
private sector institutions.

~~~
twstws
Good point. I do think the frequency of cases where the only option is private
fund raising is much reduced under public systems.

------
jaggederest
The real thanks goes to the oncologists. I'm pretty sure they would have
shrugged off the monetary losses to save a life.

~~~
dfc
I wholeheartedly agree that the oncologists deserve a lot of praise/gratitude
for their work. That gratitude is precisely the reason why I disagree with the
latter half of your statement. I think it is unfair to to suggest that they
would have accepted a monetary loss. Nobody visits an oncology specialist
because life is wonderful. Every patient is somebody's mother, brother or
spouse and every patient is facing an uphill battle.

Doctors deserve a paycheck to feed their families and pay off medical school
debt just like everyone else.

~~~
jaggederest
Of course they do. But if he'd only raised $30k, they'd have gone "Welp, not
enough, guess you're just going to have to die"? I seriously doubt it. You're
going to serve the patients you can serve and get the recompense you can -
people without insurance are going to bring some losses, but you don't just
let them die.

~~~
dfc
_" people without insurance are going to bring some losses, but you don't just
let them die."_

Are you aware of the health insurance debate/disaster in the US? How long can
doctors operate at a loss?

I must say that you are very fortunate if you do not know someone who has died
of cancer and was unable to see/pay every specialist they could fit in to
their final months days. People die of cancer all the time wishing they had
the money to see the ______ oncology specialist.

~~~
jaggederest
I've actually worked with health insurance billing.

The way it works is that they bill ridiculously large amounts, which nobody
without insurance can pay. They know this. The insurance companies negotiate
it, other people pay what they can, and it all more or less works out in the
end. I'd much, much prefer to see a single payer system.

Seeing every specialist is different than being in treatment with a doctor and
having them cut you off because you can't pay. It's very rare I hear of a
doctor going "well it's a shame you can't afford to pay for this surgery" \-
nearly always they do it, bill it, and accept the losses. Hospitals recover
less than 20% from people without insurance.

~~~
foobarbazqux
Do doctors make individual decisions about working pro bono, and does it come
directly out of their paycheque, or does the hospital cover it for them?

~~~
refurb
Texas oncology is a private practice. The $50K most likely paid for all the
non-labor costs of the treatment. The doctors were working for free; i.e. they
weren't compensated for their time

------
foobarbazqux
It's great that people here helped him out and that a life was saved, but it's
also sad that some US citizens - in this case a veteran - have to beg for
healthcare.

~~~
rbanffy
It's a tragedy when anyone, anywhere, dies because he/she cannot afford or has
no access to adequate medical care.

We have a very long way to go.

------
wozniacki
Often the least mentioned and discussed approach to solving the healthcare
morass is the customer driver model of healthcare.

David Goldhill is the author of Catastrophic Care: How American Health Care
Killed My Father--and How We Can Fix It

He advocates restricting the insurance system gradually and phasing out
eventually, to increase accountability and vastly improve delivery standards.

His father was afflicted by a series of hospital infections that compounded
his condition and eventually killed him.

When admitted in hospitals, he was thrice subjected to medical procedures that
were meant for other people.

This Atlantic article is eminently readable.

How American Health Care Killed My Father

[http://www.theatlantic.com/magazine/print/2009/09/how-
americ...](http://www.theatlantic.com/magazine/print/2009/09/how-american-
health-care-killed-my-father/307617/)

[http://www.youtube.com/watch?v=Y_7qCpiS_ZQ](http://www.youtube.com/watch?v=Y_7qCpiS_ZQ)

[http://www.youtube.com/watch?v=2A9y_FttOGE](http://www.youtube.com/watch?v=2A9y_FttOGE)

[http://www.youtube.com/watch?v=u0OAj9J_HW4](http://www.youtube.com/watch?v=u0OAj9J_HW4)

------
shinratdr
Nobody is turning this into a political issue. This IS a political issue. The
only people who argue otherwise are Americans that selfishly support the
current system in their country.

Well bully for them. If they want people to stop "politicizing" issues that
are entirely the result of the political game they play, then maybe they
should stop being so selfish when a story like this comes up and some poor
American has to pass around a hat so he can continue to live.

The minor inconvenience of ruining some feel-good story for you is nothing
compared to the blind eye you choose to turn in regards to everyone out there
who has the exact same problems but doesn't have HN to turn to to fund their
treatment. One is barely an issue, the other is a travesty that you can help
to change.

Expect this to come up every time until it's no longer needed.

------
relaunched
I remember when this story was first posted. It's not often in life that
someone gets a happy ending. It's a moment we can all revel in.

------
p4bl0
This story makes me glad to live in France and have such a good healthcare
system.

~~~
snogglethorpe
Also, you get to live in France... :]

------
mathattack
Wow - that a tear jerker that's hard to respond to. Glad to hear he is well!

------
barking
HN : 1 USA health system : 0

------
dmak
I honestly thought this was going to be a SEO success story when I saw the
white hat vs black hat picture.

------
zhemao
What's with all the extra periods in the title?

~~~
542458
iPhone keyboard is my bet. Two taps of the space bar (easy enough to do
accidentally) gets you " ." and capitalizes the next letter.

------
sgt
Well done to HN. You cared.

------
kenshiro_o
I am very happy for you! It's amazing what a community can do when its focus
is directed towards a single goal.

~~~
harrytuttle
Spot on.

If only all of humanity did this to each other.

~~~
twstws
Except for the US, most of the developed world does, via public health care.
It's not perfect, but better than the alternative.

------
WasimBhai
I have often wondered given the kind of cost involved in good health care in
USA, along with college fees, why don't more Americans move to Europe for
health care and education where it is probably free most of the time?

P.S.: I am from Pakistan.

~~~
drone
Don't most of those "free" public health care systems only apply to citizens?
I recall a story about a foreigner in Germany having to pay for their care,
even if the price was reduced. Non-emergency care in the UK, for example,
requires legal residency, which may be hard to come by for someone too poor to
afford health care in the US. France requires non-EU citizens to have
insurance for care in France to get a visa, as I understand it.

So, it's not just as easy as "let's pack up and move to the EU so we can get
free healthcare tomorrow." Otherwise, you can imagine that every time a non-
insured American got sick, they could compare the cost of getting new
insurance to the cost of a plane ticket, and the plane ticket would win, I'm
sure. =)

~~~
WasimBhai
Yes, of course. But then I am talking more about the whole life, not only in
the case of emergency etc.. I mean for someone like me, from what I have read
about American healthcare and education system, I will choose Europe any day
over America. And even though, I really don't have that choice with my
passport. But in the case of US citizens, the choice seems realtively easy.

~~~
Wingman4l7
Being a US citizen doesn't mean that you can just waltz into Europe. Like
other commenters said, you usually need to be a citizen or at least some sort
of permanent resident to take advantage of European healthcare. Obtaining such
status usually takes _years_ and is only possible for the young and highly
employable.

Packing up and moving is simply not an option for those who cannot afford to
pay for healthcare in the US in the first place, and oftentimes logistics like
family, employment, and language would prevent that anyway.

------
gojomo
Any link to the original thread?

~~~
gojomo
This one, from 330 days ago, looks like it was the main one:

[https://news.ycombinator.com/item?id=4430020](https://news.ycombinator.com/item?id=4430020)

------
denzil_correa
Feels good to be part of such a community.

