
42 percent of new cancer patients lose their life savings - petethomas
https://bigthink.com/how-much-does-cancer-cost-2612936248.html
======
kbos87
I recently watched a family member go through this. A few things that were
sobering to see:

\- Three weeks in she was buried in paperwork. One chemo treatment would turn
into 4-5 invoices from different subcontractors at a single hospital, some
covered by her insurance, others not covered. Her insurer denied claims
arbitrarily and made her go through a bunch of invasive and unnecessary
procedures to prove her illness.

\- Her insurer started calling her incessantly, insisting that she join some
sort of program where they would “help” her make decisions about her care. It
undermined the confidence she had in her doctors and the decisions she was
trying to make, which is a terrible feeling for anyone to go through when they
are sick with cancer and trying to survive.

\- There were a series of insurance “land mines” on the horizon - forget to
renew this thing on this random date 2 months from now? You’ve lost your
insurance.

The whole healthcare and insurance system is a dark pattern, even for working
adults who are fully covered.

~~~
kxyvr
I'm sorry your family member went through this. That's terrible and no one
should have to deal with that kind of treatment.

I'll echo much of what you said. When I was 21, I was diagnosed and treated
for malignant melanoma (skin cancer) that had metastasized to my lymph nodes.
The treatment worked and I've been healthy for many years. That said, it
changed the way and manner in which I deal with billing and insurance, so I'll
share a couple of things that I learned in case someone else runs into the
same issue.

\- Do not immediately pay any invoice. Wait until the explanation of benefits
arrives first and then verify that the two match. Basically, verify that the
doctor is billing what the insurance company states is uncovered. Sometimes
they're different and that indicates a problem.

\- Check all statement of benefits for uncovered claims. It's important to
understand why a claim is denied. If a doctor is not in network, it's
important to drop them right away. If the doctor used an unapproved billing
code or sequence of codes, it's important to know this and insure that this
doesn't happen again or else it gets expensive. Alternatively, the doctor's
office can resubmit the claim using different billing codes.

\- Just because a doctor shows up under the "find a doc" in the insurance
search doesn't mean they're in network. PHCS is notorious for this, which
happens to be the network used by the health sharing ministries (which is part
of the reason why these organizations are a terrible idea.) Anyway, even if a
doctor is listed, it doesn't mean that they're using that tax id for their
services. The insurance company and the underwriter maintain a database of tax
ids that really determine who is in network or not. The doctor nor the front
desk will have this information. The billing department does. As such, the
process is to call billing, before the appointment, and get their tax id.
Then, call your insurance and verify the tax id directly. Some phone support
want to just verify the name. That is not good enough. Verify the actual tax
id and insist that this is what is checked.

\- Even if the tax id is verified, the claim may still be denied. This an
innumerable number of reasons why this may happen. I had one denied because
they billed a new patient the same day as a procedure. Anyway, the only way to
truly know the cost is to get the procedure code _and_ the tax id and then
verify with the underwriter that this is covered. I mention the underwriter
because the insurance company doesn't have this information, at least the ones
I've used. Generally, the insurance company will refuse to give the
underwriters contact and the underwriter will refuse to talk to you even if
you get it, so the insurance company has to call them and then verify both the
tax-id and billing codes. This only works some of the time, but they really
can do it if they want. Most of the time, I don't go this far unless there's a
dispute. Generally, verifying the tax-id is good enough.

\- Hospitals do not just hire their own people. Most are filled and staffed
with medical groups who use their own billing. Here's where things gets
stressful. You basically have to be forceful, while sick, and ask each new
physician and lab tech what medical group they work for and what their tax-ids
are. The really crappy situations occur when the hospital gets slammed and
then they bring in someone to help cover the gap and they use a tax-id that's
not in network. This gets astronomically expensive quickly. And, look, the
hospital will get tired of you asking. I get it. If I'm there, I'm either sick
or dying and don't want to ask either, but these surprise bills can bankrupt
you.

\- Hospitals may randomly apply funds paid to random invoices. If this shell
game goes on long enough, bills can be sent to collections even if you've paid
them purely because funds paid were applied to new invoices and not old.
Generally, hospitals will try 3 or 4 times to collect on an invoice. If you
know one has been paid, verify the money has been collected from checking or
credit, and then call the hospital to complain. It needs to be fixed sooner
rather than later.

\- As far as paperwork, I save the doctors notes from that day, the insurance
explanation of benefits, the bill, and the receipt of payment from my bank, in
a single file labeled for that day of service. This has saved my ass multiple
times because I can quickly determine whether a bill has been paid and when.

\- Do not overpay. Ever. Getting money back from a hospital is extremely
difficult. Then, they'll randomly apply the credit to new invoices, which
screws up the bookkeeping. This is part of why I delay paying invoices till I
know they're good.

Alright, that was longer than I anticipated. Anyway, the situation is
ridiculous and I hope no one here has to go through this mess. Hopefully, what
I wrote above will help someone else.

~~~
matorl
Great advice, thanks.

...also, you've called out a very significant pain point for lots of people in
the American health system, i.e. managing and paying bills while dealing with
the Kafka-esq processes. Your process is steps towards a solution.

Can your process of ensuring bills are paid correctly be turned into a
business? Can it sold as a service - not to hospitals, not to employers, not
to insurance companies - but to us? We buy the service and know we can trust
it has our interests at heart, esp. when we are at our most vulnerable.

I've had to jump through hoops with insurance bills before, it isn't pleasant
and I've got good health insurance.

Pricing structure would be challenging...monthly and use when needed, per
transaction, etc?

(didn't do any deep searching before posting, so I'm betting a hospital
billing concierge service already exists...)

Service should be called Auntie Kafka.

~~~
ryandrake
Yea, this sounds like a great idea. If I got a major sickness, I know I'm
financially screwed anyway, even with insurance, because I have no idea how to
navigate the insurance/hospital/doctor bureaucracy. I'd rather hire someone
like OP to be my "health care agent" and do all this paperwork and chasing
people down, in hopes he might be able to make my out of pocket bill $100K
rather than $1M. That kind of service would be worth more than lawyers charge.

------
gred
A big factor here seems to be lifetime limits to benefits:

> Financial toxicity led Fumiko Chino to co-write a research letter in JAMA
> Oncology last November. After her husband surpassed his insurance policy's
> $500,000 lifetime limit, Chino drained her savings to pay for his treatment.
> When he died, she was left hundreds of thousands of dollars in debt.

However, these limits were outlawed by the Affordable Care Act, even for
grandfathered plans:

[https://www.hhs.gov/healthcare/about-the-aca/benefit-
limits/...](https://www.hhs.gov/healthcare/about-the-aca/benefit-
limits/index.html)

~~~
zrail
Yeah, the study appears to be looking at 2000–2012. The lifetime limit ban
started on March 23rd 2010, according to this Vox article:

[https://www.vox.com/policy-and-
politics/2017/2/15/14563182/o...](https://www.vox.com/policy-and-
politics/2017/2/15/14563182/obamacare-lifetime-limits-ban)

Thanks Obama.

~~~
njarboe
Every European health care system, I believe, has some way of limiting the
amount of care provided to people. It is just not so out in the open as a
dollar cap on what people can get in a lifetime. Not every possible, super-
expensive procedure is approved to be available to people through the public
healthcare system. (Would love to hear of a country that has "universal health
care" that does not limit what procedures people can have done to see how it
is possible).

Everyone can't get the best possible care unless those experimental and
expensive procedures are just banned and we give up on expensive procedures
becoming cheaper in the future. Cancer is the biggest reason for this. If you
have a cancer and can afford to employ a small research team for a few million
a year, your chances them finding a custom way to beat it is much better than
just trying to select from the existing treatments already out there. Health
care already is 17% of the US GDP and the US government spends more % of GDP
on healthcare in America than almost all European countries.

Not sure the best way to a better health care system in the USA, but just
uncapping how much can be spent under insurance plans, while fixing one
problem, won't work in the long run (as we are already seeing).

~~~
DanBC
This seems to be pushing a myth: expensive treatments must be better
treatments, right?

We have very good evidence that these new, expensive, treatments do not extend
life and that they make quality of life worse.

England set up something called the Cancer Drugs Fund. This provided access to
new medication that hadn't yet been assessed for value; that were in the
process of being assessed; or that had been assessed and were found to be too
expensive for no benefit over existing treatment:
[https://en.wikipedia.org/wiki/Cancer_Drugs_Fund](https://en.wikipedia.org/wiki/Cancer_Drugs_Fund)

Most drugs paid for by £1.27bn Cancer Drugs Fund had no “meaningful benefit”
[https://www.bmj.com/content/357/bmj.j2097](https://www.bmj.com/content/357/bmj.j2097)

The Cancer Drugs Fund was popular with the UK press who pushed for it to be
expanded without bothering to see if it was extending life or improving
quality of life.
[http://journals.sagepub.com/doi/full/10.1177/014107681879680...](http://journals.sagepub.com/doi/full/10.1177/0141076818796802)

> Health care already is 17% of the US GDP and the US government spends more %
> of GDP on healthcare in America than almost all European countries.

And yet it has worse outcomes across a range of measures, including "life
expectancy".

~~~
chimeracoder
> This seems to be pushing a myth: expensive treatments must be better
> treatments, right? We have very good evidence that these new, expensive,
> treatments do not extend life and that they make quality of life worse.

It's not pushing any myth at all. As explained elsewhere government-run
systems like the NHS _do_ attach actual dollar amounts to treatments that are
effective and do extend life, but for which they're not willing to pay.

The NHS's version is actually quite ruthless when you peel back the details,
where they determine how "good" a person's life is, and essentially how much
they are willing to spend to extend that person's life by N years. This is, in
effect, a benefits cap, just framed slightly differently.

This is _not_ , as you are implying, saying "this treatment is ineffective or
harmful, so we won't pay for it". It is literally saying "we understand that
this treatment would extend this person's life by 5 years, but it costs
£50,000, and based on their condition, we're only willing to spend £25,000 to
extend their life by 5 years.

> And yet it has worse outcomes across a range of measures, including "life
> expectancy".

Life expectancy has so many confounding variables which have a much stronger
effect that it's ridiculous to try and use that as a measure of a healthcare
system directly. It's like trying to measure the fuel efficiency of different
models of cars by looking at the total number of miles driven by all drivers
of each car model in a given year. Yeah, there's... _a_ connection between the
two, but that's certainly not what you're analyzing when you try to compare
them naively.

~~~
DanBC
> where they determine how "good" a person's life is

No they don't. This is not true.

> This is not, as you are implying, saying "this treatment is ineffective or
> harmful, so we won't pay for it". It is literally saying "we understand that
> this treatment would extend this person's life by 5 years, but it costs
> £50,000, and based on their condition, we're only willing to spend £25,000
> to extend their life by 5 years.

This is just not true. Find just one single medication that i) extends life by
5 years ii) costs just £10,000 per year and iii) has been banned.

~~~
chimeracoder
> No they don't. This is not true.

That is literally what QALY is.

> Find just one single medication that i) extends life by 5 years ii) costs
> just £10,000 per year and iii) has been banned.

It seems like you don't understand how coverage works for cancer treatment.
The question isn't whether the medication is banned outright - it's whether it
will be approved to be used _for a specific patient_ in their treatment plan
(paid for by the NHS).

~~~
DanBC
> It seems like you don't understand how coverage works for cancer treatment.
> The question isn't whether the medication is banned outright - it's whether
> it will be approved to be used for a specific patient in their treatment
> plan (paid for by the NHS).

Please tell me how you think cancer drug funding works in England, because I'm
pretty sure you're wrong.

But let's assume for the moment that you're right: please link to an article
about a patient who would have been kept alive for 5 years if they'd been
given treatment but they were denied the treatment because it cost more than
£50,000.

If anything the UK was spending too much on cancer drugs that provided no
benefit - no extension of life, combined with unpleasant side effects that
lowered quality of life.

[https://www.newscientist.com/article/dn26785-the-uks-
cancer-...](https://www.newscientist.com/article/dn26785-the-uks-cancer-drugs-
fund-does-more-harm-than-good/)

[https://www.bbc.co.uk/news/health-35494660](https://www.bbc.co.uk/news/health-35494660)

~~~
chimeracoder
> Please tell me how you think cancer drug funding works in England, because
> I'm pretty sure you're wrong.

Just to be clear: you're telling me that you think QALY calculations are _not_
factored into the decisions of which treatments will be covered for an
individual cancer patient under the NHS?

------
cabaalis
I am a moderate conservative. I believe in self-reliance, fiscal
responsibility, limited government. But receiving a death sentence like this
one, physically and financially, is something I believe society could easily
work together to create a parachute for.

It seems reasonable to me that not all healthcare should be covered by the
government. Individuals need skin in the game for their own care. But
catastrophic, life-ending diseases like cancer are a public crisis that every
single one of us has been affected by in some way.

If there's a reason for government intervention of some kind, it's that.

~~~
sjg007
>Individuals need skin in the game for their own care.

So smokers who get cancer? People who are obese? A car accident?

How do you decide?

What's the skin? A deductible?

~~~
cabaalis
I don't know the answer. The government does make low-interest loans available
when there are natural disasters, as one example.

------
alejohausner
Perhaps the real problem is that chemo, radiation, and surgery don't really
cure cancer, in most cases. There is a lot of bad science in cancer research.
The "science" that bothers me the most is the use of 5-year survival rates.

Suppose that a cancer that starts at age 60 becomes symptomatic at age 65, and
kills the patient at age 70.

Scenario 1: you are 60 years old, get screened, and opt for treatment (who
wouldn't?). However, the treatment does temporarily put the cancer into
remission, and you are "cured" at age 65. But then the cancer comes back, now
resistant to the treatment, and you die at age 70.

Scenario 2: you don't get screened, and die at age 70.

Both outcomes are the same, but in the first scenario your oncologist declares
you "cured" at age 65.

This kind of statistical chicanery leads people to opt for treatment, which is
usually very bad for you.

If you or your child has cancer, could you bring yourself to not spend every
penny you have? Most people would opt for treatment. But it's often a futile
waste of money and life, as the article points out.

~~~
zrail
You're being very misleading when you say "in most cases". There are a lot of
very common cancers that respond very well to treatment.

"If you or your child has cancer, could you bring yourself to not spend every
penny you have?"

This is what health insurance is for. You buy insurance so that you don't have
to worry about monetary decisions and can make decisions based on quality of
life.

~~~
alejohausner
That's not really true. A few cancers can be put into permanent remission (eg
Hodgkins'), but most cancers kill you regardless of what you do.

~~~
zrail
You should do more research. Most skin cancers are trivial to treat.
Testicular cancer, one of the most common cancers in boys and young men is,
for the most part, extremely treatable as long as it's caught relatively
early.

------
so_tired
I am sympathetic. From HN stories, the US health care situations seems
abysmal.

BUT, i want to make 3 counter points, if only for the sake of discussion.

a. Cancer for many is a terminal disease. There are always some very very
expensive and experimental or marginal treatments. If u have money, and are
going to die, and decide to spend all you can to squeeze an extra year of life
, i am very sympathetic but even the most generous European have spending
limits.

b. This is about the US. The US has made a conscious decision to low-tax and
low-safety-net. This is very harsh for the ill or poor. But this choice is
reaffirmed every 4 years by sort-of-functional elections at multiple levels of
government. Bernie never even made it past the primaries.

c. No one mentions the non terminally ill 95% who presumably enjoy high
salaries for years and years (only in the US could a new $60K car be described
as "a low cost model")

~~~
J5892
Buying a $60k car seems like a completely insane concept to me, even with a
Silicon Valley tech industry salary. Even $16k (used) was higher than I wanted
to pay for my current car.

~~~
andreygrehov
Respectfully disagree. Recently leased a $60k car and I enjoy every single
minute I'm driving it. I'm not paying for a transportation vehicle, I'm paying
for joy and pleasure. What else should I spend money on? Burgers and coke?

~~~
yazr
/s Well - u could save up for cancer treatment /s

Seriously though. Enjoy it. I had a cool sport car as a young-ish engineer and
it gave joy after every long dreary day at the office.

~~~
sjg007
It's super awesome to drive your expensive sports car at 5mph in stop and go
traffic on the 101 or 405. s/ Just the best. /s

------
refurb
Interestingly, medical bankruptcies aren't all _that_ much higher in the US
versus Canada, who has universal medical coverage[1].

Turns out that a major cause of medical bankruptcies is the inability to work,
not just the medical bills.

[1][https://www.theatlantic.com/business/archive/2009/09/bankrup...](https://www.theatlantic.com/business/archive/2009/09/bankruptcy-
comparing-ourselves-with-our-neighbor-to-the-north/26591/)

------
chrisbennet
I think if I get cancer I'm just going to have to die. I can't leave my wife
destitute.

~~~
ams6110
Here's the thing. Cancer comes in basically two types. That which is
treatable, and that which isn't. This can be either because of the type of
cancer, or based on how early/late it was detected.

A lot of (possibly most of?) the money spent treating cancer is spent in cases
that have very little chance for long term success. I don't think it really
is, but it almost seems like a deliberate attempt to extract all the wealth
from the patient before he dies.

~~~
nowarninglabel
It'd be helpful to track down where the wealth goes. It seems to be broken
down between the care provider, hospital, pharmaceutical companies and
possibly the insurance company. Has anyone fully tracked down averages on
where the money tends to go (possibly different for different types of
cancer?)

~~~
noelsusman
Depends on the treatment. The cost to a hospital of a typical chemo visit is
roughly 50% drugs and 50% labor. An endoscopic surgical procedure for lung
cancer is roughly 70% labor and 30% supplies. The average total costs for both
are in the tens of thousands of dollars. That doesn't include fixed costs,
just variable costs.

------
maxxxxx
I have seen that with an acquaintance. She had insurance but there was a never
ending string of things that cost $20k here, $10k there until she was wiped
out and had to file for bankruptcy.

In the US even if you have insurance it's still a gamble whether you'll get
wiped out or not.

------
apo
_Of the 9.5 million cancer diagnoses studied between 2000–2012, researchers
discovered that 42.4 percent of patients (median age 68.6±9.4 years) spent all
of their money, averaging $92,098. This follows disturbing news from earlier
this year that 40 percent of Americans can 't afford to pay $400 in case of an
emergency. The math is not adding up._

No, the math doesn't make sense. Either the author of the linked article
misinterpreted the journal article, or the authors of the journal article
didn't reports their numbers correctly.

The only other conclusion might be that cancer strikes the "wealthy" (those
with 100K in savings) more than the poor.

~~~
labster
The poor just die from cancer. The lower classes "borrow" money from friends
and family, because cancer makes a better charity case than "my alternator
broke". The middle class, and lower upper class has savings and home equity,
and spends all of that to fight cancer. The upper class can spend whatever it
takes.

Though now that I think about it, maybe the alternator fix is the more
effective altruism, because it's something that can keep someone from falling
a rung on the economic ladder, and being unable to afford health care. There's
never enough, is there.

------
Alex63
1\. I think the title may be a little misleading. Only 3% declare bankruptcy,
though higher numbers deplete all their savings. It's hard to find a good
estimate of per capita "savings". A search indicates that the median savings
account balance in the US is about $5,000. The median 401(K) appears to be
about $36,000. Based on this, I'll assume that means the typical out-of-pocket
costs of cancer treatment are somewhere around $30,000. That seems in line
with what the out-of-pocket costs for 5 years of treatment might be under my
current coverage.

2\. The problem with any discussion of healthcare issues is that we are
naturally swayed by our empathy for those who are suffering. Almost all of us
would choose to pay whatever was needed to save a loved one, and would grant
that ability to others if we could. It seems simple enough to say "we should
spend less money on the military/international aid/tax breaks for
corporations/the NEA/etc." if it means that we can provide affordable
treatment to those who are suffering. Unfortunately, until the singularity
arrives there is probably always going to be a cost that is too high, and hard
decisions must be made. As a Canadian, I know that one of the downsides of
universal healthcare is that some treatments must be rationed and bureaucrats
will make decisions affecting the life of my loved ones. Now that I live in
the US I can avail myself of diagnostics and treatments that may simply not be
available in Canada. The cost may beggar me and the likelihood of a positive
outcome may be remote, but it is my choice, and a choice that may not be
available under other systems.

3\. No, I have not read all of the comments. As with many HN comment pages,
the marginal value of descendant comments seems to drop off quickly.

------
jlv2
Sometimes I think I'm really lucky. I was dx'd with stage 2b Hodgkin's
lymphoma 20 years ago. Half a year of twice-monthly chemotherapy and then an
agonizing month of daily radiation doses was able to eradicate the disease.
Because of the health insurance I had with the startup I was then working for,
my total out-of-pocket cost to was $0. We never paid a single co-pay or saw a
single bill for any of the treatment (there were co-pays for the 10 years of
follow-up visits).

To this day I don't know what the total cost of saving my life was. I guess it
was 6 digits USD.

I contrast to the health insurance I have now. Were I to get sick like that
again, I know my out of pocket expenses would be at least $8K per year, and I
expect I'd hit that limit several times over the course of the follow-up
period.

------
jamesb93
You should be more specific here. IN AMERICA. Developed countries dont have
this issue.

~~~
refurb
Medical costs were the cause of bankruptcy in 15% of Canadians over 55.[1]

[1][https://www.fraserinstitute.org/article/medical-
bankruptcy-m...](https://www.fraserinstitute.org/article/medical-bankruptcy-
myth)

------
ronju
What is the way to survive? <a href="
[https://www.youtube.com/watch?v=Qe3y04hYKOk](https://www.youtube.com/watch?v=Qe3y04hYKOk)
"> more information of health related video exjample united healthcare,
obamacare, health insurance, medical insurance, planet fitness others it
provide health tips and soulution this youtube video channel,cilick this
channel </a>

------
ttul
* In the United States.

~~~
expertentipp
In most of the world, even in poorer EU states, these super advanced and
expensive treatments are not available and people simply die without getting a
chance. Occassionaly one hears in media about some crowdfunding campaing for
„unique treatment in the US”.

~~~
icoder
Although a good point on itself to ponder about, I don't think in this
particular discussion it is logical to compare the US to non-EU and poor EU
countries.

------
he0001
I wonder how the predicted increase in life expectancy would effect this. I’d
say the probability of getting cancer increases with age and then also more
people will be ruined because of that, poverty in general will increase (if
people survive). I believe that those factors will be one of the toughest
questions for the future, and countries with no social way of handling this
will be effected more than those with it.

------
hi41
>When he died, she was left hundreds of thousands of dollars in debt

If a person dies, how can the bill go the spouse? I don't get this.

~~~
ams6110
She very likely signed agreements to be financially responsible for the
treatment. This is one of the very first forms a hospital will ask you to
sign.

------
emmanueloga_
In other news, the water is wet.

I've only been living for a couple of years on the US now but one thing that
is among the hardest to get used to is the costs of medical care.

Often times going to the doctor once shields 3, 4 different invoices. I once
made the rookie mistake of going to an E.R. for something I could have waited
for, I think I had one of those head splitting head aches. They charged me
something like $800 or so for ~10 minutes with the doctor. Another time, I had
to pay something crazy like $300 for an X-Ray. Gotta pay for the cost of
research of development for that cutting edge technology, X-Rays, huh? :-p

I can only imagine what it would be like if I had a very severe condition like
cancer.

This is specially shocking for me coming from a country where health care is
of high quality and publicly accessible (Argentina). Private care is also
available and reasonably priced, the reasons to go that route is shorter wait
times for appointments, nicer facilities, etc.

------
bondolo
What are your life savings for if they can't be used to save your life? Every
other use is fortuitous but until you have more money than you could spend to
save your life then that is the purpose of that money.

~~~
amanaplanacanal
Most people would like to retire some day, I think.

The good news is we cured your cancer! The bad news is that you will now have
to work until you die.

------
disordinary
I had an uncle who was quite well off and ran an exotic car garage in the US.
He had all the insurance, etc. His wife got cancer, insurance wouldn't cover
some of the treatment. She died, he went bankrupt, then killed himself.

I'm glad I live in a country where I literally don't even think about
treatment or care, it's just not something I worry about. I've had a few
relatives in NZ who've had cancer, they've all had excellent care which
prolonged their lives and when they passed they didn't leave their survivors
with the financial strain in addition to the heartache of losing a loved one.

~~~
refurb
The likelihood is if a cancer drug isn’t covered in the US, it’s not covered
in NZ.

------
yc-kraln
42 percent of new cancer patients _in the united states_

The rest of the developed world has a healthcare system.

------
nil_pointer
Sad, but not surprising. The majority of bankruptcies are caused from medical
bills.

------
aerodog
Meanwhile, in Turkey... [https://www.dailysabah.com/turkey/2018/07/06/cancer-
treatmen...](https://www.dailysabah.com/turkey/2018/07/06/cancer-treatment-
now-free-in-turkeys-landmark-health-reform)

~~~
anticensor
Free treatment is limited to standard forms. Research treatments not included.
Source: my grandparents receive cancer treatment

------
pascalxus
Normally, I'm all for invisible hand capitalism for most things, but clearly
in the case of medical services it's completely broken.

What we need is price ceilings on medical procedures, something reasonable.
Perhaps, cap procedures cost in some way, maybe 1k to 4k based on what it is
(make it illegal to charge more and hold hospitals financially accountable).
There has to be some kind of cost control, either from the government or the
insurance companies. We can't expect patients to choose these cost controls. I
realize this means that some procedures won't be done but it's better than
bankrupting everyone left and right.

~~~
malvosenior
It's only broken because of regulation. If I could shop across state lines for
insurance, prices would drop. I may not even opt to get insurance as I'm very
healthy and I've never had medical costs approach even an order of magnitude
of my insurance costs. Yet I'm forced to purchase this unneeded service by the
government, pushing up demand and prices in an artificially controlled market.

~~~
amanaplanacanal
I see this mentioned a lot as a cost cutting measure: buy insurance across
state lines. I don't see how purchasing insurance in another state would help.
Every medical facility where you live would then be out of network. How do
people think this would work, exactly?

------
pvaldes
... in USA

------
emayljames
"42 percent of new _US_ cancer patients..."

------
ameixaseca
*in the US.

------
Pharmakon
Sometimes I’m just amazed that people haven’t risen up in bloody revolt yet.
Recently my mother had a flare-up up radiation-induced pneumonitis and the PPO
insurance she pays $14,000 annually wouldn’t approve a single unit of Advair.
It took a week of talking to doctors and insurance drones to figure out that
they were pushing her to an alternative that cost them $100 less.

If I woke up tomorrow and people were burning Wall Street to the ground I’d be
less than shocked.

~~~
stewbrew
In the US, it would have been sufficient to vote for a different party. Enjoy
the government, the majority of you people voted for.

~~~
rhcom2
In the US we are currently enjoying the government (at least in the executive)
that the majority of people did not vote for.

~~~
CelestialTeapot
And many states are enjoying the government that jerrymandering and voter
suppression efforts provide.

------
mikeyouse
Feels like the headline should include "In America". This certainly doesn't
happen in the rest of the civilized world.

~~~
colordrops
Is China civilized? Cuz it definitely happens there. I've heard a doctor ask a
family how much money they've got in the bank, and took it all to keep a dying
uncle on life support for another month. A crime.

~~~
Retric
> Is China civilized?

No. The rampant corruption, lack of free speech, etc don't qualify as
civilized IMO.

~~~
PenguinCoder
By those metrics (and others), United States isn't a civilized country either.

~~~
dionidium
This is silly. Please don't make easily-refuted, throwaway political
statements like this. On almost any corruption index, the United States ranks
far, far better than China. Here's one example:

[https://www.transparency.org/news/feature/corruption_percept...](https://www.transparency.org/news/feature/corruption_perceptions_index_2016?gclid=CjwKCAjwgabeBRBuEiwACD4R5o0dlkb6DcpygujvgIFhuljCeU9CoNTB7mkDw_q9ZfDVil0hQFSjBRoCULYQAvD_BwE)

People do try to measure this stuff.

~~~
jahaja
That link measures peoples perception. My perception is that the influence of
money is blatantly epidemic in US politics. But it uses an euphemism;
lobbying. Luckily it's not corruption if it's legal.

~~~
Retric
Lobbing is not inherently corrupt. When a small group cares a lot about a
specific issue say astronomers and light pollution lobbing is simply trying to
get politions to pay attention to an issue. That effort is not free, in some
cases they approach the issue by mailing or dolling people directly, in others
they pay somone else to make these calls and phrase things in political terms
etc.

Now, that does open the door for people to game the system, but you can’t
simply define all lobbing as corruption or even all lobbing you disagree with
as corruption.

So, yes their are plenty of blatant cases of corruption but they are
relatively rare compared to China.

~~~
jahaja
Why is it important for you to issue a petty nuance to this that you should,
and probably do, realise that I already acknowledge?

Compare: "China is actually not inherently undemocratic there's a lot of local
officials etc being voted in".

Yes, but on the systemic, overall, scale there's a blatant democratic deficit
present for all to see.

~~~
Retric
Because it's a question of scale not kind, when you go to the DMV etc in the
US you don't expect to bribe anyone. That's far from culturally or
historically universal, so day to day it's just not that corrupt relative to
other countries.

Now, is politics in the US rigged? Ehh. You do need to actually participate to
be counted. Don't vote and don't lobby then sure they your voice is not heard.
Now does everyone get equally rewarded when they vote or lobby? Clearly not as
every vote is not equal and frankly that's part of our constitution. So is the
US a democracy? Nope.

On the other hand the US is not a totalitarian state, the will of the people
does actually matter and things happen without bribes every day. Compare it to
say England where the landed gentry got to hold extra special power rather
than ever shifting groups in the US and yea it's not that bad.

~~~
jahaja
Indeed it is. The scale I wrote about above was lobbying [people in power],
not giving the highway cop half the official fine.

------
anigbrowl
Thanks, capitalism.

Snarky as that may sound, it's a simple statement of fact: our society places
a higher value on capital allocation than human life, and so the most
vulnerable people are stripped of their assets and dignity to satisfy the
demand for wealth.

Frankly, I think socialized medicine would also reduce violence in society if
deployed as part of a larger economic realignment.

~~~
debacle
The real value of the work output of a single human life tends very close to
zero, unfortunately.

Excepting some intrinsic value to life, in the grand scheme of things most
people's lives are not worth very much.

~~~
feistypharit
There are infinitely many ways other than work value by which to value a human
life. Some day, I hope you learn this. Most of what really differentiates you
from anyone else is luck.

------
tschellenbach
US is the only western country that has this problem. It's also one of the
richest countries in the world.

