Often we talk of the future and it's wonders waiting to be discovered, but the here and now has become equally astonishing.
The breadth, depth and scale of human ingenuity and endeavour is jaw-dropping and here Simone and her story is another example.
Maybe I'm being trite by looking for the good in the bad but pause for a moment and think of all that has been learned, how we have built a society and developed infrastructure such that at this particular confluence of time and space we as a species are capable of performing this life saving surgery.
And half a world away I follow the story through yet more confluences of knowledge and development.
It is astonishing. i know it's tempting to take it for granted but take a step back and think about it for a moment. It's astonishing.
I'm 32. I can only imagine how much more marvels I'll witness in my life, either remotely or in person.
And when you arrive at the hospital it gets really cool - at a level 1 trauma center, they should be prepared to give you a CT scan and treat you in 10 minutes or less. That might involve snaking a tiny wire through your arteries all the way from your leg to your head, or administering one of thousands of drugs that has exactly the desired effect.
It's easy to take it all for granted but the technology and systems in place to take care of us are amazing.
To quote the lead surgeon during the 6 month follow up - "I stopped looking at what we billed, and what I got paid years ago. It never made any sense to me, so I focused on the patient outcome, which did make sense to me". Great human, saved my kids life, was totally supportive afterwards and stayed in touch for a few years.
Medical practices in the USA makes no sense to me. I am Canadian.
Relevant to Simone, I have a friend who had the same problem and actually went to the same surgeon for the problem, but 5 years earlier. My son was recovered in a few days, she spent 6 months in the hospital to recover. The change was a new technique. They fixed my son through his leg, my friend had her skull removed and replaced.
Humanity can do awesome things sometimes. Sometimes great, sometimes horrid.
Now, many countries have this problem solved – for now. As the population ages, the solutions may have to change everywhere.
What I find interesting is that the discussion is almost never framed to address the actual issue: the medical industry in the US simply overcharges with impunity. I was shocked to discover that labor (as in, doctors) isn't even the biggest line item in many (most?) medical bills. Hospitals and clinics will simply crank the bill sky high and then have you or the insurance try to haggle it back down, sometimes at a 3 or 4 digits percentage difference. It's insane. There's also zero transparency on pricing, so it is difficult to shop around even if you have the time.
First off, this would kill of a huge part of the open source community (the free as in beer software would all disappear). Employee contracts might be structured in such a way that the employee is responsible for any potential liability. Any customer who felt wronged could sue the individual developer who wrote that code.
These lawsuits would then be decided by a jury of people who know nothing about software development. One of the biggest deciding factors in that case would be who could hire the best lawyers and which lawyers could bring in the best "software experts" to explain why the developer did or did not make a mistake. Even if it was ruled that the developer did not make a mistake, they would be unlikely to ever be able to recoup their legal costs. Meanwhile the payouts from the cases in the customer's favor are so large, people are now incentivized to sue over a much wider range of possible mistakes.
These developers just need to accept that these lawsuits and the wasted time and stress that results from them is simply a part of their profession. Regardless of a developers skill, a majority of developers now won't be able to make it through a career without being sued at least once. Eventually the software developers turn to insurance which costs tens of thousands of dollars per year to protect them against these risks.
Would you think this is a fair system? Could you see that system having a negative effect on the software industry? Do you think this would push people out of the industry who might otherwise be great developers? Would this system, that is ostensibly designed to protect customers, actually result in a better level of service?
We already live in this world, it’s just that most software had zero impact on the wellbeing of individuals and/or its mostly licensed as-is.
Software with actual guarantees behind it tends to be very expensive. Their users have tort recourse.
Also major software companies get sued and settle on a fairy regular basis.
I agree with the "most" designation, but there is still plenty of software that does have a direct impact.
>or its mostly licensed as-is.
Which is exactly my point. Most software comes with an agreement that limits the liability for the company or person who created or sold the software. Developers are able to hand waive away that legal liability in ways that other professions, specifically in the industry, are not able to.
>Software with actual guarantees behind it tends to be very expensive. Their users have tort recourse.
But that is dictated by the contract which sets standard that is above the legal bare minimum. The legal minimum is much higher for doctors.
>Also major software companies get sued and settle on a fairy regular basis.
I will admit my analogy isn't perfect because of the relatively high number of private practice doctors compared with the relatively lower number of smaller ISV developers. Doctors as a whole have a much higher exposure than software developers as a whole. That is why I noted that contracts might change if software malpractice cases really became a thing.
My grandmother was born in 1888. In her lifetime, she saw the first automobile, the first airplane (propeller-driven, followed by jet aircraft!), radio, "talkies" (movies with soundtracks), television (black & white, then colour!), stereo records, indoor plumbing and electrical service, electronic computers, rockets, artificial satellites, the moon landing, refrigeration(!), vaccinations and antibiotics(!), the internet, and on and on.
She lived through two world wars, and the aftermath, losing brothers and friends as a result. There were joys and horrors to be sure. She remembered seeing the first car (which she called "a noisy piece of junk"), and the first time she spotted an airplane, and her first electric appliances (refrigerator and clothes washer).
For a thousand years prior, life had changed but only incrementally -- someone from the year 900 could still recognize life in 1400. However, in this short 100 year span during her lifetime, from 1890 to 1990, the transformation of civilization was so thorough and amazing that it is difficult to appreciate civilization's quantum jump.
What a profound change! Just stop and imagine this for a moment: a world without automobiles, where all travel is by horse/carriage, or train, or boat, or foot. No antibiotics. The milkman delivered (unpasteurized milk to the front porch) and the ice man delivered a block of ice every few days. There was no telephone -- a telegraph was the "text message" of the day and the radio was as close to instant information as one could get. There was no telephone. Photographic news could take weeks/months to travel across a country or an ocean, and the only way to cross the oceans was a boat with cloth sales or a steam boiler and a commitment of months.
So to think of the transition from a time where a little scratch could lead to an infection that kills you, or an injury to a limb means chopping it off and hoping one lives, a scientific (lack of) understanding illuminated only briefly by Phineas Gage's tamper-rod-through-the-frontal-lobe injury to a time where surgeons can cut abnormal things out of your brain and you go home in a couple days functioning normally is just astounding.
We live in a time of miracles. There is no other way to say it.
Before the last century, the majority of humans supported themselves by farming, and farming didn't change that much until the advent of engines.
But then I remember it's only happening because someone's in severe trouble in the first place so it's like "humanity is awesome...oh something not good is happening"
Thank you 'PuffinBlue and 'goodells for bringing this observation up. The civilization our predecessors built and to which we have privilege of contributing is, for all its failings, truly miraculous.
 - https://en.wikipedia.org/wiki/Heart_(novel)
The mobile CT scanner is also not super helpful for much other than determining whether a potential stroke patient has a grossly hemorrhagic stroke. In that one case, it is beneficial, but I don't think mobile CT scanners are used for much else.
And there's parts of the world where this is simply not a thing. We take it for granted.
It doesn't compare to brain surgery, but the experience was so profound it came close to breaking my mind (if such a thing is possible), I had to give up and leave, because I just couldn't take it.
I can even just say "call (insert name of restaurant)" and it directly calls them up. I am beyond blown away. The future is now.
As for that bill -- I'm curious: is there any resource I can look up to see how much of that the average Medicare/Medicaid/private insurance plan pays?
I ask because I just had two teeth repaired after a bike accident and it'll cost me ~$100 after insurance covers the other ~$500. By that ratio, she'd be looking at ~$38,000 bill.
If anyone knows why care providers high ball the rates on bills when insurers have negotiated rates, I'd love to hear it. Is it something in the insurer's contract that gives insured the illusion that insurance is saving them a lot?
In any case I've received first medical bills in the many thousands of dollars only to have them go through four or five revisions before settling down to hundred dollars. This is because the first bill you receive reflects all of the claims to insurance (e.g. if your insurance covers 80% you're on the hook for 20%) but as the insurer and the care provider negotiate and revise the billing the price falls.
In my opinion it's a horrible experience for the insured and the added stress of the huge bills certainly doesn't help with recovery.
I really wish people would talk about these sorts of soft costs more often.
I grew up in the UK, moved to the USA in my mid 20s. While growing up, my parents divorced and my mother had to take care of me and a sibling. All 3 of us had medical conditions that needed regular care/checkups.
Not once did my mum ever spend hours on the phone chasing down bills or insurance rejections. We never paid out of pocket for prescriptions, doctor visits, A&E (USA translation: ER) visits, etc.
That stress, or lack of, is a huge factor in quality of life for a family.
Unfortunately this sort of discussion is heavily politically charged. I really don't want to start an argument thread comparing how taxes pay for socialized care, etc.
It can get even worse and more subtle than that. I don't even get care in some situations that feel optional because I don't know what the true cost will be. I have money and insurance, but I'm instinctively uncomfortable about electing for services that I won't know the true cost of until weeks later after the care provider and insurance company have done their dance.
There's the deductible which I understand but that's not a blanket thing where everything is free after that. There's always fine print and a cloud of uncertainty about where the limits are for each category.
I'm starting to break this instinct, Blue Cross seems transparent enough when I call them and have a specific question. But that's because I'm getting older and taking health more seriously. I went through a long period when I was younger just ignoring symptoms when I could. Nothing bad happened to me but I've seen friends get diagnosed with cancer that might have been more treatable if found sooner. How many insured people don't get care that they should because they're confused or cynical about the system being set up to extract money from them?
Healthcare in the US is screwed up beyond belief.
In the usa my insurance lets me go to 10 doctors for differing opinions. I can go straight to a specialist. When I need non urgent surgery it's scheduled with a few weeks instead of months.
Only if you have good insurance. Insurance companies have been cracking down on this behavior. For example, there are certain specialists which are straight-up not covered unless you have an explicit referral. Likewise, networks of providers will vary. For example, sometimes your area's top hospital won't be "in network", so you're now paying significantly more out-of-pocket for going out of network.
If you currently are enjoying this benefit, please anticipate that privilege to be gone within a decade, regardless of what direction the US healthcare market goes.
1. Doc recommends a long list of blood tests for reasons she can’t seem to articulate. She’ll also recommend a testing lab. Oh, and see this specialist!
2. Now I have to figure out:
a) which tests do I actually need and which ones are just being recommended out of abundance of caution or because the doc needs to protect herself legally?
b) will my insurance cover the tests I’m going to do? If not (or even if so) how much will they cost me?
c) will my insurance work at this particular lab? The lab often won’t know.
d) do I really need to see this specialist or is my doc just tossing some juicy business to her med school buddy?
e) is the specialist in my insurance’s network?
f) how much is the specialist’s bill likely to be?
g) how much will my insurance pay?
3. Do all the things (or not)
4. Random bills for random amounts start landing in my mailbox over the next few months. They could be anywhere between $100 and $10,000, totally impossible to know ahead of time. I now have to pick up the phone and start negotiating with the doctors and my own insurance company, figuring out what I can pay now, what will have to wait, etc. Usually the insurance company will say something about a deductible and “you have to pay LOL.”
The stress is enough to give me an ulcer (which I’d need to visit yet another specialist for, is this one in-network or out?)
There are still a occasional billing hiccups but the big tradeoff is that I can only visit the Kaiser hospitals except if I'm traveling and have an emergency.
Only thing I paid? The taxi ride home. For anything else there was my insurance card.
This is the same type of insurance plan 89% of the population uses – including the unemployed, middle managers, elderly, students, chronically ill, and always healthy.
Oh, so you don't pay for your insurance card? Nice deal! Because I also have public health insurance in Germany, and last time I checked, it cost 14% of my gross salary.
For employees, half of the fee is payed by their employer.
If you have to pay the fee on your own and miss at least two months (which can't really happen for regular employees as the fee is taken directly out of their paycheck) the fees can be collected with exactly the same procedure as other taxes. Until this happens you are only covered in an acute illness or pain situation, pregnancy, and for some preventive checkups. Health insurance (both private and public) can never be cancelled for nonpayment.
> I can go straight to a specialist.
Me too. But if I schedule an appointment with any specialist it's going to be at least a month. And after that appointment, the followup will be in another two months. The appointment costs at least $400 and gets me about 10 minutes of face-time with the doctor but about one hour with the administrative/support staff.
> When I need non urgent surgery it's scheduled with a few weeks instead of months.
That is true, because that's the bread-and-butter of the McMedicine world. If however you need to do something which is not an emergency and slightly off the beaten path in terms of symptoms or which crosses medical specializations, good luck coordinating medical care. You will be scheduled in a couple of months to minimize liability, so that perhaps it goes away or you go away.
Not all insurances are equal, you or your employer are paying for that privileged and can obviously afford it.
You should price out insurance options for a minimum wage job and compare it to your own to see just how lucky you are.
Cadillac insurance, PPO? Most people have HMOs which don't allow that.
In socialized medicine doctors usually aren't profit driven and their job/salary are dependent on the level of care they provide and not the number of patients they churn through.
The difference is if I couldn't afford to pay, I would've been seen based on the urgency of the condition at no charge anyway.
For those who can afford that class of insurance, maybe. I had to wait 3 months to set up my primary care physician, and for a specialist the initial wait of 4 months turned into 6 after they rescheduled me. I lived in Boston where you pretty much can't throw a rock without accidentally hitting a physician.
Also, as someone who has lived in Germany and has family in Germany, these conservative anecdotes about the quality of American care in comparison to Europe always strike me as full of shit. They don't align with any reality.
When my daughter is old enough, if she wants to go to university or college, I will do my best to pay for as much as I can. The great thing about this country is that if she gets seriously sick I won't have to choose between her health and her education.
The US healthcare system is barbaric.
What insurance covers 9 second opinions?
You can still go to 10 doctors, and pay for 9 of these visits.
US companies operating in the UK even tend to provide private healthcare insurance. Such "perk" makes UK employees chuckle, but hey, if you want private healthcare, the same US/multinational corporations operate in the UK too.
All told it was ~18 weeks of hospitalization (the only major procedure was the c-section, and obviously the NICU care is a little more intensive than average, but neither of the twins needed super high acuity care). Total bill was a bit over a million dollars. We were out of pocket ~$5k (our annual out of pocket max at the time).
The percentage of the population who don't have anything like that kind of money in savings is huge. And that is after you already pay huge amounts for insurance.
Additionally, the less money you make, the worse coverage you probably can afford, leaving you even more exposed.
You're absolutely right that it's insane that Americans talk about this as if it's just the only way things could work.
I constantly hear economists saying people are spending outside their means, but when the price of getting sick with a throat infection is beyond their means, or will set their savings back by months or even years, is it really the people who are at fault?
Maybe if we don't want people spending beyond their means, we shouldn't have highly paid professions entirely devoted to getting people to spend without regard to their means.
Those who are fortunate to have good benefits are also usually able to set aside money for medical expenses. On the opposite side of things you end up having people with poor to no insurance with medical bills of more then they can afford to ever pay.
How do you do that though? The video which started this discussion is a young healthy woman who suddenly discovered she had a brain tumour. It could happen to anyone.
Fair enough, if I have a large amount of savings I might try to reduce the monthly payment by increasing the amount of risk I'm taking. But aren't those the people who would be most likely to have their insurance as part of their benefits package and so aren't paying for it directly anyway?
In my case we are offered a HSA plan that the employer ends up paying us a small amount by contributions into your HSA account. That is a high deductible plan though so you will pay for everything until you hit that deductible.
We are also offered more traditional 80/20 and 90/10 plans which have a much higher monthly cost but spaces out the cost of things more as the deductible is much lower.
The HSA plan is very risky for the first year as my max out of pocket was more then I was legally allowed to contribute to my HSA. The second year I had enough savings put away where even if I ended up with a giant expensive issue I had enough put away for that max out of pocket number. This plays well into the scenario in the video. I have to protect myself going forward from the unforeseen medical issues. In my current situation that means making sure I have at least 1 years worth of my max out of pocket expenses saved up. Now I am covered even if unexpected things happen.
As a single adult with a good job it is much easier then if I had a family or was working a lower paying job. Even then you can do all the calculations but the risk factor goes up with the more people you have as the unknown portion grows. There is no good solution, that I know of, with our current healthcare system. I just try to play the game and do my best to stay healthy and prepare for the day when I am not.
Like gun control the issue has reached a stable equilibrium of political stupidity and I don’t see how it could change in the current climate.
I have no sympathy whatsoever for my hostage-takers, but I'm unlikely to fight my way out of this one, so might as well go back to talking about out-of-pocket maximums until I can make a shiv out of this toothpick.
I will tell you it's HEAVILY dependent on the zip code and procedures.
Private insurance is a whole different mess, likely going to hit deductible and be done. Last time my partner had to have surgery and billed insurance she paid $1000 and the insurance picked up the other $10k+ (precancerous mass removal, 45 minute surgery).
There is no publicly available source for price cross lookups. This is largely due to the fact that billing, coverage and pricing varies not only from hospital to hospital but even within the same provider on the same service (a given CPT). So now, there is no way to know the likeness of billing/coverage and it's also highly likely that if she disputes the claim, or there is a renegotiation then she will end up paying significantly less.
EDIT: Ok, she lives in San Fransisco now. Didn't know.
That $5k (for me) resets every year.
I really, really wish insurance was less confusing though! So many copays, coinsurances, deductibles, out of pocket maximum, lifetime maximum, different tiers of drug prices, etc etc.
That stuff should be made simple by law.
(I have no knowledge of health care in the US - both countries I lived in have free health care)
And I'm glad she had insurance, even more so considering she lives in the US. In our case he had it too, but where we live the top neurosurgeons unfortunately don't accept it – you need to pay the operation yourself. It can be incredibly expensive as she mentioned.
It's great to hear she's doing fine. I don't recall ever being so happy about the health situation of someone I didn't know 10 minutes before. What a beautiful video.
This creates a relationship where doctors get paid much less than they would normally charge (e.g. $20 for an insurance-paid appointment vs. $100 for a customer-paid appointment). But this way they end up receiving a steady number of clients from the insurer. And in most cases doctors have to accept this deal because they don't have enough demand on their own.
Naturally, that's not the case for top neurosurgeons. They have way too much demand and can make only a few surgeries per week. So virtually none of the top ones agree to being "accredited". They make an order of magnitude more money by charging the customer directly.
If you decide to use a "non-accredited" doctor you have to pay out of your own pocket. Typical insurers won't reimburse you in this case, and even the high end ones will give you back only up to 10 or 15%. They do cover for hospital expenses (room, nurses, meals, etc.), but these are a small fraction of the cost of brain surgery.
There are some different insurance plans that will reimburse your customer-paid appointments/procedures, but – since the cost for these visits is way higher – these are plans that only multi-millionaires can afford.
Luckily being UK based I didn't have a bill of any kind to pay afterwards and was paid in full while I recovered.
It is great to see her doing so well. Medicine has come a long way... the bills not so much.
Yeah, cancer-related bills can add up fast. Worse, they'll send you bills for years after the fact... my father had been dead almost a decade from his cancer and the occasional bill would still come and my mom would have to spend hours arguing with them on the phone "uh yeah, he's dead, he's been dead, this happened a decade ago, get your shit together" and they'd usually be all 'oops our bad' almost like they were trying to double dip.
We need some serious healthcare reform in the US.
Then when a real bill comes they get angry at you for ignoring it, even though it was mostly indistinguishable from their bullshit bills.
It's this whole circular firing squad of people charging others as much as possible for every little thing. Individually you may do OK, but the system is made more and more complex and stressful with each extra charge.
If everyone really internalized that it could just as easily happen to them, I bet things would change pretty quick.
Paul Krugman has also mentioned, the insane thing is, many of the rich in the USA who inherited their wealth or got lucky with investments also believe that they're successful not because of luck, but because they're hard workers...
I think that, frankly, those two are in opposition to one another. Self-sufficiency at scale is a game of numbers and luck; systems of thinking that try to put more emphasis on mutual support and shared responsibility for success seem to work more towards eliminating luck as a factor.
A) Healthcare costs are too high, and it's due to malpractice/overregulation/other government influences.
B) In the event that an individual can't afford healthcare, the community will pick up the tab -- and have the money to do it, since the government isn't taxing it away from them.
Not at all:
If you multiply inequality times lack of social mobility, US scores at the bottom across developed countries.
It always finds the form of "America is the richest country in the world, yet they can't [insert problem]."
This assumes that there is some objective resource need recognition system and misses that there is no overarching explicit capital allocation system to direct funds in such a way.
The cash balance of Apple corporation has no connection to whether a blogger can afford brain surgery or not.
So I'm not sure why this keeps coming up.
The US government pays more for healthcare than some other western countries, but gets worse outcomes across a range of measures.
"America has enough wealth, why can't we just enact single payer?"
It completely ignores the structural challenges to doing that.
That ultimately means that they're locked into what their insurance company mandated health regimen should be. But at least they can sort of choose their insurer, or no insurer (which is usually 10-100 times cheaper on the total medical bill).
All of a sudden, my choice to say, engage in martial arts or boxing, goes from a personal decision (Do I want to do this? Do I have the money for the gear? Is this in my risk comfort zone?) to a decision involving the government (is this behavior too risky for the general pool of insured people?)
Healthcare is not free. Healthcare research and technology is in fact, extremely expensive. Somebody is paying - whether that's the individual via an insurance pool or the government through taxpayers. Does the person paying your bill have your same prerogatives in mind?
I've never seen anything about martial arts, or indeed about sports in general. I'm sure it costs more than £0/year to treat the resulting injuries, just not enough more to make it worth worrying about by comparison.
Real life on YouTube is better than any other content out there ;)
Great human being, glad things went well for her.
I played the brain tumour game a few years back. Healing can really take the wind out of your sails so I'm glad to see she still seems to have a lot of energy.