The most interesting stat I ever heard about Medicare was this: prior to Medicare the number one cause of personal bankruptcy in Australia was medical bills.
So I'm with Bernie on this: health coverage for all is an incredibly important goal.
While we're at it, let's end the monopoly given to drug companies on the sale of pharmaceuticals in the US. You should be able to legally import them from, at the very least, any NAFTA country and any EU member.
I think repealing this would be a good start. All other industries are required to provide price lists. My friend went to the ER recently for a sprained thumb. They wrapped it in some bandage and he got a bill for $14,000.
His insurance is covering 80% but he is still on the hook for $2800 for a sprained thumb. Something is not right here.
Unless its an actual emergency, go to urgent care. I live in a pretty expensive area of California and they still only charge $95 per person they see. And our insurance covers it completely. And rightly so, they would much prefer a $95 bill to a $14,000 one.
With kids we go a couple times per year. They definitely have saved us a lot of money and time.
Years ago I crashed my mountain bike and had a high suspicion that I had broken one of my fingers. Urgent care was closed by the time I got home and cleaned up and my college roommate was in town so I met up with him after taping my fingers together to prevent unnecessary/unplanned movement. Urgent care confirmed a break the next morning, and fixed everything for $300. Healed perfectly.
Anyway, anecdotes are just that, but the emergency room is not the place to go for "simple" things like a possible sprain, minor break.
Deep cut at 9pm... emergency room is only option.
In contrast if you have not met your deductible and say you’re paying cash, it’s often cheaper as the cash price is something like $75.
I got in an argument once at an urgent care on this topic. I asked how much they would bill my insurance (“We can’t/won’t tell you) vs not having insurance and paying cash price ($75). They then proceeded to insist I give them my insurance information as “Sir- you must use your insurance. That’s illegal!”.
I've got family in health management and THEY can't reliably figure out what a procedure costs(not even something like a simple statistical characterization) much less what they should charge for it.
higher bills means more money insurance companies can skim off the top without patients objecting. direct costs are basically pass-throughs to policy holders. the risks are higher but execs are in it for salaries and bonuses, so that exhibits the principle agent problem.
Just about every country in Europe has private hospitals that will do non-emergency surgeries without wait if you pay. They'll also have no problem quoting you a fairly exact cost if you call them up.
I can't get better care even if I pay for it, I'm only legally allowed to pay only for trivia; the only care available to me is the "free" (read: costing ~8% of my income in mandatory medical tax) one with, yes, months of waiting and nobody giving a damn about you.
It's almost certainly better than the US system, but it's not all roses in EU either.
edit: since this thread is about cancer, I will not reply more because it's OT in pretty fundamental ways. The US healthcare system has massive issues, but I am not sure this particular case relates to the thread or is a great example of the dysfunction in general. A price sheet is not possible for "my thumb really hurts" ... it will depend on a lot of situationally appropriate decisions being made by the attending that cannot be predicted.
I live (well, lived. currently in the UK) in Australia, and the concept of a $14k bill for a sprained thumb is so out of my world. I cannot fathom how anyone would find that even remotely acceptable.
I have another story that is cancer related. Four years ago I had cancer surgery, in the private system. The public system judged that I could wait a month or two (our system isn't perfect), but I was fortunate to have health insurance and elected to be treated immediately. After a few days at home I awoke in the most excrutiating pain imaginable. I was just able to stagger to the phone to call for an ambulance. I would judge it was less than five minutes before I heard the wonderful siren of an approaching ambulance with well trained paramedics and their lovely lovely morphine. It turned out I had a relatively rare complication, a urinoma, my resectioned kidney was leaking urine into my abdomen. Ambulance care (google "Wellington Free Ambulance" it's a wonderful thing), ER assessment, CT scan, stent insertion to help the kidney heal, five days in hospital. Total cost: Who knows, probably astronomical. Total bill: zero dollars.
I love capitalism, I'm a true believer. But I believe even more in a compassionate society and it seems to me that means not using capitalism as a solution to all problems. It makes total sense to have a model that relieves victims of sudden medical trauma from financial stress and spreads the cost across society. The victims are not well placed to play the role of rational economic actors.
You mean total bill zero dollars. Cost was much greater than this, it just wasn't covered by your mother.
Sure in hindsight it’s a sprained thumb, but likely because of pain thought to be broken or worse...requiring x-ray and being set by a trained professional or maybe even surgery. It is a thumb so it would be less than ideal to lose feeling or mobility or the thumb itself (say there was nerve or circulatory damage).
You can keep a lot of your assets, generally including your retirement accounts, at least some equity in your home, your car, your personal property. Your credit is badly dinged and you'll have trouble borrowing money for a while, but even that is only a temporary setback.
I know people who have gone through it, in once case more than once, and at least from appearances they have a pretty normal lifestyle.
The recovery from a bankruptcy is probably a walk in the park compared to recovery from cancer (not speaking from experience). Ultimately it's just money.
Sure, but they're also dramatically less likely to survive the cancer than Americans are at a population level. There have been multiple long-term studies on cancer survival rates that have demonstrated this.
And it's notoriously difficult to compare. If cancer is registered as "discovered" early, because a for profit doctor starts treating it early, but the government hired doctor maybe doesn't, the early treated will statistically appear as living longer.
First, you're posting data that isn't relevant: that's the rate of cancer incidence, not the survival rates. That says nothing about how well the cancer is treated.
Secondly, it's nonsensical to compare aggregated cancer statistics between countries, because the demographics vary drastically, many cancer risk factors are highly hereditary, and the survival rates for different types of cancers vary so dramatically.
If you look at the actual survival rates, once adjusted for racial composition and type of cancer, the US comes out far ahead. https://www.ncbi.nlm.nih.gov/pubmed/18639491
2. The data is talking about 5 year survival rates and not actual survival. The US Healthcare system is great at keeping people alive who should have stopped treatment long ago.
3. The US is behind on every other major health indicator, Infant Mortality, Life Expectancy, Cardiovascular Disease, Obesity etc. Cancer isn't the only expensive illness in the US.
This thread is overrun with Astroturfers.
It's from a study published 10 years ago. The study was repeated more recently and republished less than a year ago, reaffirming the original results.
> 2. The data is talking about 5 year survival rates and not actual survival. The US Healthcare system is great at keeping people alive who should have stopped treatment long ago.
There is no such thing as "actual survival". 5-year survival rates are the global standard for cancer epidemiology.
> 3. The US is behind on every other major health indicator, Infant Mortality, Life Expectancy, Cardiovascular Disease, Obesity etc. Cancer isn't the only expensive illness in the US.
This thread is about cancer, in response to an article posted about cancer.
> This thread is overrun with Astroturfers.
From the HN guidelines: https://news.ycombinator.com/newsguidelines.html
> Please don't impute astroturfing or shillage. That degrades discussion and is usually mistaken. If you're worried about it, email us and we'll look at the data.
If so, it is possible for two countries that have the same survival rate measured from actual onset of the cancer to have a different 5 year survival rate.
It's worrying that the US places so much emphasis on 5 year survival rates, and not on eg all cause mortality.
I'm not, if you actually read the research I linked instead of speculating.
This causes people to get tested, get treated, and sometimes get harmed by that treatment, but does not extend their life.
This is discussed and addressed in each of the three instances of the study that have been conducted, so I recommend reading those for the response.
That's a completely different situation.
Currently, if an American pharmaceutical company produces a drug in the US and exports it to another country, people in the US cannot purchase it from foreign suppliers, even though it's both FDA-approved and produced by the same manufacturer. This dramatically raises the prices of drugs in the US.
Allowing imports of FDA-approved drugs from both domestic and foreign manufacturers would reduce prescription costs in the US greatly.
I agree. I interpreted the OP's comment of "You should be able to legally import them from, at the very least, any NAFTA country and any EU member." to be too lax.
What if living paycheck-to-paycheck is a consequence of having no health coverage?
Think about it. If you're on a low income that largely matches your outgoings, bills of thousands of dollars will wipe you out regardless of whether or not you save. So why save? You may just reduce any benefits you get from the state or Federal government (medical or otherwise) and those will be wiped out anyway. So you may as well spend now.
Consider, the Earned Income Tax Credit is one of the few times lower income households can make large purchases (and there's evidence of this in TV purchases and elsewhere).
Is there any amount of currency printing that you believe might be problematic? Or is the sky the limit?
Perhaps most importantly: What happens if we accept your claim, spend and print money ad infinitem, and then you're wrong?
Reforming the US healthcare system is incredibly difficult because everything is interconnected. If you try to reform it piecemeal things start to fall apart.
WW2 is more complicated as there were price controls and rationing in place to prevent inflation. it is unlikely that you could impose such controls outside of a total war situation.
All the historical examples of hyperinflation have occurred when governments have printed far more currrency than they have raised in tax or via the debt market. Spending tens trillions dollars more than you raise in taxes is likely to end in tears.
Well, actually, maybe it is a national emergency? Definitely seems more of an emergency than some wall.
First is an example. As much as I, personally, liked (and continue to like) Obama as a person and as much as I agree with most of his policies, at the end of the day he was a pretty ineffective president. Why? Because he could get hardly any legislation passed (Obamacare aka the Affordable Care Act being the principle counterexample). He was a president who ruled by executive order.
The White House is the largest and loudest bully pulpit in the country, by far. You can point to Congress and call them obstructionist but the buck stops with you as president to move your policy agenda and change the national debate. And Obama just wasn't effective at that.
Again, with one exception. It used to be a fairly popular opinion in the US that health coverage was for those with jobs, basically. That still is the position of a significant portion of the population but it's not as popular as it used to be. Obama did change the national debate on this such that the question became how we should provide health coverage and not whether we should.
Go back a decade or more and the Bernie Sanders coverage-for-all policy platform would've relegated him to being a minor player in the primaries, not taken seriously. The fact that he was as prominent a figure as he was is in no small part due to Obama changing the debate on health care (IMHO).
The second thing I'll say is that nothing lasts forever. Demographics change. Opinions change. California voted for Reagan. Twice. It used to be a competitive state. Now it's safely Democratic. Florida used to be safely Republican but (largely due to migration from the Northeast) but now it's a battleground state.
Let's just say that at some point Conservatives get what they've been hoping for: Roe v. Wade overturned in the SCOTUS. It could happen. Largley though the "damage" has been done already. It won't be illegal. It'll just be a state issue. Many states will legallize it the next day. New York for example has already made moves to enshrine the legality of abortions in state law. Now this will suck for particularly poor people in Alabma but in a way Alabamans will get the state government they seem to want.
So let's say that happens. The problem then for Conservatives is they've lost a defining and unifying (for their base) issue. One can argue they're better off politically this way as they'll fracture in the aftermath.
I see the current Conservative bent as a desperate last gasp for what is a majority (in their respective states) that's in decline. A lot of damage can be done before this naturally remedies itself but we're not headed to a dystopian Handmaid's Tale future either.
Do you hold this opinion due to the nature of his orders? His rate of orders issued doesn't make this look plausible, on its own. Lowest per-year average since well before WWI, by the look of things.
This will slow down the speed of pharmaceutical development. So I think it needs to be paired with reforms to the FDA to reduce the go to market costs for drugs.
“A study has placed the amount spent on drug marketing at 2-19 times that on drug research”
Maybe this should be reduced first?
That's a non-sequitur. Companies have no incentive to spend any more on marketing than they have to. Tech companies also spend more on marketing than R&D--would innovation increase if the government forced that number downward?
We’ve tried the free market way, let’s try it the “rest of the developed world way” next.
Marketing does not only include direct-to-consumer advertising.
> Does the rest of the world not innovate?
Pharmaceuticals are a global market. As it turns out, European pharmaceutical companies make a disproportionate share of their revenues from pharmaceutical sales in the US.
But to answer your question: statistically, no, the rest of the world doesn't innovate. Half of all pharmaceutical R&D costs in the entire world are funded by the US. That share has dropped slightly in recent years, but not because the "rest of the developed world" has been increasing their funding: it's because India and China have been rapidly expanding their R&D.
The other flavor bribes doctors to overprescribe - it is much worse.
If marketing has a return on investment (and it does) then marketing spend also increases money available for R&D.
Marketing and R&D are not pieces of a fixed pie. Marketing spend grows the entire pie and provides additional dollars for the company to spend on R&D.
You're talking like marketing extracts money from the ground as if it's a raw resource. If 10x as much is spent on marketing as RD then the money spent on pharmaceuticals is <10% going to RD. That's not good for the consumer. It would be good if marketing was regulated and that pharmaceuticals were forced to compete by spending money on RD and making better drugs.
Marketing increases revenue. A portion of revenue goes to R&D. Ergo, more marketing means more revenue available for R&D.
If I have a cure for X. And if you have X but don't know about my cure -- perhaps you don't even know a cure is possible -- it's a net good for me to tell you about my cure for X. And how do I tell you if there are millions of yous I'm trying to reach? Via marketing.
Consumers are not good at making informed pharmaceutical choices on their own, and the idea that magazine advertisements showing smiling old people does anything to inform them is laughable.
Also, pharma doesn't market cures, they prefer to market long-term treatments that are recurring funding streams.
If drug companies are willing to sell the exact same drug in Canada or the UK or Germany or France for less than a percent (in some cases) of what they sell it here for then why can't US insurance companies, hospitals and consumers buy it for that price? There's no reason other than an artificial monopoly.
You'll note that I didn't say "anywhere" and that was deliberate. India, for example, has decided that drug companies largely (it's complicated) don't get monopolies from patents and thus you can buy a lot of low-cost high-quality generics in India because no drug company is getting paid.
Obviously this is untenable at the global scale.
And before anyone lambasts India for not respecting patents here, countries do this sort of thing all the time. In the US, for example, you can't patent nuclear technology as a matter of national security.
They're willing to do that because the US is a much larger market than any of those countries. Most pharmaceutical companies - including European companies - make the lion's share of their profits from the US market. If they couldn't, you'd certainly see the costs for essential medicines increase in European countries.
> You'll note that I didn't say "anywhere" and that was deliberate. India, for example, has decided that drug companies largely (it's complicated) don't get monopolies from patents and thus you can buy a lot of low-cost high-quality generics in India because no drug company is getting paid.
India has pretty solid reasons for not honoring drug patents that don't apply to the US or Europe.
"Willing" is a broken way to look at it. The drug prices are negotiated by the government in the single-payer systems.
Most countries don't have single-payer systems, and even where that's the case, "negotiated" is the broken term. For essential medications, the supplier always has greater leverage than the purchaser.
The main incentive for the US to enforce patents is that it is at the forefront of technology development, so many patents are held by US companies.
As the lead the US has in technology lessens, as it has been predicted (and has already started) to do so for quite some time due to its poor education system and decreased funding and prioritization of science, other countries will catch up and overtake the US on the technology front, and they'll be the ones getting patents. Then it's quite possible that the US won't care quite as much about patents, and may even start "stealing" technology from other countries.
Because who cares if you've made a breakthrough product and no one knows about it?
>why can't US insurance companies, hospitals and consumers buy it for that price
Because profits for future R&D has to come from somewhere? And if everyone is lined up for a discount, future R&D will suffer.
Couple this with the fact that there is a large focus on designer drugs, and dependency rather than curative drugs, and there’s snake oil being sold by drug companies that they absolutely need a regional monopoly to bring us new and life changing drugs.
Imagine the government decides to tax 80% of all revenue from all technology companies forever. Do you think funding for startups would increase, stay the same, or drop?
The obvious answer is drop, but what type of evidence would you expect to support this statement. A study of people taxing technology companies @ 80%? Or are you arguing with the premise that investment rates are correlated with profitability?
>The obvious answer is drop
No. You "feel" it is "right" and "obvious" even, and it might as well be if we really did that experiment, but humans are pretty bad at predictions.
The idea that competition leads to innovation is not exactly new.
Big Pharma already abuses the patent system so much, like inventing something and then when the 20 year monopoly has passed they create a new patent that says "this same drug can be used for Y purpose, too" - and bam, another 20 year monopoly on the exact same or very slightly tweaked recipe.
Tens of thousands are already dying every year in the US because they can't afford healthcare. If the argument is that "if we reduce the Big Pharma profits then it would be even worse!", I'm sorry, I just don't buy it. If drugs were cheaper, a large portion of those people could be saved (yes, I realize there are problems with the healthcare system, too, but those would also be fixed by Medicare for all).
I'm not saying they should be excluded, but I don't think they would be willing to participate if it meant giving up a cash cow. I could be wrong though.
So do public universities.
Considering what a disaster the insurance marketplace was, I'm very skeptical.
Edit: what I mean by "disaster": when it launched, the site completely crashed for over a month and then, when it finally came back up, the policies offered weren't accepted by most doctors, because they had crazy restrictions.
In most cases it's a good thing to detect cancers early, but saying a country is good at detecting cancers is not near as strong of a statement as saying that a country is good at treating cancers.
And this gets complicated by prostrate cancer -- many would argue that mass screening for prostrate cancer causes more pain and suffering than it prevents.
If you look at pretty much any general population level outcome, a country with a high concentration of health insurance (as proxy for financial resource to get healthcare) is going to have bad "average" outcomes.
If you look at metrics that select a sample that tends to have access to healthcare (e.g., cancer tends to cluster in over-65s, who have access to Medicare and, at greater rates than the general population, Medicaid), you're going to get a look at "what the healthcare technology is like in that country for people with access to it."
It's entirely fair to point out that average outcomes suck for average people because "average" access to healthcare is "really shitty access to healthcare."
It's also fair to point out that if you change how the system operates, it's not unreasonable to ask whether you'll change the system's strong points, which may well be "technically sophisticated care for those that actually have access."
My position on this is a third, orthogonal position (which is that how you pay for care and the operations that produce that care are not unrelated, and fractured, free-market operations produce fractured care, and that operations have much more day-to-day impact on healthcare outcomes than technical sophistication.) But it's unrelated to the above.
2. What percentage of poorer "health outcomes" are due to the US's ~33% obesity rate and overall horrid diet and have nothing to do with care or access?
Obesity and diet are very much related to care and access. If you can't afford to go to the doctor unless you're dying, nobody is going to tell you when your cholesterol is getting too high and you should adjust your diet, or your blood sugar is getting into the warning zone, or whatever.
We have such high obesity because we don't focus enough on preventative care, and lots of people can't afford preventative care even if they want it.
I have a hard time swallowing the idea that obesity and diet are related to access to medical care. Our great great grandparents undoubtedly had far less access to healthcare than even the average lower class, modern American, and yet obesity was almost non-existent for their generation.
Occam's razor would say that an epidemic of diet related illness is caused by a societal shift in diet. The simplistic boiling down of the complex answer from nutrition experts is that the massive increase in processed foods in the American diet, post WWII, along with the insane increase in sugar consumption, have led to the obesity and diabetes epidemics (and increasingly believed to be one of the main causes of cancer).
IMHO we could do exponentially more for the life expectancy of poor Americans by solving the problem of food deserts than by upending the entire medical system, that is functional for the majority, for a wholly bureaucratically controlled system - which, by the way, will eventually have to include decisions on which people do not get access to treatment.
Once diagnosed however I've never had any problem getting top quality treatment. This is an anecdote, of course, so I'd be interested to see the statistics.
\* Or even over-diagnosis? It's "easy" to have a high 5-year survival rate if you push removal of tumors that may well have been benign.
5 year survival rates vary by the type of cancer, while cancers like leukemia, prostate, and breast cancer have made progress, most of those survival rate numbers are based on catching the cancer early, which, unfortunately most aren't caught early leading to a poor prognosis, my prognosis for example is 5% overall survival for 5 years with a significant drop off after 3 years. The survival rate is also heavily dependent on comorbidities, or other things that impact your health, this can leave things like surgery off the table.
Another fun fact is that we really still suck at cancer treatment because we don't know how it functions, and as previously stated there's over 100 different types of cancer, each with their own mechanisms and subtypes.
So to your main point, no unless there's some massive breakthrough in immunotherapy that's pan-cancer responsive for most patients (right now immunotherapy only works for roughly 20-30% of patients), the costs aren't going to go up dramatically as the primary option is surgery if it's early and if it's late you're probably still going to be dead within 5 years. The number of patients surviving each year only goes up by about roughly 2% per year.
On both of these the US is somewhere in the 30s in terms of rank among countries. But we are #1 in terms of cost per capita :)
5 year cancer is too low level in my opinion to give an overall picture
Right now our overall system does little to discourage the obesity epidemic, but in a universal coverage system there would be massive financial incentive to fight it (either the government or insurance companies being forced to provide coverage for all)
As I mentioned, our costs are significantly higher and our outcomes are worse than 30 other countries who have universal coverage. We should be learning something from the systems in place in other countries. I think you are focusing too narrowly on obesity in particular, when there are many reasons why this is happening.
I would suggest reading this book:
It was written by William Hsiao, who was hired by the Taiwanese government to advise them on modernizing/reforming their health care system. It does a lot to compare health systems in various countries. I think one underlying thread is how much health systems improve once there is a commitment to universal coverage.
I work in this space and am trying to see what can be done about changing behaviors to make people healthier but it is incredibly difficult, especially when there is so much financial incentive in getting people to behave in unhealthy ways.
EDIT: My comment is in reference to the old thread title, which was something like "More than 42 percent of the 9.5 million people diagnosed with cancer from 2000 to 2012 drained their life's assets within two years"
Just thought I'd shed some light on the issue.
If it can hit her that hard, it would be devastating to someone without $500.
If you have money and insurance then a hospital and insurance company will gladly work together to take what money you do have. Sort of like a chicken wishbone.
A rational person says "some costs are too extreme and thus we must allow some to die".
A flip side of the argument is that very high cost(read profit margin) of treatment incentivizes others to fund research for treatments and cures.
I have family that suffered from cancer and spent a good lot of money prolonging their life by about eighteen months. They were not pleasant months, but I don't think for a second that the family would have preferred to take the lump sum instead.
In short, every decision is horrible.
> Over a 10-year stretch, he said, Amgen’s scientists had tried to replicate the findings of 53 “landmark” studies in cancer biology. Just six of them came up with positive results.
After that, there's a sunk cost issue: once you've dropped (N*your current net worth) on treatment, what's the harm in continuing?
If you had no family, you could save many more lives for cheaper and easier to treat sicknesses, plus donating your healthy organs.
40 something white American male college drop out with no social connections. Tinnitus and hyperacusis long term.
The biggest part is figuring out how to maximize the donation of my organs to the medical school by coordinating self termination in a country where suicide is still largely frowned upon.
I have no insurance and just yesterday I had serious chest pains for the first time on the right half. This is almost certainly the result of not taking care of my body. Better to self terminate and spare suffering and resources, and to donate the organs.
The next best option seems to donate body to medical school.
If I ever receive a cancer diagnosis it will probably be the end of me. I have great life insurance and my survivors will be well taken care of. Even with the modern, immune-based chemo(which my friend had for melanoma), there are severe and permanent side-effects. After watching my friend with GBM die, I realized the medical industry is more than happy to take any money you have even if there is no chance they can help.
I've been thinking about my own death since ~2003. I have established what I want to happen to my body; I have yet to determine an official will, medical attorney, &c and that great fault is on me.
I recommend following "Order Of The Good Death" for the "US alternatives on Death". It is good times. Yes, talking about Death counts as "good times"; it is not difficult to imagine your survivors arguing over your body... about your body... about your assets... about your legacy... about your estate... and so forth.
Not that I really disagree with the sentiment, but I find it difficult to judge people actually staring death in the face based on my comfortable position of, well, not.
What a shame they can't see outsides themselves and realize they're only an inch away from financial ruin.
I've considered that if something like this ever did happen, I'd move to Lithuania and do it there paying in cash over trying to do it in the US system. Universal health care can't come fast enough.
What do you mean by "Universal healthcare"?
As with many things I think the details of how is critically important...
more info: https://en.wikipedia.org/wiki/Universal_health_care
(I do appreciate that this is a bad experience for patients.)
I don't doubt cancer is probably the most expensive hit that we have a good chance of receiving, but I'd be inclined to point to the lack of "life's assets" being fluid as the first problem to tackle.
I also kept my job despite being off work for nearly a year going through chemo, and I even got sick pay for all of that time. (Not at full wage, but still a very generous proportion of it).
Post-treatment I went back to my same workplace, doing the same job, and found out that I had even acrued annual leave at full rate during the 9 months I was off sick, so had 25 "extra" vacation days that I wasn't expecting.
Yes, this is more than the legal baseline, but even the legal baseline would let me keep my job, acrue leave, get some sick pay (although the statuatory sick pay isn't huge), but most importantly, have completely free treatment, so I wasn't spending the little energy I had worrying about medical bills or insurance.
Hell that's just insurance in America... if you just use it.
I've been dealing with a bill where the insurance company decided that my kid's pediatrician was out of network all of a sudden. All the other visits to the same pediatrician have been covered, but they can't seem to fix this one bill....
There's no incentive for the company to be helpful as what am I going to do? Change insurance companies? That's not my choice.
The removal of lifetime benefits, ability to deny pre-existing conditions, and setting a maximum range between the lowest premium that can be offered and highest premium that can be offered greatly improved access to health insurance benefits for everyone. At the expense of making it more expensive for the young and healthy, but obviously someone has to pay, and we as a nation don't want it to be via taxes.
But I don't think that's necessarily moral, compared to something like Medicaid, which requires people to spend down their assets first before the government will pay. The median net worth for someone between 65-74 is $225,000. Why should the government spend tax dollars to protect those savings for people unfortunate enough to get cancer, when there are many people unfortunate enough to never enter the middle class and be in a position to save that kind of money in the first place? Isn't it unfair to spend tax dollars protecting the inheritance of an upper-middle-class kid when that money could be given to a kid that never had a hope of an inheritance?
Put differently, there is a huge moral difference between the government ensuring that everyone can get cancer treatment, and the government intervening to protect the financial and social status of people fortunate enough to have significant assets.
I have a very simple set of recurring claims against my healthcare provider that I'm handling myself (out of network, no problem, I thought). Due to job changes I had successfully had my charges reimbursed by my previous 2 insurance companies over the past year.
The current one has taken 6 months to finally start reimbursing me -- and actually, they're almost caught up! Every goddamned time, the helpful phone persons sees the problem: "Your provider was entered as an XYZ type of provider instead of a ZYX provider, so it was being sent to the wrong unit. I'll re-enter him correctly, delete the old entry, and resubmit your claims marked as urgent. They should be processed within 7-10 days..." Very helpful staff. They seem to get it. They seem to figure it out. They seem to fix it. And it's never. fucking. fixed. And so you wait 7 days. You want 10 days. Still in process (if the horrible online system even allows you to login today). You wait 14 days, thinking maybe that was 10 BUSINESS days. Then you call back. Again, and it's the same thing. Over and over again.
My reimbursements came totally out of sequence. The claim numbers don't match. The dates on the claim number don't match the dates on the EOB, they're paying me back for the wrong visits!
But somehow, somewhere, on the backend, someone is reconciling it. Amazingly, the amounts are adding up. I think the processors are REALLY GOOD at not accidentally double-paying, so even though they're paying me for the wrong dates here, the next time they avoid double-paying, and find ANOTHER date to pay for (properly). It actually looks like it'll somehow all get paid back. Again, all one insurance company and one health care provider. And it's my insurance. And it's top tier private tech company employer PPO type stuff.
My wife was in the hospital after a car crash. The first EOB I got for $200,000 saying "Denied", and that number didn't even include the surgery. I just laughed.
It went to the wrong insurance, a simple call and it was sorted.
But I can't fathom having less than perfect insurance (and I don't even know how to manage to maintain good insurance while having cancer and potentially being out of work and having a partner who might not be able to work while they're helping you), and having millions of dollars in bills, and having them come in from countless different providers.. sheer misery.
And possibly traumatized that you killed yourself so they could have money.
I remember taking my friend to a Dr. visit when he had a brain tumor. The parking was confusing, with signs threatening fines of hundreds of dollars for parking anywhere near the building(this was at UCSD in La Jolla). This was at a cancer center, where you'd expect they'd prioritize access for patients. He went in for an eye exam, and the doctor was getting extremely agitated because my friend had problems communicating and performing a few tasks as quickly as the doctor wanted. Very few people in the hospitals seemed equipped to handle someone who had problems seeing, walking and communicating.
That would be the convoluted medical bills that fill multiple binders, depleted savings accounts that destroy early retirement plans and so, so many phone calls with insurers and medical providers."
Is it like this in other OECD countries? I ask because I'm told that we in America have "the best health care system in the world."
After he passed away(the cancer unfortunately came back and not much could have been done at that point) his savings account was definitely not affected by 8 years of illness.
That's in Poland btw.
I'm going to assume that you're asking an honest question, but I'll tell ya that (and I can not emphasize this enough) from my perspective the question is so naive that I seriously think I'm missing the sarcasm.
But in good faith I shall carry on...AFAICT, "US=='best'" is propaganda, or ignorance at best. We (I am an American) have poorer outcomes for more money spent. Now, many excuses will be offered as to why that is, but I'm not here to argue; as best as my research can do, that appears to be fact. On top of that, for a less capable and more expensive product, we have a byzantine system of forms and providers.
So, no, it would appear that other OECD countries do not have this issue, partly/mainly because all but a few (and I would be hard-pressed to name those few) socialize their medical care.
That's the worst. Pricing is totally arbitrary. You may spend 5000 or 100000 for the same thing and there is no way to know upfront.
During birth, should one stand outside their wife's delivery room and ask each provider to wait outside while you look up if they are in network or not on your insurance company's app? At least we have apps to do that nowadays.
My late wife passed away of cancer a few years ago, we lived in Australia. She went through rounds of intensive treatment. We had private health insurance which kicked in, limiting our up-front costs. Not all was covered, but what wasn't covered was capped through public health care. It might have cost us $10k AUD, but not more.
We spent little to no time worrying about paperwork and billing, it was almost all auto-handled for us.
Some people are genuinely concerned than touching the former (administrative side) will result in lowering the level of the latter (quality/availability of care, drugs, etc.). That it's the inherent high cost of the current US system that somehow makes it so good in terms of availability/quality of care. I disagree, but can somehow understand the line of thought.
EDIT: I have no idea to what extent care is really better in the US than elsewhere, but know first hand of someone who had to pay for interferon out of pocket in Japan because it was not yet covered at that time. It's not rare for the newest US drugs to take many years to cross the Pacific ocean...
Rudy Guliani said this in a campaign ad  when he was running for U.S. president in 2007-2008. I also recall him saying this in one of the Republican debates. When my (now) wife, who is German and has also lived in Denmark, heard this she couldn't help laughing.
The article mentions a variety of causes but I'm having a hard time figuring out which ones are most important. In the example above with a $10k out-of-pocket maximum, how much money did these patients actually end up paying? Is that the main reason for their bankruptcy, or is it their loss of income? Does disability insurance cover things like cancer, and if not, are there similar programs that do?
Americans are Drowning in Debt: https://thenib.com/americans-are-drowning-in-debt
Countries like Germany and some south american countries have much more affordable treatment even factoring in the lodging and flying.
Then when you actually try to use the insurance you pay monthly for (but don't get to use until you reach the deductible #1 and #2?) they may just send the bill to you with a lot of legalese that amounts to "we don't cover this, or we do but we have better lawyers, get fucked peasant."
Luckily the debt collection industry is incompetent so all you gotta do is keep replying with "please mail proof of debt" and you're golden!
How much clearer can maximum out of pocket be?
Edit: I do think in network and out of network should be easier/faster to figure out though.
I had an out patient surgery about a year ago and while my doctor and every admin I talked said that everything would be in network, I still had someone sneak in who was supposedly out of network.
Then came the bill of what should have been ~$300 was around $2500. I got that BS waived only by called my doctor's office and talking with them about it. Once we talked it all through, the nurses called the _head management of company that ran the out patient surgery clinic_ in order to get it removed. It feels like people have to do you favors in order to get your actual correct billing.
Our health care system is so royally f'ed in the U.S. It desperately needs fixing and I hope it does before something serious happens to myself or my wife because it's currently feels like gambling with ruination. No $2.5k isn't ruination but health care is the only thing in this country where I go in knowing NOTHING about what my final bill will actually be.
Or I wonder if a similar "HIPAA trap" could be constructed by categorically revoking consent to share your PMI with any out-of-network individuals and companies?
As for what's covered by my insurance, I strongly disagree that this is "clearly explained." It is not, some of it is outright "and other services," most of it is buried in pages of medical terms I don't understand.
My understanding is that past that point, you become mostly uninsurable, but maybe I'm wrong.
Also, do ‘good’ insurance plans typically deem any signicantly life saving treatment as necessary?
Sorry, I’ve always been healthy so have never taken the time to understand this but my parents are getting old.
From the article: Since she's unable to work, the family lost her nursing salary.
"Their high-deductible insurance policy meant they had to spend $6,000 before their insurance started covering her treatment expenses. They hit their annual out-of-pocket maximum of $10,000 well before the year was over."
Even with a lower deductible, many plans have annual and lifetime limits.