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Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake.

In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later.

I want all the tubing. I want the cracked ribs and surgeons transform me to a piece of blubber and then anlyze the hell out of it so anyone else don't have to go through the same thing.

Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering.

"In Sweden medical care is free. I can fight as long as I want without them getting in trouble."

It's not free. It's free to you, but it is placing additional costs on the Swedish medical system, which somebody is ultimately paying for. You don't have to internalize the costs of your decision.

I'm not arguing whether or not you're a making a good or bad decision, or whether or not "free" medical care is a good thing. I'm just pointing out that providing such a system skews decision making.

Free or not, it seems to work pretty well for the citizens there. You don't have a sizable portion of the population filing bankruptcy over medical bills and they haven't gone bankrupt like Greece. Something Sweden is doing is right.

Greece has socialised healthcare, as do the rest of the European countries circling the drain. http://en.wikipedia.org/wiki/Health_care_in_Greece

It's worth noting that the US health model isn't a free-market system - the state links health care to employment, which distorts the market away from individual private health ownership, and creates patterns that make it easy for costs to creep up. The US health care model is a disaster: the state doesn't supply health care, but then also prevents the free market from operating effectively.

The EU countries that are not circling the drain also have socialized healthcare, for the most part. Healthcare is a driver of public sector costs, but hardly the only one.

Yup. That's why I thought the Sweden/Greece thing above was odd.

Nice job blaming socialized healthcare for the greek situation. Has there been a single serious or unserious comment blaming their problems on socialized healthcare? Glenn Beck wouldn't even do that.

Germany has socialized healthcare too, FWIW. Cheaper cost per capita than our system, with better results.

The state does a lot of other things too, like setting the ratio of a GP's pay to a specialist's pay to something much higher than in other countries, and letting pharmaceutical companies charge whatever they want in the US market but banning the re-importation of drugs from companies where they're sold far more cheaply.

Ireland has an extremely poor socialised health care system, and is in trouble right now. By your logic, the fact that the health care system was gutted in the 1980s should have allowed Ireland to avoid these issues. Sadly, it really isn't that simple.

How is the state linking health care to employment?

My understanding is that health care is linked to employment because of the adverse selection problem that occurs in a free market of individual health insurance. Can you elaborate on why you consider this to be the government's fault?

Health insurance is not taxed when a company pays for it, but individuals need to pay for it with after tax dollars.

Assume you can sign up for plan A at your company that costs 200$ a month and covers everything you want. Or you can buy Plan B which costs 180$ a month for the same coverage.

Assuming your marginal tax rate is over 10% then plan A costs you less money. Now, most company's bundle healthcare so it's harder to get that money out of the equation, but for small company's it easy to negotiate if you can get heath care cheaper though your spouse etc.

    > How is the state linking health care to employment?
During the second world war US wages were frozen. But there was an exception where you could provide employees with differing levels of health care. So that became a mechanism for competing for staff: it became common for companies to offer corporate health care at the same time that individual private health was dropping off because nobody had any money to afford it. This pushed the market towards group-based programs. After the war, public policy further cemented the patterns that had developed.

I understand that if you live in the US it's impractical to get private health insurance on an individual basis because there's low business in the space, meaning low competition, as well as the tax structures described by other commenters.

    > My understanding is that health care is linked to
    > employment because of the adverse selection problem that
    > occurs in a free market of individual health insurance
I'm not familiar with this effect, which isn't to say that it doesn't exist - don't know. Certainly there were healthy private health markets in countries I'm familiar with before the age of government intervention.

The adverse selection can be solved a different way: legislate that health plans have to be open to all comers and regulate price differentiation to a few key cost drivers that are politically viable (eg smoking).

As would a pay-for-treatment medical system, like in the United State, which simply skews decision-making in a different direction.

(Or, if your uninsured/indigent, reduces the choices you have available to make a decision between anyway)

My mother succumbed to cancer over 10 years back. I was in my late teens and remember the treatment being way more painful than the cure. The medical care was so bad in india that once the nurse messed up the chemo shot and delivered it wrong. This resulted in oedema. Doctors could offer nothing more than an apology. I still find a lump in my throat when I recollect those days. However, in the end, my mother rejected treatment. She did however wish to live a long life. But she could not bear the treatment. Doctors gave her 2 months. But she lived on for 8 more months on painkillers to maintain as normal a life as possible. She managed to remain cheerful and positive before us kids. Living with someone you love knowing that they would die soon is really painful.

If I am terminally ill, I will probably reject treatment and choose to go peacefully.

"For my daughter and my own sake."

Your family is your business, but I have watched both friends and family die fighting hard in the ICU. It would not have been my choice to watch them, nor for them to go through that for the sake of myself.

Fighting for the sake of fighting alone has no value.

Watching a loved one suffer is agonizing.

Medical care is free, but it too has a limit. There is a finite amount of money available for treatment, and there is an almost infinite amount of new, unproven treatments that might just work.

Lots of people put themselves into debt trying alternative or experimental therapies, even in countries with universal healthcare. The sad truth is that whatever kills you will probably not be something that the doctors can learn much from. It will be some disease that is well known, with lots of data on survivability etc.

Interesting. I found myself responding to the article in much the same way as you. Also Swedish. The question is: are we being rational or deluded?

I have friends who are medical professionals and I don't recognize them in this either: I highly doubt any of them have NO CODE tattoos or anything equivalent. I suspect society shouldering most of the cost might be a factor: with a privatized payment system, there are perhaps incentives to go too far that aren't there when there's no profit to be made? That's pure conjecture, though.

This is not a question of being "rational", and there's no right or wrong answer. People make trade-offs between quality and quantity of life every day. Do I want to quit smoking, drinking, drugs, and take up sports, etc for a chance at a longer, healthier life? Or do I grab all the fun I can, and if it costs me ten years, oh well? The right decision will look different for every person - and it's not black or white, but a continuum.

The choice of how much pain is worth it for how much of a chance at a longer life is going to look different depending on your religion, your responsibilities, your age, your experiences with pain, your family, your culture, etc. And yes, of course the cost of treatment will factor into that decision for both the doctors and the patient.

It can be a rational or irrational choice depending on the available treatment and the specific case. A blanket statement that says "do not resuscitate" ignores cases where resuscitation could have been successful and where the chance of revival outweighs the risk of undue pain and suffering.

In a world where the only available treatment is blood-letting or getting your limbed sawed off by a hacksaw, a "do not resuscitate" policy is clearly more rational than in the Star Trek/sci-fi world where treatment consists of a doctor waving a magic iPad over your head and nanobots cure you painlessly. Since we're somewhere in between those two it becomes more complicated, but evaluating the risks and benefits and making an as informed choice as possible based on the available information still seems to me to be the rational way to look at it. Making future medical decisions based on an emotional reaction to individual cases, on the other hand, seems to me to be irrational and counter-productive.

I'm an american and for me, it's not an issue of cost. The issue is how do you want to end your life on this earth. My father died of lymphoma when I was 17; he got it twice. The survivorship rates if the first set of treatments didn't work were not awesome. In his case, he died after multiple rounds of chemo and radiation and surgeries, incisions that didn't heal for multiple months, collapsed veins leading to a shunt installed in his chest, persistent nausea for half a year, so much pain that if properly medicated he was barely lucid, being forced into a wheelchair, having to wear a diaper, bleeding from his eyes and mucous membranes, etc.

Having seen his tour of the medical system, I desperately hope that if I were ever in that position, I'd have the strength to say no: treat the pain and I'll die in peace.

I don't think the issue is the cost to the patient, but rather that in a private payer system, it becomes profitable to keep patients alive for as long as possible. In a public payment system, you could crassly say that keeping patients alive is a cost to the system. Now, that would seem to imply that the public option might lead to early termination of treatment in cases where treatment would be feasible but expensive, and perhaps that does happen.

Here, here. I'm from Australia where medical care is also free. This idea of dying quickly as to not burden your family with medical expenses is ridiculous, given the success that single-payer health care has had in many countries all over the world.

I understand that some conditions cause insufferable pain with very slim chances of surviving, but there are many success stories from people who have battled through. Its often these same people who provide the courage to others to battle on and raise money to support the families of those who have had similar experiences. We shouldn't be thinking about optimising our lives for our own happiness, but for the generations yet to come.

I will always fight for my life to the bitter end. There is no way I would leave my children to come to grips with why their father gave up without a long, hard fight.

It's not free, public hospitals are overcrowded and full chemo etc costs a lot. Fight to your last breath if you want to but the point of this article is that doctors themselves think that on average you will be happier living your final days without extreme treatment. All the miracles you've heard of are effected by reporting bias.

In Sweden medical care is free. I can fight as long as I want without them getting in trouble.

I thought Sweden had committees to decide on what standards of care would be provided or not, preventing you from making the mistakes discussed in the article?

EDIT: Also, remember that the US government spends more per capita paying for people's health care than Sweden, but manages to spend that huge amount of money on only poor and old people who don't have employer-provided health care.

So, I'm living in a country that has public health care too, worse than Swedish, but oncology is pretty well funded.

I also have "fight for life at all cost" experience, though only with animals (I provided a kitty foster home, and through that assisted in a vet clinic somewhat). It's not like with humans, but enough.

I have also seen my grandfather's last days, so maybe that influences me somewhat.

If I ever get cancer, barring some incredibly lucky circumstances when it's completely resolvable, I will avoid treatment. The suffering is not worth it, and the pressure on the loved ones is not just financial.

I don't think we've read the same article. It's not about money.

Have you ever been hospitalized? How old are you?

Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering.

It's not about being tough and macho. A lingering decline can be psychologically painful for everyone involved. Pretty much everyone I know that has been involved in caring for someone who suffered a slow decline - particularly alzheimers - don't want to go through that themselves.

You say now that you may want all the tubing and to be bounced around from doctor to doctor (not all of whom know what they're doing, by the way), but it's a very different beast when you're actually experiencing it. Some folks just say 'do what you gotta do'. Others say 'I don't care what you think you'll find with yet another test, the endless battery of tests is worse than the disease'.

A lingering death can sometimes be easier for those round about you, to some extent. They know what's happening, get a chance be resigned to the future, but still talk to you before the end. And if it's painful, they can feel relief that your suffering is over.

When you die quickly, you personally don't suffer, but those around you are stunned by the sudden, often unexpected loss and life. It seems cruel and arbitrary.

My mother died of a sudden heart attack at home. It was so sudden that she seemed perfectly fine that very afternoon and evening according to everyone who had seen her that day. It was a shock to hear about. On the other hand, my father died, unconscious and hospitalized, after a week of unsuccessfully trying to recover from emergency surgery after months of intensive medical treatment and going in and out of hospitals. Speaking from experience, I think a sudden death is far less cruel to your loved ones. At the very least, it doesn't require them to make tough decisions.

You never get a choice, though. Some people, like my father, survive their first heart attack with no apparent long term damage while others, like my mother, don't. Some people get cancer. Some people even get hospitalized for things that aren't life-threatening--but when something life-threatening does happen, those medical problems become obstacles to effective treatment.

It may seem counterintuitive, but I think the opposite is true. Think about it: what will people remember about you? If your death is relatively quick, the majority of their memories will be of happier times spent with you in good health. On the other hand, if you have a long, drawn-out, multi-year struggle, that will be what they remember most.

I don't have the link handy, but there was a study a while back comparing hospice care to class 3 chemo (that's the really, really poisonous bad stuff). The study found that families of those who went into hospice coped better with the loss. Furthermore, almost counterintuitively, those in hospice care actually lived longer on average. Sometimes, taking stress off the body gives it just enough room to keep fighting on its own a bit longer...

This is my experience.

I've lost friends to sudden deaths -- usually accidents. It's a bolt out of the blue, but it's over quickly and there's rarely much suffering.

I've lost family "after a long illness" as the news reports say, and the roller-coaster of misdiagnoses, initial treatments, exploratory surgeries, continued uncertainty of diagnostic monitoring and procedures, hope for treatment advances, false hope from charlatans and quacks, relapses, remissions, and the final, inevitable, unstoppable, and increasingly debilitating decline, tears people, families, and communities to pieces.

I've also seen cases where the end was known, but treatment brought, at a relatively low cost and with little dread or pain, an extra six months of a life that was happy and full of love. In that case, not so bad.

There's a difference between a quick "he was fine this morning" death and a quick "gone in two months" death. The idea of letting the disease take it's course with only comforting care gives people time to say goodbye - it's mentioned in the main article as even being able to give more quality time with loved ones.

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