EDIT: Here's the link for the Indiegogo campaign: http://www.indiegogo.com/helios
I apologize to the author, but I hope my comment helps you raise way more money for such great causes next time.
I made the payment through paypal, I sincerely hope it isn't "suspended" due to a rapid influx of cash.
I'm simply blown away, as day after day the outpouring of support for Ken grows. When I put my blog post together, my hope was to help a good friend with a new monitor, and the rest was kindof a pipe dream.
Now, 8 days and almost $40,000 later, I'm at a loss for words.
Thank you to everyone who has donated, commented, passed it on, or done anything else to help us out. Both Ken and I are speechless.
So for someone who has paid things forward, he certainly deserves help. See the following article from his hometown newspaper in Austin, Texas for more about the good works that he has done:
Update: Thomas Knight reports that they have raised the necessary $50,000. It looks like the Indiegogo campaign is still open, and there's a note than any excess that isn't needed for his medical expenses (if all goes well the $50k should be enough) will go to Reglue, his non-profit which helps children to get access to computers.
Anyway, donated some money, really wish he gets all the help he needs.
* US: According to the World Health Organization (WHO), the United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in 2008. The United States had the fourth highest level of government health care spending per capita ($3,426).
I wasn't aware that a government-sponsored healthcare system this old existed in the world, because it's always seemed to me that such programs are fundamentally unsustainable.
So what I want to know is, how do they keep it sustainable? For example, if there's no longer a market where demand responds to price signals, how do they determine how much procedures cost? What keeps providers from increasing prices 5% every year, regardless of cost increases, until they're essentially looting taxpayers' money on a massive scale? If the government sets prices, how do you avoid damaging shortages or surpluses when it gets the pricing wrong? How about moral hazard -- the problem of people who waste healthcare resources by going to the doctor for every little sniffle, scrape and twinge since it's free? What keeps people in other countries who don't pay into the system from getting a burning desire to move to Germany when they find out they have something really expensive to treat like cancer or AIDS?
Moral hazard doesn't seem to be a large problem with hospital services (doctors aren't going to order an unnecessary surgery), and there is a strong culture against unnecessary prescription drugs. So about the worst that can happen is someone wastes their local physician's time 30 minutes at a time. Since small-time office visits aren't where most of the healthcare costs go (in either Denmark or the U.S.), it's a minor concern. As far as foreigners, that's a concern, and handled by the immigration system (you probably won't get a visa if that's the reason you're trying to enter). The main current concern is intra-EU system-shopping of that sort from Europeans, who don't need visas. There are attempts to standardize something around that (the EU "blue card" scheme is one), but it's one of those awkward areas that showcases the EU's quasi-integration. There is also a debate currently about whether Denmark should start charging tourists, since it's one of the few countries that provides completely free emergency care to anyone. Many see this as the right thing to do: if a visitor is injured in a mugging, for example, some people view charging them for the hospital visit as adding insult to injury, like sending them a bill for the police investigation would be. But there is also annoyance that other countries don't reciprocate, so a little bit of a sentiment of, "well if the bastards are going to charge me for getting mugged in NYC, let's charge them when they come here".
I've also heard a theory that this isn't a bad thing: IIRC in Japan there's a culture of going to the GP for every tiny little thing, which means that they have a massive number of 5-minute visits - but potentially serious illnesses are spotted and cured before they become serious, which means that overall health costs are lower and results are better.
There's not much change if you look at the severity of need for meds either - many organ transplants fail because people don't comply with the meds.
Further, if you spread the risk of getting ill across a whole nation, paying for health insurance gets cheaper for each individual. You cannot have that with a health care market.
Anyways, your questions concerning sustainability are valid.
There's a catalog about how much health care providers get from insurance companies for each procedure. I don't know who sets up that catalog or how it is negotiated, though.
Recently, a (small) fee has been added which you have to pay once per quarter if you visit a doctor. Further, you have to pay a small amount (~$5) for each medication you buy (unless you need a lot of it). So, people don't visit the doctor and buy medication that easily (anymore).
People who have not paid into the system are only treated for acutely life-threatening symptoms (and even then have to pay for themselves). To pay into the system, you usually need to have a job, so it's not something that you can just do once you see you have a costly illness.
What is it about them that seems unsustainable to you? Are you an economist or an accountant? Do you have a citation to back up this point of view?
Here's a recent one against it: http://www.cepr.net/index.php/op-eds-&-columns/op-eds-...
> I wasn't aware that a government-sponsored healthcare system this old existed in the world, because it's always seemed to me that such programs are fundamentally unsustainable.
They are not fundamentally unsustainable but Germany's current social system is unsustainable and will eventually fail because the demography and economics have undergone massive changes since it has been designed.
> So what I want to know is, how do they keep it sustainable For example, if there's no longer a market where demand responds to price signals, how do they determine how much procedures cost?
We do have a market in which insurance and health care providers negotiate prices and as you can see not only does this work it works a lot better than the US market does.
> What keeps providers from increasing prices 5% every year, regardless of cost increases, until they're essentially looting taxpayers' money on a massive scale?
Health care providers can't set arbitrary prices and insurance providers are regulated. Also insurance is mandatory but not paid for from taxes unless you don't have any income. The mandatory social insurances, of which there are four, all get paid a certain amount relative to your income.
> If the government sets prices, how do you avoid damaging shortages or surpluses when it gets the pricing wrong?
See above. The government doesn't set the prices.
> How about moral hazard -- the problem of people who waste healthcare resources by going to the doctor for every little sniffle, scrape and twinge since it's free?
You want to detect serious stuff early to keep the costs down, so to a certain degree you want that to happen. Apart from that there is a small 10€ fee you have to pay once every quarter for each doctor you visit unless you were referred to him by another doctor. This keeps moral hazard down and especially prevents unnecessary visits to specialized doctors.
> What keeps people in other countries who don't pay into the system from getting a burning desire to move to Germany when they find out they have something really expensive to treat like cancer or AIDS?
Like moral hazard this is not such a big issue as one might think it is. Most people tend to be reluctant to make such big moves, especially if they don't speak the local language which applies even more so if the topic they would like to talk about is their health. Apart from that there aren't that many countries in the world with a health care system as catastrophic as the one in the US.
More importantly though the people who do actually move to Germany for treatment tend to have lots of money and have no problem spending it on their health. So these patients are flown into the hospital using the dedicated helipad, on top of the luxury ward, in which they wait for overpriced procedures and get their overpriced medications.
The German government covers 77% of its citizens health care costs. The US government covers 48%.
In countries like Germany, I am sure that 77% number is evenly distributed across the population. I.e. All citizens are mostly covered by government insurance. In the US, I am sure the number is disproportional to the elderly and on government assistance, such that people between 20-60 are not covered by any government insurance. So it's a bit more lop-sided than the Wikipedia chart says.
USA has made the enourmous mistake of making of health a large business managed by private corporations that dont care about human life. Just money. Other countries see health as a right (luckily thats the case here in Argentina). So, most medics dont get super rich. They work for a salary, they dont get 30 or 50 grand for a surgery. But they still do their job, they work hard and they give their best (well, most of them). Because when you choose that kind of profession, its not for making lots of money, but to help people. Or at least, thats how it should be, and I'm absolutely sure that there are lots of medical doctors there that think this way, but they are just the little fishes inside a pool full with big sharks.
I feel sorry for you USA, because you lost it and you wont get it back. There are lots of interests against it.
There's not political will, there's not professional will (AMA anyone). Sometimes, from the outside it seems like there's not even a cultural or popular will. A few months ago I discussed this with an American friend and he was totally against universal health care. His argument was something like "why should my taxes pay for some random unemployed or most probably lazy man's health" "if he gets free health care he won't work as hard" "if i make more money why should he have the same benefits as me?" And my answer "because he's a human being too"didn't seem to help.
You said it yourself, 17/18 % of the biggest gdp in the world and still cant take care of all of your people. Think about it. Just imagine what you could do with that money in a different system.
Seeing this kind of things happening there I can only think about the USA, as a strange place. Home of great technological progress and sad social regress.
Dont take it personal.
The position that the USA "lost" the policy of "health as a right" is nonsensical, because it never previously possessed it in its 236 years of existence. You might want to try a different narrative archetype.
While he still needs money, they did find a doctor to perform the surgery. But don't let that stop you from donating, if you're able.
He also answered a question that I had: he's a veteran, so he should qualify for VA medical assistance. According to his post above, the VA system moves too slow to stop his rapidly spreading cancer.
All this takes time for the VA to consider. And worse still, there's a HUGE backlog of claims right now (for obvious reasons).
Just pointing this out in case anyone declines to help out cause you're hoping the VA will come through. I mean, they will, it will take time though. And he doesn't have time.
Tangent, that's good to hear. I've known more than a few individuals who pushed paper in the service for two years and actively avoided a tour, and seemed to be reaping all the same benefits as the ones who saw combat.
This is an advice: I think with this kind of money they can fly somewhere else and do the operation and pay all costs associated with money to spare.
I think they can even try that in Canada
The United States fucking sucks sometimes.
5% of our 300 million population is starving/malnourished children.
Sometimes you wonder if the kids in less affluent countries don't have it better.
Lifespan is a good first pass indicator of the quality of health care.
In 32 states, being on SSI disability payment generally qualifies you for Medicaid without a further application, unless you also have additional income. States then vary in how much additional income, and in some you can still "buy in" to Medicaid even above the threshold, by paying some of the premium out of your additional income.
In other states the criteria for SSI disability and Medicaid are different, and may interact badly, with someone on SSI considered "not poor enough" for Medicaid. This is particularly likely in states with extremely low Medicaid thresholds where even someone at the poverty line wouldn't qualify. Here is a summary of the overall effect of all those variations: http://www.workworld.org/wwwebhelp/state_1619_b_threshold_am...
The upcoming PPACA Medicaid expansion may sort out some of it, for states that don't opt out, but we'll see.
How does that work exactly?
I'm trying to think of how I could even deliberately overuse health care, in the event that I decided health care were something desirable rather than something I tend to avoid because it's boring. The best I can come up with would be to hit myself with a hammer occasionally, necessitating treatment of the injury. I'm not sure why people with a public system would deliberately do something like that.
I'm not really trying to be facetious. This seems to be one of the ways in which health care isn't like any consumer product: people really do not want as much of it as they can get. In terms of preventative medicine, just getting them to use it can be quite a chore. In terms of treatment of disease or injury, I don't see how using it for its intended purpose qualifies as "overuse."
Since emergency rooms cannot turn patients away, there are a lot of people to come to the emergency rooms for things like pains in their big toe, menstrual cramps, and so on.
This is why the emergency room is so absurdly expensive in the United States. Health care here really isn't very expensive so long as you go nowhere near the emergency room.
Continuing to remind people about pharmacists, NHS_Direct, GPs, and out of hours GPs is helping reduce pressure on the NHS, but still.
See also the gently cheeky "Acute admission units" - a method for A&E units to avoid the penalties for keeping people longer than 4 hours by cycling people out of A&E and into aau for monitoring and then release or admission into hospital proper.
Over the past 5 years I have seen many A&E units; and spent many many hours in them. They have all been very busy, and often with many people who probably didn't need to be there. (Although I have no way on knowing that; I am not a doctor and I have no medical training and there's no way of telling just by looking at someone if they should be there or not.)
The most serious problem in all of them was people turning up for things that were very minor - a splinter; a bruised ankle; some other very minor injuries. These are the kind of things that may need treatment, but you don't need to go right that instant to hospital. I didn't even mind the people who were waiting quietly, but you hear people grumbling about the wait times. I'm not sure they realised that there are minors, majors, and resus, and that if there are 8 ambulances outside it's likely that majors is chock-a-block and all the clinicians are a bit busy tonight.
Perhaps this could be solved algorithmically.
But someone with a broken arm is in a lot of pain; someone with X is at risk of death. And if you have people that need to be triaged that's one less nurse for treatment (because they're triaging) and the triage queue gets long.
And the people with a graze are likely to have to wait a very long time, because (for some reason) it's not acceptable to tell people to go and see someone more appropriate. These people also count against the hospital for the 4 hour wait limit for A&E patients.
Certain hospitals have "express care" or "urgent care" on premises, that will treat patients without insurance, same as the ER. Santa Clara Valley Medical Center has a pretty efficient "express care" clinic.
Read into that what you will.
I think it's more the "80/20" customers - old people who are bored. Drug addicts begging for pain killers. Hypochondriacs. People who have done their own diagnosis and want the doctor to give them their antibiotics (when it's really a common cold, and antibiotics won't help). There's a common meme on HN that free services attract bad customers.
One thing people can and will do is not so much 'demanding second opinions', but 'revisiting the same doctor to get reassured'. The latter does not have to be that expensive, if the cultural norms are OK. There are countries with costly culture where a visit to a doctor must end with a prescription or treatment. In other countries, patients leave happily with the message "it does not look broken and it isn't infected; if the swelling does not go away in two weeks, come back"
P.S. thanks, editing the comment
Two days ago, there was a post on HN announcing Watsi, essentially a Kickstarter for healthcare (Sorry if I'm discrediting it's overall value in any way, it's a great idea: http://news.ycombinator.com/item?id=4424081). Most of us in the Western world aren't the target audience for Watsi, but this seems appropriate. Can we not make this happen and see a cohesive case to be made for those asking questions about cause and background?
The $50,000 we collected in 10 days will more than cover all of Ken's medical expenses as he continues through his difficult cancer treatment. Thank you to everyone who helped out, you are all wonderful people. :)
It would help if they told us what his contribution actually was.
If you live in Texas you should consider cleaning out your closet and donating some computers to the cause. They're basically looking for P4 class machines and better. Something gathering dust in your closet can changes a kid's life forever.
This kind of massively-overinflated cost is endemic in US healthcare. Getting rid of it would easily allow you to lower spending whilst covering more people.
Do like Mitt does, keep your money outside the country where the Government can't get it.
8/25 - Update 4: Thank you!
I can't thank you enough. Not only have we found Ken a surgeon, but the surgeon has agreed to
do the surgery for a fraction of the original cost. We have raised $47,600 total now, enough
to cover the surgery, any and all pre and post op medical expenses, all medication Ken will
need for the foreseeable future, and there might even be some left over to go to Reglue.
I can't stress enough how thankful I am to everyone who has helped. The outpouring of support
is amazing. You are all wonderful people. :)
"The cost just to book the OR for Ken's surgery is $50,000, and that doesn't include the surgery itself, nor any post-op medical expenses."
What is the total cost of expenses, or is that unknown? Knowing how much is needed would possibly help raise more funds.
I believe it's Thomas' company.
In the UK, the National Health Service certainly has inefficiencies, delays and issues. However, care is free at the point of need.
I suppose there are different ways of rationing a resource for which there is theoretically an infinite need. I prefer the way we do it in the UK.
Most of us, even the most starving bootstrapper of the bunch, has enough change in his/her pocket to make an impact on a real human life.
Let's not brag about what we donated, or how much, or if we donated at all. But please everyone, let's reach out for someone who needs us like every good human should.
Geeks with heart. You're a lovely bunch HN peeps...
Wishing Diane and Ken all the best.