9 ms·

End-of-Life Warning at $618,616 Makes Me Wonder Was It Worth It

59 points by AdamN 17y ago

Solid long-format article about the costs of healthcare for a dying husband.

hapless 17y ago
Seems pretty clear that it was worth it. The actual bill was closer to $250,000 -- $618,000 was without any discounts. We work and save and pay premiums for decades specifically so that we CAN have someone pay $250,000 to extend our lives by 17 months. That is the PURPOSE of a health insurance policy. It's hard to see this one as an example of our (admittedly terrible) healthcare costs.
- houseabsolute 17y ago
  Based on the conclusion of the article it seems that she agrees.
- jcdreads 17y ago
  Right, but her point is that had they (the author and her late husband) actually understood the costs at the time that they were making treatment decisions they might have made different ones. On the other hand, as you note, in a very real sense they'd already paid for the treatment in the form of decades of premiums.
- bobbyi 17y ago
  Also, the money that was spent didn't just go to extending his life. A lot of that money was spent on pharmaceuticals where he was an "early adopter". People like him covering the massive costs of developing those pharmaceuticals are paving the road for the day when they can be available as cheaply as the vaccinations the article talks about.
  - Confusion 17y ago
    People like him covering the massive costs You mean people like us, the ones that pay the premiums, subsidizing the research of pharmaceutical companies?
noonespecial 17y ago
The real problems start not when "end of life" becomes very expensive (which it has) but when technology advances to the point where it is possible to keep someone alive indefinitely but at geometrically increasing costs. We've set it up so that everyone will feel entitled to that one extra week, no matter what the cost.
- houseabsolute 17y ago
  I doubt that costs can increase geometrically for any significant period of time. The technological ramp would have to be enormous. Unless your belief is that current technologies will remain at their current prices and new technologies will be built at exclusively higher prices.
  - noonespecial 17y ago
    Its not about any particular technology, per se. It was cheap to die in 1600 no matter what killed you simply because there was very little that could be done. Each year we add more and more expensive interventions from ECMO machines to artificial hearts. Put this together with the "if it can be done, it should be done, damn the cost" attitude we've trained ourselves to expect and we could find ourselves in for a severe reality check. Medical technology seems strangely resistant to Moore's law (witness the price of a CT scan over time), but even if it weren't, the improvements in individual areas might not be enough to offset the growth of intervention technology in general.
- pw0ncakes 17y ago
  That's unlikely to happen. If nanotech and anti-aging succeed, they'll push back the costs. If they don't, there's going to be a lot of scaling back on things that don't work or aren't proven.
  - orangecat 17y ago
    If nanotech and anti-aging succeed, they'll push back the costs. Yes, anti-aging is the best possible research we could be funding. Unfortunately most people shut down when it's brought up, because thinking about your own decline and death isn't pleasant. If they don't, there's going to be a lot of scaling back on things that don't work or aren't proven. How will the "scaling back" be accomplished? Governments can and should stop paying large amounts for treatments that don't do much, but unless private services are banned, lots people will spend whatever they have to try to keep themselves or their loved ones alive.
giardini 17y ago
Even oncologist question their utility today when they can offer the average cancer patient only meager life extension, and those are often pain-filled years at that. But it's a good business model: people will often spend their net worth to extend the life of themselves or their child a few months. But in the end they almost always die the same miserable death. So I expect even more "childrens' cancer centers" to open and rake in millions.
- sp332 17y ago
  Oncologists offer significant resources in pain management, which is very important. Life extension isn't the only thing doctors are good for.
  - giardini 17y ago
    Yes, but an oncologist is unnecessary for this. Pain management becomes the single most important thing to the patient until, finally, they reach the level where no legal painkiller can do anything for them. Then they lapse into a drug-induced coma-like state and die an excruciating death. But before this, the patient is negotiating for something, anything, that will relieve his suffering. And money ceases to become an object. Skip the oncologist, pass the drugs.
- enjo 17y ago
  This is an emotionally charged issue for me, I lost my mom to ovarian cancer. My bet is that you, quite frankly, have no damn idea what your talking about. My mom was supposed to live 6 months longer (at best). Instead she made it more than 2 years. Where they difficult years? Yep. However, they where still valuable ones. She got to see me marry. She met the future mother of her grandchildren. She got to see and do things she always wanted to do. She saw her estranged family again. The value of those oncologists simply can't be discounted. It's an incredibly difficult profession, one in which most of your patients die. However, the ability to extend lives...even by a few months... and manage to make those last days as painless and productive as possible makes them angels in my book. Not profiteers. It was interesting getting to know her oncologist. He clearly struggled with the emotions of his job. In the wake of her death he couldn't bring himself to attend her funeral (understandable). There was hardly a human being who knew her better in those last two years... and for that I'll be eternally grateful to him.
AdamN 17y ago
I like the “That moron Bush” quote when he can't remember anything but the response to who the president is.
danteembermage 17y ago
I think a partial solution to this is to require some small portion of health care costs to be covered by the patient. Would she have spent 5% of $40,000 if he was probably going to die overnight? If if she could afford it she probably wouldn't have. What about the previous two times when there was more hope? Probably so. Alternatively, she paid higher premiums under the assumption that some extreme end of life dollars would be nearly wasted by some policy members, but that's okay because that's what they chose to pay for so that they would never have to make a cost benefit analysis in their own care. I don't think she needs to wring her hands about it, that's what she bought.
- axod 17y ago
  >> "I think a partial solution to this is to require some small portion of health care costs to be covered by the patient." What the hell??? Health care should be a right. Something you don't have to ever worry about. If my kid is lying in hospital sick, I'm not going to make a decision based on money, because I'd always say "Yes take all my money", and that puts me in a very vulnerable position indeed. One that could be exploited by evil companies if given the chance. Health should always be far far far more important than money, but to prevent evil companies making a ton of money out of desperate people, it should be provided by the government. Why is there such a disconnect in America between socialized war mongering, and socialized health care?
  - jrockway 17y ago
    "American exceptionalism". We are too good to get free stuff that is good for us, and we are too good to not impose our views on the rest of the world. I don't think this, of course, but that's why I am not elected to a public office. Relevant painting: http://en.wikipedia.org/wiki/File:Progress_of_America,_by_Domenico_Tojetti.jpg http://en.wikipedia.org/wiki/File:Progress_of_America,_by_Do...
  - noonespecial 17y ago
    Free speech is a right. When I speak freely, I don't diminish your ability to do so. Healthcare can never be a "right" in the same way because it is bounded by scarcity. There is some point at which when I consume more, it leaves less for everyone else. We can decide to ration what we have fairly. (How to do this is a matter of great debate). I'd argue that facing this problem in a clear-eyed, rational manner is almost a rite of passage for civilization, but calling it a "right" clouds the issue considerably.
dustingetz 17y ago
ice cold alert. what was gained by keeping him alive, in a bed, not creating value, for 400k? the family suffered with him while he died. let him die, grieve, get on with your lives. and save the rest of us the 400k.
- jrockway 17y ago
  Will you be this cold when you are dying? What about when your wife and kids are dying? Maybe I am just a hopeless optimist, but personally, if my wife/kid is dying, I am probably not going to say "BAI!1!", rip the cord out of the electrical outlet, and grin as I watch his/her eyes close for the last time. Ever. Instead, I am going to spend a lot of money to hopefully avoid ever seeing that. Because while you can always make more money, we can't clone people yet.
  - pw0ncakes 17y ago
    My own death doesn't scare or disturb me. It might happen suddenly tomorrow, or in 50 years, or in a million (if anti-aging succeeds). I'm sufficiently curious about what happens next not to be upset about the concept. (Although death is weird; I've never done it before.) On the other hand, I'd fight for a child or a (healthy, not doomed to die soon) relative with everything I've got. Which is why it surprises the hell out of me that health insurance companies aren't getting the Joseph Stack treatment all over the place over rescissions and life caps.
    - giardini 17y ago
      You're genetically programmed to protect children. Doctors and hospitals know this and exploit it. Unfortunately children with cancer or birth defects are money sinkholes. Spartan parents would kill children with defects. In contrast we keep physically and genetically damaged children alive (or on life-support in the case of cancer) at much cost to ourselves and at peril to our offspring. Would you want your daughter to marry a man who carried a life-threatening gene? Did she? That's what we're doing. Maybe someday we'll be able to fix these problems, but today we cannot.
  - 17y ago
steveplace 17y ago
I'm sure we can find ways to view the US healthcare issue as "Hacker News," but please let me have some sanctuary.
- pw0ncakes 17y ago
  It's of relevance to anyone in the US who is considering working for startups, since anyone who does so runs the (admittedly low-probability) risk of being murdered due to unaffordable or inadequate health coverage.
  - nandemo 17y ago
    I think steveplace covered that when he wrote 'we can find ways to view the US healthcare issue as "Hacker News"'. In that sense, almost any political news can be made to be "relevant" to HN. The California budget deficit, Iraq, the tax code, the next elections, you name it. And when the topic is politics, even though people here tend to remain civil, the level of discourse inevitably goes down. For instance, consider your superlative usage of "murder". This sort of thing practically precludes any further fruitful discussion: anyone who disagrees with you is automatically in the uncomfortable position of "abetting murder".
    - axod 17y ago
      I think it's fairly relevant. For example as relevant as all the startup visa stuff. I would never startup in the US, and one of the reasons would be lack of public healthcare.
dhyasama 17y ago
Some friends lived with me for a few months while their daughter was in the NICU because she was born extremely prematurely. I don't know the final tally, but at some point the calculated the total cost to be just north of $2,000,000. I don't think it is possible for me to rationally discuss if is worth it because I'm emotionally involved (they now have a beautiful, healthy little girl), but it's easy to see that it doesn't take many cases like hers to jack insurance premiums up pretty high. As our medical skills are improving we can keep people alive that used to die. Unfortunately our medical skill isn't advanced enough to do it cheaply. Perhaps the luxuries of time and money will get us there one day.
- dtby 17y ago
  It seems unlikely that medical technology will not continue to advance. As such, there will always be new techniques which are, by their very nature, expensive relative to older proven means. So, yes, we'll be able to provide today's state of the art medical care "cheaply" in the not too distant future... but that will no longer be the standard by which emotionally-involved people judge "good enough" care.
- vaksel 17y ago
  the same 2 million dollar treatment probably costs 3-5 grand in Mexico or India. Personally I think health tourism is going to be much more popular soon, since the healthcare costs in the states are getting less and less affordable.
  - sokoloff 17y ago
    Are you honestly suggesting that someone would travel to Mexico or India to put their premie in newborn intensive care unit there? Really; that seems remotely reasonable (or even possible) to you?
delackner 17y ago
Since the article is talking about examining the detailed costs of the long, drawn-out process of his slow decline, it is important to note that she says he was an overweight ex-smoker, which made him (she says) a prime candidate for kidney cancer. The biggest cost in western-style health care is not end of life care, it is lifestyle-induced illness that leads to an explosion of totally preventable terminal diseases.
- pw0ncakes 17y ago
  Cancer is not "totally preventable". Non-smokers die of lung cancer (and other cancers) too.

59 points by AdamN 17y ago

Solid long-format article about the costs of healthcare for a dying husband.

Seems pretty clear that it was worth it. The actual bill was closer to $250,000 -- $618,000 was without any discounts. We work and save and pay premiums for decades specifically so that we CAN have someone pay $250,000 to extend our lives by 17 months. That is the PURPOSE of a health insurance policy. It's hard to see this one as an example of our (admittedly terrible) healthcare costs.

houseabsolute 17y ago
Based on the conclusion of the article it seems that she agrees.
jcdreads 17y ago
Right, but her point is that had they (the author and her late husband) actually understood the costs at the time that they were making treatment decisions they might have made different ones. On the other hand, as you note, in a very real sense they'd already paid for the treatment in the form of decades of premiums.
bobbyi 17y ago
Also, the money that was spent didn't just go to extending his life. A lot of that money was spent on pharmaceuticals where he was an "early adopter". People like him covering the massive costs of developing those pharmaceuticals are paving the road for the day when they can be available as cheaply as the vaccinations the article talks about.
- Confusion 17y ago
  People like him covering the massive costs You mean people like us, the ones that pay the premiums, subsidizing the research of pharmaceutical companies?

noonespecial 17y ago

The real problems start not when "end of life" becomes very expensive (which it has) but when technology advances to the point where it is possible to keep someone alive indefinitely but at geometrically increasing costs. We've set it up so that everyone will feel entitled to that one extra week, no matter what the cost.

houseabsolute 17y ago
I doubt that costs can increase geometrically for any significant period of time. The technological ramp would have to be enormous. Unless your belief is that current technologies will remain at their current prices and new technologies will be built at exclusively higher prices.
- noonespecial 17y ago
  Its not about any particular technology, per se. It was cheap to die in 1600 no matter what killed you simply because there was very little that could be done. Each year we add more and more expensive interventions from ECMO machines to artificial hearts. Put this together with the "if it can be done, it should be done, damn the cost" attitude we've trained ourselves to expect and we could find ourselves in for a severe reality check. Medical technology seems strangely resistant to Moore's law (witness the price of a CT scan over time), but even if it weren't, the improvements in individual areas might not be enough to offset the growth of intervention technology in general.
pw0ncakes 17y ago
That's unlikely to happen. If nanotech and anti-aging succeed, they'll push back the costs. If they don't, there's going to be a lot of scaling back on things that don't work or aren't proven.
- orangecat 17y ago
  If nanotech and anti-aging succeed, they'll push back the costs. Yes, anti-aging is the best possible research we could be funding. Unfortunately most people shut down when it's brought up, because thinking about your own decline and death isn't pleasant. If they don't, there's going to be a lot of scaling back on things that don't work or aren't proven. How will the "scaling back" be accomplished? Governments can and should stop paying large amounts for treatments that don't do much, but unless private services are banned, lots people will spend whatever they have to try to keep themselves or their loved ones alive.

giardini 17y ago

Even oncologist question their utility today when they can offer the average cancer patient only meager life extension, and those are often pain-filled years at that. But it's a good business model: people will often spend their net worth to extend the life of themselves or their child a few months. But in the end they almost always die the same miserable death. So I expect even more "childrens' cancer centers" to open and rake in millions.

sp332 17y ago
Oncologists offer significant resources in pain management, which is very important. Life extension isn't the only thing doctors are good for.
- giardini 17y ago
  Yes, but an oncologist is unnecessary for this. Pain management becomes the single most important thing to the patient until, finally, they reach the level where no legal painkiller can do anything for them. Then they lapse into a drug-induced coma-like state and die an excruciating death. But before this, the patient is negotiating for something, anything, that will relieve his suffering. And money ceases to become an object. Skip the oncologist, pass the drugs.
enjo 17y ago
This is an emotionally charged issue for me, I lost my mom to ovarian cancer. My bet is that you, quite frankly, have no damn idea what your talking about. My mom was supposed to live 6 months longer (at best). Instead she made it more than 2 years. Where they difficult years? Yep. However, they where still valuable ones. She got to see me marry. She met the future mother of her grandchildren. She got to see and do things she always wanted to do. She saw her estranged family again. The value of those oncologists simply can't be discounted. It's an incredibly difficult profession, one in which most of your patients die. However, the ability to extend lives...even by a few months... and manage to make those last days as painless and productive as possible makes them angels in my book. Not profiteers. It was interesting getting to know her oncologist. He clearly struggled with the emotions of his job. In the wake of her death he couldn't bring himself to attend her funeral (understandable). There was hardly a human being who knew her better in those last two years... and for that I'll be eternally grateful to him.

AdamN 17y ago

I like the “That moron Bush” quote when he can't remember anything but the response to who the president is.

danteembermage 17y ago

I think a partial solution to this is to require some small portion of health care costs to be covered by the patient. Would she have spent 5% of $40,000 if he was probably going to die overnight? If if she could afford it she probably wouldn't have. What about the previous two times when there was more hope? Probably so. Alternatively, she paid higher premiums under the assumption that some extreme end of life dollars would be nearly wasted by some policy members, but that's okay because that's what they chose to pay for so that they would never have to make a cost benefit analysis in their own care. I don't think she needs to wring her hands about it, that's what she bought.

axod 17y ago
>> "I think a partial solution to this is to require some small portion of health care costs to be covered by the patient." What the hell??? Health care should be a right. Something you don't have to ever worry about. If my kid is lying in hospital sick, I'm not going to make a decision based on money, because I'd always say "Yes take all my money", and that puts me in a very vulnerable position indeed. One that could be exploited by evil companies if given the chance. Health should always be far far far more important than money, but to prevent evil companies making a ton of money out of desperate people, it should be provided by the government. Why is there such a disconnect in America between socialized war mongering, and socialized health care?
- jrockway 17y ago
  "American exceptionalism". We are too good to get free stuff that is good for us, and we are too good to not impose our views on the rest of the world. I don't think this, of course, but that's why I am not elected to a public office. Relevant painting: http://en.wikipedia.org/wiki/File:Progress_of_America,_by_Domenico_Tojetti.jpg http://en.wikipedia.org/wiki/File:Progress_of_America,_by_Do...
- noonespecial 17y ago
  Free speech is a right. When I speak freely, I don't diminish your ability to do so. Healthcare can never be a "right" in the same way because it is bounded by scarcity. There is some point at which when I consume more, it leaves less for everyone else. We can decide to ration what we have fairly. (How to do this is a matter of great debate). I'd argue that facing this problem in a clear-eyed, rational manner is almost a rite of passage for civilization, but calling it a "right" clouds the issue considerably.

dustingetz 17y ago

ice cold alert. what was gained by keeping him alive, in a bed, not creating value, for 400k? the family suffered with him while he died. let him die, grieve, get on with your lives. and save the rest of us the 400k.

jrockway 17y ago
Will you be this cold when you are dying? What about when your wife and kids are dying? Maybe I am just a hopeless optimist, but personally, if my wife/kid is dying, I am probably not going to say "BAI!1!", rip the cord out of the electrical outlet, and grin as I watch his/her eyes close for the last time. Ever. Instead, I am going to spend a lot of money to hopefully avoid ever seeing that. Because while you can always make more money, we can't clone people yet.
- pw0ncakes 17y ago
  My own death doesn't scare or disturb me. It might happen suddenly tomorrow, or in 50 years, or in a million (if anti-aging succeeds). I'm sufficiently curious about what happens next not to be upset about the concept. (Although death is weird; I've never done it before.) On the other hand, I'd fight for a child or a (healthy, not doomed to die soon) relative with everything I've got. Which is why it surprises the hell out of me that health insurance companies aren't getting the Joseph Stack treatment all over the place over rescissions and life caps.
  - giardini 17y ago
    You're genetically programmed to protect children. Doctors and hospitals know this and exploit it. Unfortunately children with cancer or birth defects are money sinkholes. Spartan parents would kill children with defects. In contrast we keep physically and genetically damaged children alive (or on life-support in the case of cancer) at much cost to ourselves and at peril to our offspring. Would you want your daughter to marry a man who carried a life-threatening gene? Did she? That's what we're doing. Maybe someday we'll be able to fix these problems, but today we cannot.
- 17y ago

steveplace 17y ago

I'm sure we can find ways to view the US healthcare issue as "Hacker News," but please let me have some sanctuary.

pw0ncakes 17y ago
It's of relevance to anyone in the US who is considering working for startups, since anyone who does so runs the (admittedly low-probability) risk of being murdered due to unaffordable or inadequate health coverage.
- nandemo 17y ago
  I think steveplace covered that when he wrote 'we can find ways to view the US healthcare issue as "Hacker News"'. In that sense, almost any political news can be made to be "relevant" to HN. The California budget deficit, Iraq, the tax code, the next elections, you name it. And when the topic is politics, even though people here tend to remain civil, the level of discourse inevitably goes down. For instance, consider your superlative usage of "murder". This sort of thing practically precludes any further fruitful discussion: anyone who disagrees with you is automatically in the uncomfortable position of "abetting murder".
  - axod 17y ago
    I think it's fairly relevant. For example as relevant as all the startup visa stuff. I would never startup in the US, and one of the reasons would be lack of public healthcare.

dhyasama 17y ago

Some friends lived with me for a few months while their daughter was in the NICU because she was born extremely prematurely. I don't know the final tally, but at some point the calculated the total cost to be just north of $2,000,000. I don't think it is possible for me to rationally discuss if is worth it because I'm emotionally involved (they now have a beautiful, healthy little girl), but it's easy to see that it doesn't take many cases like hers to jack insurance premiums up pretty high. As our medical skills are improving we can keep people alive that used to die. Unfortunately our medical skill isn't advanced enough to do it cheaply. Perhaps the luxuries of time and money will get us there one day.

dtby 17y ago
It seems unlikely that medical technology will not continue to advance. As such, there will always be new techniques which are, by their very nature, expensive relative to older proven means. So, yes, we'll be able to provide today's state of the art medical care "cheaply" in the not too distant future... but that will no longer be the standard by which emotionally-involved people judge "good enough" care.
vaksel 17y ago
the same 2 million dollar treatment probably costs 3-5 grand in Mexico or India. Personally I think health tourism is going to be much more popular soon, since the healthcare costs in the states are getting less and less affordable.
- sokoloff 17y ago
  Are you honestly suggesting that someone would travel to Mexico or India to put their premie in newborn intensive care unit there? Really; that seems remotely reasonable (or even possible) to you?

delackner 17y ago

Since the article is talking about examining the detailed costs of the long, drawn-out process of his slow decline, it is important to note that she says he was an overweight ex-smoker, which made him (she says) a prime candidate for kidney cancer. The biggest cost in western-style health care is not end of life care, it is lifestyle-induced illness that leads to an explosion of totally preventable terminal diseases.

pw0ncakes 17y ago
Cancer is not "totally preventable". Non-smokers die of lung cancer (and other cancers) too.