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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

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.
  - axod 17y ago
    Yeah sorry, the choice of words wasn't correct. It's not a right to demand every treatment under the sun etc. But I believe it is a right to have some level of basic healthcare provided by government. I simply couldn't live in a country without it :/ I guess the issue is that you can spin that as "Death panels" if you wish - the government/NHS/etc get to decide who gets treatment, and who doesn't. It's a great shame it's been spun that way though.
    - pw0ncakes 17y ago
      First world European countries use a quality-of-life-year or disability-adjusted life-year metric. If resource X will give patient A an expected 20 years of life as a vegetable (Q = 0.1) vs. patient B 10 fully-healthy years (Q = 1), patient B gets it. The goal is to maximize total life-years. Obviously, these numbers are estimates, the quality multiplier is subjective, and the optimization problem is very difficult, but the goal is fair and noble, and I think most people would agree with it. When I'm 90, if we haven't made any anti-aging progress, I would want the 20-year-old to get the heart transplant instead of me.
      - dhyasama 17y ago
        I would want myself to want the 20-year-old to get the transplant instead of me. Whether or not I would make that decision while lying on my death bed is another matter.
        pw0ncakes 17y ago
        Assuming no anti-aging progress, me being 90 implies that I've got 15 years left of life, tops... and most likely 2-4 given that I've just had a transplant. I'd be willing to give that up in order for someone else to live, as long as I can die a decent death. I believe that there are benefits to doing the right thing, both in the here and the hereafter. It'd be a harder decision if I was 50 and had children who depended on me, and if the 20-year-old didn't have good odds anyway (or had done something incredibly stupid). Then I might be tempted to do make the "selfish" decision if it were mine to make. But not if I am 90 and decrepit.
- anamax 17y ago
  > Health should always be far far far more important than money, I'm pretty sure that your own behavior proves otherwise. (I'm not claiming that your choices are wrong, but they do show that health isn't always your highest priority.) > but to prevent evil companies making a ton of money out of desperate people, it should be provided by the government. In what universe can govts provide unlimited healthcare? The current US healthcare "reform" includes significant cuts in Medicare spending on certain conditions. Folks who have those conditions will get less care. You know, pre-existing conditions.... Feel free to provide a checkable citation to any govt healthcare system that doesn't limit the amount of care.
  - wallflower 17y ago
    > Health should always be far far far more important than money Your most important asset is your ability to produce income. By that definition, your health is very, very important.
  - pw0ncakes 17y ago
    I'm not a fan of the current "reform", which is a total mess and won't achieve fundamental change. I think we should become a First World country, which means universal healthcare.
    - anamax 17y ago
      > I think we should become a First World country, which means universal healthcare. The US has univeral healthcare. As I've pointed out, most people opt out, in part because it's a lot like the DMV. It's unclear why making it bigger would change that. The US has a lot of experience with govt healthcare and it's mostly bad. (The Indian Health Service is especially bad.) It's unclear why we'd go for more before demonstrating that we could do it well. In other words, as long as Medicare and Medicaid are disasters, why would we want more? And yes, you can fix Medicare/Medicaid without increasing their scope. If they're fixable. And if they're not, increasing their scope won't fix them either.
      - pw0ncakes 17y ago
- mrkurt 17y ago
  It can't be a "right". You might ask for it to be a "limited" right, but medical care is expensive and a constant struggle between cost and benefit. The tough part is admitting that either some disinterested third party should specify what's worth doing, or people should be responsible for their own care. My personal belief is that a properly functioning market (ie: something vastly different than what we have now in the US) allows for more nuanced and personal decisions regarding what's worth paying for than a blanket set of policies. I also happen to think that letting people allocate their own resources between competitive providers is the best way to find that lovely equilibrium where prices are as low as they can be for a reasonable level of quality. Assuming you disagree with me, you still can't consider unlimited healthcare an achievable human right. If your kid is sitting in a hospital, someone is making a decision based on money. I'd rather I be in control at that point. I also assume that in such a happy fairytale of a free market, I'd have planned for such an occurrence and purchased a reasonable level of medical insurance to cover that sort of event. Be careful not to paint America with such a broad brush. Most of us are "victims" of fearmongering and policies that are well outside of our control. It's a sad byproduct of a dysfunctional system that's grown well outside the bounds of what it was originally designed for.
  - axod 17y ago
    I never said unlimited, and I disagree @ "I'd rather I be in control at that point". I'm not a doctor, and I'll leave it to them to decide the best course of action. The problem I have though is that most Americans seem to think pretty much unlimited socialised military spending is fine.
  - infinite8s 17y ago
    What do you consider a "properly functioning market"? People who espouse free market views of health insurance believe that it can work like other insurances (such as car and home insurance). But this ignores the fact that health insurance is fundamentally different. With other types of insurance, the max value of the insured is fixed (to basically its replacement cost). However, since we can't replace ourselves, we have to resort to fixing the problem with medicine, and the cost of this is dependent on the type and severity of the illness. The free market approach is exactly what you see with today's dysfunctional system. Health insurance companies charge healthy people and drop them when they get sick. Or healthy people decide not to insure themselves, and so the rolls are left with sick people who have higher insurance premiums. Of course, sometimes the healthy people get sick, go to the ER, and raise everybody's costs. Health insurance companies would love to purge their rolls of all unhealthy people, and only charge premiums to healthy people. The free market cannot fix this.
- lionhearted 17y ago
  > Health should always be far far far more important than money, Currently, I've got mild damage in my left elbow, both knees, and one of my teeth is very slightly chipped from a martial arts match. I could afford treatments to all of these, but I choose not to because there's other stuff I value more with my money. I like that I can make that choice for myself. I also like that no one has any say in what I do with my life - I can eat horrible fried foods, or not, I can drink loaded-with-fructose beverages, or not, I can smoke cigarettes and drink vodka, or not, and so on - and no one else has a say, because I pay for my own medicine and medical treatment. If everyone had to pay for my medicine, then logically they'd want a say in how I lived my life. I don't want to pay for someone who gets a preventable disease because of lifestyle choices, and I don't want someone to pay for mine. I'm happy that I get choice over my own life, and others don't get a say in how I live it, and I don't want a say in how others live their lives.
  - infinite8s 17y ago
    Until you get a heart attack, or some other critical medical condition. Are you willing to pay the $1000-$3000+ a night for your hospital stay? Or are you willing to stay home so those of us who do pay for insurance don't have to cover your expenses, since you will most likely not be able to pay them without bankrupting yourself.
jrockway 17y ago
Would she have spent 5% of $40,000 if he was probably going to die overnight? There are unintended consequences, of course. If a patient had invested hundreds of thousands of dollars in care that ultimately failed, the incentive for his family to sue for malpractice is much greater. This raises the price of malpractice insurance, which makes medical care more expensive for people that aren't at the end of their life; people with routine problems that are easily treatable. Also, you could agree to pay and just not pay. If I was going to die in an hour, and someone asked, "will you pay us a million dollars to use a new treatment", I would easily answer yes. I won't be needing the money if I die, and if I live, I can just change my name and not pay it. When you're broke, there are ways out. When you're dead, you're dead. That's it. Forever.
twstdroot 17y ago
They did pay a small portion... between 3% and 4% "The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 became $254,176 when the insurers paid their share and imposed their discounts. Of that, Terence and I were responsible for $9,468 -- less than 4 percent."

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.
- axod 17y ago
  Yeah sorry, the choice of words wasn't correct. It's not a right to demand every treatment under the sun etc. But I believe it is a right to have some level of basic healthcare provided by government. I simply couldn't live in a country without it :/ I guess the issue is that you can spin that as "Death panels" if you wish - the government/NHS/etc get to decide who gets treatment, and who doesn't. It's a great shame it's been spun that way though.
  - pw0ncakes 17y ago
    First world European countries use a quality-of-life-year or disability-adjusted life-year metric. If resource X will give patient A an expected 20 years of life as a vegetable (Q = 0.1) vs. patient B 10 fully-healthy years (Q = 1), patient B gets it. The goal is to maximize total life-years. Obviously, these numbers are estimates, the quality multiplier is subjective, and the optimization problem is very difficult, but the goal is fair and noble, and I think most people would agree with it. When I'm 90, if we haven't made any anti-aging progress, I would want the 20-year-old to get the heart transplant instead of me.
    - dhyasama 17y ago
      I would want myself to want the 20-year-old to get the transplant instead of me. Whether or not I would make that decision while lying on my death bed is another matter.
      - pw0ncakes 17y ago
        Assuming no anti-aging progress, me being 90 implies that I've got 15 years left of life, tops... and most likely 2-4 given that I've just had a transplant. I'd be willing to give that up in order for someone else to live, as long as I can die a decent death. I believe that there are benefits to doing the right thing, both in the here and the hereafter. It'd be a harder decision if I was 50 and had children who depended on me, and if the 20-year-old didn't have good odds anyway (or had done something incredibly stupid). Then I might be tempted to do make the "selfish" decision if it were mine to make. But not if I am 90 and decrepit.
anamax 17y ago
> Health should always be far far far more important than money, I'm pretty sure that your own behavior proves otherwise. (I'm not claiming that your choices are wrong, but they do show that health isn't always your highest priority.) > but to prevent evil companies making a ton of money out of desperate people, it should be provided by the government. In what universe can govts provide unlimited healthcare? The current US healthcare "reform" includes significant cuts in Medicare spending on certain conditions. Folks who have those conditions will get less care. You know, pre-existing conditions.... Feel free to provide a checkable citation to any govt healthcare system that doesn't limit the amount of care.
- wallflower 17y ago
  > Health should always be far far far more important than money Your most important asset is your ability to produce income. By that definition, your health is very, very important.
- pw0ncakes 17y ago
  I'm not a fan of the current "reform", which is a total mess and won't achieve fundamental change. I think we should become a First World country, which means universal healthcare.
  - anamax 17y ago
    > I think we should become a First World country, which means universal healthcare. The US has univeral healthcare. As I've pointed out, most people opt out, in part because it's a lot like the DMV. It's unclear why making it bigger would change that. The US has a lot of experience with govt healthcare and it's mostly bad. (The Indian Health Service is especially bad.) It's unclear why we'd go for more before demonstrating that we could do it well. In other words, as long as Medicare and Medicaid are disasters, why would we want more? And yes, you can fix Medicare/Medicaid without increasing their scope. If they're fixable. And if they're not, increasing their scope won't fix them either.
    - pw0ncakes 17y ago
mrkurt 17y ago
It can't be a "right". You might ask for it to be a "limited" right, but medical care is expensive and a constant struggle between cost and benefit. The tough part is admitting that either some disinterested third party should specify what's worth doing, or people should be responsible for their own care. My personal belief is that a properly functioning market (ie: something vastly different than what we have now in the US) allows for more nuanced and personal decisions regarding what's worth paying for than a blanket set of policies. I also happen to think that letting people allocate their own resources between competitive providers is the best way to find that lovely equilibrium where prices are as low as they can be for a reasonable level of quality. Assuming you disagree with me, you still can't consider unlimited healthcare an achievable human right. If your kid is sitting in a hospital, someone is making a decision based on money. I'd rather I be in control at that point. I also assume that in such a happy fairytale of a free market, I'd have planned for such an occurrence and purchased a reasonable level of medical insurance to cover that sort of event. Be careful not to paint America with such a broad brush. Most of us are "victims" of fearmongering and policies that are well outside of our control. It's a sad byproduct of a dysfunctional system that's grown well outside the bounds of what it was originally designed for.
- axod 17y ago
  I never said unlimited, and I disagree @ "I'd rather I be in control at that point". I'm not a doctor, and I'll leave it to them to decide the best course of action. The problem I have though is that most Americans seem to think pretty much unlimited socialised military spending is fine.
- infinite8s 17y ago
  What do you consider a "properly functioning market"? People who espouse free market views of health insurance believe that it can work like other insurances (such as car and home insurance). But this ignores the fact that health insurance is fundamentally different. With other types of insurance, the max value of the insured is fixed (to basically its replacement cost). However, since we can't replace ourselves, we have to resort to fixing the problem with medicine, and the cost of this is dependent on the type and severity of the illness. The free market approach is exactly what you see with today's dysfunctional system. Health insurance companies charge healthy people and drop them when they get sick. Or healthy people decide not to insure themselves, and so the rolls are left with sick people who have higher insurance premiums. Of course, sometimes the healthy people get sick, go to the ER, and raise everybody's costs. Health insurance companies would love to purge their rolls of all unhealthy people, and only charge premiums to healthy people. The free market cannot fix this.
lionhearted 17y ago
> Health should always be far far far more important than money, Currently, I've got mild damage in my left elbow, both knees, and one of my teeth is very slightly chipped from a martial arts match. I could afford treatments to all of these, but I choose not to because there's other stuff I value more with my money. I like that I can make that choice for myself. I also like that no one has any say in what I do with my life - I can eat horrible fried foods, or not, I can drink loaded-with-fructose beverages, or not, I can smoke cigarettes and drink vodka, or not, and so on - and no one else has a say, because I pay for my own medicine and medical treatment. If everyone had to pay for my medicine, then logically they'd want a say in how I lived my life. I don't want to pay for someone who gets a preventable disease because of lifestyle choices, and I don't want someone to pay for mine. I'm happy that I get choice over my own life, and others don't get a say in how I live it, and I don't want a say in how others live their lives.
- infinite8s 17y ago
  Until you get a heart attack, or some other critical medical condition. Are you willing to pay the $1000-$3000+ a night for your hospital stay? Or are you willing to stay home so those of us who do pay for insurance don't have to cover your expenses, since you will most likely not be able to pay them without bankrupting yourself.

jrockway 17y ago

Would she have spent 5% of $40,000 if he was probably going to die overnight? There are unintended consequences, of course. If a patient had invested hundreds of thousands of dollars in care that ultimately failed, the incentive for his family to sue for malpractice is much greater. This raises the price of malpractice insurance, which makes medical care more expensive for people that aren't at the end of their life; people with routine problems that are easily treatable. Also, you could agree to pay and just not pay. If I was going to die in an hour, and someone asked, "will you pay us a million dollars to use a new treatment", I would easily answer yes. I won't be needing the money if I die, and if I live, I can just change my name and not pay it. When you're broke, there are ways out. When you're dead, you're dead. That's it. Forever.

twstdroot 17y ago

They did pay a small portion... between 3% and 4% "The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 became $254,176 when the insurers paid their share and imposed their discounts. Of that, Terence and I were responsible for $9,468 -- less than 4 percent."