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This seems to be more of a problem with insurance - there often is little transparency and doctors simply charge all sorts of things to the insurer that the pat

This seems to be more of a problem with insurance - there often is little transparency and doctors simply charge all sorts of things to the insurer that the patient has no idea about. I think that is one of the main challenges of health insurance. In my country (Germany) I have actually shied away from switching to private insurance, because they pay doctors more, and doctors are known to do as many tests and procedures as possible (not always a good thing, but in the end it is a gamble - too many examinations/procedures or too few?). The "public" health insurance is quite regulated as to what gets paid and how much. The downside is that doctors have to waste a lot of time on bureaucracy (every examination has to be entered into the computer to determine the costs), and transparency is still missing (patients typically don't even know how much their treatments cost). And some committee decides what procedures get paid. I don't trust committees. I trust the market (I mean I trust "in" markets, not necessarily any given market as markets can be broken by regulations, lack of transparency, all sorts of things). I have also spent a lot of money on things that weren't covered by public insurance. One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. I think it is actually unavoidable that insurance will have to make a cut at some point, because medical procedures can become arbitrarily expensive. Perhaps even now for the right money, people could be kept alive indefinitely. I would have no problem with a doctor trying to be profitable - just as with other businesses. I guess the classic assumption is that to be profitable, businesses have to provide good service.

DanWaterworth 9y ago
> One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. A quick Google search reveals this claim is spurious, so maybe don't believe everything you hear.
- anothercomment 9y ago
  Sorry about that - I heard it a long time ago. Nevertheless, health insurance will always be capped at some point, you can not guarantee arbitrarily high expenses for everybody.
  - DanWaterworth 9y ago
    What happens is: treatments are evaluated and declared either cost effective or not. They don't refuse people treatment because they've used more than their 'fair share' of some allowance.
DanBC 9y ago
> One story I heard is that for example in the UK they won't pay for dialysis after a certain age. This is not true. In fact, most people getting dialysis are over 65. https://www.renalreg.org/wp-content/uploads/2014/12/Incidence-and-prevalence-final.pdf https://www.renalreg.org/wp-content/uploads/2014/12/Incidenc... > Kidney disease is more common as we get older, and although people of all ages can need to start dialysis, it most commonly affects people aged between 65 and 84 years. Figure 2 shows the number of people starting dialysis or going straight to transplantation in each age group and it can be seen that the age group with the most people was 65–74 for both haemodialysis and peritoneal dialysis. In 2013, the average age of people starting treatment was 65 years and this has changed little over the last six years. The average age at start was 67 years for people starting on haemodialysis, 60 for people starting on peritoneal dialysis and 50 for those having a transplant before they start dialysis. In 2013, more men started treatment than women (63% male versus 37% female). Diabetes was the single most common cause of kidney failure (25%). Here's a document talking about cost of dialysis for older people: https://academic.oup.com/ndt/article/18/10/2122/1807737/Costs-of-dialysis-for-elderly-people-in-the-UK https://academic.oup.com/ndt/article/18/10/2122/1807737/Cost... The NHS Constitution for England forbids discrimination based on age, as does the Equality Act 2010. https://www.gov.uk/government/publications/the-nhs-constitution-for-england https://www.gov.uk/government/publications/the-nhs-constitut... > The NHS provides a comprehensive service, available to all > It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population. http://www.legislation.gov.uk/ukpga/2010/15/section/5 http://www.legislation.gov.uk/ukpga/2010/15/section/5
- anothercomment 9y ago
  Sorry, I heard it many years ago and didn't double check. Nevertheless for sure there are caps on health care expenses. Speaking of kidneys - don't they prioritize recipients of organs somehow? If age based discrimination is forbidden, an 85 year old person would be as eligible as an 8 year old to receive a new kidney? Not saying it would be wrong, just curious.
grkvlt 9y ago
> [I]n the UK they won't pay for dialysis after a certain age This is completely WRONG, there are NO age-related limits for treatment like this in the UK. Dialysis is a life-saving procedure for those with kidney failure, and is available to everyone in the UK who requires it regardless of age. The same goes for heart surgery, bypass operations, stents etc. which are also sometimes claimed to be age restricted. The fact that people actually believe that a cruel system like this (one that would cause people to die by withholding treatment just because of their age) might really exist probably says much more about the way US health care works and the perceptions surrounding it.
- anothercomment 9y ago
  I am actually from Germany and heard the story about NHS dialysis many years ago, so it has nothing to do with US right wing propaganda or whatever. My apologies, though, if it isn't correct. Nevertheless I think there will always be procedures that won't be paid for, in any health care system, because it would always be possible to incur arbitrarily high costs. As an extreme example, you could assemble a team of 1000 scientists to try to cure one person.
  - grkvlt 9y ago
    That's interesting, I assumed it was a solely US belief, and certainly there have been plenty of scare-story emails circulating there regarding NHS and ACA. Obviously NICE [0] (National Institute for Health and Care Excellence) does make calculations about when and what treatment should be given or withheld, using a system called QALYs [1] (Quality Adjusted Life Years) to attempt to ethically and deterministically decide this, which will always cause some people to be unhappy, unfortunately. 0. https://www.nice.org.uk/ https://www.nice.org.uk/ 1. https://en.wikipedia.org/wiki/Quality-adjusted_life_year https://en.wikipedia.org/wiki/Quality-adjusted_life_year

DanWaterworth 9y ago

> One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. A quick Google search reveals this claim is spurious, so maybe don't believe everything you hear.

anothercomment 9y ago
Sorry about that - I heard it a long time ago. Nevertheless, health insurance will always be capped at some point, you can not guarantee arbitrarily high expenses for everybody.
- DanWaterworth 9y ago
  What happens is: treatments are evaluated and declared either cost effective or not. They don't refuse people treatment because they've used more than their 'fair share' of some allowance.

DanBC 9y ago

> One story I heard is that for example in the UK they won't pay for dialysis after a certain age. This is not true. In fact, most people getting dialysis are over 65. https://www.renalreg.org/wp-content/uploads/2014/12/Incidence-and-prevalence-final.pdf https://www.renalreg.org/wp-content/uploads/2014/12/Incidenc... > Kidney disease is more common as we get older, and although people of all ages can need to start dialysis, it most commonly affects people aged between 65 and 84 years. Figure 2 shows the number of people starting dialysis or going straight to transplantation in each age group and it can be seen that the age group with the most people was 65–74 for both haemodialysis and peritoneal dialysis. In 2013, the average age of people starting treatment was 65 years and this has changed little over the last six years. The average age at start was 67 years for people starting on haemodialysis, 60 for people starting on peritoneal dialysis and 50 for those having a transplant before they start dialysis. In 2013, more men started treatment than women (63% male versus 37% female). Diabetes was the single most common cause of kidney failure (25%). Here's a document talking about cost of dialysis for older people: https://academic.oup.com/ndt/article/18/10/2122/1807737/Costs-of-dialysis-for-elderly-people-in-the-UK https://academic.oup.com/ndt/article/18/10/2122/1807737/Cost... The NHS Constitution for England forbids discrimination based on age, as does the Equality Act 2010. https://www.gov.uk/government/publications/the-nhs-constitution-for-england https://www.gov.uk/government/publications/the-nhs-constitut... > The NHS provides a comprehensive service, available to all > It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to improve, prevent, diagnose and treat both physical and mental health problems with equal regard. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population. http://www.legislation.gov.uk/ukpga/2010/15/section/5 http://www.legislation.gov.uk/ukpga/2010/15/section/5

anothercomment 9y ago
Sorry, I heard it many years ago and didn't double check. Nevertheless for sure there are caps on health care expenses. Speaking of kidneys - don't they prioritize recipients of organs somehow? If age based discrimination is forbidden, an 85 year old person would be as eligible as an 8 year old to receive a new kidney? Not saying it would be wrong, just curious.

grkvlt 9y ago

> [I]n the UK they won't pay for dialysis after a certain age This is completely WRONG, there are NO age-related limits for treatment like this in the UK. Dialysis is a life-saving procedure for those with kidney failure, and is available to everyone in the UK who requires it regardless of age. The same goes for heart surgery, bypass operations, stents etc. which are also sometimes claimed to be age restricted. The fact that people actually believe that a cruel system like this (one that would cause people to die by withholding treatment just because of their age) might really exist probably says much more about the way US health care works and the perceptions surrounding it.

anothercomment 9y ago
I am actually from Germany and heard the story about NHS dialysis many years ago, so it has nothing to do with US right wing propaganda or whatever. My apologies, though, if it isn't correct. Nevertheless I think there will always be procedures that won't be paid for, in any health care system, because it would always be possible to incur arbitrarily high costs. As an extreme example, you could assemble a team of 1000 scientists to try to cure one person.
- grkvlt 9y ago
  That's interesting, I assumed it was a solely US belief, and certainly there have been plenty of scare-story emails circulating there regarding NHS and ACA. Obviously NICE [0] (National Institute for Health and Care Excellence) does make calculations about when and what treatment should be given or withheld, using a system called QALYs [1] (Quality Adjusted Life Years) to attempt to ethically and deterministically decide this, which will always cause some people to be unhappy, unfortunately. 0. https://www.nice.org.uk/ https://www.nice.org.uk/ 1. https://en.wikipedia.org/wiki/Quality-adjusted_life_year https://en.wikipedia.org/wiki/Quality-adjusted_life_year