21 ms·
42 percent of new cancer patients lose their life savings
- chrisbennet 8y agoI think if I get cancer I'm just going to have to die. I can't leave my wife destitute.
- ArrayList 8y agoCan't she get a job?
- toomuchtodo 8y agoAnd spend the rest of her life paying back medical debts that she shouldn't have to? To me, this sounds like indentured servitude and not acceptable in a first world country.
- henryfjordan 8y agoDivorce is an option. Legally divorce then cut a new will to leave 100% to the wife before you start your treatment. That way she's only out half at most if the medical debts take everything. You'd have to be careful to not treat any money or assets as communal but so long as you go through the motions there's not much anyone can do.
- jakelazaroff 8y agoIt's crazy that the U.S. healthcare system is so messed up that this is actually being made as a serious suggestion.
- croon 8y agoThat sounds like the sort of hacky solution I would be ashamed to ship, but would do if the project is systemically badly managed to the point where you can't expect the sources of problems to be fixed.
- ams6110 8y agoHere's the thing. Cancer comes in basically two types. That which is treatable, and that which isn't. This can be either because of the type of cancer, or based on how early/late it was detected. A lot of (possibly most of?) the money spent treating cancer is spent in cases that have very little chance for long term success. I don't think it really is, but it almost seems like a deliberate attempt to extract all the wealth from the patient before he dies.
- harshreality 8y agoIt's not deliberate, but that's just how the incentives align. You have expensive treatments with outcomes not much better than control/placebo[1], but doctors and hospital administrators prefer to have nicer houses and drive better cars, so this is what you get. It's not their problem if patients pay tens or hundreds of thousands of dollars more, based on the hope of being in the small percentage of those who get good outcomes. Medical services are an inelastic good. If someone has a problem that's a serious threat to life or happiness, they will spend every penny they have and some they don't on the slightest chance to avoid it. Competition, for various reasons[2], doesn't work well. [1] In some cases where the intervention has slight mean/median benefit. In other cases, the outcomes are no better than control/placebo, even on average, but studies funded by drug companies or medical suppliers suggest that the intervention outcomes are better than controls, due to scientific mistakes or even intentional fraud (starting with bad experimental design, then cherry-picking data and cherry-picking studies). [2] Comparison shopping works well for choosing suppliers of standardized drugs and services, in non-emergencies, but even that's usually torpedoed by what your insurance will cover; If you have the luxury, you can compare various brands of drugs that have generic versions. You can comparison shop for prices for blood draws and scans (CT/MRI). Beyond simple things like that, the treatments are not identical so comparing costs is difficult. Also, patents. Nobody will raise the price of a drug 100% in a day, but companies build in fatter and fatter margins because they have a patent monopoly, and everyone else is doing it to. There is no price control through competition except where there are genuine equivalent goods. Since healthcare is largely price-inelastic, without strong competition on the supply side, you get runaway costs. This shouldn't be a surprise.
- jopsen 8y ago
- Pica_soO 8y agoJust repatriate to a country with a decent medical system.
- Pharmakon 8y agoSometimes I’m just amazed that people haven’t risen up in bloody revolt yet. Recently my mother had a flare-up up radiation-induced pneumonitis and the PPO insurance she pays $14,000 annually wouldn’t approve a single unit of Advair. It took a week of talking to doctors and insurance drones to figure out that they were pushing her to an alternative that cost them $100 less. If I woke up tomorrow and people were burning Wall Street to the ground I’d be less than shocked.
- village-idiot 8y agoAgain and again history reveals a surprising fact: you can push people really far before they finally reach their breaking point. And when that breaking point is finally reached, the trigger will not be what you expected.
- api 8y agoThis is especially true when there are no obvious and politically viable good alternatives. In the US everyone outside the center-left or center-right seems to be an absolute lunatic of one sort or another, and even if that weren't the case the two party oligopoly system is deeply entrenched and guarantees that alternatives can't succeed. There's nobody who is both sane and electable that isn't part of the mainstream duopoly. The more polarized people become between the two major parties the more deeply entrenched the duopoly becomes. People don't dare vote for anyone but D or R because otherwise the hated other side will win. It completely rules out any third party or independent. Only two parties means there really isn't that much diversity of thought beyond a small number of hot-button issues, and it also reduces the work load for lobbyists and other influence peddlers. Fewer parties means fewer people that have to be begged, bribed, misinformed, or blackmailed to get whatever you want. It makes regulatory capture a lot easier to achieve. I really don't think the American two party system is working. We need more of a parliamentary type system where you can have many parties and a greater variety of views can get a hearing.
- AnIdiotOnTheNet 8y agoEven if we could just find a way to keep people from thinking about political parties the same way they do about sports we could make a lot of progress.
- maxxxxx 8y agoI have seen that with an acquaintance. She had insurance but there was a never ending string of things that cost $20k here, $10k there until she was wiped out and had to file for bankruptcy. In the US even if you have insurance it's still a gamble whether you'll get wiped out or not.
- mikeyouse 8y agoFeels like the headline should include "In America". This certainly doesn't happen in the rest of the civilized world.
- colordrops 8y agoIs China civilized? Cuz it definitely happens there. I've heard a doctor ask a family how much money they've got in the bank, and took it all to keep a dying uncle on life support for another month. A crime.
- Retric 8y ago> Is China civilized? No. The rampant corruption, lack of free speech, etc don't qualify as civilized IMO.
- PenguinCoder 8y agoBy those metrics (and others), United States isn't a civilized country either.
- kpommerenke 8y agoNot true: Corruption: The USA ranks 16th (1 is best) out of 180 countries according to Transparency International: https://www.transparency.org/news/feature/corruption_perceptions_index_2017#table https://www.transparency.org/news/feature/corruption_percept... Free speech: If anything, there is too much free speech in the USA, as people can and do say all kinds of nonsense, starting at the very top.
- twoheadedboy 8y agoMan I would hate to live in a country that is ostensibly more corrupt than North Korea...
- dionidium 8y agoThis is silly. Please don't make easily-refuted, throwaway political statements like this. On almost any corruption index, the United States ranks far, far better than China. Here's one example: https://www.transparency.org/news/feature/corruption_perceptions_index_2016?gclid=CjwKCAjwgabeBRBuEiwACD4R5o0dlkb6DcpygujvgIFhuljCeU9CoNTB7mkDw_q9ZfDVil0hQFSjBRoCULYQAvD_BwE https://www.transparency.org/news/feature/corruption_percept... People do try to measure this stuff.
- gred 8y agoA big factor here seems to be lifetime limits to benefits: > Financial toxicity led Fumiko Chino to co-write a research letter in JAMA Oncology last November. After her husband surpassed his insurance policy's $500,000 lifetime limit, Chino drained her savings to pay for his treatment. When he died, she was left hundreds of thousands of dollars in debt. However, these limits were outlawed by the Affordable Care Act, even for grandfathered plans: https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/index.html https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/...
- zrail 8y agoYeah, the study appears to be looking at 2000–2012. The lifetime limit ban started on March 23rd 2010, according to this Vox article: https://www.vox.com/policy-and-politics/2017/2/15/14563182/obamacare-lifetime-limits-ban https://www.vox.com/policy-and-politics/2017/2/15/14563182/o... Thanks Obama.
- mikeyouse 8y agoAnd before people get too comfortable -- Every single "Obamacare replacement" plan does away with the ban on lifetime caps either directly or indirectly. These are enormously beneficial to insurance companies (they essentially have unlimited liability without them) and there is a ton of money to have the caps reinstated.
- dragonwriter 8y ago> Every single "Obamacare replacement" plan does away with lifetime caps either directly or indirectly. You mean, does away with the ban on such caps, right?
- mikeyouse 8y agoI did indeed, thanks for the proofread.
- deleted 8y ago[deleted]
- coolboy93290 8y agoIf I find out I have cancer: 0) Take all my money from all the accounts, turn it into cash. 1) Give cash to a blood relative in a backpack. 2) If married divorce, uncontested. [You will need 3 months]. 3) Apply for 10 credit cards. [Maybe 3 weeks] 4) Use credit cards for all medical expenses. 5) With last card, get a lawyer to help file bankruptcy. 6) Slowly die in blood relative's backyard. 7) Die. (This is the best solution I have worked out in USA for me.)
- alejohausner 8y agoPerhaps the real problem is that chemo, radiation, and surgery don't really cure cancer, in most cases. There is a lot of bad science in cancer research. The "science" that bothers me the most is the use of 5-year survival rates. Suppose that a cancer that starts at age 60 becomes symptomatic at age 65, and kills the patient at age 70. Scenario 1: you are 60 years old, get screened, and opt for treatment (who wouldn't?). However, the treatment does temporarily put the cancer into remission, and you are "cured" at age 65. But then the cancer comes back, now resistant to the treatment, and you die at age 70. Scenario 2: you don't get screened, and die at age 70. Both outcomes are the same, but in the first scenario your oncologist declares you "cured" at age 65. This kind of statistical chicanery leads people to opt for treatment, which is usually very bad for you. If you or your child has cancer, could you bring yourself to not spend every penny you have? Most people would opt for treatment. But it's often a futile waste of money and life, as the article points out.
- malcolmgreaves 8y agoScenario 2 implies you don't have cancer. If you have it and don't get treated, you'll probably die by 62 in your scenario.
- DanBC 8y agoParent post makes a reasonable point about the problems of 5 year survival rates in a culture of massive screening of otherwise healthy people. If you scan every man over the age of 55 you'll pick up a lot of prostate cancer. If you then do nothing else at all your country's 5 year survival rate improves because you have a bunch of people who'll die with, from from, cancer.
- zrail 8y agoYou're being very misleading when you say "in most cases". There are a lot of very common cancers that respond very well to treatment. "If you or your child has cancer, could you bring yourself to not spend every penny you have?" This is what health insurance is for. You buy insurance so that you don't have to worry about monetary decisions and can make decisions based on quality of life.
- anigbrowl 8y agoThanks, capitalism. Snarky as that may sound, it's a simple statement of fact: our society places a higher value on capital allocation than human life, and so the most vulnerable people are stripped of their assets and dignity to satisfy the demand for wealth. Frankly, I think socialized medicine would also reduce violence in society if deployed as part of a larger economic realignment.
- debacle 8y agoThe real value of the work output of a single human life tends very close to zero, unfortunately. Excepting some intrinsic value to life, in the grand scheme of things most people's lives are not worth very much.
- feistypharit 8y agoThere are infinitely many ways other than work value by which to value a human life. Some day, I hope you learn this. Most of what really differentiates you from anyone else is luck.
- anonuser123456 8y agoDon't blame capitalism for regulatory capture. The healthcare industry has done a fantastic job at ensuring consumers can only choose the options the industry wants.
- anigbrowl 8y agoYour second sentence does a great job of rebutting your first one ¯\(°_o)/¯
- anonuser123456 8y agoYou're mistaking corporatocracy for capitalism. One can believe in the ratchet of the market and trade to elevate the human condition while disbelieving in the merits of governance by private interest. Capitalism means I should be able to trade freely without restraint, provided I pay the costs. It does not mean I'm free to regulate my competition out of business.
- ttul 8y ago* In the United States.
- expertentipp 8y agoIn most of the world, even in poorer EU states, these super advanced and expensive treatments are not available and people simply die without getting a chance. Occassionaly one hears in media about some crowdfunding campaing for „unique treatment in the US”.
- 738472527784 8y agoCitation needed.
- icoder 8y agoAlthough a good point on itself to ponder about, I don't think in this particular discussion it is logical to compare the US to non-EU and poor EU countries.
- tschellenbach 8y agoUS is the only western country that has this problem. It's also one of the richest countries in the world.
- so_tired 8y agoI am sympathetic. From HN stories, the US health care situations seems abysmal. BUT, i want to make 3 counter points, if only for the sake of discussion. a. Cancer for many is a terminal disease. There are always some very very expensive and experimental or marginal treatments. If u have money, and are going to die, and decide to spend all you can to squeeze an extra year of life , i am very sympathetic but even the most generous European have spending limits. b. This is about the US. The US has made a conscious decision to low-tax and low-safety-net. This is very harsh for the ill or poor. But this choice is reaffirmed every 4 years by sort-of-functional elections at multiple levels of government. Bernie never even made it past the primaries. c. No one mentions the non terminally ill 95% who presumably enjoy high salaries for years and years (only in the US could a new $60K car be described as "a low cost model")
- moonbug 8y agoExcept that net US personal taxation isn't far off that found across the EU.
- ravitation 8y agoNot only is it not far off, the practical personal tax rate is actually higher in the US than in several European countries. It's not as simple as "the US has lower taxes, and therefore fewer public benefits".
- Agathos 8y agoYeah, the US spends more on socialized medicine than anyone. Most of it goes through Medicare.
- refurb 8y agoThe EU varies a lot in personal tax rates. The higher end of the EU is much higher than the US.
- J5892 8y agoBuying a $60k car seems like a completely insane concept to me, even with a Silicon Valley tech industry salary. Even $16k (used) was higher than I wanted to pay for my current car.
- pascalxus 8y agoNormally, I'm all for invisible hand capitalism for most things, but clearly in the case of medical services it's completely broken. What we need is price ceilings on medical procedures, something reasonable. Perhaps, cap procedures cost in some way, maybe 1k to 4k based on what it is (make it illegal to charge more and hold hospitals financially accountable). There has to be some kind of cost control, either from the government or the insurance companies. We can't expect patients to choose these cost controls. I realize this means that some procedures won't be done but it's better than bankrupting everyone left and right.
- travisoneill1 8y agoSo killing people who need expensive treatments is better than bankrupting them?
- malvosenior 8y agoIt's only broken because of regulation. If I could shop across state lines for insurance, prices would drop. I may not even opt to get insurance as I'm very healthy and I've never had medical costs approach even an order of magnitude of my insurance costs. Yet I'm forced to purchase this unneeded service by the government, pushing up demand and prices in an artificially controlled market.
- amanaplanacanal 8y agoI see this mentioned a lot as a cost cutting measure: buy insurance across state lines. I don't see how purchasing insurance in another state would help. Every medical facility where you live would then be out of network. How do people think this would work, exactly?
- aerodog 8y agoMeanwhile, in Turkey... https://www.dailysabah.com/turkey/2018/07/06/cancer-treatment-now-free-in-turkeys-landmark-health-reform https://www.dailysabah.com/turkey/2018/07/06/cancer-treatmen...
- anticensor 8y agoFree treatment is limited to standard forms. Research treatments not included. Source: my grandparents receive cancer treatment
- pvaldes 8y ago... in USA
- kbos87 8y agoI recently watched a family member go through this. A few things that were sobering to see: - Three weeks in she was buried in paperwork. One chemo treatment would turn into 4-5 invoices from different subcontractors at a single hospital, some covered by her insurance, others not covered. Her insurer denied claims arbitrarily and made her go through a bunch of invasive and unnecessary procedures to prove her illness. - Her insurer started calling her incessantly, insisting that she join some sort of program where they would “help” her make decisions about her care. It undermined the confidence she had in her doctors and the decisions she was trying to make, which is a terrible feeling for anyone to go through when they are sick with cancer and trying to survive. - There were a series of insurance “land mines” on the horizon - forget to renew this thing on this random date 2 months from now? You’ve lost your insurance. The whole healthcare and insurance system is a dark pattern, even for working adults who are fully covered.
- Bjorkbat 8y agoI'm curious to find out what it would take for someone to create a service that counters some of these dark patterns. The abundance of companies using dark patterns in their subscriptions to prevent subscription cancellations has led to other companies offering services that allow you to manage your various subscriptions with ease and cancel subscriptions with even greater ease. I'm wondering what it would take to apply the same mindset to managing healthcare-related paperwork.
- platz 8y agoIt's called medical tourism
- andrewprock 8y agoI somehow read that as "medical terrorism".
- mythrwy 8y agoNo that's the topic of the article.
- apo 8y agoOf the 9.5 million cancer diagnoses studied between 2000–2012, researchers discovered that 42.4 percent of patients (median age 68.6±9.4 years) spent all of their money, averaging $92,098. This follows disturbing news from earlier this year that 40 percent of Americans can't afford to pay $400 in case of an emergency. The math is not adding up. No, the math doesn't make sense. Either the author of the linked article misinterpreted the journal article, or the authors of the journal article didn't reports their numbers correctly. The only other conclusion might be that cancer strikes the "wealthy" (those with 100K in savings) more than the poor.
- labster 8y agoThe poor just die from cancer. The lower classes "borrow" money from friends and family, because cancer makes a better charity case than "my alternator broke". The middle class, and lower upper class has savings and home equity, and spends all of that to fight cancer. The upper class can spend whatever it takes. Though now that I think about it, maybe the alternator fix is the more effective altruism, because it's something that can keep someone from falling a rung on the economic ladder, and being unable to afford health care. There's never enough, is there.
- dnjdirjrmrf 8y agoAnd? How many people "lose" their life savings for having children. How many people "lose" their life savings to buy a home/food clothing. Your body/health is more important than any of the above.... why the negative term "lose" instead of "spent money on health/life"?
- jamesb93 8y agoYou should be more specific here. IN AMERICA. Developed countries dont have this issue.
- icoder 8y agoAlthough I personally find the last sentence unnecessary, I agree with the first part. I've noticed on multiple occasions the last few weeks on both HN and Reddit that headlines + reactions all somehow assume that when no geographic details are given, US is assumed.
- refurb 8y agoMedical costs were the cause of bankruptcy in 15% of Canadians over 55.[1] [1]https://www.fraserinstitute.org/article/medical-bankruptcy-myth https://www.fraserinstitute.org/article/medical-bankruptcy-m...
- deleted 8y ago[deleted]
- mmirate 8y agoIn related news, 100% of newly dead people lose their life savings.
- emmanueloga_ 8y agoIn other news, the water is wet. I've only been living for a couple of years on the US now but one thing that is among the hardest to get used to is the costs of medical care. Often times going to the doctor once shields 3, 4 different invoices. I once made the rookie mistake of going to an E.R. for something I could have waited for, I think I had one of those head splitting head aches. They charged me something like $800 or so for ~10 minutes with the doctor. Another time, I had to pay something crazy like $300 for an X-Ray. Gotta pay for the cost of research of development for that cutting edge technology, X-Rays, huh? :-p I can only imagine what it would be like if I had a very severe condition like cancer. This is specially shocking for me coming from a country where health care is of high quality and publicly accessible (Argentina). Private care is also available and reasonably priced, the reasons to go that route is shorter wait times for appointments, nicer facilities, etc.
- nil_pointer 8y agoSad, but not surprising. The majority of bankruptcies are caused from medical bills.
- refurb 8y agoInterestingly, medical bankruptcies aren't all that much higher in the US versus Canada, who has universal medical coverage[1]. Turns out that a major cause of medical bankruptcies is the inability to work, not just the medical bills. [1]https://www.theatlantic.com/business/archive/2009/09/bankruptcy-comparing-ourselves-with-our-neighbor-to-the-north/26591/ https://www.theatlantic.com/business/archive/2009/09/bankrup...
- Alex63 8y ago1. I think the title may be a little misleading. Only 3% declare bankruptcy, though higher numbers deplete all their savings. It's hard to find a good estimate of per capita "savings". A search indicates that the median savings account balance in the US is about $5,000. The median 401(K) appears to be about $36,000. Based on this, I'll assume that means the typical out-of-pocket costs of cancer treatment are somewhere around $30,000. That seems in line with what the out-of-pocket costs for 5 years of treatment might be under my current coverage. 2. The problem with any discussion of healthcare issues is that we are naturally swayed by our empathy for those who are suffering. Almost all of us would choose to pay whatever was needed to save a loved one, and would grant that ability to others if we could. It seems simple enough to say "we should spend less money on the military/international aid/tax breaks for corporations/the NEA/etc." if it means that we can provide affordable treatment to those who are suffering. Unfortunately, until the singularity arrives there is probably always going to be a cost that is too high, and hard decisions must be made. As a Canadian, I know that one of the downsides of universal healthcare is that some treatments must be rationed and bureaucrats will make decisions affecting the life of my loved ones. Now that I live in the US I can avail myself of diagnostics and treatments that may simply not be available in Canada. The cost may beggar me and the likelihood of a positive outcome may be remote, but it is my choice, and a choice that may not be available under other systems. 3. No, I have not read all of the comments. As with many HN comment pages, the marginal value of descendant comments seems to drop off quickly.
- disordinary 8y agoI had an uncle who was quite well off and ran an exotic car garage in the US. He had all the insurance, etc. His wife got cancer, insurance wouldn't cover some of the treatment. She died, he went bankrupt, then killed himself. I'm glad I live in a country where I literally don't even think about treatment or care, it's just not something I worry about. I've had a few relatives in NZ who've had cancer, they've all had excellent care which prolonged their lives and when they passed they didn't leave their survivors with the financial strain in addition to the heartache of losing a loved one.
- refurb 8y agoThe likelihood is if a cancer drug isn’t covered in the US, it’s not covered in NZ.
- lukeylunchbox 8y agoThis is why I don't consider the US a first world country.
- cabaalis 8y agoI am a moderate conservative. I believe in self-reliance, fiscal responsibility, limited government. But receiving a death sentence like this one, physically and financially, is something I believe society could easily work together to create a parachute for. It seems reasonable to me that not all healthcare should be covered by the government. Individuals need skin in the game for their own care. But catastrophic, life-ending diseases like cancer are a public crisis that every single one of us has been affected by in some way. If there's a reason for government intervention of some kind, it's that.
- sjg007 8y ago>Individuals need skin in the game for their own care. So smokers who get cancer? People who are obese? A car accident? How do you decide? What's the skin? A deductible?
- cabaalis 8y agoI don't know the answer. The government does make low-interest loans available when there are natural disasters, as one example.
- Gibbon1 8y ago> . Individuals need skin in the game for their own care. 1996 a friend got lung cancer at 32 she lost everything and died. In 2002 both a friend and I got sick. He's dead, I lost everything but I'm still here. Seems to me we all had skin in the game. But hell if I know what a 30 year old woman and two men in their early 40's could have done different.
- dev_dull 8y agoA lot of people are like you. Myself included. Which is why this topic is a front-and-center part of the democratic strategy for 2020. And if there isn’t a working alternative proposed by Republicans I don’t see much hope for them.
- krapp 8y ago
- bondolo 8y agoWhat are your life savings for if they can't be used to save your life? Every other use is fortuitous but until you have more money than you could spend to save your life then that is the purpose of that money.
- amanaplanacanal 8y agoMost people would like to retire some day, I think. The good news is we cured your cancer! The bad news is that you will now have to work until you die.
- ameixaseca 8y ago*in the US.
- hi41 8y ago>When he died, she was left hundreds of thousands of dollars in debt If a person dies, how can the bill go the spouse? I don't get this.
- ams6110 8y agoShe very likely signed agreements to be financially responsible for the treatment. This is one of the very first forms a hospital will ask you to sign.
- he0001 8y agoI wonder how the predicted increase in life expectancy would effect this. I’d say the probability of getting cancer increases with age and then also more people will be ruined because of that, poverty in general will increase (if people survive). I believe that those factors will be one of the toughest questions for the future, and countries with no social way of handling this will be effected more than those with it.
- yc-kraln 8y ago42 percent of new cancer patients _in the united states_ The rest of the developed world has a healthcare system.
- emayljames 8y ago"42 percent of new US cancer patients..."
- jlv2 8y agoSometimes I think I'm really lucky. I was dx'd with stage 2b Hodgkin's lymphoma 20 years ago. Half a year of twice-monthly chemotherapy and then an agonizing month of daily radiation doses was able to eradicate the disease. Because of the health insurance I had with the startup I was then working for, my total out-of-pocket cost to was $0. We never paid a single co-pay or saw a single bill for any of the treatment (there were co-pays for the 10 years of follow-up visits). To this day I don't know what the total cost of saving my life was. I guess it was 6 digits USD. I contrast to the health insurance I have now. Were I to get sick like that again, I know my out of pocket expenses would be at least $8K per year, and I expect I'd hit that limit several times over the course of the follow-up period.
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