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Every European health care system, I believe, has some way of limiting the amount of care provided to people. It is just not so out in the open as a dollar cap

Every European health care system, I believe, has some way of limiting the amount of care provided to people. It is just not so out in the open as a dollar cap on what people can get in a lifetime. Not every possible, super-expensive procedure is approved to be available to people through the public healthcare system. (Would love to hear of a country that has "universal health care" that does not limit what procedures people can have done to see how it is possible). Everyone can't get the best possible care unless those experimental and expensive procedures are just banned and we give up on expensive procedures becoming cheaper in the future. Cancer is the biggest reason for this. If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there. Health care already is 17% of the US GDP and the US government spends more % of GDP on healthcare in America than almost all European countries. Not sure the best way to a better health care system in the USA, but just uncapping how much can be spent under insurance plans, while fixing one problem, won't work in the long run (as we are already seeing).

sangnoir 8y ago
> If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there. Is there a public example of a rich person that 'beat' cancer this way?
- bluGill 8y ago
  Not really (that I know of). Andy Grove did spend a few months researching cancer before forcing his doctors to give him a new treatment that was showing better lab results than the traditional one, and the cure he got was probably better than the transnational one (less side effects). However from what I can tell the only thing he spent was his own time which means nothing a poor person couldn't do. The option is open to anyone who is rich, and if you have an slow incurable cancer it is reasonable to try: you don't have anything to lose and it might work. Of course if your cancer is already curable focus on the existing cure. If the cancer is fast you don't have enough time to for research to produce results. At best it is a long shot, but it is what you have. If you are young and healthy you actually have a better chance of your small donation making a difference. Just figure out what cancer you are at risk for and start regular donations to that research now. While your donation alone won't do much, the regular source of income helps those already doing the research keep going for the years required to get results. Your smaller donation along with others goes farther because time is a factor. The only problem is which: the cancer mom's mom had, the cancer dad's mom had, the cancer mom's brother had, the non-hereditary cancer both dad's brother and sister had, the cancer someone else in the family will get in two years?
DanBC 8y ago
This seems to be pushing a myth: expensive treatments must be better treatments, right? We have very good evidence that these new, expensive, treatments do not extend life and that they make quality of life worse. England set up something called the Cancer Drugs Fund. This provided access to new medication that hadn't yet been assessed for value; that were in the process of being assessed; or that had been assessed and were found to be too expensive for no benefit over existing treatment: https://en.wikipedia.org/wiki/Cancer_Drugs_Fund https://en.wikipedia.org/wiki/Cancer_Drugs_Fund Most drugs paid for by £1.27bn Cancer Drugs Fund had no “meaningful benefit” https://www.bmj.com/content/357/bmj.j2097 https://www.bmj.com/content/357/bmj.j2097 The Cancer Drugs Fund was popular with the UK press who pushed for it to be expanded without bothering to see if it was extending life or improving quality of life. http://journals.sagepub.com/doi/full/10.1177/0141076818796802 http://journals.sagepub.com/doi/full/10.1177/014107681879680... > Health care already is 17% of the US GDP and the US government spends more % of GDP on healthcare in America than almost all European countries. And yet it has worse outcomes across a range of measures, including "life expectancy".
- chimeracoder 8y ago
  > This seems to be pushing a myth: expensive treatments must be better treatments, right? We have very good evidence that these new, expensive, treatments do not extend life and that they make quality of life worse. It's not pushing any myth at all. As explained elsewhere government-run systems like the NHS do attach actual dollar amounts to treatments that are effective and do extend life, but for which they're not willing to pay. The NHS's version is actually quite ruthless when you peel back the details, where they determine how "good" a person's life is, and essentially how much they are willing to spend to extend that person's life by N years. This is, in effect, a benefits cap, just framed slightly differently. This is not, as you are implying, saying "this treatment is ineffective or harmful, so we won't pay for it". It is literally saying "we understand that this treatment would extend this person's life by 5 years, but it costs £50,000, and based on their condition, we're only willing to spend £25,000 to extend their life by 5 years. > And yet it has worse outcomes across a range of measures, including "life expectancy". Life expectancy has so many confounding variables which have a much stronger effect that it's ridiculous to try and use that as a measure of a healthcare system directly. It's like trying to measure the fuel efficiency of different models of cars by looking at the total number of miles driven by all drivers of each car model in a given year. Yeah, there's... a connection between the two, but that's certainly not what you're analyzing when you try to compare them naively.
pgeorgi 8y ago
> Would love to hear of a country that has "universal health care" that does not limit what procedures people can have done to see how it is possible. It will attract quacks like shit attracts flies, so yes, of course there are limits: New treatments need to be more effective or cheaper for some well-defined ailment to end up on the approved list. If they're very expensive, they might not be first in line (but still available for patients where the case can be made that they need it). That can be frustrating, but shouldn't be life threatening. Experimental treatments are research. Their test subjects are picked by a schedule that is unrelated to medical care needs but optimizes for good data acquisition. Pay for them from research budgets, not health care.
refurb 8y ago
This is definitely one of the drivers of lower healthcare costs outside the US. A good example is the cbc.ca article where two friends were diagnosed with the same cancer. The one in the US got treated with the latest cancer drug and is remission, where the woman living in Canada has to sell her house to pay for it.[1] "It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication." [1]https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-friends-with-breast-cancer-1-has-coverage-for-costly-drug-the-other-forced-to-pay-1.4495123 https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-...

sangnoir 8y ago

> If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there. Is there a public example of a rich person that 'beat' cancer this way?

bluGill 8y ago
Not really (that I know of). Andy Grove did spend a few months researching cancer before forcing his doctors to give him a new treatment that was showing better lab results than the traditional one, and the cure he got was probably better than the transnational one (less side effects). However from what I can tell the only thing he spent was his own time which means nothing a poor person couldn't do. The option is open to anyone who is rich, and if you have an slow incurable cancer it is reasonable to try: you don't have anything to lose and it might work. Of course if your cancer is already curable focus on the existing cure. If the cancer is fast you don't have enough time to for research to produce results. At best it is a long shot, but it is what you have. If you are young and healthy you actually have a better chance of your small donation making a difference. Just figure out what cancer you are at risk for and start regular donations to that research now. While your donation alone won't do much, the regular source of income helps those already doing the research keep going for the years required to get results. Your smaller donation along with others goes farther because time is a factor. The only problem is which: the cancer mom's mom had, the cancer dad's mom had, the cancer mom's brother had, the non-hereditary cancer both dad's brother and sister had, the cancer someone else in the family will get in two years?

DanBC 8y ago

This seems to be pushing a myth: expensive treatments must be better treatments, right? We have very good evidence that these new, expensive, treatments do not extend life and that they make quality of life worse. England set up something called the Cancer Drugs Fund. This provided access to new medication that hadn't yet been assessed for value; that were in the process of being assessed; or that had been assessed and were found to be too expensive for no benefit over existing treatment: https://en.wikipedia.org/wiki/Cancer_Drugs_Fund https://en.wikipedia.org/wiki/Cancer_Drugs_Fund Most drugs paid for by £1.27bn Cancer Drugs Fund had no “meaningful benefit” https://www.bmj.com/content/357/bmj.j2097 https://www.bmj.com/content/357/bmj.j2097 The Cancer Drugs Fund was popular with the UK press who pushed for it to be expanded without bothering to see if it was extending life or improving quality of life. http://journals.sagepub.com/doi/full/10.1177/0141076818796802 http://journals.sagepub.com/doi/full/10.1177/014107681879680... > Health care already is 17% of the US GDP and the US government spends more % of GDP on healthcare in America than almost all European countries. And yet it has worse outcomes across a range of measures, including "life expectancy".

chimeracoder 8y ago
> This seems to be pushing a myth: expensive treatments must be better treatments, right? We have very good evidence that these new, expensive, treatments do not extend life and that they make quality of life worse. It's not pushing any myth at all. As explained elsewhere government-run systems like the NHS do attach actual dollar amounts to treatments that are effective and do extend life, but for which they're not willing to pay. The NHS's version is actually quite ruthless when you peel back the details, where they determine how "good" a person's life is, and essentially how much they are willing to spend to extend that person's life by N years. This is, in effect, a benefits cap, just framed slightly differently. This is not, as you are implying, saying "this treatment is ineffective or harmful, so we won't pay for it". It is literally saying "we understand that this treatment would extend this person's life by 5 years, but it costs £50,000, and based on their condition, we're only willing to spend £25,000 to extend their life by 5 years. > And yet it has worse outcomes across a range of measures, including "life expectancy". Life expectancy has so many confounding variables which have a much stronger effect that it's ridiculous to try and use that as a measure of a healthcare system directly. It's like trying to measure the fuel efficiency of different models of cars by looking at the total number of miles driven by all drivers of each car model in a given year. Yeah, there's... a connection between the two, but that's certainly not what you're analyzing when you try to compare them naively.

pgeorgi 8y ago

> Would love to hear of a country that has "universal health care" that does not limit what procedures people can have done to see how it is possible. It will attract quacks like shit attracts flies, so yes, of course there are limits: New treatments need to be more effective or cheaper for some well-defined ailment to end up on the approved list. If they're very expensive, they might not be first in line (but still available for patients where the case can be made that they need it). That can be frustrating, but shouldn't be life threatening. Experimental treatments are research. Their test subjects are picked by a schedule that is unrelated to medical care needs but optimizes for good data acquisition. Pay for them from research budgets, not health care.

refurb 8y ago

This is definitely one of the drivers of lower healthcare costs outside the US. A good example is the cbc.ca article where two friends were diagnosed with the same cancer. The one in the US got treated with the latest cancer drug and is remission, where the woman living in Canada has to sell her house to pay for it.[1] "It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication." [1]https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-friends-with-breast-cancer-1-has-coverage-for-costly-drug-the-other-forced-to-pay-1.4495123 https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-...