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To be fair, this perspective does assume that people care about the health of society as a whole. If you're willing to let others get substandard care or even d

To be fair, this perspective does assume that people care about the health of society as a whole. If you're willing to let others get substandard care or even die, it may be more optimal for you to have your own smaller, lower-risk pool with better benefits.

deleted 7y ago
[deleted]
FireBeyond 7y ago
Right. And therein lies the rub. The US is quite possibly one of the worst in the world for "Fuck you I got mine" (until you don't got yours). And then there's the cognitive dissonance of people who might have otherwise screamed about "socialized medicine" who find themselves on the unlucky end of a diagnosis and are singing a different tune (or sometimes still singing the same tune, even as they put up a GoFundMe...). How many other countries in the world consider medical bankruptcy a thing to be accepted and tolerated?
- rayiner 7y ago
  By contrast, would the US be able to stomach denying cutting-edge treatment because it’s too expensive, like the UK? https://www.theguardian.com/science/2017/dec/20/drug-giants-hefty-prices-nhs-vital-medication-pharma-profits https://www.theguardian.com/science/2017/dec/20/drug-giants-... That’s what makes me nervous about socialized medicine in the US. I’m absolutely in favor of universal coverage—a healthcare system that maximizes the health of the average productive person. But I worry that Americans lack the cold realism of Brits, and won’t be able to effectively control costs by denying cost-ineffective treatments.
  - FireBeyond 7y ago
    Well, that article talks about blaming Big Pharma for the costs that make it expensive, not the National Health Service. With the big pool comes big leverage. The NHS effectively said "We're not paying that much", and the pharmaceutical companies decided they'd rather be paid something. Because if someone is not getting treatment, then they're not getting those drugs. Medicare in the US does this. "This is what we are paying for this drug". The issue isn't so much this. It's that drug industry lobbies in the US will have far more sway over the politics of this than they would in the UK (or Canada, or Australia, or...). I definitely don't claim to be an expert on these things. But I have lived in the UK with the NHS, in Australia with its medical system, and now in the US. In addition to that, I've worked as a healthcare provider, and for a Health Benefits Management software company, so I'd at least like to think I have something of a varied perspective.
    - rayiner 7y ago
      The very first part of the article explains how the NHS denied coverage for certain breast cancer drugs because it was too expensive. My concern is that the Americans won’t be willing to do that. Here, you see all these articles talking about how terrible it is that families went bankrupt going out of pocket after they hit a $1 million cap. The UK wouldn’t have paid for that treatment in the first place.
      - roywiggins 7y ago
        You have an admirable faith the American insurance companies don't do exactly the same thing, with much less oversight. https://www.nytimes.com/2019/02/27/obituaries/carrie-ann-lucas-dead.html https://www.nytimes.com/2019/02/27/obituaries/carrie-ann-luc... > Her family said an antibiotic Lucas needed to treat her symptoms cost about $2,000 and her insurance company denied coverage of the medicine, leading her to take a less-effective drug. Lucas, who was allergic to multiple drugs and antibiotics, had a reaction to that medication, Lee Lucas said.
        selimthegrim 7y ago
        That’s not in the obituary?
        roywiggins 7y ago
        My bad, meant to link here: https://www.denverpost.com/2019/02/28/carrie-ann-lucas-obituary/ https://www.denverpost.com/2019/02/28/carrie-ann-lucas-obitu...
    - scarface74 7y ago
      Medicare in the US does this. "This is what we are paying for this drug". That is definitely not true. Part of the prescription drug coverage that was added during the Bush administration was that Medicare could not negotiate drug prices. https://www.politifact.com/wisconsin/statements/2017/jan/17/tammy-baldwin/tammy-baldwin-federal-government-prohibited-negoti/ https://www.politifact.com/wisconsin/statements/2017/jan/17/...
  - exelius 7y ago
    I have a feeling that without the US market capable of paying a hundred thousand dollars a patient, many of those cost-ineffective treatments never get developed. People could still pay for them out of pocket, but without the guarantee of insurance payments the drug companies likely won’t take the risk. And I don’t think that’s necessarily a bad thing — if a drug costs $500,000 and keeps my cancer at bay for 6 more months, it provides a high personal benefit from my selfish point of view; but at a high cost to society without much societal benefit. I think you’re right that Americans do lack the realism, but it may become easier if those treatments aren’t developed in the first place.
    - malandrew 7y ago
      > but at a high cost to society without much societal benefit. People are employed and knowledge is gained. That may be $500,000 treatment for 6 months now, but that treatment may be improved and democratized until it evolves into something that is $50,000 for 6 years.
      - exelius 7y ago
        A citizen science model — which is what we de-facto have for anything that isn’t cancer — is more efficient and cost effective. As it is, if someone finds a new life-saving use for an 80 year old drug, there are suddenly shortages of the old drug while a new, patented analog is sent through clinical trials. See also ketamine and depression.
    - andrekandre 7y ago
      > People could still pay for them out of pocket, but without the guarantee of insurance payments the drug companies likely won’t take the risk. this, in my opinion, points out a significant flaw in the rush to privatize just about everything: there are many many “markets” that are either under-served or not served at all because the rate of profit would be (a) too low to “justify” or (b)none at all. jmo but, there has to be a balance between for-profit and basic research that won’t necessarily be able to be monetized to the extent many in industry would want...
  - yardie 7y ago
    > would the US be able to stomach denying cutting-edge treatment because it’s too expensive No, we're much better off denying basic ass treatments because there isn't enough money in it.
  - gumby 7y ago
    Of course it does, by rejecting many people from the medical system.
  - CydeWeys 7y ago
    Insurers deny expensive or cutting-edge treatments in the US all the time! You don't have to look hard to find sob story after sob story. And it makes sense. If a treatment is super-expensive and unlikely to be effective anyway, and that money could be put to better use to help more other people ... It's like how someone who smokes isn't going to get a lung transplant; there's too many others that need transplants and not enough lungs to go around, so give the lungs to the people who will benefit the most from them (generally, people who are young and otherwise healthy). There aren't infinite resources in this world, so in the cases where scarcity comes into play, they should be doled out in the way that creates the greatest good.
    - mikeash 7y ago
      Before Obamacare, insurance plans had lifetime limits. So even if you got a really expensive treatment approved, it would potentially push you over your lifetime limit and leave you with no coverage at all.
      - danans 7y ago
        To clarify, I think you mean lifetime limit for the insurance company, not you.
        mikeash 7y ago
        What do you mean? The limit was on your coverage. Once you exceeded that limit, you had no more coverage.
        danans 7y ago
        Right, a limit on how much the insurance company will pay to cover your healthcare expenses
        mikeash 7y ago
        I don’t understand the distinction you’re making.
  - quattrofan 7y ago
    It's weird you think that insurance means they don't deny care, I worked on systems back in the 90s in the US that was focused around rationing. The source of the money is irrelevant since ultimately you have to cap spending somewhere as it's not limitless. The NHS generally does a great job in getting bang for the buck, in fact in terms of treatment effectiveness and longevity it's considered the best in the world.
  - trashface 7y ago
    This is solvable. Rather than just "deny" treatments, the insurer (public or private) can just pay the customary amount for treating the given disease. The rest is the patient's responsibility. So rich people can still get the latest $500K insta-cure prostate cancer treatment (and they are paying out of pocket for most of it), and the rest of us make do with surgery/radiation.
  - mnm1 7y ago
    Private insurance companies do this every single day. So you're worried that the government might do what insurance companies are guaranteed to do. At least the government wouldn't have the profit motive that drives insurance companies to these measures that literally kill people. Your argument is completely out of touch with reality.

deleted 7y ago

[deleted]

FireBeyond 7y ago

Right. And therein lies the rub. The US is quite possibly one of the worst in the world for "Fuck you I got mine" (until you don't got yours). And then there's the cognitive dissonance of people who might have otherwise screamed about "socialized medicine" who find themselves on the unlucky end of a diagnosis and are singing a different tune (or sometimes still singing the same tune, even as they put up a GoFundMe...). How many other countries in the world consider medical bankruptcy a thing to be accepted and tolerated?

rayiner 7y ago
By contrast, would the US be able to stomach denying cutting-edge treatment because it’s too expensive, like the UK? https://www.theguardian.com/science/2017/dec/20/drug-giants-hefty-prices-nhs-vital-medication-pharma-profits https://www.theguardian.com/science/2017/dec/20/drug-giants-... That’s what makes me nervous about socialized medicine in the US. I’m absolutely in favor of universal coverage—a healthcare system that maximizes the health of the average productive person. But I worry that Americans lack the cold realism of Brits, and won’t be able to effectively control costs by denying cost-ineffective treatments.
- FireBeyond 7y ago
  Well, that article talks about blaming Big Pharma for the costs that make it expensive, not the National Health Service. With the big pool comes big leverage. The NHS effectively said "We're not paying that much", and the pharmaceutical companies decided they'd rather be paid something. Because if someone is not getting treatment, then they're not getting those drugs. Medicare in the US does this. "This is what we are paying for this drug". The issue isn't so much this. It's that drug industry lobbies in the US will have far more sway over the politics of this than they would in the UK (or Canada, or Australia, or...). I definitely don't claim to be an expert on these things. But I have lived in the UK with the NHS, in Australia with its medical system, and now in the US. In addition to that, I've worked as a healthcare provider, and for a Health Benefits Management software company, so I'd at least like to think I have something of a varied perspective.
  - rayiner 7y ago
    The very first part of the article explains how the NHS denied coverage for certain breast cancer drugs because it was too expensive. My concern is that the Americans won’t be willing to do that. Here, you see all these articles talking about how terrible it is that families went bankrupt going out of pocket after they hit a $1 million cap. The UK wouldn’t have paid for that treatment in the first place.
    - roywiggins 7y ago
      You have an admirable faith the American insurance companies don't do exactly the same thing, with much less oversight. https://www.nytimes.com/2019/02/27/obituaries/carrie-ann-lucas-dead.html https://www.nytimes.com/2019/02/27/obituaries/carrie-ann-luc... > Her family said an antibiotic Lucas needed to treat her symptoms cost about $2,000 and her insurance company denied coverage of the medicine, leading her to take a less-effective drug. Lucas, who was allergic to multiple drugs and antibiotics, had a reaction to that medication, Lee Lucas said.
      - selimthegrim 7y ago
        That’s not in the obituary?
        roywiggins 7y ago
        My bad, meant to link here: https://www.denverpost.com/2019/02/28/carrie-ann-lucas-obituary/ https://www.denverpost.com/2019/02/28/carrie-ann-lucas-obitu...
  - scarface74 7y ago
    Medicare in the US does this. "This is what we are paying for this drug". That is definitely not true. Part of the prescription drug coverage that was added during the Bush administration was that Medicare could not negotiate drug prices. https://www.politifact.com/wisconsin/statements/2017/jan/17/tammy-baldwin/tammy-baldwin-federal-government-prohibited-negoti/ https://www.politifact.com/wisconsin/statements/2017/jan/17/...
- exelius 7y ago
  I have a feeling that without the US market capable of paying a hundred thousand dollars a patient, many of those cost-ineffective treatments never get developed. People could still pay for them out of pocket, but without the guarantee of insurance payments the drug companies likely won’t take the risk. And I don’t think that’s necessarily a bad thing — if a drug costs $500,000 and keeps my cancer at bay for 6 more months, it provides a high personal benefit from my selfish point of view; but at a high cost to society without much societal benefit. I think you’re right that Americans do lack the realism, but it may become easier if those treatments aren’t developed in the first place.
  - malandrew 7y ago
    > but at a high cost to society without much societal benefit. People are employed and knowledge is gained. That may be $500,000 treatment for 6 months now, but that treatment may be improved and democratized until it evolves into something that is $50,000 for 6 years.
    - exelius 7y ago
      A citizen science model — which is what we de-facto have for anything that isn’t cancer — is more efficient and cost effective. As it is, if someone finds a new life-saving use for an 80 year old drug, there are suddenly shortages of the old drug while a new, patented analog is sent through clinical trials. See also ketamine and depression.
  - andrekandre 7y ago
    > People could still pay for them out of pocket, but without the guarantee of insurance payments the drug companies likely won’t take the risk. this, in my opinion, points out a significant flaw in the rush to privatize just about everything: there are many many “markets” that are either under-served or not served at all because the rate of profit would be (a) too low to “justify” or (b)none at all. jmo but, there has to be a balance between for-profit and basic research that won’t necessarily be able to be monetized to the extent many in industry would want...
- yardie 7y ago
  > would the US be able to stomach denying cutting-edge treatment because it’s too expensive No, we're much better off denying basic ass treatments because there isn't enough money in it.
- gumby 7y ago
  Of course it does, by rejecting many people from the medical system.
- CydeWeys 7y ago
  Insurers deny expensive or cutting-edge treatments in the US all the time! You don't have to look hard to find sob story after sob story. And it makes sense. If a treatment is super-expensive and unlikely to be effective anyway, and that money could be put to better use to help more other people ... It's like how someone who smokes isn't going to get a lung transplant; there's too many others that need transplants and not enough lungs to go around, so give the lungs to the people who will benefit the most from them (generally, people who are young and otherwise healthy). There aren't infinite resources in this world, so in the cases where scarcity comes into play, they should be doled out in the way that creates the greatest good.
  - mikeash 7y ago
    Before Obamacare, insurance plans had lifetime limits. So even if you got a really expensive treatment approved, it would potentially push you over your lifetime limit and leave you with no coverage at all.
    - danans 7y ago
      To clarify, I think you mean lifetime limit for the insurance company, not you.
      - mikeash 7y ago
        What do you mean? The limit was on your coverage. Once you exceeded that limit, you had no more coverage.
        danans 7y ago
        Right, a limit on how much the insurance company will pay to cover your healthcare expenses
        mikeash 7y ago
        I don’t understand the distinction you’re making.
- quattrofan 7y ago
  It's weird you think that insurance means they don't deny care, I worked on systems back in the 90s in the US that was focused around rationing. The source of the money is irrelevant since ultimately you have to cap spending somewhere as it's not limitless. The NHS generally does a great job in getting bang for the buck, in fact in terms of treatment effectiveness and longevity it's considered the best in the world.
- trashface 7y ago
  This is solvable. Rather than just "deny" treatments, the insurer (public or private) can just pay the customary amount for treating the given disease. The rest is the patient's responsibility. So rich people can still get the latest $500K insta-cure prostate cancer treatment (and they are paying out of pocket for most of it), and the rest of us make do with surgery/radiation.
- mnm1 7y ago
  Private insurance companies do this every single day. So you're worried that the government might do what insurance companies are guaranteed to do. At least the government wouldn't have the profit motive that drives insurance companies to these measures that literally kill people. Your argument is completely out of touch with reality.