6 ms·

One entirely maddening thing is that the ACA was labeled as having "death panels" that would decide who lives and dies. That phrase was powerfully effective in

One entirely maddening thing is that the ACA was labeled as having "death panels" that would decide who lives and dies. That phrase was powerfully effective in making large group of Americans strongly oppose the ACA. Even if they knew nothing else about the ACA, they knew they didn't want death panels. But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them. It makes me despondent that we can ever get to a place where our politicians can make rational, informed decisions about complex issues requiring multiple trade-offs. Cheap political rhetoric is not only easy to sell, stoking fear and tribalism is a winning strategy to getting reelected. 30 years ago most voters didn't bother to read a paper and were simply uninformed; now most voters are actively misinformed.

taneq 7y ago
The rational, informed decision is that the government should run its own medical R&D. But no, we can't do that because muh freedums.
- surfmike 7y ago
  You mean like the National Institutes of Health?
  - taneq 7y ago
    Yes, but more. You guys spend eleventy billion dollars on fighter jets with questionable hovering capability, can't you spend like four billion on nobody having cancer ever again?
    - caseysoftware 7y ago
      Well hell, if you know it's going to be $4B to eradicate cancer, it should be easy to put the plan together and get funding. You'll save everyone billions forever. Why are you screwing around on Hacker News?
    - dmoy 7y ago
      NCI alone has a budget of like $5-6B/yr.
    - DoreenMichele 7y ago
      I have a relative who works at the CDC and has had cancer multiple times. Before life and money got in the way, we used to talk regularly on the phone. She bitched a lot about how 99 studies out of 100 were variations on a theme because that's where the funding was. There was very little that was genuinely new and innovative. I don't know how to solve that. I've been getting myself well (different condition) for years when that's not supposed to be possible. I'm quite open about that on the internet. I get attacked for talking about it and called crazy. I'm told "Produce studies backing up your claims" when there are none. No one is latching on to my story and going "What if she's on to something? Maybe we can do a study that will open up new treatment modalities for patients!" I don't think it's as simple to solve this as you think it is. I don't know what needs to happen to break the herd mentality where humans don't seem to want to give any credibility to anything not already proven, which actively interferes with being able to prove anything new.
- Irene 7y ago
  My grandmother was denied drugs by government-run healthcare and died in severe pain.
  - taneq 7y ago
    That is awful and I'm so sorry to hear. :( It also doesn't invalidate my point, although it highlights that I should have said the government should run its own competent R&D
    - idrios 7y ago
      I believe what you just described is the NIH.
    - Irene 7y ago
      You are right, according to medical journal "The Lancet", 85% of (government-funded) research funding is “avoidably wasted across the entire biomedical research range (e.g., clinical, health services, and basic science)” Government-funded medical R&D (budget for the NIH: $34.4 billion for 2019) needs smarter spending.
  - lotsofpulp 7y ago
    What does that have to do with taxpayer funded R&D for medicine? Presumably, taneq's point was that medicine owned by taxpayers can be sold at the cost to manufacture and distribute it at far lower costs, as opposed to the current system where the owners of the research also needed to be compensated.
    - Irene 7y ago
      Most (if not all) new medicines came out of basic research supported by the NIH. This research was tweaked and patented by companies who profit from selling the drugs. Is start-to-finish government drug pipeline a better solution? Perhaps, but current academic culture doesn't support it. It's not just about pouring more taxpayer money.
  - deleted 7y ago
    [deleted]
- IanDrake 7y ago
  Examples of prodects created by government run medical R&D?
  - chroem- 7y ago
    Tofacitinib is one that I am familiar with. I am sure there are many more. https://en.wikipedia.org/wiki/Tofacitinib https://en.wikipedia.org/wiki/Tofacitinib Also, I think it's a valid question that doesn't deserve downvotes.
    - tryptophan 7y ago
      >Pfizer worked with O'Shea's [NIH funded] laboratory to define the structure and function of JAK3 and its receptors, and then handled the drug discovery, preclinical development, and clinical development of tofacitinib in-house. This says the exact opposite...
  - SolarNet 7y ago
    NASA alone has plenty of good examples. Enriched baby food, CAT scans, heart replacement devices, better thermometers and imaging, and other minor advancements for specific procedures: better fiber optic devices for baby delivery, better lighting for brain cancer operations, improved cooling devices for certain symptoms. And again that's just specifically medical products that accidentally fell out of a space program.
  - DanBC 7y ago
    A pop-sci list: https://www.med-technews.com/features/the-nhs-at-70-inventions-decade-by-decade/ https://www.med-technews.com/features/the-nhs-at-70-inventio... 1949: Intra-occular lens 1958: ultrasound for obstetrics 1962: total hip replacement 1978: test tube baby 1986: combined heart, liver, lung transplant 1991: robotic surgery 2000: gene therapy for children with no immune system 2013: bionic hand There are lots more.
    - IanDrake 7y ago
      At best those examples are misleading. The article ignores the R&D which often happened at private institutions and cherry pics the first use or minor refinement that occurred at a government facility.
cheeky78 7y ago
"But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them." It's not inflammatory when it's true. When the government runs our healthcare, choices are removed and someone else gets to decide if you should get surgery needed or not...and many times this is life or death. At least now, if a cancer patient gets denied drugs, they can go to another doctor or get a second opinion. All of my elderly relatives live in Canada and come over the border for any major surgery. This is mostly because the wait times are sometimes in the years..when they can just get private care in the US and get it done in a matter of weeks. Doctors are also usually maxed out when it comes to patients, so individual care is lacking and they usually just want to try to push you out the door. I also feel like I should have a say in someone's behavior, if I'm paying for their healthcare with my tax dollars: smoking, drinking, risky behavior, etc. I've lived in countries with universal healthcare and the quality is sub-par compared to the US/private care. Sure private care can be improved, but it shouldn't be ripped out and replaced.
- hestipod 7y ago
  >I've lived in countries with universal healthcare and >the quality is sub-par compared to the US/private care. My experience has been the exact opposite. America's healthcare business ruined my life. As a result I have no insurance and have lost the "privilege" to BUY said American healthcare. I struggle with low income options and programs, all insufficient. The only good care I ever got was in Europe. My experiences with social hospitals and doctors was much better than in the USA where it counts. Places weren't often as fancy looking, but the care was superb. Even the private systems in those countries was far more affordable. a few hundred for an MRI etc rather than a few thousand. Healthcare and education in America can bankrupt you. That isn't something people in countries with social options have to fear...despite any drawbacks since no place is perfect. I don't know if Americans who are so opposed to doing things like the rest of the first world just need to believe it's always better here so they ignore the benefits...or if they just haven't had to face this issue personally and are incapable of caring until they do. But I do know I had a future and now I do not...and there is no net to catch me or care. Whenever I see comments like yours I just get so upset realizing how it's an unwinnable battle in this country because of these ingrained beliefs.
mnm1 7y ago
Seriously. People who aren't aware of the current death panel situation and claim that the aca or future single payer healthcare will bring them are incredibly naive, uninformed, and stupid. They sure as hell haven't lost a relative to our current death panels. But of course, what do they care? Until it's happening to them, they will continue to believe whatever idiotic political bullshit their party or tribe subscribes to and eschew any logic or reason whatsoever. These people comprise most of our electorate, sadly.
Scoundreller 7y ago
Canadian here. We also have decision makers that decide what gets covered or not. It's stupid not to. We shouldn't plunder health care funds on $1m per year of life saved interventions when you can spend that on 100 interventions costing $10k per year of life saved. It works pretty well (something like 15th longest life expectancy). Of course, you're always free to pony up your own cash to pay for a treatment that isn't covered by your insurance, so the individual is always their own final death panel.
- ta0987 7y ago
  Logically, yes... But an acquaintance with Canadian relatives told me he knows a middle aged single man that was denied a knee replacement he needed because of these trade-offs. Left with decades to live, partially disabled, because: "Old? No family? Well fuck that guy then."
  - hestipod 7y ago
    Every time this discussion comes up people tell stories of "things they heard" but I hear very little first hand experience that validates them. I have had discussions in the past with my very right wing relatives about social healthcare and quality of life abroad (where I have lived and they have not) and they always had a pocket full of stories they heard from someone that undid anything I said in their minds. A more recent one was a supposed tale from a Danish immigrant to the USA who had told them how terrible the quality of life is in Copenhagen (a city while not perfect as none are, that is consistently rated as one of the highest qualities of life in the world) and how America is objectively better in every way which validated their world view. If people cannot even be realistic about the life on the ground...nothing ever changes.
    - robocat 7y ago
      New Zealander here, and I will speak about cases I have direct experience of (and project a little based on what I've read in media). Firstly, our social healthcare is actually pretty good for emergency procedures. But there is only so much money budgeted per year for healthcare, and everyone in need competes for that limited pool, so there is a variety of ways care can be delayed or denied. "Elective" procedures like hip and knee replacements can have long delays (queues) and seemingly odd requirements. One friend was "too" young: they had to wait for years in severe pain because they "shouldn't" need their hip replaced yet. Another acquantance had a record of hurting their knee as a young child: so they were not covered by ACC for knee replacement even though it was a ridiculous excuse in circumstances. Once a procedure is approved, you get reasonable treatment, and it is free. There is a certain amount of gaming of the system - if you can find a sympathetic specialist you can jump the queue a bit. However that is a zero sum game, and it benefits those with time, intelligence and contacts (and screws some minorities). Pharmac has a yearly government budget, and they choose which treatments can be afforded. We do the same with roading - cost benefit analysis is done for all roadworks and the best get funded until the fixed budget is met (small country, so one main roading department). It is interesting that our two biggest healthcare insurers (maybe covering 80% of private insurance) are non-profit co-operatives: all premiums are either paid out in care or pay administration overhead. I think overhead works out to be about 10%. Fantastic system: pay premiums and don't get sick is winning, getting payouts is often actually losing. It's like a socialist system for everyone that has some disposable income. Private healthcare premiums are extremely cheap compared to the US e.g. "the premium for a member aged 0-21 years on our most popular plan, Wellbeing Two, is just $9 a week", and "Pay for 2 kids, the rest are free*"; you can see what is covered by that plan here: https://www.southerncross.co.nz/Portals/0/Society/EFulfillment/Product/Comparision_chart.pdf https://www.southerncross.co.nz/Portals/0/Society/EFulfillme...
jMyles 7y ago
> It makes me despondent that we can ever get to a place where our politicians can make rational, informed decisions about complex issues requiring multiple trade-offs. It is OK if our politicians can't do this; it just means that, as the information age marches forward, we don't need politicians (or at least, that we don't need the state making these sorts of decisions).
specialist 7y ago
Every possible system will have some kind of rationing. I'm okay with the notion that tough choices have to be made. Especially if the rules are clear ahead of time. But that's not the system we now have. The default answer is "no" and patients have to fight to get to "yes". The real kicker is even people within the system (eg nurses, techs) struggle to get proper insurance and healthcare. If insiders are getting screwed, what chance do the rest of us have? (FWIW, I've been denied various life saving treatments, scripts, etc. multiple times. I'm fortunate to have had multiple angels in my life who've gone to bat for me. eg FHCRC fredhutch.org)
pteredactyl 7y ago
True. However, there's a difference between death panel singular and death panels plural.

taneq 7y ago

The rational, informed decision is that the government should run its own medical R&D. But no, we can't do that because muh freedums.

surfmike 7y ago
You mean like the National Institutes of Health?
- taneq 7y ago
  Yes, but more. You guys spend eleventy billion dollars on fighter jets with questionable hovering capability, can't you spend like four billion on nobody having cancer ever again?
  - caseysoftware 7y ago
    Well hell, if you know it's going to be $4B to eradicate cancer, it should be easy to put the plan together and get funding. You'll save everyone billions forever. Why are you screwing around on Hacker News?
  - dmoy 7y ago
    NCI alone has a budget of like $5-6B/yr.
  - DoreenMichele 7y ago
    I have a relative who works at the CDC and has had cancer multiple times. Before life and money got in the way, we used to talk regularly on the phone. She bitched a lot about how 99 studies out of 100 were variations on a theme because that's where the funding was. There was very little that was genuinely new and innovative. I don't know how to solve that. I've been getting myself well (different condition) for years when that's not supposed to be possible. I'm quite open about that on the internet. I get attacked for talking about it and called crazy. I'm told "Produce studies backing up your claims" when there are none. No one is latching on to my story and going "What if she's on to something? Maybe we can do a study that will open up new treatment modalities for patients!" I don't think it's as simple to solve this as you think it is. I don't know what needs to happen to break the herd mentality where humans don't seem to want to give any credibility to anything not already proven, which actively interferes with being able to prove anything new.
Irene 7y ago
My grandmother was denied drugs by government-run healthcare and died in severe pain.
- taneq 7y ago
  That is awful and I'm so sorry to hear. :( It also doesn't invalidate my point, although it highlights that I should have said the government should run its own competent R&D
  - idrios 7y ago
    I believe what you just described is the NIH.
  - Irene 7y ago
    You are right, according to medical journal "The Lancet", 85% of (government-funded) research funding is “avoidably wasted across the entire biomedical research range (e.g., clinical, health services, and basic science)” Government-funded medical R&D (budget for the NIH: $34.4 billion for 2019) needs smarter spending.
- lotsofpulp 7y ago
  What does that have to do with taxpayer funded R&D for medicine? Presumably, taneq's point was that medicine owned by taxpayers can be sold at the cost to manufacture and distribute it at far lower costs, as opposed to the current system where the owners of the research also needed to be compensated.
  - Irene 7y ago
    Most (if not all) new medicines came out of basic research supported by the NIH. This research was tweaked and patented by companies who profit from selling the drugs. Is start-to-finish government drug pipeline a better solution? Perhaps, but current academic culture doesn't support it. It's not just about pouring more taxpayer money.
- deleted 7y ago
  [deleted]
IanDrake 7y ago
Examples of prodects created by government run medical R&D?
- chroem- 7y ago
  Tofacitinib is one that I am familiar with. I am sure there are many more. https://en.wikipedia.org/wiki/Tofacitinib https://en.wikipedia.org/wiki/Tofacitinib Also, I think it's a valid question that doesn't deserve downvotes.
  - tryptophan 7y ago
    >Pfizer worked with O'Shea's [NIH funded] laboratory to define the structure and function of JAK3 and its receptors, and then handled the drug discovery, preclinical development, and clinical development of tofacitinib in-house. This says the exact opposite...
- SolarNet 7y ago
  NASA alone has plenty of good examples. Enriched baby food, CAT scans, heart replacement devices, better thermometers and imaging, and other minor advancements for specific procedures: better fiber optic devices for baby delivery, better lighting for brain cancer operations, improved cooling devices for certain symptoms. And again that's just specifically medical products that accidentally fell out of a space program.
- DanBC 7y ago
  A pop-sci list: https://www.med-technews.com/features/the-nhs-at-70-inventions-decade-by-decade/ https://www.med-technews.com/features/the-nhs-at-70-inventio... 1949: Intra-occular lens 1958: ultrasound for obstetrics 1962: total hip replacement 1978: test tube baby 1986: combined heart, liver, lung transplant 1991: robotic surgery 2000: gene therapy for children with no immune system 2013: bionic hand There are lots more.
  - IanDrake 7y ago
    At best those examples are misleading. The article ignores the R&D which often happened at private institutions and cherry pics the first use or minor refinement that occurred at a government facility.

cheeky78 7y ago

"But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them." It's not inflammatory when it's true. When the government runs our healthcare, choices are removed and someone else gets to decide if you should get surgery needed or not...and many times this is life or death. At least now, if a cancer patient gets denied drugs, they can go to another doctor or get a second opinion. All of my elderly relatives live in Canada and come over the border for any major surgery. This is mostly because the wait times are sometimes in the years..when they can just get private care in the US and get it done in a matter of weeks. Doctors are also usually maxed out when it comes to patients, so individual care is lacking and they usually just want to try to push you out the door. I also feel like I should have a say in someone's behavior, if I'm paying for their healthcare with my tax dollars: smoking, drinking, risky behavior, etc. I've lived in countries with universal healthcare and the quality is sub-par compared to the US/private care. Sure private care can be improved, but it shouldn't be ripped out and replaced.

hestipod 7y ago
>I've lived in countries with universal healthcare and >the quality is sub-par compared to the US/private care. My experience has been the exact opposite. America's healthcare business ruined my life. As a result I have no insurance and have lost the "privilege" to BUY said American healthcare. I struggle with low income options and programs, all insufficient. The only good care I ever got was in Europe. My experiences with social hospitals and doctors was much better than in the USA where it counts. Places weren't often as fancy looking, but the care was superb. Even the private systems in those countries was far more affordable. a few hundred for an MRI etc rather than a few thousand. Healthcare and education in America can bankrupt you. That isn't something people in countries with social options have to fear...despite any drawbacks since no place is perfect. I don't know if Americans who are so opposed to doing things like the rest of the first world just need to believe it's always better here so they ignore the benefits...or if they just haven't had to face this issue personally and are incapable of caring until they do. But I do know I had a future and now I do not...and there is no net to catch me or care. Whenever I see comments like yours I just get so upset realizing how it's an unwinnable battle in this country because of these ingrained beliefs.

mnm1 7y ago

Seriously. People who aren't aware of the current death panel situation and claim that the aca or future single payer healthcare will bring them are incredibly naive, uninformed, and stupid. They sure as hell haven't lost a relative to our current death panels. But of course, what do they care? Until it's happening to them, they will continue to believe whatever idiotic political bullshit their party or tribe subscribes to and eschew any logic or reason whatsoever. These people comprise most of our electorate, sadly.

Scoundreller 7y ago

Canadian here. We also have decision makers that decide what gets covered or not. It's stupid not to. We shouldn't plunder health care funds on $1m per year of life saved interventions when you can spend that on 100 interventions costing $10k per year of life saved. It works pretty well (something like 15th longest life expectancy). Of course, you're always free to pony up your own cash to pay for a treatment that isn't covered by your insurance, so the individual is always their own final death panel.

ta0987 7y ago
Logically, yes... But an acquaintance with Canadian relatives told me he knows a middle aged single man that was denied a knee replacement he needed because of these trade-offs. Left with decades to live, partially disabled, because: "Old? No family? Well fuck that guy then."
- hestipod 7y ago
  Every time this discussion comes up people tell stories of "things they heard" but I hear very little first hand experience that validates them. I have had discussions in the past with my very right wing relatives about social healthcare and quality of life abroad (where I have lived and they have not) and they always had a pocket full of stories they heard from someone that undid anything I said in their minds. A more recent one was a supposed tale from a Danish immigrant to the USA who had told them how terrible the quality of life is in Copenhagen (a city while not perfect as none are, that is consistently rated as one of the highest qualities of life in the world) and how America is objectively better in every way which validated their world view. If people cannot even be realistic about the life on the ground...nothing ever changes.
  - robocat 7y ago
    New Zealander here, and I will speak about cases I have direct experience of (and project a little based on what I've read in media). Firstly, our social healthcare is actually pretty good for emergency procedures. But there is only so much money budgeted per year for healthcare, and everyone in need competes for that limited pool, so there is a variety of ways care can be delayed or denied. "Elective" procedures like hip and knee replacements can have long delays (queues) and seemingly odd requirements. One friend was "too" young: they had to wait for years in severe pain because they "shouldn't" need their hip replaced yet. Another acquantance had a record of hurting their knee as a young child: so they were not covered by ACC for knee replacement even though it was a ridiculous excuse in circumstances. Once a procedure is approved, you get reasonable treatment, and it is free. There is a certain amount of gaming of the system - if you can find a sympathetic specialist you can jump the queue a bit. However that is a zero sum game, and it benefits those with time, intelligence and contacts (and screws some minorities). Pharmac has a yearly government budget, and they choose which treatments can be afforded. We do the same with roading - cost benefit analysis is done for all roadworks and the best get funded until the fixed budget is met (small country, so one main roading department). It is interesting that our two biggest healthcare insurers (maybe covering 80% of private insurance) are non-profit co-operatives: all premiums are either paid out in care or pay administration overhead. I think overhead works out to be about 10%. Fantastic system: pay premiums and don't get sick is winning, getting payouts is often actually losing. It's like a socialist system for everyone that has some disposable income. Private healthcare premiums are extremely cheap compared to the US e.g. "the premium for a member aged 0-21 years on our most popular plan, Wellbeing Two, is just $9 a week", and "Pay for 2 kids, the rest are free*"; you can see what is covered by that plan here: https://www.southerncross.co.nz/Portals/0/Society/EFulfillment/Product/Comparision_chart.pdf https://www.southerncross.co.nz/Portals/0/Society/EFulfillme...

jMyles 7y ago

> It makes me despondent that we can ever get to a place where our politicians can make rational, informed decisions about complex issues requiring multiple trade-offs. It is OK if our politicians can't do this; it just means that, as the information age marches forward, we don't need politicians (or at least, that we don't need the state making these sorts of decisions).

specialist 7y ago

Every possible system will have some kind of rationing. I'm okay with the notion that tough choices have to be made. Especially if the rules are clear ahead of time. But that's not the system we now have. The default answer is "no" and patients have to fight to get to "yes". The real kicker is even people within the system (eg nurses, techs) struggle to get proper insurance and healthcare. If insiders are getting screwed, what chance do the rest of us have? (FWIW, I've been denied various life saving treatments, scripts, etc. multiple times. I'm fortunate to have had multiple angels in my life who've gone to bat for me. eg FHCRC fredhutch.org)

pteredactyl 7y ago

True. However, there's a difference between death panel singular and death panels plural.