6 ms·

It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cov

It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. Such treatments will probably always exist. (And if they didn't, then that could he a problem by itself.) But at least basic modern healthcare (things that existed ~20 years ago) should be provided as (mostly) free to the patient. We need people to not worry about going to the doctor - there should be minimal paperwork and cost. More people going to healthcare earlier would hopefully pay off through better preventative care.

arcticbull 6y ago
> It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. Such treatments will probably always exist. (And if they didn't, then that could he a problem by itself.) Not in a single-payer state, no. It's also not really a problem in and of itself. You'll find that if cancer treatments are actually cheaper and more effective than the status quo as demonstrated by a study that a single payer state will quickly take them up. [edit] Frequently you'll find these eccentric or fringe treatments that are incredibly expensive aren't actually better per se. There is a point of diminishing returns in everything. If you paid $200K for cancer treatment, would you get a better outcome? $1M? $10M? $1B? No. We know what we know, and we have the tools we have. Healthcare isn't a pay-to-win game. Generally if you find a way to pay more to get better care you're just bumping someone else down the priority list. That may be acceptable in America but it's not in much of the rest of the world.
- etaioinshrdlu 6y ago
  Extremely rich people in non-USA countries can still travel elsewhere and pay exorbitant amounts for exotic treatment if they so desire. Some of those might be lifesaving.
  - arcticbull 6y ago
    Some (who don't understand the value of money) may even visit the US. My question is do you have some good examples of this, particularly where efficacy is disproportionately better?
    - jjeaff 6y ago
      I could be wrong, but I believe one of the few metrics that the US outperforms in is cancer survival. I have heard that there are quite a few wealthy people (even from places like canada and the uk) that come here for cancer treatments that are not provided in their country because the public health system will not pay for them.
      - arcticbull 6y ago
        That's a funky one, and I'll be the first to say that America does have some very good cancer treatment clinics if you don't mind bankruptcy (although the same is true if you break your leg). Part of that has to do with how cancer survival rates are measured and what role screening has in the various systems. This came up with Giuliani a while ago and is well described here [1]. tldr: The statistics are quite misleading as cancer survival is measured in 5-year survival rates, and the US has aggressive (sometimes medically unjustified) early screening programs. Early detection of some kinds of cancer, such as prostate cancer, doesn't change the mortality rate but it does change the 5-year survival rate as the disease is detected earlier. If you have more data, or this isn't what you were referring to, I'd love to read it! [1] https://www.factcheck.org/2007/10/a-bogus-cancer-statistic/ https://www.factcheck.org/2007/10/a-bogus-cancer-statistic/
        deleted 6y ago
        [deleted]
        refurb 6y ago
        Here is a good example as to why you might want to go to the US for cancer care. "It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication." 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-...
- Anon1096 6y ago
  This isn't correct in the UK under NHS. There's a set amount NHS is willing to pay for drugs and treatment, and beyond that, it's refused altogether. You'd have to go elsewhere and on your own dime for expensive treatments. Here's a link from the BBC I quickly found but it's widely documented: https://www.bbc.com/news/health-28983924 https://www.bbc.com/news/health-28983924
  - arcticbull 6y ago
    The QALY metric they mention is exactly what I had in mind, actually, very cool. Wealth won't get you better care, or faster care, or different in the NHS. That's the point I was making, and your article supports that position. > "You'd have to go elsewhere and on your own dime for expensive treatments." [In a single payer system there's nowhere else to go.] (retracted)
    - grey-area 6y ago
      The majority of single payer systems don't outlaw private care. There are private hospitals in the UK for example. Single payer is about removing insurance companies from the process (saving money), standardising care (saving money, improving outcomes), collective bargaining for drugs (saving money), providing a base level of care to all (saving money and improving QOL). But it doesn't usually forbid spending money on private care. As a result single payer results in similar outcomes for vastly less public money, and almost zero private money spent on healthcare.
      - arcticbull 6y ago
        Indeed, and I retract my final sentence.
        fraggle_sock 6y ago
        Ideally though, all private healthcare would be banned. Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic benefit in ensuring that the public healthcare system is up to standard. That is, if the wealthy and powerful are forced to use it too, it means they have skin in the game and won't just use their power to run it into the ground in pursuit of profit or from lack of concern for others.
- toshk 6y ago
  There are a few treatments that work well but are just to expensive to be viable. For instance a few decades there was a gene therapy developed for people with a gene deficiency that blocks them from digesting fats. If I remember correctly it was developed in Canada. Even though it cured the people, it was and is too expensive for it to be used at the moment.
- Aerroon 6y ago
  >Not in a single-payer state, no. You can always go to another country or just pay someone personally to hear out your problems and help fix them. You can't avoid that. >It's also not really a problem in and of itself. You'll find that if cancer treatments are actually cheaper and more effective than the status quo as demonstrated by a study that a single payer state will quickly take them up. Some people report that doing a ketogenic diet helps them control some diseases (eg diabetes). It's been a decade since its surge in popularity. Keto doesn't seem to always work, but it seems to work for some. Is it considered a treatment yet? Because doing a keto diet is likely to incur a higher cost - carbs are cheaper compared to protein and fats. >Healthcare isn't a pay-to-win game. Generally if you find a way to pay more to get better care you're just bumping someone else down the priority list. What do you mean? Healthcare is not a fixed pie. It's constantly expanding in what can be treated, you can train and hire more doctors and nurses, you can make more and better equipment. If people are willing to pay enough extra for some treatment, then this can directly lead to the capacity of that treatment increasing. >That may be acceptable in America but it's not in much of the rest of the world. This is exactly how it works in many countries. You have your public healthcare and then private healthcare, where you can skip queues.
- cmrdporcupine 6y ago
  I like our healthcare system here in Canada, but this is not fully true. There are often experimental or very expensive treatments that the provincial health care systems don't cover, and so every few months I hear about some medication for a rare disease or cancer that someone is struggling/lobbying to get covered. One historical example is Herceptin, for treating breast cancer. It took six years to get the Ontario gov't to finally cave and cover it, meanwhile some people were traveling to Buffalo or other places in the US and paying out of pocket to get it. See this old article from 2005: https://www.theglobeandmail.com/life/ontario-makes-herceptin-widely-available/article1122113/ https://www.theglobeandmail.com/life/ontario-makes-herceptin... On average, yes, it is better to be a cancer patient here than in the US, especially if you're working class or poor. And I believe last time I looked the life expectancy and recovery rates statistics etc. bore that out. But there are definitely medications and treatments not covered, still, and having extra insurance coverage is important enough that people I know have struggled to keep their jobs so they could continue to pay for their partner's treatments. In general, in Canada, medical care is covered but prescription pharmaceuticals are not. Which needs to be remedied.
  - arcticbull 6y ago
    > In general, in Canada, medical care is covered but prescription pharmaceuticals are not. Which needs to be remedied. Dental and vision too!
wvenable 6y ago
> Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. I have co-worker with a very unique disease with a very niche and very expensive treatment and here in Canada it's free. The whole point of public health care is that the cost is spread among everyone -- the young, the healthy, the old, the very sick.
- fraggle_sock 6y ago
  This spreading of cost amongst the whole of society should really be the norm rather than the exception, particuarly for all the other essentials of human existence and dignity. For example, here in the UK we have a growing network of food banks who have stepped in to fill the needs of the many people who are in dire financial straits (and not just because of the pandemic - their use has been rising rapidly for the past ten years, due to right-wing austerity policies that have decimated the welfare state). These are almost all run by the third sector (charities, etc.) and they do excellent work in the circumstances. But coverage is patchy and uneven, and many families still suffer from food poverty. How much better it would be for us to have a National Food Service, with country-wide service guarantees such that everyone's nutritional needs can be met. No more wondering where your next meal is coming from, or starving yourself to feed your kids, or eating unhealthily because it's the cheapest option with the resources available. It's just provided as needed and the cost is shared. Indeed you may even have paid for it already with your taxes, or will do in the future. And a similar sort of thing should be done for housing, water, etc.
  - rvx80 6y ago
    So, communism, then?
  - arethuza 6y ago
    I'm appalled that we have come to the point where we need food banks for people here in the UK - they were practically unheard of before 2008 and the subsequent "austerity".
- Aerroon 6y ago
  You can sink virtually infinite resources into healthcare. There are always going to be more things to research and develop treatments for. At some point you have to draw a line, because the cost to the system can become enormous. Take some of the gene therapies as an example.[0] Zolgensma costs over $2 million per treatment or Zynteglo[1] that costs $1.8 million per treatment. Maybe US healthcare can afford this, but poorer countries can't. The hope is that the existence of these treatments means that they will eventually come down in price. 20-50 years from now I expect these treatments to be part of basic healthcare in most countries. On the other hand, if we limit the existence of treatments like these right now, then maybe 20-50 years from now these treatments simply wouldn't exist. Healthcare systems always play with limited resources. We should first start covering dental care, glasses and eyesight surgeries as an example of something that's missing in a lot of countries. Furthermore, regardless whether the system had the money or not, some 'treatments' will still be niche and not considered 'healthcare'. Traditional medicine can help with some problems, but it might not fall under healthcare. Most things related to diet are basically a pseudo science, but some of them work for some people. You'll never cover all of this. [0] https://www.reuters.com/article/us-novartis-genetherapy-idUSKCN1SU1ZP https://www.reuters.com/article/us-novartis-genetherapy-idUS... [1] https://www.wsj.com/articles/new-gene-therapy-priced-at-1-8-million-in-europe-11560529116 https://www.wsj.com/articles/new-gene-therapy-priced-at-1-8-...

arcticbull 6y ago

> It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. Such treatments will probably always exist. (And if they didn't, then that could he a problem by itself.) Not in a single-payer state, no. It's also not really a problem in and of itself. You'll find that if cancer treatments are actually cheaper and more effective than the status quo as demonstrated by a study that a single payer state will quickly take them up. [edit] Frequently you'll find these eccentric or fringe treatments that are incredibly expensive aren't actually better per se. There is a point of diminishing returns in everything. If you paid $200K for cancer treatment, would you get a better outcome? $1M? $10M? $1B? No. We know what we know, and we have the tools we have. Healthcare isn't a pay-to-win game. Generally if you find a way to pay more to get better care you're just bumping someone else down the priority list. That may be acceptable in America but it's not in much of the rest of the world.

etaioinshrdlu 6y ago
Extremely rich people in non-USA countries can still travel elsewhere and pay exorbitant amounts for exotic treatment if they so desire. Some of those might be lifesaving.
- arcticbull 6y ago
  Some (who don't understand the value of money) may even visit the US. My question is do you have some good examples of this, particularly where efficacy is disproportionately better?
  - jjeaff 6y ago
    I could be wrong, but I believe one of the few metrics that the US outperforms in is cancer survival. I have heard that there are quite a few wealthy people (even from places like canada and the uk) that come here for cancer treatments that are not provided in their country because the public health system will not pay for them.
    - arcticbull 6y ago
      That's a funky one, and I'll be the first to say that America does have some very good cancer treatment clinics if you don't mind bankruptcy (although the same is true if you break your leg). Part of that has to do with how cancer survival rates are measured and what role screening has in the various systems. This came up with Giuliani a while ago and is well described here [1]. tldr: The statistics are quite misleading as cancer survival is measured in 5-year survival rates, and the US has aggressive (sometimes medically unjustified) early screening programs. Early detection of some kinds of cancer, such as prostate cancer, doesn't change the mortality rate but it does change the 5-year survival rate as the disease is detected earlier. If you have more data, or this isn't what you were referring to, I'd love to read it! [1] https://www.factcheck.org/2007/10/a-bogus-cancer-statistic/ https://www.factcheck.org/2007/10/a-bogus-cancer-statistic/
      - deleted 6y ago
        [deleted]
      - refurb 6y ago
        Here is a good example as to why you might want to go to the US for cancer care. "It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication." 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-...
Anon1096 6y ago
This isn't correct in the UK under NHS. There's a set amount NHS is willing to pay for drugs and treatment, and beyond that, it's refused altogether. You'd have to go elsewhere and on your own dime for expensive treatments. Here's a link from the BBC I quickly found but it's widely documented: https://www.bbc.com/news/health-28983924 https://www.bbc.com/news/health-28983924
- arcticbull 6y ago
  The QALY metric they mention is exactly what I had in mind, actually, very cool. Wealth won't get you better care, or faster care, or different in the NHS. That's the point I was making, and your article supports that position. > "You'd have to go elsewhere and on your own dime for expensive treatments." [In a single payer system there's nowhere else to go.] (retracted)
  - grey-area 6y ago
    The majority of single payer systems don't outlaw private care. There are private hospitals in the UK for example. Single payer is about removing insurance companies from the process (saving money), standardising care (saving money, improving outcomes), collective bargaining for drugs (saving money), providing a base level of care to all (saving money and improving QOL). But it doesn't usually forbid spending money on private care. As a result single payer results in similar outcomes for vastly less public money, and almost zero private money spent on healthcare.
    - arcticbull 6y ago
      Indeed, and I retract my final sentence.
      - fraggle_sock 6y ago
        Ideally though, all private healthcare would be banned. Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic benefit in ensuring that the public healthcare system is up to standard. That is, if the wealthy and powerful are forced to use it too, it means they have skin in the game and won't just use their power to run it into the ground in pursuit of profit or from lack of concern for others.
toshk 6y ago
There are a few treatments that work well but are just to expensive to be viable. For instance a few decades there was a gene therapy developed for people with a gene deficiency that blocks them from digesting fats. If I remember correctly it was developed in Canada. Even though it cured the people, it was and is too expensive for it to be used at the moment.
Aerroon 6y ago
>Not in a single-payer state, no. You can always go to another country or just pay someone personally to hear out your problems and help fix them. You can't avoid that. >It's also not really a problem in and of itself. You'll find that if cancer treatments are actually cheaper and more effective than the status quo as demonstrated by a study that a single payer state will quickly take them up. Some people report that doing a ketogenic diet helps them control some diseases (eg diabetes). It's been a decade since its surge in popularity. Keto doesn't seem to always work, but it seems to work for some. Is it considered a treatment yet? Because doing a keto diet is likely to incur a higher cost - carbs are cheaper compared to protein and fats. >Healthcare isn't a pay-to-win game. Generally if you find a way to pay more to get better care you're just bumping someone else down the priority list. What do you mean? Healthcare is not a fixed pie. It's constantly expanding in what can be treated, you can train and hire more doctors and nurses, you can make more and better equipment. If people are willing to pay enough extra for some treatment, then this can directly lead to the capacity of that treatment increasing. >That may be acceptable in America but it's not in much of the rest of the world. This is exactly how it works in many countries. You have your public healthcare and then private healthcare, where you can skip queues.
cmrdporcupine 6y ago
I like our healthcare system here in Canada, but this is not fully true. There are often experimental or very expensive treatments that the provincial health care systems don't cover, and so every few months I hear about some medication for a rare disease or cancer that someone is struggling/lobbying to get covered. One historical example is Herceptin, for treating breast cancer. It took six years to get the Ontario gov't to finally cave and cover it, meanwhile some people were traveling to Buffalo or other places in the US and paying out of pocket to get it. See this old article from 2005: https://www.theglobeandmail.com/life/ontario-makes-herceptin-widely-available/article1122113/ https://www.theglobeandmail.com/life/ontario-makes-herceptin... On average, yes, it is better to be a cancer patient here than in the US, especially if you're working class or poor. And I believe last time I looked the life expectancy and recovery rates statistics etc. bore that out. But there are definitely medications and treatments not covered, still, and having extra insurance coverage is important enough that people I know have struggled to keep their jobs so they could continue to pay for their partner's treatments. In general, in Canada, medical care is covered but prescription pharmaceuticals are not. Which needs to be remedied.
- arcticbull 6y ago
  > In general, in Canada, medical care is covered but prescription pharmaceuticals are not. Which needs to be remedied. Dental and vision too!

wvenable 6y ago

> Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. I have co-worker with a very unique disease with a very niche and very expensive treatment and here in Canada it's free. The whole point of public health care is that the cost is spread among everyone -- the young, the healthy, the old, the very sick.

fraggle_sock 6y ago
This spreading of cost amongst the whole of society should really be the norm rather than the exception, particuarly for all the other essentials of human existence and dignity. For example, here in the UK we have a growing network of food banks who have stepped in to fill the needs of the many people who are in dire financial straits (and not just because of the pandemic - their use has been rising rapidly for the past ten years, due to right-wing austerity policies that have decimated the welfare state). These are almost all run by the third sector (charities, etc.) and they do excellent work in the circumstances. But coverage is patchy and uneven, and many families still suffer from food poverty. How much better it would be for us to have a National Food Service, with country-wide service guarantees such that everyone's nutritional needs can be met. No more wondering where your next meal is coming from, or starving yourself to feed your kids, or eating unhealthily because it's the cheapest option with the resources available. It's just provided as needed and the cost is shared. Indeed you may even have paid for it already with your taxes, or will do in the future. And a similar sort of thing should be done for housing, water, etc.
- rvx80 6y ago
  So, communism, then?
- arethuza 6y ago
  I'm appalled that we have come to the point where we need food banks for people here in the UK - they were practically unheard of before 2008 and the subsequent "austerity".
Aerroon 6y ago
You can sink virtually infinite resources into healthcare. There are always going to be more things to research and develop treatments for. At some point you have to draw a line, because the cost to the system can become enormous. Take some of the gene therapies as an example.[0] Zolgensma costs over $2 million per treatment or Zynteglo[1] that costs $1.8 million per treatment. Maybe US healthcare can afford this, but poorer countries can't. The hope is that the existence of these treatments means that they will eventually come down in price. 20-50 years from now I expect these treatments to be part of basic healthcare in most countries. On the other hand, if we limit the existence of treatments like these right now, then maybe 20-50 years from now these treatments simply wouldn't exist. Healthcare systems always play with limited resources. We should first start covering dental care, glasses and eyesight surgeries as an example of something that's missing in a lot of countries. Furthermore, regardless whether the system had the money or not, some 'treatments' will still be niche and not considered 'healthcare'. Traditional medicine can help with some problems, but it might not fall under healthcare. Most things related to diet are basically a pseudo science, but some of them work for some people. You'll never cover all of this. [0] https://www.reuters.com/article/us-novartis-genetherapy-idUSKCN1SU1ZP https://www.reuters.com/article/us-novartis-genetherapy-idUS... [1] https://www.wsj.com/articles/new-gene-therapy-priced-at-1-8-million-in-europe-11560529116 https://www.wsj.com/articles/new-gene-therapy-priced-at-1-8-...