It wouldn't be safe to assume that I'd have been authorized for an elective surgery, so fair point.
I also never suggested that it should be free.
> American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking.
This hasn't been my experience. Before my dad died from glioblastoma last year, his insurance refused to pay anything for his treatment. They refused to pay for anything, fighting us every step of the way. A single chemo pill cost over $2200, and he needed 60 of them, and they wouldn't cover any portion of them. And that was just one of many the things they wouldn't pay for. They wouldn't even cover anti-nausea medication. I did, and it cost less than $30. They wouldn't even cover hospice care.
My dad paid premiums to that same insurance company for 20 years, and was healthy the entire time. No major health issues, non-smoker, non-drinker, no heart problems, no accidents. He learned about his rapidly growing tumor on his own. He decided, mostly out of curiosity about the technology, to pay for a full body MRI (at his own expense of course) and found it. He spent his life savings trying to fight the cancer and the insurance company, just so he could have enough time to say goodbye to people. He died within 8 months of discovering the tumor.
The money he paid that insurance company over a 20 year period would have covered all of the costs had he put the money into a savings account, even if he made zero interest and accounting for inflation.
I know that there will be those who say "but what about Medicare/Medicaid?" - he didn't qualify for either of them.
The only outside help he might have had was from an organization that houses people near cancer facilities, but they pulled their support the moment the pandemic was declared, shutting down all their housing facilities. The irony there, as well, is that that particular organization, even in non-pandemic times, required 6 months lead time before they could place an individual. He'd have been dead before they were able to place them. I paid for an AirBnB instead, which cost me close to $5k for the duration of his treatment, which he paid for out of pocket.
My dad's story isn't uncommon either. Why would insurance companies have any incentive to step up when they know that if they just wait things out, they'll be able to keep their money?
The American health care system is utterly broken, perhaps even criminally corrupt.
I’m sorry to hear your dad’s experience. It’s the nature of a private system in a country of 300 million people that experiences will differ. Aggressive glioblastoma is something that won’t be covered with the cost effectiveness thresholds in many European systems. The median survival duration of treated patients is just over one year, with costs, as you outline above, of $120-250k. The typical upper end in the UK NHS is 30,000 pounds per quality adjusted life year ($36,000). The UK recently introduced a cancer drugs fund that can go beyond that, but it’s been intensely controversial within the UK, because in that country there is a deeply established focus on cost effectiveness and “NICE” protocol. But US insurance companies routinely pay hundreds of thousands of dollars for glioblastoma treatment. Median insurance payments for high grade glioma were $180,000 in one study: https://ar.iiarjournals.org/content/anticanres/39/3/1375.full.pdf https://ar.iiarjournals.org/content/anticanres/39/3/1375.ful...
Over the years so many people have patiently explained why and how you're wrong whenever you mention the NHS that I can only think you're choosing to misrepresent the information now.
And here you're repeating the claim that US health insurance is a unlimited source of healthcare funds for anyone who wants it, even though someone else is telling you that's not their personal experience.
Denial of health insurance is so common in the US the charitable orgs give advice about how to deal with it: https://www.cancer.org/treatment/finding-and-paying-for-treatment/managing-health-insurance/if-your-health-insurance-claim-is-denied.html https://www.cancer.org/treatment/finding-and-paying-for-trea...
"It’s not unusual for insurers to deny some claims or say they won’t cover a test, procedure, or service that doctors order. You can appeal many types of health insurance decisions – sometimes even things that are written into your health plan’s contract. You can appeal Medicare claim denials, too."
All the available evidence directly contradicts your claims about the generosity of health insurance.
Dan, over the years you’ve baselessly accused me of misrepresenting how the NHS system works, without any substance. The UK NHS’s use of QALY is well established: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-5050-9 https://bmchealthservres.biomedcentral.com/articles/10.1186/... (“The U.K. National Institute for Health and Care Excellence (NICE) currently uses a cost-effectiveness threshold in the range of £20,000 to £30,000 per quality-adjusted life year (QALY) for reimbursing new drugs in the National Health Service”). I also mentioned to the cancer drugs fund.
And the US system, unlike the UK NHS, is a highly fragmented contractual system. Obviously there’s going to be a wide range of experiences with willingness to pay. But I cited specific sources for the median insurance reimbursement of glioblastoma being over $180,000.
So please tell me, with particularity, what part do you disagree with?
You're claiming that this is a limit for treatment and that this is maximum amount the NHS will spend per patient. That's simply untrue.
Yet again: that figure is the negotiation amount used by the NHS when dealing with companies designing meds to be sold into the NHS. It has nothing at all to do with how much the NHS will spend per patient per year.
The cancer drugs fund is useful: the first version had to be scrapped because it was spending billions of pounds on new meds that were fantastically expensive but didn't extend life, nor improve quality of life, and which often made QoL worse or shortened life. https://www.newscientist.com/article/dn26785-the-uks-cancer-drugs-fund-does-more-harm-than-good/ https://www.newscientist.com/article/dn26785-the-uks-cancer-...
> But I cited specific sources for the median insurance reimbursement of glioblastoma being over $180,000
You're doing a few things here. 1) You're implying that US treatment is good, and 2) you're insinuating that people in the UK aren't going to be treated for glioblastoma because the cost is greater than the NICE guideline for cost of treatment.
1) https://www.nice.org.uk/guidance/ta121/chapter/4-Evidence-and-interpretation https://www.nice.org.uk/guidance/ta121/chapter/4-Evidence-an...
> The Assessment Group reported that the Food and Drug Administration (FDA) in the USA expressed several concerns when it evaluated the trial. There was an imbalance between the types of tumours in the study arms, which could have favoured carmustine implants. The FDA requested a review of histological diagnoses and a sensitivity analysis was performed using diagnoses by an alternative pathologist. A further concern was that the manufacturer's analysis treated death as an event when measuring time to progression. A reanalysis was performed of the data on the time to progression as determined by decline of neurological symptoms and performance status, with deaths being censored. In addition, the manufacturer's analysis of the overall survival data included stratification by country, and the data were reanalysed without stratification. The data reported below relate to the unstratified analysis unless otherwise stated. [...]
> There was no difference in progression-free survival between treatment groups. Median time to progression was 5.9 months (95% CI 4.4 to 8.3 months) in the carmustine implant group and 5.9 months (95% CI 4.7 to 7.4 months) in the placebo group (using stratified analysis). The manufacturer's analysis suggested that both the time to decline of KPS score and the time to progression on neurological indices were statistically significantly improved (that is, increased) in the carmustine implant group. The FDA reanalysis of these data found that there were no statistically significant differences in these measures of progression-free survival and that the differences resulted from variations in survival times between the treatment arms.
> [...] The effect of temozolomide on the quality of life of patients was investigated in the largest RCT using a cancer-specific quality-of-life questionnaire. Of seven preselected scales, the only statistically significant difference between treatment groups was in social functioning at the first follow-up during adjuvant treatment with temozolomide (in favour of the radiotherapy alone group).
US treatment gives people brain damage, decreases quality of life, doesn't do much to increase length of life, and then because the US doesn't negotiate drug prices costs a lot of money. In the US with its expensive treatment we still see that the five year survival rate on less than 10%, that the average life expectancy is only 8 months, and that these very expensive treatments (which can severely degrade QoL) extend life by maybe a couple of months. Remember, these aren't months when you're walking around living normal life, they're time spent in hospital. Regret rates for cancer treatment ("I wish I didn't have that treatment, I wish I'd done something else") are very high.
2) It's simply untrue to suggest that people in England[1] don't get treatment for gioblastoma. They do get treatment. What does happen is that they don't get ripped off for meds.
https://bnf.nice.org.uk/drugs/carmustine/medicinal-forms/ https://bnf.nice.org.uk/drugs/carmustine/medicinal-forms/
> Carmustine NHS indicative price £5,203.00 (Hospital only)
https://bnf.nice.org.uk/drugs/temozolomide/medicinal-forms/ https://bnf.nice.org.uk/drugs/temozolomide/medicinal-forms/
> Temozolomide 250 mg NHS indicative price £814.00 (Hospital only)