4 ms·

I'm trying to understand what point you're trying to make here. Are you saying America's system is better or worse than that of your country? I'm in America, a

I'm trying to understand what point you're trying to make here. Are you saying America's system is better or worse than that of your country? I'm in America, and I have fantastic health insurance (by American standards) and waited over a year for a hip replacement surgery. Even with insurance, I paid almost $10,000 for the surgery. Without insurance it would have cost well over $100k. I suspect that in any other country that provides universal health care it would have been less expensive (for everyone) and I would have waited less then 15 months to have it done.

rayiner 4y ago
Why do you assume you would have gotten authorized for a hip replacement at all? Many elective qualify of life surgeries aren’t covered in European health care systems. Look, there is no free lunch. The UK NHS has strict standards of “cost effectiveness” that would shock Americans: https://www.nice.org.uk/media/default/guidance/lgb10-briefing-20150126.pdf https://www.nice.org.uk/media/default/guidance/lgb10-briefin.... 20-30,000 pounds per quality adjusted life year. 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. A friend of the family was diagnosed with terminal cancer and given six months to live. She received treatment costing hundreds of thousands of dollars, and lived almost two years. In European systems she would have been sent into hospice.
- elhudy 4y ago
  > A friend of the family was diagnosed with terminal cancer and given six months to live. She received treatment costing hundreds of thousands of dollars, and lived almost two years. In European systems she would have been sent into hospice I’m not sure why you’re being downvoted, this seems factual. It’s also the part of the problem that’s never discussed - the big cancerous whale in the room. Culturally, Americans can’t accept that sometimes people are going to die, and let it happen. 2 years of chemo and carT treatments with neurological damage, organ damage, chemo brain, the list goes on, isn’t worth it for most people. But they don’t even realize that until they’re almost gone. Taking a holistic look at the health of the patient and running costa / benefit on quality of life vs treatment are two ways that the uk controls costa really well. As far as I’m aware it’s the same with obese people. There are limits on their reimbursement amounts for certain things and they need to buy extra insurance to cover that (someone from the uk correct me if I’m wrong?)
  - kcplate 4y ago
    > I’m not sure why you’re being downvoted, this seems factual. I’ll make a guess at why. Because some folks in the US who want universal healthcare have a misunderstanding of what that actually means to make it affordable. Any comment criticizing or expressing what might be perceived as negative of any aspect of “European style healthcare” (as if that is a singular thing) will get downvoted by these folks. They have a belief that the level of end of life care most folks currently receive in the US will continue. Their 89 year old grandmothers with cancer are still going to get experimental and expensive chemotherapy all the way up to her dying breath. And don’t you dare suggest that she is not!
    - sterlind 4y ago
      why can't the 89-year old grandmother get supplemental insurance that covers the fancy therapies? I don't buy that there's no way to get people state-covered insulin and chemo without consigning everyone to bread lines. just make Medicare universal, and let people buy BCBS or Kaiser etc. on top, to skip the lines or cover more end of life stuff.
      - kcplate 4y ago
        Not saying that she can’t, but I am saying that the expectation of universal healthcare from many of the folks supporting it is that she won’t have to buy supplemental coverage, but will get the same or better care.
      - rayiner 4y ago
        > why can't the 89-year old grandmother get supplemental insurance that covers the fancy therapies? I think they can, but I also think that most people advocating for “Medicare for all” in the US don’t even realize supplemental private health insurance exists in many if not most European systems. Healthcare is a systems engineering problem to explore design trade offs within a solution space. Most people don’t think of it that way.
- evgen 4y ago
  Sure, and I will say the ugly truth: She might have been better off in hospice (end of life care can be rather grim and there is a reason many older Americans are terrified of the process and results) and society in general would have been better off if she died sooner in hospice care. The European system is much better because it does not hide reality from people who seem to have difficulty grasping the concept that they, and the people they cherish, are eventually going to die. Instead of giving one old lady and additional 18 months of end of life care the Euro system has the ability to make sure that basic health needs of the entire population are actually taken care of, something at which the American system fails completely. An approach based on cost effective treatment is easy to attack using cherry-picked sob stories, but overall it is a far superior system to the 'you only get what you can pay for' American approach.
- buffington 4y ago
  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.
  - rayiner 4y ago
    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...

rayiner 4y ago

Why do you assume you would have gotten authorized for a hip replacement at all? Many elective qualify of life surgeries aren’t covered in European health care systems. Look, there is no free lunch. The UK NHS has strict standards of “cost effectiveness” that would shock Americans: https://www.nice.org.uk/media/default/guidance/lgb10-briefing-20150126.pdf https://www.nice.org.uk/media/default/guidance/lgb10-briefin.... 20-30,000 pounds per quality adjusted life year. 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. A friend of the family was diagnosed with terminal cancer and given six months to live. She received treatment costing hundreds of thousands of dollars, and lived almost two years. In European systems she would have been sent into hospice.

elhudy 4y ago
> A friend of the family was diagnosed with terminal cancer and given six months to live. She received treatment costing hundreds of thousands of dollars, and lived almost two years. In European systems she would have been sent into hospice I’m not sure why you’re being downvoted, this seems factual. It’s also the part of the problem that’s never discussed - the big cancerous whale in the room. Culturally, Americans can’t accept that sometimes people are going to die, and let it happen. 2 years of chemo and carT treatments with neurological damage, organ damage, chemo brain, the list goes on, isn’t worth it for most people. But they don’t even realize that until they’re almost gone. Taking a holistic look at the health of the patient and running costa / benefit on quality of life vs treatment are two ways that the uk controls costa really well. As far as I’m aware it’s the same with obese people. There are limits on their reimbursement amounts for certain things and they need to buy extra insurance to cover that (someone from the uk correct me if I’m wrong?)
- kcplate 4y ago
  > I’m not sure why you’re being downvoted, this seems factual. I’ll make a guess at why. Because some folks in the US who want universal healthcare have a misunderstanding of what that actually means to make it affordable. Any comment criticizing or expressing what might be perceived as negative of any aspect of “European style healthcare” (as if that is a singular thing) will get downvoted by these folks. They have a belief that the level of end of life care most folks currently receive in the US will continue. Their 89 year old grandmothers with cancer are still going to get experimental and expensive chemotherapy all the way up to her dying breath. And don’t you dare suggest that she is not!
  - sterlind 4y ago
    why can't the 89-year old grandmother get supplemental insurance that covers the fancy therapies? I don't buy that there's no way to get people state-covered insulin and chemo without consigning everyone to bread lines. just make Medicare universal, and let people buy BCBS or Kaiser etc. on top, to skip the lines or cover more end of life stuff.
    - kcplate 4y ago
      Not saying that she can’t, but I am saying that the expectation of universal healthcare from many of the folks supporting it is that she won’t have to buy supplemental coverage, but will get the same or better care.
    - rayiner 4y ago
      > why can't the 89-year old grandmother get supplemental insurance that covers the fancy therapies? I think they can, but I also think that most people advocating for “Medicare for all” in the US don’t even realize supplemental private health insurance exists in many if not most European systems. Healthcare is a systems engineering problem to explore design trade offs within a solution space. Most people don’t think of it that way.
evgen 4y ago
Sure, and I will say the ugly truth: She might have been better off in hospice (end of life care can be rather grim and there is a reason many older Americans are terrified of the process and results) and society in general would have been better off if she died sooner in hospice care. The European system is much better because it does not hide reality from people who seem to have difficulty grasping the concept that they, and the people they cherish, are eventually going to die. Instead of giving one old lady and additional 18 months of end of life care the Euro system has the ability to make sure that basic health needs of the entire population are actually taken care of, something at which the American system fails completely. An approach based on cost effective treatment is easy to attack using cherry-picked sob stories, but overall it is a far superior system to the 'you only get what you can pay for' American approach.
buffington 4y ago
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.
- rayiner 4y ago
  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...