9 ms·

I lost my sister to cancer 9 years ago when she was in her early 20s and I was in my teens. Her experience with the medical system was humiliating, futile, and

• guylhem 14y ago
  > "it is also imporant for us as a people to let go when nothing can be done, not to make things worse out of a need to be seen doing something" In the case of cancer, universal care unfortunately seems like running in the opposite direction. Sometimes admitting that nothing can be done is the right thing. Look at the case description - I wouldn't be surprised if the total bill was at least between 100k and 200k - for 20 days of useless care which ultimately resulted in the patient death. There are some good economical analysis showing yearly cost that'll make you cry, especially if you consider the alternative uses of that money and how many lives could be saved - say in other countries. With our current technology, universal healthcare for fighting cancer seems like trying to stop a fire with gasoline.
  • niels_olson 14y ago
    > universal healthcare for fighting cancer seems like trying to stop a fire with gasoline Tell that to the unemployed dad whom, twenty minutes ago, I directed to take his son to the ENT. He has had a swollen left tonsil for 5 years (last time he saw his pediatrician). Now he presents with 1 day of left ear pain. There's a mass hanging off his ear drum. Cholesteatoma? Unlikely. Maybe bullous myringitis. But at this point this kid's whole left pharynx is suspect and 5 years of infection starts one thinking about scary things.
    • lostlogin 14y ago
      I don't get what is being discussed here. How is universal healthcare like fuel to a fire where cancer is concerned? I live in a country with universal care, so my perceptions will obviously differ to others, but I'm totally not getting what is being discussed.
      • niels_olson 14y ago
        The topic of universal health care is actively debated in the US. Some people have adopted a position that universal health care is less ideal than our current fee-for-service model. As they explore the merits of their position, they try adopting various arguments. He tried adopting the argument that universal healthcare leads to more access to care, which leads to more interventions between diagnosis and death for people with cancer. However, and perhaps our responses help persuade him of this, that argument ignores the vast middle ground of people who survive several years or even are effectively cured for life. It also, as my prior comment pointed out, ignores the value of routine screening, especially at the extremes of age.
      • glenra 14y ago
        A big part of the problem in the original article is that of TOO MUCH CARE being provided regardless of cost without much consideration for whether the care is worth providing. One plausible concern about adopting "universal care" in the US is that it will make a bad situation worse, even further insulating patients from the cost of the care provided to them and thus making it more likely that we waste effort on extremely expensive procedures that don't do any good. Now, certainly one might IMAGINE putting rules in place such that this didn't happen, but that doesn't mean such rules will get put in place or will actually work as intended given our generally messed-up political process.
        • pyre 14y ago
          > Now, certainly one might IMAGINE putting rules in > place such that this didn't happen, but that doesn't > mean such rules will get put in place or will > actually work as intended given our generally > messed-up political process. Isn't the assumption that universal health care will have no rules just as based in speculation as the idea that it will? 'Universal health care' is a pretty broad term. Most discussions that aren't about particular implementations are meaningless.
  • lubos 14y ago
    Universal care is not running in the opposite direction. I live in a country with universal healthcare. I have several relatives who were diagnosed with terminal cancer. In this case, the hospital simply told them, the cancer is terminal and they've been given doses of morphine until they passed away. In USA, hospitals are facing conflict of interest. On one hand, they shouldn't be providing unnecessary expensive care but then they wouldn't be making as much money. No hospital should be ever put in this position. Honestly, I'm shocked at how many people in US are against universal health care.
    • Jach 14y ago
      I'd be nice if in addition to offering morphine they would also offer a basic cryonics plan...
      • jtheory 14y ago
        Heh... "basic" like "head only", or "6 months only"?
        • Jach 14y ago
          I'm not sure what you find funny about "we'll suspend you, but only for six months." "Basic plan" typically means "cheapest plan with a certain minimum quality of care", which is the only kind of plan that has a chance at full or partial subsidization; whether that's head-only or not depends on what the market costs for the procedure would look like if people started taking death seriously.
    • crusso 14y ago
      How does this: > I have several relatives who were diagnosed with terminal cancer. In this case, > the hospital simply told them, the cancer is terminal and they've been given > doses of morphine until they passed away. Go with this? > Honestly, I'm shocked at how many people in US are against universal health care. You can ask for palliative care from US doctors any time you like. You tell them you don't want to be treated and they'll send you home to die. Morphine prescriptions at that point aren't tough to obtain. The shocking thing to me is that anyone would want universal health care that leaves them with palliative care as their only option. If I'm diagnosed with cancer that may be terminal, I might choose to go out in a blaze of money desperately looking for a cure... or I might choose to give up and die quietly. It should be my choice, though. When you look beyond the political demagoguery for obvious power grab reasons, you see that the US healthcare system produces just about the best results in the world: http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-americans-poor-life-expectancy/ http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-amer... I'm shocked at how quickly people would give away their Freedoms for the illusion of being cared for.
  • potatolicious 14y ago
    This is less of a problem when he patient has been paying into the system his/her entire life, the premiums of which are not subject to profit margins or administrative inefficiencies (as much), and medical care costs less than half of what it does in the USA. End of life care is surprisingly affordable when the above conditions are met.
    • crusso 14y ago
      > This is less of a problem when he patient has been paying into the system his/her entire life, That argument ignores the opportunity cost of doing other things with the citizen's money, obfuscates the actual lifetime cost of healthcare, and is just an inherently Liberty-reducing due to a lack of opt-out. > the premiums of which are not subject to profit margins or administrative inefficiencies Which large long-term government programs can we refer to that are efficient? I'd be really surprised if you could name even one of significance.
      • infinite8s 14y ago
        Medicare has lower administrative costs than most health insurance providers.
        • crusso 14y ago
          ... with significantly reduced treatment options for patients and an ever-dwindling number of doctors who will work with Medicare-insured patients. It's fine for what it is, but I don't want it to be the only game in town. Given that the whole "If you like the insurance you have now, you can keep it." turned out to be a lie, healthcare reform in the US needs some rollback and rework.
  • gnu8 14y ago
    > useless care which ultimately resulted in the patient death. Don't state it as if the hospital care caused the death, it was the cancer. This was a worst case scenario. In many cases that care could have bought the patient months or years to live, which most would agree is worth $100k to $200k when facing death.
    • guylhem 14y ago
      I remember about an Australian medical economics study from approx 2 years ago which specifically removed "easy" to treat cancer (skin cancer + some leukemias) then tried to compute the average cost and average survival compared to abstention for all remaining cancers. IIRC, it was about $1 million per person for at best 1 year saved on average. Is $1 million when facing death still worth it, for less than 1 more year? If it's your money and you've got plenty - or if it's someone else money, I am sure it is. I'm sorry I can't find it back - only some midly interesting investigations on the subject like http://www.mnwelldir.org/docs/fraud/able.htm http://www.mnwelldir.org/docs/fraud/able.htm If someone can find it back, I'd be really interested.
      • DanBC 14y ago
        Are those AUD or USD dollars? Here's one about women with ovarian cancer (http://www.ncbi.nlm.nih.gov/pubmed/20973265 http://www.ncbi.nlm.nih.gov/pubmed/20973265) Here's one about the cost effectiveness of skin cancer prevention (http://heapro.oxfordjournals.org/content/14/1/73.full http://heapro.oxfordjournals.org/content/14/1/73.full) Here's one about skin cancer prevention using sun screen for white populations in sunny locations (http://www.ncbi.nlm.nih.gov/pubmed/22433757 http://www.ncbi.nlm.nih.gov/pubmed/22433757) Here's one about the skin care costs of skin cancer caused by UV (http://www.rand.org/pubs/notes/N2538.html http://www.rand.org/pubs/notes/N2538.html) Some of these look interesting, but obviously I haven't had a thorough read yet.
        • guylhem 14y ago
          These are separate studies about specific cancers, and interesting. But the biggest point in the study I remember reading was that it mixed up all the "not easy to treat [1]" cancers together, pondering each cost and survival time with the cancer incidence. It gave a better picture of the "less known" cancers - which is addressing the real question with universal healthcare. I mean, if overall the expansive cancer or deadly cancers are rare they we can afford them - but they weren't, and overall outside specific case, even if one tried the best healthcare, it was not a very efficient outcome. I'll love to find it back - that or a study sharing the methodology. IIRC it was in USD. [1] : by easy to treat I mean cancer which is very unlikely to reoccur if properly treated, for which one or more therapies are known to be effective, with costs and morbidity well known - like skin cancer.
  • Devilboy 14y ago
    Just so we are clear: You're against universal health care?
    • guylhem 14y ago
      In a best case scenario, with educated and understanding people, no political interference, even with our limited technology, it would be a good thing and I'd favor it - especially for diseases which are cheap and easy to treat if caught early. In the real world we live it, it will be bringing our economies on their knees. It's a bad idea. Generally, I am biased against bad ideas.
      • purplelobster 14y ago
        Real world data show the opposite of what you're saying. The US spends more on health care than other developed countries with universal healthcare. You must know that, so what point are you trying to make here?
        • guylhem 14y ago
          I know that. In the US, a market economy applied to healthcare limits the demand. Yet a lot of money gets spent uselessly in healthcare- and this happens even in government run programs. People want more of everything, but there are physical limits about what is possible. Even if each person get less per dollar than in other countries, for some reason I don't fully understand there is a high demand of healthcare, and also more distrust of an expert run system (like QALY evaluation in the UK) It's not just an inelastic demand - it is more like a weird moral hazard scenario, or as if healthcare had increasing marginal returns for people utility function. In this situation, replacing the market system by a government program might cost less in the short run - I fully agree - but much much more in the long run if demand is liberated. That's because healthcare is not just like any usual good where you have reducing marginal returns, and it will be made worse especially after it has been "shown" that the endless money supply of the government can provide healthcare to anyone! ("shown" not as a valid proof, but as "noticed" by people who can cast a vote) In the long run, I believe it will end up costing much more by this self perpetrating demand, up to the point it actually damages the economy. A dollar spent on healthcare is not "productive" - healthcare is an investment with a negative interest rate. You can only put more money to try to keep your capital - but in the end you still die (maybe that's the reason for the increasing marginal returns - you need more and more of it). It's bad enough when a country make debts not for investment but for consumption, yet it's much worse to make debts to "invest" in something like healthcare - with a negative interest rate European countries are in for a bad day when they won't be able to patch the system anymore. In France IIRC the social deficit was around 100 billions in 2008 - much more than the government budget - with a 10 billions deficit just for healthcare. Now it's 160 billions in 2012 - http://online.wsj.com/article/BT-CO-20121001-707300.html http://online.wsj.com/article/BT-CO-20121001-707300.html] Almost doubling in 5 years - let's round that to 60 billions per 4 years for a country of 60 millions persons. Let's make some quick calculations. Do you have any reason to think than, in a country with 5 times more people, and spending 16% of its GDP on healthcare instead of 9% in France (not sure about the precise %, but it's around 33% more), all others things being equal it won't create at least a 6051.33 ~ 400 billions deficit in 4 years? (and that's a baseline scenario with an identical efficiency - with the highest cost of healthcare in the US, which can't be slashed in a day, I'd expect something at least like a 1000 trillion/5 years - and that won't be a stimulus, except for increasing demand)
  • petercooper 14y ago
    Look at the case description - I wouldn't be surprised if the total bill was at least between 100k and 200k - for 20 days of useless care which ultimately resulted in the patient death. This is exactly why universal health care is a good idea. For each person gaining little from expensive care, there are many who can be saved or get a better quality of life from cheap and relatively minor medical services they otherwise may not feel able or comfortable to pay for. If you put all of those experiences into one huge melting pot and manage it properly, you get a positive net outcome, as demonstrated by numerous countries.
    • glenra 14y ago
      The fact that something might work in "numerous other countries" is of limited utility in determining whether it would work in the US. Consider: If your kid is a bad student, pointing out that the neighbor's kids down the street are excellent students doesn't really help your kid pass math. Telling Microsoft or GM it should just "be more like Apple" doesn't mean they could succeed following Apple's strategies. The US system has been very different from these other counties for quite a long time. We have different values, different skills, a different history, a different political process. It's quite possible that you simply can't get there from here. The transplant surgery necessary to put a european welfare system into an otherwise-American sociopolitical system could kill the patient. America is just NOT LIKE a tiny european country, and the ways IN WHICH they are different are relevant to what is politically and practically possible.
      • pyre 14y ago
        The US system already have 'universal health care'-ish systems. Medicaid and the VA health system. Both different models (government as insurer and government as hospital owner).
      • dripton 14y ago
        I think the country most similar to the US is probably Canada. Canada has both significantly cheaper medical care (US$4360/person/year vs. $7960/person/year) and significantly higher life expectancy (80.7 vs. 78.2) than the US. Another candidate would be Australia. Life expectancy 81.81 years, medical cost $3445/person/year. Or maybe the UK. Life expectancy 80.05 years, medical cost $3487/person/year. I think we can get there from here. We've had Medicare for over 40 years. It's just a matter of slowly lowering the eligibility age until everyone is covered. Of course it's not politically easy -- the healthcare industry makes a ton of money and owns a lot of politicians -- but it's possible.
  • sethg 14y ago
    A lot of the discussion in this thread seems to be along the lines of “if universal care is instituted in the US, then it will be ruinously expensive, because doctors will authorize every kind of treatment and the taxpayers will pick up the bill” vs. “no, because when this is done in other countries, the agency that finances health care sets standards for what procedures and drugs they will cover under what circumstances”. I would like to point out that whether or not universal health care is brought to the US (it’s scheduled to kick in under Obamacare, but if the Republicans win they can effectively kill it), the fee-for-service model of paying doctors will have to go away, because right now that model is one of the things running up the cost of private health insurance here. The insurance companies, faced with rising costs, can either impose more restrictive rules about what they will or will not cover, or they can hike their premiums. In the former case, they’re doing the same thing that a government agency would do, except that people generally change insurers when they change jobs... meaning that any care that costs money up front but would prevent problems five or ten years down the line is not worth spending money on, because some other insurance company would be picking up the savings. In the latter case, middle- and upper-class families see more of their paycheck going to insurance, while people who can’t afford the premiums but aren’t poor enough for Medicaid just go without insurance, depend on the emergency room if they really really need something, and risk getting bankrupted by medical bills if a serious condition does appear. (Which is why Obamacare was passed in the first place.)
• tsotha 14y ago
  >...it is also imporant for us as a people to let go when nothing can be done, not to make things worse out of a need to be seen doing something. The problem is you don't know for sure when nothing can be done. A coworker's sister was diagnosed with lung cancer and told the prognosis was grim. Three months, maybe. She considered a palliative treatment only approach, but in the end decided a tiny chance was better than no chance. The cancer responded well to chemotherapy. Before it relapsed a drug was approved for this particular type of cancer (based on a DNA test). After six years she's still alive and in apparent good health. Sometimes you get lucky, and the medical interventions do help. Now, the case in the article may be different in the sense that it was clear there was no hope from the very beginning. But that's not normal with cancer.
  • javajosh 14y ago
    Yes, there are cases like this. But consider: what are the odds of misdiagnosis? Is that higher or lower than spontaneous remission? Is that higher or lower than a response to chemotherapy? I have a sneaking suspicion that the "miracle" recoveries from cancer are simply misdiagnoses. Cancer is often a diagnosis of elimination. This is very easy to get wrong. Lesions are the tell-tale, but it is only inference that links them together. Millions of people have benign lesions that have naught to do with cancer. And these stories are dangerous to the vast majority of (accurately diagnosed) cancer patients who have metastasized and are looking for miracles. This "slim ray of hope" takes away from them whatever slim shred of hope they had to make peace with death. And making peace with death is a huge quality of life issue for both the patient and their family, an issue which has been almost entirely ignored.
    • scott_s 14y ago
      The above is not a "miracle" recovery. She was treated medically, and responded well. Don't confuse that with people who go into remission without treatment. I agree with you that there is a point at which individuals and families have to consider the balance between invasive treatment with small chance of success against accepting death and having a better quality of life during those months. But for most people, as long as those chances are even in the single digits, they're going to try for the treatment.
• stcredzero 14y ago
  > Her experience with the medical system was humiliating, futile, and expensive. My girlfriend, her father, my sister, and various friends of mine have had such experiences. (Not to say all of the above have died. Just have had Kafka-esque experiences with the US medical system.) There is something about our system that elicits cold authoritarianism in the manner of caregivers. Our system does not incent caregivers to look out for the patient's best interests and the uncanny facsimile of the patient's best interests which is their target (avoiding lawsuits, maximizing profits, shutting down and ensuring obedience of relatives) leaves much to be desired.
• dionidium 14y ago
  When it is my time to die I intend to fully engage with the experience of dying, and not to numb the experience with knife wounds, drugs, and over-stimulating hospitals. This strikes me as fairly useless talk. You'll find out how you'll handle the dying process whenever you're actually faced with it.
  • jtheory 14y ago
    It's certainly true that "I intend to" (in the GP comment) can't be the same as "I will". I strongly disagree that it's useless talk, though. If you haven't put any thought into the possible ways to respond to life and death decisions, when you find yourself facing them -- quite possible in pain, short on sleep, and flooded with anxiety and emotion -- it's not a good bet you'll be able to make the best choices then.
    • dionidium 14y ago
      That's fair, more or less. My argument is that it's very difficult to predict how you'll act when you're "in pain, short on sleep, and flooded with anxiety and emotion." Even if you've thought a lot about what you intend to do in advance.
      • jtheory 14y ago
        I've had two personal experiences of making stressful life/death decisions after several physically taxing days with no sleep. Not end of life decisions -- and my own life wasn't on the line -- so it's not the same thing, but my personal experience was that the earlier research and prep I had done was like a ray of clear light in my otherwise clouded mind. I realize this is less persuasive given the lack of detail, but these are not really my stories to tell.
        • dionidium 14y ago
          We're in the realm of anecdotes now, so let me just add that I wouldn't want my last fully conscious decision -- asking for the morphine drip that might make the final few days of my life tolerable -- marred by the feeling that my resolve had suddenly failed. I think I want to remain open to the idea of a pain-reduced death at least until I know for sure how intense that pain is going to be. (And this just focuses on the pain aspect. Similar arguments could be made against limiting last-minute surgical options, as well.)