Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

42 percent of new cancer patients lose their life savings

bigthink.com

Post reply on HN
Print view View original

281–290 of 314 posts

Re: 42 percent of new cancer patients lose their life savings

#281

Post by davvolun »

chimeracoder wrote: post #280
davvolun wrote: post #262

Earlier quoted context omitted.

Yes, but let's say in the U.S. the numbers are 100% survival for the richest 50% and 0% survival for the other 50%. Clearly the average survival rate is 50%. Now let's say the Netherlands has a flat survival rate of 50%. If I don't consider wealth, it doesn't matter which country I get care in. If I'm at 49.999% of wealth in the U.S., the difference is 0% survival vs 50%. We know healthcare quality and healthcare cos…

> Yes, but let's say in the U.S. the numbers are 100% survival for the richest 50% and 0% survival for the other 50%. Clearly the average survival rate is 50%. Now let's say the Netherlands has a flat survival rate of 50%. If I don't consider wealth, it doesn't matter which country I get care in. If I'm at 49.999% of wealth in the U.S., the difference is 0% survival vs 50%. Instead of just making up numbers that coul…

Do any of those numbers refute my point?

Instead of saying "take a look at what's already been linked" either link something that refutes my point or make a clear argument that does so.

The statement was: > To play devil's advocate, looking at 5-year survival rates by country, you'd be 15-20% more likely to survive in the US after you contract cancer than in the Netherlands. YMMV.

I asked "Did you factor wealth into that?" and then backed it up with a hypothetical that shows how it could matter. I see no comments regarding whether the numbers given factor wealth in or if anyone can clearly show it doesn't matter. You want to challenge my claim that quality of healthcare is correlated with ability to pay, fine, but "look it up" isn't an argument.

Re: 42 percent of new cancer patients lose their life savings

#282

Post by mikeash »

SamReidHughes wrote: post #279
mikeash wrote: post #91

Earlier quoted context omitted.

Is there an explicit limit, or is it just implicit based on how many crashes you can possibly get into and get repaired within the policy period?

There are very explicit limits that you select when buying car insurance.

Per incident, though, not total, isn’t it?

Re: 42 percent of new cancer patients lose their life savings

#283

Post by Gibbon1 »

cabaalis wrote: post #212

I am a moderate conservative. I believe in self-reliance, fiscal responsibility, limited government. But receiving a death sentence like this one, physically and financially, is something I believe society could easily work together to create a parachute for. It seems reasonable to me that not all healthcare should be covered by the government. Individuals need skin in the game for their own care. But catastrophic, l…

> . Individuals need skin in the game for their own care.

1996 a friend got lung cancer at 32 she lost everything and died. In 2002 both a friend and I got sick. He's dead, I lost everything but I'm still here.

Seems to me we all had skin in the game. But hell if I know what a 30 year old woman and two men in their early 40's could have done different.

Re: 42 percent of new cancer patients lose their life savings

#284

Post by SamReidHughes »

mikeash wrote: post #282
SamReidHughes wrote: post #279

Earlier quoted context omitted.

There are very explicit limits that you select when buying car insurance.

Per incident, though, not total, isn’t it?

Hmm, you’re right. I always figured the non-minimum limits were per term. This Geico policy document I’m reading specifically states it’s per incident.

Re: 42 percent of new cancer patients lose their life savings

#285

Post by ItsMe000001 »

nostrademons wrote: post #214
ItsMe000001 wrote: post #90

Earlier quoted context omitted.

Just to continue the aside, it actually is perfectly normally distributed, since it is a purely statistical measure. http://michna.com/iq.htm

His rebuttal to the "IQ has fat tails" argument isn't very convincing. He's arguing that IQ should be defined as your percentile rank converted into a numeric score based on a Gaussian of mean 100 and stddev 15, but then goes on to say that yes, the results of most IQ tests will deviate from that Gaussian in the extremes, but that's because the tests are inaccurate, and will have whatever distribution the test-makers…

There also is https://math.stackexchange.com/questions/1311149/why-are-iq-... In particular, the comment by Ron Maimon. https://en.wikipedia.org/wiki/Intelligence_quotient#Current_... has a few relevant things. In "References" see [5], for example.

Re: 42 percent of new cancer patients lose their life savings

#286

Post by DanBC »

refurb wrote: post #231
DanBC wrote: post #210

Earlier quoted context omitted.

> the US has dramatically better survival rates for cancer in the US, No, the US massively over-tests and over-diagnoses cancer at very early stages, but this does not lead to better quality of life nor to longer life.

Overdiagnoses? I thought the US had bad preventative healthcare. Any sources you’d like to share? Sounds like BS.

Over diagnosis is a well known problem in the US.

https://scienceblog.cancerresearchuk.org/2018/03/06/overdiag...

https://academic.oup.com/jnci/article/94/13/981/2519795

Re: 42 percent of new cancer patients lose their life savings

#287

Post by DanBC »

chimeracoder wrote: post #241
DanBC wrote: post #210

Earlier quoted context omitted.

> the US has dramatically better survival rates for cancer in the US, No, the US massively over-tests and over-diagnoses cancer at very early stages, but this does not lead to better quality of life nor to longer life.

> No, the US massively over-tests and over-diagnoses cancer at very early stages, but this does not lead to better quality of life nor to longer life. Prostate cancer is considered one of the most treatable forms of cancer. It's lethal if not treated. But given the proper intervention, a person can live for literally years (if not decades). The treatment isn't fun, but it's very effective, and most people consider it…

Buit this is the point: The US appears to have better 5 year survival rates for prostate cancer because they massively over diagnos cancers thatwould otherwise not kill the patient. Once you've detected these cancers you don't need to provide any treatment at all, your 5 year survival rates increase. But when you do treat all these men you significantly decrease the quality of life for many of them without providing any benefit.

https://academic.oup.com/jnci/article/94/13/981/2519795

> Background: Overdiagnosis of clinically insignificant prostate cancer is considered a major potential drawback of prostate-specific antigen (PSA) screening. Quantitative estimates of the magnitude of this problem are, however, lacking. We estimated rates of prostate cancer overdiagnosis due to PSA testing that are consistent with the observed incidence of prostate cancer in the United States from 1988 through 1998. Overdiagnosis was defined as the detection of prostate cancer through PSA testing that otherwise would not have been diagnosed within the patient's lifetime.

> Methods: We developed a computer simulation model of PSA testing and subsequent prostate cancer diagnosis and death from prostate cancer among a hypothetical cohort of two million men who were 60–84 years old in 1988. Given values for the expected lead time—that is, the time by which the test advanced diagnosis—and the expected incidence of prostate cancer in the absence of PSA testing, the model projected the increase in population incidence of prostate cancer associated with PSA testing. By comparing the model-projected incidence with the observed incidence derived from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry data, we determined the lead times and corresponding overdiagnosis rates that were consistent with the observed data.

> Results: SEER data on prostate cancer incidence from 1988 through 1998 were consistent with overdiagnosis rates of approximately 29% for whites and 44% for blacks among men with prostate cancers detected by PSA screening.

> Conclusions: Among men with prostate cancer that would be detected only at autopsy, these rates correspond to overdiagnosis rates of, at most, 15% in whites and 37% in blacks. The observed trends in prostate cancer incidence are consistent with considerable overdiagnosis among PSA-detected cases. However, the results suggest that the majority of screen-detected cancers diagnosed between 1988 and 1998 would have presented clinically and that only a minority of cases found at autopsy would have been detected by PSA testing.

That's a lot of people being put through unpleasant surgery that has considerable side effects for no benefit.

See also this: https://scienceblog.cancerresearchuk.org/2018/03/06/overdiag...

Re: 42 percent of new cancer patients lose their life savings

#288

Post by DanBC »

chimeracoder wrote: post #240
DanBC wrote: post #203

Earlier quoted context omitted.

> where they determine how "good" a person's life is No they don't. This is not true. > This is not, as you are implying, saying "this treatment is ineffective or harmful, so we won't pay for it". It is literally saying "we understand that this treatment would extend this person's life by 5 years, but it costs £50,000, and based on their condition, we're only willing to spend £25,000 to extend their life by 5 years.…

> No they don't. This is not true. That is literally what QALY is. > Find just one single medication that i) extends life by 5 years ii) costs just £10,000 per year and iii) has been banned. It seems like you don't understand how coverage works for cancer treatment. The question isn't whether the medication is banned outright - it's whether it will be approved to be used for a specific patient in their treatment plan…

> It seems like you don't understand how coverage works for cancer treatment. The question isn't whether the medication is banned outright - it's whether it will be approved to be used for a specific patient in their treatment plan (paid for by the NHS).

Please tell me how you think cancer drug funding works in England, because I'm pretty sure you're wrong.

But let's assume for the moment that you're right: please link to an article about a patient who would have been kept alive for 5 years if they'd been given treatment but they were denied the treatment because it cost more than £50,000.

If anything the UK was spending too much on cancer drugs that provided no benefit - no extension of life, combined with unpleasant side effects that lowered quality of life.

https://www.newscientist.com/article/dn26785-the-uks-cancer-...

https://www.bbc.co.uk/news/health-35494660

Re: 42 percent of new cancer patients lose their life savings

#289

Post by marvin »

refurb wrote: post #205
desertrider12 wrote: post #72

Earlier quoted context omitted.

I agree with low safety net, but an average income is taxed about as heavily as the UK or Germany.

Source? The highest bracket kicks in a much lower salary in the UK and Germany than it does in the US. My income taxes were much lower in the US coming from Canada.

Plus many European countries have _lots_ of taxes that aren't income tax, that don't apply to the US to the same degree. Not sure how this works out for the UK or Germany, but a high-income earner in Norway who uses a lot of their disposable income might pay 75% of their pre-tax salary in taxes and fees. This is in spite of an income tax that is 43% at the top marginal bracket, of which ~8 percentage points is in effect forced pension savings.

Re: 42 percent of new cancer patients lose their life savings

#290

Post by he0001 »

I wonder how the predicted increase in life expectancy would effect this. I’d say the probability of getting cancer increases with age and then also more people will be ruined because of that, poverty in general will increase (if people survive). I believe that those factors will be one of the toughest questions for the future, and countries with no social way of handling this will be effected more than those with it.
Post reply on HN