US doctor forgives $650k in medical bills for cancer patients • Hacker News Board

Re: US doctor forgives $650k in medical bills for cancer patients

#81

Post by varjag » Wed, Jan 06, 2021, 8:35 AM UTC

grey-area wrote: post #49

arcticbull wrote: post #37

Earlier quoted context omitted.

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)

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 o…

Thing is a good public option decimates the market for advanced private care of the level you have in the US.

Here in Norway the private health providers that do exist mostly deal with low-investment, low-asset, high-return cases. They will look into your psoriasis but ain't going to treat your cancer.

Fortunately the advanced care in public system is great. Still it's not unheard for patients that can afford it to go to the USA for specific treatments.

Re: US doctor forgives $650k in medical bills for cancer patients

#82

Post by pg_bot » Wed, Jan 06, 2021, 8:38 AM UTC

atmosx wrote: post #48

A good question would be what can be done to fix healthcare in the US ? My understanding is that most voters don't support universal healthcare. IIRC even Obamacare was labeled as controversial. Current model costs way more, the model is clearly broken, why there is no pressure to fix it? ps. I don't want to get political or anything by mentioning Obamacare. I'm genuinely curious because the problems of the current h…

A lot needs to be fixed. Most of our problems boil down to lack of competition and regulatory capture.

As a regular citizen, I would do the following.

See if your state has certificate of need laws and ask your state representatives to repeal them. If your state has these laws you are likely paying 5% more for medical services with no difference in quality of care.

Look into direct primary care clinics. Oftentimes you can get wholesale prices for labs, procedures, and imaging as a membership benefit of their practice. You can find a lot of clinics that run in the $80-100 range per month per person. (usually cheaper if you have multiple family members) You get more time with your doctor, and the incentive structures in this type of practice are much better aligned than in traditional fee for service clinics.

I would look into reforming the Hatch Waxman Act. Specifically I would require drug manufacturers to give samples of their drugs to the FDA which in turn would give them to generic drug manufacturers who want to enter the market. I would also end the (many) shenanigans that occur when drug patents expire.

Let nurses and doctors easily transfer credentials across state lines. This is often unbelievably burdensome.

Most prices aren't "real" when you get your medical bill. Most of the markups are insane and thus you can negotiate with billing offices to get a more reasonable rate. My general rule of thumb is to start at 10% of the bill and negotiate from there.

Re: US doctor forgives $650k in medical bills for cancer patients

#83

Post by fraggle_sock » Wed, Jan 06, 2021, 8:38 AM UTC

wvenable wrote: post #45

Aerroon wrote: post #20

Earlier quoted context omitted.

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 no…

> 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.

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.

Re: US doctor forgives $650k in medical bills for cancer patients

#84

Post by jjeaff » Wed, Jan 06, 2021, 8:44 AM UTC

arcticbull wrote: post #34

etaioinshrdlu wrote: post #31

Earlier quoted context omitted.

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.

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?

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.

Re: US doctor forgives $650k in medical bills for cancer patients

#85

Post by imtringued » Wed, Jan 06, 2021, 8:45 AM UTC

efwfwef wrote: post #50

pcurve wrote: post #46

Sure this is mostly PR not just for doctor but also for the collection agency. But the outcome was positive. Everyone wins.

What about the people who cannot pay their medical bills? Or who cannot get medical care due to the cost? They're winning too?

Their debt was forgiven after the doctor realized he couldn't squeeze blood from a stone.

Re: US doctor forgives $650k in medical bills for cancer patients

#86

Post by vidarh » Wed, Jan 06, 2021, 8:48 AM UTC

arcticbull wrote: post #72

fraggle_sock wrote: post #63

Earlier quoted context omitted.

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…

Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested. Personally, I agree with you. Private healthcare should be abolished entirely.

In the UK, about 10 percent has private insurance, but nearly all private plans are 'top up' type plans where the assumption is that you usually rely on the NHS first, but ask for a private referral if you need a specialist or procedure there's a wait for.

As a result they're generally pretty cheap.

In effect you're paying to jump queues for a limited resource.

Re: US doctor forgives $650k in medical bills for cancer patients

#87

Post by e_y_ » Wed, Jan 06, 2021, 8:48 AM UTC

amitport wrote: post #24

Why is this an article? People and organizations (even banks) and governments erase debt all the time. Sometimes it's from kindness, sometimes for PR, usually because they're unable to collect it. You can't really tell the difference among the cases.

John Oliver's Last Week Tonight bought and forgave $15M of medical debt for $60k (probably deemed uncollectible) as part of a segment about the debt collection industry. And because on paper it was a bigger giveaway than Oprah's "Everybody gets a car" giveaway.

Re: US doctor forgives $650k in medical bills for cancer patients

#88

Post by fraggle_sock » Wed, Jan 06, 2021, 8:49 AM UTC

arcticbull wrote: post #72

fraggle_sock wrote: post #63

Earlier quoted context omitted.

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…

Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested. Personally, I agree with you. Private healthcare should be abolished entirely.

Thank you for the information - it is interesting to learn of a case where discouragement and disincentivisation, in lieu of abolishment, has turned out to be a reasonable and pragmatic secondary option.

Re: US doctor forgives $650k in medical bills for cancer patients

#89

Post by nobrains » Wed, Jan 06, 2021, 8:49 AM UTC

ryzvonusef wrote: post #59

nobrains wrote: post #52

Sorry, if this is another angle, but I would have been more happy if instead of mentioning US doctor (or in addition to mentioning it), they would have mentioned his traits viz. "muslim" and "pakistani-origin". (I am happy none the less) Muslims are currently vilified, and Pakistani isn't in the best books right now. So, a little nod to someone who did good being muslim and pakistani-origin goes a long way to neutral…

OBL was found in Abbottabad /minor_nitpick

You are right. Corrected. Thanks.

Re: US doctor forgives $650k in medical bills for cancer patients

#90

Post by beagle3 » Wed, Jan 06, 2021, 8:52 AM UTC

arcticbull wrote: post #74

onion2k wrote: post #70

Earlier quoted context omitted.

In a single payer system there's nowhere else to go. We have private health care in the UK in addition to the national health service (eg https://www.bupa.co.uk/ ). It's insurance-based, and it pays for treatment in hospitals both inside and outside of the NHS. It's even offered as a perk by some employers. Specifically relevant to this HN story, there's access to cancer treatments before they're approved by the NHS…

I wasn't commenting on the NHS there, I was making my comments with reference to the Canadian system. I retracted my comment because I made it overly board. If you'd like to learn more about the legality of private cover within the Canadian system you can do so here. [1] In Canada, while in general private cover is not illegal, for covered health services, it roughly speaking does not exist and my statement that you…

> In Canada, while in general private cover is not illegal, for covered health services, it roughly speaking does not exist and my statement that you "have nowhere else to go" holds.

The key is “covered health services”. E.g. a friend who broke his arm in Israel (which has an NHS like medical system) needed to have it cast; a standard plaster cast was covered, but for an extra $150 or so, he was able to pay and get a super-lightweight composite cast material (which he had to buy at a pharmacy down the road himself, but the doctors at the public hospital happily applied).

This was about 20 years ago - I suspect the ultra lightweight cast is covered by now as well - but there will always be treatments which may make sense for an individual to pay for, but not for the system.

Similarly to the NHS, more money doesn’t buy you better care within the system in Israel; but there is a complementary private system which occasionally can get you better care (and can often get you the same non urgent care faster). The general rule for coverage inclusion in the Israeli system is: if it’s life saving, it is covered. If it’s life extending or quality improving, then a QALYs analysis and budget constraints set the priorities (most proven reasonable cost treatment are indeed covered)