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

bbc.com

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

#121

Post by lotsofpulp »

hippich wrote: post #102
Chris2048 wrote: post #58

Earlier quoted context omitted.

> the deeply flawed idea that healthcare should be a "marketplace" It should be a marketplace. instead, it's a racket.

And an insurance should be, well, an insurance. What is referred as "health insurance" is more like "health care plans" (insurers even call it "plans"). Just consider how comprehensive auto insurance is different from health insurance in practice.

Overall health is not insurable. It’s a misnomer.

There is a 100% chance of everyone needing healthcare in the future. US health insurance does a few things:

1) premiums partially serve as a tax to transfer wealth from young and healthy to old an sick

2) insurers healthcare recipient from the big costs (over out of pocket maximum - $7k to $13k per year), subject to in network providers

3) Negotiates pricing and determine appropriate level of healthcare, I.e. acts as informed agent for uninformed buyers

The last one is controversial, but it’s funny since people complain about high insurance premiums and then also complain about insurance companies denying what might be frivolous charges by healthcare providers.

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

#122

Post by lotsofpulp »

29athrowaway wrote: post #120

This episode of "Adam ruins everything" covers healthcare insurance providers: https://www.youtube.com/watch?v=CeDOQpfaUc8 My takeaway is that the system is calibrated to aggresively punish people without insurance.

The system was calibrated to create as much friction to receiving healthcare if you are poorer (usually meant you didn’t have insurance pre ACA). Medicaid is the “insurance” for poor people, which pays healthcare providers on the low end and a as a result is not accepted as much.

The more friction that it creates for poorer people, the less healthcare they will use, and that helps keep taxes low.

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

#123

Post by arcticbull »

refurb wrote: post #109
arcticbull wrote: post #96

Earlier quoted context omitted.

That's a funky one, and I'll be the first to say that America does have some very good cancer treatment clinics if you don't mind bankruptcy (although the same is true if you break your leg). Part of that has to do with how cancer survival rates are measured and what role screening has in the various systems. This came up with Giuliani a while ago and is well described here [1]. tldr: The statistics are quite mislead…

Here is a good example as to why you might want to go to the US for cancer care. "It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication." https://www.cbc.ca/news/canada/british-columbia/a-tale-of-2-...

That's one people out of 36 million, making national news. You'll trip over a stack of them on your way to the news stand in the US. "I'm looking at having to sell my house for coverage of my medication" is practically America's national anthem.

Failures happen from time to time but they are the exception and not the norm. Numbers available here: [1] for the most part Canadians getting medical care in the US are "snowbirds" who live in Florida or California for half the year. This is utterly logical as Canadians don't usually have $100,000 to pay for a new hip.

If you dig into that specific situation, the issue was that Health Canada only gave conditional approval for Ibrance in early 2016. Broader approval was granted in mid/late 2017. This article was written in January of 2018 - between when Health Canada had approved Ibrance and when the British Columbia Ministry of Health had added it to it's list of covered drugs. That happened just 3 months after the article was published, in April of 2018.

This particular lady chose to travel to the US to obtain a drug that was not approved for sale in Canada at the time. That has since changed.

I don't think it's fair to indict the health system over this especially when not all health Canada approved drugs are fda approved and vv.

[1] https://www.vox.com/2016/10/9/13222798/canadians-seeking-med...

[2] https://www.pfizer.ca/pfizer-receives-expanded-health-canada...

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

#124

Post by simonh »

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…

In fact a single payer system alongside private insurance works really well to keep the private insurance providers honest. Up against a single payer one of their primary value add for most people isn't even better health care per se but better customer service, faster appointments, clear and helpful advice, etc. This is a good deal for the NHS as well because they still get your tax contributions but the private system takes some of the load off them.

In theory I'm mostly a Friedmanite. I think he has good reasons for preferring private enterprise for most thing. In theory private enterprise should be able to provide better health care than a public system as well. The problem is politics, lobbying and market distortions always introduce complications and obstacles. Health care is one of those markets where the resources and incentives on the provider side just overwhelm the ability for private individuals to get a fair deal.

I'm very glad we have the NHS over here, yes it has inefficiencies and weaknesses but compared to the horror show in the US I think it's far preferable.

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

#125

Post by yladiz »

ant6n wrote: post #107
rangibaby wrote: post #55

Earlier quoted context omitted.

In rich countries outside of the US it’s called “the government”

Other countries are slipping, though. For example, Germany does not actually have a single-payer system, but instead a "system" of public and private health insurance companies. As an employee you`re usually in the public system, which can be more expensive for higher-earners because the fees are based on your income (although the health taxes are regressive, capped above like 65K income per year). Self-employed peop…

Please. Let’s not turn this into whataboutery. This isn’t about other countries doing things poorly, and more specifically Germany was not named by the parent commenter. This is about the US doing things significantly worse than basically any other developed country. I live in Germany, and know that the German healthcare system is not perfect, but I also know, as an American, that it is significantly better by essentially any metric than the US, and it’s unfair to pretend otherwise. I’m glad I don’t live in a society anymore in which I have to worry about taking an ambulance for an emergency because I can’t afford the fucking $500 price.

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

#126

Post by lotsofpulp »

alphabettsy wrote: post #28
shakezula wrote: post #13

Earlier quoted context omitted.

And even if you can contest the denial, it can take days to months to get it back, meanwhile you’re shouldered with the burden of paying full price for your treatment with the _hope_ that they’ll reimburse you later. My fiancée has cancer, and we regularly joke that dealing with insurance companies is worse than the actual stage 3 cancer she has. They constantly deny her coverage for medications she’s been on for yea…

It’s intentional. They save billions using this practice because some people don’t have the time, knowledge or resources to dispute.

It’s not intentional. Insurance companies are better labeled “managed care organizations” (MCO).

They offer services for adjudicating services and prices for self insured and non self insured clients.

Self insured clients would be governments (Medicaid, Medicare, large corporations that can afford to pay for all of the healthcare). Non self insured are clients like smaller companies and people on healthcare.gov that pay insurance premiums, but are not liable for the entire amount of healthcare.

In the event the MCO is administered a self funded plan, they are simply following rules laid out by the payer. The payer (usually government) can come in and audit the MCO anytime and penalize them for approving healthcare that the payer deemed outside the scope of the rules. This works out quite well for the payer, as the MCO serves as the fall guy and takes the heat of being a “bad actor” and denying people healthcare.

The reality is that healthcare in the US is rationed, and MCOs are tasked with rationing it. The government gets to avoid being blamed for denying care.

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

#127

Post by roenxi »

shakezula wrote: post #13
Areading314 wrote: post #11

One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. It is unrealistic in practice for a patient to know or understand the process by which claims are made (since they are made by an error prone and disinterested provider administrator, and are made in a non-transparent and highly complex way), and also…

And even if you can contest the denial, it can take days to months to get it back, meanwhile you’re shouldered with the burden of paying full price for your treatment with the _hope_ that they’ll reimburse you later. My fiancée has cancer, and we regularly joke that dealing with insurance companies is worse than the actual stage 3 cancer she has. They constantly deny her coverage for medications she’s been on for yea…

> Medical care should never be tied to personal wealth, period.

There is literally no limit to how much effort society can put into one person's healthcare. In the absurd extreme, we could reshape society into doctors, farmers and medical manufacturers in a mad quest for best possible medical care.

At some point we have to ration healthcare and decide when to put more resources towards something else. If not personal wealth, what do you want to use for the rationing process? Age? A lottery?

Unless there is some really amazing alternative, money is one of the best proxies available for for contribution to society. A bunch of edge cases exist, but they are edge cases. It is a fair way of rationing healthcare.

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

#128

Post by globular-toast »

fraggle_sock wrote: post #42

The only real thing this story presents is a reminder of how fucked up the US healthcare system is. It's barbaric, backwards and uncivil that medical debt even exists. The US government really needs to get over its slavish devotion to capitalism and implement a single-payer healthcare system that is free at the point of use for all. The hundreds of billions of dollars they dish out each year on killing people would b…

Capitalism is great where choice exists. Capitalism means each individual can choose how to allocate his resources based on the market at the time. I might decide, for example, that owning a car is currently too expensive and I'd rather shift that allocation towards owning a house. It's my choice.

Healthcare is not a choice. Nobody who discovers they are critically ill examines the market and decides it is not worth allocating resources to it. Once you're ill, you're all in. No choice. The only thing that makes capitalism good is gone. But everything that makes it bad is still there.

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

#130

Post by trungdq88 »

shakezula wrote: post #13
Areading314 wrote: post #11

One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. It is unrealistic in practice for a patient to know or understand the process by which claims are made (since they are made by an error prone and disinterested provider administrator, and are made in a non-transparent and highly complex way), and also…

And even if you can contest the denial, it can take days to months to get it back, meanwhile you’re shouldered with the burden of paying full price for your treatment with the _hope_ that they’ll reimburse you later. My fiancée has cancer, and we regularly joke that dealing with insurance companies is worse than the actual stage 3 cancer she has. They constantly deny her coverage for medications she’s been on for yea…

my god, that sounds horrible
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