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

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

#251

Post by TrackerFF » Wed, Jan 06, 2021, 2:56 PM 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…

US healthcare culture is very different from that of many countries with "free" universal healthcare.

In many such countries, there's no such thing as a yearly / annual checkup. People go to the doctor when they feel sick - or if they actually get checkups, it's in the light of some illness like cancer.

Usually, there's nor any "full" check, meaning that doctors will run every test known to man on you, just to be sure. Tests are done in a holistic way, as they start getting an idea of what's wrong with you.

And unless you have something really pressing, you won't get an appointment (or even treatment) STRAIGHT AWAY.

I guess my point is that a lot of Americans would probably feel that they were receiving vastly inferior treatment, but maybe they're used to getting overtreatment?

In any case - doing all that extra stuff adds up.

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

#252

Post by kritiko » Wed, Jan 06, 2021, 2:56 PM UTC

varjag wrote: post #81

grey-area wrote: post #49

Earlier quoted context omitted.

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 g…

https://www.aleris.no/en/cancer-center/cancer/

"Aleris’s Cancer Centre (Aleris Kreftsenter) provides a complete range of diagnostic tests and therapies for most types of cancer.

We offer the latest cancer drugs and innovative treatments, such as immunotherapy, before they are available in public hospitals."

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

#253

Post by splaytreemap » Wed, Jan 06, 2021, 2:57 PM 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.

Because it serves as a jumping off point for people of a certain political persuasion to agitate for political change.

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

#254

Post by denisastoyanov » Wed, Jan 06, 2021, 2:58 PM 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…

Well the first step would be to ban the so called lobbying. Idk in other countries we just call it corruption. In US that seems to be legalized.

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

#255

Post by salawat » Wed, Jan 06, 2021, 2:59 PM UTC

lotsofpulp wrote: post #179

kmos17 wrote: post #173

Earlier quoted context omitted.

Where is your data to backup this claim? Maybe you are right that claims are approved most of the time but in my experience the problem with our health care system is not just denial of claims, but about the cost of medical services and medicine. In my anecdotal experience I have had insurance deny claims on medicine prescribed by my doctors frequently, in one case they would not cover a medicine costing $50 over the…

> Where is your data to backup this claim? I’m claiming that insurers do not erroneously deny claims in the hopes that people give up. I don’t have data for it, but I’ve also never seen data that shows insurers deny coverage just to dissuade people (post ACA). > experience the problem with our health care system is not just denial of claims, but about the cost of medical services and medicine. Yes, I agree here about…

I have some exposure to the claim adjudication space, and I can say that there are undeniably people who see it as a fiduciary duty to make people jump through hoops before paying out a claim. This is a large part of why so many prior authorization proccesses suck royally.

However, w.r.t. long term medications getting denied, keep in mind that every claim starts denied until a path through to an approval can be traversed. This is a fundamental starting pount for any insurance related system. It is fundamentally a filter.

You as the customer do not have readily available access to many of the clinical programs going on in the background. Opting in and out by a plan sponsor can substantially change the footprint or character of approvable claims. Especially if paired with formulary changes.

If you happen to be on any type of high cost or specialty treatment, you're on course to misery-town, because you just popped up on the radar for entire divisions worth of second guessing justified by fiduciary duty, but often implemented in ways that leaves the patient both helpless to know what is going on, and holding the bag.

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

#256

Post by valenterry » Wed, Jan 06, 2021, 3:03 PM UTC

lotsofpulp wrote: post #224

valenterry wrote: post #212

Earlier quoted context omitted.

> There is a 100% chance of everyone needing healthcare in the future. 1) that's not true. One can die in an accident and not cause an future healthcare costs. 2) health care costs are of course insurable, why not? Just because everyone will create costs with a high chance does not mean that everyone will always create the same costs. The insurance is there for when you have some illness that causes more costs than y…

I didn't feel like writing 99.9999% chance at the time, so I rounded up to 100%. It's not insurable in the sense that at some point, the losses are so large and so frequent, that the insurer needs to collect premiums from almost everyone in order to cover the costs. At that point, the premiums start to resemble a tax. I actually do consider the premiums a tax for the following reasons: 1) there is a mandate to purcha…

> It's not insurable in the sense that at some point, the losses are so large and so frequent, that the insurer needs to collect premiums from almost everyone in order to cover the costs. I actually do consider the premiums a tax for the following reasons

Could it be that you limit your perspective onto only the US at the current point in time? Otherwise what you say just doesn't make any sense and your points can't be generalized. And even in the US, health insurance is not mandatory (as you say yourself), hence I would still not call it a tax.

> No private insurer would touch this market since the losses are so high, so the government created the National Flood Insurance Program, which is the federal taxpayers taking on the liability for flood damage for those homes.

Yeah, so if you don't talk about flooding being insurable in general but that there just isn't any company that is doing it for Florida then I agree. And to be honest, I think it's not good that the taxpayers are paying here. The nice thing about insurance is that it gives incentives, such as "don't live somewhere if you can't afford the dangers at this place".

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

#257

Post by stronglikedan » Wed, Jan 06, 2021, 3:11 PM 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…

> My understanding is that most voters don't support universal healthcare.

They don't support the version of universal healthcare that's usually proposed, but give them a way to make their own choices to keep them out of a Charlie Gard (a.k.a. "Death Panel") situation, even if it means having to pay extra, then there would be much more support.

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

#258

Post by stickyricky » Wed, Jan 06, 2021, 3:17 PM UTC

dfxm12 wrote: post #250

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…

My understanding is that most voters don't support universal healthcare. Most Americans think it is the government's responsibility to ensure all Americans have healthcare coverage [0]. Also, it seems like you're talking about Obamacare as if it is universal healthcare. It's not. why there is no pressure to fix it? There is pressure. We're not even weeks removed from the "Force the Vote" campaign for Medicare for all…

> Overall, this is just another way where most politicians (in this case, Republicans and moderate Democrats) are representing their lobbyists more than their constituents.

I would be careful with this interpretation. Universal healthcare has broad support but when phrased in the context of specifics or in the context of what has to be given up to achieve it the percentage of people supporting it declines.

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

#259

Post by DavidPeiffer » Wed, Jan 06, 2021, 3:22 PM UTC

pg_bot wrote: post #82

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 yo…

I just learned about Direct Primary Care a few weeks ago from the White Coat Investor podcast [1].

The doctor interviewed does a direct pass-through on lab expenses. MRI's get done for hundreds (not thousands or tens of thousands) of dollars, basic blood work costs single dollars (and I think one common test was under $1). It's a whole different world of medical care in which your medical insurance becomes more like every other insurance product out there - only used for significant events not the mundane day-to-day stuff.

[1] https://www.whitecoatinvestor.com/what-is-direct-primary-car...

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

#260

Post by alistairSH » Wed, Jan 06, 2021, 3:22 PM UTC

lotsofpulp wrote: post #237

alistairSH wrote: post #228

Earlier quoted context omitted.

I’m claiming that insurers do not erroneously deny claims in the hopes that people give up. You keep saying "erroneously" but I'm not sure what you mean by that. My experience is that for any major change in medication (either dosage or brand, but for the same chronic condition) the insurance will initially deny the claim. This kicks off many hours of phone tag between my family, the insurance, and the doctor. Eventu…

>You keep saying "erroneously" but I'm not sure what you mean by that. "Erroneously" as in denying coverage for something that should be covered (per the terms of the contracts). It's unfortunate that you have to go through all of that when changing medications. I don't know the reason for it in your specific case, but I would hope it's not widespread fraud across all of those companies.

Sure, I won't go as far as calling it outright fraud. But, it certainly is part of the business. And as the consumer, at the time of service, I really don't care why it happens, only that it does and that it costs me time and money and delays treatment.

As far as I can tell, it's a byproduct of an adversarial relationship between the 3 parties (consumer, doctor, insurer). Insurance doesn't trust the MD to do his job, so hires their own MDs to second guess. And on anything that costs more than $100, that second guessing is the default action - the insurance company's own MDs are only there to provide legitimacy to the initial denial. I say this because in ALL cases, my medical needs have eventually been covered, but not before committing more time and energy than should be necessary.

At the end of the day, we pay more money (and time) for worse outcomes than most of Western Europe and the wealthier nations in Asia.