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

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

#331

Post by arcticbull » Thu, Jan 07, 2021, 3:38 AM UTC

chordalkeyboard wrote: post #324

lazyasciiart wrote: post #112

Earlier quoted context omitted.

Perhaps at an extreme point, but most white collar crime is dealt with by fines and licensing rather than arrests and jail. E.g minimum wage laws.

But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?

This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services outside the public system. If you do, then you are practicing without a license, and whatever comes of that comes of it. Likely a fine, or license suspension or if you continue to defy the law, prison.

Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, and in my scenario, that would not change.

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

#332

Post by chordalkeyboard » Thu, Jan 07, 2021, 3:57 AM UTC

arcticbull wrote: post #331

chordalkeyboard wrote: post #324

Earlier quoted context omitted.

But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?

This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services…

> This situation exists today. If I'm an physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van.

I agree and this is terrible.

> Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license,

it may not be a legal defense but it is absolutely a moral defense.

> in my scenario, that would not change.

I just want to make it explicit that you agree with the criminalization of healing people without permission.

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

#333

Post by arcticbull » Thu, Jan 07, 2021, 4:03 AM UTC

chordalkeyboard wrote: post #324

lazyasciiart wrote: post #112

Earlier quoted context omitted.

Perhaps at an extreme point, but most white collar crime is dealt with by fines and licensing rather than arrests and jail. E.g minimum wage laws.

But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?

Replying here because rate limiting, and I find this conversation interesting :)

> it may not be a legal defense but it is absolutely a moral defense.

I suppose that's so.

> I just want to make it explicit that you agree with the criminalization of healing people without permission.

By framing your reply as "criminalization of healing people without permission" you have baked in a lot of unstated assumptions:

1. The person doing the 'healing' has met your personal standard for a 'healer' - in this case foreign experience. Without licensing, I could, with no experience whatsoever, just cut you open and go to town. You would die, and then what? Who's liable? What if I get half way through and then realize that Milton Bradley's Operation is not a replacement for Grey's Anatomy and you are rushed to a real hospital?

2. You assume the 'healing' is successful. Does it become butchering if I fail to do so?

So, to that end, while I may not agree with all aspects of licensing physicians (for instance, I'm with you on the foreign degree and experience limitations) I believe that on the whole it does more good than harm.

I will therefore be explicit and say, yes, I do "agree with the criminalization of healing people without permission [of competent authorities]," even if I do not today agree with all of their requirements, however I reject your framing.

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

#334

Post by chordalkeyboard » Thu, Jan 07, 2021, 4:28 AM UTC

arcticbull wrote: post #333

chordalkeyboard wrote: post #324

Earlier quoted context omitted.

But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?

Replying here because rate limiting, and I find this conversation interesting :) > it may not be a legal defense but it is absolutely a moral defense. I suppose that's so. > I just want to make it explicit that you agree with the criminalization of healing people without permission. By framing your reply as "criminalization of healing people without permission" you have baked in a lot of unstated assumptions: 1. The…

> The person doing the 'healing' has met your personal standard for a 'healer' - in this case foreign experience.

I'm not imposing my standards for a healer on a sick person in his personal quest for a healer.

> Without licensing, I could, with no experience whatsoever, just cut you open and go to town.

Indeed, you could do the same thing absent a license in a regulated regime, and also you could get a license and kill me on purpose and say it was an accident or unfortunate outcome. What the requirement for a license does is create a class of people who are approved healers, and criminalize medicine outside of that state-sponsored context.

> You would die, and then what? Who's liable?

You'd be liable, just like you would if there were licenses and you either had one or did not. Or are you referring to the fact that physicians are shielded from liability if they meet industry accepted standards of care?

> You assume the 'healing' is successful. Does it become butchering if I fail to do so?

I don't assume that. I'm just referring to the telos of the act. You're allowed to give people free tattoos. You're not allowed to give them a tattoo if you claim it is medicine. It doesn't matter if its a drug or whatever. The intent to heal is what's criminalized here.

> So, to that end, while I may not agree with all aspects of licensing physicians (for instance, I'm with you on the foreign degree and experience limitations) I believe that on the whole it does more good than harm.

The problem arises when you enforce your values on other people who do not share those values because of your belief that "on the whole it does more good than harm."

> I will therefore be explicit and say, yes, I do "agree with the criminalization of healing people without permission [of competent authorities]," even if I do not today agree with all of their requirements, however I reject your framing.

Thanks for your reply and thanks for engaging my perspective directly :)

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

#335

Post by arcticbull » Thu, Jan 07, 2021, 7:06 AM UTC

refurb wrote: post #325

arcticbull wrote: post #303

Earlier quoted context omitted.

> I'm just calling out that health care coverage in Canada isn't all peaches and cream. I've experienced both systems so I know what the pros/cons of each are. As have I. The US system is also generally ranked below the Canadian system on every measure I've seen. That doesn't necessarily mean much, as being better than the worst isn't much to write home about. One great example of this is the US is the only developed…

Sure. Again, if you are lower middle income you’re better off in Canada. If not, better off in the US.

Not if you’re giving birth apparently. People seem to say this as fact, because it’s a pay to play system (so if you pay more, you must get ... something; right) but I don’t think I’ve come across evidence to support your conclusions. Did you happen to have some data I could look at?

All the data I’ve seen ranks the Canadian system ahead of the American on outcomes.

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

#336

Post by arcticbull » Thu, Jan 07, 2021, 7:08 AM UTC

chordalkeyboard wrote: post #334

arcticbull wrote: post #333

Earlier quoted context omitted.

Replying here because rate limiting, and I find this conversation interesting :) > it may not be a legal defense but it is absolutely a moral defense. I suppose that's so. > I just want to make it explicit that you agree with the criminalization of healing people without permission. By framing your reply as "criminalization of healing people without permission" you have baked in a lot of unstated assumptions: 1. The…

> The person doing the 'healing' has met your personal standard for a 'healer' - in this case foreign experience. I'm not imposing my standards for a healer on a sick person in his personal quest for a healer. > Without licensing, I could, with no experience whatsoever, just cut you open and go to town. Indeed, you could do the same thing absent a license in a regulated regime, and also you could get a license and ki…

> Thanks for your reply and thanks for engaging my perspective directly :)

I think you have a totally reasonable and consistent position, it’s just not one I personally agree with. Thanks for sharing and have a great evening!

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

#337

Post by dusted » Thu, Jan 07, 2021, 8:56 AM UTC

leetcrew wrote: post #262

dusted wrote: post #188

Earlier quoted context omitted.

And here my "socialist" ass was thinking the most unfair characteristic of the US "healthcare system" was that not all citizens have the basic right to the same, best-effort treatment.

> same, best-effort treatment no matter how enlightened the society is, you can still pick at most one of these.

that'd be nitpicking the wording, the best-effort is resource-constrained, this is not what's happening in the US, the resources exist but policy is to only make them available to a minority of the population.

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

#338

Post by alphabettsy » Thu, Jan 07, 2021, 10:35 AM UTC

lotsofpulp wrote: post #219

DangitBobby wrote: post #211

Earlier quoted context omitted.

You seriously over-estimate how much people know about their rights and the time they are willing to spend exercising them. But you are right that they should. https://www.npr.org/sections/health-shots/2014/04/14/3025478...

That's actually very interesting. Although the article is from Apr 2014, it has some statistics that may be relevant to insurers erroneously denying coverage: https://www.capradio.org/articles/2014/04/01/patients-win-ab... >Insurers say only about three percent of claims are denied. >California data show about half the time a patient challenges a denied health care service through a third party, the patient wins and…

It’s easy to lie with statistics. I’d be willing to bet lots of money that it’s 1% because the vast majority of claims are doctors appointments and other very routine things and that major medical procedures, that are less common though more impactful, make up a disproportionate number of denials.

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

#339

Post by alphabettsy » Thu, Jan 07, 2021, 10:41 AM UTC

lotsofpulp wrote: post #315

spaetzleesser wrote: post #248

Earlier quoted context omitted.

“I would hope it's not widespread fraud across all of those companies.” Assume it is. It’s the normal way of doing business. Deny things and hope that most people will give up.

If it is fraud, then it's not manifesting in outsize profits for insurance company. Almost all premiums go towards paying for benefits, and they are left with ~5% or less in profit. The executives are not earning outsized compensation compared to executives at other large companies, there is no army of people with FAANG salaries, so who is the fraud benefiting? This is all public information per their SEC filings. Yo…

5% or less is still a massive amount of money.

Cigna alone posted annual profits of $122 billion in the same year that General Motors and Ford combined made less than $7 billion.

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

#340

Post by pembrook » Thu, Jan 07, 2021, 1:04 PM UTC

leetcrew wrote: post #270

pembrook wrote: post #144

Earlier quoted context omitted.

What’s so ironic about GoFundMe is that it’s basically a diorama of how socialized medical care would work (minus the cost savings), and yet nobody has any political objections to socialized funding when it happens there. I recall debating with a friend who was against socialized healthcare recently, and then seeing them promote a GoFundMe campaign for a mutual friend’s medical bills on Facebook a few days later. The…

> I recall debating with a friend who was against socialized healthcare recently, and then seeing them promote a GoFundMe campaign for a mutual friend’s medical bills on Facebook a few days later. > The irony was lost on him. I think the key is that Americans love to dream of themselves as wealthy philanthropists (no matter how poor they actually are). I'm not sure I see the irony either. if I'm understanding correct…

Because at scale, countries are also just a group of people pooling resources to achieve greater outcomes.

The only difference between micro-socialized funding (GoFundMe) and macro-socialized funding (government healthcare) is that the government version results in massive cost savings for the entire system.

Micro-socialization is the worst of both worlds. No cost savings, no preventative care, and only the most sensational and dramatic ailments receive GoFundMe support from peers.

For proof of the cost savings, look at the cost of X given procedure in any developed country with socialized care (Australia, Sweden, Germany, etc.) and then compare it to the US.

In the US it will cost anywhere from 2X-10X more to do X given procedure. It's not even worth citing any research since there's mountains of studies proving this.