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Sick and struggling to pay, 100M people in the U.S. live with medical debt

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Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#371

Post by heavyset_go »

missedthecue wrote: post #335
heavyset_go wrote: post #308

Earlier quoted context omitted.

This is an important distinction. Nobody is getting free chemo or radiation therapy, treatment for chronic illness or anything like. For example, diabetics are not going to get a supply of insulin from the ER, especially if they can't pay, and someone with cancer isn't going to get treatment, either. Plenty of people die in the US from the inability to afford the medical care they need to live. If you're brought into…

"Nobody is getting free chemo or radiation therapy, treatment for chronic illness or anything like" Sure you can. In the US, you cannot be denied chemo or other treatments. You will be billed after the fact, and it's going to be a ton of money, but it's not as if they have security escort you out just because you don't have an insurance card. That simply doesn't happen. You'll get care, and if you don't qualify for a…

> Sure you can. In the US, you cannot be denied chemo or other treatments. You will be billed after the fact, and it's going to be a ton of money, but it's not as if they have security escort you out just because you don't have an insurance card. That simply doesn't happen.

This does, indeed, happen all of the time.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#373

Post by rayiner »

sterlind wrote: post #348
kcplate wrote: post #343

Earlier quoted context omitted.

> I’m not sure why you’re being downvoted, this seems factual. I’ll make a guess at why. Because some folks in the US who want universal healthcare have a misunderstanding of what that actually means to make it affordable. Any comment criticizing or expressing what might be perceived as negative of any aspect of “European style healthcare” (as if that is a singular thing) will get downvoted by these folks. They have…

why can't the 89-year old grandmother get supplemental insurance that covers the fancy therapies? I don't buy that there's no way to get people state-covered insulin and chemo without consigning everyone to bread lines. just make Medicare universal, and let people buy BCBS or Kaiser etc. on top, to skip the lines or cover more end of life stuff.

> why can't the 89-year old grandmother get supplemental insurance that covers the fancy therapies?

I think they can, but I also think that most people advocating for “Medicare for all” in the US don’t even realize supplemental private health insurance exists in many if not most European systems.

Healthcare is a systems engineering problem to explore design trade offs within a solution space. Most people don’t think of it that way.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#374

Post by rayiner »

buffington wrote: post #368
rayiner wrote: post #333

Earlier quoted context omitted.

Why do you assume you would have gotten authorized for a hip replacement at all? Many elective qualify of life surgeries aren’t covered in European health care systems. Look, there is no free lunch. The UK NHS has strict standards of “cost effectiveness” that would shock Americans: https://www.nice.org.uk/media/default/guidance/lgb10-briefin... . 20-30,000 pounds per quality adjusted life year. American end of life c…

It wouldn't be safe to assume that I'd have been authorized for an elective surgery, so fair point. I also never suggested that it should be free. > American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking. This hasn't been my experience. Before my dad died from glioblastoma last year, his insurance refused to pay…

I’m sorry to hear your dad’s experience. It’s the nature of a private system in a country of 300 million people that experiences will differ. Aggressive glioblastoma is something that won’t be covered with the cost effectiveness thresholds in many European systems. The median survival duration of treated patients is just over one year, with costs, as you outline above, of $120-250k. The typical upper end in the UK NHS is 30,000 pounds per quality adjusted life year ($36,000). The UK recently introduced a cancer drugs fund that can go beyond that, but it’s been intensely controversial within the UK, because in that country there is a deeply established focus on cost effectiveness and “NICE” protocol. But US insurance companies routinely pay hundreds of thousands of dollars for glioblastoma treatment. Median insurance payments for high grade glioma were $180,000 in one study: https://ar.iiarjournals.org/content/anticanres/39/3/1375.ful...

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#375

Post by DanBC »

rayiner wrote: post #374
buffington wrote: post #368

Earlier quoted context omitted.

It wouldn't be safe to assume that I'd have been authorized for an elective surgery, so fair point. I also never suggested that it should be free. > American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking. This hasn't been my experience. Before my dad died from glioblastoma last year, his insurance refused to pay…

I’m sorry to hear your dad’s experience. It’s the nature of a private system in a country of 300 million people that experiences will differ. Aggressive glioblastoma is something that won’t be covered with the cost effectiveness thresholds in many European systems. The median survival duration of treated patients is just over one year, with costs, as you outline above, of $120-250k. The typical upper end in the UK NH…

Over the years so many people have patiently explained why and how you're wrong whenever you mention the NHS that I can only think you're choosing to misrepresent the information now.

And here you're repeating the claim that US health insurance is a unlimited source of healthcare funds for anyone who wants it, even though someone else is telling you that's not their personal experience.

Denial of health insurance is so common in the US the charitable orgs give advice about how to deal with it: https://www.cancer.org/treatment/finding-and-paying-for-trea...

"It’s not unusual for insurers to deny some claims or say they won’t cover a test, procedure, or service that doctors order. You can appeal many types of health insurance decisions – sometimes even things that are written into your health plan’s contract. You can appeal Medicare claim denials, too."

All the available evidence directly contradicts your claims about the generosity of health insurance.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#376

Post by rayiner »

DanBC wrote: post #375
rayiner wrote: post #374

Earlier quoted context omitted.

I’m sorry to hear your dad’s experience. It’s the nature of a private system in a country of 300 million people that experiences will differ. Aggressive glioblastoma is something that won’t be covered with the cost effectiveness thresholds in many European systems. The median survival duration of treated patients is just over one year, with costs, as you outline above, of $120-250k. The typical upper end in the UK NH…

Over the years so many people have patiently explained why and how you're wrong whenever you mention the NHS that I can only think you're choosing to misrepresent the information now. And here you're repeating the claim that US health insurance is a unlimited source of healthcare funds for anyone who wants it, even though someone else is telling you that's not their personal experience. Denial of health insurance is…

Dan, over the years you’ve baselessly accused me of misrepresenting how the NHS system works, without any substance. The UK NHS’s use of QALY is well established: https://bmchealthservres.biomedcentral.com/articles/10.1186/... (“The U.K. National Institute for Health and Care Excellence (NICE) currently uses a cost-effectiveness threshold in the range of £20,000 to £30,000 per quality-adjusted life year (QALY) for reimbursing new drugs in the National Health Service”). I also mentioned to the cancer drugs fund.

And the US system, unlike the UK NHS, is a highly fragmented contractual system. Obviously there’s going to be a wide range of experiences with willingness to pay. But I cited specific sources for the median insurance reimbursement of glioblastoma being over $180,000.

So please tell me, with particularity, what part do you disagree with?

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#377

Post by buffington »

rayiner wrote: post #374
buffington wrote: post #368

Earlier quoted context omitted.

It wouldn't be safe to assume that I'd have been authorized for an elective surgery, so fair point. I also never suggested that it should be free. > American end of life care can cost hundreds of thousands of dollars for a year or two of extra life and American insurance companies will pay it without blinking. This hasn't been my experience. Before my dad died from glioblastoma last year, his insurance refused to pay…

I’m sorry to hear your dad’s experience. It’s the nature of a private system in a country of 300 million people that experiences will differ. Aggressive glioblastoma is something that won’t be covered with the cost effectiveness thresholds in many European systems. The median survival duration of treated patients is just over one year, with costs, as you outline above, of $120-250k. The typical upper end in the UK NH…

The paper you linked to is hardly proof that US insurance companies routinely pay hundreds of thousands for GBM treatment. It's a very narrowly focused description of what it cost Excellus BlueCross/BlueShield, the sponsors of the paper, to treat 88 patients insured by Excellus. They try to suggest that excluding data from "national datasets" improves the quality of the research.

> The patient cohort involved 88 patients with over 44,000 separate insurance claims. This dataset represented a happy medium that is large enough to provide a good estimate of overall patient costs, but small enough to individually verify each patient diagnosis and treatment rather than relying on administratively coded national datasets.

It's marketing disguised as scientific research that tries to justify the high cost of health care by claiming that those costs, and commercial insurance, are strongly correlated with higher survival rates.

> Healthcare payments for HGGs patients were substantial and such high healthcare expenditures were positively associated with patient survival and commercial insurance.

Translated: our costs are high, and so are our customer's premiums, but it's worth it because patients last a few extra months compared to the inferior Medicare options.

Private insurance companies don't just fight their customer's claims, they fund "research" that "proves" anything other than private health insurance is worse.

Then there's those 88 patients. With a median age of 59, and a median KPS score of 90, they're cherry picking patients who, would, statistically, survive the longest.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#378

Post by hedora »

Sohcahtoa82 wrote: post #272
hedora wrote: post #238

Earlier quoted context omitted.

No, the problem is that the actions of the federal government aren't even correlated to public opinion any more. When Obamacare was passed, 70% of the population wanted Medicare for all instead: https://thehill.com/hilltv/what-americas-thinking/412545-70-... In 2020, 54% supported single payer health care: https://www.pewresearch.org/fact-tank/2020/09/29/increasing-... overage/ I can't find any post-covid polls, but…

I literally linked those two polls just yesterday, hah [0]. Did you see my comment, or did you just happen to do a similar search and get those results? As I mention in my other comment, I speculate the possibility that people think "Single payer" and "Medicare For All" are different things [1] and so report a different opinion on each, similar to how the ACA was viewed MUCH more favorably than ObamaCare despite one…

Similar search. Duck Duck Go, fwiw.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#379

Post by jahaja »

buffington wrote: post #377
rayiner wrote: post #374

Earlier quoted context omitted.

I’m sorry to hear your dad’s experience. It’s the nature of a private system in a country of 300 million people that experiences will differ. Aggressive glioblastoma is something that won’t be covered with the cost effectiveness thresholds in many European systems. The median survival duration of treated patients is just over one year, with costs, as you outline above, of $120-250k. The typical upper end in the UK NH…

The paper you linked to is hardly proof that US insurance companies routinely pay hundreds of thousands for GBM treatment. It's a very narrowly focused description of what it cost Excellus BlueCross/BlueShield, the sponsors of the paper, to treat 88 patients insured by Excellus. They try to suggest that excluding data from "national datasets" improves the quality of the research. > The patient cohort involved 88 pati…

No post body was provided.

Re: Sick and struggling to pay, 100M people in the U.S. live with medical debt

#380

Post by silicon2401 »

SoftTalker wrote: post #298
silicon2401 wrote: post #271

Earlier quoted context omitted.

> In the USA, he or his family would likely have demanded aggressive surgery and/or chemo or radiation In the US, if you can't afford it, medical care basically isn't even an option. If you have a lot of money, then you're set. In Europe if you don't have much money, you at least have some options, and if you have a lot of money, you can still go to the US. Or if you're open to $100k's of debt, you could've easily go…

Well, I'm saying that he had no options. He went to a (very nice) facility to die. They kept him comfortable and relatively pain-free. Any other option he had, should he have wished to pursue it, would have been outside of the Danish social medical system. That may be "better" than what would have happened in the USA under Medicare/Medicaid, but my point was there really wasn't a choice in the matter for him. He didn…

> Well, I'm saying that he had no options. He went to a (very nice) facility to die. They kept him comfortable and relatively pain-free

I'm just saying that's an option that he took. Just because it wasn't ideal, doesn't mean it wasn't something. If he was in the US, that wouldn't have been an option in the first place. Still a massive improvement over the US.

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