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42 percent of new cancer patients lose their life savings

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Re: 42 percent of new cancer patients lose their life savings

#161

Post by pgeorgi »

njarboe wrote: post #84
zrail wrote: post #14

Earlier quoted context omitted.

Yeah, the study appears to be looking at 2000–2012. The lifetime limit ban started on March 23rd 2010, according to this Vox article: https://www.vox.com/policy-and-politics/2017/2/15/14563182/o... Thanks Obama.

Every European health care system, I believe, has some way of limiting the amount of care provided to people. It is just not so out in the open as a dollar cap on what people can get in a lifetime. Not every possible, super-expensive procedure is approved to be available to people through the public healthcare system. (Would love to hear of a country that has "universal health care" that does not limit what procedure…

> Would love to hear of a country that has "universal health care" that does not limit what procedures people can have done to see how it is possible.

It will attract quacks like shit attracts flies, so yes, of course there are limits: New treatments need to be more effective or cheaper for some well-defined ailment to end up on the approved list. If they're very expensive, they might not be first in line (but still available for patients where the case can be made that they need it). That can be frustrating, but shouldn't be life threatening.

Experimental treatments are research. Their test subjects are picked by a schedule that is unrelated to medical care needs but optimizes for good data acquisition. Pay for them from research budgets, not health care.

Re: 42 percent of new cancer patients lose their life savings

#162

Post by chimeracoder »

TheOtherHobbes wrote: post #139
rayiner wrote: post #57

Earlier quoted context omitted.

It's absurd to say that imposing a limit is somehow misleading for something sold as "insurance." "Actual insurance" almost always has a policy limit. Everything from car insurance to corporate liability insurance has a limit. I can't think of any "actual insurance" besides health insurance that doesn't have a limit. Again, I'm not arguing against having health insurance be unlimited. I'm taking exception to your rhe…

It's also how single-payer healthcare works in the majority of countries that have it. The problem is simple - in most developed countries, health insurance doesn't bankrupt the people it serves. It also doesn't have policy limits for common terminal illnesses. So why does this happen in the US - a country with insanely high costs and relatively mediocre health outcomes? The problem isn't insurance, it's the influenc…

> It's also how single-payer healthcare works in the majority of countries that have it.

Only a couple of countries actually have single-payer healthcare[0]. For those that do, treatment for complex, expensive conditions like cancer is regulated by the government much more strictly than in the US, with the result that patients have far fewer options for (covered) treatment. Incidentally, those countries, like the UK, tend to have dramatically worse cancer survival outcomes than the US does.

[0] The UK (if we ignore the divisions between the NHS in England, Wales, Scotland, and Northern Ireland) is one of the only ones.

Re: 42 percent of new cancer patients lose their life savings

#164

Post by malvosenior »

pascalxus wrote: post #58

Normally, I'm all for invisible hand capitalism for most things, but clearly in the case of medical services it's completely broken. What we need is price ceilings on medical procedures, something reasonable. Perhaps, cap procedures cost in some way, maybe 1k to 4k based on what it is (make it illegal to charge more and hold hospitals financially accountable). There has to be some kind of cost control, either from th…

It's only broken because of regulation. If I could shop across state lines for insurance, prices would drop. I may not even opt to get insurance as I'm very healthy and I've never had medical costs approach even an order of magnitude of my insurance costs. Yet I'm forced to purchase this unneeded service by the government, pushing up demand and prices in an artificially controlled market.

Re: 42 percent of new cancer patients lose their life savings

#165

Post by pasbesoin »

gred wrote: post #12

A big factor here seems to be lifetime limits to benefits: > Financial toxicity led Fumiko Chino to co-write a research letter in JAMA Oncology last November. After her husband surpassed his insurance policy's $500,000 lifetime limit, Chino drained her savings to pay for his treatment. When he died, she was left hundreds of thousands of dollars in debt. However, these limits were outlawed by the Affordable Care Act,…

The ACA significantly shored up benefits for members of group plans. It also, I hear and read, provided significant cost controls that helped put the brakes on group policy premium increases. Just one aspect of that: Hospitals' uninsured treatments dropped from the mid-teens or worse to around or under 5%. Costs that no longer had to be "spread around" to insured coverage.

But a lot of group policy members have no... pardon me, "fucking" clue about this.

Study after study has demonstrated this lack of knowledge.

And politicians have been complicit in furthering it, along with outright lies casting the ACA in worse light. Not to mention deliberately sabotaging it through their actions, such as not providing promised transition funding written into the law. (For those who don't know, this is a common political ploy: You can write any law you want; if you don't, through the separate appropriations bills, fund it, that law effectively accomplishes little or nothing.)

Still, even a superficial examination of the U.S. medical field inclusive of insurers, shows it to be awash in money.

Every fucking middleman (that includes many providers, from products to services -- and the suits who now own them) pushing to grab as much of it as possible, before the rest trickles down to the patient (actual care).

Pardon my vitriol, but I've encountered far too much of this, first hand.

Re: 42 percent of new cancer patients lose their life savings

#166

Post by dragonwriter »

FabHK wrote: post #159
api wrote: post #46

Earlier quoted context omitted.

This is especially true when there are no obvious and politically viable good alternatives. In the US everyone outside the center-left or center-right seems to be an absolute lunatic of one sort or another, and even if that weren't the case the two party oligopoly system is deeply entrenched and guarantees that alternatives can't succeed. There's nobody who is both sane and electable that isn't part of the mainstream…

Yeah, it's funny - from my superficial understanding political theory predicts that a first-past-the-post system turns into a two party system with the parties getting ever more similar ("median voter theorem"). But that's not what happened in the US in the last decade or so. But agreed - proportional parliament allows for articulation of important non-majority views (such as the emergence of the Green party in Germa…

Median voter theorem ignores a lot of critical things, the most critical being that political viewpoints may not be distributed normally (or even with a single central peak) and turnout is influenced by engagement.

If you assume engagement (and, thus, likeliness to vote) is driven in part by proximity of the nearest candidates positions to your own, and that political viewpoints are bimodally distributed, you'd actually expect FPTP to turn into a two-party system where parties, even if they start at some point close to each other, drift out toward the two peaks.

While still a gross simplification, this seems closer to reality in the US to the premises required for the Median Voter Theorem to work.

Re: 42 percent of new cancer patients lose their life savings

#167

Post by zanny »

PenguinCoder wrote: post #63
Retric wrote: post #30

Earlier quoted context omitted.

> Is China civilized? No. The rampant corruption, lack of free speech, etc don't qualify as civilized IMO.

By those metrics (and others), United States isn't a civilized country either.

1. Lets its citizens die destitute of curable illness.

2. Condemns children at birth to poverty and / or crime due to their birth parents as a result of how the public education system is structured.

3. Ten year wait list for housing if homeless.

4. Epidemic police state where officers are unaccountable for any atrocity comitted.

5. Justice system is bribeable out of almost any crime comitted, including wrecking the whole economy.

6. Uses the measure of a three hundred year dead kings foot as its base unit of measurement, and uses a temperature scale where 0 and 100 mean nothing. Both of which nobody else uses.And they have daylight savings time across four time zones.

7. Puerto Rico still isn't a state.

8. Two out of the three heads of state this millennia won election after losing the popular vote to their opponent.

As an American, we certainly aren't civilized.

Re: 42 percent of new cancer patients lose their life savings

#168

Post by chimeracoder »

DanBC wrote: post #149
njarboe wrote: post #84

Earlier quoted context omitted.

Every European health care system, I believe, has some way of limiting the amount of care provided to people. It is just not so out in the open as a dollar cap on what people can get in a lifetime. Not every possible, super-expensive procedure is approved to be available to people through the public healthcare system. (Would love to hear of a country that has "universal health care" that does not limit what procedure…

This seems to be pushing a myth: expensive treatments must be better treatments, right? We have very good evidence that these new, expensive, treatments do not extend life and that they make quality of life worse. England set up something called the Cancer Drugs Fund. This provided access to new medication that hadn't yet been assessed for value; that were in the process of being assessed; or that had been assessed a…

> This seems to be pushing a myth: expensive treatments must be better treatments, right? We have very good evidence that these new, expensive, treatments do not extend life and that they make quality of life worse.

It's not pushing any myth at all. As explained elsewhere government-run systems like the NHS do attach actual dollar amounts to treatments that are effective and do extend life, but for which they're not willing to pay.

The NHS's version is actually quite ruthless when you peel back the details, where they determine how "good" a person's life is, and essentially how much they are willing to spend to extend that person's life by N years. This is, in effect, a benefits cap, just framed slightly differently.

This is not, as you are implying, saying "this treatment is ineffective or harmful, so we won't pay for it". It is literally saying "we understand that this treatment would extend this person's life by 5 years, but it costs £50,000, and based on their condition, we're only willing to spend £25,000 to extend their life by 5 years.

> And yet it has worse outcomes across a range of measures, including "life expectancy".

Life expectancy has so many confounding variables which have a much stronger effect that it's ridiculous to try and use that as a measure of a healthcare system directly. It's like trying to measure the fuel efficiency of different models of cars by looking at the total number of miles driven by all drivers of each car model in a given year. Yeah, there's... a connection between the two, but that's certainly not what you're analyzing when you try to compare them naively.

Re: 42 percent of new cancer patients lose their life savings

#169

Post by Spivak »

travisoneill1 wrote: post #136
dragonwriter wrote: post #128

Earlier quoted context omitted.

> I don't understand why you'd phrase it this way. Under the ACA, 80% of premiums have to go to medical care. A dollar saved providing care disproportionately benefits the premium payers, not the company. The retained premiums rule and the lifetime limit ban were both adopted as part of the ACA; lifetime limits only existed before the ACA, and indeed benefited the insurance companies. > Lifetime caps insure that you,…

If an insurance company underestimates tail risk then it may not be solvent when it's time for you to make a claim. Not sure if this is what was meant, but a policy holder always assumes some risk even with caps.

Unless the insurance industry is insolvent you don't really have to worry about that. Any company you're buying insurance from has reinsurance against abnormally high payouts.

This makes the risk effectively zero since if the 'turtles all the way down' system can't pay out then we're probably in a state of national emergency.

Re: 42 percent of new cancer patients lose their life savings

#170

Post by 738472527784 »

nkozyra wrote: post #32
alejohausner wrote: post #24

Perhaps the real problem is that chemo, radiation, and surgery don't really cure cancer, in most cases. There is a lot of bad science in cancer research. The "science" that bothers me the most is the use of 5-year survival rates. Suppose that a cancer that starts at age 60 becomes symptomatic at age 65, and kills the patient at age 70. Scenario 1: you are 60 years old, get screened, and opt for treatment (who wouldn'…

> your oncologist declares you "cured" at age 65 I don't think an oncologist would do this, though.

Yes. I think after 10 years you are pronounced "cured", which means no clinical presentation after that time usually means this type of cancer won't come back.

The 5-year interval is the minimum used in studies on cancer survival benefit.

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