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The Almighty Buck Medicine

Lessons of a $618,616 Death 651

theodp writes "Two years after her husband's death, Amanda Bennett examines the costs and complex questions of keeping one man alive. The bills for his seven-year battle with cancer totaled $618,616, almost two-thirds of which was for his final 24 months. No one can say for sure if the treatments helped extend his life, and she's left with a question she still can't answer: When is it time to quit?"
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Lessons of a $618,616 Death

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  • Re:Happiness (Score:4, Informative)

    by sys.stdout.write ( 1551563 ) on Sunday March 07, 2010 @06:45AM (#31388086)

    Euthanize the depressive!!!

    I'm pretty sure he's restricting his proposition to the terminally (or likely terminally) ill.

  • Easy (Score:5, Informative)

    by LatencyKills ( 1213908 ) on Sunday March 07, 2010 @06:46AM (#31388090)
    It's time to quit when the patient says it's time, and it's not the business of the spouse, the church, or the government to decide otherwise.
  • Re:Easy (Score:2, Informative)

    by jonadab ( 583620 ) on Sunday March 07, 2010 @07:32AM (#31388278) Homepage Journal
    Yeah, that works as long as the patient is conscious.

    The question becomes somewhat more difficult when the patient doesn't look, medically speaking, like he's ever going to wake up ever again.
  • by Kijori ( 897770 ) <ward,jake&gmail,com> on Sunday March 07, 2010 @07:43AM (#31388314)

    The studies I have seen put American and European survival rates at about the same level, with normally a slight advantage to the Americans, although critics point out that reporting differences (for example, in Great Britain anyone diagnosed with cancer is included in the survival figures, while in America deaths that may not be related are not counted, plus many American hospitals publish only estimated survival percentages rather than actual counts), differing access to treatment (if you don't go to the hospital you won't get counted, which could stack the deck against socialised healthcare) and uncontrolled variables (incidence of cancers is lower across much of Europe, possibly because of differences in the health care systems) make comparisons contrived at best.

  • by Anonymous Coward on Sunday March 07, 2010 @07:55AM (#31388370)

    The average German goes to see a doctor over 20 times a year for nothing. Wtf? I have to pay for this. And when I am sick, I still to have pay for medicine that soothes my pain. Even vaccines are not free, I paid about 80 euro for Hepatitis protection, because I went on holidays to an affected country. Because it's all not free. All you get for free is antibiotics and how much does this stuff cost?

    You do know that a doctor gets _one_ quarterly amount of money by the insurance company for appointments with a
    single patient, irrespective of how often the patient visits him, as long as he visits once? You "subsidize" patients who visit
    the doctor 20 times a year with the same amount of money as someone who visits him 4 times a year.

    Vaccines required for holidays no one forces you to take are one of the very few kinds of commonly needed medicine
    that you have to pay for yourself if you have public insurance.

    Fancy looking tooth replacements in places others would not see when you smile are another. Cosmetic stuff costs extra.

    EVERYTHING ELSE is paid for by the insurance company. If a doctor prescribed it, of course. Saying that only antibiotics
    are paid for is a blatant fucking lie.

    By the way, you certainly know that here in Germany, we _do_ have private insurance companies. Paying 300€ a month
    for health insurance, you certainly earn enough to go with them. What is holding you back? You won't have to subsidize
    anyone! Their rates are actually way cheaper in your case, as you seem to be healthy. Go with them and stop complaining.

    They won't take people with pre-conditions though.

  • 600K is quite low (Score:4, Informative)

    by 140Mandak262Jamuna ( 970587 ) on Sunday March 07, 2010 @08:03AM (#31388406) Journal
    The cancer must have been one of the aggressive ones. I see the 600K billed is on the low side. The actual payments to the providers would have been less 125K. Typically the terminal patients generate 1M$ in bills in their last 24 months. And generate about 300K in actual payments if they die in a hospital.
  • by thebian ( 1218280 ) on Sunday March 07, 2010 @08:42AM (#31388606)

    On my own, my health insurance choice is a limited $1,500 a month plan and an average $2,500. Those are different companies, and the only ones selling insurance in my state (in the U.S.). I'd say Germany's plan looks OK to me.

    Luckily there is a group for freelancers in my state, but keep in mind:

    • You have to be relatively successfully every year in order to qualify.
    • You have to do one of several types of job.

    If you have no income (say 10% in the U.S.) or low income, you are screwed.

    It's not a political problem here because 70% or so of the people are covered by employer plans that more or less support the entire wasteful system.

    Again, the 30% are screwed.

  • Re:Uh, FUCK no! (Score:5, Informative)

    by the eric conspiracy ( 20178 ) on Sunday March 07, 2010 @10:26AM (#31389548)

    A friend of mine who read the Obama bill said they DEFINITELY had tiered levels of coverage by age - older people won't get the same level of care.

    That is true under the current system as well. As you get over age 80 a lot of procedures become unavailable because they just don't make sense and your insurance won't pay for them.

  • by fbjon ( 692006 ) on Sunday March 07, 2010 @10:33AM (#31389618) Homepage Journal
    All jokes are appropriate. Some are just badly made.
  • Re-tooling (Score:5, Informative)

    by sycodon ( 149926 ) on Sunday March 07, 2010 @10:41AM (#31389702)

    Ever notice that all the "fixes" proposed in Washington revolve around getting more people into this failed economic model and accommodating the costs? No one asks why a scan costs some $3000 or why a drugs costs $750 per dose.

    It's time to just re-tool the whole thing from the ground up, focusing on having prices that reflect the actual costs or services. A probably not so far fetched example, a one million dollar MRI machine. Amortized over 5 years, 8 scans a day, that comes out to about $68. Add on the technician's fees and misc. for power and space in the hospital and your scans should not cost more than a couple hundred dollars sans the radiologist's fees to read them.

    Health care reform should be 100% about bringing transparency and predictability to the costs. Only then can you look at how to cover more people.

  • by Rich0 ( 548339 ) on Sunday March 07, 2010 @11:02AM (#31389904) Homepage

    Actually, from what I've been able to glean, the uninsured pay much more.

    Here is the problem - you don't get the bill until AFTER services are rendered. For kicks, go ahead and ask your doctor what a procedure he is recommending will cost. He'll look at you like you're an alien.

    So, you get a bill. The problem is that now you've already incurred the service, so you can't decide to shop around. You can try to barter, but bartering after the sale is not very effective. You're relying purely on the hospital's generosity. However, if the hospital really were generous, why would they be mailing you a bill for $100k knowing that most insurance companies would only give them $20k?

    Most likely you'll talk that $100k bill down to $30k and then talk to your friends about how nice the hospital was to you. What you don't realize is that they give a better deal to every insurance company on the planet. Nobody pays sticker price.

    If I were running US healthcare one of the first laws I'd pass was that hospitals would need to publicize a full price list, and that EVERYBODY pays the same price. Since the hospital doesn't want to be dropped from every insurance plan in the country they'll publish a fair price, and then there is no penalty for not having insurance, or for having an insurance company without a lot of patients in the local area. Note, I am under no illusions that this would fix US healthcare entirely - it is a huge mess that needs MANY changes. This would just be one of the first I'd pass, since it saves money regardless of whether taxpayers or private insurers are paying for care.

  • Re:Mixing up advice (Score:5, Informative)

    by blackest_k ( 761565 ) on Sunday March 07, 2010 @02:16PM (#31391974) Homepage Journal

    The real problem with the American healthcare system is that the cost of treatment often has to be met by the family of the sick patient.

    Should people be made to face the choice of continuing treatment or costing their families future. Should your wife be forced into living in a trailer park as your widow your children forced to withdraw from college in order to maintain your life for a few more years?

    Essentially it becomes a choice of suicide or putting the people you love most through intense hardship, probably worse than that since suicide would invalidate any life insurance so you need to bare the pain of cancer for as long as your body holds out.

    I'm lucky I live in a country where most of my medical needs are taken care of some options will be limited due to cost and the benefit they provide. However I will get treatment and my family will be ok.

    Health care is the number one reason for not wanting to live in the usa.

  • by Ma8thew ( 861741 ) on Sunday March 07, 2010 @02:32PM (#31392192)
    The kind of cancer drugs that NICE (the body which decides which treatments are covered by the NHS in England and Wales) rejects are not exactly 'life saving'. The most recent examples tend to extend life by a few months, but are extremely expensive. NICE uses a formula to calculate whether a treatment is value for money, and they actually made an exemption for life prolonging cancer drugs to allow some of the more expensive ones to be used. Make no mistake, NICE does not reject cancer curing treatments.
  • Re:Re-tooling (Score:3, Informative)

    by Stormy Dragon ( 800799 ) on Sunday March 07, 2010 @03:27PM (#31392734)
    The problem is that the vast majority of healthcare is paid for by someone other than the patient, so even if costs were transparent there's no incentive for them to bother paying attention.
  • by MattskEE ( 925706 ) on Sunday March 07, 2010 @03:49PM (#31392950)

    RTFA.

    When it came to the insurance companies, the sticker price meant little since they had negotiated their own deals with the hospital. Neither the hospital nor the insurance companies would elaborate. The entire medical bill for seven years, in fact, was steeply discounted. The $618,616 was lowered to $254,176 when the insurers paid their share and imposed their discounts. The portion of the charges that were not covered for the most part vaporized. Terence and I were responsible for and paid $9,468--less than 4%.

    Ironically if they were uninsured, they would be on the hook for the entire $618,616 instead of what the insurance companies paid.

  • by Wildclaw ( 15718 ) on Sunday March 07, 2010 @03:53PM (#31392978)

    it might be interesting to consider where better than 90% of new drug research and development occurs. If you guessed 'the United States' then you were right.

    If you guessed that this was a made up statistic, you guessed right.

  • Re:easy (Score:1, Informative)

    by Anonymous Coward on Sunday March 07, 2010 @08:43PM (#31395572)

    One of the key distinctions I think missing in the health care reform debate, is that just like your health insurer now (if you have one) decides what it will and won't pay for, often excluding elective or experimental treatments, is that gov't health care would do the EXACT SAME THING your insurance company is doing right now.

    And a public option doesn't mean that you can't have your own supplemental insurance that covers more treatments. There's plenty of that in markets around the world.

    It baffles me that we have made the health care reform debate so confusing when it doesn't need to be.

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