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?"
Happiness (Score:4, Interesting)
It is only time to quit when the patient ceases to be happy. As long as they are still in good spirits and enjoying their life, keep trying...
easy (Score:4, Interesting)
After all, when it comes to health we should never forget what a life is worth... in terms of hard currency.
Free healthcare (Scandinavia etc.) (Score:5, Interesting)
Re:Health Insurance in Germany (Score:4, Interesting)
In your case it's 300 €, but keep in mind that the amount you pay for insurance is directly linked to your income, not to how much you've been sick last year. You could argue it's unfair that you have to subsidize a bunch of students and old people for a while, but it sure beats any other system I've seen. I agree it's not fun to pay the insane amount of insurance and taxes here in Europe, and yes, a huge part of it is going to be wasted on government pork and mismanagement. We need to address that. I'd speculate we could cut those insurance premiums in half if we abolished all the profiteering, corruption and misappropriation. But all in all, it's the price we pay for a pretty decent attempt at social equality.
You sir, are an idiot. (Score:1, Interesting)
Value is subjective for absolutely everything. Even paper with absolute numbers printed on them.
Your example about hiring someone to commit murder is over-simplified. Murder is illegal and has stiff penalties, including life imprisonment or capital punishment, which is trading one life for another.
To your group of family and friends, your value approaches inf. whilst the state might glom you up into it's statistics, and assign you a value of around $15.00 per hour
And if you were to threaten my life, I would kill you for free. Free as in beer, and free as in freedom.
Re:Maybe we can just take the right away from her. (Score:4, Interesting)
Having private health insurance and then not letting people make use of it seems to be the worst of both worlds...
Questionable Source (Score:4, Interesting)
Why is it when we have health care discussions, the media tends to quote widows and widowers? They are not experts in health care and they are not unbiased. Sure, her story is interesting and compelling, but does it tell us anything useful about medicine in the US?
I think that it's pretty much always worth it (Score:5, Interesting)
True, it's horrendously expensive. But that money pays for research, and that research will allow people to stay alive or even get cured a lot cheaper later.
People aren't going to pay half a million for battling cancer forever. At some point it'll be understood and become curable with a few of the right pills and injections. But for that to happen, somebody needs to try the less understood or experimental treatments and see if it works out.
Incidentally, I believe that paying for the "vaccine for nearly a quarter million children in developing countries" is on the long term a rather pointless thing. Doing it that way we'll just be shipping vaccines over there forever. Instead, money should be invested on infrastructure in those countries that need it, so that they can manufacture their own vaccines. Also, actually allowing those countries to manufacture them by eliminating the need to obey the patents would do a whole lot more of good.
end of life medicine is expensive (Score:5, Interesting)
In Australia, the last time I looked, around 90% of the lifetime medical expenses is spent on the last year of life. This has been true for decades.
You think you are doing good stuff, but all too many suffer and die. As a GP, my role is to keep folk alive. If I was a complete rationalist, I would work out some way of stopping useless treatments, but unfortunately that is usually only obvious in retrospect.
I counsel folk on the pros & cons of cancer treatments.
Sometimes it is obvious you are flogging a dead horse, and really they should pull out and enjoy their last days in comparative health, without the misery of chemotherapy et al, with the horrible side effects, and before you recover, the cancer catches up to you & you die in continued misery. I kept one of my mates out of lung cancer chemotherapy (in this case there really was no chance), and he enjoyed his last few good months without being stuffed by chemo. His family still thank me years later.
Then there are the less obvious cases, where the therapy may help, but usually just adds to life's burden of misery, worst just before they die.
Then there are the successes. They are wonderful, but not that common.
Sure, some guys making chemo drugs make a lot of dollars, but what drives most medicos is that we care, and we are not very good at pulling back when things are hopeless, because sometimes we succeed.
Re:You're Sick! (Score:3, Interesting)
Should doctors work for free? Should drug companies not be compensated for the work they put into making their products? Should a construction company build a new hospital, from scratch, with no reimbursement?
Health care has a dollar value because the things which comprise are not free. How twisted are you Europeans because you think, just because you don't pay for these things directly, that no one has to pay for them at all?
Re:So how much was for actual medical care? (Score:5, Interesting)
An example demonstrating it very clearly is the cervical cancer vaccine developed with Australian taxpayers money, certified to US standards by the Australian taxpayer (similar to Australian standards so not a lot more) and licenced to US manufacturers for a very low fee. Guess what - it costs more than twice as much as anywhere else in the USA with the "R&D" excuse without a single dollar spent on research and development by those jacking up the price..
Most US commercial medical "R&D" is finding loopholes in patents or slight refinements in research paid for by taxpayers somewhere, often US taxpayers. There are exceptions but the markup seems to be an order of magnitude more. It's really just a way to lie about profit instead of being up front about it. Since there is very little competition in that market there is a lot of room to gouge money about of people instead of just making a comfortable living.
Re:I think that it's pretty much always worth it (Score:3, Interesting)
Of course not all of it. Not even a large part of it probably.
But, if when people got cancer they decided to just take pain relief medication and die quietly, nobody would do any research. Somebody has to fight until the bitter end. And those people are precisely those who try the experimental medicine, in case it helps. Even if research was entirely funded by donations, somebody still has to volunteer to try it.
The first heart transplants were a desperate gamble, but now thanks to all the attempts many people can actually enjoy a normal life afterwards, and some even manage to climb mountains.
Re:Stupid argument - money wasted elsewhere (Score:2, Interesting)
Since it's less than the price of Carly Flonina's stupid Devil Sheep advertisement who are we to say it's more of a waste of money?
Well, as a taxpayer being asked to potentially foot the bill for socialized medicine, I certainly get a say in this. I didn't pay a dime for that ad, so I could care less how much it cost. When I buy a product I pick the best product I can get for the money I'm spending, and as a result I could care less whether it might have cost 0.1 cents less if some particular corporate decision were made differently.
There's a vast industry and only a tiny proportion of it is focused on health care, most of it is about carving out monopolies to maximise profit.
I'll certainly agree that quite a bit of money goes into satellite industries, although the majority are focused to some extent on providing care. They all have overhead, but that is true of all industries.
When you look at healthcare there really isn't any single "evil" industry or factor you can point to as being responsible for all the cost. Insurers do create overhead and take profits, but they are only a component of the cost. Tort law certainly creates overhead and takes profits, but they're only a component as well. Doctors create overhead and take profit, and they're a component of the costs (and if doctors were perfect you wouldn't need all the overhead in the insurers and lawyers to catch them when they make mistakes or try to overcharge). Patients crave treatments that aren't cost-effective, and that drives up costs. There are a ton of factors that drive up healthcare costs.
you can forget about the "free market" because it does not apply
On that, we can agree. I'd go further and say that healthcare will NEVER be a truly free market, due to the nature of the bargaining positions of providers, payers, and patients. However, I do think that regardless of whether care is socialized or not that some reforms should be enacted to at least make the market a little more functional. There will always be a need for heavy regulation in this area, but the more effective the market can be made the more money whoever is paying for care can save, whether that ends up being patients or taxpayers.
Re:What is that for a question? (Score:1, Interesting)
I agree. But it is still a legitimate question to ask in some ways. Here (Canada) doctors have to ask it every time they consider treatment. However, they go about it in a very specific way: will this treatment improve/prolong this person's life and is it what the patient wants? If not, it doesn't happen.
I'm facing a rather similar situation with an 85-year-old close family member. They have terminal cancer and they've beaten the odds for 2 years now. The doctors were not expecting that length of time, but any treatment this person needed they got, and it has paid off. I'm sure they would have died a couple of years ago otherwise. Judging by degradation in their condition recently, it won't be much longer now, but I haven't had to worry about the financial aspects of treatment. The doctors have just done what is needed and what my relative wanted (my relative rejected some treatment options).
I've heard the rhetoric in the U.S. about "death panels". It's pathetic propaganda. These are honest doctors that are trying their best for the patient. They don't make these kind of decisions on their own. They consult the patient, they consult the family, and they weigh the medical options. Their job is to know the best medical treatment and what the likely effects are. They won't put patients through the misery of some invasive treatment or test with no hope of actual success. They will pick the cheaper/more efficient technique over the more expensive one if the outcome is the same (it's common sense). They explain the procedures, the risks and the potential benefits, and the patient makes the call -- every time, for as long as they are able to do so. After that the wishes they recorded beforehand apply, or the family steps in.
It is hard enough to make these decisions under the current circumstances, but to go through all of that *plus* having to wonder "Can I afford this? Is it covered by insurance?" is ... truly horrible to think about. And yet that's an aspect that families in the U.S. face all the time. I don't know how they do it. It must be hell on top of hell.
Re:Maybe she can answer in hindsight (Score:3, Interesting)
yes, but GP was talking about cancer. Is any joke appropriate?
Do what now? Are you saying there's some law forbidding jokes about cancer? Are there any other diseases on that list or are safe to joke about menstrual cramps, MS (the disease not the software company ... actually on this w/s that doesn't necessarily disambiguate!), D&V?
I used to wonder whether doctors should have a "Fuck me! Cancer" form they could just sign and hand to patients instead of all that hand wringing sad face crap!
We'd learn to dread the doctor pressing the intercom button and saying "Nurse, could you get me the FMC pad please".
IMHO laughing at cancer is the way forward. We should do all we can to diminish the general conception that cancer is a death sentence. Obviously, some cancers are bad - REALLY BAD - but a lot aren't, and something's got to get us in the end. There may even be some mileage in the perception that "being happy" is better for you than "being sad" so what better medicine than a book of cancer jokes, to be taken twice a day before meals.
Re:So how much was for actual medical care? (Score:5, Interesting)
Very simple - make medicare reimbursement legally dependent on eliminating the disgusting practice of overbilling uninsured patients. Legally mandate the same price for a procedure for everybody. The problem is right now they bill a theoretical price of $3000 for an X-ray, as somebody else just posted in this thread, but an insured patient gets $2200 of that price "waived by agreement" on their insurance statement, the hospital gets a $700 reimbursement from the insurance company, and ends up with a $100 bill to pay out of pocket.
A medicare or medicaid patient will be billed whatever the legally reimburseable and billable amount for the procedure under those programs.
The amazing part is only the uninsured patient, who is likely either young or poor or simply unlucky, is the only yutz who ever gets billed $3000. That is a made-up number. NOBODY else pays $3000. I promise you. My mother was hospitalized for a long period of time and I used to get these bills all the time for $2k-$5k procedures done while she was there. Reimbursement was generally between 20% and 40% of the theoretical billed amount. Even when a procedure was not reimbursed at all by the insurance company, they often would waive 60-70% of that theoretical cost "by agreement with insurance company" so I'd end up owing 500-600 bucks instead of thousands.
This practice should be made illegal. It's really despicable and punitive to the uninsured. If the hospital knew that medicare would immediate cease all reimbursements if they discovered this practice occurring, they'd suddenly find a way to bill a true, common price for the same procedure, not a hypothetical maximum which represents the most they think they could ever extort from any insurance provider or individual payer.
Aligning interests... (Score:4, Interesting)
The problem is that the best interests of the doctor are not aligned with the best interests of the patient. Instead, we've got a situation where the best interests of the doctor are to "play it safe, spend as much as necessary, preserve life at ALL costs (because that won't get me sued)". The tail is wagging the dog, in the form of a very small percentage of patients who will someday sue their doctors.
However, the solution is not tort reform--in the sense of limiting verdicts--because the problem is not the size of verdicts. The problem is the things that doctors do in over-the-top efforts to avoid really frivolous lawsuits. (Believe it or not, many doctors are devastated when they lose a patient, and to then be sued by the patient's family just makes it worse. So, to defend their own self-image, they of course do *everything* they can to avoid being sued. Which is very expensive.) I think something more akin to the "good samaritan" laws, where the nature of a doctor's obligations are spelled out, would be a better choice.
Re:So how much was for actual medical care? (Score:3, Interesting)
There is a HUGE amount of overhead in US health care starting with a massive markup on medicine which isn't seen elsewhere and ending with the support of a lot of middlemen. It doesn't matter if it's private or public - what matters is removing the leeches and profiteers from the system and turning it back into medicine instead of a protection racket pretending to be insurance and hospitals where care is an afterthought. The doctors are not the ones getting rich and if you want to see a nurse laugh ask them if they are rich. I doubt that the same amount of care elsewhere with the same treatments under a public system would have cost the taxpayer anywhere near one fifth of that. Remember folks, it's still a drain on the economy even if rich sick people are the ones getting ripped off instead of the taxpayer - it still hurts everyone to an extent.
My Dad was a doctor - a GP - in the UK and back in the 80's I remember him telling me about "medical insurance" for Drs, in case you get sued. He told me that Drs in the US paid more in insurance premiums than he earned per year! Who's benefiting from that and who's paying the cost!
it doesn't have to be that way (Score:3, Interesting)
Re:end of life medicine is expensive (Score:3, Interesting)
A third path (Score:3, Interesting)
After 250+ comments I am surprised that there is no discussion of a 3rd path, e.g. cryonic suspension. Ralph Merkle often presents a 2x2 decision matrix with "cryonics works / doesn't work" on one axis and "choose / don't choose cryonics" on the other axis. In only one of those boxes does one come out surviving. Yes, in one box, one comes out as "stupid" (cryonics doesn't work + choose cryonics) -- but asserting the negative (cryonics doesn't work) is a very hard thing to prove (esp. when asserting the alternatives -- disassembly by cremation or microbes are fairly certain to "not work").
Given that current prices (which I haven't checked lately) were of the order of $30-$50K for head/brain preservation and $130-$150K for whole body preservation it looks like the costs are 4+x cheaper for allowing a hospice path "death" followed by immediate cryonic suspension vs. the current medical paradigm of pulling out all the stops (no restrictions on costs) end-of-life care for people who are certain to die (and have presumably a low quality of life during that period).
I would request that you not even think about responding to this post in a "cryonics won't work" vein unless you really know what you are speaking about (meaning you really understand nanotechnology and nanomedicine and have a good working knowledge of cell biology and current cryonic suspension (vitrification) processes -- the information is out there on the WWW if one bothers to educate oneself). By and large I consider the current medical community to be guilty of malpractice if they only present the two "standard" paths (hospice care vs. full medical intervention) and leave out cryonic suspension. It is interesting that in the current debate regarding controlling health care costs that cryonic suspension has not come up in the discussion as an alternative.
Re:Mixing up advice (Score:5, Interesting)
I'm assuming by "brain leaking out", you mean that they performed a decompressive craniectomy. With such treatment, even someone with a severe head injury has some chance of survival without serious damage. What the doctor did in this case might not be at all unreasonable, depending in large part on a lot of subtle considerations like whether the patient had good pupil response on admission, the age of the patient (which in this case leads to a much better prognosis than with an older person), etc.
In one (admittedly small) study of severe head injury cases (all of which, AFAIK, would likely have been described in much the way you described this case), fully half of the people who underwent such surgery survived, and a third survived with no or minor disability.
In other words, the outcome is not always clear from outward appearance or even from the severity of impact. The doctor might well have legitimately thought the girl had a reasonable chance of recovery. Nine days is not really unreasonable. Brain swelling can easily continue for a couple of weeks, and I actually had a teacher once who was in a coma for many months (or was it years, I forget). I'd have to know a lot more than you've given me before I would agree that the case was hopeless.
Re:Health Insurance in Germany (Score:3, Interesting)
It is better to go to the doctor before a problem gets really bad. It is also cheaper.
And no, you don't pay for that. You pay for your own insurance.
Also you are a liar.
Twinrix costs EUR 65.60 per shot [medvergleich.de], Havrix 1440 costs EUR 47.25 per shot [medvergleich.de]. For just holidays one shot is enough and often the insurance companies pay for the vaccine if vaccination is recommended for that country by the Federal Foreign Office [big-direkt.de].
And by the way, antibiotics are quite expensive. The price of a box of generic amoxicillin is around EUR 70.
Re:So how much was for actual medical care? (Score:3, Interesting)
Legally mandate the same price for a procedure for everybody.
Stop the government takeover of health care!!!
Yes, I'm being sarcastic. At this point the best thing we could is have the government take over the other 50% of what it doesn't already control via Medicare, Medicaid, and the VA system.
Re:Mixing up advice (Score:3, Interesting)
Car insurance is much less than health insurance.
Well, sure. A nice car costs 20k. Insurance covers damage to that car, and another similar car, in the event of a crash. Some plans cover limited property damage, maybe a little medical too, but those plans are a steep step up from basic liability. Compare that to health care, I've worked in rooms where one piece of equipment the doctor is using costs more than that. Now instead of covering a 20k car, we are paying not only for some very very expensive equipment, but also the wages of a dozen people to give exclusive attention to a single person for several hours/days/weeks. Medical care costs exponentially more than a new car, hence insurance for one is much higher than the other.
You want proof? Uninsured medical procedures fall in price while insured medical procedures climb in price.
In all the operating rooms I've worked in, all the surgical procedures I've done, and in all my career, I've never known the insurance status of the guy on the bed. Nobody talks about it. What I have heard is doctors debating with themselves if they are going to need the $2000 sterile package that I have on hand and if I should open it or not. I've seen them try very very hard to avoid opening supplies because they know how much it costs, and don't want to have to charge the patient for it if they dont have too, irrespective of insurance status.
Re:Re-tooling (Score:4, Interesting)
I work in a publicly funded tertiary hospital in Australia. I'm not medical (I used to be a medical scientist) so I don't have the hands-on, day-to-day experiences of the clinical side of the hospital, but I do get to have glimpses of a 'big picture' view of it.
The head of radiology recently told me that the Uni was willing to "donate" a big expensive machine. Poisoned chalice, he said. They get all the kudos (and access to it for research), the hospital gets the bills. And no funding. Things like:
- floor space (and these are big mofos, some machines require vibration-proof rooms, or shielded rooms etc)
- installation (cranes and shit)
- power, both getting massive amounts of power to it and paying for massive amounts of power.
- operators
- maintenance (that's a biggy it seems)
None of these costs fit under "misc. expenses" I'm afraid.
Plus there's things like the PACS system to store all this data. Radiology has an IT storage system a little bigger than the rest of the hospital.
Buying the machine is small potatoes.