Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

https://www.npr.org/sections/health-shots/2019/02/26/696321475/cancer-complications-confusing-bills-maddening-errors-and-endless-phone-calls

by thebent • 7 years ago

265 300 7 years ago

npr.org

moviuro• 7 years ago

GDPR-friendly: https://text.npr.org/s.php?sId=696321475

_Microft• 7 years ago

Thanks!

davidscolgan• 7 years ago

This is honestly one of the things that most stresses me out as I get older. I don't use my insurance much now because I'm pretty healthy, but I know my cancer risk will just go up over time.

I've considered that if something like this ever did happen, I'd move to Lithuania and do it there paying in cash over trying to do it in the US system. Universal health care can't come fast enough.

creaghpatr2• 7 years ago

When you get old you presumably qualify for Medicare.

komali27• 7 years ago

Why not just make it so that you always qualify for Medicare?

emddudley2• 7 years ago

A lot can happen before age 65, and cancer doesn't wait!

maerF0x03• 7 years ago

Universal health care can't come fast enough.

What do you mean by "Universal healthcare"?

maerF0x03• 7 years ago

For the haters out there. I was genuinely asking a clarification question because "Universal Healthcare" can often mean compulsory insurance purchase, Single payer, single provider or other means too ...

As with many things I think the details of how is critically important...

more info: https://en.wikipedia.org/wiki/Universal_health_care

vamos_davai2• 7 years ago

It's such an absurd expense that I wonder if I get diagnosed with cancer, I would just deny treatment, accept death, and hand my assets to loved ones. Not sure if anyone else thinks the same way.

Filligree• 7 years ago

A lot of cancers have good a prognosis, especially if diagnosed early. Would you still do so if your chance of long-term survival and full remission, with treatment, is 50% or higher?

pacala• 7 years ago

Problem is, the treatment provider offers no hard guarantees: full remission or your money back. The claimed success rates could be based on research studies, which have a reputation to be systemically flawed.

Over a 10-year stretch, he said, Amgen’s scientists had tried to replicate the findings of 53 “landmark” studies in cancer biology. Just six of them came up with positive results.

https://slate.com/technology/2016/04/biomedicine-facing-a-wo...

vamos_davai2• 7 years ago

I think it depends on cost. Maybe if the cost is 5x my yearly income, then it's probably not worth it for me to continue going on.

leaveyou• 7 years ago

I'm not even in US and I'm considering the same.. if the expenses go above some reasonable threshold, I don't see the point of me living enough to see my family dragged into poverty. I don't delude myself - it's not easy to do.

InitialLastName• 7 years ago

Part of the problem is that, especially with an illness with as complicated a treatment process as many cancers, there's no way to even estimate the expenses. Even once you get treatment, the expenses might not be accessible until the bill comes in and you find out what your insurance company will pay for.

After that, there's a sunk cost issue: once you've dropped (N*your current net worth) on treatment, what's the harm in continuing?

untog3• 7 years ago

I don't think anyone can think about it realistically until they are in that situation. How much is another year of your life worth to you? And to your loved ones for that matter? (assuming we're talking terminal cancer here, which it might not be)

I have family that suffered from cancer and spent a good lot of money prolonging their life by about eighteen months. They were not pleasant months, but I don't think for a second that the family would have preferred to take the lump sum instead.

In short, every decision is horrible.

hirundo• 7 years ago

My mom fought cancer at great expense and with everyone's support, and just ended up prolonging her suffering. When my dad was diagnosed with cancer a few years later, remembering that experience, he fought pretty much everyone and declined treatment, and died swiftly. If my turn comes and my odds are about as bad as theirs, I may well prefer to follow his example.

ams61104• 7 years ago

I'm on the downward side of 50. My best years (physically) are in the past. My kids are nearly adults. I'd rather pass on my assets to them and set them up for a better life than piss it away on medical treatments that don't have much hope of working.

peteradio• 7 years ago

Take that lump sum or in another way of looking at it have that lump sum taken from them. Depending on the family situation this could cause knock on effect leading to financial burdens that who knows, could lead to suicide? Is that worth 18 months of a doomed persons life?

maerF0x03• 7 years ago

That is rational thinking through and through. Part of the reason that medical costs are so high is because some people will pay any price, to themselves or to society, to get/stay healthy.

A rational person says "some costs are too extreme and thus we must allow some to die".

A flip side of the argument is that very high cost(read profit margin) of treatment incentivizes others to fund research for treatments and cures.

JustSomeNobody• 7 years ago

This is a very good reason to make sure one has a living will.

duxup3• 7 years ago

If you've got kids and a family, they may not agree. It's a terrible situation to be in.

komali27• 7 years ago

I think your family would spend that money and more to get more time with you.

fastball• 7 years ago

Still not rational. Just because people want to do something, does not mean it is the best decision for them.

DanBC3• 7 years ago

How much time? Two weeks? This is how long some of these advanced, very expensive, cancer meds give you. https://www.bmj.com/content/357/bmj.j2097

drdeadringer• 7 years ago

I would consider this seriously for myself.

I've been thinking about my own death since ~2003. I have established what I want to happen to my body; I have yet to determine an official will, medical attorney, &c and that great fault is on me.

I recommend following "Order Of The Good Death" for the "US alternatives on Death". It is good times. Yes, talking about Death counts as "good times"; it is not difficult to imagine your survivors arguing over your body... about your body... about your assets... about your legacy... about your estate... and so forth.

brightball• 7 years ago

That was actually one of the cornerstones of the HSA for everyone plan that Ben Carson was pushing. The government would pay into your HSA and when you got a diagnosis like that, you’d have the option of not continuing treatment and passing the balance of the HSA to your family.

ZeroFries• 7 years ago

I think that route is unpopular because we no longer have a sane relationship with death as a society. Religion, at least in theory, should help, but rates are declining there too. We'll pay any price to avoid the inevitable. We'll spend hundreds of thousands to get one more year of poor quality time with family, yet neglect to spend that time in better quality when health is taken for granted.

If you had no family, you could save many more lives for cheaper and easier to treat sicknesses, plus donating your healthy organs.

evolvedcleaning2• 7 years ago

This is precisely my plan. I gave away upwards of $1 million USD last year. I have no assets remaining, no career, parents, spouse or pet. I’m almost out of money finally.

40 something white American male college drop out with no social connections. Tinnitus and hyperacusis long term.

The biggest part is figuring out how to maximize the donation of my organs to the medical school by coordinating self termination in a country where suicide is still largely frowned upon.

I have no insurance and just yesterday I had serious chest pains for the first time on the right half. This is almost certainly the result of not taking care of my body. Better to self terminate and spare suffering and resources, and to donate the organs.

AnIdiotOnTheNet3• 7 years ago

When societies began moving on, philosophically, from dogmatic religions and into the current era of empiricism, we lost the ability to put death in context. Empiricism tells us that when you die, there is nothing, and the objectively rational thing to do is whatever it takes to live as long as possible. Empirical thought patterns tend towards extremes. What society needs to do, and possibly is in the process of doing, is recognizing empiricism as an incomplete model of reality. Hopefully that will lead us back towards a healthier relationship with our mortality.

mrburkins• 7 years ago

I always thought this was the way to go. People routinely punch the numbers to figure out if they can 'afford' to have a child, why is it so strange to do the same for end of life?

011000113• 7 years ago

I have two friends who have survived cancer. Both of them have said that they would skip treatment if they could relive the experience. I lost another friend to an agonizing one year battle with glioblastoma.

If I ever receive a cancer diagnosis it will probably be the end of me. I have great life insurance and my survivors will be well taken care of. Even with the modern, immune-based chemo(which my friend had for melanoma), there are severe and permanent side-effects. After watching my friend with GBM die, I realized the medical industry is more than happy to take any money you have even if there is no chance they can help.

AnIdiotOnTheNet3• 7 years ago

That's any easy statement to make when being diagnosed with cancer is some small probability potential future event.

Not that I really disagree with the sentiment, but I find it difficult to judge people actually staring death in the face based on my comfortable position of, well, not.

rootusrootus3• 7 years ago

My doctor and I had a conversation about this and that was his position, though not for reasons of expense. He says it's a fairly popular position amongst his peers, as well. Those who get to see first-hand what treatment looks like don't want to go through it themselves.

cannonedhamster11• 7 years ago

So it's definitely something that goes through your mind, however I've had the discussion with my wife. There's also the possibility that you'd be cured. It's entirely going to depend on your diagnosis, which you literally don't know until after you've gone through a CT scan, PET scan, and possibly surgery to determine tumor staging. I can say based on numerous conversations with other people, if you think you're going to die, you're going to die. Cancer is also extremely painful physically for some people with or without treatment. Best bet? Get life insurance.

ucaetano• 7 years ago

More than 42% of 9.5M people with cancer drained life's assets within 2 years in the US.

porphyrogene• 7 years ago

The publication is NPR so that it is US news goes somewhat without saying. However, this is something that Americans need to understand is exceptional for a nation of its resources.

mbostleman3• 7 years ago

So what is the solution? More than 42% went all in with the constraint being their personal assets. If that constraint was lifted, then what would the next constraint be? Obviously the additional assets would come from other people, and probably not voluntarily (which is a different issue), but what would be the limiting factor then? Also, I assume the new pool of assets would be available not just to the 42% that were willing to put all of their own in but to the remaining 58% as well. The US may be a nation of relatively high resources, but they aren't infinite. What do the rules look like for this in other nations?

refurb3• 7 years ago

Yes, but bankruptcy due to health reasons is actually quite common in Canada as well.

Why? If you’re sick enough you can’t work or pay your bills so you go bankrupt.

It’s not just healthcare costs.

Survey research commissioned by the Canadian government found that despite having a government-run health system, medical reasons (including uninsured expenses), were cited as the primary cause of bankruptcy by approximately 15 percent of bankrupt Canadian seniors (55 years of age and older).

astrodust• 7 years ago

It happens more frequently with non-life-threatening conditions where you slowly get ground down not from hospital bills, those don't really exist, but from ongoing medical costs, like expensive prescription medication or other supplies.

Kurtz79• 7 years ago

Not sure for Canada, but in many EU countries, if you are employed, you will keep receiving a large percentage of your salary when on extended sick leave, mostly paid by social security after the first few days.

https://www.researchgate.net/figure/Paid-sick-days-and-sick-...

My mother was on sick leave for many months for breast cancer and the illness had a relatively small impact in terms of family finances.

LorenPechtel• 7 years ago

Yup. The real issue is a lack of disability insurance, not failings of the health insurance system.

this_user• 7 years ago

In the US.

RIMR• 7 years ago

I hate to be political, but anyone who looks at these numbers, and believe that the system is working properly as intended is absolutely an enemy of American Prosperity.

lghh• 7 years ago

I would argue that the system is working as intended, it's just not to your or my or most other people's benefit.

FilterSweep• 7 years ago

I would say both your comments are true.

zawerf• 7 years ago

I think that's just a corollary of "63% Of Americans Don't Have Enough Savings To Cover A $500 Emergency":

https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-...

EDIT: My comment is in reference to the old thread title, which was something like "More than 42 percent of the 9.5 million people diagnosed with cancer from 2000 to 2012 drained their life's assets within two years"

tashoecraft• 7 years ago

That was my initial thought, and it's definitely related, but the term used here is assets which people generally have a lot more of then just raw cash savings.

vonmoltke• 7 years ago

The abstract to the paywalled study cites the average expenditure being about $92k per person in the study. While it is still ridiculous that people should have to pay that much to fight off an illness, that is a disturbingly low value for an "entire life's assets", particularly considering the study was restricted to people who are 50 or older (with an average age of 68.6).

lojack• 7 years ago

None of the surveys linked in this article go over age distribution of savings -- something I'd expect to be inversely proportional to incidences of cancer.

lenticular• 7 years ago

Even with insurance, folks often wind up with six figures of bills out of pocket treating cancer. That's a huge amount for the even most frugal of the lower or middle class.

zxcvbn4038• 7 years ago

When my son was born he fit in my hand and spent his first three months in NICU. I guess the nurses thought his survival was questionable so they entered in his name into the computer as “Baby Boy”. A few months later I started getting bills (eventually around $3 million) because there was nobody named “Baby Boy” on my insurance. Calling the insurance to try and correct was a nightmare - wait on hold for an hour, get 3rd degree interrogation about my identity, wait on hold, explain that son was on insurance but not called literally “Baby Boy”, wait on hold, get interrogated for his details on son’s identity, wait on hold, long series of questions to determine Baby Boy isn’t real and let me know about penalties for fraud. Three hours later done, that covers the first $50. Decided I would never do that again, let it go to collections and explain it to the judge. Turns out that before it goes to collections it goes to someone with a brain who realizes “Baby Boy” is in-fact the infant boy with identical birth date on my policy, notices stop coming. No telling how much money they spent sending me all the nasty payment due letters in the mean time.

cushychicken• 7 years ago

Certainly, but the person in the article was a woman with enough savings that she had planned to retire early.

If it can hit her that hard, it would be devastating to someone without $500.

Para2016• 7 years ago

Not really, if you don't have money you likely don't have insurance and you are moved to hospice care. Maybe you can get a round of palliative chemo when tumor burden is high enough to cause symptoms (shortness of breath, gastric outlet obstruction, liver dysfunction, etc). So it's less of a financial devastation and more of a life ending diagnosis.

If you have money and insurance then a hospital and insurance company will gladly work together to take what money you do have. Sort of like a chicken wishbone.

dajohnson89• 7 years ago

cancer treatments in USA are several orders of magnitude more expensive than $500. I know a breast cancer survivor with $100k of medical debt.

cannonedhamster11• 7 years ago

Let's see, since starting treatment in October, even with awesome healthcare we've spent over $5k in treatment. I absolutely believe the $100K statement as I've seen what the insurance pays.

maxxxxx2• 7 years ago

Not with cancer. I know people who had cancer and there was a never ending inflow of bills for 5000 here, 10000 there until they were wiped out. Add to that the fact it’s very hard to fight your insurance while you are very sick.

erichurkman• 7 years ago

I wonder what the downstream effects of this are on building generational wealth. 100 years ago, when your parents died, you might inherit a home or a small amount of money. That then helped uplift the next generation. Now, if your assets are drained, you have a reverse mortgage, etc, there's nothing to pass on except for the very wealthy.

Cancer sucks.

DanCarvajal• 7 years ago

This was definitely the case with my grandparents, but it wasn't even cancer it was just the long term cost of care for people who live well into their 90s.

triplewipeass2• 7 years ago

When I was in my early 20s, I got myself a beefy life insurance policy that covers suicide after some waiting period that has expired many years ago. I know that in case of crippling illness I can always take the easy way out while preserving my assets plus the life insurance payout. My family would be taken care of.

viburnum• 7 years ago

This a good solution that scales.

phonon• 7 years ago

Ummm...maybe buy Aflac instead (cancer insurance).

komali27• 7 years ago

My family would be taken care of.

And possibly traumatized that you killed yourself so they could have money.

triplewipeass2• 7 years ago

In case of being stricken by an incurable disease, I'm going to die anyway. I'm sure my people will understand my choice to make a graceful exit before illness takes away any shred of my dignity.

smallgovt5• 7 years ago

It's interesting to me that life insurance policies exist that cover suicide. I assume it means that people over-estimate their eventual willingness to commit suicide.

bluetidepro• 7 years ago

I didn't know this was a thing (life insurance policy that covers suicide), very interesting.

lotsofpulp8• 7 years ago

My plan in a situation that would burn up all of my assets for little guarantee of meaningful gains is to off myself to prevent using up my family's assets. I wouldn't want to sacrifice the future of the rest of my family to milk a couple more years, especially with reduced quality of life. Assuming I'm mentally strong enough to, anyway. Although, nowadays with mandatory out of pocket maximums, if you have insurance, this shouldn't be as widespread of a problem.

komali27• 7 years ago

off myself to prevent using up my family's assets

I'd give 90% of my income if it meant my friend that "offed herself" could still be alive.

Decisions like that have consequences beyond you...

lotsofpulp8• 7 years ago

I agree, and I think one consequence of using up my family's assets would be a decrease in the probability of my kids' having secure futures, which I wouldn't want either.

h3daz• 7 years ago

Moving to Switzerland, you'll be compelled by law to get health insurance and you will be covered no matter what for roughly 500 bucks a month with a 300$ deductible.

OnACoffeeBreak• 7 years ago

This is a 2019 article covering a study that covers 2000 to 2012 and doesn't mention the Affordable Care Act signed into law in 2010. Insurance landscape has changed quite a bit in the USA since ACA, which makes this not very interesting. What I would be interested in is repeating the study now and comparing results.

corbet• 7 years ago

I would expect the results to be no different - the article was talking about people who already have insurance. I've been through the incredible medical-bill maze that results from cancer treatment since then; it's just the same. The ACA was explicitly designed to perpetuate the current insurance system, why would you expect the situation to have improved?

lotsofpulp8• 7 years ago

Before ACA, there were lifetime benefit limits. After ACA, there is no limit, so it will have greatly changed the situation that people facing years of very expensive treatment faced. Now, you are spending a max of $10k per year on in network providers, or whatever your annual out of pocket max is. Before the insurance company had the option of telling you that you've maxed out your benefits and you're on your own, and/or not offering health insurance coverage for you in the future period.

The removal of lifetime benefits, ability to deny pre-existing conditions, and setting a maximum range between the lowest premium that can be offered and highest premium that can be offered greatly improved access to health insurance benefits for everyone. At the expense of making it more expensive for the young and healthy, but obviously someone has to pay, and we as a nation don't want it to be via taxes.

cannonedhamster11• 7 years ago

I got cancer in 2018. Very little has changed. It's still very expensive.

deisner2• 7 years ago

"But none of these is her most gnawing, ever present concern.

That would be the convoluted medical bills that fill multiple binders, depleted savings accounts that destroy early retirement plans and so, so many phone calls with insurers and medical providers."

Is it like this in other OECD countries? I ask because I'm told that we in America have "the best health care system in the world."

lotsofpulp8• 7 years ago

No, my family in Canada and UK don't deal with any of this. In the US, it's not even worth your time figuring out how much your treatment will cost, other than whether or not the provider is in network or not. Assume it's the out of pocket maximum for your insurance, because when you go to a provider, you sign a blank check that says you will be responsible for whatever chargers they make up during the course of your treatment. So your only ally is the insurance company, who has the power to deny payment for things like $15 worth of linens (which was actually a few pieces of paper towel).

shereadsthenews4• 7 years ago

You can't figure out whether your provider is in or out. Just yesterday I got a bill from someone I've never heard of who turns out to be a "Medication Safety Specialist" who allegedly rendered services to me worth $392. You'd think such a person would just be a functionary of the hospital who in any case bill me $27k every day, but actually they are some kind of mercenary who bill patients directly.

maxxxxx2• 7 years ago

" whatever charges they make up during the course of your treatment"

That's the worst. Pricing is totally arbitrary. You may spend 5000 or 100000 for the same thing and there is no way to know upfront.

lars512• 7 years ago

No, this side of it is definitely better in other countries.

My late wife passed away of cancer a few years ago, we lived in Australia. She went through rounds of intensive treatment. We had private health insurance which kicked in, limiting our up-front costs. Not all was covered, but what wasn't covered was capped through public health care. It might have cost us $10k AUD, but not more.

We spent little to no time worrying about paperwork and billing, it was almost all auto-handled for us.

mikestew• 7 years ago

I ask because I'm told that we in America have "the best health care system in the world."

I'm going to assume that you're asking an honest question, but I'll tell ya that (and I can not emphasize this enough) from my perspective the question is so naive that I seriously think I'm missing the sarcasm.

But in good faith I shall carry on...AFAICT, "US=='best'" is propaganda, or ignorance at best. We (I am an American) have poorer outcomes for more money spent. Now, many excuses will be offered as to why that is, but I'm not here to argue; as best as my research can do, that appears to be fact. On top of that, for a less capable and more expensive product, we have a byzantine system of forms and providers.

So, no, it would appear that other OECD countries do not have this issue, partly/mainly because all but a few (and I would be hard-pressed to name those few) socialize their medical care.

Sharlin• 7 years ago

No, it is definitely not. Whoever tells you that is either lying, ignorant, or in denial.

deisner2• 7 years ago

My question was slightly sarcastic, but primarily sincere, in that I want to hear first-hand accounts from cancer patients in other OECD countries.

Rudy Guliani said this in a campaign ad [1] when he was running for U.S. president in 2007-2008. I also recall him saying this in one of the Republican debates. When my (now) wife, who is German and has also lived in Denmark, heard this she couldn't help laughing.

[1] https://www.cbsnews.com/news/giuliani-ad-chances/

gambiting• 7 years ago

My father fought cancer for the last 8 years of his life, and was on 2 boxes of Glivec a month for all those years(in US Glivec treatment costs about $146,000/year[0]). He also had 2 operations to remove some tumors, plus bi-monthly MRI to check if the cancer came back. He has never paid a single penny towards the treatment. In fact, the hospital would always reimburse him for taking the train every month to get his drugs and check-ups done. There were no bills to pay, I think he only had to sign one piece of paper every month to say that he picked up his medicine and we could go home. There were never any calls to any insurers or medical providers, simply because as patient over here you don't care who is paying for the treatment. You turn up to the hospital for whatever treatment is planned and that's about it. You don't even know how much the hospital is paying and to whom. It doesn't even matter if you are currently employed/unemployed and if you're paying towards the national health service - if you are not employed(say as a result of your illness) you are still 100% covered anyway.

After he passed away(the cancer unfortunately came back and not much could have been done at that point) his savings account was definitely not affected by 8 years of illness.

That's in Poland btw.

[0] http://www.ascopost.com/issues/may-25-2016/the-arrival-of-ge...

Xixi• 7 years ago

The administrative/insurance side of American healthcare is probably one of the worst, if not the worst in the developed world. But the quality of the care itself (the actual treatments) is very high, probably one of the very best. I think the American health care is especially good in terms of treatment availability: many drugs are simply not available in other countries (or are available but not covered).

Some people are genuinely concerned than touching the former (administrative side) will result in lowering the level of the latter (quality/availability of care, drugs, etc.). That it's the inherent high cost of the current US system that somehow makes it so good in terms of availability/quality of care. I disagree, but can somehow understand the line of thought.

EDIT: I have no idea to what extent care is really better in the US than elsewhere, but know first hand of someone who had to pay for interferon out of pocket in Japan because it was not yet covered at that time. It's not rare for the newest US drugs to take many years to cross the Pacific ocean...

cletus4• 7 years ago

In Australia the Leftist government of Gough Whitlam introduced health-coverage-for-all in 1975 with a scheme called Medibank. In 1984 after a couple of governments, Bob Hawke's Leftist government created the Medicare scheme (Medibank became a government provider of private health insurance), which exists to this day.

The most interesting stat I ever heard about Medicare was this: prior to Medicare the number one cause of personal bankruptcy in Australia was medical bills.

So I'm with Bernie on this: health coverage for all is an incredibly important goal.

While we're at it, let's end the monopoly given to drug companies on the sale of pharmaceuticals in the US. You should be able to legally import them from, at the very least, any NAFTA country and any EU member.

chaosbutters• 7 years ago

doesn't matter who is president in 2020, if the senate isn't blue. And right now, it doesn't look like the senate will even hit 50/50.

metalliqaz2• 7 years ago

The political system in the US biases area over population. The Senate will remain conservative as long as rural states remain conservative, and that will never change.

kibwen• 7 years ago

Fortunately (ironically, sardonically), thanks to the precedents being set by the sitting president, future presidents will be free to declare healthcare a national emergency and divert funds away from, say, the defense department in order to pay for it. A slim majority in the senate and a minority in the house won't be near enough to stop them. The current senate dissolves the checks and balances at their own institutional peril (and no, this isn't a situation anyone ought to be celebrating, except for the authoritarians).

cletus4• 7 years ago

So there's a lot I could say about this.

First is an example. As much as I, personally, liked (and continue to like) Obama as a person and as much as I agree with most of his policies, at the end of the day he was a pretty ineffective president. Why? Because he could get hardly any legislation passed (Obamacare aka the Affordable Care Act being the principle counterexample). He was a president who ruled by executive order.

The White House is the largest and loudest bully pulpit in the country, by far. You can point to Congress and call them obstructionist but the buck stops with you as president to move your policy agenda and change the national debate. And Obama just wasn't effective at that.

Again, with one exception. It used to be a fairly popular opinion in the US that health coverage was for those with jobs, basically. That still is the position of a significant portion of the population but it's not as popular as it used to be. Obama did change the national debate on this such that the question became how we should provide health coverage and not whether we should.

Go back a decade or more and the Bernie Sanders coverage-for-all policy platform would've relegated him to being a minor player in the primaries, not taken seriously. The fact that he was as prominent a figure as he was is in no small part due to Obama changing the debate on health care (IMHO).

The second thing I'll say is that nothing lasts forever. Demographics change. Opinions change. California voted for Reagan. Twice. It used to be a competitive state. Now it's safely Democratic. Florida used to be safely Republican but (largely due to migration from the Northeast) but now it's a battleground state.

Let's just say that at some point Conservatives get what they've been hoping for: Roe v. Wade overturned in the SCOTUS. It could happen. Largley though the "damage" has been done already. It won't be illegal. It'll just be a state issue. Many states will legallize it the next day. New York for example has already made moves to enshrine the legality of abortions in state law. Now this will suck for particularly poor people in Alabma but in a way Alabamans will get the state government they seem to want.

So let's say that happens. The problem then for Conservatives is they've lost a defining and unifying (for their base) issue. One can argue they're better off politically this way as they'll fracture in the aftermath.

I see the current Conservative bent as a desperate last gasp for what is a majority (in their respective states) that's in decline. A lot of damage can be done before this naturally remedies itself but we're not headed to a dystopian Handmaid's Tale future either.

JamesBarney6• 7 years ago

I'm all for universal coverage too. But reducing the profits of pharmaceutical companies well reduce the money they have for r&d dramatically.

This will slow down the speed of pharmaceutical development. So I think it needs to be paired with reforms to the FDA to reduce the go to market costs for drugs.

rndgermandude3• 7 years ago

What kind of evidence do you have for this claim?

gregcrv• 7 years ago

From https://en.m.wikipedia.org/wiki/Prescription_costs

“A study has placed the amount spent on drug marketing at 2-19 times that on drug research”

Maybe this should be reduced first?

AWildC182• 7 years ago

They'll do just fine. The money doesn't all go to R&D, it goes to execs and shareholders. If you force them to compete then you streamline cashflows.

milesvp• 7 years ago

I’ve never bought this argument about r&d for drug companies, and I have even less faith in the argument after learning recently that much of this r&d is used to modify an existing drug, not to make it better, but to essentially earn another patent on said drug and keep it out of the public domain for longer.

Couple this with the fact that there is a large focus on designer drugs, and dependency rather than curative drugs, and there’s snake oil being sold by drug companies that they absolutely need a regional monopoly to bring us new and life changing drugs.

EliRivers• 7 years ago

I wonder if, even with a reduction in new drug development, cheaper healthcare would nonetheless work out as a net win. If all the drugs that currently exist getting much cheaper would improve people's lives (both now and into the future) to a degree that outweighed the benefits of continuing R&D at the current pace.

cletus4• 7 years ago

Pharmaceutical companies spend way more on marketing than research.

If drug companies are willing to sell the exact same drug in Canada or the UK or Germany or France for less than a percent (in some cases) of what they sell it here for then why can't US insurance companies, hospitals and consumers buy it for that price? There's no reason other than an artificial monopoly.

You'll note that I didn't say "anywhere" and that was deliberate. India, for example, has decided that drug companies largely (it's complicated) don't get monopolies from patents and thus you can buy a lot of low-cost high-quality generics in India because no drug company is getting paid.

Obviously this is untenable at the global scale.

And before anyone lambasts India for not respecting patents here, countries do this sort of thing all the time. In the US, for example, you can't patent nuclear technology as a matter of national security.

deogeo• 7 years ago

Going by this logic, is there a limit to how extortionate drug pricing can get? After all, some fraction will go towards R&D!

cannonedhamster11• 7 years ago

Most basic research is funded by the government as there's no inherent profit motive. Research to make use of the foundational discoveries is funded by profit motive, as they get a monopoly on any working product. I'm pretty sure R&D is safe as there will always be profit to be made. You're also assuming congress isn't in bed with the industries, the ones who massively fund their campaigns and offer nice lobbying jobs afterwards.

ranie932• 7 years ago

I think the current friction in free flow of medication across borders is not unwarranted. I'm thinking of Thalidomide as an example.

https://en.wikipedia.org/wiki/Thalidomide https://en.wikipedia.org/wiki/Frances_Oldham_Kelsey

chimeracoder9• 7 years ago

I think the current friction in free flow of medication across borders is not unwarranted. I'm thinking of Thalidomide as an example.

That's a completely different situation.

Currently, if an American pharmaceutical company produces a drug in the US and exports it to another country, people in the US cannot purchase it from foreign suppliers, even though it's both FDA-approved and produced by the same manufacturer. This dramatically raises the prices of drugs in the US.

Allowing imports of FDA-approved drugs from both domestic and foreign manufacturers would reduce prescription costs in the US greatly.

5trokerac37• 7 years ago

The United States currently has the highest 5 year survival rate for all cancers combined. I think it's a fair question to ask if that would continue to be the case in a MFA system for 300 million patients.

Considering what a disaster the insurance marketplace was, I'm very skeptical.

Edit: what I mean by "disaster": when it launched, the site completely crashed for over a month and then, when it finally came back up, the policies offered weren't accepted by most doctors, because they had crazy restrictions.

dontreact4• 7 years ago

The U.S. actually has worse health outcomes overall than Japan and France who both have universal coverage (through different systems)

Sahhaese2• 7 years ago

I wonder how much of that is down to better/earlier diagnosis \* ? My experience with the NHS is that diagnostics in general isn't great because it's essentially a money-sink, you have to push very hard for a diagnosis a lot of people get a diagnosis privately before going back to the NHS for treatment.

Once diagnosed however I've never had any problem getting top quality treatment. This is an anecdote, of course, so I'd be interested to see the statistics.

\* Or even over-diagnosis? It's "easy" to have a high 5-year survival rate if you push removal of tumors that may well have been benign.

burkaman2• 7 years ago

That's a cherry-picked stat. Most health outcomes are worse in the US than other rich countries with universal healthcare. There are many studies and charts you can search for, here's one: https://jamanetwork.com/journals/jama/article-abstract/26746...

bryanlarsen• 7 years ago

5 year survival rate is poorly correlated with treatment efficacy. It's mostly correlated with how early a cancer is diagnosed.

In most cases it's a good thing to detect cancers early, but saying a country is good at detecting cancers is not near as strong of a statement as saying that a country is good at treating cancers.

And this gets complicated by prostrate cancer -- many would argue that mass screening for prostrate cancer causes more pain and suffering than it prevents.

emddudley2• 7 years ago

It sounds like you are implying that cancer survival rates are affected by the way Americans pay for healthcare. What specific mechanisms do you think are the cause? Total spending, ability to see doctors, insurance company approval of certain treatments...? Or something else?

cannonedhamster11• 7 years ago

As a person with cancer going through treatment, even with fully paid for by my employer healthcare and making a good amount of money, this is super expensive and if I didn't have a job where I could work remote, I'd probably be bankrupt by now with all the time I have to spend in treatment and the initial surgeries.

5 year survival rates vary by the type of cancer, while cancers like leukemia, prostate, and breast cancer have made progress, most of those survival rate numbers are based on catching the cancer early, which, unfortunately most aren't caught early leading to a poor prognosis, my prognosis for example is 5% overall survival for 5 years with a significant drop off after 3 years. The survival rate is also heavily dependent on comorbidities, or other things that impact your health, this can leave things like surgery off the table.

Another fun fact is that we really still suck at cancer treatment because we don't know how it functions, and as previously stated there's over 100 different types of cancer, each with their own mechanisms and subtypes.

So to your main point, no unless there's some massive breakthrough in immunotherapy that's pan-cancer responsive for most patients (right now immunotherapy only works for roughly 20-30% of patients), the costs aren't going to go up dramatically as the primary option is surgery if it's early and if it's late you're probably still going to be dead within 5 years. The number of patients surviving each year only goes up by about roughly 2% per year.

flexie4• 7 years ago

And that's the essence of this: In the developed world, this is all but a US specific issue. Cancer and other life threatening diseases rarely bankrupt Europeans, Canadians, Australians, Kiwis, Japanese etc.

chimeracoder9• 7 years ago

Cancer and other life threatening diseases rarely bankrupt Europeans, Canadians, Australians, Kiwis, Japanese etc.

Sure, but they're also dramatically less likely to survive the cancer than Americans are at a population level. There have been multiple long-term studies on cancer survival rates that have demonstrated this.

ams61104• 7 years ago

I don't know about the rest of the world, but bankruptcy in the USA is not really the catastrophe you might think it is.

You can keep a lot of your assets, generally including your retirement accounts, at least some equity in your home, your car, your personal property. Your credit is badly dinged and you'll have trouble borrowing money for a while, but even that is only a temporary setback.

I know people who have gone through it, in once case more than once, and at least from appearances they have a pretty normal lifestyle.

The recovery from a bankruptcy is probably a walk in the park compared to recovery from cancer (not speaking from experience). Ultimately it's just money.

onetimemanytime2• 7 years ago

If health care for all reduces prices and total cost, then yeah. Otherwise, the cost will cripple the government, and by extension taxpayers. Right now they can declare bankruptcy and just don't pay (at a great cost, no doubt) but the government will have to pay. Cancer is a fact of life,38.4% will get it in their life https://www.cancer.gov/about-cancer/understanding/statistics and unless costs are dramatically lowered any plan will be bankrupt.

bubbleRefuge3• 7 years ago

The federal government cannot be crippled because it can issue currency ad-infinitem. As AOC is wonderfully publicizing, the notion that government finance works like household and business finance is finally starting to be debunked and at least talked about openly. There maybe other problems with universal healthcare, but financing it is not one of them.

mywittyname4• 7 years ago

People often don't even need to declare bankruptcy. Lots can get away without paying and the hospital will write off the charges without any ill effect.

tmaly• 7 years ago

We still cannot get a price list of medical procedures in the US thanks to the antitrust exemption provided in McCarran-Ferguson Antitrust Act of 1945.

I think repealing this would be a good start. All other industries are required to provide price lists. My friend went to the ER recently for a sprained thumb. They wrapped it in some bandage and he got a bill for $14,000.

His insurance is covering 80% but he is still on the hook for $2800 for a sprained thumb. Something is not right here.

throwaway57523• 7 years ago

Why did he go to the ER?

sbov3• 7 years ago

Don't go to the ER for a sprained thumb.

Unless its an actual emergency, go to urgent care. I live in a pretty expensive area of California and they still only charge $95 per person they see. And our insurance covers it completely. And rightly so, they would much prefer a $95 bill to a $14,000 one.

With kids we go a couple times per year. They definitely have saved us a lot of money and time.

kindatrue• 7 years ago

Interesting trivia - health insurers kind of don't care about these big bills, despite what most people think: https://www.propublica.org/article/why-your-health-insurer-d...

ticviking• 7 years ago

This!

I've got family in health management and THEY can't reliably figure out what a procedure costs(not even something like a simple statistical characterization) much less what they should charge for it.

jimmydddd• 7 years ago

Yes-- we need price information. A family member (US citizen) lives in Europe and has free government health care there, but you often have to wait several months to get treated. Instead of waiting, she thought she might just do needed cataract surgery in the US to get it done if it didn't cost too much. I called several medical centers that do cataract surgery for an estimate. Can't provide it. Can you give a ballpark range? No. Can you say if it's closer to $1k, $10k or $100k? No.

joelx• 7 years ago

Our healthcare system is set up for the enrichment of doctors at the expense of patients. Here is a great article showing this yet again. When you go get a fast food hamburger for $1.49, you will only extremely rarely receive a poorly made burger or have a billing mistake or get food poisoning. So why are you virtually guaranteed to not get what you pay for and get overbilled anytime you visit a hospital? The doctors union has strictly prevented any kind of competition and innovation in healthcare.

mnm1• 7 years ago

This is the only solution. Every other developed country in the world has healthcare for its people. Politicians that don't support this are monsters who'd rather kill millions and ruin millions' more lives. They are disgusting, inhuman, immoral scum who would rather enrich their billionaire backers than help people live and recover from illness. These are the people that we should use the death penalty on because they have killed and will kill millions unnecessary. All out of greed and hate for their fellow Americans.

coredog64• 7 years ago

A fair chunk of what we in the US would consider “medical bankruptcy” is not the bills, but a consequence of chronic illness. If I’m living paycheck to paycheck, any disruption is going to hurt. That could be unpaid leave, but it could also be disability insurance that doesn’t replace 100% of your income. Regardless of how health insurance is paid for, those are going to happen.

cletus4• 7 years ago

Let me play devil's advocate.

What if living paycheck-to-paycheck is a consequence of having no health coverage?

Think about it. If you're on a low income that largely matches your outgoings, bills of thousands of dollars will wipe you out regardless of whether or not you save. So why save? You may just reduce any benefits you get from the state or Federal government (medical or otherwise) and those will be wiped out anyway. So you may as well spend now.

Consider, the Earned Income Tax Credit is one of the few times lower income households can make large purchases (and there's evidence of this in TV purchases and elsewhere).

notabee• 7 years ago

Disability insurance, like other insurance, is motivated to find loopholes with which to deny you. Make sure to read the fine print while you're still well and able.

shereadsthenews4• 7 years ago

I'd like to know where the patient with the $870 MRI bill was seen. My last MRI was billed at over $7500. Before I started treatment for my brain tumor I got divorced for purely financial reasons and gave all my remaining money to my children. USA is so fucked.

Marsymars• 7 years ago

We've got private MRI clinics in Canada, and Googling prices for my city gives a number of clinics with prices in the 700 CAD range.

nradov2• 7 years ago

For non-emergency imaging studies it's worth shopping around. Prices really can vary by a factor of 10× between facilities in the same area. For those with private insurance, most major insurance companies offer some sort of cost estimator on their web sites which allow members to see which radiology centers are cheaper.

(I do appreciate that this is a bad experience for patients.)

rarecoil• 7 years ago

I needed an MRI a few years ago, and my insurance provider actually called me to tell me about insurance-preferred imaging centers, and how much the out-of-pocket cost would be at those centers vs. the one my MRI was initially scheduled at.

madengr• 7 years ago

Other than cash, how do you give money over $15k without being nailed by the gift tax? Keeping as much money in retirement savings seems wise as those are exempt from liens.

bluesroo2• 7 years ago

On top of the yearly exemption, you have a lifetime exemption in the US of $11.18M.

ThrustVectoring2• 7 years ago

IRAs are not exempt from creditors in all states, FYI. Texas has solid unlimited protection at least, though.

011000113• 7 years ago

Some of the cost difference is likely due to different procedures and materials(i.e. contrast agents).

pastor_elm• 7 years ago

I remember the radiolab episode on worth[0]. Is another month of life with cancer worth x amount of dollars? Who should pay 100k for a medication that might let you live a month longer with pancreatic cancer. I imagine most Americans don't look at it that way.

[0]https://www.wnycstudios.org/story/worth

kevmo• 7 years ago

I published a piece on debt in America last week and touched in the subject of medical debt. When you look at it from a broader perspective, most Americans are in a financially dire situation. 42% sounds lower than I would have expected.

Americans are Drowning in Debt: https://thenib.com/americans-are-drowning-in-debt

cpursley• 7 years ago

Yep, paying off my debt (except mortgage, which is affordable and only 15-year term) has been the most liberating thing I've done. Learning to live below my means was difficult (still is), but absolutely worth it.

cabaalis• 7 years ago

57% of Americans cant handle a surprise bill of $500 without going into debt. [1]

I don't doubt cancer is probably the most expensive hit that we have a good chance of receiving, but I'd be inclined to point to the lack of "life's assets" being fluid as the first problem to tackle.

[1] https://www.cbsnews.com/news/most-americans-cant-afford-a-50...

BucketSort• 7 years ago

It's amazing that you got down voted so much. Do people not like facing reality or something?

DigiMortal• 7 years ago

Our healthcare system is wildly inefficient. A major overhaul would need to take place --- for me, as long as biotech and pharma innovation/production is not negatively affected (because I actually want to cure cancer) then I'm all for hearing options.

duxup3• 7 years ago

Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

Hell that's just insurance in America... if you just use it.

I've been dealing with a bill where the insurance company decided that my kid's pediatrician was out of network all of a sudden. All the other visits to the same pediatrician have been covered, but they can't seem to fix this one bill....

There's no incentive for the company to be helpful as what am I going to do? Change insurance companies? That's not my choice.

ThrustVectoring2• 7 years ago

File a regulatory complaint. Boom, now they have incentive to fix things.

xkcd-sucks• 7 years ago

A cynical viewpoint might add that if the patient has a terminal illness, and if they are overcharged, then the process can be dragged out past the patient's lifespan and their estate just might not get around to it.

duxup3• 7 years ago

I think they just expect I'll get tired of it and pay.

smallgovt5• 7 years ago

I’m confused. If you have medical insurance, shouldn’t you only pay up to your deductible? Is this saying people’s life assets don’t cover the deductible? Or, people are uninsured?

josefresco• 7 years ago

From the article:

"Their high-deductible insurance policy meant they had to spend $6,000 before their insurance started covering her treatment expenses. They hit their annual out-of-pocket maximum of $10,000 well before the year was over."

Even with a lower deductible, many plans have annual and lifetime limits.

smallgovt5• 7 years ago

Ok, so basically the article says most ppl don’t have 20k in savings?

komali27• 7 years ago

The deductible might be huge, and there's also this magic new thing I've just discovered (or United invented out of nowhere) called "co-insurance" and "maximum out of pocket" which I call "deductible #2."

Then when you actually try to use the insurance you pay monthly for (but don't get to use until you reach the deductible #1 and #2?) they may just send the bill to you with a lot of legalese that amounts to "we don't cover this, or we do but we have better lawyers, get fucked peasant."

Luckily the debt collection industry is incompetent so all you gotta do is keep replying with "please mail proof of debt" and you're golden!

lotsofpulp8• 7 years ago

All of the terms you listed are easily understandable concepts clearly explained on healthcare.gov or any health insurance company's website, and they've been a thing for decades.

How much clearer can maximum out of pocket be?

Edit: I do think in network and out of network should be easier/faster to figure out though.

dylanpyle• 7 years ago

There's a huge spectrum of what's covered under US insurance plans. Mine, for example, is a "good" plan for the size of company we are, but if I was rushed to a hospital that wasn't in-network in an emergency, or a hospital visit was later deemed "unnecessary" by the insurance company, I could be subject to huge bills.

smallgovt5• 7 years ago

I see. Are doctors unable to tell you which treatments are defined as “necessary” ahead of time? Or, do you have to do this research yourself?

Also, do ‘good’ insurance plans typically deem any signicantly life saving treatment as necessary?

Sorry, I’ve always been healthy so have never taken the time to understand this but my parents are getting old.

morningmoon• 7 years ago

They were insured, and insurance covered treatment, but they lacked savings to begin with, so they drained assets to make up for lost income. Most Americans don’t save and only have “savings” in their house, which is usually mortgaged.

From the article: Since she's unable to work, the family lost her nursing salary.

tehlike• 7 years ago

I have good healthcare through employer, but god forbid - i have no idea what'd happen even with the insurance.

Unexpected health problems are the only reasons i'd go back to my home country to get treatment. US healthcare is nuts.

rayiner2• 7 years ago

This came up last year when it was discovered that Leon Lederman had to sell his Nobel Prize to pay for cancer treatments. But there is more moral complexity to this issue than people appreciate. Cancer treatment is inherently expensive; it just doesn't seem that way in some other countries because the government pays from the outset.

But I don't think that's necessarily moral, compared to something like Medicaid, which requires people to spend down their assets first before the government will pay. The median net worth for someone between 65-74 is $225,000. Why should the government spend tax dollars to protect those savings for people unfortunate enough to get cancer, when there are many people unfortunate enough to never enter the middle class and be in a position to save that kind of money in the first place? Isn't it unfair to spend tax dollars protecting the inheritance of an upper-middle-class kid when that money could be given to a kid that never had a hope of an inheritance?

Put differently, there is a huge moral difference between the government ensuring that everyone can get cancer treatment, and the government intervening to protect the financial and social status of people fortunate enough to have significant assets.

justwalt• 7 years ago

I would think the average person would feel slimy/predatory buying someone else’s Nobel prize. Unless it’s the case of a friend offering to help out, but then why not just lend the money without the collateral?

AnIdiotOnTheNet3• 7 years ago

Could have been a museum or something.

sangnoir2• 7 years ago

Maybe it was a pharma exec?

whack• 7 years ago

"Their high-deductible insurance policy meant they had to spend $6,000 before their insurance started covering her treatment expenses. They hit their annual out-of-pocket maximum of $10,000 well before the year was over."

The article mentions a variety of causes but I'm having a hard time figuring out which ones are most important. In the example above with a $10k out-of-pocket maximum, how much money did these patients actually end up paying? Is that the main reason for their bankruptcy, or is it their loss of income? Does disability insurance cover things like cancer, and if not, are there similar programs that do?

mruts2• 7 years ago

This is unfortunate, but what do you want to do, have the government pay for it? Maybe there are a lot of people with cancer who will get better and live for X number of years. But many people are going to die in a year or two and we would just end up spending millions of dollars on them, essentially wasting the government's money. How much money would you spend to increase someone's life by a minute, an hour, a day, a month, etc?

And if there was a maximum amount the government was willing to pay, then people would just be talking about how the government is deciding the price of life. Maybe you could devise a fair system in which every individual has a certain dollar amount allocated to all the healthcare in their life, and then if they go over that, they would have to pay it themselves. But I think people would be upset about that as well.

At the end of the day, every system we create (bridges, power plants, cars, etc) is implicitly or explicitly deciding the price of a human life. People are uncomfortable with that idea, so they try to think of things in different terms.

Our healthcare system is broken, but not for the reason people think. It's broken because it's this public-private Frankenstein monster of rent-seeking, self-dealing, and corruption. It was terrible to begin with, but Obamacare made it so much worse. The system has become so complex that the government can't properly model or anticipate how legislation would affect the long-term stability of the system. Over the years, the government has legislated bug fixes over bug fixes, patches over patches.

What needs to be done is replace this horrible and inefficient beast with a completely free market system. Just get rid of all of the laws and start anew. I guarantee you that the free market would be able to offer reasonably priced insurance plans that would service a variety of needs.

The solution isn't free healthcare for everyone. The US government does not have the money to even begin to do something like that.

asark3• 7 years ago

What do other wealthy states with populations who generally prefer their healthcare system to one like ours (the US) do? That'd be a good place to start looking. Plenty of examples. Like, all of them, pretty much.

The solution isn't free healthcare for everyone.

I mean....

mruts2• 7 years ago

it’s not a coincidence that the US is much wealthier and home to much more innovation than socialist European countries.

Clearly our system is bad, but there are multiple ways to skin a cat.

grecy• 7 years ago

It always seems any American that is against Universal Healthcare quickly changes their tune as soon as they or their loved ones are hit with bankruptingly large bills for things they have no control over.

What a shame they can't see outsides themselves and realize they're only an inch away from financial ruin.

mrhappyunhappy• 7 years ago

That’s how it is in other aspects too: unemployed? Must be lazy. Homeless? Must be mentally I’ll or a druggy. Lost the houses? Must have been living paycheck to paycheck. People are quick to judge others until that thing happens to them and all of a sudden the tune changes.

pulse7• 7 years ago

Maybe it will not be easy to read this: In this particular case the US can learn something from past socialist regimes - or from Germany and many other western countries, which already learned, that OBLIGATORY state medical insurance solves such issues. It is not the ideal solution, but the best compromise available. Who would like to get cancer and fight with private insurance company while being ill?

Asooka• 7 years ago

past socialist regimes

Ok, I agree with the spirit of your post, but don't ever hold up the USSR or Venezuela or any of the others. It's obvious you don't know how shit actually worked back then, so let me tell you. It was a prime example of an underfunded system that was forced to meet bullshit metrics and shit was falling apart. If you wanted treatment for anything more major than the flu you basically had to bribe the doctors. Otherwise you could e.g. go to the ER bleeding out, be left to bleed out and just be written off as "well he died outside the operating room, nothing we could do guv'nor, metric for people surviving the OR = met". Mixups were constant, corruption was rampant and the doctors who were in this mess were all day-drinking to cope with it. To this day government healthcare back home is underfunded and oversubscribed and you need to pass doctors bribes to get priority treatment. Or you can go to a private clinic that openly just takes money on top of your standard insurance, thank god.

Previous socialist regimes are what NOT to do when you're implementing government services. Look at what they did and do the opposite.

Sahhaese2• 7 years ago

Well I can't speak for all countries, but here in the UK I haven't paid a penny toward my cancer treatments.

I also kept my job despite being off work for nearly a year going through chemo, and I even got sick pay for all of that time. (Not at full wage, but still a very generous proportion of it).

Post-treatment I went back to my same workplace, doing the same job, and found out that I had even acrued annual leave at full rate during the 9 months I was off sick, so had 25 "extra" vacation days that I wasn't expecting.

Yes, this is more than the legal baseline, but even the legal baseline would let me keep my job, acrue leave, get some sick pay (although the statuatory sick pay isn't huge), but most importantly, have completely free treatment, so I wasn't spending the little energy I had worrying about medical bills or insurance.

rconti• 7 years ago

I cannot even imagine the toll this would take.

I have a very simple set of recurring claims against my healthcare provider that I'm handling myself (out of network, no problem, I thought). Due to job changes I had successfully had my charges reimbursed by my previous 2 insurance companies over the past year.

The current one has taken 6 months to finally start reimbursing me -- and actually, they're almost caught up! Every goddamned time, the helpful phone persons sees the problem: "Your provider was entered as an XYZ type of provider instead of a ZYX provider, so it was being sent to the wrong unit. I'll re-enter him correctly, delete the old entry, and resubmit your claims marked as urgent. They should be processed within 7-10 days..." Very helpful staff. They seem to get it. They seem to figure it out. They seem to fix it. And it's never. fucking. fixed. And so you wait 7 days. You want 10 days. Still in process (if the horrible online system even allows you to login today). You wait 14 days, thinking maybe that was 10 BUSINESS days. Then you call back. Again, and it's the same thing. Over and over again.

My reimbursements came totally out of sequence. The claim numbers don't match. The dates on the claim number don't match the dates on the EOB, they're paying me back for the wrong visits!

But somehow, somewhere, on the backend, someone is reconciling it. Amazingly, the amounts are adding up. I think the processors are REALLY GOOD at not accidentally double-paying, so even though they're paying me for the wrong dates here, the next time they avoid double-paying, and find ANOTHER date to pay for (properly). It actually looks like it'll somehow all get paid back. Again, all one insurance company and one health care provider. And it's my insurance. And it's top tier private tech company employer PPO type stuff.

My wife was in the hospital after a car crash. The first EOB I got for $200,000 saying "Denied", and that number didn't even include the surgery. I just laughed. It went to the wrong insurance, a simple call and it was sorted.

But I can't fathom having less than perfect insurance (and I don't even know how to manage to maintain good insurance while having cancer and potentially being out of work and having a partner who might not be able to work while they're helping you), and having millions of dollars in bills, and having them come in from countless different providers.. sheer misery.

g3houdini• 7 years ago

This same issue exists for autoimmune disease as well as many other diseases. My understanding is that the hospitals were going to post the costs for treatments and make the process more transparent. Has this happened?

js2• 7 years ago

Recent discussion on “U.S. Health Care Spending Highest Among Developed Countries” (50 days ago, 698 points, 522 comments):

https://news.ycombinator.com/item?id=18851823

Opinion – “A Better Path to Universal Health Care: The United States should look to Germany, not Canada, for the best model.”:

https://www.nytimes.com/2019/02/20/opinion/health-care-germa...

Decade old Frontline episode – “Sick Around The World: Five Capitalist Democracies and How They Do It”:

https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

What I don’t know is how we get from here to there. The health insurance companies are already gearing up to fight MFA – “Health Care and Insurance Industries Mobilize to Kill ‘Medicare for All’”:

https://www.nytimes.com/2019/02/23/us/politics/medicare-for-...

wpdev_63• 7 years ago

Has anyone tried flying to another country for more affordable treatment after the diagnosis?

Countries like Germany and some south american countries have much more affordable treatment even factoring in the lodging and flying.

justin66• 7 years ago

Having to fly to receive treatment seems like it might significantly affect the likelihood of a full recovery. Cancer patients tend to have compromised immune systems and airplanes are filthy.

cannonedhamster11• 7 years ago

As a cancer patient, wear a mask. I travel for work all the time, even right after chemo. I'm not older, which makes for a stronger immune system in the first place, but planes just require hand sanitizer and a face mask. The real problem would be you would have to be able to pay out of pocket for lodging, translation services, treatment, etc. and in most cases overall survival is better in the US for late stage cancer.

011000113• 7 years ago

It's not just the billing that sucks. It's also the care, or lack thereof, in the health care system.

I remember taking my friend to a Dr. visit when he had a brain tumor. The parking was confusing, with signs threatening fines of hundreds of dollars for parking anywhere near the building(this was at UCSD in La Jolla). This was at a cancer center, where you'd expect they'd prioritize access for patients. He went in for an eye exam, and the doctor was getting extremely agitated because my friend had problems communicating and performing a few tasks as quickly as the doctor wanted. Very few people in the hospitals seemed equipped to handle someone who had problems seeing, walking and communicating.

SQL2219• 7 years ago

At some point a lot of us will have to make the decision if we want to go through this type of nightmare, physically and financially. When do you say, I've had a good run, time to not participate in these horrendous medical systems.

vinceguidry• 7 years ago

Canadian version of Breaking Bad:

"You have cancer. Treatment starts next week."

The end.

karakot• 7 years ago

A real Canadian version is the following:

- You've got a backpain? Here is your ibuprofen peal.

- But I have very severe back pain.

- Here is your bigger ibuprofen peal, come back in 6 month to see the specialist.

6 month later in US:

- Congratulations, you've got cancer.

3 years and more than $1M in bills later:

- This is the end.

cwkoss7• 7 years ago

It would be cool if you could sue for emotional damages and timecost of resolving the issue when someone fraudulently bills you.

Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

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