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[cancer] What's my life worth to you? - Lakeshore
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Jay Lake
Date: 2010-01-07 05:54
Subject: [cancer] What's my life worth to you?
Security: Public
Tags:calendula, cancer, child, culture, health, healthcare, politics
This morning in Link Salad, I posted a link to a piece on the Freakonomics blog on the ROI of cancer spending. It's a serious question, and such cost-benefit analysis, along with risk-reward analysis, is a critical element of social policy. As ericjamesstone has quite rightly said to me in a slightly different context, you don't make law (or policy) based on individual cases.

But in my individual case, this cost-benefit analysis directly impacts my short- and long-term mortality risks.

Without digging into the details (though I do have all the paperwork filed here), my Excellent Cancer Adventures of 2008 cost about $100,000 all told. I paid about $6,000 of this, the rest of the cost was borne by my insurance carrier. Most of this was surgery and hospitalization costs, along with some fairly spendy tests and a bunch of psychotherapy.

My New Adventures in Cancer, commencing in May of 2009, cost about $50,000 in that year. The spending pattern was similar to 2008's, mostly surgery and hospitalization, with tests and head shrinkage. i don't have the tally yet, but I believe I've paid about $5,000 out of pocket this past year.

Chemotherapy, primarily due to drug costs, will run about $180,000, I believe. Throw in another $20,000 for a couple of CT scans and whatnot along the way, and by the midyear mark, another $200,000 will have been spent on me. About $6,000 or more of that will be out of my pocket. (And no, I don't make that much money. Cancer is expensive, even with good insurance.)

Tally it up, and by next July we will see a total of $350,000 having been spent keeping me alive over a two-year span, with $17,000 of that coming out of my pocket. The balance of $333,000 is borne by the insurance carrier, and thus somewhat less directly by my employer, their investors, and society in general. All of which is, incidentally, considerably more than has been expended on me in my entire life put together prior to the onset of cancer.

What is my life worth to you?

For example, if you're a conservative who believes the current healthcare finance system is "the best there is", and that the current healthcare reform effort will ruin American medicine, then you believe that the $1,000,000 lifetime limit my insurance carrier places on my benefits is appropriate. At my current burn rate, in three or four more years I'll run out of benefits, and you believe it's ok for me to crawl off and die.

Obviously it's not that clear cut. For one thing, the hoped-for, and reasonably expected, result of chemo is that future treatments will not be necessary. This is not a given. For another, if I were out from under the insurance umbrella due to lifetime limits or unemployment, there are programs for the uninsured. But my standard of care would drop precipitously, and I would literally be bankrupted by the personal financial responsibilities. the_child would have a much poorer childhood, and a much more difficult time getting a college education and a strong start in life, for example. And even then, society is still paying most of my bills, just via different mechanisms than a private insurance carrier.

Obviously, the benefit to me personally of continued life and health is incalculably high. But I'm only bearing about 5% of the costs. And I'm damned lucky I'm well-paid enough to even manage that much. What is the cost worth to you? To society at large? Because there's a wall at the other end of this tunnel, not a light, and someday soon I'll smash into it at the speed of mortality if I'm only a little bit unlucky.

What would your politics be in my position? What would you think of the conservative opposition to reform if you were me? There are some problems the free market will never solve, and I'm living in the heart of one of them.

Meanwhile, chemo starts tomorrow. calendula_witch arrives today. shelly_rae has been taking good care of me. I'm scared spitless, but I'm going to live. Literally and figuratively.

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Leenacia
User: leenacia
Date: 2010-01-07 14:51 (UTC)
Subject: (no subject)
When I was diagnosed with cancer six years ago, I didn't have any health insurance (as I was inbetween well-paying, benefit-providing jobs and thought I could save a few bucks by taking a chance on my previously good health - ha) . You don't even want to get me started on the cost. I was just thanking my lucky stars that I lived in NY and had access to a great gov't-run healthcare system.

Did you have chemo last time? It's really not that bad. I had dense-dose (every two weeks) and I'd be tired for the week I had it, but the other week I felt relatively normal. I basically just slept it off.
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Jay Lake
User: jaylake
Date: 2010-01-07 14:57 (UTC)
Subject: (no subject)
Oi yah, on health insurance. No chemo in 2008. Cancer was stage I, colonic resectioning had clean margins and lymph nodes, we thought we were good. Chemo now because of the mets. And yes, every two weeks for a 48-hour infusion cycle...
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Leenacia
User: leenacia
Date: 2010-01-07 15:09 (UTC)
Subject: (no subject)
Well, my unsolicited advice would be, don't make the mistake of jumping out of the chemo chair thinking, "That wasn't bad at all. I don't feel sick! I think I'll go out and have a huge, garlicky bowl of pasta fagioli to celebrate." Cause you'll probably throw up and be put off pasta fagioli for at least six years (and counting). :D
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Jay Lake
User: jaylake
Date: 2010-01-07 15:20 (UTC)
Subject: (no subject)
So noted. Heh.
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Katherine Sparrow
User: ktsparrow
Date: 2010-01-07 15:19 (UTC)
Subject: (no subject)
I want a universal single payer health care system, for you and for me and for the country. Partially, these costs are so high because of the privatized hospitalized system. Partially, who cares? Some people need expensive health care, others don't, let's pool it all together and take care of each other, no?
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mcjulie
User: mcjulie
Date: 2010-01-07 16:12 (UTC)
Subject: (no subject)
Until a few months ago I lived for nearly ten years without health insurance. I wasn't just gambling on a history of good health with that. The kinds of insurance I could have purchased as a lone wolf, without benefit of employer-sponsoredness, were both expensive and crappy. Which is a problem, because one of the reasons I didn't have insurance is that I didn't have a nice high-paying job.

So these were my options as I saw them:

1. Buy insurance. Nothing serious goes wrong with my health. Bankruptcy.

2. Buy insurance. Something serious goes wrong with my health. Bankruptcy and possibly death. And lots of paperwork.

3. Don't buy insurance. Nothing serious goes wrong with my health. Slightly lower chance of bankruptcy.

4. Don't buy insurance. Something serious goes wrong with my healthy. Bankruptcy and possibly death. Slightly higher chance of death.

The system is indeed broken. I hope the new bill is a real move toward fixing it.
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Kari Sperring
User: la_marquise_de_
Date: 2010-01-07 15:00 (UTC)
Subject: (no subject)
I hate, hate, hate that lives get to be costed this way. But then, I'm British, and our healthcare model is different. Of course, we pay for the NHS through taxation, but we mostly accept this not only as necessary but as positive. Even our worst right-wingers mainly have that view.
Your life is priceless. All lives are. There is something fundamentally flawed -- something immoral -- in a model that assumes that cost to others is a core element in healthcare.
Kari, old-fashioned British socialist.
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Jay Lake
User: jaylake
Date: 2010-01-07 15:24 (UTC)
Subject: (no subject)
A core driver in American conservatism is the mortal fear that someone, somewhere, might be enjoying an undeserved benefit at one's own expense. Conservatism in the modern age has completely thrown out the idea of public good or social responsibility.
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fjm
User: fjm
Date: 2010-01-08 04:35 (UTC)
Subject: (no subject)
Nobody says it out loud but the best guarantee we have that the Tories won't try to dismantle the NHS this time, is that their leader was heavily indebted to it for the quality of life experienced by his son (he had epilepsy and cerebral palsy, the kind of thing that can bankrupt an American family).
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Brent "Chip" Edwards: dragon
User: chipuni
Date: 2010-01-08 01:09 (UTC)
Subject: (no subject)
Keyword:dragon
Hihi, Kari.

You say that "There is something fundamentally flawed -- something immoral -- in a model that assumes that cost to others is a core element in healthcare." I say that's impossible to get around. Health care costs money: doctors and nurses cost money, drugs cost money, machinery costs money, and so forth. Every society must choose how much of one form of value (money) to exchange for another form of value (human life).

I admire the British NHS system -- and had hoped that it would be brought to the United States -- for an opposite reason to yours: it delivers better service to its patients, for less total money.
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wyld_dandelyon: Disintegrations and Defenestrations! by
User: wyld_dandelyon
Date: 2010-01-07 16:21 (UTC)
Subject: (no subject)
Keyword:Disintegrations and Defenestrations! by
You didn't even mention the morality of the "my standard of care would drop precipitously" issue. Is it fair for people's standard of care to be determined by their income?

And in practical terms, that standard of care difference is there for lots of things, from prenatal care on up. What are the costs to society that the majority have a lower standard of care?
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mcjulie
User: mcjulie
Date: 2010-01-07 16:25 (UTC)
Subject: (no subject)
One of the interesting things about the health care debate in the modern era is: technology that will save your life exists that didn't exist even ten or twenty years ago. But it tends to be expensive.

For thousands of years of human history, you couldn't really *purchase* life in that way. But now you can. And that adds a certain extra sociopathic edge to the right wingers who *in principle* oppose a collective societal solution to paying for health care.*

Because essentially they are telling you, and anyone else with the misfortune to have a serious but treatable illness: we believe the abstract principles of the free market are more important than your very life!

*To distinguish them from centrists or others who might actually oppose only certain types of solutions. My impression, from the right wing debate on this topic, is that they oppose the reform primarily in principle, but will cook up objections to specific elements of it in order to get centrists on board. But there is literally no health insurance reform that they would support, so it's all just rhetorical techniques.

Example: cap and trade. Right wingers claim they wanted a "market solution" for global warming. But cap and trade *is* the market solution. In fact, I remember being skeptical of it for that very reason, until there was some data that it actually worked. They don't actually want a market solution for global warming because for some insane reason they don't want a solution at all. "Market solution" is just something they like to say.
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shelly_rae: Bleeding Hearts
User: shelly_rae
Date: 2010-01-07 16:59 (UTC)
Subject: (no subject)
Keyword:Bleeding Hearts
Health care should not be a commodity. It's like firefighters--they're for the good and safety of the general public and everyone should have equal access. Why is that so hard to understand?
Anon
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e_bourne
User: e_bourne
Date: 2010-01-07 18:24 (UTC)
Subject: (no subject)
We live in the richest third world country on the globe. Our health care sucks. Our education system sucks. We have religous crazy people. If we weren't us, we'd be shaking our heads at the poor, misguided people whose children would soon be speaking Chinese.

Health care is a benefit to everyone. One person's illness is everyone's illness. One person's ignorance is everyone's ignorance. This is not socialism, it's not bleeding heart liberalism, it's pragmatism.

Your life is worth a great deal to me because your'e my friend. but even if I didn't know you from Boo, your illness should be covered. No matter what it was. It's just good practice.
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Kevin Standlee: Not Sensible
User: kevin_standlee
Date: 2010-01-07 18:33 (UTC)
Subject: (no subject)
Keyword:Not Sensible
It occurs to me that if we placed the same value per human life on healthcare as we do on preventing deaths due to terrorist activity, that $1m becomes lost in the rounding.

Without reference to your specific case, those people who say, "We can't put a value on human life" tend to conveniently forget that we do exactly that all of the time. For example, when the road department won't put up a traffic light (let's notionally put the cost of doing so at $250K) at a given intersection until 5 people have been killed by accidents at that intersection, they've valued a human life at $50,000.

(The specific values may differ, but that's the process as I understand it.)

I'd be delighted if we reduced the excessive amount of resources we Americans pour into Security Theatre that does essentially nothing to make us safer (and thus saves no lives at all and probably actually costs lives by causing more people to drive instead of fly, statistically killing more people) and spent it on healthcare instead.

But, statistically speaking, nobody understands statistics or cares about them even if they understand them.

Edited at 2010-01-07 06:34 pm (UTC)
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User: swan_tower
Date: 2010-01-07 21:27 (UTC)
Subject: (no subject)
Keyword:swan
This is part of why I'm rabidly in favor of measures that decrease the cost of health care. I can't remember the example perfectly -- and maybe you were the one who posted it, so I'm just echoing the choir -- but doctors in Japan have figured out a way to do an MRI (or other Really Common Test; I might have the wrong one) for about 1/15th the cost we do them in the U.S.

Some of the reason our health care is so expensive is because of the structure of our insurance system. Some of it's because there's no particular incentive to find cheaper methods. Some of it's immutable -- but not all of it. If we could press that inefficiency out of the system, even incompletely, it would really change the dynamic of these conversations. (Though nothing makes the core question go away.)

I know others have said it, but thank you for discussing these things publicly. Even if you were the only one it helped, they'd be worthwhile, but their value goes far beyond that.

I almost said "good luck tomorrow," but decided that the "chance" connotation of that phrase isn't what I want. So instead I'll resort to Japanse: ganbatte yo. Go get 'em!
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Randall Randall
User: randallsquared
Date: 2010-01-08 01:49 (UTC)
Subject: (no subject)
From a market perspective, here's an argument against tax-funded health care:

If prices are high (and they are, even most conservatives would agree, I think), the high price reflects that more health care is desired than is available at lower prices. There's a shortage of health care at lower prices, and a surplus at higher prices; price is merely a mechanism for distributing scarce resources.

If you remove the price mechanism for distributing scarce health care resources, you are not thereby creating more health care resources, you're just creating a need for some *other* mechanism for denying someone the health care they want/need, and possibly changing who actually gets the health care.

Of course, at least one of the bills that was passed (who knows what we'll actually get when they hash out the final version) makes paying for insurance mandatory, instead. That sounds like an insurance company subsidy, which is probably not what Obama voters had in mind. Even if it turns out that there's little subsidy at first, the fact that the regulations matter more to the health insurance industry than to the rest of us, in terms of how much lobbying money they're willing to throw at it, means that it *will* be a subsidy for insurance companies before too long; regulatory capture is inevitable given the political system we have. Ah, well.

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kzmiller
User: kzmiller
Date: 2010-01-08 04:06 (UTC)
Subject: (no subject)
It's my understanding that part of the high cost of medical care involves liability insurance. I only heard this over the radio, so I don't know how accurate it is, but apparently liability/malpractice insurance costs a doc in Japan about $35 a year. In the USA, it would be more like $35 a day.
As much as I like people's ability to say to doctors, if you screw up, it will cost you, it seems to me that what actually happens is that if a doctor screws up, it costs millions which the insurance company pays out, and the victim or survivors get. I'm not sure how to make this better. I'd be curious to know how other countries handle it. Common sense to me would seem that either you're a good enough doctor or not, and that if you're not a good doctor you get booted out and have to do something else (and may involve criminal charges) and then another, better doctor does everything they can to make things better. As for punitive damages awarded to the family--this starts to get into a what price to put on a life or well being category, and I'm not sure what the right thing to do there might be.
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e_bourne
User: e_bourne
Date: 2010-01-08 05:45 (UTC)
Subject: (no subject)
That's a common argument, but it's not actually true. While it is true that some specialties (gynecology, neurosurgery, cardiac surgery) do carry high insurance costs to the doctor, it doesn't really have anything to do with health insurance. Your health insurance doesn't pay the doctors' health insurance.

Every year, health insurance companies negotiate rates with doctors, which means what the insurance companies are willing to pay them. They also negotiate separately with hospitals. Hospitals and doctors are different entities and carry different agreements with the insurance companies.

So, when you pay $350 for an MRI, you are paying the hospital, who owns the equipment and hires the technicians etc. Your doctor has nothing to do with that. If you go see your doctor (who has a relationship with a hospital, but the insurance company has nothing to do with that), s/he bills you/your insurance separately depending on their agreed on rate for that service for the particular year.

If you choose to go to a doctor who is outside of your insurance (e.g., one who does not have a contract with your insurance company) your insurance company pays less and you pay more to cover that difference.

In 2009, no doctors in Seattle were able to come to an agreement with a particular insurance company. Pretty crazy, huh?

Also, insurance companies are significantly changing their insurance model this year, so expect changes to come to you soon, depending on when your insurance year is up unless you are insured through the government.

And, just for the record, the percentage of people who sue doctors for malpractice compared to the general population not only is tiny, most cases settle, and when they do go to court, most jurors decide in favor of the doctors. How do I know? We defend hospitals in med mal cases, and hospitals are not so lucky. Even so, they are a tiny percentage, less than 1% of all the people who use their facilities. Liability insurance is up because they can. The 1 or 2 cases a year where massive punis are award are rare beasts, trotted out to amaze the unsuspecting public.
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alumiere
User: alumiere
Date: 2010-01-08 04:23 (UTC)
Subject: (no subject)
I'm behind and you're probably offline for the night, but I wanted to let you know that I'm hoping your first day of chemo isn't too terrible, and that it does what it's supposed to as painlessly as possible.
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Zhaneel
User: zhaneel69
Date: 2010-01-08 07:16 (UTC)
Subject: (no subject)
First off: Your life, Jay Lake, is very valuable.

But being to answering the question:
Have you actually figured out how much money (over the years) you've personally paid your insurance company prior to this? I know it won't be $350,000 but it will also not be insignificant. I pay roughly $2k/year in health insurance off my paycheck. I've never (to my knowledge) had that much in health insurance costs, but maybe I'm wrong. To that end, as someone who has been in the workforce for your 20+ years you've also paid $40k into the system overtime, more if you count inflation, less whatever normal medication costs. So you have borne more than your stated 5% and the burden on the rest of us is lower as a result.

That's the whole point of insurance, however, is to have everyone put in a little over the years so that people who need help have it. I'm great with the idea that my $2k/year this year might go toward helping save your life.

Zhaneel
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