Both of the American Ebola survivors who were treated in Omaha spent about 3 weeks on the unit, and both have said that their bills came to about $600,000. I haven’t heard anything along these lines from any of the others; two were treated at the NIH research facility which is funded entirely by the Federal government. One was in and out fairly quickly; the other, who remains anonymous, was described by Dr. Anthony Fauci as “the sickest patient I’ve ever treated who recovered”. :eek:
If smallpox ever showed up, the whole world would be on lockdown.
But costs are an issue; it is just at what point we choose to limit care. Suppose there was an operation (and don’t fight the hypo here; I’m not a doctor, so we can build on this however you want) that would cure most diseases and extend the human lifespan to 200 years. The operation costs $50 million per person. Everyone wants it.
Should private or public insurance cover this procedure?
I think you’re missing the point. People who pay insurance premiums are paying the cost of meeting the insured risk. That’s how insurance works. What the OP is propoosing is that people should not be allowed to pay more than a certain amount of medical costs through insurance. If their costs exceed that amount, they’re either very rich or they die.
UDS is right: you missed the point. The question is not whether it’s ever allowable to have any form of healthcare rationing at all: as your example illustrates, we can easily think of scenarios where it’s simply impossible for cost reasons to provide a particular treatment to everyone who wants it, so the treatment will necessarily be rationed in one way or another.
But that doesn’t mean that healthcare rationing should take the form of a universal one-size-fits-all maximum lifetime insurance payout cap.
A. “Umm, Will my insurance pay for this?”
vs
B. “Am I willing to become destitute to get this treatment?”
If no insurance, bypass A; go directly to B.
As we transition from
“employment” with Health Insurance, paid sick leave, paid vacation/holidays, and pension in one’s old age
to
“Gig economy” - your work is paid far as piecemeal - $x for Y service. No Health insurance, unemployment insurance, no Social Security taxes paid, no holidays, no vacation…
In short: From Yellow Cab driver to Uber driver (until they can fire even the drivers)
We are going to back ourselves into “Socialized Medicine” - ACA still says that your primary insurance is from your employer (stop giggling) - once nobody is getting Health Insurance from any of their gigs, they will end up on ACA.
Except in Red States which tried to sabotage ACA by not establishing their own “Exchanges” and then tried to block their residents from using the Federal Exchange.
I’m sure those God-Fearing Christian* Republicans will try to scuttle Health Care at every turn.
exactly what kind of god do these people have who expects to be regarded as “Feared”? That is incredibly sad.
Such as when one country decides to implement a system for, let’s make up a word, Belth Care that causes it’s people to spend 50% more per capita for that service than people in other countries.
So for those who feel a lifetime cap is undesirable, what other methods do you recommend for rationing health care paid for by private or public insurance? Or, if you feel every individual ought to be offered limitless care, how do we pay for it?
My personal preferences tend towards utilitarianism, but I readily acknowledge those are not politically palatable. I readily recognize the difficulties in a lifetime max, but I’m not aware of an alternative that works better. And I suspect a lifetime max could potentially have desirable impact on the consumption and provision of care.
No objections and no problem at all, as long as it’s someone else’s life. If it’s your own life, or that of a loved one, then it’s a whole different story, innit? What does that tell you about the moral principles involved?
Your analogy fails with “everyone wants it”. The foundational principle of universal health care is medical necessity, not “want”. It means that if you have a disease, a broken leg, a heart condition – maybe even needing a heart transplant – you are entitled to the requisite proper medical care as a basic human right. You are also entitled to preventive care both as prudent medical practice, as a contributor to quality of life, and as a long-term cost saving to the system. If, OTOH, you feel your nose is a little bit too big, you’ll need to cough up some cash if you want it beautified.
None. I live in Canada, and to the best of my knowledge, none of the independently administered provincial single-payer systems have any such limitation, mainly because it isn’t any kind of major cost driver. Health care costs overwhelmingly come from large numbers of relatively mundane, common procedures, and the key to controlling costs is to negotiate uniform and reasonable provider fees and pay the damn providers with a minimum of fuss and overhead so that their administrative costs are rock-bottom minimal.
Well, as I said upthread, I don’t think I am worth many millions of dollars to society, or entitled to such a huge subsidy. I’m surprised I am unique in that perspective.
The problem with a lifetime cap is that you will end up with some number of cases where people have reached the cap - and then need a relatively inexpensive test or procedure. We don’t really want to deny a 20 year old an appendectomy because his cancer treatment at age 2 nearly hit the limit, and conversely, we don’t really want to give a 98 year old a heart-lung transplant simply because he was healthy up until then and was nowhere near the cap. It has to be done on a case by case basis, which means that we will need some way to measure and compare the life expectancy and quality of life after the treatment. Most disabilities or medical conditions that pre-existed the treatment should not affect the quality of life - for example, if you were blind before the treatment that should not affect the quality of life measurement. If the treatment is going to *cause *you to become blind, it probably should have some effect.
I need to correct you on this. I’ve received bills for my dialysis. $22k-$24k PER session, or $66k-$72k per week. This is before insurance adjustments, which lowered the amounts to $17k-$19k per session. The dialysis companies make serious bank. Luckily, I have insurance through work and now have Medicare as a secondary plan. The “cost” for a transplant is over $250k, barring complications.
It would be easier AND cheaper to transplant; however, despite what it seems like, FEW people actually make the list. You can be excluded for a wide variety of reasons: obesity, history of cancer, age, legal status, drug use, obeyance of doctors orders, obeyance of attending dialysis…not one reason is ability to pay. BUT. My insurance company (thankfully) has decided they will pay for the transplant, if it happens this year. It will be reviewed again in March.
Dialysis costs THAT much? :eek: I had no idea. I would have guessed that many hundred per session, not thousand! We can thank the DaVita corporation for a lot of that.
I had a relative who was placed on the transplant list, and taken off just weeks later when she was re-evaluated and it was determined that her overall health was too poor for her to benefit from a transplant; she died a few months later. Cancer also gets a person taken off the list unless the transplant is needed to treat the cancer.
ETA: I just Googled “how much does dialysis cost” and most of the links I saw while skimming the home page agreed with this one - in other words, $50,000 to $75,000 a year depending on the method.
I think others have already mentioned ways in which universal healthcare countries tackle this problem.
In the UK it is done via NICE. It is not a perfect system and there will always be hard cases and choices at the limits of such decisions but I’ll take it over the horror of a lifetime cap any day.
Strictly speaking, NICE is about prescribing, on the basis of cost-effectiveness evidence of treatments/procedures in principle*, what the NHS must cover, if the doctors consider it clinically necessary for any individual patient. They can prescribe outside those regimes and have an argument with the local NHS organisation as to why, in any given case, it’s clinically preferable to the standard treatments.
*(If memory serves, the rule of thumb is a maximum cost of £30,000 for every “quality-adjusted year of life”, i.e., there’s a problem when it’s a question of new and highly expensive drugs, particularly for cancer, that only offer a marginal extension of significantly improved life, but all the regular and routine treatments are well within the cost-effectiveness limits.)
The NHS’s basic form of cost control is a process of determining standard tariffs for the different courses of treatment as a means of establishing the block contracts for its internal market between the local fundholding/commissioning organisations (controlled by the GPs) and the hospitals and other specialist services. And the tariff is for the whole course of treatment (together with associated hospital support costs - no itemised billing for every test, pill and bandage, just a block sum): there are massive spreadsheets you can download that itemise the figures for each year, if you really want to know! http://www.gov.uk/government/publications/nhs-national-tariff-payment-system-201617
And it is a wholly practical set-up that mirrors what happens in a “real” business. You don’t want micromanagement and questioning of every purchasing decision, in business you will set it up so that there is a raft of stuff you can just go ahead and order if you need it but above a certain threshold you need higher justification and an individual case needs to be made.
I hadn’t quite thought of it like that, but, yes, essentially, it works on the principle that the doctors’ clinical judgement is paramount in the individual case, but not to the point of having a blank cheque over the finances for the entire system. Where there is standardisation of treatment and organisational protocols, it’s done by getting the professionals to work them out together, as guidance (rather than legislation) for the system as a whole.