My father was diagnosed with Stage IV colon cancer in 2007. He died in 2010 at the age of 60. I was 25. He too had multiple surgeries, chemo, radiation, etc. While we here in Canada don't pay directly for treatments, there was the cost of missed work, medical supplies, and the like. The following is directly, and deeply, informed by my own very personal experiences with cancer:
Let her die.
Chemo isn't going to save her, and it sure as hell won't improve her quality of life. It will give you maybe an extra year to watch her fade away before your eyes, and will inflict all manner of pain and discomfort on her in the process.
Your mother is going to die, far sooner than either of you would wish. That's unavoidable. What you do have control over is the quality of her life in her last few months, and in the effect that her passing has on the people she cares about. You can control how you spend what time you have left, but you have precious little control over how much of it you have to spend.
I'd suggest reading How Doctors Die[1], a take on how those who have the most experience with cancer and its treatments choose to deal with it. Generally speaking, they don't.
I'm sorry if this sounds harsh, but I watched my stepmother tear herself apart refusing to accept the inevitable and pushing for every last available treatment. The extra six months or so that may have afforded him are not a six months I would wish on anyone.
You are going to lose your mother, and it will break both of your hearts. Pumping poison into her and bankrupting your family won't change that. Make your peace, and let her go.
I'm very sorry about your father. My father was just diagnosed with cancer (literally today). Obviously what you wrote is not sound advice for all kinds of cancers. I have two close family relatives who were cured of two different kinds of cancers (yes "cured", as in they lived for a decade plus after being cured and one died from other causes and the other is still alive). There are also people who are cured through these poisons, even of late stage deadly cancers like stage iv pancreatic:
http://www.pancan.org/section_stories/story_details.php?id=1...
Ultimately how you choose to treat cancer depends on the stage, type of tumor, and the advice of your doctors. With that said, there are people who beat even the deadliest cancers, and that very small chance, is one worth thinking about.
No, it's not for all types of cancer. My advice relates only to those with terminal, metastatic cancer, and is not an admonition but rather a reflection on what I wish we had done.
>With that said, there are people who beat even the deadliest cancers, and that very small chance, is one worth thinking about.
I vividly recall looking at the 5-year survival rates for people diagnosed with Stage IV colon cancer. <5%. <. I don't know if I've ever stared at a single character on a screen for so long. That was about a year or so before he died, and I remember the mental gymnastics I went through trying to rationalize how he would be the exception. At the time, it seemed unthinkable that we would give up. Of course we would pursue every option.
I can't say what I would do if I were in that position again; I can only say what I wish I'd done at the time.
Thanks I'm 26 and my dad is 59 and it's a serious cancer (not that any are "not serious") so I'm a similar age. I respect your story. I just wanted to point out the flip side of the equation - the real life, completely true, stories of the 5%.
lost 3 members of family during last 10 years to cancer. In one case it was caught at early stage and resulted in 9 years of life with last year being pretty hard. Earlier surgery and treatments were definitely worth it (i mean "worth" in general not in financial sense). In 2 other cases, late detection, despite pretty aggressive surgery and treatments - 2 years and 0.5 year with things going downhill pretty fast at the speed that one can't just stop and rethink the whole thing. In the last case i was directly responsible for the aggressiveness of approach and given the chance i hope i'd not do it this way again (though at the start it was "promised" more like 3-5 years instead of actual 0.5 years - in addition to cancer there are also very grave/deadly complications possible, including the ones from treatments and overall stress on the body by the illness, that one need to watch for very carefully). In the former case the first year wasn't that bad so i'd say it was worth it, problem is that it is very hard to stop at the right time where more treatments would only decrease quality of life.
Very few people are "cured". Most get life extensions ranging from 6 months to 5 years.
It's better to concentrate on letting one live their last days on their own terms. Meds and hospitals are pretty good at keeping people "alive" medically speaking. But all that extra time usually comes at a price.
It really depends on where you are in your life. I'd think that parents with young kids would want that extra 3 months. If you're older and your kids are older, perhaps it would be best to just let go.
It's not the quantity of years that you live that's important, it's the quality.
That is a deeply personal choice, and as a Brit one that I believe equally deeply should not have the threat of bankruptcy or the lack of funds as a factor in the decision.
Your advice, won through sorrow, may be very good advice. I remmeber when my own mother found out her cancer had returned after a remission, and I know I would fight any move to a society that made "Can we afford it?" a question at that time.
I am sorry for your loss and the OPs pending loss. This is not for you, but for everyone else reading in the US - for fucks sake sort your shit out guys.
QALYs are barely relevant in this discussion. Quality Adjusted Life Years are an attempt to allocate scarce resources in the absence of a pricing mechanism. It is by no means perfect, but thats not the point - it is used at the margins. Do we spend money on this cancer drug that will extend the life of 75 year old prostate cancer patients by 6 months or spend it on heart disease drugs for children giving them 50+ years. Unless you are one of the 75 year olds or children it is a pretty easy question.
But the question we do not ask ourselves is - do you have the means to pay now you are dying of a horribly expensive disease? No-one cares about QALYS here in the UK except when newspaper editors decide to go for a ratings pull
I feel the same. Getting bankrupt just to have a couple more years of miserable life?
What I know is: if I get ill will when my son is 22, I would never allow him to destroy his financial life because of me. I would hide in the woods to die there if necessary.
It is pretty funny how the guy complains so loooooong about his father and sister.
I'm sorry for your problems, but could you please clarify a few questions for me because there are a lot of problems with what I'm reading:
1) You claim to be 22 years old, but your dad hasn't had a relationship with your mom in 25 years... what does that even mean?
2) You're 22 years old and you accumulated $150k already? What sort of work did you do, and for how long?
3) You claim to be penniless, but you spend you money on Uber all the time because you can't drive in the snow? Can you expand on this? Don't you think that Uber is an expensive choice for someone in your situation?
4) Your credit rating is already "bamboozled" and you're $6k in debt? But didn't you just have $150k 8 months ago? When did your credit rating start taking a hit?
5) Could you expand on the treatments that your mom underwent over the last 4 months that cost $150k?
I have to say I find it suspicious that 284 days ago he posted about how he had "no cash to build an MVP" and yet 3 months later he had 150k in savings.
It was more of an open-ended question for discussion, and I was wondering how other people had bootstrapped themselves when they needed to buy product in order to kickstart something.
It seems you were begging for money for a brand-new project of yours. I actually remember it from last year. If you were dishonest about money then, why should we trust you now?
I found this believable. Hi lived in LA and saved some money. Single person, some reasonable skills, shared accommodation, not buying ijunk.... he could made this savings in 2 years. Not everyone has student loan.
1. They don't get along. They haven't slept in the same bed in 25 years. tl;dr my father is Catholic and doesn't believe in divorce, and no matter how big of an asshole my father is to my mother, she won't divorce him because she still loves him.
2. I mentioned it in the post, but to clarify: sold some tech to a hosting company, sold a few domains I scooped up, lotto ticket, had some really well-paying clients.
3. Again, I mentioned that I have free monthly Uber credit.
4. It became fucked when I was 18. I don't have credit cards, nor do I believe in them. Yes, I know there are other ways to recoup them, but still.
5. Everything from proton therapy to Folotyn to Gamma Knifes. Brain tumors are expensive.
1) If you don't believe in credit cards, how did you get in $6000 debt in 6 months?
2) How do you get free monthly Uber credit?
3) That's 3 very intense treatments over the course of 6 months. That doesn't leave very much room for monitoring to see whether or not the treatment worked. What was the schedule of treatment over 6 months?
>3) You claim to be penniless, but you spend you money on Uber all the time because you can't drive in the snow? Can you expand on this? Don't you think that Uber is an expensive choice for someone in your situation?
It says that he won a credit. Hence, being free, it does sound like the cheapest option.
Serious question: Why were these bills paid by the son who would have no financial obligation in the case of his mother's bankruptcy?
America's health care safety net is bankruptcy and the 'cannot refuse critical treatment based on ability to pay' role of emergency rooms.
Seems the right course to take in these situations is to string along the hospitals until it ends up in bankruptcy and only pay out of pocket from the next generation when a deposit is required before care will be given. I don't like it, but that's the way the system works currently.
Edited to add: I'm clearly ignorant of some of the mechanics here, so longer explanations of how things work with illnesses like this would be very much appreciated.
I went through a similar thing. My mom had advanced ovarian cancer ten years ago, and even though she 'had insurance' in the American sense of the phrase then, when you added up the things they didn't pay for, it was thousands of dollars a month, punctuated by five-figure expenses here and there. (Spoiler alert: I spent all my savings, went $100k into debt, and then she died.)
I think there is a misconception about the health care you get in the USA if you are broke and uninsured/underinsured. They will set your broken bones, they will amputate a gangrenous limb, they will do what they need to do in order to prevent you from dying today in their hospital.
But you certainly won't have an easy time scheduling a consultation with the specialist who is treating patients with that new cutting-edge chemotherapy compound with less violent side effects, or obtaining long-term treatment to suppress multiple sclerosis episodes, etc.
The son pays the bills because otherwise his mom will probably have to suffer more and will probably die sooner.
The problem is that cancer treatments are extremely expensive and not usually very effective. Believe me; the hospital is not pulling these charges from thin air.
The right course to take is avoid contracting cancer for as long as possible, and if you do get cancer, to find and treat it ASAP. If you do get late-stage cancer, you can pay for a drug and treatment regimen that may provide you with a few more months of life at great expense to your wallet and your body. This is an American phenomenon; nowhere else in the world do people spend so much money on caring for terminally ill patients.
I'm very sad it's come to this, but bankruptcy is what I was thinking.
That said, lets start the discussion:
a) They're only obligated to provide some treatment (Here's a band-aid for your tumor) to get to stability. That counts, right?
...and that seriously is the case. My aunt who had no insurance had to get a thyroid tumor removed. She got it done, but she had a less-than hospitable stay. Normally you get a day or two monitoring. She got...well... "Here's your homecare". I have to wonder
b) I've noticed they've gotten very good about seeing if you can pay or not. I don't know how legal it is, but like my elective birth control procedure was cash-n-carry (in a reputable clinic, even). My wife going to the ER got a scan of the discover card on admission.
I read on the news this morning that the administration is proposing to cut homecare by 40%. I did a double-take when I read that. Unless the article I read got it wrong, a lot of people are going to be hurt.
Sorry for the extremely long response to such a short statement. The pain medication I'm now on makes me "speed" and talk a lot. The girlfriend has already told me once this evening "I like you better when you're not talking". :)
> The people doing the treatment and the billing department don't talk to each other.
Don't be so sure. While you're almost certainly correct in the literal sense ("[they] don't talk to each other"), the medical staff working directly with the patients almost certainly know of your ability to pay.
Anecdote
On October 3rd, I was on the losing end of a (not-at-fault) head-on motorcycle vs. Jeep Cherokee collision. I had insurance on my motorcycle, of course, but did not have health insurance at the time. [0]
Five days in the hospital plus three surgeries quickly added up to roughly $106,000 USD, according to a hospital lien that was filed with the courts -- and that doesn't even include all of the follow-up visits, the ambulance ride (over $3,000 for a couple mile trip across town), the home health nurses, nearly three months of physical and occupational therapy, and so on. I haven't actually added everything up yet, but the total cost is probably somewhere around $150,000.
(Since someone usually asks... Both of my wrists were broken along with the femur in my right leg. Initially, they thought that my nose and ankle were also broken but that turned out to not be the case. I was wheelchair-bound and couldn't walk for about six weeks, couldn't bathe myself, and couldn't perform a few other "self-hygiene" activities that I won't mention (use your imagination -- it's hard to reach certain places when you can't bend your elbows). Side note: the old joke about having a nurse come and give you baths? In reality, it's not nearly as hot or sexy as it might sound. :)
However, on pretty much every form that needed a signature while I was in the hospital, it was noted quite clearly right at the top that I had no health insurance. That said, I have no reason to believe I was treated any differently than if I did have health insurance and I am very satisfied with the level of care that I received. The highly recommended specialist surgeon who operated on my extremely messed up left wrist cleared his calendar for the day and made a two-hour (one-way) trip to perform the surgery after finding out that my injuries were sustained in a motorcycle accident (he is also a biker).
Another anecdote
I have had a sore throat since Saturday which progressively got worse. After becoming completely unable to eat or drink anything due to the extreme pain when swallowing and not being able to sleep at all last (Tuesday) night, I was waiting at the local walk-in clinic before 0800 this morning when the staff arrived.
In under an hour, I had been seen by one of the intake nurses, been checked out by a doctor, diagnosed with an abscess on my tonsils [1], had arrangements made with an ENT specialist (handled completely by the staff, of course) and was on my way across town to see the specialist.
At her office, I was "jumped ahead" in line due to the immense pain I was suffering (as I found out later when I asked just how I managed to get seen so quickly when the waiting room was packed) and was in the exam room talking with the specialist within about 20 minutes of my arrival.
Very quickly, her staff had brought in all the necessary tools she needed, and she went to work spending nearly an hour performing a "needle aspiration" [2] on a patient whose gag reflex was making it extremely difficult. =)
Fortunately, everything went well. I left and picked up several prescriptions at the pharmacy and was feeling wonderful just two hours later. I'm writing this just 10 hours after leaving the specialist's office.
When asked about health insurance upon my arrival at both the walk-in clinic and the specialist's office, I told the receptionists that I was a "self-pay" and offered to pay up front. Both times I was told, in effect, "we'll have to wait until afterwards because we don't know what all will need to be done". They made a note on the paper work which was passed around between the nurses and doctors but I wasn't treated any differently in the least (at the specialist's, "self-pay -- will pay balance at end of visit" was written in red ink at the top of the first page; it clearly stood out). At the time I was seen and treated, no one had any idea whether I actually had the ability to pay a single penny. Despite that, the specialist had already explained that they were prepared to quickly perform a tonsillectomy (which would, obviously, have been a much, much more expensive procedure) if the needle aspiration was not successful.
Before leaving each of the offices, I wrote a personal check to cover the costs of the exams and procedures (in full). I have no evidence to cite but, based upon personal knowledge, I would wager that the average uninsured U.S. resident is not in a position to do so, financially. I am confident, however, that they would not have been treated any differently. (I was told up front at the specialist's that I would need to pay at least $35 today but I was not required or even asked to pay it prior to any services being rendered.) Keep in mind that this is the same hospital system where I currently have an outstanding balance of $150,000 or so (although this is more of an issue between the two insurance companies and not really "my problem" and the hospital is aware of that).
Again, during the five-day hospitalization after the crash and during my visits today, I do not feel that I was in any way treated differently because I do not have health insurance. Perhaps my experiences are anecdotal, but I simply do not feel that it is correct that ...
> The people doing the treatment and the billing department don't talk to each other.
I should make it clear that I am absolutely NOT a fan of the health care system in the U.S. and I likely wouldn't even believe what I have written above had I not experienced it firsthand myself.
Side note: I called up an ex-girlfriend while typing up this novel of a comment. She's an MSN and the charge nurse in the cardiac department at the largest local hospital (the same one where I spent five days recently). According to her, there are some "extras" that a person without health insurance might not receive (think "fringe benefits" or "above and beyond") but an individual's insurance coverage/ability to pay (or lack thereof) "isn't even something that we pay attention to. Insurance info is usually on the paperwork if they are an existing patient but in my department the patients are often well into their recovery or have died by the time we would even know anything about their insurance. If you come onto my floor my first priority is treating you and doing everything in my power to save your life. Whether or not you can pay the bill is not an exception to the oath [3] that I took. Personally, I don't give a shit. That's up to billing to deal with later." (I quoted here but I'm paraphrasing.)
[0]: After leaving my previous job, I maintained COBRA for 18 months but it had since elapsed and I had not gotten around to signing up with my current employer's health insurance plan (and still haven't, actually. Note to self.).
Some random thoughts, as a recent hospital patient and EMT/paramedic.
- You think your bill for $150,000 is bad for your car-bike MVA? I had a kidney stone and walked away with a bill for $58,000 (thankfully I had insurance).
- I don't work (you didn't claim I did) for an ambulance service that performs "wallet biopsies" on scene. Never heard of that term until The Sopranos came along. Interesting fact - in most states, ambulance costs, private or otherwise, are regulated, and must be registered - and approved - by the DOH EMS and Trauma department. This is due to the fact that very many, if not most, of the people who receive this service have only "implicitly consented" to it.
- you're right, we don't care about insurance - nor do the docs we work with.
- Your ex-gf swore the Hippocratic Oath? Out of curiosity, at what school? Mainly because it's generally the Declaration of Geneva these days... only 2% of medical schools use the Oath... fun fact, the Oath forbids the use of the knife on flesh, which might be ... problematic ... for surgeons.
Since I see people suggesting Medicaid all over the thread. It seems there is a basic pervasive misunderstanding of government services in the US. For anyone who doesn't realize it, it is very difficult to qualify for Medicaid. Even if you miraculously qualify for it objectively, which can be derailed if you own anything or you or someone in your immediate family has an income, but even if you should qualify, the nuts and bolts process of applying, documenting, and in some cases liquidating your assets can be so daunting that it's common for people to hire lawyers just for this. If you're already busy dying, it can be fairly discouraging. Good job taking care of your own, Land of Opportunity. Make sure nobody accidentally gets anything unless their back is to the grindstone of capitalism.
You might be able to get ER treatment for when the cancer throws a clot and causes a stroke or infarction, but somehow I'm guessing that ERs don't perform chemotherapy and radiation for people who can't pay. Am I wrong on that? Do ERs perform chemotherapy?
Definitely, which means that hospitals soak up a lot of uncompensated E.R. costs associated with people whose long term health issues are not being treated. Those hospitals are not required to actually provide that long-term care, e.g. chemotherapy regimens. (Unless you're saying they are, which would be happy news to me, since I understood the situation to be a lot bleaker than that for the uninsured.)
In Europe it is kind of similar, but not as bad. My relative has non-lethal cancer. It was diagnosed by private doctor and waiting list for operation is a few months. So he called ambulance and went to public hospital with 'unknown pain'. The very same doctor (who also work in public hospital) diagnosed cancer second time and bumbed him on top of the list, since it is an 'emergency'.
Just in case someone ask about morals: it is very commom here. This guy has bellow average salary, worked 40 years and got medal for rescuing 5 soldiers in combat.
There is a very big difference between non-lethal cancer and lethal cancer. "Treating" a late-stage cancer is an order of magnitude more expensive than treating a cancer that was diagnosed early.
You say "the alternative" as if every other country on Earth has one system, and the US has a second system, and that first system is what we should have. Whereas all those other countries have a bunch of different systems (compare Canada to the UK to France to Singapore). And each of those systems has real tradeoffs for real people. (To be clear: I'd be fine with many, even most, of those tradeoffs, but people who aren't can't be convinced to my side just by insulting them.)
It depends on the treatment. Not all systems offer full cancer treatment, which is really expensive. What the other systems do have is free basic care - you won't be bankrupted if you break your arm or need a gall bladder removed.
It's a myth that all healthcare needs are free everywhere. There's always some diseases that will fall through a net somewhere. This of course does not mean that the situation in the US is not abysmal, just that 'everywhere else has fully free medicine' is a myth.
> People pay taxes that pay for healthcare for every single citizen. No person is without care. (end of comparison).
The Netherlands and Switzerland have a system of compulsory insurance that's closer to PPACA than it is to "pay taxes that pay for healthcare for every single citizen."
Germany has a combination of sickness funds combined with insurance mandates.
Singapore has compulsory health savings accounts.
The US technically has "no person without health care" because you can get it in emergency rooms, and I'll have to spell this out that I think that's a horrible system, but it meets a "no person without health care" checklist.
I think almost any other system would be preferable to the American system, but again they do involve real tradeoffs for real again.
EDIT FOR PARENT EDIT It's definitely not true that no one pays out of pocket for health care in any other country.
> Even single-payer Canada only has 70% of health-care costs covered by the government
I happen to live in Canada. Sure, Canadians pay out of pocket for some health care, like chiropractors and dentists, but it's important to note no Canadian ever went bankrupt or died due to lack of care (the OP) because of a car crash, slipping on ice, or simply getting hit by statistics.
Canadians don't pay out of pocket for things like broken arms or needed surgeries. Also worth noting that applies to the un-employed, mentally disabled, those unable to work, and those too young or too old to work, etc.
You can nit-pick my broad statement all you want, at the end of the day, health care in America is severely, shockingly, disgustingly lagging behind the developed world.
You should note, however, that in OP's case his mother does have some amount of health insurance; her case would very much fall under "no person is without care." It's the fine print of how much care is given in which the problem lies, and there is a fundamental tradeoff here that all countries implement slightly differently. Is the U.S. at the Pareto optimum, if such an optimum exists? Almost certainly not. But there's no guarantee that any other country is at this optimum themselves.
> People pay taxes that pay for healthcare for every single citizen. No person is without care.
There's a bit more variation than that. The main things is: "No person is without health care", but how that care is paid for, varies quite a bit.
Netherland, for example, still has privatized health insurance. Care is paid for through that insurance. The big difference is that, contrary to the US, that insurance is regulated and compulsory. Everybody has to have insurance, and insurers have to accept anyone.
What exactly is covered by the insurance also varies somewhat, but generally prolonged hospital stays and expensive life-saving procedures are completely covered. And that's the big thing, because that's what drives people into bankruptcy.
You say "the alternative" as if every other country on
Earth has one system, and the US has a second system,
and that first system is what we should have.
That's actually fairly accurate. We have a system with 15% of the population without any sort of insurance, whereas 'the other' system provides universal coverage.
The payment details may vary widely from country to country, but it's unconscionable that tens of millions of Americans are an accident or diagnosis away from permanent financial ruin.
The payment details may vary widely from country to country, but it's unconscionable that tens of millions of Americans are an accident or diagnosis away from permanent financial ruin.
I would bump that to "hundreds of millions". Even when you have insurance, most of it's garbage. Health insurance means you're probably OK, but not always.
The PPACA ("Obamacare") outlawed some of the worst garbage insurance plans (that almost qualify as scams) but that left people with no insurance, and the "market solution" isn't working at all.
If the difference is between having your life savings wiped out and going bankrupt, versus having medical costs taken care of, then regular people do not care about the nerdy details.
Main reason I never want to live in America is health care. Just knowing that no matter what I'll be admitted to the hospital and treated is something I never want to live without.
*2nd reason would be gun violence.
First, a federal law called EMTALA requires hospitals to provide emergency treatment regardless of citizenship or ability to pay.
Second, there is more violence in the UK (about 2.5x-3x times as much per capita -- 993 violent crimes/100K vs. 399 violent crimes/100K) than the United States. And more pro-2A decisions from courts have led to a trend of reduction in US gun violence, including DC murders falling below triple digits post-Heller for the first time since 1963. (Of course it's possible that you live in a very peaceful society and view the UK as also having an unacceptable level of violence.)
Now you may or may not choose to ever live in the United States; I don't care and it doesn't affect me either way. But you may want to educate yourself first.
The UK has a violence problem, probably at least in part due to the drinking. I feel less safe in London than LA. But it is crazy to deny that US gun violence isn't a thing.
Nobody is saying that gun violence doesn't exist (though I wonder how much is limited to inner cities in areas none of us want to live in if we have a choice).
But we're talking at cross purposes. The first post talked about violence. The second talked about violence. The third in the sequence, yours, switched the discussion to talk about homicides. Not all violent crimes are homicides.
The frequency of violence in the US is lower, but the death rate due to violence is much higher. Violence seems to be much more lethal in the US, for some reason.
Gun violence vs gun homicide is really just two sides of the same coin. Either way I don't want to be somewhere that chances of being shot go up appreciably, let alone just having a gun pulled on me w/ no shots fired.
Those statistics mean little outside of cohorts. I would wager to guess the murder rate for the class of people who visit HackerNews is 1 per 10,000,000. Being randomly murdered is not a rational fear in America.
Who's sweeping problems under the rug? I'm simply saying it's not something you need to fear, unless you plan to enter the drug trade instead of coding.
Unfortunately we can't fact check your statistics since you didn't provide sources for them, but it's naive and irresponsible to compare "violent crimes" between the US & UK. The definition varies quite substantially - for example in the UK "violent crimes" encompasses harassment (without any physical injury) which to most lay people would not strike them as especially "violent".
The facts are that in 2010, the US had an average murder rate of 4.8 murders per 100,000 people - 4 times higher than the UK’s rate of 1.2 per 100,000. Likelihood of being killed would seem to me to be a more useful indicator of societal violence.
> First, a federal law called EMTALA requires hospitals to provide emergency treatment regardless of citizenship or ability to pay.
Required emergency treatment is just short-term stabilization, it doesn't include the further treatment which may be medically necessary to provide a reasonable chance of good outcomes. This means, approximately, that without ability to pay, your treatment will stop at the point at which you would be admitted to the hospital from the ER.
"emergency treatment" is not the same as the parent's "treated". Patching me up is not the same as taking care of my health.
You seem to be in some kind of denial about the downsides of life in the US. It is great in many ways, but the financial risk of poor health and the gun-related murder rates are not good compared to most developed countries.
You can still think it best overall without going out of your way to deny some serious issues.
At no point will I ever have to write a post like this, because I know I(and my family) will be covered. I don't care what your laws say, the fact that someone is in this type of situation at all just isn't right. Especially in the richest country in the world.
Funnily enough, the first time I ever saw a gun was on a trip to Paris on two military-looking guards when I was in my early 20s. They were pointed level which freaked me out.
Large parts of the US have very little interaction with guns or gun violence except for occasional stories in the news.
Gun violence is not a good reason to avoid the US. It's actually very rare. If you don't get involved in the drug trade and are middle-class are higher, the odds are overwhelming that you'll probably never see a gun fired at a person.
Our healthcare system is terrifyingly bad, however. It's a damn good reason to avoid living here.
No not even that I think. People in the USA perceives any kind of added tax, as money stolen from the state. Most of them do not have the notion of public regarded as something positive.
Let's say it's a very different perception of property, compared to Europe.
I am trying to convince myself that it's not wrong it's just different.
I try to accept the fact that I don't understand their approach and get over with, otherwise turns me kinda crazy.
> People in the USA perceives any kind of added tax, as money stolen from the state.
Hmm? The typical perception (among those who actually share the perception, which is not all Americans) reads more like: additional taxes are money stolen from the people and transferred to the state, whereupon significant chunks of it are wasted by a soulless bureaucracy (and sometimes select corporate sycophants) before the bureaucracy gives the People back a lot of substandard services.
Of course, enough US citizens were willing to vote for certain Congresspeople and presidents that a significant law was recently passed, with the ostensible goal of reforming health care. You may have heard about it as "the Affordable Care Act" or, colloquially, "Obamacare". So be careful with generalizations about American attitudes.
Perhaps study of this law's actual effects will ultimately be able to demonstrate the accuracy or inaccuracy of this perception?
Disclaimer. This post attempts to describe attitudes only, without endorsing or condemning them.
There's no need to raise taxes, just provide universal healthcare. US is already spending as much per capita on public healthcare to European countries![1] This means that instead of tax hikes you would need to use the existing budget for public healthcare to provide free public healthcare to everyone, just like all other countries who provide a "free" public healthcare paid with taxes.
How did they arrive at $4000 per capita on health expenditures? Times 300 million people, that's $1.2 Trillion. DHHS including Medicare and Medicaid was $940 Billion in 2013.
Anyway, I'd love to see a system that reallocated the money that the government is spending right now only on certain groups and used it to provide the best boost to public health it could for all Americans. But you would be running right into the AARP lobby who would frame this as taking care away from seniors. That's a fierce lobby, and you'd need some sort of plan.
I'm European, and I perfectly understand this approach. Increased taxes can go to increased services (and they do, in some countries), or they can go into the pockets of corrupt government officials (which they do, in many other countries). It's insane to pay higher taxes, and see no benefit in return. I often wish my own country had much lower taxes, to "starve the beast", in a way.
The government is in bed with the industry. I don't trust the government with increased power over health care, because they will just screw everyone even more and give money to corporations. I have 0 confidence in the federal government to represent my interests, and that's the only reason I don't want them to have more control over my healthcare costs.
> What your government is currently offering for health care is completely and utterly unacceptable beyond belief. It's your job to make them change it.
Many of us argue that it's reprehensible that government is "offering" healthcare at all. We are protesting, though :)
Really? I've never seen anything on the news about it, yet I see plenty of citizens of other countries in the news because they are protesting things their government is doing.
You must not be protesting loud enough ;)
It's a fucking embarrassment that there isn't an obvious person to call for help here.
I wish there was an organization that would help people navigate their healthcare. Like a medical concierge/social worker. Someone is an expert on The System and acts entirely on your behalf.
The would oversee your entire healthcare. They book your appointments, remind you to go, handle most billing issues, make sure you're up to date on prescriptions, and even provide emotional support. They involve themselves deeply with your medical care the way an old loyal family doctor might. All you do is be the patient.
You would have to hire and train amazingly great people, but I think there's enough good people in the world that would find the work so fulfilling you could make it work.
Medical problems can be incredibly sad, lonely, scary and it's the one place where procrastination literally kills. Regardless of how crazily you could spend a project like this it would still probably pay for itself based on early detection, better outcomes, etc.
Exactly how much do you think is fair for "amazingly great people" who "[are] expert[s] on The System" and "can oversee your entire healthcare"? Some contractors on HN no doubt get paid more for less.
It's not about what people get paid, it's about what you charge. If you're charging $125/hr you're not going to be helping nearly as many people as you could.
> Does my family qualify for assistance? No. Plain and simple.
Can you elaborate on this?
Prestigious, well-endowed, non-profit hospitals - typically major university medical centers - usually have the most robust financial assistance programs available. Most of them will simply write off the cost of your treatment if you really can't afford it.
I can't say for sure how it works for terminally ill cancer patients, but, I haven't seen anything to indicate disqualification or lack of coverage would take place. I'm sure it depends on the hospital though.
If she's currently receiving treatment from a for-profit hospital without deep pockets, then it's a safe bet their financial assistance program(s) are probably bullshit.
From what I have read, the for-profit hospitals spend the same or more resources on helping financially strapped patients compared to their non-profit counterparts.[1]
Sorry, I should have made it more clear I was speaking in context of coverage for exorbitantly expensive, state-of-the-art cancer treatment. Interesting paper, though.
Have you considered moving her for treatment to another country, like in France or Germany? I don't think they'll rip you off as much, and they'll treat you much better.
I have been seeing this a bit on HN... To the OP and anyone else dealing with a situation similar:
This is going to be the worst time of your life. God forbid you have to go through it multiple times. You can't "save" people. Their misfortune is not your fault. You support, as much as you fucking can, you pay bills, you sacrifice, you love, you care, you show up! But at the end of the day, try to feel the love and not the anger and depression.
It won't "save" your loved ones, but you can save yourself from letting their sickness eat you as well. I feel so bad for this kid, real or not. I was just their in December and lost my second parent. I too share the burden of debt and stress and nightmares, all of which are immense. I hope she makes it, and if she does, give her the time with her son that she probably deserves. If she doesn't, you should first focus on just breathing, the rest of your future is dictated by letting your emotions go the course and not regretting supporting your loved one through the fight.
It's kind of like being a boat with your loved one and it's sinking. Everyone is watching it sink. You scream and yell all you want, but everyone knows its going down. Soon you sink and it stills shocks you, even though you also knew it was going to happen. Don't try to breath underwater.
I’m 22. I’m stressed. Everything’s fucked up. My mom is dying. I need help.
TL;DR If anyone has any work for me (strengths are Ruby/Rails, data mining) please email me. ilovemymomjeanine@gmail.com (will go to my professional email) -- This is in regards to https://news.ycombinator.com/item?id=7214446
If you’re in Minnesota and would like to meet with me, let’s meet.
Very-long; will read:
I’m posting here so I can vent to people that I would normally talk to in my day-to-day life. My life, however, hasn’t felt day-to-day in so long.
It’s felt like one, long clusterfuck of a bullet train inside my head.
I’m not popular here or in the startup community (in the larger sense). I haven’t worked for any well-known startups nor do I contribute to any open-source projects. I haven’t developed any killer libraries and I don’t belong to mailing lists.
But I don’t let that define me. At all.
There’s nothing that I haven’t taught myself. I’m very prideful and mostly confident about my abilities, but I don’t consider myself an all-star at any one thing. I’m just pretty damn good at a lot of things.
I made a post on the Richard Lynch thread where we were discussing how the healthcare system is failing us because families shouldn't struggle to make ends meet. (and thus, my cover is blown) You have to go to page two to see the comment, and for the lazy: https://news.ycombinator.com/x?fnid=iFI3WthoE1Lln4guTBx4gL
My mom isn’t well. While her tumor is shrinking (it was originally the size of a baseball), her doctors continuously insist on more and more treatment to get it as small as possible, even though it’s stage-IV. Her treatments are so fucking specialized that even after the insurance company does their thing, we’re still out five-figures per treatment. It’s insane, and criminal. When asked if there were any alternatives, the reply is always, “this is what we have to treat her with. There’s nothing around it.”
While I’m not a conspiracy theorist, I’m confident in saying that someone is getting paid. Guess what? It’s not my mom.
There was news today, however, that with four more months of what she’s doing with her treatments, she might have bought herself another year to live. If everything goes to plan, she’d able to pump the brakes on all these hardcore treatments.
In August of 2013, I had in excess of $150k in my savings. This was from good client relationships, an acquisition, some domains I sold, a lucky lotto ticket, and always being thrifty. (and not spending money on clothes, though I desperately need some)
When it was confirmed she was very ill in late October of 2013, I moved back home. I packed up all my stuff, said cheers to my startup fam on the coast (which I was going to do anyway), and began a frivolous job hunt. I sold my car, and everything I could, because I knew what was about to come.
My bank account is nearly dry. It’s currently sitting at $10. Yes, just $10. My checking account is at $1.26, and there are no pending checks, or wires, coming my way.
Where did the money go? 97% of it went to my mom’s bills: 4 months of treatments, drugs, hospital visits, seeing specialists…
My father, who is a good man some of the time, hasn’t had a relationship with my mother for 25 years. How they popped out three kids is beyond me. (it’s funny because if you look at our birthdays, our dates of conception are all holidays!) There are politics behind that which I don’t care to go into but will if asked.
Sometimes he’s a good father, particularly to my brother -- why? I don’t know. He does nothing special, and has an assortment of issues (violence, anger). My sister, being the only girl of two generations on my father’s side, is of course spoiled endlessly.
My sister, while we’re on the subject: She’s my best friend, and she sticks up for me whenever my family (“ “) decides to talk shit about me -- because I’ve been so removed for so long, and still misunderstood, my mother/father/brother assume the things that happened so many years ago and applies them now. My sister will plead with them in tears in her eyes, begging for them to just get the facts straight.
What does my word mean? Very little to them. To my sister? Everything.
My father is able to provide the basics, but not able to assist in the bigger picture of things for reasons I’m not cleared to know. He was taken back by me taking control up until this point, but now the future is up in the air. Will she get her treatments? That depends if it becomes classified as “emergency” by the hospital. I’ve spoken with the Patient Advocate Foundation and this is unfortunately the news I got.
Does my family qualify for assistance? No. Plain and simple.
Will my father step in? He didn’t for his own mother who he was close to, so I’m just going to assume he’ll continue to be negligent.
I can’t take out a loan because my credit is bamboozled. I’m already in about $6k in debt and it’s not fun.
I’m desperate to do what I can for my mom. I haven’t always been the best of son, but that doesn’t mean that I’m not trying to be now. I am doing what I would do for anyone, and because it’s my mom, it’s all that more dear to my heart.
I have a (mostly) full-time job right now, co-founding a startup that we’re bootstrapping. I’m yet to get a paycheck after almost 2 months of work because my co-founder hit a snag with some investors from a previous gig. I’m OK with this because in the long-run things will be golden. While those checks would be nice, they don’t cover much unfortunately. Thankfully, though, I have a lot of what I need to do done, so I’m able to look for other work to fill the gaps.
I’d get a full-time job but I don’t have a car and I live in the deep suburbs of Minneapolis. I’m also terrified of driving in the snow (PTSD). I Uber everywhere (I won some monthly credit on my account a while ago).
If anyone has any work they can kick off their hands / can put me to use for, I’d be gracious to take it. I know my ways with Ruby and I do love Rails. Lately I’ve whipped up some SaaS platforms, written APIs, conquered APIs, mined iTunes/Play Stores, built my mom an app to keep track of her meds, stuff like that. I’ll email a portfolio / linkedin / whatever when we talk.
To all of you, "Be Content with what you have; rejoice in the way things are. When you realize there is nothing lacking, the whole world belongs to you.”
To me it sounds like you never had a long-term plan for the treatment or your own future. You jumped in, blew your savings, and now you're stuck.
It's too late for "could-have, should-have", but if you somehow manage to procure more money, at least consider alternatives such as slower treatment schedules or flying your mother to a country where such treatments are cheaper (India comes to mind as a potential option)[0]. Also, consider a second opinion to understand whether continued treatments will make a fundamental difference.
>I’m also terrified of driving in the snow (PTSD). I Uber everywhere
I've heard of PTSD from rape or war, but this is totally new to me. What happened?
>I’m yet to get a paycheck after almost 2 months of work because my co-founder hit a snag with some investors from a previous gig. I’m OK with this because in the long-run things will be golden.
That sounds very strange to me. If my family was in need, I personally would jump on a first job with a stable paycheck that I could get so I could (slowly but surely) provide money. This seems like poor timing to bet on a lottery ticket (which, as HN reminds us, most startups are).
[0] - inb4/none of these are an option because reasons
> To me it sounds like you never had a long-term plan for the treatment or your own future. You jumped in, blew your savings, and now you're stuck.
I'm 22, young; my future is good. For what it's worth, the way I see it is that everyone I would have graduated college with (I only did a semester), is now in massive amounts of debt. I'm just starting from near-zero (-$6k).
> I've heard of PTSD from rape or war, but this is totally new to me. What happened?
Snowstorm, lost traction. Ended up under a semi and was dragged under. The supporting beams of the trailer (which were perpendicular to my windshield) came through it and nearly put my face off.
> That sounds very strange to me. If my family was in need, I personally would jump on a first job with a stable paycheck that I could get so I could (slowly but surely) provide money. This seems like poor timing to bet on a lottery ticket (which, as HN reminds us, most startups are).
It is, and you're absolutely right. I wasn't expecting to not get a check, and I wasn't expecting to <completely> clear out my savings.
>To me it sounds like you never had a long-term plan for the treatment or your own future. You jumped in, blew your savings, and now you're stuck.
You think that the OP is to blame for not having a long-term plan for a scenario in which one's very close family member is diagnosed with a previously unknown disease and $150k is not enough to take care of that?
You think this is an instance of poor planning on the OP's fault?
Cancer kills quickly, but not "tomorrow" quickly. This gives an opportunity to consider the big picture and how you'll navigate this challenge. The OP himself writes that his savings lasted for 4+ months. I was surprised that, in this timeframe, zero thought appears to have been given to the question: "What happens when my money runs out?".
The final outcome may have been the same (asking for donations online), but you'd be starting out early instead of with your back against the wall. Same as with startup funding: if you look for funding only when you're out of runway, you'll have a next-to-impossible time of securing it (or securing it on good terms).
Okay! Scenario time! Same thing happens to you, or your family. A family member has cancer. It's going to cost $50k and a few months. What do you do?
Oh wait. Instead of $50k, it's more like $75k. Actually, make that $125k. But it's going to be $125k and no more.
Just kidding. In fact, because I'm playing the role of Life + Healthcare in this scenario, I'm going to lob a little bit more at you. In fact, it's going to be $1M. (Think this is implausible? Sorry, it's not. [1]) What are you going to do? Also, I may up that number a little bit more, just for kicks. What are your plans?
Your post may be more convincing if you outlined your actual point instead of relying on hypothetical scenarios. My only guess at what you're saying is: "Healthcare costs can be unpredictable." That's a fair assumption, but it fails to negate my previous point in any way.
What 22 year old plans for their parent's cancer? Or really has a solid idea of exactly what their future has in store?
He was doing what people in their early 20s are supposed to do: take risks. He was probably involved in startups before his mom got sick.
Let's not beat him up for doing what many of us are doing right now, then getting caught in an unpredictable and terrible situation and trying to do what he thought was right at the time under a lot of stress and emotion.
You can have chronic PTSD from many things. For example, people who were abandoned, beaten and physically abused as children. That's just one example, there are many others. You don't have to be a war vet who saw active combat or a woman who was raped to suffer from PTSD.
It is depressing that how US healthcare system is structured to bankrupt middle class people so healthcare companies can make more billions.
Can any of these things work for you?
1) Can your mother get medicaid? I believe there is almost no copay with medicaid.
2) Can you get any other medical insurance plan where you have lesser or no copay? May be something through Healthcare.gov?
3) Can you go to India and get medical treatment? Most treatments and medicines in India cost about 1/10 of US. There are several hospitals and doctors in India which can provide treatments compared to US. I can dig up some information if you want to do this.
While I'm sure you mean well, and it's not like HN is full of trolls who want to trick you, you shouldn't just be asking for PayPal accounts that you'll willy-nilly send money to. You have no idea if this story is true or if this is just a scam. Let's at least do some due-diligence, then we can get a serious campaign going.
I'm sorry to be so skeptical, but I've seen some truly conscienceless scammers--both on and off the internet--to not trust anything anymore until it checks out from multiple angles.
It's hard for me to accept handmeouts, but if anyone decides to be insisting, I'll vow to pay it forward (I always do) and even start a blog about the course of the treatments (with pictures of paid bills, etc.) I'm a big believer in full-disclosure.
I made the account under ilovemymomjeanine@gmail.com and I'll follow up with you with pictures of the paid invoices. I know there are trolls that do this, but for all that I have, I'm not one.
Are you just using your money for copays/deductibles or does she not have any insurance at all? Will they stop treating her if you stop paying? Defer as long as possible and either work out a payment plan later or let the insurance company eat it down the road. I know many people who have been bankrupted paying off medical bills as they come but you should pay just enough to keep the treatments going. Let everything else ride then declare bankruptcy if any of it is in your name.
She does have insurance, and it's great insurance. The treatments are just so specialized that the bill, after the insurance does their "work", is still anywhere from $10k to $50k.
They've made it clear that because the treatments are so specialized and that they have had to go outside of the normal realms for a patient (e.g. they had to bring in another specialist), that once the money stops flowing, things will need to be reevaluated.
It's a fucking scam. And a fucking shame to this country.
She does have insurance, and it's great insurance. The treatments are just so specialized that the bill, after the insurance does their "work", is still anywhere from $10k to $50k.
That is not "great insurance". I am not a big fan of PPACA, but every single one of those plans has an annual out-of-pocket limit on costs (~$6,400 per individual, twice that for a family). My out of pocket limit on my (excellent) BCBS PPO is $500 + minimal copays.
Now that preexisting conditions are no longer a barrier to changing plans, you should shop around.
Under PPACA, as of this year, there's something called "Guaranteed Issue", which means that if you offer an insurance plan at a particular rate, you have to give that rate to everyone, and accept anyone who will pay it. The only variables that can go into the rate calculation (AFAIK) are age, a community rating, and whether the applicant is a smoker.
She should get on her state's or the federal exchange and find a plan that includes her doctors. If she's seeing top flight specialists, that might be expensive, but it will be much cheaper than "$10-50K per incident".
I am surprised to be shilling for Obamacare, but there it is!
It's hard for me to accept handmeouts, but if anyone decides to be insisting, I'll vow to pay it forward (I always do).
I made the account under ilovemymomjeanine@gmail.com and I'll follow up with you with pictures of the paid invoices. I know there are trolls that do this, but for all that I have, I'm not one.
I'm always astonished on how BAD the situation with Health care actually is over there. Surely the best, you just need to be rich. It's just disgusting.
I don't, I actually have everything with Beanstalk (private repos)
inb4 someone says "that's $$$ that you could be spending on yo momma" -- I used to sleep with one of their execs and put me the plan they give their employees.
I still wish that instead of some massive, problematic bill, we had got something that would stop disasters like this.
I really wish a simple fee[1] had been added to insurance plans, paid to the government, to cover a "catastrophic care" insurance to pick up all bills over $50K or maybe $75K. It would have save everyone on premiums[2] and stopped the destruction of a family by one event. Instead we got targeted, issue-based freebees.
1) Government should just add all the uninsured
2) having a max payout on an incident of care makes for some interesting changes to risk
I lost my Mom to cancer in September. Cancer is a nightmare. My heart goes out to you.
They didn't catch my Mom's cancer until it was already Stage 4 and the size of an orange to grapefruit. She developed massive ascites which caused her to gain 30+lbs of fluid. People don't know how bad cancer is until you live it first-hand.
I was my Mom's full-time caregiver. It was hard. But now that I can look back, I feel privileged to have been able to be with her.
Do you know what the word "diaper" is spelled the other way around? Repaid.
Post on ruby.mn, with a link to a github account with some code samples, preferably with a unit test.
Minnesota is an outstanding place that has programs in place for these sorts of things, and plenty of work. The winters are brutal, but the people are well read & kind.
In fact I referred a PHP transplant from DC to 4 startups today, I'll email you for your deets and get the ball rolling.
[UPDATE] Meeting at Spyhouse NE to get him sorted @7 we'll be the ones dressed as nerds by accident instead of on purpose.
Have you thought about applying for medicaid? As far as I understand they cover all your medical expenses, as long as you're making below a certain amount per year?
That's a tough read, wish I could help. Shame on the other readers who want to lecture you and quiz you instead.
Seems to me many people don't realize that the uninsured only have access to emergency room treatment only, and cancer therapy is not provided by the ER. If you're not insured and you can't pay then you don't get therapy, it's sadly that simple.
He needs to consult with a patient advocate that knows Medicaid procedures. IT will be frustrating..more so since he needed to do it in the fall of 2013.
In Europe cancer is treated for free. But there is barrier which prevents doctors from puring money into terminal patients. Some special procedures available in US are not on the list (not accredited yet). Some others have priority queue and person over 50 would not have a chance to qualify.
Horrible to hear. My mother died when I was at a similar age. Although there was little support from my family either, I live in Germany, so the state pays for Health care and there is welfare for people who cannot work.
And still the stress seemed overwhelming. But in comparison I really can't complain...
What is the 'max out of pocket' on your mother's insurance plan? With many plans I've seen, once you've paid out of pocket X thousands of dollars for the year, the insurance picks up 100% of the cost, as long as you are seeking treatment at an in-network provider.
It's hard for me to accept handmeouts, but if anyone decides to be insisting, I'll vow to pay it forward (I always do) and even start a blog about the course of the treatments (with pictures of paid bills, etc.) I'm a big believer in full-disclosure.
I made the account under ilovemymomjeanine@gmail.com and I'll follow up with you with pictures of the paid invoices. I know there are trolls that do this, but for all that I have, I'm not one.
"I feel sorry for you but your mom should have worked harder to get a better job that had better insurance. If we just give people free healthcare, it will breed laziness"
-typical HN libertarian. They'll show up, just wait.
Let her die.
Chemo isn't going to save her, and it sure as hell won't improve her quality of life. It will give you maybe an extra year to watch her fade away before your eyes, and will inflict all manner of pain and discomfort on her in the process.
Your mother is going to die, far sooner than either of you would wish. That's unavoidable. What you do have control over is the quality of her life in her last few months, and in the effect that her passing has on the people she cares about. You can control how you spend what time you have left, but you have precious little control over how much of it you have to spend.
I'd suggest reading How Doctors Die[1], a take on how those who have the most experience with cancer and its treatments choose to deal with it. Generally speaking, they don't.
I'm sorry if this sounds harsh, but I watched my stepmother tear herself apart refusing to accept the inevitable and pushing for every last available treatment. The extra six months or so that may have afforded him are not a six months I would wish on anyone.
You are going to lose your mother, and it will break both of your hearts. Pumping poison into her and bankrupting your family won't change that. Make your peace, and let her go.
[1] http://www.nytimes.com/2013/11/20/your-money/how-doctors-die...