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Tuesday, June 11, 2019

Crowdfunding health care

This HuffPo piece caught my eye on my iPhone.

While health insurance or government programs like Medicaid and Medicare can shield against huge medical bills, massive debt and even bankruptcy, only the truly wealthy can feel secure that sickness won’t lead to financial ruin.

This is why thousands of Americans have turned to crowdfunding website GoFundMe in the last decade to help cover medical bills and related costs. HuffPost is profiling some of those people, and what their stories reveal about the shortcomings of the American health care system.

These are not feel-good stories.

That’s often how the news media cover these fundraisers ― focusing on the generosity of individuals giving rather than the systemic failures that created the need. While it’s hard not to be inspired by successful campaigns and the fortitude of those suffering through terrifying ordeals, such stories portray a chilling reality that Americans ― even those with good jobs and health insurance, can be one bad day away from financial ruin.

A serious disease can put financial strain on people even in countries with universal health care systems and strong safety nets. But the United States, which has neither of those things, leaves its residents uniquely vulnerable…
In my more cynical moments, I might have written the title as "Inside America's Go[Bleep]Yourself Health Care System."

Both of my late daughters died well beyond flat broke from their respective cancers. There was no "GoFundMe" in the 1990's when Sissy was ill. Her younger sister Danielle, however, got a bit of OoP and "bucket list" benefit in 2017-18 from a crowdsourcing account set up by one of her friends.

As I ponder my new Kaiser Permanente Medicare Advantage membership, my max annual OoP (out-of-pocket) caps at $6,700--plus monthly premiums of $51 ($612 for a year, even if I never use them, though I will have ongoing Rx co-pays).

I lost track of my 2018 OoP. Suffice to speculate that it was well beyond $6,700, in light of my hernia and SAVR surgeries. I know my (BS) "Chargemaster" 2018 tally on my final EoB was close to $600k.

Tangentially, as recently reported by STATnews, one family in Iowa took things to a whole 'nuther level:
When ‘right to try’ isn’t enough: Congress wants a single ALS patient to get a therapy never tested in humans
...“What about other patients who can’t afford this kind of access and don’t have this kind of political clout? Should people be contributing to a GoFundMe that is extremely unlikely to lead to benefit? What are we doing to patients when we advance this spirit of fighting disease at all costs?”
Read all of it, including the fractious comments. Tough, tough case.


How will we pay for the coming generation of potentially curative gene therapies?
Senator Bill Cassidy, MD (R-LA)

We have arrived at a special moment in health care. Innovative, life-changing gene therapies are here that will cure or ease debilitating diseases. Yet these expensive treatments are entering a market structure that was not built to price them…
...Life-changing gene therapies are coming. We must give thought now on how to determine the price of these innovative, new-age treatments and how to finance them to ensure that we realize their full, beneficial potential while also ensuring that society can pay for them...
Another good STATnews item. No amount of crowdfunding will suffice in this area. More broadly, there's a bit of "market" condundrum with respect to "precision / personalized medicine," no? A "market of one?"


Firewalled, but we get the point.

"The U.S. health system has been carefully structured, often through enabling legislation triggered by special interest groups, to allow the supply side of the health care sector to extract enormous sums of money from the rest of society. Nowhere is this clearer than with specialty drugs, whose prices per year of treatment now routinely exceed $100,000. Yet on Capitol Hill, this system has always had its staunch defenders, for obvious reasons."

Reinhardt, Uwe E.. Priced Out (pp. 145-146). Princeton University Press. Kindle Edition. September 2016 Princeton interieww.
The Worst Patients in the World
Americans are hypochondriacs, yet we skip our checkups. We demand drugs we don’t need, and fail to take the ones we do. No wonder the U.S. leads the world in health spending.

…For years, the United States’ high health-care costs and poor outcomes have provoked hand-wringing, and rightly so: Every other high-income country in the world spends less than America does as a share of GDP, and surpasses us in most key health outcomes.

Recriminations tend to focus on how Americans pay for health care, and on our hospitals and physicians. Surely if we could just import Singapore’s or Switzerland’s health-care system to our nation, the logic goes, we’d get those countries’ lower costs and better results. Surely, some might add, a program like Medicare for All would help by discouraging high-cost, ineffective treatments.

But lost in these discussions is, well, us. We ought to consider the possibility that if we exported Americans to those other countries, their systems might end up with our costs and outcomes. That although Americans (rightly, in my opinion) love the idea of Medicare for All, they would rebel at its reality. In other words, we need to ask: Could the problem with the American health-care system lie not only with the American system but with American patients?...
Yeah. Recall my prior post "Can medicine be cured? Some views from across the Pond"

More to come...

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