[Thriptic]

The real root problems with the system are that a tiny minority of very sick patients account for an overwhelming majority of treatment costs; that it's difficult to prevent this from happening; and that the current care structures make it hard to take early action to incentivize these patients to improve.

It also is almost impossible to have a real discussion about this fact because it makes people uncomfortable.

[majormajor]

There's a lot of moralizing in this, without numbers justifying it. Show me the evidence that an overwhelming majority of costs come from few recalcitrant bad actors vs things like cancers, expensive surgical or drug remedies of rare diseases, or just plain expensive end-of-life care (a somewhat separate discussion from the others, but a conversation that'll have to be had sometime).

Without that... the costs will always be unevenly distributed due to the nature of illness, that's why the only sane first-step health policy is mandated universal insurance coverage, public or private, since the main question is who is going to get the bad news that they've got the unlucky genes/mutated cells/whatever. Everyone pays in, everyone gets covered if/when they need it.

And if you pay in your whole life and never get seriously ill? That's not a reason to complain, that's a reason to thank your lucky stars you didn't have to deal with being seriously ill or injured! It's not fucking fun, like sick people are trying to get a free ride here.

[adventured]

The parent comment was correct when they said this:

"The real root problems with the system are that a tiny minority of very sick patients account for an overwhelming majority of treatment costs"

It's impossible to tell exactly what the parent comment meant any more precisely without clarification, whether they were talking about unnecessary over-consumption of resources (Americans have been over-healthcare'd for decades), or that eg cancer patients or elderly consume vast resources (as one would expect). However, it is of course the case that a tiny percentage of the population produces a very large share of the cost. The bottom 50% of healthcare consumers, are a mere 3% of the cost in the system. I don't know what the point of any of that is however, there are only ultimately two choices: go back to the old system that was far less expensive for the majority, but didn't properly cover about 1/3 of the population; or continue to shift toward universal healthcare with a fully distributed cost (which means significantly raising taxes on the middle class, as in every universal healthcare system).

"When it comes to America's spiraling health care costs, the country's problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country's medical spending. ... In 2009, the top 1% of patients accounted for 21.8% of expenditures."

https://www.theatlantic.com/business/archive/2012/01/5-of-am...

[cjalmeida]

You can do the NHS way and forbid paying for unwarranted procedures for life extension.

Can't find data right now, but a generally healthy person will spend most of it's lifetime healthcare expenses on its last 2 years.

NHS adopts this measures in the so called death panels. So it can have money to fund preventive care and promote healthy lifestyles.

[DanBC]

> You can do the NHS way and forbid paying for unwarranted procedures for life extension.

Please cite which of these procedures are forbidden.

> NHS adopts this measures in the so called death panels

The US has these too, in the form of insurance companies.

I think if you're going to have them it's better to ahve them be publically owned not for profit organisations under intense government regulation, rather than profit making companies.

[cjalmeida]

NHS guidelines is to not extend a terminal patient's life indefinitely. Not sure the explicitly reason is costs but having people months on intensive care is pretty darn expensive

http://www.telegraph.co.uk/news/health/news/6127514/Sentence...

Also, it had a policy of not funding what they call "procedures of limited clinical value"

http://www.miltonkeynesccg.nhs.uk/referrals-and-priorities-p...

[DanBC]

Your first link refers to the Liverpool Care Pathway. This was only for people with end stage terminal illness. It doesn't happen anymore -- the Liverpool Care Pathway has been stopped in all hospitals in England.

https://www.compassionindying.org.uk/wp-content/uploads/2015...

https://www.theguardian.com/society/2013/jul/15/liverpool-ca...

Your second link is even weirder. Firstly you've linked to a local organisation that covers a population of 250,000 people. Milton Keynes CCG is not a national organisaton. Secondly, you've said this is about not funding some treatments, but you've linked to the page where people can request funding for those treatments. Thirdly, You think US insurance companies fund anything and everything?

Some treatments are very expensive and also do not work. We see this most commonly with cancer drugs. To ease the burden for CCGs there's a national "Cancer Drugs Fund", set up to provide access to the latest cancer drugs.

They do not work. They do not work, and they cause harm, and they are very expensive.

https://www.theguardian.com/science/2017/apr/28/cancer-drugs...

> The Cancer Drugs Fund, set up by the government to pay for expensive medicines that the NHS would not normally finance, failed to benefit patients and may have resulted in some of them suffering unnecessarily from toxic side-effects, experts say.

> An analysis in a leading cancer journal has found that the fund paid out £1.27bn from 2010 to 2016 – an amount that would have paid for an entire year of mainstream cancer drugs for the NHS.

> But medicine it paid for was not worth the money, the report concluded. The analysis in the Annals of Oncology journal looked at 29 cancer drugs approved for 47 different types of treatment (known as indications), some of which were approved to treat more than one cancer. They found that only 18 of the 47 treatments prolonged the patient’s life, and then only by an average of three months.

But assuming someone still wants it, and they apply for individual funding and don't get it, they're now in the same position as many Americans: they can crowd-fund and go private.

[telchar]

Mostly the expensive people are, as you say, the ones screwed by fortune or those whose health declined in the past for whatever reason and their present behavior is not going to be able to fix things even if it contributed to their present poor health. Still it doesn't make much difference to the hospital when they have to explain why a routine knee replacement is going to cost 20k.