[cybwraith]

While this person should definitely get treatment or at the least isolate per the court order... Why is this treatment that can cost from $50,000-$500,000 something a person can be burdened with by court order?

The CDC and relevant laws around TB only have the government cover treatment "if you are unable to pay", so if someone had $150,000 in their 401k and got Tb with charges of $149,000 their progress towards any sort of financial stability could be brought back to effectively zero.

Even if they were low income and covered by an ACA plan, those usually have pretty high coinsurance percents so this is still a very possible scenario.

This is clearly a case where treating anyone with TB in this country is a public good and should never burden the individual to such an extent (or at all, really).

[TazeTSchnitzel]

In Sweden healthcare is already so cheap (due to state control) that Americans would consider it free, but there's a list of special diseases that are a unique danger to public health,[0] which includes TB, and in those cases you are not charged at all for treatment.[1] It seems reckless from a “not-having-epidemics” standpoint that a wealthy place like the US wouldn't do the same. Hell, it shouldn't be a problem for health industry profits, they could be paid by the state if necessary.

[0] https://www.folkhalsomyndigheten.se/smittskydd-beredskap/ove...

[1] https://www.1177.se/sa-fungerar-varden/lagar-och-bestammelse...

[teawrecks]

It's gonna take some pretty wealthy people getting pretty awful sick for that to ever happen.

I don't like the typical cynical circle jerks about capitalism etc, but that's just how it is here. The US citizens don't have the power over their healthcare system that the wealthy do. Everyone knows it, everyone readily and openly discusses it, but no one affected is in any position to change anything. Politicians are paid off, votes never go through, bills die off, nothing is allowed to happen. Politicians are voted against, money is speech, they win anyway, the cycle continues.

[madaxe_again]

The cycle also ends, going by historical precedent. We humans have a long-standing tradition of painting ourselves into a sociological corner and then having no option but revolution. It always seems unthinkable before it happens, and then, once it does happen, it seems to have been inevitable.

What the second American revolution will look like, and when and where and how it will happen, I can’t say — but it will. That much is a certainty.

The other option is conquest by a power that isn’t yet in its decadent days - but that remains unlikely in the case of the US - their rivals would do better to simply wait for them to fall on their own sword, rather than expend the energy or political capital on an active invasion. The situation is not dissimilar to Russia in the early 20th century.

The window-dressing is certainly correct at the moment, with a lot of technical development and new communication methodologies available, and growing and accelerating wealth disparity.

[trilbyglens]

A key difference though is that in modern America people are still nominally comfortable. People don't revolt because of expensive Healthcare, they revolt when they cannot buy food. The tragedy of modern America is that even though things are bad and people do suffer, the majority are utterly complacent and uninterested in real systemic change. As long as people can go to Walmart and watch their TV shows, nothing will meaningfully change.

[PragmaticPulp]

> Why is this treatment that can cost from $50,000-$500,000 something a person can be burdened with by court order?

The court order is that she must either take her treatment or isolate.

If she didn't/wouldn't/couldn't treat, she was not allowed to expose other people. That is the core issue. Note that she did start the treatment, but she refused to finish the course of treatment and refused to comply with necessary testing to ensure the case had been treated. I can't find any articles suggesting that she stopped because it was too expensive, though that is what most commenters are assuming.

Also, TB antibiotics don't cost $50K to $500K, at least for first-line treatment (the treatment she refused). The published treatment costs generally include multiple weeks of inpatient hospital treatment (for example: https://www.cdc.gov/tb/publications/infographic/appendix.htm ). If someone had a case that fit this description, they wouldn't be wandering around in the world infecting others.

[jwestbury]

Regardless of this particular case, ordering someone with a disease to either pay to treat it or to isolate is surely the behavior of a dystopian state.

[HDThoreaun]

Allowing someone with tuberculosis to infect other people is the behavior of a dystopian state.

[classichasclass]

I can't say this for every state, but this is exactly the case in California: if you can't afford TB treatment, you're still covered. Every health jurisdiction has a TB control program, some very large, and every jurisdiction with cases gets state money to ensure those cases are treated. That goes for relatively uncomplicated active TB through horrid multi-drug resistant cases. That goes for citizens and immigrants alike. Some of the best TB docs in the state work for local health departments. I've treated cases for over 15 years. We want you to succeed. We do not want you bankrupt for a disease you had the bad luck of getting, and we don't want you to give it to other people in the process, because we're the ones that have to clean up the mess.

It's precisely because we'll bend over backwards with treatment coverage, free doctor visits, rent assistance, helping apply for short-term disability or Medicaid, home directly observed therapy, you name it to break down those barriers, that when I walk into court and say this person needs to be confined until they're no longer communicable, it's not because they can't afford it. We've done everything we could do to avoid getting to this point. Now they're a danger to the public, and we can't let that go on.

Source: public health TB physician

[smnrchrds]

> if you can't afford TB treatment, you're still covered.

Does this help in the hypothetical case OP is mentioning? Or does the government coverage kick in only after the person has been made to spend every last dollar that they have on the mandatory treatment and are now left penniless?

[classichasclass]

Again, can't speak for places other than California, but here TB treatment is not like Medi-Cal where you have to spend your assets down first. We'll see you because it's emergent, and we'll ensure your treatment is complete because it's necessary. We'll bill your coverage if we can but we'll never bill you. If you have insurance, you can see them, or you can still see us. I have Kaiser patients who would rather come in because it's easier to get an appointment and we handle everything for them.

This is not necessarily true of other diseases. But TB's legal complications plus its serious nature make it essential to handle it this way. It's cheaper for the local health department, too: think of what has to go into evaluating and testing all the people who ended up with a preventable exposure. I remember a case in which we tested over 5500 people because it was a nurse and they weren't detected for six months.

[marcus0x62]

> If you have insurance, you can see them, or you can still see us.

Outside of an HMO, what does this mean? You cannot “see” or be treated by most insurers in the United States. You “see” a licensed provider, then some time later find out what, if any, of the charges billed by those provider(s) are covered by your insurance plan.

[classichasclass]

Obviously it means you can see the provider they cover, whomever that is.

[marcus0x62]

Then maybe say that instead of confusing payors and providers.

[verall]

Under the ACA, the out of pocket maximum for a marketplace plan cannot be larger than $9100 for an individual and $18200 for a family in 2023.

The US healthcare system is broken but if you had insurance they could not take your whole 401k.

[smnrchrds]

If the woman was uninsured, would she be able to purchase insurance outside of the annual open enrolment period or would she need to pay out of pocket until November?

[kevingadd]

Insurance does not cover all health expenses, there are maximums and deductibles. Sometimes a treatment isn't covered.

[PragmaticPulp]

> Insurance does not cover all health expenses, there are maximums and deductibles. Sometimes a treatment isn't covered.

Lifetime and annual insurance limits aren't legal any more. It's incorrect to say that insurance has maximums.

Tuberculosis treatment for an active, diagnosed TB infection would be considered an Essential item and therefore would be covered. It's also incorrect to suggest that insurance might just choose not to cover it.

[kevingadd]

Insurance companies can and will reject treatments recommended by a doctor on a regular basis. It's not hard to find examples of this. You can insist that The Rules say TB is exempt from this but laws aren't real unless the people responsible for enforcing the rules believe in them. Do you think some faceless health insurance administrator - whose name you don't even know - is going to go to prison for rejecting your TB treatment? Have fun with months of appeals and maybe having to retain a lawyer to get your treatment.

I've personally dealt with this post-ACA (though not for TB).

[marcus0x62]

Sigh. Lifetime limits on covered procedures aren’t allowed. That isn’t to say the treatment your doctor recommends will be deemed medically necessary and be covered.

[Teever]

> Tuberculosis treatment for an active, diagnosed TB infection would be considered an Essential item and therefore would be covered.

As a non American who doesn't know much about the American healthcare system beyond what the internet and news tell me I so want to believe what you're saying but something tells me that there's at least one person out there right now in the US walking around with untreated TB because treatment wasn't classified as essential by some uncaring bureaucrat.

[PragmaticPulp]

> As a non American who doesn't know much about the American healthcare system beyond what the internet and news tell me I so want to believe what you're saying

You don't need to trust me. It's really easy to Google: https://www.healthcare.gov/coverage/what-marketplace-plans-c...

> but something tells me that there's at least one person out there right now in the US walking around with untreated TB because treatment wasn't classified as essential by some uncaring bureaucrat.

No, TB is treated as a significant public health threat. No insurance company would dare deny treatment for TB because the ensuing liability would be massive. They'd be on the receiving end of gigantic lawsuits from everyone who was possibly exposed to the person, not to mention on the receiving end of legal inquiries from the government to punish them for very clearly violating the very clear federal laws on the matter.

The US has a lot of room to improve, but it's not like the cartoonishly evil version you read about online.

[lukeschlather]

This woman lives in Washington State, where eligibility for Medicaid is income dependent. There is no means test, which means that as long as her income is under $1,563/month she would be eligible. So assuming she's unemployed or marginally employed I would expect this to be free for her.

[wesleywt]

What? It is insane for a person to have to pay for TB treatment. We have a huge TB burden here in South Africa. Treatment is free because we don't want it to spread. Unfortunately, because of the massive urbanization movement after Apartheid, the shanty towns makes the spread quite easy.

[HarryHirsch]

It's insane for you. For them, it's good business sense, because they can protect themselves from respiratory disease. Even better if you can sell orphan drugs for huge markups because TB requires specialty antibiotics. Follow the money, as they say...

[lamontcg]

> This is clearly a case where treating anyone with TB in this country is a public good and should never burden the individual to such an extent (or at all, really).

universal health care. the same logic doesn't stop with TB, the contagiousness just makes the public health benefit obvious.

[gremlinsinc]

> When they performed X-rays of her chest and saw the state of her lungs, they initially suspected she had cancer. But in fact, the X-rays revealed that her tuberculosis case was worsening.

> Moreover, she also tested positive for COVID-19, "which also strongly suggests that she is not isolating as per this court’s order," the health department's court filing said.

What's the point of going after her at this point, it seems to me like she's circling the drain. Covid is bad enough without also having TB, the only people who stand to profit are lawyers. She def, should be made to get treatment one way or another, ideally it should be free.

The CDC should cover all but 5% of the person's income worth, so instead of 150k treatment taking all of a person's 401k, maybe it takes 8k. That's much more reasonable IMHO.

[acdha]

The point is to get her to stop endangering innocent people. Note how that includes things like going to the ER and not telling them that you have a nasty disease until you have had plenty of time to infect others.

And, yes, treatment should be free: if she’s poor, Medicare will cover it and if she’s over that the ACA will cover it until something like $50k annual income.

[xboxnolifes]

> The CDC should cover all but 5% of the person's income worth, so instead of 150k treatment taking all of a person's 401k, maybe it takes 8k. That's much more reasonable IMHO.

What's the point of putting 5% on the person here? Why not just cover 100%?

[omao]

Those inflated prices are for tb that has become resistance to basic treatment which is the path she’s going on. because she had already started treatment and stopped increasing the likelihood of resistance. Also the treatment was offered to her by the county it’s basically free.

[ThrustVectoring]

401k accounts are generally exempt from bankruptcy proceedings and other debt-collection activities.

[Renaud]

Meaning that if you can afford insurance, or your employer pays for it, you might be ok.

If your situation is already precarious and you cannot afford insurance then you’re doubly f*ed.

In cases like this, it is a benefit to society that people get treatment before they think (rightly or wrongly) that they can’t afford it and infect others.

Treatment should be free.

[pyuser583]

Are IRAs exempt?

[tzs]

Against specifically bankruptcy? Yes. As marcus0x62 already noted they are not covered by ERISA which is what deals with 401(k) plans.

However, they are covered under the Bankruptcy Abuse Prevention and Consumer Protection Act (BAPCPA) of 2005. This covers up to $1 million dollars. (I've seen something that suggests if the IRS is a rollover IRA rolled over from an ERISA-qualified plan there might be no limit, but haven't looked to see if that is right).

Note that this just covers bankruptcy, whereas ERISA also covers seizure by creditors, so the 401(k) is better in this regard since you would actually have to declare bankruptcy in the case of an IRA. States usually provide protection against creditors. See the link in marcus0x62's comment.

Also if you do something stupid like use your IRA as security for a loan the BAPCPA protections will not apply. I've also seen something that said if you borrow money from your IRA it can reduce your BAPCPA protection.

[compsciphd]

Its fairly easy enough to setup a Solo 401k. While it could be difficult to send contributions to it directly, you can contribute to an IRA and then rollover into the Solo 401k.

Solo 401Ks are also useful for enabling backdoor roth IRA contributions. For those with traditional 401Ks, one doesn't want to roll them over into a traditional IRA as that would remove one's ability to do backdoor roths.

[marcus0x62]

Depends on the state. IRAs are not ERISA-qualified plans, it may have some state-level protection. https://www.irafinancialgroup.com/learn-more/self-directed-i...

[briantakita]

The elephant in the room is the inflated costs for medical care in the USA. Some go to Mexico to save money on medication & treatment.

[Maursault]

> Why is this treatment that can cost from $50,000-$500,000 something a person can be burdened with by court order?

Though the US talks a good game about rights and freedoms, LEO and courts do not respect the Bill of Rights, nor is there ever any consequences for them for illegal searches, illegal interrogations nor coerced confessions. In this case, the 8th Amendment should protect her from this burden quite obviously as "excessive fines," but these rights really don't exist, nor is it possible for any court in the US to find a defendant, "innocent."

Most state law, at least, once accused, it simply is not possible to be acquitted, making nearly all trials a sham. The prosecutor, not any judge, as Robert Jackson said, "has more control over life, liberty, and reputation, than any other person in America." They don't care about justice, they only care about their conviction record. They will never agree to consider exculpatory evidence. It is only a matter of whether they think they can win, such that they will happily and readily convict the innocent if they can, and will avoid prosecuting the guilty if they have any doubt they could not.

Individuals that never had the misfortune of being charged with a crime and attempted a defense in court could never understand, and they also, as a rule, have a strong bias towards accused being guilty, even prior to conviction, even if there is no evidence of crime. There is a reason most cases end before there is any ruling... they usually end as plea deals. There is no presumption of innocence in US courts. All that is needed for a conviction is an ambitious prosecutor to slander the accused with absolute bullshit fantasy.

The ability of a prosecutor to seat and manipulate a Grand Jury, even to indict a ham sandwich if that's what they wanted, is the source of their power, which is nearly absolute, and that power is the source of their corruption. There are very few with that power that have resisted its corruption and are not obsessed with their ambition to win at any cost over the platitude of justice being served. We have to assume Associate Justice Robert Jackson was one. I think probably Kenneth Star and Merrick Garland, also. I would have insisted John Roberts was also among them until he saw the opportunity to overturn Roe with an illegitimately weighted conservative Court, and despicably did so, and young women will bear the consequences with their very lives, not him.

[naikrovek]

think a bit more before you reply, please. or maybe read a bit closer and get the details before you type out a 500 word essay on why the justice system is broken.

the court order is to get treatment according to doctors instructions, OR isolate.

isolation costs nothing.

what is worrying to me is that A) you just had this entire wall of text ready to go, it seems, waiting for somewhere to put it, and B) what the hell kind of a society do we live in where the society doesn't take care of its citizens, and how the hell do we view this as normal in the US?

in this case, it doesn't matter. she's got TB and doesn't want treatment for whatever reason. so you sit your ass down and you don't leave the house until you either die, miraculously are cured, or you change your mind about treatment.

[Maursault]

Maybe you want to rethink your argument as something better than a string of ad hominem attacks. I'll give you a massive hint: any time you focus on the person, you are committing a fallacy and your reasoning is invalid and unsound. All that matters is what was said, not who was saying what. You're welcome to disagree with me, but you can only rationally argue such by speaking to the argument, not the man.

The 8th Amendment reads, Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.

The issue here is that defense is expensive, which means it necessarily discriminates against anyone that can not afford $50K in attorneys fees, just for starters, so to protect one's 8th Amendment rights against excessive fines often costs more than the excessive fine itself.

[naikrovek]

there's no fine! all she has to do is stay home and wait to die.

why would she even want to be around other people, when she knows she has an extremely serious and contagious disease?

she is a literal menace to society and that all but voids her individual rights to freedom from fines, punishment, or excessive bail. she had her chance to play according to the rules. she chose not to. now she must pay the penalties. if she infected anyone and they die from it, she must be treated, against her will or not, and then put in prison for an appropriate amount of time.

you can't go around infecting others with tuberculosis and expect to keep your rights, no matter what "excessive" means to you. court opinion is valid and one does not get to say that legal precedent on interpretation of the bill of rights is invalid because you personally disagree with it.

how's that? please think more. not everything is an attack against you.

[jrmg]

What’s a solution to (or, I guess, outcome of) someone refusing to get treatment or isolate with a highly infectious disease that conforms to your ideology?

[Maursault]

> She noted that the cost of treating drug-resistant TB can run $100,000 or more.

My ideology is to not violate the patient's 5th and 8th Amendment rights. The government can pay for the treatment in the interests of public health rather than discriminate against her because she can't afford it. Though you wouldn't know it, being poor isn't a crime.

[jrmg]

Sorry, I assumed from your other responses that you were not okay with enforced treatment. Given how focused you were on the government not infringing rights, and how you were explicitly against enforcing isolation, I guess I assumed that carried over to not allowing the government to enforce medical treatment (even if it was free).

I’m still unclear what you think should be done in this concrete case. I see a few options here:

- Don’t enforce anything, allow the person to spread TB unrestricted.

- Enforce isolation until death or recovery.

- Enforce treatment until death or recovery (note though that if you were not to enforce isolation during treatment you’re allowing TB to spread during this time!)

- Something else?

Forgetting for a moment about payment, It sounds like you would be in favor of the third option?

We can also discuss who should pay for the latter two (and I know the answer to that is not an isolated question - they go together). I would agree it should be the government - though I’m also for government-provided, taxpayer funded healthcare generally, which I suspect you are not - and would possibly consider its imposition as unconstitutional?

[locustous]

> isolation costs nothing.

Seems to me that indeterminate isolation is a much steeper cost than mere money.

> so you sit your ass down and you don't leave the house until you either die, miraculously are cured, or you change your mind about treatment.

This is the pavement of the road to totalitarianism.

What if the doctors are just... wrong?

[Maursault]

> Seems to me that indeterminate isolation is a much steeper cost than mere money.

I think you are correct, and that GP's solution violates the suspect's right of due process under the 5th Amendment, which is the source of an individual's right to freely travel within the borders of the US. Commonly known as the "travel right," it entails privacy and free domestic movement without governmental abridgment.

[naikrovek]

you do not get to travel free while carrying tuberculosis, and while turning down treatment.

her rights do not extend to the point where she has the right to infect others with tuberculosis. common cold, sure, fine, it isn't especially dangerous. tuberculosis IS especially dangerous.

her rights extend to the point where she impedes the rights of others, and no further. this means she can't walk around and spread tuberculosis because of "travel right". travel right is not applicable in certain situations and her situation is one of them.

people do not have unabridgable rights. if you kill someone, and you are found guilty, you lose a lot of rights, including travel right. are you arguing that the 5th amendment applies to everyone, no matter what? that the 2nd amendment applies to everyone, no matter what? you violate the freedoms of others, you get your rights taken away. that's what judicial punishments are.

if you are saying that you can go into a school and kill everyone then walk out and continue to exist freely with your 2nd and 5th amendment rights intact, you may be a sociopath. if you are not saying that, then state what you are saying more clearly, because it sounds like you want complete freedom for people who have tuberculosis and refuse treatment.

spreading tuberculosis is potentially no different than shooting a bunch of people. it's just as lethal, but over a longer period. so if you're saying that she should be allowed to spread tuberculosis wherever she wants, and never be confined because of that, then it sounds like you think you're free to do anything you want to others without any changes to your own freedoms.

if I'm wrong, please explain how I'm wrong.

[locustous]

> if I'm wrong, please explain how I'm wrong.

Motive matters. There is a world of difference between intentionally trying to infect others and doing your best to not infect while still using the right to travel.

A distinction you have failed to acknowledge at all in your narrative. You simply assume guilt and appear to have no real conceptual understanding of justice, guilt, fault and appropriate punishments.

This individual has needs and rights that must be upheld as well.

The ends justify the means is a terrible philosophy that, if pursued, ends in sorrow. Another way to describe it is the many out weigh the few. It is the pavement of the road leading to pretty much every totalitarian government in history.

Finally, every day activities entail a certain amount of risk. Car accidents, disease, pests. You assume these risks to participate in public and they cannot be eliminated. Reasonable efforts to reduce them is fine, but there is a growing mentality that any risk you impose on others is unacceptable and this is an untenable position. You can't reasonably zero out risk.

[naikrovek]

> This is the pavement of the road to totalitarianism.

no, it isn't. telling someone that they are not allowed to freely spread a lethal disease is the exact same as telling someone that they can't freely assault anyone they choose.

> What if the doctors are just... wrong?

all of them? over time? all of whom have reached false positive diagnoses for tuberculosis, for which there are good, reliable tests?

unlikely to the point of virtual impossibility. winning the lottery while being bitten by a shark is probably more likely.

[marcus0x62]

> isolation costs nothing

Isolation, absent treatment, for TB will cost you your life. Untreated TB will kill you.