Jump in cancer diagnoses at 65 implies patients wait for Medicare: study

When you first become eligible for Medicare you get a special 'Introduction to Medicare' appointment with your doctor. It takes an hour or so, includes extra tests, and discussion of different topics. People might not be 'waiting for Medicare' but instead may simply mention things in this more detailed appointment, or get extra tests, that they wouldn't normally.

My wife (a senior consultant, and director of medicine at a major Australian hospital) took her sabbatical at Stanford Medicine in part because of the elevated level of stage IV cancer presentation in the US.<p>Key quote: &quot;these are cases we hardly ever get to see at home&quot;.<p>The financial disincentive to seek care is strong.

For non-US folks who need a translation here -<p>In the US, we have a nationwide public healthcare system called “Medicare”. You generally only qualify for Medicare once you’re 65 except in special circumstances. Many of our citizens can’t afford to be diagnosed with cancer at an earlier age, as it will increase their non-Medicare private insurance premiums^, result in denied coverage for unrelated issues, and potentially send them into bankruptcy if treated. So they wait until they turn 65, and only then bring in pre-existing conditions for diagnosis and treatment, confident that they can no longer be bankrupted by doing so.<p>^ Insurance premiums average $300-$700 USD per month per person nationwide, when not available through full-time employment or (65+) Medicare. ~75.000.000 US citizens age 18-64 are employed full-time, which compels their employers to subsidize their monthly health insurance costs; the remaining ~127.000.000 citizens are not employed full-time and thus do not qualify for mandatory employer-provided insurance.<p>EDIT - Military veterans, poor people, and so on often have access to <i>additional</i> free public health systems other than Medicare, offered either nationwide or by member states of our union or by non-governmental organizations; degree of subsidy and quality of coverage varies wildly among them.<p># The above estimates were constructed using napkin math and the below links.<p>“Average Monthly Benchmark Plan Premiums for a 27-Year-Old in Plan Year 2020 in Healthcare.gov States” <a href="https:&#x2F;&#x2F;www.investopedia.com&#x2F;how-much-does-health-insurance-cost-4774184" rel="nofollow">https:&#x2F;&#x2F;www.investopedia.com&#x2F;how-much-does-health-insurance-...</a><p>&quot;Population estimates&quot;: <a href="https:&#x2F;&#x2F;www.census.gov&#x2F;quickfacts&#x2F;fact&#x2F;table&#x2F;US" rel="nofollow">https:&#x2F;&#x2F;www.census.gov&#x2F;quickfacts&#x2F;fact&#x2F;table&#x2F;US</a><p>&quot;The U.S. labor force&quot;: <a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Labor_force_in_the_United_States" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;Labor_force_in_the_United_Stat...</a>

Seeing a specialist at a decent hospital can cost you over a week&#x27;s paycheck out of pocket just for an introductory 15 minute meet and greet.<p>It isn&#x27;t so much as &#x27;waiting&#x27; as having no other option&#x2F;getting stuck in some system where you&#x27;ve got no viable way to really figure out the cause of your symptoms.<p>Not to mention the 55-65 age range seems to be particularly bad for for disposable income.

The lesson here for anyone in mainstream computing, is that strongly typed languages are better than weakly, or untyped languages. The reasoning being that early detection of problems is cheaper, and better in terms of outcome, than delayed detection.<p>To be more on point, This effect can happen outside of the US too. Many people (like me) who laud being in a full-service health system economy don&#x27;t talk about how optical and dental services are excluded from &quot;full&quot; and incur excess costs. You have to meet income tests to qualify for free, and if your health cover is not sufficiently generous, (yes, even with full service public health we are encouraged to have private cover, and we have co=pay costs, simply 2-3 orders of magnitude less than the US and basically discretionary for many things: either wait, or pay, but if you do wait you will be treated) then delaying service until you are on a pension is a bad, but sort-of rational choice.<p>I know people who say &quot;I&#x27;ll wait until I retire to deal with that&quot;

I really wonder what the eventual end state is of many problems in the US that really seem so glaringly apparent (i.e. the US healthcare system is the most expensive in the world with some of the worst outcomes compared to other 1st world countries) but also politically unfixable.

The government is on the hook for the majority of the sickest (most expensive) people in our system. Private insurance companies take your money for the majority of your healthy life and hand you off to the government as you move into your most expensive days. It&#x27;s absolutely insane.

I wonder what kind of circular logic this could create. Clearly we don&#x27;t need to lower the age of Medicare eligibility, because 64-year-olds never get sick. 65 is the perfect cut-off based on the numbers! &#x2F;s

3rd world country with iPhones and nothing more.

When the cost of a service goes down the demand goes up. It would be notable if cancer treatment was an exception to that rule.

“People go to the doctor more when it’s free” seems pretty obvious to me.

I’m going to be out of healthcare for a month because I’m transitioning jobs. It’s a bit scary I have to admit. If I have an emergency I’ll refuse to pay the bill.

This seems to be related to some of the discussion on this thread: <a href="https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=26646541" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=26646541</a><p>When incentives are created in a specific way, the underlying data and what it tells you can be significantly altered. Cool to see people questioning the reasoning behind this data rather than accepting it at face value!

Dan Luu has a great blog post on discontinuities and public policy: <a href="http:&#x2F;&#x2F;danluu.com&#x2F;discontinuities&#x2F;" rel="nofollow">http:&#x2F;&#x2F;danluu.com&#x2F;discontinuities&#x2F;</a><p>I found it very interesting!

Of course they do? Not sure why this is surprising.

Just reading the title I think: Duh! As soon as I get Healthcare I&#x27;m going to the doctor! Maybe that is next month or next year

Timing analysis in health care is amazing. There is plenty of documentation that hour and day of week affects physician intervention in births. Women who are in labor during normal work hours are much more likely to have medical interventions like cesarean section. On a weekend, the rate of these is far less. Basically it depends a lot on whether your attending doctors need to leave at 5pm on a Friday because they have theater tickets.

Of course they do, and this is why medicare for all is a great idea. It strikes me as rather perverse that health care is largely a for-profit business and that even non-profits (like systems associated with religions) are all about cutting corners and maximizing revenues. It seems logicl to me that health care be a right.

What do you guys think about subscription models for hospitals?<p><a href="https:&#x2F;&#x2F;www.statnews.com&#x2F;2020&#x2F;06&#x2F;12&#x2F;fee-for-service-is-a-terrible-way-to-pay-for-health-care-try-a-subscription-model-instead&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.statnews.com&#x2F;2020&#x2F;06&#x2F;12&#x2F;fee-for-service-is-a-ter...</a>

Lower the age for Medicare to zero.

Yes, this is more evidence of the failure of the American health care system. If the US healthcare system really cared about outcomes, it would want people to be diagnosed earlier. It is clearly more economically efficient to treat malignant cancers earlier. We (Americans) all end up paying more with the perverse system we have.

this is just sad. we have been collectively conned by the American private health insurance industry under the guise of &quot;socialism is bad&quot;

The richest third world nation in the world.

The actual study is paywalled, but you can view the main figure here: <a href="https:&#x2F;&#x2F;acsjournals.onlinelibrary.wiley.com&#x2F;cms&#x2F;asset&#x2F;09416968-f2f8-4d15-9934-48603af93f34&#x2F;cncr33498-fig-0001-m.jpg" rel="nofollow">https:&#x2F;&#x2F;acsjournals.onlinelibrary.wiley.com&#x2F;cms&#x2F;asset&#x2F;094169...</a><p>I&#x27;m not sure &quot;patients wait for Medicare&quot; is necessarily the right interpretation.

The easy way to fix it is to dismantle Medicare and make the old people pay too. Then it will be no incentive to wait.

What do you guys think about subscription models for healthcare?<p><a href="https:&#x2F;&#x2F;www.statnews.com&#x2F;2020&#x2F;06&#x2F;12&#x2F;fee-for-service-is-a-terrible-way-to-pay-for-health-care-try-a-subscription-model-instead&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.statnews.com&#x2F;2020&#x2F;06&#x2F;12&#x2F;fee-for-service-is-a-ter...</a>

To those who are in favor of a national healthcare system which is payed for using tax revenue:<p>Can you give an example of an existing state or federal government agency which is consumer facing and well functioning?<p>I am personally a big fan of the FAA, which I believe fits those criteria, but the FAA requires a <i>substantial</i> filter you have to pass (generally: getting a pilot&#x27;s license) before you begin interacting with them.<p>Is there some government program that works well that you could point to and say: it will work like <i>this</i>?<p>Because the unfortunate experience I have had is that some of these national-level projects <i>do</i> work passably-well for micro-countries like Canada, but don&#x27;t seem like they would scale <i>at all</i> for the 3rd largest (by population) country in the world.