1mo ago

How do you treat cancer in the US? Asking out of curiosity but I want serious answers.

I am not from the US. Had my close relative fight with cancer. If not for the government which sponsored it almost fully, excluding a couple of procedures like PET, it would cost our family a lot. Just for the scale: pial for one infusion of one out of three drugs would cost us $8k and my relative would've needed 16 infusions.

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They made a really good documentary about this a few years ago:
https://en.wikipedia.org/wiki/Breaking_Bad

You start a GoFundMe then die
- This is, increasingly, the answer.

are you asking how we treat, or what do we pay?
many people with cancer in the u.s. go the cheapest routes for treatment because some are incredibly expensive. hospitals are only required to 'stabilize'. they are not mandated to cure. poorer people have worse outcomes as they cant afford the best treatments.
- are you asking how we treat, or what do we pay?
  Both actually.
  cheapest....they are not mandated to cure
  So even the stabilization requires paying the bill? Isn't it like an emergency medicine where doing nothing just kills?
  
  yes, there is no free healthcare.
  those with the lowest incomes qualify for government assistance in the form of medicare/medicaid but this is fairly minimal and specifically excludes most novel treatments. our republicans/conservatives continually find ways to reduce this funding. they are truly awful human beings despite being the 'pro life', 'pro god' block of our electorate.
  the united states sucks donkey balls for poor people considering its wealthy status otherwise. all that money is at the top, and its getting worse.
  
  We are responsible for paying for emergency medicine

Holy crap, all these answers and hardly anything about how health insurance is supposed to work.
Basically, most people have health insurance. With the Affordable Care Act (aka Obamacare) from years ago, it's basically required but getting care is simpler (you can't be denied a plan for a preexisting condition, for example. But it's hella expensive. It's also typically tied to your employer as part of your compensation package like retirement contributions, which means if you change employers there's a good chance you need to change insurance and even doctors.
ANYWAY, say you have procedures done. Insurance companies typically have contracted amounts for stuff with each provider (a "discount" from insane prices nobody actually pays). You typically pay the first however many dollars, depending on what you're having done and how your plan works. Eventually, you'll reach a dollar amount that's your maximum for the year, and from there insurance generally covers everything they normally would
Some people also have Medicare (ages 65+) and/or Medicaid (based on income or disability). Some people have private insurance on top of it. My daughter was born extremely early and stayed in the hospital for months. Her very low birth weight was a qualifying disability for Medicaid, and she was on my work health insurance. Claims would go through work insurance first, and any remaining costs (deductible) would be passed to Medicaid. If there was anything left, I'd be responsible for that. But I don't think that ever happened
Obviously, coverage is different for different people - different employers have different plans that cover different things differently. But in theory, that's how it should work.

In financial terms, for most people the government doesn’t help you at all[^1]. Either your private health insurance pays some of the costs, or else you pay completely out of pocket. Even if you do have health insurance, it’s still going to cost you several thousand dollars per year until it’s resolved. It’s quite common for cancer to cause people to go bankrupt even with good health insurance.
[^1]: If you’re 1) old or 2) through means testing are found to be both poor and physically unable to work, then you get government-funded a health insurance plan. You still might go bankrupt though, just as with private health insurance.
- And after I go bankrupt, my children go broke, could I receive the governmental treatment for remission?

Are you asking about the specific course of treatment, which will verify by type and stage, or how people pay?
As for paying, the only national programs are Medicare (restricted by age) and Medicaid (restricted by income). The US veterans administration is a separate govt program for military veterans and I believe their families, too. Everyone else either has some level of insurance provided by their employer (which will still generally be terrible), or nothing at all.
The charts here are helpful https://pmc.ncbi.nlm.nih.gov/articles/PMC6778988/
- It looks like if a person is above the poverty line and is under 65 they will have to pay like 20% of the medical bill which could be insane, given they have an insurance. Otherwise most first line treatments are covered by Medicare and Medicaid Plan B.
  So if a person earns, like not insane $3k/mo, they will most certainly be billed with enormous bills and be refused to be treated again in case of relapse, just because they haven't paid the previous bill?
  
  In addition, medical costs in the US are higher than many places, because the insurance companies don't have to bargain with the whole nation at once. Even Medicare and Medicaid have historically been prevented by law from using their full bargaining power in some cases.
  I don't actually know what happens to medical coverage if you have medical debt. It will eventually go to collections and can be used to garnish your wages, I believe.
  
  So there is also an out of pocket maximum which is the most you’ll pay in a calendar year no matter how much your expenses are which vary by insurance plans but in my experience have generally been between 5-15k with 15k being for much cheaper insurance and 5k being for better insurance so if you have 1m in medical expenses and copay would be 200k it would instead be just that max out of pocket of approximately 10k, which while not great is much more manageable. The unfortunate thing is that is tied to the year so if you start treatment in November and finish treatment in March that 10k per calendar year turns into 20k since it was over the course of 2 years

You have money or insurance (if they dont deny coverage) or you die.

Most people in America have health insurance through their employer. This was originally designed to be a perk of jobs back in the day, but now it unfortunately links healthcare to employment. If you are retirement age, you can get Medicare, which is government sponsored healthcare that still works through the private system, so there are no "government doctors" or anything like that for that population. Similarly, for disabled folks, or those poor enough (which can be hard to prove), they can get Medicaid.
If you lose your job, there's a system to pay to extend your employer's insurance policy until your next job's plan kicks in, but it's expensive cause your old job is no longer paying a big percentage of it, so a lot of people gamble on not needing insurance if for example, they end one job in May and know they have a new job starting in September.
With insurance, there are some government mandated policies. For example (and don't quote me on this cause I don't know the exact policies), things determined to be "preventative" have no out of pocket cost, so you won't generally pay for a regular yearly checkup, vaccines, etc. There are often options for insurance types to pick from depending on if you anticipate needing lots of care (e.g., a healthy young person probably won't, but if you are trying to have a baby, you know there are a lot of costs associated).
My employer pays for my insurance. If I were to get cancer, I would probably end up paying for a couple thousand dollars of appointments, scans, etc (called the deductible). Then I'd reach a point where my insurance covers most of the cost, and I kick in 20% (called the coinsurance level). Eventually, if my costs hit a certain limit (the out of pocket limit), insurance covers everything. I think it's like $8k or something like that for me. That's the most I could ever have to pay in a year.
People get screwed over by a few things. First is that while I could put together $8k if I had to, many people still have trouble with that. The second is people falling through the cracks of the labyrinthine system, and they end up without insurance while in between jobs or whatever. The third thing is that insurance decides what is necessary, so if you live in the middle of nowhere, and your child gets a specific type of cancer, you might not want to settle for whatever the "standard of care" is at your local hospital, you might want to fly across the country to go to the best hospital for that cancer, and your insurance isn't going to cover that cost.
And it is incredibly important to note that the insurance companies don't play fair. When your doctor tells the insurance company that you need a certain procedure, they have an automated system send out a "no". Your doctor then has to spend time to appeal the decision. Eventually, you might get the care you need paid for, but by engaging in these practices, they are hoping you will either 1: pay yourself, or 2: die.
Also, a final note that I think is important is that cancer, and many chronic illnesses, makes people desperate, and willing to try anything. There is a huge ecosystem (and it probably exists in your country, too), of people selling alternative (i.e., fake) medicine to cure them. Yeah, it's possible to wind up with a $50k bill for real medicine, but you also have people paying large sums to feed bleach to their autistic kids and then trying to pay for it with go fund me.

Like most other countries, expect that a lot of people only treat what they can afford. A lot of Go Fund Me sites have been created due to expensive medical treatments.
- Ok, I get the Black mirror reference, but I wanted serious answers
  
  they are being serious, though. a lot of people in the US use fundraising platforms like GFM in order to afford medical treatments. not just cancer, but other important surgeries, medical devices, service animals, etc. even if they have health insurance. insurance companies can semi-arbitrarily decide if the issue is "severe" enough to warrant full coverage (or coverage period).
  
  Yeah, it’s easy to think people are joking about using Go Fund Me for medical treatments, but it’s real. More than that, you’ll see news stories here about people donating their money so a kid can get some treatment, or their time off so that a parent can take a kid to their treatment, and they’re treated like “feel good” stories about communities banding together rather than the dystopian hellscape that they really are. The US is capitalism run amok, and the populations of other countries really should take notice before their wealthy classes succeed in making the same political decisions that got us here. It’s already happening in the EU.
  
  This was a serious answer.

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