Breaking Bad S1E4: The High Cost of Dying
In the fourth episode of Breaking Bad Walter White comes clean with his family about his lung cancer diagnosis. They react in different way, unsurprisingly. His wife, Skyler, tries to stay optimistic. She first insists he get a second opinion then urges him to pursue treatment with the best cancer specialist around. The best don't come cheap, though. And there's the rub. What does it cost to live? What does it cost merely to die a bit more slowly?
Walt balks at the cost for just consulting with the best doctor. It's $5,000 just for the consult. Walt's family doesn't have that kind of money. Remember, he was working a demeaning second job at a carwash just to meet basic expenses for his family. "I can borrow against my pension," Walt says to stop Skyler's nagging- though instead of borrowing he uses money he took from drug dealers he killed.
That $5,000 was just for a second opinion. Getting treatment is a whole 'nother thing. The doctor estimates to Walt and Skyler it'll cost $90,000 a year. Ninety thousand. For a family that can't afford nine hundred to replace their furnace without stretching payments out for a year or more on credit cards. And oh, by the way, that $90,000 a year doesn't make Walt a healthy person. The treatment comes with a long list of terrible side effects the doctor rattles off. Lack of energy. Aches and pains. Nausea. Bruising. For $90,000 a year* Walt gets to die slowly.
While Breaking Bad is obviously a fictional story, this element of it is starkly real. It's a reality I started thinking about years ago. I don't have cancer, I don't plan to get cancer, but the reality is if I do I'll face a choice similar to Walt's. To get treatment- which only slows death and does not provide quality-of-life- I'd drain my family's savings and/or face bankruptcy.
When I first started thinking about this, the common figure was $80,000 a year. It would cost $80,000 a year to prolong an inevitable death in the face of terminal cancer or similar disease. And again, that's not $80k for a year of good life. It's $80k for a year of suffering. This show uses the figure $90k. It was filmed years after I thought about the $80k figure; costs obviously went up. Similarly, this Breaking Bad episode was written almost 20 years ago now. A quick search indicates that the average cancer treatment in 2024 in the US costs $150,000/year.
My choice if faced with such a diagnosis wouldn't be as stark as Walter White's. I wouldn't need to consider turning to a life of crime to avoid bankrupting my family. We've built decent wealth through decades of hard work and prudent saving. But all that wealth can drain quickly against these types of costs. FWIW, this problem- medical problems costing hundreds of thousands to millions of dollars out of pocket- is the primary reason why affluent people in the US don't feel rich.
At some point you decide it's not worth it. If I get a terminal diagnosis, I'd rather die in comfort (e.g., via hospice care) than to piss away hundreds of thousands, potentially millions of dollars of money my family needs for the rest of its life just to buy myself an extra year of suffering.
This is one of the things that makes this story uniquely American, BTW. Imagine what this story would be like set in a minor city in the UK instead of one in the US. Instead of "Mild mannered chemistry teacher turns to a life of violent crime so medical bills don't bankrupt his family" it'd be, "Walt gets a cancer diagnosis in episode 1 and then spends the next 5 seasons getting free treatment at the NHS."
Walt balks at the cost for just consulting with the best doctor. It's $5,000 just for the consult. Walt's family doesn't have that kind of money. Remember, he was working a demeaning second job at a carwash just to meet basic expenses for his family. "I can borrow against my pension," Walt says to stop Skyler's nagging- though instead of borrowing he uses money he took from drug dealers he killed.
That $5,000 was just for a second opinion. Getting treatment is a whole 'nother thing. The doctor estimates to Walt and Skyler it'll cost $90,000 a year. Ninety thousand. For a family that can't afford nine hundred to replace their furnace without stretching payments out for a year or more on credit cards. And oh, by the way, that $90,000 a year doesn't make Walt a healthy person. The treatment comes with a long list of terrible side effects the doctor rattles off. Lack of energy. Aches and pains. Nausea. Bruising. For $90,000 a year* Walt gets to die slowly.
While Breaking Bad is obviously a fictional story, this element of it is starkly real. It's a reality I started thinking about years ago. I don't have cancer, I don't plan to get cancer, but the reality is if I do I'll face a choice similar to Walt's. To get treatment- which only slows death and does not provide quality-of-life- I'd drain my family's savings and/or face bankruptcy.
When I first started thinking about this, the common figure was $80,000 a year. It would cost $80,000 a year to prolong an inevitable death in the face of terminal cancer or similar disease. And again, that's not $80k for a year of good life. It's $80k for a year of suffering. This show uses the figure $90k. It was filmed years after I thought about the $80k figure; costs obviously went up. Similarly, this Breaking Bad episode was written almost 20 years ago now. A quick search indicates that the average cancer treatment in 2024 in the US costs $150,000/year.
My choice if faced with such a diagnosis wouldn't be as stark as Walter White's. I wouldn't need to consider turning to a life of crime to avoid bankrupting my family. We've built decent wealth through decades of hard work and prudent saving. But all that wealth can drain quickly against these types of costs. FWIW, this problem- medical problems costing hundreds of thousands to millions of dollars out of pocket- is the primary reason why affluent people in the US don't feel rich.
At some point you decide it's not worth it. If I get a terminal diagnosis, I'd rather die in comfort (e.g., via hospice care) than to piss away hundreds of thousands, potentially millions of dollars of money my family needs for the rest of its life just to buy myself an extra year of suffering.
This is one of the things that makes this story uniquely American, BTW. Imagine what this story would be like set in a minor city in the UK instead of one in the US. Instead of "Mild mannered chemistry teacher turns to a life of violent crime so medical bills don't bankrupt his family" it'd be, "Walt gets a cancer diagnosis in episode 1 and then spends the next 5 seasons getting free treatment at the NHS."