A Critical Look at Comprehensive Member Standby (CMS)

All topics about cryopreservation costs, membership dues, etc.
paulwakfer

Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by paulwakfer » Mon Mar 05, 2012 5:21 pm

bwowk wrote:The problem with making standby optional is that almost no one will do it. We have ample precedent for that in the low standby rates of the 1990s and early 200s when most Alcor cryopreservations were performed on members who suffered cardiac arrest unattended by any cryonics personnel.
But if one is trying to promote self-responsibility rather than paternalism, one does not solve such a problem by making the CMS option mandatory. Instead, one uses whatever evidence one has (or gathers more evidence) to use reasoned persuasion on members to influence more of them to opt for CMS.
bwowk wrote:Asking a dying person or their family to come up with approximately $50K cash while dealing with all the other issues that accompany serious illness or end-of-life isn't realistic, or some would say even humane.
If the member is pre-persuaded that CMS is highly valuable (worth the cost), then such payment can be fully set up ahead of time and no "asking" is necessary at the time of "serious illness". And it certainly is not "inhumane" to seek a decision which will almost certainly enable a better chance for future life - it would only be inhumane if this was being marketed to the person for the very first time and/or s/he had already clearly said no when still well. Under the latter circumstances, it would also be unfair (a kind of inhumane, IMO) to use the fees of other members for the CMS of a person who has not paid and/or does not want one.

southbay

Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by southbay » Mon Mar 05, 2012 7:54 pm

I should also add one other concern. The costs of standby are indeed highly variable. Some people will die in Scottsdale and have an extremely low standby cost (there is a $5k fund to let terminal patients move to Scottsdale, but other than that the cost is quite low.)

Some people will die without warning. In that case there is no standby, just the effort to get a team to you as quickly as possible, have them prep you and move you.

A large fraction of Alcor members are in California or not too far from Phoenix, where trained Alcor volunteers are available quickly. Their standby cost is going to be lower than somebody from Nebraska or Nova Scotia. While I understand the desire to offer the service for one price, I am not sure that people would be so upset at a cheaper price for Californians. Though in any event med-evac insurance is actually not that expensive and it's annoying those principles can't apply into cryonics for now.

In addition, at different ages, the risk of needing an expensive standby vary a lot. People under 60 have a much lower chance of needing one. People over 80 are very likely to need one. Yet all pay the same fees. That's not true in the rest of life in medical insurance or many other things.


Perhaps it is predicted the average standby will cost the $55,000 of 2050 dollars that a 40 year old joining Alcor is being asked to pay.

TDK
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Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by TDK » Mon Mar 05, 2012 11:09 pm

I guess the problem is that no one knows what will happen to them in advance.
You may assume you will die in a very predictable way, in Scottsdale, with Alcor ready to go.
But even if you assume that, you could still end up in a car accident, and be touch and go
for weeks or months.

So in some ways, it makes sense that they would generally assume that
everyone wants Alcor to respond in the patient's best interest, regardless of the situation.
If you die on vacation in Italy, they will do what they can to handle that situation in the best
way possible. And sure, some patients will know about an illness in advance, and be in Scottsdale,
and everything will go incredibly smoothly. But none of us know what will happen.
We might die at 45, we might die at 95.

What Alcor is doing, with CMS, is providing everyone with the best possible response,
and charging everyone extra for that service, because they think it's important.

I just don't like extra fees. I don't like extra fees for CMS, I don't like Alcor dues.
I prefer that all of these "services" be paid for by the cost of the cryopreservation.
So that whatever Alcor needs to do, is done properly, and cost-efficiently.
If that means I have to pay $150k, or $200k for a neuro, so be it. I just want
to pay one monthly fee, for my life insurance, and that's it... I don't want all
these other fees going up, going down, changing structure, etc.

southbay

Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by southbay » Tue Mar 06, 2012 4:23 pm

I understand. It is, effectively insurance. You have an unknown risk, and negotiate a flat fee in advance to cover it based on average risk. This is what insurance companies do. Of course, in a competitive market, insurance companies modify the price based on risk factors. Your age. Your health. Where you live. Perhaps how often you go overseas. Generally, they look at the factors they can easily measure that make a big difference.

Of course they sell a lot of insurance, and hire teams of actuaries to work out what those prices can be. Alcor can't efficiently do that, though it could consult an actuary on basic risk factors like age and location. The tables for age will be already well know -- how likely is each form of death in each given age bracket.

Another thing that's well known is the cost of med-evac, since you can buy relatively cheap insurance for it. Those insurances even cover returning your remains, though not on ice and not in a hurry. However, it means the actuaries can probably easily work out the probabilities and costs. Alcor only offers standby in USA/Canada which makes it easier to do.

Best of all would be if Alcor could convince a regular insurance company to underwrite this. They are professionals at it. Of course, they need to know they will get customers. The 1500 signed up for the various cryo companies might verge on being enough. The insurance company would have no understanding of the costs of a standby, but Alcor knows that average. The insurance company would understand the probability of a life-threatening event, and even know how many don't end in death.

I might wish to self-insure. My credit rating is good enough that I can put the price of a standby on my cards if I have to.

However, if, as the fees suggest, an average standy is costing as much as $50,000, then Alcor needs to work to bring this cost down, or offer a cheaper standby that is not as good.

For that, I think there is something counter-intuitive. CMS fees do not cover charter jet transport, it is seen as a premium. But in fact, for the large fraction of Alcor members who live within 1,500 miles of Scottsdale, jet transport might be a cheaper way to do the service. Rather than sending out a team ready to do everything on site, if one has locals (as there are in NorCal and SoCal to be sure) who can do the basic drugs and cool-down, and a jet is ready in 2 hours to take you to Scottsdale in 2 hours, what quality of suspension can be done by that method, and what would it cost? (Typical light jet charter is around $2,500 per hour. 1.5 hours to Bay Area, 2.5 to Seattle, 50 minutes to LA. Main questions are how short notice they will fly on (particuarly with notice of imminent death.) Probably can't talk a company into letting you do perfusion on the plane though.

bwowk
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Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by bwowk » Tue Mar 06, 2012 7:05 pm

TDK wrote: I just don't like extra fees. I don't like extra fees for CMS, I don't like Alcor dues.
I prefer that all of these "services" be paid for by the cost of the cryopreservation.
So that whatever Alcor needs to do, is done properly, and cost-efficiently.
If that means I have to pay $150k, or $200k for a neuro, so be it. I just want
to pay one monthly fee, for my life insurance, and that's it... I don't want all
these other fees going up, going down, changing structure, etc.
This view is being communicated to the board. Speaking for myself, I think Alcor can do better than levying three different annual fees. Generally, though, big issues such as this get tabled until Strategic Meetings in September.

With respect to standby costs being lower in California than elsewhere, that's not as true as it used to be. There has been a push in recent years to try and get medical professionals, either Alcor's paramedic and/or SA surgeons and perfusionists, on the ground for all standbys for which there is CMS coverage. This means that local teams are first responders in emergencies, but generally wouldn't be relied upon to do a stabilization/transport if professionals can get there in time. Southern California case A-2091 was placed on cardiopulmonary bypass only 15 minutes after cardiac arrest by a professional team, an amazing accomplishment. If clinical death occurs before professionals arrive, circulation of meds and cooling by volunteers can made a world of difference. But if there is sufficient time to come on scene, professionals under ideal circumstances can do even better.

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