5 ms·

Let me ask the relatively cruel question though for the purposes of prompting further discussion: At what point does subsidizing other people's outlier events

Let me ask the relatively cruel question though for the purposes of prompting further discussion: At what point does subsidizing other people's outlier events become unacceptable? I will never have kids (biological issues). I will likely die from a one off critical heart failure (also genetic in my family) rather than anything that will cost me significant amounts of money. I do not drive, leave the house much, or do any risky activities, yet as the parent said, I pay _hilarious_ amounts of money each year for insurance. And the real kicker for me, I've developed some conditions related to stress-side effects, sedentary behavior, and joint issues because of my work. So the insurance money would be BETTER SERVED being reinvested so I could stop working in such a way that damages my body. Now, you can say this is selfish, but as I said, I'm taking an intentionally selfish point of view for this argument. At what point do we draw the line of "I need this money for me now" or "someone else needs the net effect of re-balancing costs across a society?" I will openly admit that as I've gone through a decent chunk of my career without incurring any major events, but while incurring major costs, where I sit on being OK with the current arrangement has shifted.

ceejayoz 10y ago
That question is pretty close to home for me. Our family's highest yearly billing was about $3M, and we've hit $100k every year in the last 8. If you were writing a textbook about healthcare outliers, we'd be in it. The closest thing I have to an answer for you is single-payer like the rest of the developed world, where they pay substantially lower medical costs for similar health outcomes. I do hope to see our society mature a bit on end-of-life care. Dying is disproportionately expensive (http://time.com/money/2793643/cutting-the-high-cost-of-end-of-life-care/ http://time.com/money/2793643/cutting-the-high-cost-of-end-o...) and that money often results in little benefit to the patient (and at times, probably causes active harm).
- sedachv 10y ago
  > I do hope to see our society mature a bit on end-of-life care. It looks like many countries are moving that way in the past 20 years: https://en.wikipedia.org/wiki/Legality_of_euthanasia https://en.wikipedia.org/wiki/Legality_of_euthanasia
  - ceejayoz 10y ago
    I don't think that really shows progress. Patients who'd like to undertake euthanasia and can't would get a DNR order. Medicare isn't spending massive billions on folks with DNRs - it's the folks that won't accept a terminal cancer diagnosis and put grandma through intensive chemo instead of prioritizing quality of life that costs.
daxorid 10y ago
Let me ask an even crueler question. Let me preface by saying I am a parent of a child that needed some minor postpartum care in order to survive, so how horrible this sounds is not lost on me: At what point do we stop holding up infant mortality as the gold standard of medical care? Spending untold resources on keeping alive infants who would otherwise die is inherently dysgenic, and allowing whatever conflagration of genetic anomalies that contribute to the necessity of postpartum care will inevitably lead to higher incidences of these cases in the future, as these genes are allowed to propagate into future generations. Infant mortality is emotionally devastating, but preventing it will almost certainly increase our society's long-term medical costs.
- JoeAltmaier 10y ago
  But it also selects for empathy and parenting. Both will help build a better society. In fact we've been sacrificing physical skills for emotional ones, as long as human societies have existed. This is nothing new for sure.
- sliverstorm 10y ago
  On the other hand, something that is trivially treatable can be borne without issue, which, who knows, could enable later advancement. Just look at the established tradeoff our species makes- our children are born helpless. Isn't caring for them dysgenic? But, being able to care for & protect them enables significant brain development to happen outside the womb. Swaddling, clearing a wrapped umbilical cord, suctioning the nose & mouth... there are lots of things we do that improve mortality that are trivial.
- pmarsh 10y ago
  Along this topic, if we are spending so much on these infants why is our rate higher than other first world countries? Finland which is number one, "used the least resources and attained average results, making Finland the most efficient public sector health service producer according to the study's authors" https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-infant-mortality-rate-is-a-national-embarrassment/ https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-i... Granted it's way better than many other countries, but still we shouldn't be so off. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html https://www.cia.gov/library/publications/the-world-factbook/...

ceejayoz 10y ago

That question is pretty close to home for me. Our family's highest yearly billing was about $3M, and we've hit $100k every year in the last 8. If you were writing a textbook about healthcare outliers, we'd be in it. The closest thing I have to an answer for you is single-payer like the rest of the developed world, where they pay substantially lower medical costs for similar health outcomes. I do hope to see our society mature a bit on end-of-life care. Dying is disproportionately expensive (http://time.com/money/2793643/cutting-the-high-cost-of-end-of-life-care/ http://time.com/money/2793643/cutting-the-high-cost-of-end-o...) and that money often results in little benefit to the patient (and at times, probably causes active harm).

sedachv 10y ago
> I do hope to see our society mature a bit on end-of-life care. It looks like many countries are moving that way in the past 20 years: https://en.wikipedia.org/wiki/Legality_of_euthanasia https://en.wikipedia.org/wiki/Legality_of_euthanasia
- ceejayoz 10y ago
  I don't think that really shows progress. Patients who'd like to undertake euthanasia and can't would get a DNR order. Medicare isn't spending massive billions on folks with DNRs - it's the folks that won't accept a terminal cancer diagnosis and put grandma through intensive chemo instead of prioritizing quality of life that costs.

daxorid 10y ago

Let me ask an even crueler question. Let me preface by saying I am a parent of a child that needed some minor postpartum care in order to survive, so how horrible this sounds is not lost on me: At what point do we stop holding up infant mortality as the gold standard of medical care? Spending untold resources on keeping alive infants who would otherwise die is inherently dysgenic, and allowing whatever conflagration of genetic anomalies that contribute to the necessity of postpartum care will inevitably lead to higher incidences of these cases in the future, as these genes are allowed to propagate into future generations. Infant mortality is emotionally devastating, but preventing it will almost certainly increase our society's long-term medical costs.

JoeAltmaier 10y ago
But it also selects for empathy and parenting. Both will help build a better society. In fact we've been sacrificing physical skills for emotional ones, as long as human societies have existed. This is nothing new for sure.
sliverstorm 10y ago
On the other hand, something that is trivially treatable can be borne without issue, which, who knows, could enable later advancement. Just look at the established tradeoff our species makes- our children are born helpless. Isn't caring for them dysgenic? But, being able to care for & protect them enables significant brain development to happen outside the womb. Swaddling, clearing a wrapped umbilical cord, suctioning the nose & mouth... there are lots of things we do that improve mortality that are trivial.
pmarsh 10y ago
Along this topic, if we are spending so much on these infants why is our rate higher than other first world countries? Finland which is number one, "used the least resources and attained average results, making Finland the most efficient public sector health service producer according to the study's authors" https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-infant-mortality-rate-is-a-national-embarrassment/ https://www.washingtonpost.com/news/wonk/wp/2014/09/29/our-i... Granted it's way better than many other countries, but still we shouldn't be so off. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html https://www.cia.gov/library/publications/the-world-factbook/...