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Here's a different perspective: if the government is involved in paying for your healthcare, that gives voters a say in how you live your life. Taking too many

by barrkel 10y ago

Here's a different perspective: if the government is involved in paying for your healthcare, that gives voters a say in how you live your life. Taking too many risks? Like wine or soft drinks a bit too much? Maybe you enjoy rock climbing, or horse riding, or skiing, or some other dangerous activity? Well, maybe I don't want to pay for your risks, and I get to call you a drunk, fat and lazy, or foolhardy and reckless, needing more regulation and laws to keep you in your place - and your health costs low. We'll ban tasty food, nice drinks, and any activities that are more than a standard deviation or two out of the normal risk profile. We'll have a nice gentle bland life mapped out for you with low health costs. IMO the biggest elephant in the room is rationing. We can't give infinite healthcare to everybody for all their lives, particularly in very old age. We need to make hard trade-offs. In a free market system, the rationing is done by affordability and price levels: we choose who's more worthy of living longer by how much capital they've accumulated. In a more centralized system, we might choose to pay for interventions based on how much extra "life" they give, and ration by selecting a threshold for how much we pay for extra life year - this is how the UK NHS works, where life year is a QALY, quality-adjusted life year. But anything that doesn't address this elephant in the room, and appeals to emotions about the poor, sick, elderly, dying because they can't afford the treatment they need without considering who exactly we're going to leave to die and why, because we can't all be each other's caregivers for life, is intellectually bankrupt.

mobiplayer 10y ago
This law literally tells you how to live your life, especially if you're a woman: No kids, no reporting sexual assault, ... As per your claim on the NHS I'm not sure what are you trying to imply. Do you think the NHS or other similar systems choose to let people die based on economic reasons? Because that'll be a surprise. Disclosure: I live in the UK and grew up in Spain, where last night my grandmother passed at the age of 99 after A LOT of healthcare was poured into her (despite the fact she never had "a job"), of course paid by taxes.
- nextweek2 10y ago
  The NHS does have a guidelines published by NICE. Doctors would follow those when deciding care. It's not about your contribution to the economy, but about the patients quality of life and future life expectancy. Being 99 means she could have had another decade if an acute illness was corrected. Things get difficult when patients have longer term chronic illnesses. If she had kidney failure and heart desease the doctors who probably discuss a different care plan.
MaysonL 10y ago
It's a lot more likely that your insurance company will come down on your rock climbing, horse riding, vodka drinking, etc. than that government will do so. Rationing will happen by bankruptcy and/or death.
maxerickson 10y ago
The "supply" of medical care does seem quite tight to me, but increasing spending doesn't necessarily lead to rationing, it depends on whether there is existing underutilized supply and how difficult it is to increase the supply. Like for existing drugs that are profitable but expensive to produce. Our industrial capacity is such that producing those drugs doesn't really impose any medical opportunity cost.
tunesmith 10y ago
One thing I appreciated about Obamacare is how its structure flowed pretty logically from the value, or moral axiom, that people should not be able to go bankrupt from health care costs alone. That's also the kind of value that people can disagree on, though. For as much as we might believe that it's unfair for someone to do all the right things and then still end up with the wrong illness and go bankrupt, for others that is the natural order of things. Although it's worth pointing out that it was still possible (pre-ACA) to go bankrupt from health care costs even if you had done well at amassing capital. Altogether I think that's why so many people see this as deeply distorted and unfair, the sort of thing that government should smooth out.

by barrkel 10y ago

mobiplayer 10y ago

This law literally tells you how to live your life, especially if you're a woman: No kids, no reporting sexual assault, ... As per your claim on the NHS I'm not sure what are you trying to imply. Do you think the NHS or other similar systems choose to let people die based on economic reasons? Because that'll be a surprise. Disclosure: I live in the UK and grew up in Spain, where last night my grandmother passed at the age of 99 after A LOT of healthcare was poured into her (despite the fact she never had "a job"), of course paid by taxes.

nextweek2 10y ago
The NHS does have a guidelines published by NICE. Doctors would follow those when deciding care. It's not about your contribution to the economy, but about the patients quality of life and future life expectancy. Being 99 means she could have had another decade if an acute illness was corrected. Things get difficult when patients have longer term chronic illnesses. If she had kidney failure and heart desease the doctors who probably discuss a different care plan.

MaysonL 10y ago

It's a lot more likely that your insurance company will come down on your rock climbing, horse riding, vodka drinking, etc. than that government will do so. Rationing will happen by bankruptcy and/or death.

maxerickson 10y ago

The "supply" of medical care does seem quite tight to me, but increasing spending doesn't necessarily lead to rationing, it depends on whether there is existing underutilized supply and how difficult it is to increase the supply. Like for existing drugs that are profitable but expensive to produce. Our industrial capacity is such that producing those drugs doesn't really impose any medical opportunity cost.

tunesmith 10y ago

One thing I appreciated about Obamacare is how its structure flowed pretty logically from the value, or moral axiom, that people should not be able to go bankrupt from health care costs alone. That's also the kind of value that people can disagree on, though. For as much as we might believe that it's unfair for someone to do all the right things and then still end up with the wrong illness and go bankrupt, for others that is the natural order of things. Although it's worth pointing out that it was still possible (pre-ACA) to go bankrupt from health care costs even if you had done well at amassing capital. Altogether I think that's why so many people see this as deeply distorted and unfair, the sort of thing that government should smooth out.