I think it's childish to consider it ghoulish. Yes, if you only hold one thought in your mind at a time and can't consider complex systems with multiple variabl

I think it's childish to consider it ghoulish. Yes, if you only hold one thought in your mind at a time and can't consider complex systems with multiple variables, it might scare you to consider that we spend a lot of money on end-of-life care, and whether that money is being put to good use. Critical thinking demands that we can hold those thoughts in our minds, understand the economic reality that yes, absolutely, extending a life at 90 years old is actually costing lives elsewhere in the system, but yet despite this realization, after reflecting on the kind of society we want to be[come], we realize it's so much more than just a mathematical optimization problem. That realization -- that we must do more than just that which optimizes outcomes for everyone as a whole, but also work to optimize individual outcomes even when it costs the whole -- is it not a core philosophical tenant of humanity?! How could the logical steps to such a beautiful and powerful realization be in any way ghoulish! To your last point, the cost of having no healthcare system at all would be extraordinary -- there's no question that our healthcare even at 20% of GDP is a net positive for society as a whole (that's not to say it can't be improved, but clearly removing it would be an economic catastrophe). And we're not talking about evaluating the net economic value of providing a given treatment, the context was specifically that of making a claim that smoking is/isn't a net cost to society. The studies intentionally ignored basically half the equation, so in my estimation they flat out lied in claiming that smoking was a net cost, which I'd say is academically fraudulent.