5 ms·

Are you serious? Everyone regardless of age should get medical care. It's as simple as that.

JumpCrisscross 8y ago
> Everyone regardless of age should get medical care. It's as simple as that. This is debatable. Most of one’s healthcare expenses will be incurred in the final months of life. The population to whom this statistic doesn’t apply is doctors—they know when the marginal benefit of treatment isn’t worth it. If I had a choice between burning my kids’ estate to sneak out a year in agony or die with dignity, I know which I’d choose. The compassionate response isn’t always the right one.
- ddalex 8y ago
  The dichotomy you present is false. Only in the absolutely insane US system one needs to burn through savings to get paleative care. Health, just like fire fighting, should not be a for-profit business.
  - syshum 8y ago
    Why shouldnt fire fighting be for-profit Why do you believe non-profit means it has to be provided by government? Why do you believe profit is bad?
    - artimaeis 8y ago
      > Why shouldnt fire fighting be for-profit Because fires pose an undue risk to entire regions, not individuals. Because the pricing mechanism is excessively unfair to individuals. Because no one's life should be at risk because they don't have access to financial resources. Individuals should be (and are, generally) free to start for-profit fire fighting businesses, but these should not seek to displace existing infrastructure. > Why do you believe non-profit means it has to be provided by government? That wasn't said or implied in the parent post, but the government _is_ our collective resource. By the people, for the people. It is we, the people, whose lives and property are put in danger by fires. The most effective way of grouping people's interest collectively in history has been through governance. Non-profit fire fighting may be viable, but it's better that we collectively work to keep our collection safe. > Why do you believe profit is bad? It depends entirely on the context. When people's lives are at stake profits incentivize cruel and unusual behavior from those incentivized to reap the reward.
    - rrivers 8y ago
      Quite some red-herrings in this line of questioning. He never made reference to "profit is bad." Saying that medical care for our fellow humans should not be for-profit implies that the individual values human life over our current constructed system of exchange. There are hundreds of thousands of people in the U.S. who would be bankrupted instantly if they were to suffer a significant accident that required prolonged medical attention. People that would otherwise continue to live productive and meaningful lives who would be regulated to abject poverty, destroying their potential. The argument for socialized healthcare is simple; we have the resources to do it successfully and it costs less[1][2] and is more efficient than our current model. The only thing propping up our system is the millions of dollars of lobbying money from the insurance firms. -- [1] http://www.pnhp.org/news/2014/november/implementing-a-universal-healthcare-system-costs-less-provides-better-care http://www.pnhp.org/news/2014/november/implementing-a-univer... [2]https://www.bloomberg.com/news/articles/2018-07-30/study-medicare-for-all-bill-estimated-at-32-6-trillion https://www.bloomberg.com/news/articles/2018-07-30/study-med...
    - dang 8y ago
      Please don't take HN threads on generic ideological tangents. They never lead anywhere new. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
  - prostoalex 8y ago
    > Health, just like fire fighting, should not be a for-profit business. US has a reasonable share of non-profit hospitals and other medical institutions, but the prices are not drastically different. Random googling suggests that average doctor salary in Los Angeles is in the range $195,335–$254,517. Across the pond average doctor salary in Ireland is quoted at €48,020. For context, a registered nurse in California is making on average $94,120. European or Asian medical professionals go to medical or nursing school with the goals of joining the middle class. In the US "graduated med school" is synonymous with raking in cash.
    - maxxxxx 8y ago
      "US has a reasonable share of non-profit hospitals and other medical institutions, but the prices are not drastically different" Your mistake is to think that nonprofit means that they don't make profit. They still pay a ton of money to their administrators and doctors. And the rest of the profit goes into fancy buildings.
  - JumpCrisscross 8y ago
    > Only in the absolutely insane US system one needs to burn through savings to get paleative care End-of-life care is intensive, chronic, risky and generally involves cutting-edge techniques (since yesterday's death sentence is today's extendable life). This is fundamental to the cost of care. As a result, end-of-life costs are similar across the board [1]. If there is a unique American angle to this, it's doctors afraid of being sued spending too much on dying Americans. [1] https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-life-care-costs-in-us-comparable-to-europe-and-canada/#3cd68c11ada3 https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-lif...
  - pixl97 8y ago
    TANSTAAFL Fire fighting still cost money. non profit medical still costs money. And yes, there is only so much medical care to go around.
- forapurpose 8y ago
  > If I had a choice between burning my kids’ estate to sneak out a year in agony or die with dignity, I know which I’d choose. It's a false choice. The U.S. is the wealthiest country in the history of the world, and other, poorer countries provide universal health care. The choice isn't between providing health care to old or to young people, but between providing health care to everyone or (putting more money in some people's pockets? probably not even that when the cost of uninsured, unhealthy people is factored in).
- beefield 8y ago
  > The population to whom this statistic doesn’t apply is doctors—they know when the marginal benefit of treatment isn’t worth it. I would really like to have a source for this. Cynical me thinks this makes too much sense to be true...
  - JumpCrisscross 8y ago
    It holds in survey results but has not been conclusively demonstrated in treatment data. It does not hold in Medicare data, but those could be limited for this population. "In a Stanford study, 88 percent of responding physicians said they would avoid invasive procedures and life-prolonging machines. But a newly released comparative study of Medicare recipients, as well as a longitudinal study and separate analysis of Medicare data published in January, suggest that the actual differences between end-of-life treatments that doctors and nondoctors receive are slight." The other data point is the story of "La Crosse, Wisconsin," which "spends less on health care for patients at the end of life than any other place in the country, according to the Dartmouth Health Atlas" [2]. The cause? "Some 96 percent of people who die in La Crosse have an advance directive or similar documentation" while "nationally, only about 30 percent of adults have a document like that." [1] https://well.blogs.nytimes.com/2016/06/30/at-the-end-of-life-what-would-doctors-do/ https://well.blogs.nytimes.com/2016/06/30/at-the-end-of-life... [2] https://www.npr.org/sections/money/2014/03/05/286126451/living-wills-are-the-talk-of-the-town-in-la-crosse-wis https://www.npr.org/sections/money/2014/03/05/286126451/livi...
meddlepal 8y ago
Everyone should get medical care, but the amount of medical care does not need to be equal across ages.
sandworm101 8y ago
That was a great idea when healthcare was relatively cheap. But now we live in a world where keeping people alive can easily cost 1,000,000+ per year. We are hitting the point that universal healthcare (everyone gets everything) may no longer be possible. If we are to ration, measurements like "years saved" rather than "lives saved" may be necessary. Personally, i am against most organ transplants. The massive cost to save one life there could save thousands if spent on vaccinations overseas. Even at home, people die for lack of basic treatments every day.
- CydeWeys 8y ago
  Re: Organ transplants, national healthcare plans are funded by taxpayer revenue for the benefit of people living in-country. National healthcare systems will never be expanded to cover non-tax-paying patients the world over, for obvious reasons. So within the set of people that a national healthcare system can cover, it may well make sense to cover an expensive organ transplant for a relatively young person if it extends life by decades.
mediaman 8y ago
Even under nationalized systems such as Britain's NHS, they have to make utility decisions about how to allocate spend: a life is not of infinite value, and the NHS has to estimate the value of various types of care, because it simply isn't feasible to say "we'll spend and spend and spend, no matter what, for someone to stay alive." For example, saving a person's left eye is less valuable if they still have their right, because they can still see, versus someone who was already blind in their right eye that would leave them completely blind. So they're willing to spend more to save that person's left eye if they would otherwise be completely blind. Similarly, saving the life of someone young is of higher utility than someone old, because their life expectancy is longer. These sorts of calculations bother some people, but it is a practical reality that these decisions have to be made. I actually think NHS works pretty well and it's better to be open and transparent about these sorts of decisions, versus the American system.
- maxxxxx 8y ago
  Then make the calculations based on cost like the NHS does and not by age. I totally agree that we should be wary of paying 100s of thousands for some cancer cures. But we shouldn't tell old people "you are useless therefore go somewhere and die". It's hard to imagine but most of the young people here will also get old one day. And they won't be wealthy enough to pay health costs out of pocket.
  - throwawaymath 8y ago
    > But we shouldn't tell old people "you are useless therefore go somewhere and die". No one is saying that or advocating for that. I think you're unfairly assuming malice or ambivalence on the part of commenters who are trying to clarify the practical reality of the situation. Consider for a moment, regardless of how unrealistic you feel it may be, the utility of funding the care of a 20 year old with cancer versus a 90 year old with cancer. All things being equal, a system with finite resources should prioritize the 20 year old, because the younger person will likely be less expensive to save long term and can generate more productivity for society afterwards. We'll call this our Socratic baseline. Now obviously in the real world two patients' ailments are never equal. But if you can agree to this baseline, we can proceed to haggle as conditions more closely approximate reality and things stop being so equal. We should not leave the elderly out to die or abandon them. But we have to be honest and balance that moral imperative with the unfortunate, practical reality that we only have finite resources. That doesn't mean we kill anyone off. It means we make nuanced decisions about how much to invest in their care - and how to do so - given their prognosis. Age is a fundamental measure of prognosis.
deleted 8y ago
[deleted]
pwthornton 8y ago
That's what I'm saying.
prostoalex 8y ago
Considering that medical businesses are free to set their own prices, and occupational licensing prevents doctors from cheaper English-speaking countries (India, UK) from moving in and setting up a practice, how far are you willing to take that maxim? * Everyone should get medical care when a routine physical costs $100? * Everyone should get medical care when a routine physical costs $1,000? * Everyone should get medical care when a routine physical costs $10,000?
- maxxxxx 8y ago
  I don't even understand what you are getting at. Why would a routine physical cost 10000? The question makes as much sense as asking "Should we have a military if soldiers have a salary of 250 billion dollars each?"
  - prostoalex 8y ago
    "everyone should get medical care" suggests a system where one party (the taxpayers) are automatically covering a bill for medical service, while the other party (healthcare system) has every incentive to milk the system via over-testing, over-prescribing, over-scheduling routine visits and just plain old raising prices. The soldier analogy doesn't quite apply, as it doesn't require complex skills and providers of the service are not in short supply. A potential candidate can surely hold out for a starting salary that's 10x the average, but others eyeing his position will likely be content with the average. An anesthesiologist, on the other hand, or an MRI lab, might be the only game in town, and if they say the prices are going up by 10% next year, the prices are going up. One is welcome to drive to the next town over, but with taxpayers covering the expense, why bother? What cost constraints exist in "everyone should get medical care" system to prevent healthcare providers from consuming 100% of GDP?
    - maxxxxx 8y ago
      Somehow plenty of countries are doing fine while even consuming less of GDP than the US. As far as I know Medicare doesn't consume 100% of GDP either.

> Everyone regardless of age should get medical care. It's as simple as that. This is debatable. Most of one’s healthcare expenses will be incurred in the final months of life. The population to whom this statistic doesn’t apply is doctors—they know when the marginal benefit of treatment isn’t worth it. If I had a choice between burning my kids’ estate to sneak out a year in agony or die with dignity, I know which I’d choose. The compassionate response isn’t always the right one.

ddalex 8y ago
The dichotomy you present is false. Only in the absolutely insane US system one needs to burn through savings to get paleative care. Health, just like fire fighting, should not be a for-profit business.
- syshum 8y ago
  Why shouldnt fire fighting be for-profit Why do you believe non-profit means it has to be provided by government? Why do you believe profit is bad?
  - artimaeis 8y ago
    > Why shouldnt fire fighting be for-profit Because fires pose an undue risk to entire regions, not individuals. Because the pricing mechanism is excessively unfair to individuals. Because no one's life should be at risk because they don't have access to financial resources. Individuals should be (and are, generally) free to start for-profit fire fighting businesses, but these should not seek to displace existing infrastructure. > Why do you believe non-profit means it has to be provided by government? That wasn't said or implied in the parent post, but the government _is_ our collective resource. By the people, for the people. It is we, the people, whose lives and property are put in danger by fires. The most effective way of grouping people's interest collectively in history has been through governance. Non-profit fire fighting may be viable, but it's better that we collectively work to keep our collection safe. > Why do you believe profit is bad? It depends entirely on the context. When people's lives are at stake profits incentivize cruel and unusual behavior from those incentivized to reap the reward.
  - rrivers 8y ago
    Quite some red-herrings in this line of questioning. He never made reference to "profit is bad." Saying that medical care for our fellow humans should not be for-profit implies that the individual values human life over our current constructed system of exchange. There are hundreds of thousands of people in the U.S. who would be bankrupted instantly if they were to suffer a significant accident that required prolonged medical attention. People that would otherwise continue to live productive and meaningful lives who would be regulated to abject poverty, destroying their potential. The argument for socialized healthcare is simple; we have the resources to do it successfully and it costs less[1][2] and is more efficient than our current model. The only thing propping up our system is the millions of dollars of lobbying money from the insurance firms. -- [1] http://www.pnhp.org/news/2014/november/implementing-a-universal-healthcare-system-costs-less-provides-better-care http://www.pnhp.org/news/2014/november/implementing-a-univer... [2]https://www.bloomberg.com/news/articles/2018-07-30/study-medicare-for-all-bill-estimated-at-32-6-trillion https://www.bloomberg.com/news/articles/2018-07-30/study-med...
  - dang 8y ago
    Please don't take HN threads on generic ideological tangents. They never lead anywhere new. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- prostoalex 8y ago
  > Health, just like fire fighting, should not be a for-profit business. US has a reasonable share of non-profit hospitals and other medical institutions, but the prices are not drastically different. Random googling suggests that average doctor salary in Los Angeles is in the range $195,335–$254,517. Across the pond average doctor salary in Ireland is quoted at €48,020. For context, a registered nurse in California is making on average $94,120. European or Asian medical professionals go to medical or nursing school with the goals of joining the middle class. In the US "graduated med school" is synonymous with raking in cash.
  - maxxxxx 8y ago
    "US has a reasonable share of non-profit hospitals and other medical institutions, but the prices are not drastically different" Your mistake is to think that nonprofit means that they don't make profit. They still pay a ton of money to their administrators and doctors. And the rest of the profit goes into fancy buildings.
- JumpCrisscross 8y ago
  > Only in the absolutely insane US system one needs to burn through savings to get paleative care End-of-life care is intensive, chronic, risky and generally involves cutting-edge techniques (since yesterday's death sentence is today's extendable life). This is fundamental to the cost of care. As a result, end-of-life costs are similar across the board [1]. If there is a unique American angle to this, it's doctors afraid of being sued spending too much on dying Americans. [1] https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-life-care-costs-in-us-comparable-to-europe-and-canada/#3cd68c11ada3 https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-lif...
- pixl97 8y ago
  TANSTAAFL Fire fighting still cost money. non profit medical still costs money. And yes, there is only so much medical care to go around.
forapurpose 8y ago
> If I had a choice between burning my kids’ estate to sneak out a year in agony or die with dignity, I know which I’d choose. It's a false choice. The U.S. is the wealthiest country in the history of the world, and other, poorer countries provide universal health care. The choice isn't between providing health care to old or to young people, but between providing health care to everyone or (putting more money in some people's pockets? probably not even that when the cost of uninsured, unhealthy people is factored in).
beefield 8y ago
> The population to whom this statistic doesn’t apply is doctors—they know when the marginal benefit of treatment isn’t worth it. I would really like to have a source for this. Cynical me thinks this makes too much sense to be true...
- JumpCrisscross 8y ago
  It holds in survey results but has not been conclusively demonstrated in treatment data. It does not hold in Medicare data, but those could be limited for this population. "In a Stanford study, 88 percent of responding physicians said they would avoid invasive procedures and life-prolonging machines. But a newly released comparative study of Medicare recipients, as well as a longitudinal study and separate analysis of Medicare data published in January, suggest that the actual differences between end-of-life treatments that doctors and nondoctors receive are slight." The other data point is the story of "La Crosse, Wisconsin," which "spends less on health care for patients at the end of life than any other place in the country, according to the Dartmouth Health Atlas" [2]. The cause? "Some 96 percent of people who die in La Crosse have an advance directive or similar documentation" while "nationally, only about 30 percent of adults have a document like that." [1] https://well.blogs.nytimes.com/2016/06/30/at-the-end-of-life-what-would-doctors-do/ https://well.blogs.nytimes.com/2016/06/30/at-the-end-of-life... [2] https://www.npr.org/sections/money/2014/03/05/286126451/living-wills-are-the-talk-of-the-town-in-la-crosse-wis https://www.npr.org/sections/money/2014/03/05/286126451/livi...

meddlepal 8y ago

Everyone should get medical care, but the amount of medical care does not need to be equal across ages.

sandworm101 8y ago

That was a great idea when healthcare was relatively cheap. But now we live in a world where keeping people alive can easily cost 1,000,000+ per year. We are hitting the point that universal healthcare (everyone gets everything) may no longer be possible. If we are to ration, measurements like "years saved" rather than "lives saved" may be necessary. Personally, i am against most organ transplants. The massive cost to save one life there could save thousands if spent on vaccinations overseas. Even at home, people die for lack of basic treatments every day.

CydeWeys 8y ago
Re: Organ transplants, national healthcare plans are funded by taxpayer revenue for the benefit of people living in-country. National healthcare systems will never be expanded to cover non-tax-paying patients the world over, for obvious reasons. So within the set of people that a national healthcare system can cover, it may well make sense to cover an expensive organ transplant for a relatively young person if it extends life by decades.

mediaman 8y ago

Even under nationalized systems such as Britain's NHS, they have to make utility decisions about how to allocate spend: a life is not of infinite value, and the NHS has to estimate the value of various types of care, because it simply isn't feasible to say "we'll spend and spend and spend, no matter what, for someone to stay alive." For example, saving a person's left eye is less valuable if they still have their right, because they can still see, versus someone who was already blind in their right eye that would leave them completely blind. So they're willing to spend more to save that person's left eye if they would otherwise be completely blind. Similarly, saving the life of someone young is of higher utility than someone old, because their life expectancy is longer. These sorts of calculations bother some people, but it is a practical reality that these decisions have to be made. I actually think NHS works pretty well and it's better to be open and transparent about these sorts of decisions, versus the American system.

maxxxxx 8y ago
Then make the calculations based on cost like the NHS does and not by age. I totally agree that we should be wary of paying 100s of thousands for some cancer cures. But we shouldn't tell old people "you are useless therefore go somewhere and die". It's hard to imagine but most of the young people here will also get old one day. And they won't be wealthy enough to pay health costs out of pocket.
- throwawaymath 8y ago
  > But we shouldn't tell old people "you are useless therefore go somewhere and die". No one is saying that or advocating for that. I think you're unfairly assuming malice or ambivalence on the part of commenters who are trying to clarify the practical reality of the situation. Consider for a moment, regardless of how unrealistic you feel it may be, the utility of funding the care of a 20 year old with cancer versus a 90 year old with cancer. All things being equal, a system with finite resources should prioritize the 20 year old, because the younger person will likely be less expensive to save long term and can generate more productivity for society afterwards. We'll call this our Socratic baseline. Now obviously in the real world two patients' ailments are never equal. But if you can agree to this baseline, we can proceed to haggle as conditions more closely approximate reality and things stop being so equal. We should not leave the elderly out to die or abandon them. But we have to be honest and balance that moral imperative with the unfortunate, practical reality that we only have finite resources. That doesn't mean we kill anyone off. It means we make nuanced decisions about how much to invest in their care - and how to do so - given their prognosis. Age is a fundamental measure of prognosis.

deleted 8y ago

[deleted]

pwthornton 8y ago

That's what I'm saying.

prostoalex 8y ago

Considering that medical businesses are free to set their own prices, and occupational licensing prevents doctors from cheaper English-speaking countries (India, UK) from moving in and setting up a practice, how far are you willing to take that maxim? * Everyone should get medical care when a routine physical costs $100? * Everyone should get medical care when a routine physical costs $1,000? * Everyone should get medical care when a routine physical costs $10,000?

maxxxxx 8y ago
I don't even understand what you are getting at. Why would a routine physical cost 10000? The question makes as much sense as asking "Should we have a military if soldiers have a salary of 250 billion dollars each?"
- prostoalex 8y ago
  "everyone should get medical care" suggests a system where one party (the taxpayers) are automatically covering a bill for medical service, while the other party (healthcare system) has every incentive to milk the system via over-testing, over-prescribing, over-scheduling routine visits and just plain old raising prices. The soldier analogy doesn't quite apply, as it doesn't require complex skills and providers of the service are not in short supply. A potential candidate can surely hold out for a starting salary that's 10x the average, but others eyeing his position will likely be content with the average. An anesthesiologist, on the other hand, or an MRI lab, might be the only game in town, and if they say the prices are going up by 10% next year, the prices are going up. One is welcome to drive to the next town over, but with taxpayers covering the expense, why bother? What cost constraints exist in "everyone should get medical care" system to prevent healthcare providers from consuming 100% of GDP?
  - maxxxxx 8y ago
    Somehow plenty of countries are doing fine while even consuming less of GDP than the US. As far as I know Medicare doesn't consume 100% of GDP either.