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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

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.
  - maxxxxx 8y ago
    All fine and good. What I hear a lot is that young people shouldn't pay for old people. That's extremely short sighted. I am on board with taking age into account for coat of treatments. But you also need to accept that older people need more care and that that's ok. It's a difficult balance.
  - a_tractor 8y ago
    Including "and can generate more productivity for society afterwards" as your Socratic baseline shows a gambler's fallacy. The 90 year old has already contributed what he could to society. We know what he was worth and what he is worth, quantitatively speaking. Also, that 90 year old represents a much higher degree of cumulative investment by society, so now we are almost facing an argument of sunk cost fallacy vs gambler's fallacy... However, I would say you are discounting what he or she still has to offer, qualitatively, via knowledge and wisdom. I would deny the gambler's fallacy by saying that somebody who gets cancer at 20 years is not just as likely to be as productive as someone who didn't get cancer until they were 90. They are actually more likely to be less productive and are already proving to be more expensive to keep alive, with much longer to go... To say that the baseline should be how "productive" a 20 year old can be compared to a 90 year old, who's productive years are behind them, is imo to miss the point of life completely, and to relegate the purpose of man to that of farm equipment. So, to follow your decision making basis all the way, they both would need to be let go. One is a lemon and the other is past its extended warranty.
- mediaman 8y ago
  Yes, but age is part of the utility. If we can save someone that would be expected to live another 50 years, it's more valuable than saving someone who will live another six months. That doesn't mean they won't get any care, but it would mean that the maximum that would be spent to save them would be less than someone who was expected to live much longer because of the care.
- TheCoelacanth 8y ago
  The NHS bases their cost-effectiveness calculations on the increase in quality-adjusted life years that the treatment is expected to add. That measure will absolutely prioritize treatment of younger patients over treatment of older patients because there is more time over which the benefits of the treatment can be realized. Paying hundreds of thousands of dollars to save a ten-year-old from cancer will be accepted because it could add decades to their life. Paying hundreds of thousands of dollars to save a ninety-year-old from cancer will not because it is unlikely to increase their lifespan very much.
hpcjoe 8y ago
This is quite literally the definition of triage. You have finite resources. You have requests for resources which exceed your capabilities to service. You need to determine an order. In an ideal utopian world, no one would ever need these services. In a less ideal world, everyone who needs these services would be serviced quickly and effectively with only positive outcomes. In the real world, you have to make choices. These are very hard choices, and they have longer term impacts. It is literally "the good of the many vs the good of the few."
- tim333 8y ago
  Well, literally triage is "decide the order of treatment of (patients or casualties)" without much of the finance input. The NHS stuff is done by the National Institute for Health and Care Excellence based on quality-adjusted life years and they have a guideline of £20,000 per year. So if a cancer treatment lets you live ten more years in ok condition it's worth spending £200k to do it https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence#Quality-adjusted_life_years https://en.wikipedia.org/wiki/National_Institute_for_Health_...
  - maxxxxx 8y ago
    In the US everybody would scream "death panels" if they had something like NICE who tries to get some reality into the discussion. Instead the work of NICE is done by insurances. There is no open and rational discussion in the US about these things.
deleted 8y ago
[deleted]

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.
- maxxxxx 8y ago
  All fine and good. What I hear a lot is that young people shouldn't pay for old people. That's extremely short sighted. I am on board with taking age into account for coat of treatments. But you also need to accept that older people need more care and that that's ok. It's a difficult balance.
- a_tractor 8y ago
  Including "and can generate more productivity for society afterwards" as your Socratic baseline shows a gambler's fallacy. The 90 year old has already contributed what he could to society. We know what he was worth and what he is worth, quantitatively speaking. Also, that 90 year old represents a much higher degree of cumulative investment by society, so now we are almost facing an argument of sunk cost fallacy vs gambler's fallacy... However, I would say you are discounting what he or she still has to offer, qualitatively, via knowledge and wisdom. I would deny the gambler's fallacy by saying that somebody who gets cancer at 20 years is not just as likely to be as productive as someone who didn't get cancer until they were 90. They are actually more likely to be less productive and are already proving to be more expensive to keep alive, with much longer to go... To say that the baseline should be how "productive" a 20 year old can be compared to a 90 year old, who's productive years are behind them, is imo to miss the point of life completely, and to relegate the purpose of man to that of farm equipment. So, to follow your decision making basis all the way, they both would need to be let go. One is a lemon and the other is past its extended warranty.
mediaman 8y ago
Yes, but age is part of the utility. If we can save someone that would be expected to live another 50 years, it's more valuable than saving someone who will live another six months. That doesn't mean they won't get any care, but it would mean that the maximum that would be spent to save them would be less than someone who was expected to live much longer because of the care.
TheCoelacanth 8y ago
The NHS bases their cost-effectiveness calculations on the increase in quality-adjusted life years that the treatment is expected to add. That measure will absolutely prioritize treatment of younger patients over treatment of older patients because there is more time over which the benefits of the treatment can be realized. Paying hundreds of thousands of dollars to save a ten-year-old from cancer will be accepted because it could add decades to their life. Paying hundreds of thousands of dollars to save a ninety-year-old from cancer will not because it is unlikely to increase their lifespan very much.

hpcjoe 8y ago

This is quite literally the definition of triage. You have finite resources. You have requests for resources which exceed your capabilities to service. You need to determine an order. In an ideal utopian world, no one would ever need these services. In a less ideal world, everyone who needs these services would be serviced quickly and effectively with only positive outcomes. In the real world, you have to make choices. These are very hard choices, and they have longer term impacts. It is literally "the good of the many vs the good of the few."

tim333 8y ago
Well, literally triage is "decide the order of treatment of (patients or casualties)" without much of the finance input. The NHS stuff is done by the National Institute for Health and Care Excellence based on quality-adjusted life years and they have a guideline of £20,000 per year. So if a cancer treatment lets you live ten more years in ok condition it's worth spending £200k to do it https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence#Quality-adjusted_life_years https://en.wikipedia.org/wiki/National_Institute_for_Health_...
- maxxxxx 8y ago
  In the US everybody would scream "death panels" if they had something like NICE who tries to get some reality into the discussion. Instead the work of NICE is done by insurances. There is no open and rational discussion in the US about these things.

deleted 8y ago

[deleted]