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The problem with healthcare is that "basic minimum" is wildly subjective. Healthcare is still very expensive. There are diseases (including cancer) we could ea

The problem with healthcare is that "basic minimum" is wildly subjective. Healthcare is still very expensive. There are diseases (including cancer) we could easily spend millions per patient on. Pulling out all the stops you could spend 10s of millions. But we really don't have that kind of societal overabundance, not yet. So how much do you spend per patient? Are there certain diseases that you don't spend any public money on because the interventions are so expensive compared to success rates? It's really not a simple set of decisions to make, and those decisions do need to be made (or more to the point: agreed upon).

_Microft 6y ago
What problems do you see beside the ones that basically any country with a public health care system has (/has solved)?
- fastball 6y ago
  What do you mean? A country having implemented a nationalized healthcare system does not mean the problem in question has been "solved", it just means that particular society has managed to agree where to draw the line. But this does not guarantee the population at large will continue agreeing indefinitely into the future.
  - _Microft 6y ago
    Umm... yes? Of course this is subject to change. What else did you expect?
    - fastball 6y ago
      That is what I expect. I honestly have no idea what point you're trying to make.
jdavis703 6y ago
This complexity was one of the major reasons the Affordable Care Act’s public option was eliminated. There was going to be a group of people who made these decisions. But when the public found out they were deemed as “death panels” that would get to chose who would live or die.
- chrisbennet 6y ago
  As opposed to insurance companies determining who would die?
  - souprock 6y ago
    It really is different. The existence of unlimited pay-as-you-go care means that you could possibly raise the funds. In systems where all care is state-administered and an attempt to pay for more care would be criminalized as bribery, you'll die of a treatable disease if some bureaucrat decides that the treatment isn't cost effective for a person like you. The details of choices vary, but go something like this: "treatment X for disease Y is not cost-effective (considering quality-adjusted years of life) for people over age X, so provide only pain relief".
    - throwaway2048 6y ago
      So you just die if you cant afford insurance instead. What an improvement. Plenty of countries have both a public and private insurance options.
    - michaelmrose 6y ago
      This already happens. The average american has so small a pool of resources and health care is so expensive that surgery or drugs that insurance doesn't pay for is unaffordable beyond trivialities for the vast majority. 61% couldn't shell out $1000 if their life depended on it. https://www.cnbc.com/2021/01/11/just-39percent-of-americans-could-pay-for-a-1000-emergency-expense.html https://www.cnbc.com/2021/01/11/just-39percent-of-americans-... If little johnny needs a 150k operation and the insurance says no he's going to die and they can't all pay into each others go fund me. The economics just don't work out. Also virtually nobody has suggested outlawing cash payments for services. That idea is much outside of the mainstream as believing that the earth is flat. Pretending that is what socialized medicine is, is a straw man. They are 2 ways to cost pool neither suggests or requires the elimination of cash payment.
AussieWog93 6y ago
The only reason it costs millions to treat cancer patients is because of medical patents allowing companies to extract profit margins of several thousand percent (or more). In countries like Australia, where drug companies have to negotiate a fair price with a single government agency, the cost of treatment is an order of magnitude lower.
- fastball 6y ago
  This is not true. MRI machines are not expensive because of "patents". They are expensive because they are expensive devices that utilize superconducting magnets which need a constant supply of liquid helium. Various drugs are expensive because (regardless of patents) there aren't enough patients to justify mass-production, so the price stays high. Sometimes even with mass production drugs are hard enough to make that the price still stays high. Doctors are not cheap to train, so their services will always be expensive until we replace them with robots. There are a plethora of reasons why medicine and healthcare is expensive beyond "patents" – remove patents from the equation and you can still easily spend millions per patient for various diseases.
  - jpetso 6y ago
    For diseases where there are just a handful of patients requiring sky-high treatment prices, it would be worth investigating whether society can spread their costs among enough people that the costs are bearable anyway. And 10 people yearly requiring a $10m (each) specialized treatment would cost a population of 100 million taxpayers a dollar each. Of course, if these treatments are more common at the same price, the social costs might be too high and we'd have to let people live or die depending on their financial situation or ability to fundraise.
  - cpach 6y ago
    Good point. Not only are physicians needed, nurses are needed as well. They might be cheaper to train and hire compared to physicians – OTOH, there are more of the them and the numbers add up. Not all diseases can be cured by simply taking a pill.
grecy 6y ago
> There are diseases (including cancer) we could easily spend millions per patient on. Pulling out all the stops you could spend 10s of millions. But we really don't have that kind of societal overabundance, not yet. My Mum in Australia had a rare and aggressive form of lung cancer, discovered at stage four. She had almost three years of radiation, chemo, all the associated drugs, scans, treatments and even two different trial drugs. She never paid a cent, all of it on Australia's standard "heathcare for all". If Australia and many other countries can manage it, then more countries can too. Anything less is just an excuse.
- fastball 6y ago
  The calculus is still not that simple. What if that economic output could've instead been directed towards better education for children, or reducing the use of something which is known to cause cancer in the first place (e.g. coal power plants)? The decision is simple for you, because it's your mom. The decision is not a simple one for a society. We do not yet live in a post-scarcity world. Spending on one thing by necessity means less spending on something else.
  - chadcmulligan 6y ago
    Australia has free education as well, and optional private education. University is paid but fairly reasonable, and there's a loan system, though it could be better imho.
    - fastball 6y ago
      I'm sure you could find ways to spend more money and increase the quality of that free education, no?
      - chadcmulligan 6y ago
        Improvements are always possible, and on ongoing discussion. Though I have no major complaints with the current system, my kids are finished school and so I pay less attention now. There was a "Gonski report" commissioned a few years ago with enhancements in mind, it's the source of ongoing discussions I believe. Edit: if you don't like it you can always pay for private education - it to is partially government funded.

_Microft 6y ago

What problems do you see beside the ones that basically any country with a public health care system has (/has solved)?

fastball 6y ago
What do you mean? A country having implemented a nationalized healthcare system does not mean the problem in question has been "solved", it just means that particular society has managed to agree where to draw the line. But this does not guarantee the population at large will continue agreeing indefinitely into the future.
- _Microft 6y ago
  Umm... yes? Of course this is subject to change. What else did you expect?
  - fastball 6y ago
    That is what I expect. I honestly have no idea what point you're trying to make.

jdavis703 6y ago

This complexity was one of the major reasons the Affordable Care Act’s public option was eliminated. There was going to be a group of people who made these decisions. But when the public found out they were deemed as “death panels” that would get to chose who would live or die.

chrisbennet 6y ago
As opposed to insurance companies determining who would die?
- souprock 6y ago
  It really is different. The existence of unlimited pay-as-you-go care means that you could possibly raise the funds. In systems where all care is state-administered and an attempt to pay for more care would be criminalized as bribery, you'll die of a treatable disease if some bureaucrat decides that the treatment isn't cost effective for a person like you. The details of choices vary, but go something like this: "treatment X for disease Y is not cost-effective (considering quality-adjusted years of life) for people over age X, so provide only pain relief".
  - throwaway2048 6y ago
    So you just die if you cant afford insurance instead. What an improvement. Plenty of countries have both a public and private insurance options.
  - michaelmrose 6y ago
    This already happens. The average american has so small a pool of resources and health care is so expensive that surgery or drugs that insurance doesn't pay for is unaffordable beyond trivialities for the vast majority. 61% couldn't shell out $1000 if their life depended on it. https://www.cnbc.com/2021/01/11/just-39percent-of-americans-could-pay-for-a-1000-emergency-expense.html https://www.cnbc.com/2021/01/11/just-39percent-of-americans-... If little johnny needs a 150k operation and the insurance says no he's going to die and they can't all pay into each others go fund me. The economics just don't work out. Also virtually nobody has suggested outlawing cash payments for services. That idea is much outside of the mainstream as believing that the earth is flat. Pretending that is what socialized medicine is, is a straw man. They are 2 ways to cost pool neither suggests or requires the elimination of cash payment.

AussieWog93 6y ago

The only reason it costs millions to treat cancer patients is because of medical patents allowing companies to extract profit margins of several thousand percent (or more). In countries like Australia, where drug companies have to negotiate a fair price with a single government agency, the cost of treatment is an order of magnitude lower.

fastball 6y ago
This is not true. MRI machines are not expensive because of "patents". They are expensive because they are expensive devices that utilize superconducting magnets which need a constant supply of liquid helium. Various drugs are expensive because (regardless of patents) there aren't enough patients to justify mass-production, so the price stays high. Sometimes even with mass production drugs are hard enough to make that the price still stays high. Doctors are not cheap to train, so their services will always be expensive until we replace them with robots. There are a plethora of reasons why medicine and healthcare is expensive beyond "patents" – remove patents from the equation and you can still easily spend millions per patient for various diseases.
- jpetso 6y ago
  For diseases where there are just a handful of patients requiring sky-high treatment prices, it would be worth investigating whether society can spread their costs among enough people that the costs are bearable anyway. And 10 people yearly requiring a $10m (each) specialized treatment would cost a population of 100 million taxpayers a dollar each. Of course, if these treatments are more common at the same price, the social costs might be too high and we'd have to let people live or die depending on their financial situation or ability to fundraise.
- cpach 6y ago
  Good point. Not only are physicians needed, nurses are needed as well. They might be cheaper to train and hire compared to physicians – OTOH, there are more of the them and the numbers add up. Not all diseases can be cured by simply taking a pill.

grecy 6y ago

> There are diseases (including cancer) we could easily spend millions per patient on. Pulling out all the stops you could spend 10s of millions. But we really don't have that kind of societal overabundance, not yet. My Mum in Australia had a rare and aggressive form of lung cancer, discovered at stage four. She had almost three years of radiation, chemo, all the associated drugs, scans, treatments and even two different trial drugs. She never paid a cent, all of it on Australia's standard "heathcare for all". If Australia and many other countries can manage it, then more countries can too. Anything less is just an excuse.

fastball 6y ago
The calculus is still not that simple. What if that economic output could've instead been directed towards better education for children, or reducing the use of something which is known to cause cancer in the first place (e.g. coal power plants)? The decision is simple for you, because it's your mom. The decision is not a simple one for a society. We do not yet live in a post-scarcity world. Spending on one thing by necessity means less spending on something else.
- chadcmulligan 6y ago
  Australia has free education as well, and optional private education. University is paid but fairly reasonable, and there's a loan system, though it could be better imho.
  - fastball 6y ago
    I'm sure you could find ways to spend more money and increase the quality of that free education, no?
    - chadcmulligan 6y ago
      Improvements are always possible, and on ongoing discussion. Though I have no major complaints with the current system, my kids are finished school and so I pay less attention now. There was a "Gonski report" commissioned a few years ago with enhancements in mind, it's the source of ongoing discussions I believe. Edit: if you don't like it you can always pay for private education - it to is partially government funded.