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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 deci

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.
  - Frondo 6y ago
    If we have a health care system that's effectively only available to the very well-off, that's not a good health-care system -- it doesn't even deserve to be called one.
  - DanBC 6y ago
    The UK has public and private provision of healthcare, and adults are free to leave the UK and buy healthcare from other countries if they can afford to do so.
sokoloff 6y ago
Someone has to make these calls in any pooled-resource scheme. Jeff Bezos is free to pay whatever he likes from his own pocket, but any shared pool should be sensibly regulated to prevent ridiculously wasteful spending in the last few months of life. If we perfected artificial hearts, for example, and they cost some nominal amount (less than a typical car, for example), we still wouldn't implant them in 102 year-olds. I'd argue against that implant for my parents, myself, and in the unlikely event I'm around then, for my kids. I don't live under NHS, but the calculations they do, while often the subject of finger-wagging, seem entirely sensible to me.

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.
- Frondo 6y ago
  If we have a health care system that's effectively only available to the very well-off, that's not a good health-care system -- it doesn't even deserve to be called one.
- DanBC 6y ago
  The UK has public and private provision of healthcare, and adults are free to leave the UK and buy healthcare from other countries if they can afford to do so.

sokoloff 6y ago

Someone has to make these calls in any pooled-resource scheme. Jeff Bezos is free to pay whatever he likes from his own pocket, but any shared pool should be sensibly regulated to prevent ridiculously wasteful spending in the last few months of life. If we perfected artificial hearts, for example, and they cost some nominal amount (less than a typical car, for example), we still wouldn't implant them in 102 year-olds. I'd argue against that implant for my parents, myself, and in the unlikely event I'm around then, for my kids. I don't live under NHS, but the calculations they do, while often the subject of finger-wagging, seem entirely sensible to me.