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> A physician forced to run a for-profit hospital maximizing returns is going to make a lot of the same decisions as someone with a business background in the s

> A physician forced to run a for-profit hospital maximizing returns is going to make a lot of the same decisions as someone with a business background in the same situation. Indeed! Whereas a doctor might say yes, give that patient with cancer the treatment they need, the MBA is going to say no, it costs to much, let them die. If the goal is to maximize profit, the MBA is doing a better job. If the goal is to maximize the health of your patients, the doctor is. We must realize that these two goals are fundamentally in conflict with one another. The question isn't whether a doctor or an MBA should be running a for profit hospital, it's whether we should even have for profit hospitals. If we care about people more than profits, then clearly we should not.

brianwawok 4y ago
At some point, you have to put a value on a human life. It sucks and no one likes it, but what is the alternative? Each human life is worth infinity? So we should bankrupt the entire country, spending 10 trillion dollars on a surgery that has a 1% chance to save a 98 year olds life? Obviously that is an extreme example.. but the point is sound. We only have so many resources, how do they get divided up? Should be spend millions to give 80 year olds 1 more year of life? Do we value life on the reverse of age, so a baby we value at 10 million dollars, but a 90 year old we value at $20,000? What if that 90 year old is your Grandpa?
- slantedview 4y ago
  > So we should bankrupt the entire country, spending 10 trillion dollars on a surgery that has a 1% chance to save a 98 year olds life? This is a pretty wild straw man fallacy, but I'd like to give a good faith response nonetheless. You may not know, but the US spends more per capita on healthcare than any other country in the world, by a longshot. Many other countries provide unimpeded treatment for all of their patients. If a doctor in Japan wants chemo, the patient gets chemo, and treatment starts immediately. So how does it make sense that we spend more on our patients but doctors are still told no, the patient can't have that treatment? It's because a larger share of our biggest-in-the-world healthcare spending goes to for profit companies, like insurance companies, than anywhere in the world. So when an insurance company says no to a treatment, it's not because we don't collectively spend enough for that treatment, we do! It's just that the insurance company wants that spending for themselves.
  - calvinmorrison 4y ago
    Let's not be obtuse though. The majority of healthcare costs are incurred at end of life. Perhaps insurers and the government should not subsidize any life saving care for those over the average mortality. I know for example, my grandmother who lived in europe many years ago, had failing kidneys. While today it's likely she could have subsisted for more years on dialysis, perhaps that money didn't need to be spent. Life is finite, and racking up bills at EOL is a waste. People need to learn how let others die with grace, instead of giving chest compressions to a 85 year old 80lb grandmother.
    - ClumsyPilot 4y ago
      If you want to do that, then you have to legalise euthenasia and dace all the thorny questions that comes with
      - calvinmorrison 4y ago
        Euthenasia is already readily available in the united states. It costs somewhere around 10-15 cents per round.
  - JackFr 4y ago
    I would recommend the following EconTalk podcast on the history of the American healthcare system. https://www.econtalk.org/christy-ford-chapin-on-the-evolution-of-the-american-health-care-system/ https://www.econtalk.org/christy-ford-chapin-on-the-evolutio... Spoiler alert -- the author being interviewed doesn't have a solution, quick, easy or otherwise. But the history is fascinating -- in the end there are a lot fewer villians than you might imagine. A lot of good faith decisions seemingly made in the public interest over the past 150 years have led us into a weird local minimum that seems inescapable. Where we are was not inevitable, and as they say if something is unsustainable it has to end eventually, but before suggesting sweeping solutions I'd recommend hearing a detailed history.
  - nickff 4y ago
    >"This is a pretty wild straw man fallacy, but I'd like to give a good faith response nonetheless." Your interlocutor was actually using "reductio ad absurdum", which is a valid style of argumentation. https://en.wikipedia.org/wiki/Reductio_ad_absurdum https://en.wikipedia.org/wiki/Reductio_ad_absurdum You didn't address the scenario as presented, or demonstrate how it violated a principle you had described. Instead, you shifted to excoriating the insurers for greed and waste. Should the insurance company bankrupt itself on the first client? If not, how should they decide how much to spend on each? I should note that non-profit hospitals have similar results as for-profit hospitals (in the USA), so there's little evidence of shareholder greed playing a significant role (though there are many other stakeholders including employees).
- status_quo69 4y ago
  We already have decent (not always great but decent enough) government provided healthcare for the elderly through Medicare. So in fact, we've completely avoided your example already and said "yep, all life has value if you're eligible for medicare". Of course resources are finite, nobody ever argues that they're infinite. But we treat healthcare as if there's a constant scarcity of medicine with how much is charged because there's a constant urge to squeeze even more profits out of patients who probably have only 2 choices- pay for the medicine or die.
zip1234 4y ago
The counterpoint is that you have the exact same decisions being made in systems like the UK. People get refused cancer treatment because they were too old and their were younger patients that had a better prognosis. The fact is both types of systems don't have unlimited resources.
- slantedview 4y ago
  Yes, care rationing is a thing. But in the UK care is rationed due to capacity constraints whereas in the US it's rationed in order to make a profit. These are very, very different things. It means that people's welfare, and death, is being traded for profit.

brianwawok 4y ago

At some point, you have to put a value on a human life. It sucks and no one likes it, but what is the alternative? Each human life is worth infinity? So we should bankrupt the entire country, spending 10 trillion dollars on a surgery that has a 1% chance to save a 98 year olds life? Obviously that is an extreme example.. but the point is sound. We only have so many resources, how do they get divided up? Should be spend millions to give 80 year olds 1 more year of life? Do we value life on the reverse of age, so a baby we value at 10 million dollars, but a 90 year old we value at $20,000? What if that 90 year old is your Grandpa?

slantedview 4y ago
> So we should bankrupt the entire country, spending 10 trillion dollars on a surgery that has a 1% chance to save a 98 year olds life? This is a pretty wild straw man fallacy, but I'd like to give a good faith response nonetheless. You may not know, but the US spends more per capita on healthcare than any other country in the world, by a longshot. Many other countries provide unimpeded treatment for all of their patients. If a doctor in Japan wants chemo, the patient gets chemo, and treatment starts immediately. So how does it make sense that we spend more on our patients but doctors are still told no, the patient can't have that treatment? It's because a larger share of our biggest-in-the-world healthcare spending goes to for profit companies, like insurance companies, than anywhere in the world. So when an insurance company says no to a treatment, it's not because we don't collectively spend enough for that treatment, we do! It's just that the insurance company wants that spending for themselves.
- calvinmorrison 4y ago
  Let's not be obtuse though. The majority of healthcare costs are incurred at end of life. Perhaps insurers and the government should not subsidize any life saving care for those over the average mortality. I know for example, my grandmother who lived in europe many years ago, had failing kidneys. While today it's likely she could have subsisted for more years on dialysis, perhaps that money didn't need to be spent. Life is finite, and racking up bills at EOL is a waste. People need to learn how let others die with grace, instead of giving chest compressions to a 85 year old 80lb grandmother.
  - ClumsyPilot 4y ago
    If you want to do that, then you have to legalise euthenasia and dace all the thorny questions that comes with
    - calvinmorrison 4y ago
      Euthenasia is already readily available in the united states. It costs somewhere around 10-15 cents per round.
- JackFr 4y ago
  I would recommend the following EconTalk podcast on the history of the American healthcare system. https://www.econtalk.org/christy-ford-chapin-on-the-evolution-of-the-american-health-care-system/ https://www.econtalk.org/christy-ford-chapin-on-the-evolutio... Spoiler alert -- the author being interviewed doesn't have a solution, quick, easy or otherwise. But the history is fascinating -- in the end there are a lot fewer villians than you might imagine. A lot of good faith decisions seemingly made in the public interest over the past 150 years have led us into a weird local minimum that seems inescapable. Where we are was not inevitable, and as they say if something is unsustainable it has to end eventually, but before suggesting sweeping solutions I'd recommend hearing a detailed history.
- nickff 4y ago
  >"This is a pretty wild straw man fallacy, but I'd like to give a good faith response nonetheless." Your interlocutor was actually using "reductio ad absurdum", which is a valid style of argumentation. https://en.wikipedia.org/wiki/Reductio_ad_absurdum https://en.wikipedia.org/wiki/Reductio_ad_absurdum You didn't address the scenario as presented, or demonstrate how it violated a principle you had described. Instead, you shifted to excoriating the insurers for greed and waste. Should the insurance company bankrupt itself on the first client? If not, how should they decide how much to spend on each? I should note that non-profit hospitals have similar results as for-profit hospitals (in the USA), so there's little evidence of shareholder greed playing a significant role (though there are many other stakeholders including employees).
status_quo69 4y ago
We already have decent (not always great but decent enough) government provided healthcare for the elderly through Medicare. So in fact, we've completely avoided your example already and said "yep, all life has value if you're eligible for medicare". Of course resources are finite, nobody ever argues that they're infinite. But we treat healthcare as if there's a constant scarcity of medicine with how much is charged because there's a constant urge to squeeze even more profits out of patients who probably have only 2 choices- pay for the medicine or die.

zip1234 4y ago

The counterpoint is that you have the exact same decisions being made in systems like the UK. People get refused cancer treatment because they were too old and their were younger patients that had a better prognosis. The fact is both types of systems don't have unlimited resources.

slantedview 4y ago
Yes, care rationing is a thing. But in the UK care is rationed due to capacity constraints whereas in the US it's rationed in order to make a profit. These are very, very different things. It means that people's welfare, and death, is being traded for profit.