4 ms·

I would explain the repeated observation about lack of clear information on specific criteria as explicit policy choice that matches the explicit policy choice

I would explain the repeated observation about lack of clear information on specific criteria as explicit policy choice that matches the explicit policy choice on many other complicated healthcare aspects in those countries - essentially, that you will get all kinds of weird edge cases that should get evaluated individually case-by-case; and that this determination should be done by a doctor (or a panel of doctors) and the patient, not be prescribed and enforced by the legal system.

daenz 4y ago
Weird edge cases are very rare by definition. If they're not very rare, then they're not weird edge cases. And allowing them to exist and be handled in a bespoke way is not the same as handling all cases in a bespoke way. The law can help isolate those weird edge cases by handling the broad cases up front. That way the truly unique cases can get the resources/attention that they need.
- PeterisP 4y ago
  My point is that the policy in those countries intentionally does not try to define what exactly is "the broad case" (because, frankly, any definition will have its flaws in some unforeseen and unforeseeable cases) but instead devolves that decision to the doctors, so that every case can be treated as a "weird case" if and only if the doctors say so, because the policy in these societies is that they trust the doctors to make the proper ethical choice more than their ability to prescribe exact criteria in a legal act. In essence, allowing these cases to exist at all means that the law acknowledges that it can't explicitly state in legislation beforehand which cases will need bespoke review and which will not; and that it in such cases the law does not prescribe the final decision but devolves it to the medical specialists who see the individual case. An alternative that I've read about from recent events in USA with hospital lawyers being present in emergency room to make a decision when a certain intervention (deemed necessary by the doctors beforehand) becomes "permissible" seems literally incomprehensible and insane at least to me, as from all the people in that room they are the least appropriate, least qualified, and with least moral rights to make a decision about what should be done or not - if you don't trust these particular doctors with doing what's right, you shouldn't let them perform operations on people at all.
- mellavora 4y ago
  Right, so the author should not have called them "weird edge cases"; forgive that typo and the main point stands: This is a domain where upwards of 20% of cases do not fit standard frameworks. That's not unusual for medical situations, especially in this area where it is a combo of biology and social factors. The problem with the "law up front" is that often this means that the unique cases get ignored or no resources.
Spivak 4y ago
It’s one of the oddest things about American “democracy” — if you survey people how they feel about medical treatment you will overwhelmingly get “medical decisions should be made by the doctor and patient [1] full stop and if a doctor prescribes it insurance pays for it no questions asked” but because the people with the real influence are insurance companies and the most politically involved are niche political groups that want to weaponize medical care for varying agendas we get minority rule. [1] Minor asterisk being that in the case of minors blue tribe says child can override parent and red tribe says parent can override child. But that’s the bike shed when we’re all basically in agreement about the nuclear power plant dammit.
- nradov 4y ago
  If medical insurance companies had to pay for every claim submitted by a doctor regardless of medical necessity or the availability of more cost-effective treatments then insurance premiums would be much higher for everyone. Would that be better? Healthcare already consumes about a fifth of our GDP. The reality is that resources are limited and demand is effectively infinite, so inevitably there has to be some level of rationing.
  - tsimionescu 4y ago
    Except that most of the current cost is in enforcing all of those rules, not in the medical treatments themselves. The vast majority of Healthcare expenses are the enormous administrative costs of the huge bureaucracy that insurance companies have created to ensure they are paying the least possible amount of money to their clients.
    - nradov 4y ago
      That is not even remotely true. Rule enforcement is a tiny fraction of overall healthcare expenditure, and highly automated.
  - user_7832 4y ago
    > regardless of medical necessity I doubt most patients (especially in the US) go to the doctor often for things not important medically. > demand is effectively infinite I'm sorry, how do you get to this conclusion?

daenz 4y ago

Weird edge cases are very rare by definition. If they're not very rare, then they're not weird edge cases. And allowing them to exist and be handled in a bespoke way is not the same as handling all cases in a bespoke way. The law can help isolate those weird edge cases by handling the broad cases up front. That way the truly unique cases can get the resources/attention that they need.

PeterisP 4y ago
My point is that the policy in those countries intentionally does not try to define what exactly is "the broad case" (because, frankly, any definition will have its flaws in some unforeseen and unforeseeable cases) but instead devolves that decision to the doctors, so that every case can be treated as a "weird case" if and only if the doctors say so, because the policy in these societies is that they trust the doctors to make the proper ethical choice more than their ability to prescribe exact criteria in a legal act. In essence, allowing these cases to exist at all means that the law acknowledges that it can't explicitly state in legislation beforehand which cases will need bespoke review and which will not; and that it in such cases the law does not prescribe the final decision but devolves it to the medical specialists who see the individual case. An alternative that I've read about from recent events in USA with hospital lawyers being present in emergency room to make a decision when a certain intervention (deemed necessary by the doctors beforehand) becomes "permissible" seems literally incomprehensible and insane at least to me, as from all the people in that room they are the least appropriate, least qualified, and with least moral rights to make a decision about what should be done or not - if you don't trust these particular doctors with doing what's right, you shouldn't let them perform operations on people at all.
mellavora 4y ago
Right, so the author should not have called them "weird edge cases"; forgive that typo and the main point stands: This is a domain where upwards of 20% of cases do not fit standard frameworks. That's not unusual for medical situations, especially in this area where it is a combo of biology and social factors. The problem with the "law up front" is that often this means that the unique cases get ignored or no resources.

Spivak 4y ago

It’s one of the oddest things about American “democracy” — if you survey people how they feel about medical treatment you will overwhelmingly get “medical decisions should be made by the doctor and patient [1] full stop and if a doctor prescribes it insurance pays for it no questions asked” but because the people with the real influence are insurance companies and the most politically involved are niche political groups that want to weaponize medical care for varying agendas we get minority rule. [1] Minor asterisk being that in the case of minors blue tribe says child can override parent and red tribe says parent can override child. But that’s the bike shed when we’re all basically in agreement about the nuclear power plant dammit.

nradov 4y ago
If medical insurance companies had to pay for every claim submitted by a doctor regardless of medical necessity or the availability of more cost-effective treatments then insurance premiums would be much higher for everyone. Would that be better? Healthcare already consumes about a fifth of our GDP. The reality is that resources are limited and demand is effectively infinite, so inevitably there has to be some level of rationing.
- tsimionescu 4y ago
  Except that most of the current cost is in enforcing all of those rules, not in the medical treatments themselves. The vast majority of Healthcare expenses are the enormous administrative costs of the huge bureaucracy that insurance companies have created to ensure they are paying the least possible amount of money to their clients.
  - nradov 4y ago
    That is not even remotely true. Rule enforcement is a tiny fraction of overall healthcare expenditure, and highly automated.
- user_7832 4y ago
  > regardless of medical necessity I doubt most patients (especially in the US) go to the doctor often for things not important medically. > demand is effectively infinite I'm sorry, how do you get to this conclusion?