6 ms·

"You’re missing the bit where you can’t not give the 80 year old a hip replacement." Why not? It happens a lot in 'Europe'. (yes I know that 'Europe' isn't one

by roel_v 4y ago

"You’re missing the bit where you can’t not give the 80 year old a hip replacement." Why not? It happens a lot in 'Europe'. (yes I know that 'Europe' isn't one single thing)

robbiep 4y ago
What you're talking about is not some ideal state that we currently exist in where demographic trends aren't resulting in impairment of healthcare delivery (which is a fundamental human right). What you are talking about is the first part of the death by a thousand cuts which is demographic decline and failed service delivery which will only be exacerbated over the coming years as the impact of an ageing and reduced taxpayer, below-subsistence population replacement kicks in. The fact is, and remains, that the 'right' thing to do is to ensure adequate service provision and that the 50 or 60 or 70 or 80 year old who needs a hip replacement, or aortic valve replacement, or high level care nursing home, actually receives it. But the powers that be, even now, are able to reduce the current impact to healthcare budgets (and thus government expenditure) by pushing waiting lists out to such an extent that people are rendered basically invalid by the wait times, and die on them. It's not just europe, it's basically the rule in the US (unless you are independently wealthy or have a decent healthcare plan), and it will only get worse unless people unzip their trousers and make the beast that has two backs. Or, we decide collectively that the attempt at death by a thousand cuts is not in any way acceptable. Which is hard because the insidious nature of death by a thousand cuts is (to absolutely mix metaphors) that you don't notice the temperature rising until you are parboiled.
- roel_v 4y ago
  What? No, that's not what I'm talking about at all. What I'm talking about is sensible healthcare provisioning, under the honest observation that just because some medical intervention is technically possible, it's necessarily a good idea (from both quality of life as well as financial points of view). So no, just because it's technically possible to replace an 80 year old's hip, doesn't mean we should. There is nothing wrong with some cutoff where we say 'as a society, the maximum we want to pay for a daly is x' (or qaly or any other measure you want to take). There is nothing wrong with being honest about resources being finite, and that not every potentially possible medical intervention needs to be paid for by society. And this is what is happening in 'Europe' (although it isn't admitted as bluntly as I put it here...), and what I was referring to.

by roel_v 4y ago

"You’re missing the bit where you can’t not give the 80 year old a hip replacement." Why not? It happens a lot in 'Europe'. (yes I know that 'Europe' isn't one single thing)

robbiep 4y ago

What you're talking about is not some ideal state that we currently exist in where demographic trends aren't resulting in impairment of healthcare delivery (which is a fundamental human right). What you are talking about is the first part of the death by a thousand cuts which is demographic decline and failed service delivery which will only be exacerbated over the coming years as the impact of an ageing and reduced taxpayer, below-subsistence population replacement kicks in. The fact is, and remains, that the 'right' thing to do is to ensure adequate service provision and that the 50 or 60 or 70 or 80 year old who needs a hip replacement, or aortic valve replacement, or high level care nursing home, actually receives it. But the powers that be, even now, are able to reduce the current impact to healthcare budgets (and thus government expenditure) by pushing waiting lists out to such an extent that people are rendered basically invalid by the wait times, and die on them. It's not just europe, it's basically the rule in the US (unless you are independently wealthy or have a decent healthcare plan), and it will only get worse unless people unzip their trousers and make the beast that has two backs. Or, we decide collectively that the attempt at death by a thousand cuts is not in any way acceptable. Which is hard because the insidious nature of death by a thousand cuts is (to absolutely mix metaphors) that you don't notice the temperature rising until you are parboiled.

roel_v 4y ago
What? No, that's not what I'm talking about at all. What I'm talking about is sensible healthcare provisioning, under the honest observation that just because some medical intervention is technically possible, it's necessarily a good idea (from both quality of life as well as financial points of view). So no, just because it's technically possible to replace an 80 year old's hip, doesn't mean we should. There is nothing wrong with some cutoff where we say 'as a society, the maximum we want to pay for a daly is x' (or qaly or any other measure you want to take). There is nothing wrong with being honest about resources being finite, and that not every potentially possible medical intervention needs to be paid for by society. And this is what is happening in 'Europe' (although it isn't admitted as bluntly as I put it here...), and what I was referring to.