4 ms·

The only way to make the budget work, for all of medicine worldwide, is to let people die (!) There's a marginal dollar cost on saving one extra life, versus n

• voakbasda 3y ago
  No one wants to believe this. But it is absolutely true: there is no healthcare system that can save everyone forever. The growing assortment of treatments to combat issues that arise naturally through aging gave rise to the expectation that we can live longer. Technically, that’s true, but the collective cost of care starts to go exponential. At some point, we must acknowledge that we will go bankrupt trying to save everyone. I wish there was a way for people to check out before they become such a burden on society. Until then, we had better make peace with the reality that “death panels” are choosing for us, because we as a civilization can’t afford for everyone to live their longest possible life.
  • MattRix 3y ago
    I see no logical reason for this to be true, certainly not in any absolute sense.
    • deleted 3y ago
      [deleted]
    • pessimizer 3y ago
      You can't see that a situation will come up, every day, where you have to make a choice between spending millions to keep someone alive for another year, or spending those millions on cheaper and more effective interventions for 100 children? Here's the logic. Budgeting doesn't suddenly disappear and resources don't suddenly become infinite when healthcare moves from insurance companies to government. People who bash the NHS as a concept are people who prefer insurers to budget their healthcare instead of civil servants. Insurers are also death panels.
  • ChoHag 3y ago
    [dead]
• crote 3y ago
  It's not that simple, though. You can't set a budget and let everyone die once you reach your limit. Healthcare often uses "quality-adjusted life years", where the value of a medical intervention is judged by the amount and quality of the life years gained by doing the intervention. Once you set a value on a life year, it becomes a simple calculation whether the treatment is worth it. $5000 operation to save a newborn baby? Obviously worth it. $10M so a 90-year-old can live three more months? Yeah, not going to happen. The best part is that you can apply a similar principle to other things. For example, at a certain point you gain more quality-adjusted life year per $ if you spend it on non-healthcare things, such as safer roads, better education, preventing homelessness, and fighting crime.
  • tux3 3y ago
    I agree it's not that simple, and finding better interventions in term of quality-adjusted life years seems really good! I'm not sure though how much elasticity there is in people's willingness to contribute more in response to more effective medical interventions. Setting a value on a life-year makes sense when choosing intervention, but individuals looking at their taxes or charitable contributions don't have a step-change reaction where they're happy to give without limits to the $X QALY opportunity until it becomes $X+1 I do think you have that budget in a very real sense, and I'm not sure I know exactly how sensitive it is to the effectiveness of the interventions, especially as you expand out. I'd argue that the current price of a life year still seems relatively cheap, but the healthcare system does not often complain from being inundated with too much funding.
  • avar 3y ago
    > $5000 operation to save a > newborn baby? Obviously > worth it. Obviously? A 10 year old, sure, because you've sunk a lot of money into education etc. for that individual already. But while any given newborn has a lifetime of tax paying ahead of them, they're also easy to replace. If you made this an auction I'd bet you'd get at least two couples willing to produce newborns within a year for $2500 each.