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Hospitals need to be BIG. Basic logic does something like “population * sickness-rate = mean required beds for hospital budget”, but this is logical for lossy s

Hospitals need to be BIG. Basic logic does something like “population * sickness-rate = mean required beds for hospital budget”, but this is logical for lossy services, not mandatory ones. Not to get political, but when a service goes from being a luxury to being considered a human right, our tolerance for failure changes immediately. Anyone who works in reliability knows that the budget for “will never fail” is exponentially higher than “almost never fails”. As we transmute more services to “fundamental right”, we need to expect costs to grow non-linearly, regardless of who is paying. None of this is a bad thing, we just need to be building freakin’ massive hospital buildings!

throwaway346434 2y ago
There's a point where the vertical integration of services doesn't scale up with demand - and you get what is happening here, which is effectively kanban, a pull based model for patient flow. The scale out cost for hospitals are in the order of billions and decades to become available. The US needs significantly more diversionary, urgent care resources - a cut or fracture below a certain threshold does not need to be in the same emergency room as a stab victim or crush victim. Going back further, preventative care absolutely needs to be in place so chronic illnesses do not progress to the point of emergency. The Australian model is simple enough: for medications, for the most common treatments, these are on a pharmaceuticals benefits list. The government guarantees the price is kept low, even if the manufacturer is charging ridiculous amounts. This works, because paying $600 extra a month for someone's pills from taxes saves $1200+ of them not rocking up to hospital on death's door 12 times a year.
listenallyall 2y ago
I don't see how healthcare can be considered a "fundamental right", like freedom to practice religion or ability to own property, because it relies on (and therefore places a burden on them) to deliver that service. If healthcare is my fundamental right, how can you, who is providing care, take a day off or quit the job entirely? Am I entitled to every possible test as frequently as possible plus every potential drug or medicine even as my prospects for regaining health diminish towards zero? Government's should have some system for providing "pretty good" healthcare to the largest percentage of its citizens as possible, but raising it to a "fundamental right" is not sustainable or possible or fair.
- ImPostingOnHN 2y ago
  The same could be said of food, water, and safe shelter. The concept of a fundamental right here depends on a morality that says everyone has a right to live, and that society should help make that possible, probably partially through taxes. If your morality is different, your opinion of whether the above are fundamental rights, might also be different. I personally agree with both points: I believe "pretty good healthcare" is a fundamental right. That is to say, it should be limited only by factors humans can't control (e.g the lead time for training new people), and otherwise be "best effort" given that constraint.
  - listenallyall 2y ago
    > The same could be said of food, water, and safe shelter. Strong disagree. Let's think back 100, 200 years. A huge percentage of the population built their own shelter and grew their own food. The idea that the government ought to be required to supply these to everyone (as a "fundamental right") is very much a late 20th century concept. I agree that the government stepping in and trying to feed and house all its citizens is a noble goal - but this leads to a discussion around some minimum amount of effort and personal responsibility, or whether you want to live in a society where nothing is ever expected of the people, that it's OK for healthy, capable citizens to simply "opt-out" of work or productive pursuits, knowing the government is responsible for providing food, clothes and housing, seeing that it's a "fundamental right."
    - ImPostingOnHN 2y ago
      > Strong disagree. Let's think back 100, 200 years. A huge percentage of the population built their own shelter and grew their own food. The same could be said of medical care. I don't see how that affects morality today. > The idea that the government ought to be required to supply these to everyone (as a "fundamental right") is very much a late 20th century concept. I still don't see what history has to do with anything here. Is it a "late 20th century concept"? Maybe, maybe not, but that doesn't affect whether something is morally a fundamental right. It sounds like you fit into the "different morality" bucket I mentioned above, so we should expect you to have differing opinions on what rights are fundamental (and that's okay). And if you have differing opinions on what rights are fundamental, than we should expect you to have differing opinions on what the government should do to guarantee them. Which you appear to (and that's okay).

throwaway346434 2y ago

There's a point where the vertical integration of services doesn't scale up with demand - and you get what is happening here, which is effectively kanban, a pull based model for patient flow. The scale out cost for hospitals are in the order of billions and decades to become available. The US needs significantly more diversionary, urgent care resources - a cut or fracture below a certain threshold does not need to be in the same emergency room as a stab victim or crush victim. Going back further, preventative care absolutely needs to be in place so chronic illnesses do not progress to the point of emergency. The Australian model is simple enough: for medications, for the most common treatments, these are on a pharmaceuticals benefits list. The government guarantees the price is kept low, even if the manufacturer is charging ridiculous amounts. This works, because paying $600 extra a month for someone's pills from taxes saves $1200+ of them not rocking up to hospital on death's door 12 times a year.

listenallyall 2y ago

I don't see how healthcare can be considered a "fundamental right", like freedom to practice religion or ability to own property, because it relies on (and therefore places a burden on them) to deliver that service. If healthcare is my fundamental right, how can you, who is providing care, take a day off or quit the job entirely? Am I entitled to every possible test as frequently as possible plus every potential drug or medicine even as my prospects for regaining health diminish towards zero? Government's should have some system for providing "pretty good" healthcare to the largest percentage of its citizens as possible, but raising it to a "fundamental right" is not sustainable or possible or fair.

ImPostingOnHN 2y ago
The same could be said of food, water, and safe shelter. The concept of a fundamental right here depends on a morality that says everyone has a right to live, and that society should help make that possible, probably partially through taxes. If your morality is different, your opinion of whether the above are fundamental rights, might also be different. I personally agree with both points: I believe "pretty good healthcare" is a fundamental right. That is to say, it should be limited only by factors humans can't control (e.g the lead time for training new people), and otherwise be "best effort" given that constraint.
- listenallyall 2y ago
  > The same could be said of food, water, and safe shelter. Strong disagree. Let's think back 100, 200 years. A huge percentage of the population built their own shelter and grew their own food. The idea that the government ought to be required to supply these to everyone (as a "fundamental right") is very much a late 20th century concept. I agree that the government stepping in and trying to feed and house all its citizens is a noble goal - but this leads to a discussion around some minimum amount of effort and personal responsibility, or whether you want to live in a society where nothing is ever expected of the people, that it's OK for healthy, capable citizens to simply "opt-out" of work or productive pursuits, knowing the government is responsible for providing food, clothes and housing, seeing that it's a "fundamental right."
  - ImPostingOnHN 2y ago
    > Strong disagree. Let's think back 100, 200 years. A huge percentage of the population built their own shelter and grew their own food. The same could be said of medical care. I don't see how that affects morality today. > The idea that the government ought to be required to supply these to everyone (as a "fundamental right") is very much a late 20th century concept. I still don't see what history has to do with anything here. Is it a "late 20th century concept"? Maybe, maybe not, but that doesn't affect whether something is morally a fundamental right. It sounds like you fit into the "different morality" bucket I mentioned above, so we should expect you to have differing opinions on what rights are fundamental (and that's okay). And if you have differing opinions on what rights are fundamental, than we should expect you to have differing opinions on what the government should do to guarantee them. Which you appear to (and that's okay).