3 ms·

Varying degrees of negligence? Drink a lot and drive, your chance of homicide goes up.

by axus 1y ago

tptacek 1y ago
Every health system in the world makes decisions that result in deaths that could have been avoided had other decisions been made. I don't like many of the decisions our shambolic health system makes. But none of it is "murder".
- jack_h 1y ago
  I want to highlight your point because you're correct and this is something that a lot of people don't understand about economic systems. We exist in a resource constrained system. There are finite medical workers, finite time, finite medicine, finite medical facilities, finite medical equipment, and just finite resources in general. There will always be shortages and surpluses in such a system as resource allocation is never perfect. If you have a shortage you must ration supply through some mechanism. It can be by prices, by queue, by need, by lot, by status, or countless other mechanisms or combinations of mechanisms but you must ration regardless. This will lead to people dying under certain conditions who may not have died if some other rationing mechanism was used, but if a different rationing mechanism was used then a different set of people would have died. The only thing that can be done is to select the system that allocates resources more efficiently than other systems to minimize this failure mode. This whole idea of "statistical murder" would just lead to the banning of medical care entirely as no system has perfect allocation at all times, although some are certainly worse than others. Plus I have no idea what the word "statistical" even means in this context...
  - _DeadFred_ 1y ago
    Our system isn't this resource constrained though. Our system has evolved unintentionally to allocate things this way, but our system does in fact have the resources. In fact, we have so much resources/efficiency/excess we have all kinds of labs/practices doing all kind of optional procedures across the entire country. So many that wait times are really really low for those elective procedures. Example. I live in a mountain town. Our ER takes hours. I can go to one of the multiple nearby doc in a boxes and get seen in 15 minutes. My town HAS the resources to see those people waiting in the ER. We just don't allocated the resources that way. My town is a ski town. We have WAY more orthopedic surgeons than we need, but it's extra profitable for them here and living rich in a remote ski town is nice. My tiny town has multiple beauty skincare facilities with licensed doctors on staff. It's not a 'we don't have resources' it's a 'we don't prioritize these lives'. Which is fine. But don't lie to us and say there aren't medical resources.
    - tptacek 1y ago
      You also have way more orthopedic surgeons because the AMA lobbied to require primary care physicians to go through the same rigorous residency track as specialists do, where before they could begin practice after a year, and so there's almost no incentive to enter primary care medicine directly anymore; it's the same cost and effort as becoming a cardiologist, but less pay.
- conductr 1y ago
  An insurer having an auto-deny policy for care claims (procedure/medication/etc) and then fighting a physician’s explanation/reason for their recommendation to the extent the patient expires while this battle plays out, is evil and premeditated and arguably meets the legal criteria of murder in many jurisdictions.
  - tptacek 1y ago
    It meets the legal criteria of murder in literally no jurisdiction anywhere.
    - ceejayoz 1y ago
      The same is true for the Holocaust in 1944. We had to invent new crimes “against humanity” to cover it.
      - tptacek 1y ago
        No, that is obviously not also true of the Holocaust. Again: pretzels! It's really easy to look up why we invented new categories of crime for the Holocaust.
        ceejayoz 1y ago
        It is entirely true. The Holocaust was a sovereign nation committing actions that were legal within its judicial system at the time. > The drafters of [the Nuremberg Charter] were faced with the problem of how to charge the men at the Nuremberg Trial with committing the Holocaust and other state-sanctioned atrocities committed in Germany and German-allied states by the Nazi regime. As far as German law was concerned the men had committed no crime, but only followed orders. Not following orders however, in Nazi Germany, was a horribly punished crime. The problem in trying the individuals responsible for the German atrocities lay in the fact that, like in World War I, a traditional understanding of war crimes gave no provision for atrocities committed by a state on its own citizens or its allies. Therefore, to solve this problem and close the loophole, Article 6 of the Charter was drafted to include not only traditional war crimes and crimes against peace, but also crimes against humanity…
- ceejayoz 1y ago
  > Every health system in the world makes decisions that result in deaths that could have been avoided had other decisions been made. And some of those decisions are, shall we say, justifiable homicide. Intent and motive makes murder. “I will let these people die so I can be richer” is different than a bureaucrat who gets paid the same either way.
  - tptacek 1y ago
    None of them are homicide. Look at the pretzel you've twisted yourself into trying to defend your use of the term "murder".
    - ceejayoz 1y ago
      Look at the pretzel that’s forming from trying to avoid the “decisions to let people die for profit” aren’t homicide.
      - tptacek 1y ago
        One twist in your pretzel (or 38, if you want to break it out using the OECD) is that you've essentially indicted every health system in the world for murder.
        ceejayoz 1y ago
        The US is uniquely and aberrantly expensive amongst the OECD.
        tptacek 1y ago
        Yes! For reasons having very little to do with your argument! https://nationalhealthspending.org/ https://nationalhealthspending.org/
        ceejayoz 1y ago
        Perhaps you could elaborate on what argument that link is supposed to support? “We spend a lot” and “people make profit off denying and inflating cost of care which results in needless deaths” are not exclusive scenarios.

Varying degrees of negligence? Drink a lot and drive, your chance of homicide goes up.

by axus 1y ago

Varying degrees of negligence? Drink a lot and drive, your chance of homicide goes up.

Every health system in the world makes decisions that result in deaths that could have been avoided had other decisions been made. I don't like many of the decisions our shambolic health system makes. But none of it is "murder".

jack_h 1y ago
I want to highlight your point because you're correct and this is something that a lot of people don't understand about economic systems. We exist in a resource constrained system. There are finite medical workers, finite time, finite medicine, finite medical facilities, finite medical equipment, and just finite resources in general. There will always be shortages and surpluses in such a system as resource allocation is never perfect. If you have a shortage you must ration supply through some mechanism. It can be by prices, by queue, by need, by lot, by status, or countless other mechanisms or combinations of mechanisms but you must ration regardless. This will lead to people dying under certain conditions who may not have died if some other rationing mechanism was used, but if a different rationing mechanism was used then a different set of people would have died. The only thing that can be done is to select the system that allocates resources more efficiently than other systems to minimize this failure mode. This whole idea of "statistical murder" would just lead to the banning of medical care entirely as no system has perfect allocation at all times, although some are certainly worse than others. Plus I have no idea what the word "statistical" even means in this context...
- _DeadFred_ 1y ago
  Our system isn't this resource constrained though. Our system has evolved unintentionally to allocate things this way, but our system does in fact have the resources. In fact, we have so much resources/efficiency/excess we have all kinds of labs/practices doing all kind of optional procedures across the entire country. So many that wait times are really really low for those elective procedures. Example. I live in a mountain town. Our ER takes hours. I can go to one of the multiple nearby doc in a boxes and get seen in 15 minutes. My town HAS the resources to see those people waiting in the ER. We just don't allocated the resources that way. My town is a ski town. We have WAY more orthopedic surgeons than we need, but it's extra profitable for them here and living rich in a remote ski town is nice. My tiny town has multiple beauty skincare facilities with licensed doctors on staff. It's not a 'we don't have resources' it's a 'we don't prioritize these lives'. Which is fine. But don't lie to us and say there aren't medical resources.
  - tptacek 1y ago
    You also have way more orthopedic surgeons because the AMA lobbied to require primary care physicians to go through the same rigorous residency track as specialists do, where before they could begin practice after a year, and so there's almost no incentive to enter primary care medicine directly anymore; it's the same cost and effort as becoming a cardiologist, but less pay.
conductr 1y ago
An insurer having an auto-deny policy for care claims (procedure/medication/etc) and then fighting a physician’s explanation/reason for their recommendation to the extent the patient expires while this battle plays out, is evil and premeditated and arguably meets the legal criteria of murder in many jurisdictions.
- tptacek 1y ago
  It meets the legal criteria of murder in literally no jurisdiction anywhere.
  - ceejayoz 1y ago
    The same is true for the Holocaust in 1944. We had to invent new crimes “against humanity” to cover it.
    - tptacek 1y ago
      No, that is obviously not also true of the Holocaust. Again: pretzels! It's really easy to look up why we invented new categories of crime for the Holocaust.
      - ceejayoz 1y ago
        It is entirely true. The Holocaust was a sovereign nation committing actions that were legal within its judicial system at the time. > The drafters of [the Nuremberg Charter] were faced with the problem of how to charge the men at the Nuremberg Trial with committing the Holocaust and other state-sanctioned atrocities committed in Germany and German-allied states by the Nazi regime. As far as German law was concerned the men had committed no crime, but only followed orders. Not following orders however, in Nazi Germany, was a horribly punished crime. The problem in trying the individuals responsible for the German atrocities lay in the fact that, like in World War I, a traditional understanding of war crimes gave no provision for atrocities committed by a state on its own citizens or its allies. Therefore, to solve this problem and close the loophole, Article 6 of the Charter was drafted to include not only traditional war crimes and crimes against peace, but also crimes against humanity…
ceejayoz 1y ago
> Every health system in the world makes decisions that result in deaths that could have been avoided had other decisions been made. And some of those decisions are, shall we say, justifiable homicide. Intent and motive makes murder. “I will let these people die so I can be richer” is different than a bureaucrat who gets paid the same either way.
- tptacek 1y ago
  None of them are homicide. Look at the pretzel you've twisted yourself into trying to defend your use of the term "murder".
  - ceejayoz 1y ago
    Look at the pretzel that’s forming from trying to avoid the “decisions to let people die for profit” aren’t homicide.
    - tptacek 1y ago
      One twist in your pretzel (or 38, if you want to break it out using the OECD) is that you've essentially indicted every health system in the world for murder.
      - ceejayoz 1y ago
        The US is uniquely and aberrantly expensive amongst the OECD.
        tptacek 1y ago
        Yes! For reasons having very little to do with your argument! https://nationalhealthspending.org/ https://nationalhealthspending.org/
        ceejayoz 1y ago
        Perhaps you could elaborate on what argument that link is supposed to support? “We spend a lot” and “people make profit off denying and inflating cost of care which results in needless deaths” are not exclusive scenarios.