3 ms·

> but there will always be a desire to save people's lives even if the cost is very high. Also, Americans place extraordinarily high value on life. My wife's g

> but there will always be a desire to save people's lives even if the cost is very high. Also, Americans place extraordinarily high value on life. My wife's grandmother had cancer in her 60s and had a quarter of her lung removed. She then had a stroke in her late 80s. She was in rural Oregon, and they evacuated her via helicopter to Portland. They wanted to give her an aggressive treatment, but she refused, and passed away a couple of days later, having lived a full and complete life. She didn't have special health insurance or money saved up--she was a waitress before retiring, and had Medicare. I took my dad (who is also on Medicare) to the ER three times in the last couple of months. There was nothing serious--his blood pressure was rather high and he got scared. Here in exurban Maryland, the hospitals aren't that busy. He got a non-emergency CT scan/MRI (I forget which) scheduled within a day, and an outpatient procedure to insert a stent in a kidney artery within two weeks. When the surgeon got in there with some pre-surgery diagnostics, he realized the kidney artery was fine and didn't insert the stent. My parents were upper middle class, but there's no way they paid enough into Medicare to cover the amount of medical care they've used just since retiring (last 5 years or so).

actionfromafar 1y ago
+1 The whole system is setup to maximise the "care" whenever possible. IMHO it would be better with a universal healthcare that asked itself some tough questions. Start from a pile of money and calculate maximum impact backwards from there. But maybe that's impossible for the US. (It's satanic and/or communist or something.)
- rayiner 1y ago
  I like universal healthcare in principle, but I don't think the funding mechanism is the problem. We see the same cost inflation in the U.S. in sectors that everyone agrees should be publicly funded, like community colleges or transit. U.S. public spending on tertiary education is about 0.95% of GDP, which is higher than the U.K. (0.5%), Ireland (0.57%), Italy (0.62%), Australia (0.68%), and not that much lower than Germany (1.1%): https://www.oecd.org/en/data/indicators/public-spending-on-education.html https://www.oecd.org/en/data/indicators/public-spending-on-e.... Most of those countries have what Americans would call "free college," but we spend just as much as a percentage of GDP--and more in absolute terms--without college being free. Our colleges simply spend way more money than European colleges. I grew up in Virginia, where George Mason University (GMU) is the second tier public school (behind UVA, William & Mary, and JMU). It's got a budget of $1.4 billion for about 40,000 students. Compare that to Heidelberg University, which I understand is a renowned university in Germany. Excluding the medical school (which GMU doesn't have), the budget is about 629 million euros, or about $725 million, for about 30,000 students. GMU, which is not a world-famous university, spends almost twice as much money for only 1/3 more students.
  - actionfromafar 1y ago
    It's not the funding mechanism exactly, that matters I think. But that there's no single entity which looks at the whole pot of money and allocates according to best health for the population.
    - danielmarkbruce 1y ago
      The idea that some entity will make a good decision is almost certainly wrong.
      - actionfromafar 1y ago
        The idea that such a system will at least be less horrible has legs though. Gestures in the general direction of Europe
    - rayiner 1y ago
      Even single payer systems don’t have that. Conversely, the U.S. has huge cost inflation in education and transit as well, and those are centralized.
- danielmarkbruce 1y ago
  It's communist is the problem. Whose pile of money? If old Warren Buffett wants to spend a billion to extend his life by a year, who am I to stop him?
  - actionfromafar 1y ago
    It's not like someone would forbid Warren Buffet from doing so. The government already set up a system that is all but in name compulsory. So, let's take a pile of the same size as the current system uses, but let it go through a single arbiter, with combined purchase power.
    - danielmarkbruce 1y ago
      In some sense we have that - what is covered by medicare and the insurance companies is covered for the relevant people in those schemes.
    - rayiner 1y ago
      We have a system like that for student loans—where the federal government itself originates and owns 90% of student debt—and it has led to massive cost inflation. What makes you think we’d implement a healthcare system better?
      - actionfromafar 1y ago
        Yeah, maybe it's a lost cause. America is kinda special.
      - rangestransform 1y ago
        The federal government hasn't even lifted a finger to control undergrad education costs. In British Columbia, Canada where I'm from, the government sets limits on student loan coverage (seems to be CA$520/week right now) and universities don't get anything more from student loans. When my student loan disbursement occured, the form explicitly had $5000 of "unmet need" that I would need to scrounge up somehow. If a universal healthcare system really wanted to, it could keep costs under control in a similar manner by telling hospitals to accept X amount for Y procedure or get bent. That the government doesn't swing its big dick on colleges in the US is entirely the fault of the government and a populace that always votes for "candy for dinner" vs. "eating vegetables".
nozzlegear 1y ago
> My parents were upper middle class, but there's no way they paid enough into Medicare to cover the amount of medical care they've used just since retiring (last 5 years or so). It's a common misconception that the money we all pay into Medicare is going into a generational savings account, so we all need to "pull our weight" to make sure there's enough in there by the time we start withdrawing from it. Medicare is a pay-as-you-go system though – the money we pay into Medicare is being used by the people who are on Medicare right now, and when we're old enough to be using Medicare, it will be paid by the taxes of the young people who are working at that time. Your parents shouldn't feel guilty for using more of the Medicare resources than they feel they paid in. That money was used up years ago by people who needed it back then.
- danielmarkbruce 1y ago
  I don't think the post was about guilt. It was about math.
danielmarkbruce 1y ago
Agree. As a society we probably need to accept that saving someones life when they are 80 maybe isn't worth $5 million or whatever. We have to map back to person hours and realize that it just doesn't add up in many cases.
_DeadFred_ 1y ago
We were SPECIFICALLY told this system could do this, that unlike socialized healthcare, it doesn't have 'death panels' (I believe the term the politicians used).
- deleted 1y ago
  [deleted]

actionfromafar 1y ago

+1 The whole system is setup to maximise the "care" whenever possible. IMHO it would be better with a universal healthcare that asked itself some tough questions. Start from a pile of money and calculate maximum impact backwards from there. But maybe that's impossible for the US. (It's satanic and/or communist or something.)

rayiner 1y ago
I like universal healthcare in principle, but I don't think the funding mechanism is the problem. We see the same cost inflation in the U.S. in sectors that everyone agrees should be publicly funded, like community colleges or transit. U.S. public spending on tertiary education is about 0.95% of GDP, which is higher than the U.K. (0.5%), Ireland (0.57%), Italy (0.62%), Australia (0.68%), and not that much lower than Germany (1.1%): https://www.oecd.org/en/data/indicators/public-spending-on-education.html https://www.oecd.org/en/data/indicators/public-spending-on-e.... Most of those countries have what Americans would call "free college," but we spend just as much as a percentage of GDP--and more in absolute terms--without college being free. Our colleges simply spend way more money than European colleges. I grew up in Virginia, where George Mason University (GMU) is the second tier public school (behind UVA, William & Mary, and JMU). It's got a budget of $1.4 billion for about 40,000 students. Compare that to Heidelberg University, which I understand is a renowned university in Germany. Excluding the medical school (which GMU doesn't have), the budget is about 629 million euros, or about $725 million, for about 30,000 students. GMU, which is not a world-famous university, spends almost twice as much money for only 1/3 more students.
- actionfromafar 1y ago
  It's not the funding mechanism exactly, that matters I think. But that there's no single entity which looks at the whole pot of money and allocates according to best health for the population.
  - danielmarkbruce 1y ago
    The idea that some entity will make a good decision is almost certainly wrong.
    - actionfromafar 1y ago
      The idea that such a system will at least be less horrible has legs though. Gestures in the general direction of Europe
  - rayiner 1y ago
    Even single payer systems don’t have that. Conversely, the U.S. has huge cost inflation in education and transit as well, and those are centralized.
danielmarkbruce 1y ago
It's communist is the problem. Whose pile of money? If old Warren Buffett wants to spend a billion to extend his life by a year, who am I to stop him?
- actionfromafar 1y ago
  It's not like someone would forbid Warren Buffet from doing so. The government already set up a system that is all but in name compulsory. So, let's take a pile of the same size as the current system uses, but let it go through a single arbiter, with combined purchase power.
  - danielmarkbruce 1y ago
    In some sense we have that - what is covered by medicare and the insurance companies is covered for the relevant people in those schemes.
  - rayiner 1y ago
    We have a system like that for student loans—where the federal government itself originates and owns 90% of student debt—and it has led to massive cost inflation. What makes you think we’d implement a healthcare system better?
    - actionfromafar 1y ago
      Yeah, maybe it's a lost cause. America is kinda special.
    - rangestransform 1y ago
      The federal government hasn't even lifted a finger to control undergrad education costs. In British Columbia, Canada where I'm from, the government sets limits on student loan coverage (seems to be CA$520/week right now) and universities don't get anything more from student loans. When my student loan disbursement occured, the form explicitly had $5000 of "unmet need" that I would need to scrounge up somehow. If a universal healthcare system really wanted to, it could keep costs under control in a similar manner by telling hospitals to accept X amount for Y procedure or get bent. That the government doesn't swing its big dick on colleges in the US is entirely the fault of the government and a populace that always votes for "candy for dinner" vs. "eating vegetables".

nozzlegear 1y ago

> My parents were upper middle class, but there's no way they paid enough into Medicare to cover the amount of medical care they've used just since retiring (last 5 years or so). It's a common misconception that the money we all pay into Medicare is going into a generational savings account, so we all need to "pull our weight" to make sure there's enough in there by the time we start withdrawing from it. Medicare is a pay-as-you-go system though – the money we pay into Medicare is being used by the people who are on Medicare right now, and when we're old enough to be using Medicare, it will be paid by the taxes of the young people who are working at that time. Your parents shouldn't feel guilty for using more of the Medicare resources than they feel they paid in. That money was used up years ago by people who needed it back then.

danielmarkbruce 1y ago
I don't think the post was about guilt. It was about math.

danielmarkbruce 1y ago

Agree. As a society we probably need to accept that saving someones life when they are 80 maybe isn't worth $5 million or whatever. We have to map back to person hours and realize that it just doesn't add up in many cases.

_DeadFred_ 1y ago

We were SPECIFICALLY told this system could do this, that unlike socialized healthcare, it doesn't have 'death panels' (I believe the term the politicians used).

deleted 1y ago
[deleted]