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If you're 80 years old, you probably should not receive a subsidized hip replacement. If you can't afford it on your own, there should just be a palliative car

If you're 80 years old, you probably should not receive a subsidized hip replacement. If you can't afford it on your own, there should just be a palliative care mandate after some age. We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon. Or, we should pay doctors far less. I don't think they're multi-millionaires in other countries. Not all of them are in America, but many of them are.

analognoise 10mo ago
This is such a painfully American response. Nobody can ever imagine a better system, even if it’s used in literally every advanced nation in the world. Nope, instead we have to let Grandpa die painfully to keep those stock prices up. I’m starting to think Capitalism as it’s practiced here is a death cult of some kind.
- johnwheeler 10mo ago
  Well, I mentioned palliative care, but in general, I agree with you. I would much rather doctors just get paid less. I took my son to the ER. He had a very high fever. They gave him a child's aspirin and me a $700 bill. I just don't know what the answer is. And really, if you go into a hospital, you get the sense that there's people basically taking advantage of subsidized health insurance providers and patients both. Health insurance in America is absolutely atrocious. Next to gun fanatics, it's the worst thing about this country.
  - hermanzegerman 10mo ago
    Yes, because the doctor get the majority of that 700$ Bill. NOT Also the ER is always going to be the most expensive setting to get care. Why not take him to a pediatrician, if there are no warning signs that he needs immediate attention?
    - eitally 10mo ago
      Because the instruction from most pediatricians is to send kids with persistent (not responsive to acetaminophen and/or ice bath) fever above 104F to the ER, especially after hours. Very, very rarely will you find a pediatrician available outside an ER setting after hours.
      - johnwheeler 10mo ago
        Yes this is right
    - jrs235 10mo ago
      Most doctors are scheduled out for weeks. Best bet is an urgent care/walk in clinic. (Good luck if they have a pediatrician.)
    - HDThoreaun 10mo ago
      Doctors make up 11% of heathcare costs in the US. Their bloated salaries probably contribute about 5% to total costs. Its not insignificant.
- qcnguy 10mo ago
  The rest of the world mostly also uses subsidized private healthcare (except for the UK, where healthcare is far worse than in the US). The US system works well if you can pay the bills. It doesn't have the undercapacity issues the UK has, for example. The unique problem is costs. Controlling costs would mean consumers strongly supporting aggressive action by insurers if they take actions to push costs down. What Americans do is the opposite: they stage protests and demand immediate political retaliation on insurers who try to control costs. Then left wing politicians condemn the insurers, and they fold in the face of public pressure. Medical staff know the public acts this way and so bends insurers over the barrel, knowing people will blame the "capitalists" (who have tiny margins) over the frontline doctors and nurses who are actually taking the money. https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi... In other countries the public doesn't act this way and costs are more reasonable. Sometimes insurance premiums even fall. Switzerland has a two tier system with basic mandatory health insurance that's basically controlled by the government (private firms provide it but there are price controls and they can't refuse customers). And it has supplementary insurance for higher quality care that's almost free market. This year basic premiums went up 5% and supplemental premiums fell 0.9% https://www.bfs.admin.ch/bfs/de/home/aktuell/neue-veroeffentlichungen.assetdetail.36292138.html https://www.bfs.admin.ch/bfs/de/home/aktuell/neue-veroeffent... Cost control requires private sector discipline without people like Kathy Hochul getting involved, but healthcare even in the USA does not have that.
- vinyl7 10mo ago
  Something changed in the US in the last 15 or so years that caused our whole country to become a death cult. All I see in the economics is a bunch of looting and pillaging before the music stops
- HDThoreaun 10mo ago
  The better system that the rest of the world uses is letting grandpa have a bad hip. Absolutely insane that you take a huge part of what makes other systems cheaper and claim other systems would never do that and capitalism is to blame for everything bad.
KPGv2 10mo ago
> If you go to a hospital in the United States, it's a lot of old people getting expensive care. You think hospitals aren't full of old people getting care in other countries? And do you think it's possible that young people in the US don't go to the hospital because they can't afford to?
- johnwheeler 10mo ago
  I took that out because I didn't think it was relevant. And yes, that is my point. Young people can't afford insurance in America. It's terrible. I think the GLP-1s are going to make things better. A huge problem, as everybody knows in America, is obesity. That's also a major tax on the system.
TimorousBestie 10mo ago
> We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon. Easy enough for someone who thinks they have a “long time horizon” to say.
- mgh95 10mo ago
  What other choice is there? About 10% of all US healthcare spending is on end-of-life care [1]. It's not pleasant to talk about, but it is a discussion that needs to take place. [1] https://www.wrvo.org/health/2019-09-30/ten-percent-of-all-healthcare-spending-in-the-u-s-goes-toward-end-of-life-care https://www.wrvo.org/health/2019-09-30/ten-percent-of-all-he...
  - peterbecich 10mo ago
    Speaking only of the financial aspect, not any other ethical issues: Those end-of-life patients paid into the system, earlier in their lives, financing the cost of earlier generations of end-of-life patients. It would be unfair to change the social contract now. In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation. You may be able to alleviate this financial issue (and not any other ethical issues) by phasing-in this policy change with the youngest generation of Medicare taxpayers, somehow.
    - mgh95 10mo ago
      > Those end-of-life patients were paying into the system, earlier in their lives, financing of the cost of earlier generations of end-of-life patients. It would be unfair to change the social contract now. > In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation. This hits upon the core issue: the next generation is substantially smaller than the last and relative costs have ballooned due to greater availability of therapies. The generational contract is that you pay your taxes a percentage of wages -- in effect, a PAYG mechanism. If wages do not rise sufficiently to cover increased costs, that does not imply that the generational contract was unfulfilled; the taxes were paid. The demographic pyramid and weaker than necessary wage growth really renders the care demanded burdensome to the point where we have already provided elderly cost advantages in insurance in the form of cost premium multiple maximums and medicare from payroll taxes while beggaring the rest of the population in the process. > In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation. Fundamentally, children are an investment. They produce cash flow (taxes) from increased public health. The end-of-life are not; by definition, they will be dead soon. It's a horrible thing to say, but in the face of ever increasing elder care burdens and weak public debt/gdp ratios, what real choice is there?
jrjrjfhgggg 10mo ago
I think you need some empathy and life experience.
- johnwheeler 10mo ago
  [flagged]
  - shimman 10mo ago
    What is your plan? That it's dandy to deny access to medical care to people because you want to save money? Boy I hope you never need medical care in your life.
- ProfessorLayton 10mo ago
  It's worth pointing out that it's generally older people voting in other older people into power to deny younger people universal healthcare. (This isn't a free pass to younger people either, they don't vote as much as they should)
deleted 10mo ago
[deleted]
UncleMeat 10mo ago
The article does not list the people's ages. But we can be confident that they are not 80. They are on an ACA plan, whereas an 80-year-old would be on medicare. They are also photographed in the article and.... obviously are not 80. What does the medical expenses of 80-year-olds have to do with the situation described in the article?
- johnwheeler 10mo ago
  The subsidies are being given to the elderly in much greater proportion (free) and not the young
  - UncleMeat 10mo ago
    But what does this have to do with the ACA costs? Is this just "the government is spending on this other thing rather than this thing?"
    - johnwheeler 10mo ago
      The government subsidizes a portion of ACA payments depending on income in America. Without the subsidies, it's unaffordable for probably 95% of the population. That's why most people rely on employer-sponsored healthcare.
      - UncleMeat 10mo ago
        But what does this have to do with 80 year olds and end of life care?
Eddy_Viscosity2 10mo ago
> We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon. Perhaps we could just have a 'poor people incinerator' for those whose expected medical expenses exceed their net worth?
- salawat 10mo ago
  >Perhaps we could just have a 'poor people incinerator' for those whose expected medical expenses exceed their net worth? Thanks for putting that out there. Give it 10 years, and I'm thinking we'll see the first "bio-repurposing vats". Never mention crap like that on HN. Too many closet psychopaths looking for a big break. Understand the attempt at shaming. But there are likely a non-trivial number of readers here with such Methuselan inclinations.
- johnwheeler 10mo ago
  [flagged]
  - _DeadFred_ 10mo ago
    I mean you called to just let 80 year olds die. If they can't care for themselves, can't move around, and are left in constant pain, they end up just dieing. Then you gave the wisdom 'older people use more medical care than younger people'. Like yeah, that is how life/the universe works. My old car requires more maintenance then when it was new. But funny thing about young people, they too will one day be the old person.
    - johnwheeler 10mo ago
      No, I said palliative care. That's to ease suffering. So you're telling me we should forego cancer treatments for young cancer patients so 80-year-olds can get hip replacements? Is that what you think? Are you crazy? I never said just let people die. That's insane. It's about cost. In America, they don't just give healthcare for free, like wherever you probably live. I wish they did.
tim333 10mo ago
I don't agree about hips but if they let anyone competent become a doctor the supply would go up and the wages become more normal.
- johnwheeler 10mo ago
  Sure, that sounds fine. Something like that. Something, damn it.
silverquiet 10mo ago
The hip seems like such a bad example to me. First of all, who do you think needs hip replacements? It's not young people; surgeons don't even like to do them on young people (and to a joint replacement surgeon, "young" is under 60) since there's a good chance they'll outlive the joint itself. And it's a one-time cost for a surgery that increases an old person's independence vs an ongoing cost of palliative care (whatever that means) and having to provide more care for someone who has a potentially treatable disability. Hip replacement is considered "the surgery of the century" - the 20th century that is, because it is one of the most successful in terms of function and satisfaction provided to patients.

analognoise 10mo ago

This is such a painfully American response. Nobody can ever imagine a better system, even if it’s used in literally every advanced nation in the world. Nope, instead we have to let Grandpa die painfully to keep those stock prices up. I’m starting to think Capitalism as it’s practiced here is a death cult of some kind.

johnwheeler 10mo ago
Well, I mentioned palliative care, but in general, I agree with you. I would much rather doctors just get paid less. I took my son to the ER. He had a very high fever. They gave him a child's aspirin and me a $700 bill. I just don't know what the answer is. And really, if you go into a hospital, you get the sense that there's people basically taking advantage of subsidized health insurance providers and patients both. Health insurance in America is absolutely atrocious. Next to gun fanatics, it's the worst thing about this country.
- hermanzegerman 10mo ago
  Yes, because the doctor get the majority of that 700$ Bill. NOT Also the ER is always going to be the most expensive setting to get care. Why not take him to a pediatrician, if there are no warning signs that he needs immediate attention?
  - eitally 10mo ago
    Because the instruction from most pediatricians is to send kids with persistent (not responsive to acetaminophen and/or ice bath) fever above 104F to the ER, especially after hours. Very, very rarely will you find a pediatrician available outside an ER setting after hours.
    - johnwheeler 10mo ago
      Yes this is right
  - jrs235 10mo ago
    Most doctors are scheduled out for weeks. Best bet is an urgent care/walk in clinic. (Good luck if they have a pediatrician.)
  - HDThoreaun 10mo ago
    Doctors make up 11% of heathcare costs in the US. Their bloated salaries probably contribute about 5% to total costs. Its not insignificant.
qcnguy 10mo ago
The rest of the world mostly also uses subsidized private healthcare (except for the UK, where healthcare is far worse than in the US). The US system works well if you can pay the bills. It doesn't have the undercapacity issues the UK has, for example. The unique problem is costs. Controlling costs would mean consumers strongly supporting aggressive action by insurers if they take actions to push costs down. What Americans do is the opposite: they stage protests and demand immediate political retaliation on insurers who try to control costs. Then left wing politicians condemn the insurers, and they fold in the face of public pressure. Medical staff know the public acts this way and so bends insurers over the barrel, knowing people will blame the "capitalists" (who have tiny margins) over the frontline doctors and nurses who are actually taking the money. https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi... In other countries the public doesn't act this way and costs are more reasonable. Sometimes insurance premiums even fall. Switzerland has a two tier system with basic mandatory health insurance that's basically controlled by the government (private firms provide it but there are price controls and they can't refuse customers). And it has supplementary insurance for higher quality care that's almost free market. This year basic premiums went up 5% and supplemental premiums fell 0.9% https://www.bfs.admin.ch/bfs/de/home/aktuell/neue-veroeffentlichungen.assetdetail.36292138.html https://www.bfs.admin.ch/bfs/de/home/aktuell/neue-veroeffent... Cost control requires private sector discipline without people like Kathy Hochul getting involved, but healthcare even in the USA does not have that.
vinyl7 10mo ago
Something changed in the US in the last 15 or so years that caused our whole country to become a death cult. All I see in the economics is a bunch of looting and pillaging before the music stops
HDThoreaun 10mo ago
The better system that the rest of the world uses is letting grandpa have a bad hip. Absolutely insane that you take a huge part of what makes other systems cheaper and claim other systems would never do that and capitalism is to blame for everything bad.

KPGv2 10mo ago

> If you go to a hospital in the United States, it's a lot of old people getting expensive care. You think hospitals aren't full of old people getting care in other countries? And do you think it's possible that young people in the US don't go to the hospital because they can't afford to?

johnwheeler 10mo ago
I took that out because I didn't think it was relevant. And yes, that is my point. Young people can't afford insurance in America. It's terrible. I think the GLP-1s are going to make things better. A huge problem, as everybody knows in America, is obesity. That's also a major tax on the system.

TimorousBestie 10mo ago

> We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon. Easy enough for someone who thinks they have a “long time horizon” to say.

mgh95 10mo ago
What other choice is there? About 10% of all US healthcare spending is on end-of-life care [1]. It's not pleasant to talk about, but it is a discussion that needs to take place. [1] https://www.wrvo.org/health/2019-09-30/ten-percent-of-all-healthcare-spending-in-the-u-s-goes-toward-end-of-life-care https://www.wrvo.org/health/2019-09-30/ten-percent-of-all-he...
- peterbecich 10mo ago
  Speaking only of the financial aspect, not any other ethical issues: Those end-of-life patients paid into the system, earlier in their lives, financing the cost of earlier generations of end-of-life patients. It would be unfair to change the social contract now. In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation. You may be able to alleviate this financial issue (and not any other ethical issues) by phasing-in this policy change with the youngest generation of Medicare taxpayers, somehow.
  - mgh95 10mo ago
    > Those end-of-life patients were paying into the system, earlier in their lives, financing of the cost of earlier generations of end-of-life patients. It would be unfair to change the social contract now. > In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation. This hits upon the core issue: the next generation is substantially smaller than the last and relative costs have ballooned due to greater availability of therapies. The generational contract is that you pay your taxes a percentage of wages -- in effect, a PAYG mechanism. If wages do not rise sufficiently to cover increased costs, that does not imply that the generational contract was unfulfilled; the taxes were paid. The demographic pyramid and weaker than necessary wage growth really renders the care demanded burdensome to the point where we have already provided elderly cost advantages in insurance in the form of cost premium multiple maximums and medicare from payroll taxes while beggaring the rest of the population in the process. > In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation. Fundamentally, children are an investment. They produce cash flow (taxes) from increased public health. The end-of-life are not; by definition, they will be dead soon. It's a horrible thing to say, but in the face of ever increasing elder care burdens and weak public debt/gdp ratios, what real choice is there?

jrjrjfhgggg 10mo ago

I think you need some empathy and life experience.

johnwheeler 10mo ago
[flagged]
- shimman 10mo ago
  What is your plan? That it's dandy to deny access to medical care to people because you want to save money? Boy I hope you never need medical care in your life.
ProfessorLayton 10mo ago
It's worth pointing out that it's generally older people voting in other older people into power to deny younger people universal healthcare. (This isn't a free pass to younger people either, they don't vote as much as they should)

deleted 10mo ago

[deleted]

UncleMeat 10mo ago

The article does not list the people's ages. But we can be confident that they are not 80. They are on an ACA plan, whereas an 80-year-old would be on medicare. They are also photographed in the article and.... obviously are not 80. What does the medical expenses of 80-year-olds have to do with the situation described in the article?

johnwheeler 10mo ago
The subsidies are being given to the elderly in much greater proportion (free) and not the young
- UncleMeat 10mo ago
  But what does this have to do with the ACA costs? Is this just "the government is spending on this other thing rather than this thing?"
  - johnwheeler 10mo ago
    The government subsidizes a portion of ACA payments depending on income in America. Without the subsidies, it's unaffordable for probably 95% of the population. That's why most people rely on employer-sponsored healthcare.
    - UncleMeat 10mo ago
      But what does this have to do with 80 year olds and end of life care?

Eddy_Viscosity2 10mo ago

> We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon. Perhaps we could just have a 'poor people incinerator' for those whose expected medical expenses exceed their net worth?

salawat 10mo ago
>Perhaps we could just have a 'poor people incinerator' for those whose expected medical expenses exceed their net worth? Thanks for putting that out there. Give it 10 years, and I'm thinking we'll see the first "bio-repurposing vats". Never mention crap like that on HN. Too many closet psychopaths looking for a big break. Understand the attempt at shaming. But there are likely a non-trivial number of readers here with such Methuselan inclinations.
johnwheeler 10mo ago
[flagged]
- _DeadFred_ 10mo ago
  I mean you called to just let 80 year olds die. If they can't care for themselves, can't move around, and are left in constant pain, they end up just dieing. Then you gave the wisdom 'older people use more medical care than younger people'. Like yeah, that is how life/the universe works. My old car requires more maintenance then when it was new. But funny thing about young people, they too will one day be the old person.
  - johnwheeler 10mo ago
    No, I said palliative care. That's to ease suffering. So you're telling me we should forego cancer treatments for young cancer patients so 80-year-olds can get hip replacements? Is that what you think? Are you crazy? I never said just let people die. That's insane. It's about cost. In America, they don't just give healthcare for free, like wherever you probably live. I wish they did.

tim333 10mo ago

I don't agree about hips but if they let anyone competent become a doctor the supply would go up and the wages become more normal.

johnwheeler 10mo ago
Sure, that sounds fine. Something like that. Something, damn it.

silverquiet 10mo ago

The hip seems like such a bad example to me. First of all, who do you think needs hip replacements? It's not young people; surgeons don't even like to do them on young people (and to a joint replacement surgeon, "young" is under 60) since there's a good chance they'll outlive the joint itself. And it's a one-time cost for a surgery that increases an old person's independence vs an ongoing cost of palliative care (whatever that means) and having to provide more care for someone who has a potentially treatable disability. Hip replacement is considered "the surgery of the century" - the 20th century that is, because it is one of the most successful in terms of function and satisfaction provided to patients.