Why do we need to repeal the ACA at all costs?

[sokoloff]

As for the orphan with the broken leg, I'm sure it would be preferable if she had been terminated in utero; quality of life and all that.

Wait. What the F?!

I have two beautiful and typically healthy kids. If my wife and I are killed in a traffic accident and then one of my kids breaks a limb, the best medical solution would be a time machine that would abort them in utero?

Did I miss a sarcasm tag somewhere along the way?!

[GuitarStv]

I think the difficulty is drawing the line of 'easily treatable.'  Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts.  Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.

There's a line somewhere, perhaps; hard to draw it though.

In response to your question about line drawing, I suspect that a reasonable case can be made for not covering experimental/unproven treatments.  A reasonable case can be made to not cover treatments with survival percentages below 95%.  If we grant the elderly the right to choose to die painlessly and with dignity, then I suspect that an awful lot of tough decisions would be taken off of the table to begin with.

It is difficult to draw that line.  Since when has 'difficult' meant that we should just give up entirely?

[NoStacheOhio]

I think the difficulty is drawing the line of 'easily treatable.'  Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts.  Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.

The difference between the first two and the last one is that the last one is part of a clinical trial. Research is a completely different ballgame than welfare, and we're doing ourselves a disservice if we only allow people with money into clinical trials.

[Metric Mouse]

I think the difficulty is drawing the line of 'easily treatable.'  Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts.  Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.

There's a line somewhere, perhaps; hard to draw it though.

In response to your question about line drawing, I suspect that a reasonable case can be made for not covering experimental/unproven treatments.  A reasonable case can be made to not cover treatments with survival percentages below 95%.  If we grant the elderly the right to choose to die painlessly and with dignity, then I suspect that an awful lot of tough decisions would be taken off of the table to begin with.

It is difficult to draw that line.  Since when has 'difficult' meant that we should just give up entirely?

This is an interesting suggestion. So cancer treatment, for example. If the survivability rating for cancer X is less than 5% (or 10%? Maybe?)  then do we give zero treatment? (Other than palliative care) Even if the treatment, while not curing the cancer, would allow the patient to survive for two or three years as opposed to 6 months untreated? What about something like HIV - no cure, is almost certainly going to kill the infected; what level of care should be provided for diseases of this nature?

[GuitarStv]

I think the difficulty is drawing the line of 'easily treatable.'  Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts.  Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.

There's a line somewhere, perhaps; hard to draw it though.

In response to your question about line drawing, I suspect that a reasonable case can be made for not covering experimental/unproven treatments.  A reasonable case can be made to not cover treatments with survival percentages below 95%.  If we grant the elderly the right to choose to die painlessly and with dignity, then I suspect that an awful lot of tough decisions would be taken off of the table to begin with.

It is difficult to draw that line.  Since when has 'difficult' meant that we should just give up entirely?

This is an interesting suggestion. So cancer treatment, for example. If the survivability rating for cancer X is less than 5% (or 10%? Maybe?)  then do we give zero treatment? (Other than palliative care) Even if the treatment, while not curing the cancer, would allow the patient to survive for two or three years as opposed to 6 months untreated? What about something like HIV - no cure, is almost certainly going to kill the infected; what level of care should be provided for diseases of this nature?

In my ideal world, everyone would get free treatment for everything.  That said . . . we have budgets and cost limitations in reality that must be accounted for.

If survival rate is below a particular cut-off, or if survival is known to be for an extremely limited time then it would make sense not to pay for treatment.  Note, I'm not saying that zero treatment should be available . . . just that it wouldn't be subsidized.  While it's not an ideal situation, this would seem to be a reasonable solution to keep medical care prices in check.

Diseases where a treatment exists which can reasonably be expected to extend (decent quality of) life for a long time should be covered though.

[NoStacheOhio]

I think the difficulty is drawing the line of 'easily treatable.'  Heroin overdose? Here's $.50 worth of naloxone, go away. Anaphylaxis? Here's $10 worth of epinephrine, stay away from peanuts.  Aggressive brain tumor? Here's $100,000 of experimental medication. I mean, why not, it could work.

There's a line somewhere, perhaps; hard to draw it though.

In response to your question about line drawing, I suspect that a reasonable case can be made for not covering experimental/unproven treatments.  A reasonable case can be made to not cover treatments with survival percentages below 95%.  If we grant the elderly the right to choose to die painlessly and with dignity, then I suspect that an awful lot of tough decisions would be taken off of the table to begin with.

It is difficult to draw that line.  Since when has 'difficult' meant that we should just give up entirely?

This is an interesting suggestion. So cancer treatment, for example. If the survivability rating for cancer X is less than 5% (or 10%? Maybe?)  then do we give zero treatment? (Other than palliative care) Even if the treatment, while not curing the cancer, would allow the patient to survive for two or three years as opposed to 6 months untreated? What about something like HIV - no cure, is almost certainly going to kill the infected; what level of care should be provided for diseases of this nature?

We counsel patients about the realities of what they're facing, and all of their options, and those options' likely outcomes. But there isn't an ICD-10 code for that, so we don't do it.

The data supports end-of-life counseling and good palliative care. Where it's been studied, there's basically no downside. People end up living longer with less pain, and costing less money. They don't end up dying after a week in the ICU. Sometimes people even get better. It doesn't necessarily mean no disease treatment at all, either.

It isn't death panels. It's real conversations between providers, patients and their families about what they want, and what they should expect.

[nereo]

As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.

Mostly these treatments are designed to prolong life by a few days or weeks, and often the drugs merely counteract the worst symptoms of the disease. If the patient lives longer it isn't because of the treatment, but because of the patient himself.

We are afraid of dying and will cling to any hope, regardless of how faint or expensive or invasive it might be.

[Ben Hogan]

Anything that takes money from someone and gives it to another is morally wrong. Just that simple in my book.

Is it also morally wrong for a doctor to look someone in the eye and say "You are going to die because you don't have enough money to pay me to make you better"?

Or is that morally acceptable, but insurance isn't?

Do you also think social security is immoral?

I think that is acceptable. You dont have a right to live at all costs.

[GuitarStv]

I'm embarrassed to be part of a groupmwith some of the posters in this thread that suggest the richest country in the world should punatively deny care to the poor, helpless and children because the taxes might slighly inhibit their average consumption levels (like a new car every 5 years unstead of 3).

Since when did christians conservatives  buy into this ideology of becoming general haters.  I used to like these guys, now i feel they are mindless repeaters of fox news propaganda. Probably going to stop posting in any social thread.

Bye all.

Jesus was radically right wing and money-grubbing.  Look at all these examples:

"It is easier for a camel to pass through the eye of a needle than for a rich man to enter the kingdom of heaven."

"woe unto ye who are rich"

"blessed are the meek"

"blessed are the peacemakers"

"Blessed are the merciful"

"If you want to be perfect, go, sell your possessions and give to the poor, and you will have treasure in heaven."

"And if any man will sue thee, and take away thy cloak, let him have thy coat also.  And whosoever shall compel thee to go a mile, go with him twain. Give to him that asketh thee, and from him that would borrow of thee turn not thou away"

“No one can serve two masters, either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve both God and Money.”


And let's not forget all the free health care that he gave the poor, the lepers, and the prostitutes . . .

[Roland of Gilead]

As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.

Actually the HepC cure is pretty much exactly what you describe above.  Death sentence to cure in about 8 weeks with 1 pill a day.

And remember the movie "Dying Young".  Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee.  Not so anymore.

But yeah, those drug companies sure are evil.

[nereo]

As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.

Actually the HepC cure is pretty much exactly what you describe above.  Death sentence to cure in about 8 weeks with 1 pill a day.

And remember the movie "Dying Young".  Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee.  Not so anymore.

But yeah, those drug companies sure are evil.

Not at all what I was talking about.  HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.

[Roland of Gilead]

As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.

Actually the HepC cure is pretty much exactly what you describe above.  Death sentence to cure in about 8 weeks with 1 pill a day.

And remember the movie "Dying Young".  Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee.  Not so anymore.

But yeah, those drug companies sure are evil.

Not at all what I was talking about.  HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.

But at some point those are probably going to work too.  It is kind of like solar and electric cars.  You can't really just say "lets not invest and experiment until the payoff is really good".  If we had that thinking, solar cells would still be $5 a watt and only 12% efficient.

So yes, a drug that only reduces your cancer tumor by 20% in volume for 8 months doesn't sound really great but eventually there is hope for a true cure.  It is probably not going to happen without the crappy treatment progression.

[Ben Hogan]

I'm embarrassed to be part of a groupmwith some of the posters in this thread that suggest the richest country in the world should punatively deny care to the poor, helpless and children because the taxes might slighly inhibit their average consumption levels (like a new car every 5 years unstead of 3).

Since when did christians conservatives  buy into this ideology of becoming general haters.  I used to like these guys, now i feel they are mindless repeaters of fox news propaganda. Probably going to stop posting in any social thread.

Bye all.

One main important thing to understand about online forums is that you must be mature enough to handle all topics and all responses. This is how things gets improved, is by an open minded understanding of all sides. Denial is what got us to where this country is at right now.

[nereo]

As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.

Actually the HepC cure is pretty much exactly what you describe above.  Death sentence to cure in about 8 weeks with 1 pill a day.

And remember the movie "Dying Young".  Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee.  Not so anymore.

But yeah, those drug companies sure are evil.

Not at all what I was talking about.  HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.

But at some point those are probably going to work too.  It is kind of like solar and electric cars.  You can't really just say "lets not invest and experiment until the payoff is really good".  If we had that thinking, solar cells would still be $5 a watt and only 12% efficient.

So yes, a drug that only reduces your cancer tumor by 20% in volume for 8 months doesn't sound really great but eventually there is hope for a true cure.  It is probably not going to happen without the crappy treatment progression.

I'm not saying that at all. Designing better treatment therapies is exactly what clinical trials are for.
I believe where we are running off the rails is the idea that because a treatment is for some patients in some circumstances that it is good for all patients in all circumstances.  building on your example: treating cancer with invasive surgery - it might make sense to attempt in healthy 30 year old patients, but not for a frail 82 year old.

[NoStacheOhio]

As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.

Actually the HepC cure is pretty much exactly what you describe above.  Death sentence to cure in about 8 weeks with 1 pill a day.

And remember the movie "Dying Young".  Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee.  Not so anymore.

But yeah, those drug companies sure are evil.

Not at all what I was talking about.  HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.

But at some point those are probably going to work too.  It is kind of like solar and electric cars.  You can't really just say "lets not invest and experiment until the payoff is really good".  If we had that thinking, solar cells would still be $5 a watt and only 12% efficient.

So yes, a drug that only reduces your cancer tumor by 20% in volume for 8 months doesn't sound really great but eventually there is hope for a true cure.  It is probably not going to happen without the crappy treatment progression.

More importantly, those trials are generally funded with research money allocated for that specific thing. People higher up the food chain have decided that it's research worth doing for either humanitarian or (more likely) commercial reasons. At that point, you want as many people in the trial as you can get because more data is better.

[Metric Mouse]

If the ACA is repealed and not replaced, it is estimated that 45,000 people more will die every year.  I'm willing to deal with the cost of providing health insurance if less people die.

Source?

I think many poeple are willing to "deal with the cost of insurance." The point is that there is a more efficient way than universal insurance.

[mm1970]

As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.

Actually the HepC cure is pretty much exactly what you describe above.  Death sentence to cure in about 8 weeks with 1 pill a day.

And remember the movie "Dying Young".  Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee.  Not so anymore.

But yeah, those drug companies sure are evil.

Not at all what I was talking about.  HepC is an approved treatment with a very good track record, as are treatments to manage HIV/AIDS.
I'm talking about the more invasive, last ditch attempts that many wil undergo even when doctors tell their patients it has a very small chance of working, carries significant risks and probably won't return the patient to a basic level of quality of life.

But at some point those are probably going to work too.  It is kind of like solar and electric cars.  You can't really just say "lets not invest and experiment until the payoff is really good".  If we had that thinking, solar cells would still be $5 a watt and only 12% efficient.

So yes, a drug that only reduces your cancer tumor by 20% in volume for 8 months doesn't sound really great but eventually there is hope for a true cure.  It is probably not going to happen without the crappy treatment progression.

I'm not saying that at all. Designing better treatment therapies is exactly what clinical trials are for.
I believe where we are running off the rails is the idea that because a treatment is for some patients in some circumstances that it is good for all patients in all circumstances.  building on your example: treating cancer with invasive surgery - it might make sense to attempt in healthy 30 year old patients, but not for a frail 82 year old.

This is an interesting topic.

My husband's grandmother had cancer when she was in her late 60's.  Went through treatment, recovered.

It came back when she was in her 90s.  Do they treat it again, or make her comfortable?  FIL opted to make her comfortable, but it was a tough choice.  I think he regretted it because she lived THREE YEARS (until age 96 I think), and was in increasing amounts of pain and discomfort.

Another anecdote.  My dad has an aneurysm in his aorta burst when he was 2 months shy of 82.  The  doctor told my sis that a younger man would have a 50% chance of surviving the surgery, but not him, not likely.  They did the surgery anyway.  He died.  I wonder how much the state / medicare paid for that?  I mean, he died on the table. 

[mm1970]

If the ACA is repealed and not replaced, it is estimated that 45,000 people more will die every year.  I'm willing to deal with the cost of providing health insurance if less people die.

Source?

I think many poeple are willing to "deal with the cost of insurance." The point is that there is a more efficient way than universal insurance.

How do you define efficiency?  If you define efficiency as cost per person, than there should be no health insurance and we let God sort it out.  If you define efficiency in terms of maximizing lives saved, universal insurance makes more sense, unless you are arguing that single payer with no insurance is a better system.

good point.  We deal with this in manufacturing also.  There's ebb and flow and, for example, 30 different pieces of equipment, and 20 lots that have to go through 280 steps each.

If you use good manufacturing practices for flow, everything moves at a reasonable pace.  If you decide that this *one* lot is uber important and has to get out faster, everything else has to wait and it slows down - but far more than you'd expect.  It basically screws up the entire fab if there's too much focus on one individual.

The health care/ insurance thing is similar.  If you just let things "run" and use best practices - yeah, everyone gets decent care.  You have to stop and take time out to fix things that are broken, recover things that had a problem, and sometimes - you lose them.  But everything moves along - nothing is a rock star.

Unfortunately we have individuals.  And each individual is often looking out for themselves.  What might be "efficient" won't necessarily be best for THEM.

[waltworks]

It's funny, the efficiency thing has already been extensively debated and it's not actually a very hard thing to figure out - you just use "QALY" analysis - read up all about it here: https://en.wikipedia.org/wiki/Quality-adjusted_life_year

You can bicker about exactly how to define the variables, but it's going to produce similar results: you will spend most of your resources treating young people and doing cheap preventative work. You will spend very little on, say, hip replacements for 85 year olds.

Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.

-W

[GuitarStv]

You can bicker about exactly how to define the variables, but it's going to produce similar results: you will spend most of your resources treating young people and doing cheap preventative work. You will spend very little on, say, hip replacements for 85 year olds.

Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.

Maybe the Republicans will combine their love of firearms with their public health policy . . . say, open hunting season on all people over the age of 65?  It should increase sales of guns (guns = freedom) and reduce those expensive over 65 year old freeloaders.

[waltworks]

Good point.  I would assume that Obamacare with it's emphasis on free preventative services would rate well.  Not sure what the republican plan is for preventative services.

Medicare is like social security in that the people who use it also paid into it their whole life, so it's hard to complain about that.

I'm a bit surprised the idea of replacing the ACA/Obamacare with a free preventative and catastrophic sort of thing hasn't been floated. It would be (relatively) cheap and it would do most of the most important stuff that people aren't good at doing when left to their own devices.

Folks with chronic conditions would be sort of screwed, but my assumption is that they will be anyway going forward. Good preventative care starting in infancy would hopefully prevent some of those 30 years down the road.

-W

[sol]

Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.

People tend to forget that Medicare was created for the benefit of the private insurance industry.  It's a subsidy to for-profit insurance corporations, because it nationalizes their least profitable risk pool.

The whole point of Medicare is to get those people off of the private insurance plans before they start to get expensive.  Private insurers then get to charge premiums to only younger people, who use less healthcare.  Without Medicare, we would all pay higher insurance rates because our plans would have to cover all of that end of life care that is currently insured by the government instead.

Medicaid is the same deal.  Poor people can't afford to pay private insurance rates, so they drop out of the potential customer pool for private insurers.  Private insurers hate this, not only because they lose paying customers (until the ACA came along) but because they know they will later inherit people with expensive conditions that could have been treated cheaply, when those folks eventually grow up and get better jobs and do because customers.  So Medicaid covers that care, to make rates on the private market lower for the rest of us.

Together, this leaves only the wealthy (above Medicaid cutoff) young (below Medicare cutoff) people looking for private insurance, which is the private insurance industry's wet dream.  This is exactly the population they want to insure to maximize profits.

Which is exactly why universal coverage single payer healthcare is more cost effective than the current system.  The government already insures the worst populations, while letting the private insurance market profit off of the healthy folks.  If they just lumped everyone into the existing Medicaid/Medicare risk pool, rates would go down for everyone.

[Roland of Gilead]

Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.

-W

Actually you would spend the least on young children.  Why spend thousands or millions on kids who are not going to live long enough to be productive members of society?  A 24 year old doctor in residency who has a treatable form of cancer is a much better investment than a 2 year old who we have not spent a lot of society resources on yet.

I mean this is super cruel, but just an addition to what you posted.

[waltworks]

Medicare being available only to those over 65 basically does the opposite, of course. If you wanted an efficient outcome for public healthcare spending, you'd put most of your resources into children and young adults and very little into caring for the elderly.

-W

Actually you would spend the least on young children.  Why spend thousands or millions on kids who are not going to live long enough to be productive members of society?  A 24 year old doctor in residency who has a treatable form of cancer is a much better investment than a 2 year old who we have not spent a lot of society resources on yet.

I mean this is super cruel, but just an addition to what you posted.

Perhaps you misunderstood. The number of potential years of life you get out of a treatment is the biggest variable. So even very expensive treatments for a young child would be "efficient". Generally there's not an IQ test or something like that, every life-year is treated as equally valuable.

-W

[Burghardt]

I've seen this brought up a few times, including the requests for a topic of its own to discuss.  I certainly feel the ACA is not the best it can be and needs changes, but there are provisions that are extremely valuable, in my opinion, such as pre-existing conditions, removal of cap limits and lengthened insurance eligibility for children.  I am curious to see what the discussion will reveal.

Your healthcare system is inherently flawed, beginning with the exact same medication and healthcare services having wild and unjustifiable fluctuations in price at one and the same place instead of working like regular business.
ACA in many ways protects the monopolistic entities in their exploitation of those in need.

[Roland of Gilead]

Perhaps you misunderstood. The number of potential years of life you get out of a treatment is the biggest variable. So even very expensive treatments for a young child would be "efficient". Generally there's not an IQ test or something like that, every life-year is treated as equally valuable.

-W

No, think about it.   Imagine a drug that would prolong someone's life by 20 years.

Society would benefit a lot more from administering that drug to a 20 year old than a 2 year old.   The 2 year old is barely going to be useful by the time they die.

[Metric Mouse]

If the ACA is repealed and not replaced, it is estimated that 45,000 people more will die every year.  I'm willing to deal with the cost of providing health insurance if less people die.

Source?

I think many poeple are willing to "deal with the cost of insurance." The point is that there is a more efficient way than universal insurance.

How do you define efficiency?  If you define efficiency as cost per person, than there should be no health insurance and we let God sort it out.  If you define efficiency in terms of maximizing lives saved, universal insurance makes more sense, unless you are arguing that single payer with no insurance is a better system.

Terrible source, btw.

But yes, efficiency (under the definition I was using) would # lives saved/cost. Going for one or the other side of the equation is a poor way to use resources that could otherwise be allocated to helping others.  Getting rid of insurance would be the most logical step towards this goal.

[Metric Mouse]

Perhaps you misunderstood. The number of potential years of life you get out of a treatment is the biggest variable. So even very expensive treatments for a young child would be "efficient". Generally there's not an IQ test or something like that, every life-year is treated as equally valuable.

-W

No, think about it.   Imagine a drug that would prolong someone's life by 20 years.

Society would benefit a lot more from administering that drug to a 20 year old than a 2 year old.   The 2 year old is barely going to be useful by the time they die.

It'd be even better to use on a 40 year old - more taxes to be collected from their higher earning years.

But what about the scenario of say, a heart transplant. This would not increase life a static number of years, but allow the person to live through their natural lifespan. In this instance it would make more sense to use the money and resources on a 2 year old as the added years of life for the 20 year old has less usefulness to society than the added years of life for the 2 year old.

[Roland of Gilead]

In this instance it would make more sense to use the money and resources on a 2 year old as the added years of life for the 20 year old has less usefulness to society than the added years of life for the 2 year old.

How so?  The 2 year old still has to go through pre-school, elementary school, high school, and college, just to get to the point where he/she can start producing instead of consuming.   The 20 year old is already at or near the producing stage of life. 

You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.

[waltworks]

Roland, go read the link. A year of functional life = value of 1. If you are 2 years old, and you have a treatable condition, you can get 75 years of life out of treating that condition. If you are 25, you can only get 52.

-W

[sol]

You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.

I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year.  A five year old's next year is equally valuable to 100 year old's next year.

[waltworks]

You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.

I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year.  A five year old's next year is equally valuable to 100 year old's next year.

Exactly. This is a eudaemonic efficiency calculation.

-W

[Metric Mouse]

You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.

I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year.  A five year old's next year is equally valuable to 100 year old's next year.

Yes. Of course the argument can be made that person A is worth more per year than person B, as Roland points out - these would be conversations that would need to be had if extremely expensive, low success rate care was to be rationed.

[marty998]

You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.

I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year.  A five year old's next year is equally valuable to 100 year old's next year.

Yes. Of course the argument can be made that person A is worth more per year than person B, as Roland points out - these would be conversations that would need to be had if extremely expensive, low success rate care was to be rationed.

The argument above assumed the 24 year old was adoctor in residency. Hardly typical of the average member of the population.

Roland - perhaps if the 24 year old was one of Romney's 47% who don't pay any net tax contributions your argument might be different? :D

My view is there is enough money floating around to save both the 2 year old and the 24 year old in need. There is not currently enough money to give every 80+ year old a replacement heart or lungs or kidney etc etc and at some point (as discussed earlier up this thread), doctors and patients need to have appropriate respectful conversations about end of life care.

However if a (democratically elected) government decides it is important to keep prolonging life indefinitely, it needs to be accepted that the electors of said government are going to have to pay for it one way or another.

If Republican policy is "pro-life", then I would expect to see a Republican government raise sufficient taxes to pay to keep people alive. If only the wealthy can afford expensive care without bankrupting themselves, then I think anyone who espouses pro-life views is being facetious.

[Metric Mouse]

You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.

I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year.  A five year old's next year is equally valuable to 100 year old's next year.

Yes. Of course the argument can be made that person A is worth more per year than person B, as Roland points out - these would be conversations that would need to be had if extremely expensive, low success rate care was to be rationed.

The argument above assumed the 24 year old was adoctor in residency. Hardly typical of the average member of the population.

Roland - perhaps if the 24 year old was one of Romney's 47% who don't pay any net tax contributions your argument might be different? :D

My view is there is enough money floating around to save both the 2 year old and the 24 year old in need. There is not currently enough money to give every 80+ year old a replacement heart or lungs or kidney etc etc and at some point (as discussed earlier up this thread), doctors and patients need to have appropriate respectful conversations about end of life care.

However if a (democratically elected) government decides it is important to keep prolonging life indefinitely, it needs to be accepted that the electors of said government are going to have to pay for it one way or another.

If Republican policy is "pro-life", then I would expect to see a Republican government raise sufficient taxes to pay to keep people alive. If only the wealthy can afford expensive care without bankrupting themselves, then I think anyone who espouses pro-life views is being facetious.

Where would you suggest we draw the line? (If I may ask.)  Is there enough money to save everyone under 45 years old? 55 Years old? 65 years old?

And back to the other scenario - is say 5 years of life-extending treatments worth the price for a 2 year old? And an 85 year old? Or should life-extending treatments be self-funded, and only life-saving treatments be covered by insurance/health care coverage?

I'm pretty torn on where to draw the line on many of these topics.

[former player]

is say 5 years of life-extending treatments worth the price for a 2 year old? And an 85 year old? Or should life-extending treatments be self-funded, and only life-saving treatments be covered by insurance/health care coverage?

I'm pretty torn on where to draw the line on many of these topics.

The NHS goes pretty big on the life-saving treatments, at least until other reasons for limiting treatment kick in, such as extreme old age.  Life-extending treatments for children are also almost never limited for financial reasons: this is probably as much for the parents and rest of the family as for the child being treated.  Organ transplants are rationed for reasons that include old age, but that is because of availability not cost.

The big cost arguments in the NHS seem to be mostly about expensive new cancer drugs that can prolong life for a few weeks or months without offering a cure: on a national basis, spending hundreds of thousands of pounds for one person to live a few more months prevents that money from being spent on more cost-effective life-saving or disability-saving treatments.  Even then, the NHS will continue care and administer the drugs if the individual can raise the money to pay for them.

[marty998]

You are saying a fresh plot of ground has more value than the plot where a energy efficient four bedroom house has been built.

I think that the discrepancy here is that the referenced formula values a year of life as a year of life, regardless of the economic productivity of that year.  A five year old's next year is equally valuable to 100 year old's next year.

Yes. Of course the argument can be made that person A is worth more per year than person B, as Roland points out - these would be conversations that would need to be had if extremely expensive, low success rate care was to be rationed.

The argument above assumed the 24 year old was adoctor in residency. Hardly typical of the average member of the population.

Roland - perhaps if the 24 year old was one of Romney's 47% who don't pay any net tax contributions your argument might be different? :D

My view is there is enough money floating around to save both the 2 year old and the 24 year old in need. There is not currently enough money to give every 80+ year old a replacement heart or lungs or kidney etc etc and at some point (as discussed earlier up this thread), doctors and patients need to have appropriate respectful conversations about end of life care.

However if a (democratically elected) government decides it is important to keep prolonging life indefinitely, it needs to be accepted that the electors of said government are going to have to pay for it one way or another.

If Republican policy is "pro-life", then I would expect to see a Republican government raise sufficient taxes to pay to keep people alive. If only the wealthy can afford expensive care without bankrupting themselves, then I think anyone who espouses pro-life views is being facetious.

Where would you suggest we draw the line? (If I may ask.)  Is there enough money to save everyone under 45 years old? 55 Years old? 65 years old?

And back to the other scenario - is say 5 years of life-extending treatments worth the price for a 2 year old? And an 85 year old? Or should life-extending treatments be self-funded, and only life-saving treatments be covered by insurance/health care coverage?

I'm pretty torn on where to draw the line on many of these topics.

Why do you have to draw the line? I don't have to. We have healthcare professionals and government officials who are trained to make that decision. I may lean towards moving the line, but I don't have all the facts on every situation. Situations which are all unique to the individual. I may not agree with all of it, but I believe our doctors are trained to recognise the difference between assisting a patient and needlessly prolonging terminal illness.

I have never been personally affected by this dilemma, so for now, my answer is that I would leave that to be a conversation between doctor and patient. My country believes treatment should be available to those who need it, and then the choice can be made by the patient and family. Sure we all pay for it here, but our spending on health is much lower than yours on a per capita basis. My health insurance costs a little more than a thousand bucks a year, and taxes are not overly burdensome. Small price to pay IMO.

I am merely pointing out to all and sundry the hypocrisy of the Right in holding pro-life viewpoints and simultaneously calling for rationing of healthcare to only those who can afford it. You can't believe in saving some lives and not others, if you believe all life is sacred.

One life is not worth more than another, and you as the armchair critic certainly don't get to decide it.

[sokoloff]

I have never been personally affected by this dilemma, so for now, my answer is that I would leave that to be a conversation between doctor and patient. My country believes treatment should be available to those who need it, and then the choice can be made by the patient and family. Sure we all pay for it here, but our spending on health is much lower than yours on a per capita basis. My health insurance costs a little more than a thousand bucks a year, and taxes are not overly burdensome. Small price to pay IMO.

I mostly agree that the choices should be discussed and largely decided at the doctor/patient level, but that brings in a massive principal agent problem, where the patient is incented to work in his/her own best interests (seems reasonable), but the doctor has an agency problem. Certain choices bring them more vs less money (or interest, or scientific/medical learning, or challenge). I don't think it's generally a large enough issue to warrant making this unusual, but if you ask your barber if you need a haircut, your suit-maker if you need a new suit, or your baker if you should buy a cake for your kid's birthday, you can't really expect an unbiased answer.

One life is not worth more than another, and you as the armchair critic certainly don't get to decide it.

That is your opinion, perhaps, but as a society, we certainly act in ways contrary to that position. Some treatments are restricted by age, others rationed by other medical condition, we have literally thousands of people working full-time to keep POTUS alive.

I would rather a heart transplant go to a 25-year old than a 60-year old or to a(n otherwise) healthy 60-year old than a sickly 60-year old. That might have the unfortunate consequence of giving more transplants to rich people than poor people (as rich people are more likely to be healthy at 60 than poor people) or might have the opposite bias (that poor people might be more likely to need a heart transplant due to life circumstances).

Healthcare procedures and funds will never be unlimited. How can those that are societally-paid be spent to greatest societal good is always going to be a question IMO.

[Luke Warm]

why don't we give every person on the day they are born a set amount of money to be used for the rest of their lives for their health care? if you're a sickly kid, you blow through the money early. if you stay healthy you get to use the money to prolong your life as you see fit.

[GuitarStv]

why don't we give every person on the day they are born a set amount of money to be used for the rest of their lives for their health care? if you're a sickly kid, you blow through the money early. if you stay healthy you get to use the money to prolong your life as you see fit.

Because that's patently unfair?

Some people will need an awful lot more health care than others, through no fault of their own and they have the greatest need.  At the same time, some people can skate through life with perfect health . . . why would you reward someone with money for being a lucky accident of birth?  Particularly when it's money that should go to the person with greatest need.

[marty998]

One life is not worth more than another, and you as the armchair critic certainly don't get to decide it.

That is your opinion, perhaps, but as a society, we certainly act in ways contrary to that position. Some treatments are restricted by age, others rationed by other medical condition, we have literally thousands of people working full-time to keep POTUS alive.

Fair point, don't disagree.

Ask yourself though. If you needed expensive healthcare and couldn't afford it entirely yourself, would you want Metric Mouse* deciding whether you live or die?

*Sorry to pick on you MM, but you were the one with an equivocating opinion on whose life is worth saving...

[nereo]

Ask yourself though. If you needed expensive healthcare and couldn't afford it entirely yourself, would you want Metric Mouse* deciding whether you live or die?

Here's the thing though - if it's government sponsored some government formula is used to distribute care. If it's private insurance then the company decides who gets care (and it's in their interest to deny as much care as possible).
Either way - someone decides if you get the treatment you need to save your life or possibly just improve your QOL.

[sokoloff]

Ask yourself though. If you needed expensive healthcare and couldn't afford it entirely yourself, would you want Metric Mouse* deciding whether you live or die?

*Sorry to pick on you MM, but you were the one with an equivocating opinion on whose life is worth saving...

Well, *someone* has to decide.

Suppose two people, A and B are desiring and in need of the marginal (very last) single treatment X.
If Person B gets X, person A doesn't (and dies or suffers).
If Person A gets X, person B doesn't (and dies or suffers).

We have to choose somehow, because there aren't infinite dollars or hearts or livers or qualified surgeons or ICU beds or whatever other of a hundred limits to infinite healthcare. I believe in a finite world you can reduce the problem of allocation to the A vs B for X situation. You may complicate or obfuscate it with formulas, guidelines, quotas, or other means, but it boils down to different mechanisms of that problem.

If person A is 80 and person B is 35 and all else is equal, I genuinely believe that person B should get the treatment. Even if *I* am Person A.

[sol]

If person A is 80 and person B is 35 and all else is equal, I genuinely believe that person B should get the treatment. Even if *I* am Person A.

Do you not see any situations in which you would make a different decision?

What if the 35 year old is a mentally handicapped coma patient, and the 80 year old is the POTUS, and the treatment is a knee replacement?

I'm just saying that age is far from the only deciding factor.  I agree that somebody has to make these decisions.  If it's not going to be the patient and their doctor, then I would rather it be made by the government than by a for-profit corporation.

At least the government decision makers are marginally accountable to the people they represent, and are paid to make good decisions for people.  The insurance company is literally paid to make bad decisions for people.

[sokoloff]

If person A is 80 and person B is 35 and all else is equal, I genuinely believe that person B should get the treatment. Even if *I* am Person A.

Do you not see any situations in which you would make a different decision?

What if the 35 year old is a mentally handicapped coma patient, and the 80 year old is the POTUS, and the treatment is a knee replacement?

Then the bolded section of the premise is not held.

It's unclear to me why a coma patient would benefit from a knee replacement, but anyone in a persistent coma would be very, very low on my personal pecking order for a knee replacement.

[Roland of Gilead]

The 80 year old walks 4 miles a day and has a family history of people living to 100

The 35 year old is a heroin user who has failed in recovery three times.

Who gets the liver?

It is all so tricky to try and put rules on.

[sokoloff]

It's absolutely tricky, which is all the more important reason to be thoughtful about who gets to set the rules.

Here's a case where I do think a government run single-payer healthcare system would be better. I predict you'd see the same type of private supplemental health insurance spring into being that we see in several European countries with single-payer basic healthcare coverage.

Livers I'm comfortable letting the government program run. Knee replacement (which is limited only by money as far as I know), I'm happy to have a government program with its own eligibility and suitability guidelines, but to allow private healthcare (either insurance or out-of-pocket buyers) to buy knee replacements at their own expense if denied (or too delayed) by the government.

[radram]

As a whole we have a fairly unrealistic understanding of how extreme treatments are likely to play out. I blame Hollywood, where some terminally ill patient is given a pill and suddenly he/she's running through grassy fields and finding the love of his/her life.

Actually the HepC cure is pretty much exactly what you describe above.  Death sentence to cure in about 8 weeks with 1 pill a day.

And remember the movie "Dying Young".  Back in the day, having AIDS pretty much meant get your affairs in order and start your gradual decline into looking like a Somali refugee.  Not so anymore.

But yeah, those drug companies sure are evil.

HepC (HCV) is a fantastic example to discuss. First of all, RoG perfectly proved nero's point about an unrealistic understanding. The "death sentence" is not at all displayed in the data.

From http://www.healthline.com/health/hepatitis-c/hepatitis-prognosis-and-life-expectancy#Takeaway5

Some highlights:
15-30% clear the virus without treatment, the remaining develop chronic HCV.
5-20% of those with chronic HCV will develop cirrhosis, in about 20 to 30 YEARS.
1-5% of cirrhosis cases lead to death.
Newest treatment is up to 12 weeks @ $1,000 per day, or about $85,000 for full treatment with a cure rate as high as 95%. Note that cured patients can be re-infected.

So that is maybe 5%, OF 20%, OF 85% dying after 20 to 30 years with HCV. I would in no way describe this as "death to cure".

There are many treatments at a lower cost, with a lower cure rate, and a more inconvenient regiment (injection vs pill). There is a huge time frame to treat (20 to 30 years from detection). As many as 80% have no symptoms and do not even know they have it.

HepC is a prime example where you could escalate the drug use based on cost and progression of the disease. Not saying this is my solution, only a very interesting talking point on the subject. Many conditions do not offer these options.

[radram]

why don't we give every person on the day they are born a set amount of money to be used for the rest of their lives for their health care? if you're a sickly kid, you blow through the money early. if you stay healthy you get to use the money to prolong your life as you see fit.

Because that's patently unfair?

Some people will need an awful lot more health care than others, through no fault of their own and they have the greatest need.  At the same time, some people can skate through life with perfect health . . . why would you reward someone with money for being a lucky accident of birth?  Particularly when it's money that should go to the person with greatest need.

Sounds like a perfectly rational theory for a 100% estate tax. How about we use the money on healthcare :)

[scottish]

Will your ACA insurance cover the hepc treatment costs?   Just curious, I think - but I'm not sure - that it would be hard to get coverage for that in Canada.

In my case, I'd just fork over the money instead of dying of cirrhosis, but most people can't seem to save a few thousand let alone 100K for this sort of emergency.    Recently my doctor was astounded that I was willing to pay $175 for a very useful test not covered by public insurance.    He says, "We could do this test, it's very specific, but it costs about $200 and it's not covered by government insurance.   Most people can't afford it so I didn't mention it sooner"

Arrghh.    We could have done this 3 months ago.   It's just bizarre.