Basically establish a cap on the total dollar amount of healthcare someone could expect to have covered by private or public insurance. Set it plenty high - maybe double the cost of a heart transplant. Maybe $2 million. But when someone hits that level - all they get is barebones palliative care.
What are the most obvious objections to such a system? I expect that many would interpret this as placing a value on a human life. I’m not sure why that is a problem.
You’re saying that the 1%, who could afford more care than that, can receive it, but everyone else is out of luck? I can’t see that going over particularly well with most of us. Also, I’m not sure what you see as the advantage of this system. It would save some money for the government/insurance companies, but would that be passed on in any meaningful way?
I can picture capping liability, in the sense of no matter what happens to you through the actions or negligence of another, including lifetime disability or death, there’s a (for example) $2 million limit on damages.
Capping insurance, though… why?
Well, one problem is that my spouse hit that before he was 20. That was 40 years ago. During those 40 years he designed robotic assembly lines, invented a new electronic instrument, and taught many people to play musical instruments. So I’m not sure that his life post-medical disaster was entirely worthless to society.
What do you say to someone with, say, cancer when they hit the lifetime cap midway through treatment? Too bad, so sad, go off and die?
If someone has hit the life time cap and comes down with something contagious - say, ebola or smallpox (yes, I know that one is unlikely) - do we not treat them and simply leave them a risk to the rest of society, or do we quarantine and treat them for the benefit of the rest of us?
I know a gentleman is on his third set of kidneys. This has given him an extra 30 years of life during which he has been an entrepreneur and he currently employs about 8 people. When he dies his business probably will, too, leaving those people without a job - I dunno, maybe paying $20,000 a year to maintain his new kidneys is worth it to keep 8 other people employed year after year? (I am certain the owner has cost more than $2 million in his lifetime what with two organ transplant operations and the dialysis that proceeded both of those). Sure, he might have cost more than $2 million… but if over a lifetime he generates 10 times that is that really a bad trade?
I can’t help but wonder if part of your assumption is that once a person costs that much they’re helpless/useless/don’t have much life left anyway. That’s not the case. Nor do you consider the knock-on effects of maintaining someone like an entrepreneur who generates multi-millions per year and keeps other people employed.
There are a LOT of ways you can blow throw $2 million in medical insurance in a life time. Be born with a heart defect and eat most of that limit up, then be faced with a severe traffic accident and … whoops! Well, if you hadn’t had that birth defect we could have reduced those two compound fractures, treated the infection, and replaced your broken teeth but your hour in the ER made you exceed your lifetime limit so rather than fix your very fixable problems we’re just gonna let you die!
Honestly, you don’t see the problem here?
I think Broomstick is making the case for eugenics.
We tried it. Obamacare outlawed it so it’s not likely coming back. A more reasonable way to do this would be rationing using QALY (Quality of Life Years) like the NHS does.
It might make sense to spend more than $2 Million on a 20 years old that could be returned to perfect health. Most Benefit / Cost analysts use figures in the multiple million dollar range for a value of a life (Mn/DOT uses $10.7 Million per fatal crash). But $2 Million to give a terminally ill 80 year old cancer patient another 6 months?
I think the OP is making the backdoor case for Genocide.
"Sorry, under Malthus-care, your healthcare coverage is nasty, brutish & short. You’re over your cap, so if you’re like to die you’d best do so and decrease the surplus population.
On the bright side, today we have a nice sale on shovels. So… who’ll be digging your grave? We have some reasonably priced HS students who will bury you 2 feet deep… and they seem to be right inside your price range…"
That it’s obscene?
The proposal amounts to this: If you have enough liquid wealth to pay medical costs as they arise, you can pay as much as you like. But if you’re part of the 99% who doesn’t have that amount of liquid wealth and so uses insurance mechanisms to meet healthcare costs, the total amount you are allowed to spend is capped by law, and if you die as a result of that well, you die.
There is no possible justification for this. If you want to put a price on human life and enforce that on people by forbidding them from spending more than that amount on keeping themselves alive - I’m not sure why you would want to do this, but let’s pretend that you have a good reason for doing it - then elementary considerations of fairness suggest that you should apply this oppression to all, regardless of the funding mechanims they choose for meeting healthcare costs.
We had this before the ACA. It was usually around 1 million a year, 5 million over a lifetime.
However I think removing the cap only mildly increased medical insurance costs. I can’t find the study right now. But eliminating it didn’t really have a huge impact on insurance rates. That was my impression.
As was said by Mdcastle, using a QALY calculation could be a good idea. I think the UK has 35,000 pounds per year of QALY. They cover care that is cheaper than that, but not care that costs more (however for the more expensive care I think they cover the first 35,000 or so).
The whole point of insurance with a broad risk pool is to decouple individual care requirements from individual ability to pay: basically the opposite of what the OP is suggesting. The goal is to have the risk pool as a whole balance overall costs over the spectrum from people who pay in lots more than they cost to those who cost lots more than they pay in.
If that overall balance requires that we apply some kind of cost-reducing “healthcare rationing” on basic insurance coverage, especially where it applies to, e.g., multiple experimental super-expensive new treatments, that seems reasonable though not ideal. But applying rationing in the form of a simple monetary cap on all lifetime healthcare expenditures sounds like an absolutely terrible idea.
Personally, I wish nothing more from life than to go through the next forty or fifty years getting absolutely no significant return on investment from my health insurance premiums (except for a modest amount of routine/preventive care, natch). But if I’m not as lucky as I hope, and I end up winning the Healthcare Payout Super-Jackpot owing to some disastrous illness or injury, I sure as hell don’t want some arbitrary cap limiting how big my Super-Jackpot can be irrespective of my actual healthcare needs.
And I don’t want that fate for anybody else either. If we really can’t afford a healthcare system with absolutely zero rationing of resources, we need to find a better rationing system than a one-size-fits-all arbitrary lifetime expenditure cap.
Who decides what is and isn’t quality?
The disabled typically rate their quality of life higher than medical personnel do… so who’s right? Some people wouldn’t want to live as a quadriplegic, others are will to do so. Some people couldn’t tolerate being blind, other people live very productive lives despite lacking vision. Rinse and repeat for a lot of things. Who decides what’s quality and what’s not?
Those are the easy cases.
The devil in the details is in the ones that aren’t so clear.
How does arguing that disabled people and those with severe and/or chronic health problems can still contribute to society “the case for eugenics”? If anything, I’m arguing for the opposite.
I see a justification for it. Here’s what the argument would be, as I see it. Every time someone uses health insurance, that money comes out of the general health insurance pool. That’s the whole idea behind insurance…that the money for the person who needs to use the insurance comes out of the fund that’s paid for by everyone in the fund. This averages risk, because there will be some people who will pay more into the fund than they take out of it, and others who will take more out of it than they put in, and the first group subsidizes the medical costs of the others. The problem, of course, is, the more of the second group that are in the pool, the greater the ost to the fund, and the more everyone has to pay. So it’s in my interest, as a member of an insurance pool, to be the sickest person in the pool…I want the fellow members of my insurance pool to be as healthy as they can be, because that keeps premiums down.
So the problem is with the super-sick…the people mentioned in the OP, who cost a lot of money to keep alive. It’s in the interest of the insurance group members as a whole to kick them out (even if it’s not in the interest of the people kicked out, who will probably die).
On the other hand, if you’re talking about somebody who self funds their health care, that doesn’t affect anybody else. If Mark Cuban or Zuckerberg or whoever has some illness that will cost $5 million to cure, and he pays the check, that doesn’t affect anybody else.
Obviously, that means rich people have an advantage there that poor people don’t, but rich people have a lot of advantages that poor people don’t. That’s the whole point of being rich.
IAN Balthisar and cannot speak for him/her, but ISTM that the point may have been that justifying healthcare expenditures on the grounds of how productive the recipient’s life ended up being is a bit… utility-focused.
Surely, if we really respect the dignity and autonomy of all individuals, we should argue that spending money on lifesaving treatments for a disabled 20-year-old is equally valid whether the individual goes on to invent electronic devices, be a job-creating entrepreneur, teach music, keep house, or simply spend decades working on a completely obscure unpublished epic poem about the history of mycological evolution.
If you’re arguing that the massive expenditures were justified because the recipients then went on to contribute decades of economic/technological productivity—rather than simply because they were human beings who deserved the same chance as non-disabled people at making a life of their choice—that’s when you start to sound a bit eugenics-ish.
Back in the 1990’s, before I became a medical basket case, my Blue Shield of California PPO plan (individual plan) had a lifetime cap of $6,000,000.
I don’t know how one could get to $6M, but, as expensive as that insurance was, there should not have been ANY cap.
It was once quite common for people to be impoverished by medical bills.
And that was when medical bills were NOT included in one’s FICO score.
ACA was intended to minimize this abomination - the “richest country in all History” bankrupts its citizens if they get sick.
Would you be upset to learn that Medicare will pay for kidney transplants, no matter one’s age?
It’s called “End Stage Chronic Kidney Disease” and there are two options - dialysis and transplant.
As a matter of public policy, the USA has decided to pick up the tab for the tiny number who develop this condidtion.
Even if they had run up $6M in other expenses.
Ah, well, I would have described it more at moral utilitarianism.
Huh.
Maybe that’s why a lot of the countries with true universal coverage call it a health SERVICE and not “insurance”?
I am one of the people whom Dinsdale thinks should be left to die. I’m not going to justify my existence or rant about the insanely out-of-control medical system. I’m just saying that you’re talking about actual thinking feeling human beings.
Probably, although its also that governments often make decisions that are economically suboptimal or wasteful to keep groups happy.
Just seize and sell the assets of a billionaire or two per year and toss the proceeds into a single payor health insurance fund. Utilitarian – greatest good for the greatest number.