Thanks. I’ll have to do some more reading on it, but it looks like a very workable and sensible system. Which likely means there is NO CHANCE of it being implemented here in the US! 
What really bothers me is the apparently widely accepted idea that EACH person, ought to be provided essentially unlimited treatment, no matter what their age, lifestyle, life expectancy…
To be honest, I’ve never come across someone like that. I’m sure the people in my life are nothing close to a representative sample , but they basically come in two flavors
Yeah, you’re probably right. Most people probably fall into #2, thinking “I and people like me should get whatever we want at low cost, everyone else can go hang.”
Personally, my biggest problem is generally with heroic measures offered to the very young and the very old. In my work, I also see MANY many people receiving expensive treatment, while smoking, drinking, doing drugs, grossly obese - and while not having worked and paid into any system, and with no expectation of doing so in the future.
I feel similarly towards some expenditures towards special education. Hope not to get all Randian, but I think one significant factor in allotting resources ought to be the likelihood that it will enable the individual to be a contributing member of society. And my personal prejudice is that economic/labor contributions generally outweigh “every life is sacred” sentiments.
Where would a young Stephen Hawking have fallen in your scenario? Wor h pouring resources into, or not?
Dunno. Didn’t watch the movie. 
Not sure how old he was at the time he became symptommatic. My impression is that he was in college/post grad. Not sure what he had accomplished til then and could potentially accomplish with care. Not sure how expensive his care was, or how much he contributed thru insurance payments or earnings.
Unfortunately for many, my preferences are weighed in favor of at least some amount of brain power AND/OR physical brawn, AND a willingness to work. Fortunately for most, I don’t see how my preferences will ever be reflected in any policy outside the 4 walls of my home.
Graduate student.
His care has been pretty damn expensive - requiring 24/7 nursing care just for starters. For decades. He’s been respirator dependent for awhile now at least at night.
He’s never made an insurance payment for health care though - that’s not how the British system works. His earnings have been taxes just like everyone else’s, and his care has been paid for, just like everyone else’s. He’s probably cost more than he’s paid in over a lifetime but in any system that covers everyone there will always be some people like that.
Hawking was lucky to get a job where his disability wasn’t a bar to professional success.
I wouldn’t be too sure about that. Our NHS covers medical care, not the full package of social support and ordinary personal care. Public support for the latter comes through the local council’s social services, with a different source of funding and subject to various forms of means test.
The NHS will do its best to stabilise (if it can’t entirely cure) people’s ailments, and to get them back on their feet (metaphorically speaking). Yes, its criteria include judging whether treatment will enable a patient to function as close to normal as possible (so if you decide you’d like a boob or nose job, you pay for it yourself - but if you had some appalling accident that completely re-arranged your face, you’d get facial reconstruction and skin grafts and the like on the NHS, at least as far as the doctors consider necessary to get you looking after yourself and preferably back to work).
But if you need additional personal care after that (help to get yourself fed, washed, dressed, toileted and to get you out and about), you’d be referred to your local council’s social services department: and the kind of services you need, and how it’s paid for, would be up to you and your family to discuss with them and their specialist advisors. One of the ongoing problems we have is at the boundaries between NHS care and the “hand-on” to social services, particularly for the frail elderly, and if you’re entirely dependent on what the social services can provide, it can be pretty basic, as budgets are squeezed, particularly at the moment.
It strikes me as more than possible that people from his family background would have expected to cover much of the cost of non-medical personal care and support from private resources - and maybe even some of the less acute medical care.
I guess I could also imagine an outcome where I would say it would be better to lose the occasional Hawking, than to spend enormously on vast numbers of folk considerably less able. Not sure ANY individual is indispensable, or their contributions so valuable as to warrant across-the-board expenditures on less “capable” folk.
I don’t see the question arising in those terms.
Yeah, but it is easy for someone to toss out an extreme example, as questioning any proposal.
Of course, given last night’s developments here in the US, it seems I have little need to try to wonder about such things as the rational provision of health care to the greatest number. I’ll probably bow out of this - and most other political/policy threads - at least for a while.
Carry on or don’t as you wish, folk. I’ll be over in MPSIMS! 