How much health care are you "entitled"?

I’m sure this has been discussed before, but I started thinking about it when reading this thread.

I firmly believe that every American citizen should be provided catastrophic health care, and at least some routine preventative care. But I think my personal preference would be to draw a pretty strict line as to what level of care was provided for what type of condition. For example, I would likely favor “hospice” care over “heroic” efforts - especially for older individuals or in cases where a procedure was not reasonably expected to result in the individual being a self-sufficient, contributing member of society.

Under the current system, I understand that this “discriminates” against people who do not enjoy private insurance (or medicare) who are unfortunate to experience serious health problems. And under universal health care (which I favor), it would limit the availability of certain extremely expensive procedures.

(Apologies for the imprecise use of any terms).

I want you to take a deck of cards and deal them out face up to ten imaginary players around a poker table, Texas Hold’em style. You can deal them out however you like, but the goal it to get it to be the most fair possible. So if you dealt player #1 pocket aces one hand, you probably want to hold off on him for awhile and focus in on the others. Unless, of course, the river brought him a bad beat and he would have lost a lot of money. Then you may want to make it up in the next few hands. Don’t forget player #5 though, who’s just been sitting there folding for a round. He’s due a good hand sometime soon. And you just let player #7 go six hands in a row drawing to a four card flush that never materialized. That’s kind of against the odds so watch out for that next hand.

Or, you know what? You could just screw the whole system and deal the cards out randomly. Over a long enough time and over a good number of players, it’s all going to equal itself out. There’s really no need to play God over the system. It’s just best to-literally- let the cards fall as they may.

So it’s the same in health care.
You know, if you give health care to the entire population there will absolutely be people that take advantage of it because it’s free or because they’re greedy, or because they’re hypochondriacs, or because they’re just unlucky and disaster strikes.
Likewise, there will be people who take advantage of it in a completely different way by never going to a doctor until something preventable reaches the stage of catastrophic and costs a ton of money to everyone who pays into the system.
And just as surely, there are people who will pay into it their entire life and nothing bad ever happens to them and they just wasted all that money paying into a system they had no need to use.

Stop playing God, stop playing dealer and giving everyone what you believe would work out because over a long enough period of time and big enough population, it all will equal itself out.

So (just to take one example) you say that if we provide unlimited universal end-of-life care independent of any public or private contribution the individual may have ever made over the course of their life, things will “just equal out”? I’m not sure I understand how that works.

My position isn’t entirely that every single thing should be absolutely covered throughout infinity. But what I am saying is that if we had that sort of system in place for end of life care, it may be surprising how many people refuse, for themselves or on behalf of their loved ones, to gobble up as much money and medicinal help as is technologically possible merely because it’s free and they can.

Because some people just drop dead and some people hang on for years!



Moving thread from IMHO to Great Debates.

I think I should get full nano-cybernetic reconstruction and augmentation as soon as its available regardless of the expense.

Only the rich are entitled to health care. Those who choose to be poor deserve what they get. Nothing.

Personally, I would advocate a free market solution. The base minimum level of care should be determined by the ability to find enough people to pay enough to get over the minimum to finance everyone who is willing to accept the minimum.

Hmmmm…entitled, ehe? I guess it depends on where one lives. If one is, say, an American, then I guess that one is ‘entitled’ to some basic, minimum health care just for living here. Sort of like food and shelter…as an accident of birth, if one happens to be born here in the US, our society has a basic level that we won’t let people fall below, and I suppose that health care is one of those things. We don’t let people starve to death…we don’t let someone bleeding from a gunshot wound simply bleed to death in the street. Anything more than the minimum, if one is an American, one gets through their job or their family (if one is born to one of those ‘rich’ families gonzo is always going on about).

Myself, I’m not rich…and I have perfectly fine health care. I get it through my wife who in turn gets it through her company.

If one lives in, say, sub-Saharan Africa, though, one is ‘entitled’ to absolutely zip when it comes to health care. Or if one is from many other countries. So, I guess it depends on where one is born…and how rich the country one is born in happens to be.


What does “entitled” mean? Is every human entitled to 2010 state-of-the-art healthcare? Because that’s flatly impossible. Furthermore 2010 state-of-the-art healthcare didn’t exist in 2009. If people have a “right” to what we now consider state of the art healthcare, that’s a right that was newly discovered and that the vast majority of humanity, rich and poor, was denied.

Let’s not forget that if people are “entitled” healthcare, they are disentitled something else - some other resources such as better food or housing that went into healthcare instead. I’m all for helping the poor, but no matter how generous you are, you’re going to say “I want to devote X% of taxes to helping the poor.” If you’re forcing the government to spend certain resources on healthcare, as in Medicare, those are resources the poor will not receive in other forms with they prefer.

I think you are entitled to whatever level of care society can support. Screw the holy free market; survival and health is more important than money. I consider denying people health care when we can afford it morally no different than murdering them.

We should put our entire GDP into providing state-of-the-art healthcare, at vastly diminishing returns for new and unrefined technologies, and any other position is “equivalent to murder?”

I don’t think you realize what your bombast really means.

“Thou shalt not kill; but need’st not strive; Officiously to keep alive:”

Arthur Hugh Clough- The Last Decalogue

I would, indeed, be surprised if many people put the good of the whole against their narrower immediate good.

During my career in medicine I estimate I saw about 75-100,000 patients as an ED doctor. I could count on one hand the number who were concerned (except abstractly) about the cost of their care to society at large. (“No, Doc; hold off on the CT. Medical care is already too expensive in the US.”) And for those who had full insurance, I don’t remember anyone ever deciding to get a cheaper alternative for anything because it was cheaper.

Now this is not a position for or against anything. And I’m just one person. Perhaps my service area is atypical. In general, though, I think altruism toward wasted resources takes a back seat.

We need to get everyone decent healthcare and we need to stop the ridiculous way we fund it here in the US. However if we don’t get a handle on how to ration it, simply finding a way to guarantee everyone unlimited healthcare as defined by them and their physicians will bankrupt us. We already spend more (for less return) than anyone else, and it’s because of insurance that we spend so much. Insurance insulates the recipient from the cost of care. It’s like the Sunday brunch at the Hyatt. You’ve paid a fixed price; why not get all you can. You certainly don’t care if the tenderloin costs more than the hamburger even if both are equally nourishing.

The reality of life is that we have the resources to keep any single person alive, and to give any person an opulent lifestyle free of want. It’s about how we allocate our resources.

You clearly do not have the first clue about how markets work. The free-market isn’t a ‘luxury’ it’s the machinery that keeps us alive. You are free to kvetch about the entitlement to welfare because people strived in the country you hate so much to amass the wealth that makes it possible.

And I think you are distorting what I am saying to hide the moral bankruptcy of your position.

The philosophy of someone who would watch someone drown while laughing at them.The kind of attitude held by someone who never expects to need help.

Irrelevant, since the holy free market is perfectly happy with everything from slavery to people dropping dead in the streets. If we want a fair, efficient allocation of health care then we have to ignore the free market, because fair, efficient health care is less profitable than unfair, incompetent health care. Or outright denial of it. I have no interest in dying so you can masturbate over how wonderful the free market is.

I only want what’s fair. So just give me enough enough so that I am as safe from medical disasters as you are from the dangers of terrorists on airplanes.

Remember, germs are simply terrorists that are too small to see!

How much law enforcement are you entitled to? If you are victims of armed robberies or sexual assaults at 10 different times in your life, it may end up costing $5 million+ to find, arrest, convict and imprison all of the people involved over the course of your life. Five million is about where most health care plans have a lifetime maximum.

Then again, health care costs about 12x more than law enforcement (2.5 trillion vs $200 billion or so).

I think people are entitled to the level of care that society can afford, provided that the level of care does not push out resources that could go to more productive pursuits. A heart bypass that will give someone an extra 50 days of life is not worth more than a college education for 5 different young people.

Personally, I’m in favor of universal free primary care, universal access to free/cheap generic medications, and universal catastrophic care paid via taxes (anything above $20,000+ a year or 160k over a lifetime covered by the government).

I’d pay more in payroll and income taxes to fund that system, but it wouldn’t cost much. The savings from lower private spending should even out the higher tax rate. A plan like the one I’m talking about would probably cost (as a guess) $150 billion a year. But it would involve $150 billion+ in fewer expenses from the private sector, so it’d even itself out.