Perhaps it is time to confront the elephant in the room. With all the rhetoric thrown around in the health care debate, I really think it all comes down to this:
“It is acceptable for people to die because they can’t afford the proper treatment.”
I disagree.
To me it all comes down to the massive disparity between what a person can reasonably earn versus the insane cost of medical treatment.
I can often look the other way when it comes to shelter, food, and water because there are reasonable ways to cope, and reasonable alternatives.
To say a “right to shelter” doesn’t mean a free $200k townhouse, it means not allowing someone to die from exposure. It can be as little as a mat on the floor in a shelter. The actual cost of food to survive is well within a person’s ability to earn a few dollars a day. And water is already provided free and available in a variety of places.
You can ask a friend to let you stay with him for a month until you get your footing, or build a leanto in the woods. You can grow your own vegetables or forage for wild mushrooms. You can drink from a public fountain.
But if you are born with diabetes, to parents without substantial income, what are your options? Isolate your own insulin like Banting and Best?
So as long as medical care is unavailable and/or unaffordable, I see no other option that UHC. And to make medical care affordable would involve far more draconian measures (ie capping doctor salaries around $30k, or limiting the cost of medications).
Either people die from easily treatable conditions, or we all chip in to see that it doesn’t happen.
I’m pro-UHC-single-payer-all-that-crap, but I am capable of seeing this as a fudgy point.
On the scale of dying of exposure, a mat on the floor in a shelter, and a $200 townhouse, there is a clear line that can be drawn, at a lowish level, and the level directly correlates with the cost. So we hand out the bare minimum and it’s acceptable.
With healthcare, dead is dead, whether it would cost $5 or $5,000,000 to prevent. The baseline of acceptability doesn’t correlate well to cost across broad cases. This puts you, at the extremes, as saying either “let the poor bastards die”, or “money is no object!” - you can’t avoid both; if you don’t sometimes pay through the nose, you’re sometimes letting people die. With malice aforethought!
This is not to say that I don’t think that a near-optimal system can be constructed. But it does put to lie a direct comparison with funding a mats-and-gruel program.
I would agree that everyone under a certain age has a right to care. But once you are say, 85 years old and it’s costing hundreds of thousands, if not millions, to keep you alive hooked on all kinds of tubes and machines so you can live to 86… I don’t think that’s a good use of public money. But if extending their life a few months is really important to that person, they should of course be able to pay for the care out of their pocket if they can. And if they can’t pay, at that point it’s really time to admit you’ve had a good run and pull the plug.
Obviously, the “cap” would be what the state can sustain. But that question is something of a red herring; since the vast majority of people don’t have hugely expensive treatable diseases, its not much of a problem.
And yes; a great deal of money is spent on stretching out the lives of people one more month - but that’s not an example of money being spent on a treatable condition. That’s a separate issue.
Another point: every dollar that’s spent on health care as charity is a dollar that’s not being spent on, say, buying malaria nets in Africa. Throwing billions of dollars down the drain just so you can save a couple hundred old-man months seems like a waste of money.
Of course, the money from this bill isn’t coming from the malaria net box, but from (a) other health care plans, which is essentially saying it’s better to spend a couple hundred on 50 people than 10,000 on one (and, like it or not, you’re still potentially sentencing that 1 person to death) and (b) millionaires. (b) isn’t obviously uncontroversial, either–a dollar from them is, on average, something like 50 cents taken from investments, which increase productivity and can save more lives down the road. In a way we’re privileging present lives over future ones.
Der Trihs helps with this - we have to separate the treatable / curable situation from other medical care.
I brought this up in another thread. My 95 year old grandmother just passed away. With full dementia, plus minimal mobility due to a stroke, Medicare paid for a full hip replacement. After 3 days in the ICU, she picked up pneumonia, kidneys shut down, she could no longer swallow, feeding tube, and died.
She should have NEVER had a hip replacement done. It was a waste of money, even if she had come out of the surgery without the problems. We MUST take a clean look at medical expenditures at the end of life, and determine what to do and what not to do. Hip replacements on 95 year olds with bad bones, dementia and in wheel chairs is something that should not be paid for.
Which brings up an interesting point. We have end of life directives, so that people can state that they don’t want tons of money spent on them to keep them alive. We don’t have treatment directives. Your grandmother had no way of saying that if she had dementia then she shouldn’t have a hip replacement.
My mother in law had a hip and shoulder replacement after she fell, when she was 88. She did not have dimentia, and she live two more years, with a much better life thanks to them. She actually died of pneumonia she probably got from people coming for her 90th birthday party. Was her replacement worth it? How do you distinguish? Would it have been worth it if she had lived to 95 with it?
Not everyone, but there is clearly a curve of success vs dollars. (Or treatment value vs treatment cost.) Of course there are outliers, who would require lots of money for relatively little benefit (and this implies that we quantify the value of a year of life somehow.) But there are outliers on the other side, where a relatively small investment in care for a 5 year old could lead to 90 years of productive life. Let’s focus on that side to see if government paid for care is acceptable in principle, and then we can argue about where practicality forces us to cut things off. It isn’t acceptable for drunk drivers to kill people either, but the practicalities of cost and law enforcement and civil liberties means it is always going to happen. That doesn’t mean we don’t need DUI laws.
These panels already exist in the for-profit health insurance market, much to the detriment of those who can be helped. The point is that there will always have to be limits, whether they are framed in money or allocation of resources. However, the healthcare system can be structured such that benefits from expenditures are optimized based on patient outcomes, rather than insurance administrator pay.
Apropos of nothing, some of us have already made that decision. I have a “living will” and it includes a “do not resuscitate” clause, for exactly that sort of thing.
One of the greatest mistakes the Democrats made was their failure to frame the debate in such stark moral terms.
There have been a couple conservatives on this board that have stated that 45,000 deaths a year from lack of health care is an acceptable price to pay for freedom from government intrusion, but by and large I don’t believe the American people would actually be that cold hearted if they were fully informed about the problem.