Hacker News Reader

Comment by MereInterest | Hacker News Reader

There are three options. I'll call them options E, S, and G.

Option E is to run healthcare entirely as a business. Payment up front, and refusal to treat anyone without payment.

Option S is to take option E, but avoid immediately attributable deaths. Treat somebody at the emergency room, even if they don't have a line of credit with them. Patch them up enough to walk out the door, but don't treat the underlying issues without additional payment.

Option G is to treat patients before they reach death's door, when it is cheaper to do so. To give the preventative care that keeps costs down, even if somebody isn't able to pay for it. To treat public health as a public good, rather than as a series of purchases.

Option E is evil, to let people die unnecessarily. Option S isn't openly evil, but is stupid. It is where the US is now, and inflates the costs tremendously. Option G is to actually be good.

View on HN

Preventative care doesn't actually save money (source: https://www.nytimes.com/2018/01/29/upshot/preventive-health-... )

But a moral argument could certainly be made for option G.

Preventative care might not save money, but in a nationalized system which is funded by tax collection, having participants healthy so that they can live longer and pay more taxes sounds like a good idea.

I feel like it's not only a moral argument, instead it's a better alignment of those who pay and are served by the system. At present, the goals of insurers and providers are very different from patients, partly due to profit-seeking, partly due to the disconnect in who pays for it (49% of US population receives employer-covered healthcare).

Huh, thank you. I hadn't known that. I tend to go with the monetary argument first, since it helps to convince people who are primarily self-interested. I definitely think that there is a moral argument for option G, and will stick to those arguments overall in the future.

you've inappropriately reduced this into three bins, ignoring all nuance which is the actual hard part of the problem.

in option G, how much $ do we spend on terminally ill patients in order for them to have a few more days with their loved ones?

or how about smokers who will as a result of their actions will cost spades more than "good souls"? or type 2 diabetics on dialysis?

this false trilemma is largely useless and only presents one side of a moral choice and even then ignores the other prickly of it (read: the people paying for this glorious utopia and where the lines are drawn when it comes to saying no)

Either the system we have today works because we put enough money into it, and therefore would continue to work if we nationalized; or our system has unjust failures that we should seek to rectify.

We already pay for our healthcare in the US, we just do it predominantly via employer-contributed job benefits, and existing Medicare/Medicaid. The money for the bulk of healthcare is already there, but there are people falling through cracks all the time.

Is your position that bringing everyone's healthcare up to Medicare's baseline is too expensive? Where is the extra cost coming from?

> Either the system we have today works because we put enough money into it, and therefore would continue to work if we nationalized; or our system has unjust failures that we should seek to rectify.

That is very bad reasoning. Most things don't get cheaper when they get nationalized. There is some evidence healthcare may be different in this regard, but the point is: costs are not invariant under nationalization.

> Is your position that bringing everyone's healthcare up to Medicare's baseline is too expensive? Where is the extra cost coming from?

Cost of providing the existing service is not the only cost worth considering. The other issue is opportunity cost of innovation. Right now there are powerful incentives for people to innovate in the healthcare space, particularly in pharmaceuticals. But also in prosthetics and the procedural space. Nationalization is likely to crimp those incentives, and thereby lead to less innovation over time.

> in option G, how much $ do we spend on terminally ill patients in order for them to have a few more days with their loved ones?

Zero. They would be explicitly avoided care if they are known being unable to return to work nor parent somebody (higher-order parenting such as grandparents, uncles, aunts count too).

> or how about smokers who will as a result of their actions will cost spades more than "good souls"? or type 2 diabetics on dialysis?

Why not just tax the cigarettes and subsidise bike roads instead of car roads?

Reply on news.ycombinator.com