Comment by csomar | Hacker News Reader

Comment by csomar | Hacker News Reader

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That's not how it works in real life. Family (and maybe generous government healthcare) will take care of "too broke" to give any yield, in the future, people. Anyone else who isn't lucky to have that kind of support will find himself in the streets.

And that's fine. Societies can only function if the yield from the people it invested in is higher than the investment. This is why socialized healthcare is tricky. If you invest too much, you might be wasting resources and endangering all of your society. If you invest too little, you might be leaving people who would otherwise be productive once the investment is made.

> Are some simply too broken to fix?

There is no one too broken to fix but how compatible people are with their environments. A duck will leave its baby if it thinks it can't cross the river. Its brothers did cross, and thus it has to go forward, carry on and leave the weak behind. On the other hand, if the duck was living in your backyard and eating from your food; it would not have to do such a difficult choice. Its baby will not need to cross any river and thus it'll keep taking care of it.

> I feel awful thinking this, but I wonder if there is some truth to it.

It's life. Netflix has great series (Planet Earth) that you can watch. We are not really different from animals, we just happen to live in a different environment.

> And that's fine. Societies can only function if the yield from the people it invested in is higher than the investment. This is why socialized healthcare is tricky. If you invest too much, you might be wasting resources and endangering all of your society. If you invest too little, you might be leaving people who would otherwise be productive once the investment is made.

This is quite evidently not how most socialized healthcare systems work. Thankfully so, because you paint a nightmarish picture of people being left to die or suffer if there is no hope of them recouping an investment in their health. In fact, taken to the logical conclusion it would mean killing retirees instead of paying them pensions (imagine what society could spend all that money on, right?).

>> This is quite evidently not how most socialized healthcare systems work.

This is how socialized healthcare systems work. In an ideal world, everyone would get the healthcare they needed whatever the cost. We live in a world with finite resources. A single payer healthcare system is not free from these constraints.

The British socialized healthcare system for example will allocate up to $25K-$40K to buy a year of healthy life.

> [National Institute for Health and Care Excellence] uses a unit of measurement called the "Qaly" - the "quality-adjusted life year". It gauges drug effectiveness in terms of how much it would cost to give you a year of healthy life.

>[National Institute for Health and Care Excellence] aims to spend less than £20,000 to £30,000 per Qaly. That is not a hard limit; it will go almost twice as high for end-of-life drugs [1]

[1] https://www.bbc.com/news/health-28983924

> The British socialized healthcare system for example will allocate up to $25K-$40K to buy a year of healthy life.

"a year of healthy life" != "a productive member of society"

GP talks about "yield" from people as a measure for whether to help someone, which is decidedly different from Qaly. Yes, healthcare puts a price on life (it has to). No, that price does not primarily derive from the productivity of that individual.

You could """optimize""" society by spending more on healthcare for able-bodied than for "unproductive" people, but walk too far along that road and you get euthanasia.

> In fact, taken to the logical conclusion it would mean killing retirees instead of paying them pensions (imagine what society could spend all that money on, right?).

only a logical conclusion in a very simplistic sense. if you kill all the retirees, it will be hard to persuade the working population to produce any surplus.

> In fact, taken to the logical conclusion it would mean killing retirees instead of paying them pensions (imagine what society could spend all that money on, right?).

I'm strictly talking about people who are getting support but didn't chip in. Most retirees have saved up for their pension in the past, in the expectation that they'll get it in the future.

So socialized health care spending millions on a mentally disabled child who will never yield return on that investment is a danger to society?

Yes. It's well known that someone with, say, Down's syndrome may need a full time handler and is extremely unlikely to be a productive member of society (they'd need to be twice as productive, to make up for their handler).

Many couples when informed of Down's risk choose to abort.

I would rather spend the resources to help that person than enable another sociopathic billionaire, who would be far more dangerous to society.

We're not talking, in these instances, of someone who is mentally able but with a mobility issue, we are talking about people who will never contribute to society. That's money taken away from you, not some billionaire.

That said -- rounding up people and killing them is insane. But failing to test for birth defects and not working to prevent them is also insane.

Some ways this thread is going are kind of concerning, like, we don't know why people are depressed, so doing something like selecting against people who are liable to be depressed is probably a huge mistake. We could end up with generations that are poorly equipped to solve problems under pressure, etc, or whatever depression may naturally exist to help the host do.

Could caring for these kind of people have a utility in helping us think about compassion, and our values in a more broad way, that enables not making sub optimal decisions in cases that would have negative returns.. To use this thread as an example .. if we were in a society that was black and white utilitarian about one type of disability, it might lead to that thinking being applied directly and 'naturally' to this mental health issue also.

Maybe? But there are cases where the answer is either "no" or "it's too expensive." I've interacted with people with very serious mental disabilities and while it's not necessarily a negative experience you can usually tell the parents are lying to themselves when they say they enjoy their life.

If you create a hypothetical where the outcome is bad then I am not surprised the outcome is bad. You need to find something more concrete. I actually gave one: selecting against something nebulous like depression may have deleterious effects on the human germline leading to our own extinction. There's evidence that depression aids in avoiding potentially deadly stressors and increases problem solving ability.

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