8 ms·

The United States is the most charitable country in the world. On top of that I never said to deny coverage to those that can't afford it. There are other ways.

by curt 13y ago

The United States is the most charitable country in the world. On top of that I never said to deny coverage to those that can't afford it. There are other ways. How about the giving them an annual voucher for $X, whatever they don't spend gets rolled over into the next year. Just like a HSA.

mikeash 13y ago
People with serious diseases will outspend their voucher, and then many of them will die unnecessarily. Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. I've yet to see one, though. Not being allowed to refuse treatment screws up too much.
- burntsushi 13y ago
  > Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. No such proposal exists. Any proposal that does requires a third party to intervene as either an angel to donate whatever resources are needed or as an agent enforcing policy that one group of people must provide services to another group of people regardless of means. Both of the aforementioned scenarios do not exist within the realm of market forces because market forces cannot make guarantees. People will always die because they don't have the resources to fix what ails them. We can only hope to lower the amount of resources to get treatment, and "market forces" are absolutely a legitimate solution to that. But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely.
  - mikeash 13y ago
    "But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely." We are in agreement. My point is that society is stuck on this (note that I have made no value judgment in these comments myself) and until and unless that changes, market forces are implicitly ruled out.
    - beagle3 13y ago
      Actually, the Israeli system does sort-of stop people from dying yet still lets market forces do some magic. It is single payer (gov) through taxes, every person chooses their HMO. The HMOs get paid per member (so they compete for the members) and they are also allowed to offer extra services to their members (which they also compete on). And finally - and I think this is also crucial - the government has a special fund for expensive life saving treatments that the HMOs tap into when needed - so they do not have an incentive to avoid those treatments.
- mseebach 13y ago
  > Give me a proposal that stops poor people from dying of treatable diseases while preserving market forces, and I'll change my mind. See my comment elsewhere on the swiss model.
- baddox 13y ago
  People with sufficiently serious diseases will die, period, even if they're the wealthiest people on Earth. I don't see how the inevitability of death caused by disease is a useful argument. If there was some disease that one person had, and that could be cured only by pooling the entire wealth of the Earth, should we forcefully take that wealth to cure that one person?
  - wpietri 13y ago
    That would be an interesting hypothetical if anybody sensible had ever suggested anything close to that.
- sp332 13y ago
  Death isn't preventable, you can only delay it. Should the people pay for someone's heart surgery if their kidneys are on track to fail in a few months anyway?
  - mikeash 13y ago
    I don't know, but people in general seem to think the answer is "yes". Until and unless that changes, market forces won't really work in health care.
  - Klinky 13y ago
    Life expectancy estimates are often all over the board and wrong. Imagine it's a close relative who is having the heart surgery. Would you actively try to persuade them to not do the surgery to possibly extend their life because their kidneys might fail later, so they might as well die now because they're not worth the money that would go into the surgery? It's easy to say a Big Mac isn't worth the cost on the menu, it's harder to say that your mom's life isn't worth the cost. Keep in mind we're talking purely about economics here, as that is what your post is about. We're not talking about quality of life.
    - sp332 13y ago
      Economically speaking, I think it's fine for a person to spend huge amounts of their own money that way if they want. Also, it's fine if they ask around for friends, family, or even total strangers to finance their health. But forcing people to pay (via taxes) for an operation seems outrageous to me.
      - Klinky 13y ago
        Not really the point I was making. People will go to great lengths and effectively destroy their own life in the pursuit of saving a loved one. This makes it hard to take seriously the concept that a a free market full of economically rational consumers would exist when it comes to costly medical decisions. It's easy to say "if you didn't want to be poor, you shouldn't have bought that plasma tv or new smartphone", versus "if you didn't want to be poor you should have let your wife die instead of taking a second mortgage out on your house". Most people do not have a maximum price on something they consider priceless.
_delirium 13y ago
Isn't that just rationing in a different form? If someone has $X to spend on treatment, and the best treatment costs 10*$X, then they will not be able to receive that treatment.
- anonymoushn 13y ago
  Do we expect that our medical professionals and facilities have the capability of providing the best treatment to everyone all the time? If they do not, how should we decide how to allocate the medical care?
  - _delirium 13y ago
    I agree, that's exactly the question. Well, unless we get to a situation where literally every person can receive the best treatment for every ailment, at high-quality facilities with no waiting. If we're not in that situation, then some people can't receive the best treatment for their condition, and the question is who and when.
  - danielweber 13y ago
    how should we decide how to allocate the medical care? Our current method of deciding is to stick our fingers in our ears and pretend it doesn't matter. Anything has to be better than this.
    - anonymoushn 13y ago
      Actually, we are using money to allocate it, which seems pretty reasonable. This will be an even better idea if we can bring costs down substantially.
sp332 13y ago
Hospitals generally won't deny life-saving treatment. But they would deny anything less. Even, paradoxically, providing cheaper preventive care to avoid expensive emergencies later.
- fnordfnordfnord 13y ago
  >Hospitals generally won't deny life-saving treatment. But they would deny anything less. That's right, they will let you get sick enough to need intervention, and if you can't pay, they'll try in the meantime to find a gov't program to foot the bill.
jmathai 13y ago
Not sure what charity really has to do with it. Americans aren't going to willingly give money to "help the poor" to the extent that medicare does. I would imagine that the US is also among the greediest countries in the world. Odd how it can work out that way with percentages. [edit: grammar]
- saraid216 13y ago
  Charity is an excuse to keep the poor around in order to look good pretending to help them. As a stopgap in the immediate future? They're good things. As a long term strategy? It's intentionally ineffectual. No charity has, or ever will, end major problems like hunger or poverty.
  - rayiner 13y ago
    Also, on a dollar per dollar basis, the government is vastly more efficient than nearly any charity. The Social Security Administration's overhead was 0.8-1.4% (depending on how you count) last year. Find me a private charity that efficient. Make a Wish Foundation crows about spending 76% of funds on programs. If the SSA were as efficient as Make a Wish Foundation, it would have an overhead of an additional $185 billion a year (i.e. approximately equal to all federal payroll expenditures).
    - kareemm 13y ago
      The bulk of charitable spending is on programs and fundraising, usually in that order. The SSA doesn't have to worry about fundraising, hence the disparity in admin expenses.
    - refurb 13y ago
      What a ridiculous statement. Most of the charities' overhead is money spent on fundraising. The SSA doesn't have to fund raise since it's illegal to not pay into it.
      - mikeash 13y ago
cma 13y ago
Most of that "charity" is for religious brainwashing. Sending kids on thousand dollar flights to work on a cinder block indoctrination center and also get a beach vacation out of it. Don't remember where I read it, but someone had a good line about youth pastors essentially playing the role of cruise ship activities coordinators.

by curt 13y ago

mikeash 13y ago

People with serious diseases will outspend their voucher, and then many of them will die unnecessarily. Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. I've yet to see one, though. Not being allowed to refuse treatment screws up too much.

burntsushi 13y ago
> Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. No such proposal exists. Any proposal that does requires a third party to intervene as either an angel to donate whatever resources are needed or as an agent enforcing policy that one group of people must provide services to another group of people regardless of means. Both of the aforementioned scenarios do not exist within the realm of market forces because market forces cannot make guarantees. People will always die because they don't have the resources to fix what ails them. We can only hope to lower the amount of resources to get treatment, and "market forces" are absolutely a legitimate solution to that. But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely.
- mikeash 13y ago
  "But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely." We are in agreement. My point is that society is stuck on this (note that I have made no value judgment in these comments myself) and until and unless that changes, market forces are implicitly ruled out.
  - beagle3 13y ago
    Actually, the Israeli system does sort-of stop people from dying yet still lets market forces do some magic. It is single payer (gov) through taxes, every person chooses their HMO. The HMOs get paid per member (so they compete for the members) and they are also allowed to offer extra services to their members (which they also compete on). And finally - and I think this is also crucial - the government has a special fund for expensive life saving treatments that the HMOs tap into when needed - so they do not have an incentive to avoid those treatments.
mseebach 13y ago
> Give me a proposal that stops poor people from dying of treatable diseases while preserving market forces, and I'll change my mind. See my comment elsewhere on the swiss model.
baddox 13y ago
People with sufficiently serious diseases will die, period, even if they're the wealthiest people on Earth. I don't see how the inevitability of death caused by disease is a useful argument. If there was some disease that one person had, and that could be cured only by pooling the entire wealth of the Earth, should we forcefully take that wealth to cure that one person?
- wpietri 13y ago
  That would be an interesting hypothetical if anybody sensible had ever suggested anything close to that.
sp332 13y ago
Death isn't preventable, you can only delay it. Should the people pay for someone's heart surgery if their kidneys are on track to fail in a few months anyway?
- mikeash 13y ago
  I don't know, but people in general seem to think the answer is "yes". Until and unless that changes, market forces won't really work in health care.
- Klinky 13y ago
  Life expectancy estimates are often all over the board and wrong. Imagine it's a close relative who is having the heart surgery. Would you actively try to persuade them to not do the surgery to possibly extend their life because their kidneys might fail later, so they might as well die now because they're not worth the money that would go into the surgery? It's easy to say a Big Mac isn't worth the cost on the menu, it's harder to say that your mom's life isn't worth the cost. Keep in mind we're talking purely about economics here, as that is what your post is about. We're not talking about quality of life.
  - sp332 13y ago
    Economically speaking, I think it's fine for a person to spend huge amounts of their own money that way if they want. Also, it's fine if they ask around for friends, family, or even total strangers to finance their health. But forcing people to pay (via taxes) for an operation seems outrageous to me.
    - Klinky 13y ago
      Not really the point I was making. People will go to great lengths and effectively destroy their own life in the pursuit of saving a loved one. This makes it hard to take seriously the concept that a a free market full of economically rational consumers would exist when it comes to costly medical decisions. It's easy to say "if you didn't want to be poor, you shouldn't have bought that plasma tv or new smartphone", versus "if you didn't want to be poor you should have let your wife die instead of taking a second mortgage out on your house". Most people do not have a maximum price on something they consider priceless.

_delirium 13y ago

Isn't that just rationing in a different form? If someone has $X to spend on treatment, and the best treatment costs 10*$X, then they will not be able to receive that treatment.

anonymoushn 13y ago
Do we expect that our medical professionals and facilities have the capability of providing the best treatment to everyone all the time? If they do not, how should we decide how to allocate the medical care?
- _delirium 13y ago
  I agree, that's exactly the question. Well, unless we get to a situation where literally every person can receive the best treatment for every ailment, at high-quality facilities with no waiting. If we're not in that situation, then some people can't receive the best treatment for their condition, and the question is who and when.
- danielweber 13y ago
  how should we decide how to allocate the medical care? Our current method of deciding is to stick our fingers in our ears and pretend it doesn't matter. Anything has to be better than this.
  - anonymoushn 13y ago
    Actually, we are using money to allocate it, which seems pretty reasonable. This will be an even better idea if we can bring costs down substantially.

sp332 13y ago

Hospitals generally won't deny life-saving treatment. But they would deny anything less. Even, paradoxically, providing cheaper preventive care to avoid expensive emergencies later.

fnordfnordfnord 13y ago
>Hospitals generally won't deny life-saving treatment. But they would deny anything less. That's right, they will let you get sick enough to need intervention, and if you can't pay, they'll try in the meantime to find a gov't program to foot the bill.

jmathai 13y ago

Not sure what charity really has to do with it. Americans aren't going to willingly give money to "help the poor" to the extent that medicare does. I would imagine that the US is also among the greediest countries in the world. Odd how it can work out that way with percentages. [edit: grammar]

saraid216 13y ago
Charity is an excuse to keep the poor around in order to look good pretending to help them. As a stopgap in the immediate future? They're good things. As a long term strategy? It's intentionally ineffectual. No charity has, or ever will, end major problems like hunger or poverty.
- rayiner 13y ago
  Also, on a dollar per dollar basis, the government is vastly more efficient than nearly any charity. The Social Security Administration's overhead was 0.8-1.4% (depending on how you count) last year. Find me a private charity that efficient. Make a Wish Foundation crows about spending 76% of funds on programs. If the SSA were as efficient as Make a Wish Foundation, it would have an overhead of an additional $185 billion a year (i.e. approximately equal to all federal payroll expenditures).
  - kareemm 13y ago
    The bulk of charitable spending is on programs and fundraising, usually in that order. The SSA doesn't have to worry about fundraising, hence the disparity in admin expenses.
  - refurb 13y ago
    What a ridiculous statement. Most of the charities' overhead is money spent on fundraising. The SSA doesn't have to fund raise since it's illegal to not pay into it.
    - mikeash 13y ago

cma 13y ago

Most of that "charity" is for religious brainwashing. Sending kids on thousand dollar flights to work on a cinder block indoctrination center and also get a beach vacation out of it. Don't remember where I read it, but someone had a good line about youth pastors essentially playing the role of cruise ship activities coordinators.