[FoRK] Accidental theorist lost, wanted back

Stephen Williams sdw at lig.net
Thu Jul 16 16:41:56 PDT 2009

A good debate to have.

"Why We Must Ration Health Care "
>  Far more Americans reported forgoing health care because of cost. 
> More than half (54 percent) reported not filling a prescription, not 
> visiting a doctor when sick or not getting recommended care. In 
> comparison, in the United Kingdom the figure was 13 percent, and in 
> the Netherlands, only 7 percent. Even among Americans with insurance, 
> 43 percent reported that cost was a problem that had limited the 
> treatment they received. According to a 2007 study led by David 
> Himmelstein, more than 60 percent of all bankruptcies are related to 
> illness, with many of these specifically caused by medical bills, even 
> among those who have health insurance. In Canada the incidence of 
> bankruptcy related to illness is much lower.
> When a Washington Post journalist asked Daniel Zemel, a Washington 
> rabbi, what he thought about federal agencies putting a dollar value 
> on human life, the rabbi cited a Jewish teaching explaining that if 
> you put one human life on one side of a scale, and you put the rest of 
> the world on the other side, the scale is balanced equally. Perhaps 
> that is how those who resist health care rationing think. But we 
> already put a dollar value on human life. If the Department of 
> Transportation, for example, followed rabbinical teachings it would 
> exhaust its entire budget on road safety. Fortunately the department 
> sets a limit on how much it is willing to pay to save one human life. 
> In 2008 that limit was $5.8 million. Other government agencies do the 
> same. Last year the Consumer Product Safety Commission considered a 
> proposal to make mattresses less likely to catch fire. Information 
> from the industry suggested that the new standard would cost $343 
> million to implement, but the Consumer Product Safety Commission 
> calculated that it would save 270 lives a year — and since it valued a 
> human life at around $5 million, that made the new standard a good 
> value. If we are going to have consumer-safety regulation at all, we 
> need some idea of how much safety is worth buying. Like health care 
> bureaucrats, consumer-safety bureaucrats sometimes decide that saving 
> a human life is not worth the expense. Twenty years ago, the National 
> Research Council, an arm of the National Academy of Sciences, examined 
> a proposal for installing seat belts in all school buses. It estimated 
> that doing so would save, on average, one life per year, at a cost of 
> $40 million. After that, support for the proposal faded away. So why 
> is it that those who accept that we put a price on life when it comes 
> to consumer safety refuse to accept it when it comes to health care?
> As a first take, we might say that the good achieved by health care is 
> the number of lives saved. But that is too crude. The death of a 
> teenager is a greater tragedy than the death of an 85-year-old, and 
> this should be reflected in our priorities. We can accommodate that 
> difference by calculating the number of life-years saved, rather than 
> simply the number of lives saved. If a teenager can be expected to 
> live another 70 years, saving her life counts as a gain of 70 
> life-years, whereas if a person of 85 can be expected to live another 
> 5 years, then saving the 85-year-old will count as a gain of only 5 
> life-years. That suggests that saving one teenager is equivalent to 
> saving 14 85-year-olds. These are, of course, generic teenagers and 
> generic 85-year-olds. It’s easy to say, “What if the teenager is a 
> violent criminal and the 85-year-old is still working productively?” 
> But just as emergency rooms should leave criminal justice to the 
> courts and treat assailants and victims alike, so decisions about the 
> allocation of health care resources should be kept separate from 
> judgments about the moral character or social value of individuals.

I would go for a system where specialty, very expensive drugs have a 
reasonable base price and a monthly payment if they are successful 
(anti-cancer, etc.).  If and when it doesn't work, the drug companies do 
not profit (as much).


geege schuman wrote:
> http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/AR2009071602242.html
> On Thu, Jul 16, 2009 at 1:02 PM, Stephen Williams <sdw at lig.net> wrote:
>> I agree that health insurance company reform is what is needed.  I think
>> that the public plan is supposed to be competition that causes that.  Better
>> would be some creative incentives that encourage everyone involved to be
>> ever more efficient.
>> It is being said that the public plan idea will be killed, and instead
>> non-profit coops will be created.  This works pretty well for credit unions,
>> despite long-term and constant constraint and attacks by commercial banks.
>>  Being an entity separate from the government allows a lot of flexibility in
>> how it is set up, incentivized, etc.  It can vary from nearly commercial to
>> pseudo- or semi- governmental (Freddie Mac et al, postal service).
>> sdw

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