[hkmurakami]

> It was eye-opening to see just how low our discourse has sunk, to be forced to acknowledge that what passes for debate in the age of the internet is often nothing more than spewing venom at the other side. How are we ever supposed to find a solution that’s better than either Trumpcare or Obamacare if we can’t even shut up long enough to recognize the humanity in the people on the other side of the debate?

So people on one side of the fence are not happy about the very high medical costs required to keep a child alive. They do not understand the humanity behind the numbers.

On the other side of the fence are parents who are not happy that some people think their child is an excessive burden on the system. They (understandably) do not understand (or at the least, are looking away from) the numbers behind making their child viable.

The author correctly identifies one side's shortcoming wrt balanced discourse, but does not see the blindness of her own implied position -- that no cost is too high to save a life. Nowhere in this piece does she broach the subject of numbers and real cost [1].

Finding balance is very difficult in any area, especially in areas where you only have _one shot_ (an example is your child's education, where many parents feel that no amount of investment is enough, and more is always better). But since the system does not have infinite resources, it's a necessary conversation to have (which the author could have brought up, but failed to do so -- understandably, since this article is a strategic opinion piece meant to further the author's self-interest, which I completely respect).

A billion dollars to save a child's life, we would likely agree, is too much. $1,000, we would likely agree, is entirely justified. Where we draw the line, why, and how we get there (of urgent need is our relationship with end of life care and treatments) is an important conversation that we are failing to have, and those of us on both sides of the fence are equally culpable for this shortcoming.

[1] The large 6 figure bill and post insurance $500 bill is only used qualitatively in the introduction.

[lstamour]

Who sets the numbers and why, though? How much is profit, how much should be profit, when it comes to human health and rehabilitation whether mental or physical assistance is required? Or, ignoring profit, why take away public funding to programs for poor people just to provide tax breaks to rich folks? How much is a dollar worth to each individual, relatively-speaking? There are few easy answers, except (almost) everybody wants to see costs lower to the levels they are in other countries. Setting price or profit caps and limits is one method, ensuring the system can’t ask for inflated amounts from insurers is another. This could affect quality of service, but then again, it might not. All stores might charge the same price for some brand name item but not all stores offer equal customer service or trained staff... The same is surely true of medical facilities.

[wyager]

Profit doesn't need to have anything to do with it.

It doesn't make economic sense to spend, as an extreme example, $500M of public money to save one life. If we did whatever medical treatments we could, at whatever cost, we'd go broke as a society very quickly.

Utilitarian optimization places some upper bound on the amount of money we should be willing to spend to save a life. Making people pay for their own care approximates this bound but with more variance.

[bryanlarsen]

It'd be nice if that upper limit was somewhat consistent.

We spend billions per American life saved on terrorism.

We regularly spend $50M / life on infrastructure; hundreds of millions on an overpass over a dangerous intersection to save a handful of lives.

We regularly force companies to spend well over $10M / life on health & safety regs.

Medicaid costs about $800K / life saved.

[RcouF1uZ4gsC]

> Just to provide tax breaks to rich folks

Your statement illustrates one of two competing views. The following statements are extremes of the two positions.

1) The government by default owns all your money, and any money you get to keep after taxes is just a tax break.

2) You own your money by default, and the government should not take your money except to provide things that the market is unable to (some examples of which are law enforcement, military).

Those who espouse one of these views, tend to see people who espouse the other as morally wrong and evil.

[lstamour]

I’ve found most nations settle on: if you’re not making much, keep it. It means more to you. In fact, here’s a few hundred more for sales taxes you might have paid. If you’re making enough to “get by,” we’ll skim off the top and give you tax breaks as incentives. From there it’s a sliding scale up to some cut off. For example: If you’re making more than 3-5x the “getting by,” rate mentioned above, we’ll split it – you keep half, we’ll take half. And again, that’s only on top of other tax breaks, so 50% is an asymptotic upper bound for most people.

I may not like it come tax time, but it makes sense to me. I consider the half I don’t keep another sort of contribution to society. And of course look for ways to minimize it–money doesn’t save itself. But I don’t fight over the concept– I rely on services paid directly from taxpayer money each day. The one thing I would hope for is efficiency– but I don’t think starving and cutting systems inherently improves them. It’s just a shell game.

[nicky0]

Where do you think the money goes? You write as if money is wasted or destroyed when it is spent on treatment.