[candiodari]

In law school we were always taught that there are no rights. Rights, in practice are nothing but duties, and should be looked at like that.

You have no right to "life, liberty and the pursuit of happiness", you have a duty to not interfere with other people's life, liberty or their pursuit of their happiness. But even that is a negative duty. Positive duties, like paying tax, are more like the right to healthcare.

So this should be looked on in similar fashion. Do you have a right to healthcare ? Well, answer the question : do you have the duty to take care of others' health problems, completely irrespective of how it affects you personally (for instance, what if it takes up 90% of your time, while still not doing much more than slightly prolonging a miserable short life for them ?).

These questions are not so simple and knee-jerk statements like "right to healthcare, period" are not helpful and will do nothing but get us into a lot of trouble.

No country has "right to healthcare, period". That does not exist. For the obvious reason that it simply isn't feasible. Providing a named (but finite) list of treatments and medicine free of charge if diagnosed by a licensed physician is the furthest any country goes. In some cases that list is pretty short.

[hestefisk]

http://jeffsachs.org/2017/06/jeffrey-sachs-america-can-save-...

[candiodari]

I must say, I've read through his points on the CNN website, and I find 2 of them very wrong (capitation, and the shifting of money away from trained doctors into untrained "workers" "aided by computers"). Most others ... perhaps, but I can't see them making a large difference except the ones about medicine.

Capitation brings the insurance industry's incentives (ie. only work with healthy people) away from insurance companies and onto doctors. What is a diabetic to do when doctors just directly refuse to treat them directly (or delay, or ...). And before you say it won't happen because of hippocratic oath, we both know this rule will force doctors to do that for 90% of their time.

For such doctors and facilities getting people with longstanding illnesses that are just going to come in time after time after time and need expensive drugs and treatment, like MS patients (multiple sclerose), is going to be financially debilitating. That's not reasonable and absolutely not what we want.

As for replacing doctors with "workers" (presumably he means not even nurses), I feel like shouting at him. Doctor's salaries are high, but don't represent a decent fraction of expenses. You could give everyone in medicine a 100% raise and the cost would be in the low single digit percentages (2-3%). Let's face it, this is not what we need to save on. And if we are to save on it, let's PLEASE do it the right way: by subsidizing the training of more doctors, not by replacing doctors with idots.

What I keep hearing about US medicine is that 2 things are necessary:

1) legal changes limiting legal liability of doctors (doctors pay 5 digits per month in insurance in some places, money that is paid by patients but is definitely not going to better care). Something like the European system where a doctor can only be sued before a judge if he's found by the local ethics/hospital/national medical/... board (staffed with exclusively other doctors) to have gone overboard.

2) limit the cost of medicine and increase choices (e.g. mandatory licensing, importing of generic drugs, or just outright force the use of a generic alternative if available like a lot of European countries are doing)

This is the only point I agree with Mr. Sachs.

and for a bonus (just for bringing sanity into the system):

3) Outlaw any and all advertising for anything medicinal (something like if it requires a prescription, advertising it = jail time)