[oconnor663]

I'm curious about this thought experiment when people are discussing the pros and cons of user pays:

> Imagine that in 2019 someone invents a perfect artificial heart, which has zero risks or complications, reliably giving 5 or 10 extra years of life to typical elderly patients with heart issues. The downside is that it has to be made out of a giant diamond and so it costs $100 million. How do we decide who gets one?

The point is that somewhere down the line, as our opportunities to spend money on medicine grow and grow (which by itself is a good thing!), we have to come up with some way to draw the "user pays" line. It might be that people with a "fuck you got mine" attitude want to draw the line a lot lower than everyone else, but that's not the same thing as believing that the line exists at all.

[batiudrami]

It's an okay thought experiment but I don't think it's especially valuable when the reality is closer to "we take an additional 1-2% of your taxable income in return for people being confident that they can go to the hospital if they need to". Which is where we're at, not $100M hearts.

Of course there are issues with it. Government inefficiency, people taking up GP time when they don't need to, over-prescription pushed by drug reps as the government pays for it etc. But comparatively I think it's a small cost to pay for avoiding poor people dying because they can't afford to go to the hospital.

[oconnor663]

That is where we're at, but the word "exponential" makes me worry that it won't be where we're at for very long.

[batiudrami]

I think we're likely to cap out on a quality of life front before it becomes genuinely affordable. Bodies still break down over time, even if we're able to prolong lives a little through modern medicine.