[bell-cot]

A much deeper & wider-ranging article that I'd assumed from the title.

Though I don't see anything on whether "the cost of keeping me alive" should include a "...under America's dysfunction and greed-centric health care system" clause.

[analog31]

Right. This issue is mixed up with whether keeping the health insurance industry alive is worth the cost.

[giantg2]

It seems people are disagreeing with you, maybe because your statement is short and seen as political. However, you do have a valid point. Even in socially funded systems there has to be a cutoff on what care will be funded and what will not based on the views of society and the potential costs vs benefits (including probability of sucess).

A very interesting example on how social views influence healthcare decisions and costs can actually be seen in the US system via the Amish communities, the church health funding, and their views on medical interventions.

https://slatestarcodex.com/2020/04/20/the-amish-health-care-...

[bell-cot]

Actually, I was thinking more of "$X per month to keep me alive in the US" vs. "$X/4 per month to keep me alive in $Medical_Tourism_Destination"...would that change the answer to "is it worth it?". (In some cases, for some people, & other obvious caveats.)

[derbOac]

> there has to be a cutoff on what care will be funded and what will not based on the views of society and the potential costs vs benefits (including probability of success).

It goes even further than that though, when you start to allow for the full force of real-world economics.

These types of discussions (end-of-life economics, life value) tend to make these idealistic assumptions, that actors (providers, payers) are rational and acting in the best interest of the patient against the constraints of reality. Often like the essay, this is probably accurate.

Where it gets messy, as the OP is pointing to, is when you start admitting that sometimes providers, payers, or other individuals or entities don't have your best interests in mind, are irrational, or something else. Canada, for instance, has a socialized health care system, but also has evoked a lot of criticism for scenarios where individuals seem to be counseled into euthanasia apparently because they're lower SES, or to avoid state responsibilities (not to pick on Canada, or to argue for or against their health care policies, only to point to it as an example of potential problems that arise).

We have enough problems accurately valuating lives while people are alive and healthy; doing so with passive or active killing (for lack of a better term) raises even more economic and ethical issues. We tend to think of people as fixed unchanging objects that can be perfectly measured, which is far from the case. I have acquaintances that I can think of, for instance, that spent years doing lower-paid jobs before getting into, and then graduating from, medical school. What is the value of that person and how should we valuate it at any given moment? Are standardized tests a perfect or even, really good, measure of ability? Not really. Why is someone's life situation the way it is? Is there something else that could be done?

In my opinion, before discussions of "life value" have any traction, there has to be an equally skeptical discussion about the value of those valuations to the entity doing so, and why. What incentives do the "valuators" have in making that valuation? Often in the US we even talk about incentives to providers and so forth for artificially prolonging life and providing pointless care, but incentives can just as easily work the other way too.

In a lot of ways this is what's meant by "you can't put a value on a human life". Clearly there's a lot to that statement, but I think in part it reflects the starkness not of death but everything wrong with the processes by which we value people in general.

[s1artibartfast]

in the US, almost nobody has your financial interests in mind.

Individuals want the most expensive care when they are sick, because costs are distributed over their insurance pool. Insurance companies want the most expensive care, because profits are capped as a % of expenses. PBMs make money on the difference between list price and rebates. Lastly, manufacturers obviously want to sell for the highest price.

I honestly think that if you asked most people with 6 months to live if they would prefer care or to give their children 500k, they would choose the latter. When it is saving other people 500k, they dont.

[refurb]

If that's what you got from the article you clearly missed the most important point.

[bell-cot]

Adding ~1K words of "I agree with X...Y is a good point...Z is really interesting...I didn't know W..." to my comment felt like a poor use of time.