[Klinky]

Life expectancy estimates are often all over the board and wrong. Imagine it's a close relative who is having the heart surgery. Would you actively try to persuade them to not do the surgery to possibly extend their life because their kidneys might fail later, so they might as well die now because they're not worth the money that would go into the surgery?

It's easy to say a Big Mac isn't worth the cost on the menu, it's harder to say that your mom's life isn't worth the cost.

Keep in mind we're talking purely about economics here, as that is what your post is about. We're not talking about quality of life.

[sp332]

Economically speaking, I think it's fine for a person to spend huge amounts of their own money that way if they want. Also, it's fine if they ask around for friends, family, or even total strangers to finance their health. But forcing people to pay (via taxes) for an operation seems outrageous to me.

[Klinky]

Not really the point I was making. People will go to great lengths and effectively destroy their own life in the pursuit of saving a loved one. This makes it hard to take seriously the concept that a a free market full of economically rational consumers would exist when it comes to costly medical decisions.

It's easy to say "if you didn't want to be poor, you shouldn't have bought that plasma tv or new smartphone", versus "if you didn't want to be poor you should have let your wife die instead of taking a second mortgage out on your house".

Most people do not have a maximum price on something they consider priceless.

[vidarh]

You benefit immensely from society. To expect you to pay some portion of your income to help that society function is not unreasonable, and extensive healthcare is consistently one of the things people in most developed societies see as one of the top priorities for society to spend that money on.

I'd fully support your right to opt out of taxes if you also opt out of each and every benefit society otherwise provides you.

[sp332]

If the government starts paying (at least some) of people's medical bills, there will be a committee somewhere that determines who is deserving of care and who is not.

[vidarh]

If the government doesn't, peoples finances decide who is deserving of care and who is not, which more often than not means an insurance company decides.

Personally I'm far more comfortable with a board under democratic control setting rules based on clinical considerations for whether or not someone is suitable for care, than having someone with a profit motive to avoid paying for my care making that decision.

[sp332]

You're more optimistic than I am if you think that a government committee will be democratic, or that such a committee (democratic or not) would base its decisions on clinical considerations, or that people would not be outraged at rational clinical decisions.

In general, I think this kind of decision is highly personal and dependent on circumstance, and cannot possibly be regulated at the federal level.

[vidarh]

I am optimistic of that because I've lived all my 38 years in countries where all of those are the case for the most part, and where violations leads to lawsuits and heads rolling, resulting in health systems ranked substantially higher than the US, while costing less money per capita (UK and Norway).

In the UK this is handled by NICE: http://www.nice.org.uk/

They conduct appraisals of technology and medicine, and the NHS is required by law to provide treatments that NICE recommends.

The NHS trusts may elect to provide funding for additional treatments, though.

A number of their working groups etc. are open to healthcare professionals, and some are open to patient representatives, carers and lay people. Consultations are open to anyone. On top of that they are accountable to their sponsoring department.

Overall, this system works. You hear people complain about wait times for non-essential treatments, but everyone gets treated.

[bane]

> You're more optimistic than I am if you think that a government committee will be democratic, or that such a committee (democratic or not) would base its decisions on clinical considerations, or that people would not be outraged at rational clinical decisions.

As opposed to the democratic decision that's already being made in board rooms?

[bane]

there already is, and always has been