Hacker News new | ask | show | jobs
by sp332 4782 days ago
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.
2 comments
vidarh 4782 days ago
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.

link
bane 4782 days ago
> 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?

link
sp332 4782 days ago
It doesn't have to be democratic because it's not using the public's money.
link
bane 4782 days ago
oh I see, so long as people are killed by private money it's cool.
link
sp332 4782 days ago
Oh, so as long as people are "killed" democratically it's cool.

Nobody's killing anybody. People die. It happens. Maybe someday I will have a heart attack. On that day, I'm not going to rob somebody at gunpoint and demand they give me $33k. Equivalently, I'm not going to have the government threaten fellow citizens with jail time and garnished wages if they don't pay their taxes to pay for my treatment. And I'd appreciate it if they'd extend me the same respect.

link
bane 4782 days ago
You know what? You're right. Fuck it. People die. Let's not even bother. Let's cut out the police department, the military...even if you did have the money, why bother? You're just going to die.

Why bother eating right or exercising? Fuck, why not just off ourselves and save all the hassle.

There's absolutely no difference amongst the different kinds of things people can die from, especially ones that are easy to fix and ones that we can't do anything about.

link
sp332 4782 days ago
There's absolutely no difference amongst the different kinds of things people can die from, especially ones that are easy to fix and ones that we can't do anything about.

Hey, we actually came back to the point, kinda! There's a lot of things you can die from that fall in between "easy to fix" and "can't do anything about it". Where you draw the "fuck it, people die" line is hugely variable between different people, and it's not something you'll find a shred of consensus on across the 300,000,000 people in the USA. It's better for people to negotiate coverage with individual hospitals (and voluntary charities) than to have standards of care dictated by a central authority.

link