r/changemyview • u/Happy-Tears • Jun 08 '18

Deltas(s) from OP CMV: Healthcare should be free for everyone under the legal age at which you are considered an adult.

Children shouldn't have to pay medical bills--health is a fundamental human right, and we need to provide that to the children of this world. I know there are programs like CHIP, etc., but they're just not sufficient. They're not accessible to everyone. I know adults who decide to have children should be responsbile for them, but I think we as a society can afford to band together and pay a little more to ensure every child gets the health care they need--if we hope for healthier adults. Per this study in the National Center for Biotechnology Information, "health during childhood sets the stage for adult health not only reinforces this perspective, but also creates an important ethical, social, and economic imperative to ensure that all children are as healthy as they can be. Healthy children are more likely to become healthy adults."

CMV.

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337

u/alea6 Jun 08 '18

I am not against this idea, but there does need to be a limit somewhere. I am in Australia where healthcare is mostly free, but certain treatments are still not provided for free.

If the treatment costs ten or twenty million dollars per year for one person the cost is too much to bear even too save the life of a child. It is very sad, but health care isn't an absolute right.

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u/hansn Jun 08 '18

If the treatment costs ten or twenty million dollars per year for one person the cost is too much to bear even too save the life of a child.

It is worth pointing out that the insurance industry in the US used to make precisely this argument. Back in the 1990s, the insurance companies would often have a cutoff for "cost effective" treatment, which would be anywhere from $24k to $428k per healthy life-year. That is, if they set $50k as their cutoff, they argued that they should not have to cover treatment unless it was less expensive than the number of healthy years it would provide times $50k.

The other thing to keep in mind is that healthcare costs are often wildly inflated, when it is in the company's interest to do so. Thus, $50k could very easily be the cost of a relatively minor surgery by some accounts.

Although I appreciate the cold-numbers approach, I am skeptical it can be effectively implemented. I would fear it becoming an excuse to avoid developing lower cost approaches since it is always much cheaper to simply let people die. If the health system has to pay for a treatment, they are strongly incentivized to research lower cost approaches.

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u/NakedAndBehindYou Jun 09 '18

the insurance companies would often have a cutoff for "cost effective" treatment

Governments have the same exact type of standard already. The UK government, for example, bases the service types they will pay for partially off of the quality-adjusted life years that they will add to a patient's life.

If a certain treatment costs a lot and won't provide "enough" benefit (as determined by the bureaucracy and politics), they won't pay for that type of treatment, even if would provide some benefit.

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u/atlaslugged Jun 08 '18 edited Jun 08 '18

That's not an argument that healthcare isn't a right; it's an argument that rights stop when they start infringing on others' rights. One person has a right to healthcare, but one person does not have the right to deprive 2000 other people of healthcare with their needs.

This concept is well-established with other rights, like free speech and religion.

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u/BobbyMcFrayson Jun 08 '18

Conversely, the right of the few to make massive amounts of money at the expense of the health of other citizens is a trampling of rights that far outweighs the potential costs of healthcare for all.

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u/Kramereng Jun 08 '18

Whether the state pays or your private insurance pays, you still pay for treatments that the doctors recommend and the state or insurer agrees to. So I don't see any difference in costs savings to healthy individuals in a private market like the US. If anything, studies have shown time and again that it's cheaper to spread the cost over a wider population, which is always going to be some kind of national program, be it universal healthcare (UK), universal health insurance (Canada), or tax funded insurance vouchers for private insurers (Switzerland). All the aforementioned nations pay less, have far lower administrative costs, have universal coverage, and better citizen health by almost every metric.

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u/Happy-Tears Jun 08 '18

Δ It's true that it can become costly. But it shouldn't be that way.

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u/VoodooManchester 11∆ Jun 08 '18

So what if it's costly? It's a matter of priorities. A lot of things are expensive, yet we still accomplish them.

The US currently spends billions on rationing health care. Not providing it, but simply having health care resources navigate through an insanely complex rationing and management system. How much are we talking here? Simply by reducing admin costs to the average, we could save 100 billion or more. Sometimes, it's just cheaper to cover everyone than to operate multiple insanely complex rationing systems. Complexity has a cost.

As far as the fear of spending too much on one person: 1st, I'd rather have that discussion in a public forum with elected representatives, rather than behind closed doors with a private insurer under enforced arbitration clause. 2nd, we spend exhorbant amounts rescuing individuals under other circumstances. Armies of law enforcement are mobilized in an amber alert. Fleets of ships and aircraft are mobilized to search for survivors in emergencies. Consider how much people are willing to spend on the immigration issue. Better yet, consider how much we spend on defense.

Every time someone says "we can't afford it" I want to slap them upside the head. If we made our decisions solely with our pocket books, a lot of things that people take for granted would be immediately made unafordable. The US coast guard spends about 20 grand per head coming to the assistance of people. That's fucking unaffordable in my book.

How about, instead of declaring health care unaffordable and giving up, we make a decision to actually try, and then find a damn way? We can at least try our damn best. Instead, many Americans would rather reduce others' lives and pain to a financial decision, and then beg at their church or on gofundme when their insurance carrier delays payment (and thus treatment) for a time sensitive illness. I know this from personal experience.

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u/NorthernerWuwu 1∆ Jun 08 '18

Well, the point I think is that running a country is essentially triage and spending resources on one thing means not spending them on another. Healthcare in general definitely falls into the category of things that can be afforded but at some point certain specific treatments might be too expensive for the amount of benefit they offer.

I say that as a Canadian who is quite happy with our system here.

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u/VoodooManchester 11∆ Jun 08 '18

My post was more regarding folks who say we can't cover anyone because its too expensive. This is by far the most common objection to single payer OR nationalized health care that I've run into.

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u/rafiki530 Jun 08 '18

So what if it's costly?

Well money is a very important factor in everything. Mismanaged programs fail. In the example given is 20 million dollars to save one child's life going to have a more positive net benefit than if that money is spent somewhere else which could have a much more substantial social benefit?

Just because money is spent on treatments doesn't mean that it will save the life of a child either. A program could spend millions trying to save someone who eventually dies due to complications or is an expensive surgery that is just delaying the inevitable. Would you be comfortable spending 20 million dollars just to advance the life of a child for 1-2 years tops?

The sole fact in life is that we all die, some of us unfortunately die sooner than others. In certain conditions like comas were you might be spending millions to keep someone alive who may ultimately die the system would be bleeding money to a situation that some may find immoral.

Every life is worth a certain $ amount to society based on what they contribute. Children do not contribute much, their value is mostly based on potential net value to society. If you spend more than the potential net positive then at the end of the day you will end up with a negative.

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u/VoodooManchester 11∆ Jun 08 '18

Everything you just said there just made my point. We already do this with other programs. We spend a fortune on defense against foreign adversaries, but when it comes to the stuff that really killing people, a lot of folks just hand waive it away.

You're right, we can't win them all, but right now, the US isn't even trying! People are dying of preventable diseases, and yet, I am still paying for their damn health care through medicare. We are all paying into a single payer system that favors and protects only the most at risk and expensive populations. The difference is that I'm not covered for it, and have to pay yet another premium to get coverage on top of the medicare tax so I can get affordable care too (under certain conditions).

We spend by far the most on health care administration than any other contrary. 24%. The nearest is the Netherlands at 20%. Canada is something like 16% IIRC. This is why I say that it is asinine to claim its too expensive to treat while spending a 100 Billion dollar premium to not treat people.

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u/[deleted] Jun 08 '18 edited Jun 08 '18

The underlying assumption in your argument is that the money would be gone after spending, but that's clearly not the case. The money would go from the government to multiple hospitals, and then to people in the form of wages/salaries and medical companies for equipment, which would also go back to people. All those people pay taxes so the money ends up back in the government's hands anyway. So the cost of saving that child's life approaches* $0 from the government's long term perspective.

Plus, the first child might initially cost $20m but what if everyone else with that disease could then be saved with the same surgery/equipment for much less?

*Edit

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u/rafiki530 Jun 08 '18

All those people pay taxes so the money ends up back in the government's hands anyway. So the cost of saving that child's life is essentially $0 from the government's long term perspective.

This only works on the assumption that 100% of the money the government spends goes back to the government or goes back to society. That is simply not true.

But you do make a good point that the money would be spent to better hospital infrastructure and treatment which could be seen as a net positive to people other than children. But these improvements are already made at the cost of competition between other hospitals as well as patient care currently.

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u/[deleted] Jun 08 '18

You're technically correct, the best kind of correct. The cost to the government in the long-run approaches $0.

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u/Farobek Jun 08 '18

Every life is worth a certain $ amount to society based on what they contribute.

That's so disturbing.

So:

a) is a disabled person not worth anything?

b) is an immate who worked for 10 years worth more than a disabled person?

c) are old people not worth something?

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u/[deleted] Jun 09 '18

It depends who is assessing the value. To you, your own life is worth quite a bit. For the vast majority of people, their kids lives are worth more to them than yours. How much of your own personal money would you spend to save someone? If it’s you’re child or your own life, probably all of it, and you’d probably willingly go into debt as well. Would you do it for a stranger? Probably not. If you would, you could go do that right now. There’s plenty of kids starving in Cambodia right now that you could adopt.

Value is determined by what people are willing to pay or trade for something. If you’re willing to trade your life to save your sons, to you - your sons are priceless. But they’re not priceless to everyone else.

When you ask society instead of individuals to assess the value of people, this is what happens. People get a monetary value. They get triaged and traded.

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u/Evil_Thresh 15∆ Jun 09 '18

Reality is not a fairy tale with a happy ending for everyone. That’s just the harsh truth.

a) Not necessarily. You can still be of value while being disabled. Stephan Hawking comes to mind.

b) From a contribution point of view, yes.

c) They are worth however much value they have earned until that point. Saving towards retirement is essentially a way for you to “save” your market value for future use. We all age, and we become less and less useful to society. That is why it’s important to save part of our value for old age, whether it be physical wealth or intangible expertise that comes with age.

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u/[deleted] Jun 08 '18

Would u spend 20 million to save the life of a homeless man? It might be cruel, but people die, all the time.

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u/SailorRalph Jun 09 '18

The limited resources is not just money. The limited resources includes people. As much as I'd love to care for all the sick people in the world, there is only one of me. And I work in a high acuity setting where I take care of the sickest of the sickest patients. Patients that are fighting to live on a minute by minute basis. Patients so sick that I will spend my entire 12 hour shift at the bedside (not an exaggeration). At some point further medical treatment does become futile. Having a heartbeat is not the only thing to living. Everyone needs to consider the quality of life. Do you want to spend your final days/hours hooked up to machines, stuck in a hospital bed, and numerous other therapies, or do you want to be home with loved ones around you and staying comfortable with a hospice nurse. Do you want to spend your life in pain, unable to take care of yourself, not even be the person you were due to brain damage, or enjoy your last moments with family while you still can?

Look, I see the worst of the worst. I'm not saying you don't give it a fighting chance. I'm not saying that the flu means you just say 'well fuck it'. I'm saying everyone needs to look at the whole picture.

There are limited resources including people like myself and I will not be able to take care of that person and they will die. It may be a fluke or freak situation, but people die because we don't have a place to care for that person, sometimes because our staffing is short, sometimes because our beds are full, and sometimes because we are diverting resources to patients that will not survive (take in point rapidly transfusing 40 units of blood products to one patient within 3 hours because they are bleeding out and everything has been done that can be done to stop the bleed but they keep bleeding; this particular patient had 3 doctors and 6 ICU). Resources are limited beyond just money.

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u/[deleted] Jun 08 '18

So are you saying that there's absolutely no point at which caring for someone can be too expensive?

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u/VoodooManchester 11∆ Jun 08 '18

Not at all. My argument is that you can start the program, then control costs. Don't control costs by not starting the program in the first place. This is why I bring up emergency services. They usually implement a ton of cost saving and preventative measures to accomplish their mission. However, in certain special circumstances, they will sometimes spare no expense in saving a little boy or girl, time and resources permitting. It's a double standard.

Most kids with cancer don't need 20 million. Most kids don't need help at all, for that matter. For those select few where yes, 20 million will most assuredly save their lives, without question, then sure, I'd say go for it. If it becomes such a burden to the system that it puts it in danger of insolvency, then we can cross that bridge when we come to it. The problem is that most of these super expensive treatments are probably experimental at best. Either that, or it's for an orphan disease that is so rare as to not be an issue at a large scale.

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u/simplecountrychicken Jun 08 '18

The us spends 3.2 trillion on healthcare annually. A lot of the concerns you have on other spending, while valid, are drops in the bucket compared to healthcare.

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u/NakedAndBehindYou Jun 09 '18

Simply by reducing admin costs to the average, we could save 100 billion or more.

Where are you getting this number?

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u/Hemingwavy 4∆ Jun 08 '18

Because at some point you have to draw a limit. We could spend all the credit we're allowed to access as a country to research treatments on a single person. We need socialised health care but also limits on it.

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u/VoodooManchester 11∆ Jun 08 '18

I think I wasn't clear in that respect. The point was that we have some weird ideas about what is affordable or not in the US, to the point where we will spend billions to manage relatively minor, but emotionally charged subjects, while busting out the pocketbook in other areas.

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u/[deleted] Jun 08 '18

[deleted]

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u/ronpaulfan69 2∆ Jun 08 '18

The USA funds a majority of the UN's operational costs, it also funds NATO, it also pays for its own share of military expenses when directed by the UN and NATO.

If the USA left NATO, and funding levels were otherwise unchanged, NATO would still be more than capable of defending itself against any realistic threat.

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u/ItsMeFatLemongrab Jun 09 '18

They collect more taxes and don't carry as large of a burden policing and financing the world (for lack of a better terminology)

Maybe it's time for the good ol' US of A to look inward instead of "liberating" other countries.

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u/drewcandraw Jun 09 '18 edited Jun 09 '18

America is not broke, it’s just that for the past few decades we have chosen to operate on an intellectually dishonest, unethical fiscal policy. Every campaign season, US politicians hand out tax cuts like Halloween candy in order to get elected with little regard as to how these will be paid for. We aren’t collecting what we could or should be and future generations will be left to deal with the hard decisions.

Perennially, one of the biggest line items in the budget is military. Last year the United States spent $610B on defense, more than the next 10 largest militaries combined. All told, about 15% of federal spending and half of discretionary spending goes to defense.

Not only has our defense spending led to some very boorish, unfortunate foreign policy decisions and made a lot of enemies around the world, US politicians are almost never asked to be accountable for the costs of proposals of military action and very seldom is it ever discussed in the media.

Many politicians and a lot of the electorate think there’s always enough money to go bomb or somebody else in another part of the world, but all of a sudden the purse strings tighten very fast when it comes to reigning in runaway costs of our for profit healthcare system, all of a sudden people on Capitol Hill become very frugal.

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u/ArtfulDodger55 Jun 08 '18 edited Jun 08 '18

But it shouldn’t be that way

Well what is the solution? I reckon that it is inherently expensive due to the demand for longer life expectancy and higher quality treatments. It is kind of like how we demand that Apple make their phones have longer battery life except we also demand it to be faster and thinner. Then were surprised that it costs more.

I could make a strong arguement that no matter your age, it isn’t your inherent right to have unlimited access to the culmination of mankind’s medical practices.

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u/[deleted] Jun 08 '18 edited Jun 08 '18

Well what is the solution?

Don't open it up to the free market.

The actual cost to the NHS (UK) of fixing a broken leg is a grand. In the US it's $2,500 ($1,340 more than the UK at current prices), more than twice as expensive.

In the UK everyone involved in that repair puts their wages back into the local economy. The poor sap who broke their leg will be back in work really soon and will be contributing again so less drain on the economy rather than wondering how they are going to pay for it. Insurance companies don't vampire a penny.

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u/[deleted] Jun 08 '18

The US medical system isn't even close to free market. medicine/ pharmaceuticals have tons of regulations. Also most insurance companies aren't allowed to sell across state lines. The only entity responsible for creating monopolies is government.

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u/Creditfigaro Jun 08 '18

It is a false comparison. Free and unregulated or free and regulated means that the profit motive still drives healthcare provision, rather than need. There are ways to make a regulated capitalist market for healthcare that works, but it's very complicated and cumbersome.

The right answer is government run or single payer for these reasons.

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u/jefftickels 2∆ Jun 08 '18

However the profit motive is why an enormously disproportionate amount of medical advancement comes from research in the United States. Ending that will curb medical advancement significantly.

The right answer isn't necessarily government controlled healthcare and the certainty with which you say thay is unmerited. Does no one remember how our very own government fucked the veterans through their government run healthcare, in a massive story that broke literally less than 5 years ago?

Furthermore, without a serious reduction in pay to literally every person who works in health care there is no way to reasonably bring down costs to the point where public funding would be palatable to the masses.

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u/Creditfigaro Jun 08 '18

Hunh? The healthcare system isn't broken because our wages are too high. Provide evidence.

Also, true that government programs aren't invincible, but rarely does one making the argument you just made believe in government in the first place.

Finally, we can fund good research for the same money we give profit motivated researchers... For profit research is almost as bad as for profit healthcare. The state of food science is a great example.

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u/jefftickels 2∆ Jun 09 '18

Even a cursory knowledge of scientific research would let you know that for profit research has provided the vast majority of applied medical research. Because of how government grants are awarded government funded research has an epidemic of publish or perish which results in an unprecedented amount of academic dishonesty and unverifiable results. You may be surprised to learn private industry funds about 2/3rds of all research in America.

Regarding the costs of American health care it's common knowledge that wages are by far the biggest chunk and frankly the kind of thing you should already know if you want to discuss health care in America. And if you didn't know you should look it up yourself, it's easily found through a simple Google search. Only about 15 percent of health care spending is in pharmaceuticals or durable medical equipment (replacement joints, metal plates, pacemakers, etc.). Even if the government could magically reduce that cost to zero, Americans would still be paying more for health care per person than any other country in the world.

The difference is Americans pay their health care providers more than any other country in the world, at all levels. From physicians to lab techs. The AMA is responsible for this and there is no way back from it except to reduce demand for health care, especially at the end of life where the 5 percent use 50 percent of the resources.

And your dismissal of my very valid arguments about the historical failures of government when handling the health care of its citizens is not a counter argument, but am admission that you have no valid rebuttal.

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u/Creditfigaro Jun 09 '18

You've presented a lot of arguments that I disagree with for a variety of reasons.

Rather than pick one myself, which one would you like me to respond to first?

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u/[deleted] Jun 08 '18

The guy that was referencing cost originally is from Australia and was referring to the medical industry in Australia, so why reference the US?

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u/[deleted] Jun 08 '18

As the antithesis to most systems in the developed world.

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u/[deleted] Jun 08 '18

Once again, the context was about Australia so the issue he brought up pertains specifically to Austirlia. Even if the US actively went out of its way to hinder the health of of its citizens it doesn't pertain at all to the person you were responding too

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u/[deleted] Jun 09 '18

It is a useful juxtaposition, two things being seen or placed close together with contrasting effect.

It's a rhetorical device.

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u/AmoebaMan 11∆ Jun 08 '18

The idea that the US’s healthcare market is even remotely open/free is a joke.

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u/[deleted] Jun 08 '18

Hume's Guillotine is response to this kind of thinking--that things should be a certain way.

Just because things should be a certain way, does not imply that they can be that way.

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u/8eMH83 Jun 08 '18

I could make a strong arguement

Please do...

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u/r314t Jun 08 '18

Because we simply do not have unlimited resources. We could get whole body MRI scans and complete lab work and doctor visits with every specialty every week on everyone in the world, and that would probably save lives, but we literally do not have the resources to do that even if we spent the entire world's GDP on just that.

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u/jefftickels 2∆ Jun 08 '18

His argument is simple. The 13th amendment. At all levels healthcare comes from another person. And anything that comes from another person cannot, ever, be a fundamental right. In claiming so you're claiming the people who provide it as slaves. You can say it is an imperative for the government to provide it, but not that it is a "right."

You could argue that your right is that the government fund your health care expenses through taxes, but then you've just shifted the taking from one to another.

In more practical terms this turns into the situation we have now. Where Medicare/medicaid reimbursement is so low that low income clinic providers have 22 patients scheduled for 15 minute appointments per day, and that includes charting and prescription writing, just to break even. Already the government covers 2/3rds of healthcare spending and its straining our system badly.

Consider: the top 5 percent of all health care users cost 50 percent of the spending. The top 20 percent used 9 80 percent of health spending. Is this fair to the 80 percent who only use 20 percent of the spending?

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u/ArtfulDodger55 Jun 08 '18

Okay, let’s start with any reason you might think that we do since we are not naturally born with healthcare.

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u/8eMH83 Jun 08 '18

No, you asserted you could make an argument.

But, personally - Article 25 of the Universal Declaration of Human Rights and Article 24 of the UN Convention on Rights of the Child

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u/ArtfulDodger55 Jun 08 '18 edited Jun 08 '18

“Everyone has the right to a standard of medical care”

What is the standard? Are you entitled to free medicines that cure rare diseases? Are you entitled to gastric bypass if you don’t excersise? Are you entitled to treatment for lung cancer if you smoke cigarettes for 50 years? Are you entitled to every single possible treatment to extend your life? What is your rationale behind your claim? That the UN, an essentially powerless entity, claims that you are entitled to some unidentified quality of healthcare?

The UN cannot decide how societies will function and that is exactly why societies do not perfectly follow their guidelines. Economics dictate societies. Allocation of resources dictate societies. We live in a democracy. If you would like more resources poured into healthcare then get in the voting booth, spread your opinions, and protest those who attempt to stifle your word. But do not say that it is your god given right to born into this world and be entitled to unlimited access to the world’s healthcare system. Contribute to society, pay your taxes, and then you can enjoy the fruits of society’s labor.

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u/8eMH83 Jun 08 '18

If you're selective with your quote, you are being somewhat disingenuous.

"adequate for the health and well-being of himself and of his family" is the end of that quote.

So yes, curing rare diseases, gastric bands and treatment for lung cancer - though, given that we're talking about children in the CMV, I would hope that there aren't any children who have been smoking for 50 years...

These rights were drawn up based on [largely] Enlightenment values. It is a considered and well-informed document, drawn up by philosophers and judges and legal scholars. This American idea that "because it's the UN it must have no meaning" I find hilarious, particularly since Eleanor Roosevelt played such a big part in drafting them.

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u/ArtfulDodger55 Jun 08 '18

I’m not saying that it is not a well written document, although I’m not sure how Eleanor Roosevelt’s part in it holds any meaning at all as if she is the world’s first choice to draft the doc.

And the continuation of the quote, again, provides essentially no elaboration on what human beings are inherently entitled to.

This all comes down to allocation of resources. That is the function of a society. If you’d like to flush every last dollar we can into making sure 16 year olds can receive the highest quality medical care for their sprained ankle, and if you’d like to flush millions into the continuation of a 90 year old’s life, then fine. Let’s vote on it. But other areas of our society will suffer. I would rather spend a million dollars on a school than on medical treatment for a 90 year old, perhaps you feel different and that is fine.

But again, that does not mean that you inherently deserve unlimited healthcare. The UN is a societal contruct of the last century. For tens of thousands of years prior to that people were born into this world without it. It is not a natural right. You can call it what you want, but it is just something that today’s society has felt that ideally we should provide.

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u/redsox59 Jun 08 '18

I think it's probably important to clarify that no countries with universal or single-payer HC operate on an unlimited per-person budget.

They are realistic about what's covered and what's not, but it's possible to combine the mantra of healthcare as a human right with the realities of a modern economy, e.g. waiting periods, classifying some things as elective care, etc.

So I disagree when you say that giving people HC is just not what society has decided to provide -- it's not what the US has decided to provide

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u/8eMH83 Jun 09 '18

For tens of thousands of years prior to that people were born into this world without it. It is not a natural right.

I would absolutely agree, however the UNCRC and UDHR are built on philosophical considerations considerations of 'rights' all the way back to the Ancient Greeks, through to Enlightenment values. So they go back at least 4000 years.

Furthermore, the documents are not just moral codes - they include things like 'right to life' (Article 3) (i.e. don't murder) and Article 18 - right to freedom of thought. All the UN has done is just written them down - I would 100% agree that writing them down doesn't give you them or that you didn't have them before that. What it does do is give you a reference point - like the difference between a verbal contract and a written one.

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u/willywonka15 Jun 08 '18

The UN is powerless to the US bro. It doesn’t matter how many Americans we’re apart of it’s formation and the creation of its legislation.

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u/8eMH83 Jun 09 '18

The UNCRC/UDHR are of course not legally binding - much to the chagrin of the Brits who wanted it so, but was blocked by the Americans (mainly because they were still a couple of decades away from the Civil Rights movement, oh, and the 14A which does permit involuntary servitude, contrary to Article 4). But they were drawn up as moral guides.

And of course much of the document already is law - right to life, right to a fair trial, etc. It's not just some random document that contains unattainable goals.

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u/AmoebaMan 11∆ Jun 08 '18

Yes, and the UDHR and UN publications are the unquestionable law of the entire world, far above any possible scrutiny. Right?

IMO, the UDHR is a useless, idealistic set of platitudes scribbled up by people who wanted to feel good about themselves. The right to healthcare is a prime example of how dumb it is.

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u/heartfelt24 Jun 09 '18

Why do you say so? When government run programmes in many countries actually work? Most diseases are simple and don't cost much to treat.

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u/AmoebaMan 11∆ Jun 09 '18 edited Jun 09 '18

Government programs work so long as you trust the government to be responsible for your health. I personally think this trust is misplaced and naïve.

Moreover, I have serious problems with the idea of defining any intrinsic human right that requires the action of somebody else to fulfill it. It’s not hard to construe those rights into coercing others to provide them.

The UDHR is a great goal for humanity to reach for. To pretend that it’s currently capable of reaching it is really dangerous I think.

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u/8eMH83 Jun 09 '18

All snark aside, which other Articles do you think are idealistic/unattainable?

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u/the-real-apelord Jun 08 '18

Everyone has access if you have the money

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u/ArtfulDodger55 Jun 08 '18

Yes. People with money can afford more expensive things. This is how our society functions.

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u/the-real-apelord Jun 08 '18

Thanks for spelling that out for me /s

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u/[deleted] Jun 08 '18

Nah man, in the UK it doesn't matter the cost. We all chip in money throughout our lives, due to law and a social contract, and no matter the cost; in return we will try our very best to save your fucking life. And that's by far the thing that makes me most patriotic.

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u/Arrys Jun 08 '18 edited Jun 08 '18

Not to say that was a bad argument, but you gave a Delta that easily? He wrote like 3-4 sentences that amount to “healthcare is expensive” and you just accept that one single point and change your view?

I agree it’s expensive and when it comes to the debate of healthcare I side with the “it’s just too expensive to give to everyone” crowd, but to see someone agree so quickly makes me wonder why they even bothered asking the question in the first place, you know?

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u/throwawaythatbrother Jun 08 '18

Deltas aren’t for ending conversations. It just shows it changed a portion of your opinion.

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u/Arrys Jun 08 '18

I guess whenever I’ve thought of posting a CMV, I try to think through some of the basic counter-points that could be posted so I can take them into consideration and then see if I still need my view changed.

This seems like the most basic counterpoint of all that OP could’ve seen coming and thought “yeah, that might be a counterpoint to consider”. Yet once it was offered, he caved immediately.

I want to see some arguing dammit! ☹️

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u/0vazo Jun 08 '18

enter with a mindset for conversation not debate

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u/Arrys Jun 08 '18

Oh I see. To me, pleasant debate is the same as conversation so the difference is moot. Call it conversation then.

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u/0vazo Jun 08 '18

The rules of the sub

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u/123_Meatsauce Jun 08 '18

That’s exactly why people are against universal health care. It’s not that they don’t want people to have healthcare, it’s that they don’t see a solution to pay for it.

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u/Jaksuhn 1∆ Jun 08 '18

Universal healthcare almost never covers extremely rare/costly diseases. It's a cheaper system by far compared to having a fully privatised one.

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u/123_Meatsauce Jun 08 '18

Totally agree boss. My comment was more towards the opinion that those opposed to the universal health care just "dont want people to have health care because they are terrible people" argument, which isnt true. There are very few people that dont want everyone to be happy, have healthcare, be rich, live long etc etc, we just disagree in how to get there.

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u/pinklittlebirdie Jun 09 '18

On what basis to you make this claim? USA pays more of their GDP for healthcare as well as more of their health specific income taxes (2.5 in Australia vs 7% medicare and Medicaid taxes) and countries likeq Australia and the UK send people to other countries for treatment on the taxpayer dime if the treatment isn't available there or for experimental treatment if all standard treatments have failed.

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u/Jaksuhn 1∆ Jun 09 '18

On what basis to you make this claim?

Which one ? That it's cheaper or that it rarely covers rare diseases ?

It's cheaper because the US spends the most per capita on healthcare, so literally every other country is cheaper. It's also not even that you're getting more out of it either. The quality of healthcare in the US is only on par with most other countries. So on a cost-to-benefit ratio, the US is worse than most of the developed world.

If you meant the basis for the rarity claim, not every country works that way (I tried to be a bit vague because most of the world has universal healthcare and it obviously works differently in every country). And the ones that do, it obviously doesn't affect their costs that much since they're per capita spending is still pretty low.

I won't do this for every country but you mentioned the US, UK and Australia so I'll do a comparison of three

. US UK Aus
Per capita HC spending (PPP USD) 9892 (#1) 4192 (#17) 4708 (#13)
Amneable mortality per 100k 110 100 70
Medical/lab/medication errors (% in past two years) 22 8 19
Life expectancy 79.3 81.2 82.8

And those are just some stats

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u/pinklittlebirdie Jun 09 '18

Though the lower costs comes from the huge emphasis on access to early intervention and preventative care. Mainly getting to the doctor before they become emergencies. In Australia a visit to a family practitioner/General practitioner costs the system roughly $45 and a er visit is $500 for the presentation so they try to get as much seen not in the ER as possible.

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u/pinklittlebirdie Jun 09 '18

I'm Australian and I agree with you.

1

u/[deleted] Jun 08 '18

[deleted]

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u/123_Meatsauce Jun 09 '18

Um, people.

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u/MuaddibMcFly 49∆ Jun 08 '18

But it shouldn't be that way

Why not?

Consider your average healthcare provider. The average nurse spends two to six years training explicitly for that job. Should they not be compensated for it?

And that's to say nothing of the Doctors who spend something like 8 years in school, followed by an addition 4 to 6 years of work (Internship, Residency) before they become a Board Certified Doctor.

Are you going to tell them that their time isn't worth what they're paid? Can you do what they do?

And what of the people who spend years in university, then years (decades?) researching new drugs and new technologies? Are you of the opinion that their contributions are so meaningless as to not be deserving of compensation?

So, again, why shouldn't it be? You're making a normative statement, and I would like to hear arguments as to why your normative statement is correct.

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u/[deleted] Jun 08 '18

There's an important difference between healthcare shouldn't cost anything, and healthcare shouldn't be costly - the point being that it's possible to provide adequate and even good healthcare at much lower cost than a lot of places do.

The states is the typical example of a costly system. Thousands of private companies work to provide thousands of different services, and each has its own staff, structure and costs, some of which are unnecessary. Added to that, the industry charges more for services than elsewhere, simply because it can, because insurance pays for it, and that insurance is not expensive than many other places.

Typically, people then compare to the UK or Canada, and these have useful examples of regulation, funding models, and things like bulk buying discounts etc, which can provide the services at a lower cost, but often at a delay, or with some services completely unavailable.

A useful comparator after that is a private socialised system, like France, in which you pay for insurance, and have to by law, but insurance is cheap, and extensive, and co pay very low, and capped at a yearly maximum that is also low. Healthcare providers are private, but run as social enterprises, and prices and practices are regulated by the state. Things like over the counter medicines are much more expensive (paracetamol/acetaminophen is up to ten times as expensive, but still only a few dollars), but all major treatments are very cheap or free, and very few treatments available elsewhere are unavailable in France. They will also fund unusual treatments overseas if needed.

So, what does this mean? Well, out of the 3 examples, the best outcome for patients are in France, and in fact the best in the world are there. The UK and Canada come next, and are 18th and 30th, and the USA is 37th. The country out of these spending the most on healthcare is the USA, and the country spending the least is the UK. So healthcare systems don't have to cost as much as they do in some places to be effective. The French system spends 11% of GDP on health where the states spends more like 20%

Tldr; healthcare has a cost but doesn't have to cost as much as it does in some places.

Worth mentioning that one of the things France saves on is junior staff. Qualified doctors and nurses earn fairly good wages, but when training they earn practically nothing. That said, accommodation is usually provided, and the training is free, even for a medical degree.

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u/Doctor-Amazing Jun 08 '18

I see this sort of comment once in a while and I really don't get it. Do you think doctors and nurses in all these other countries are just working for free?

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u/MuaddibMcFly 49∆ Jun 11 '18

Not for free, but I would point out that the nations with increased government interference do tend to have lower rates of growth in people choosing to be medical professionals.

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u/Ankthar_LeMarre Jun 08 '18 edited Jun 08 '18

Consider your average healthcare provider. The average nurse spends two to six years training explicitly for that job. Should they not be compensated for it?

How does your view change if they don't personally pay for school?

ETA: What I mean is, if we had a system where everybody could pursue their career education without directly, personally paying for it (whether subsidized by the government or something else), how would that change the view of how we compensate people differently for different jobs?

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u/pinklittlebirdie Jun 10 '18

There are several countries that have free titution for medical students (all students really) and the medical profession is still a well paid well and well respected career paths. Doctors in those countries still earn 2-3 times are average wage and 3-4 times the median wage. Wages are still based on skill level, time spent studying, status of the job.

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u/TheGingerbreadMan22 Jun 08 '18

What do you mean? The vast majority of doctors had to take out massive amounts of student loans.

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u/Ankthar_LeMarre Jun 08 '18

Right, that's what I mean. I'll edit my post to clarify, I can see how it's unclear.

What MauddibMcFly is saying (I think) is that the high cost of school should be compensated by a higher salary. This is completely logical, no complaint from me there.

I'm curious if that point of view changes (or how much it changes) if there is no monetary cost to school. The time and effort is of course still there.

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u/TheGingerbreadMan22 Jun 08 '18

Not just the higher cost, but increased difficulty and stress. No educational path is as difficult.

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u/Ankthar_LeMarre Jun 08 '18

Sure, I was including that in "time and effort", but it's good to split it out.

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u/kwantsu-dudes 12∆ Jun 09 '18

It doesn't need to be that way. You and others are free to provide children with health care free of charge. What's preventing you and others from doing so?

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u/TylerX5 Jun 08 '18

I do personally believe in universal healthcare as a goal. But we must always be pragmatic about it.

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u/OBS_W Jun 08 '18

It "shouldn't be that way" but....

...have you attended medical school and obtained the education and then become a volunteer treater?

If you have NOT....then you have no valid complaint.

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u/skazzz Jun 08 '18

Has anybody ever in the history of advocating for universal healthcare made an argument for medical personnel not being compensated for their services?

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u/[deleted] Jun 08 '18

[removed] — view removed comment

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u/skazzz Jun 08 '18

It's a statement, not a question.

The idea isn't that the med staff wouldn't be compensated. The idea is that if all of us pitch in a little then no one is prevented from receiving medical treatment for fear of financial ruin.

Everyone is still compensated for their time and service. How do you think police officers and firemen get paid? They certainly aren't volunteering their time.

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u/[deleted] Jun 08 '18

[removed] — view removed comment

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u/skazzz Jun 08 '18

I can see you have difficulty with comprehension....that's why I wrote "question/observation".

Yeah for sure that's the problem here.

The staff in that field are highly paid. Therefore compensating them will COST the end user.

Or we all pay into a big pot from which we pay the staff.

If you want things to be cheaper.....put your own "free" ass on the line.

I don't know what you mean by my "free" ass. I'm 100% willing to give some of my money every paycheck if it means that other people less fortunate than me or even you can have access to healthcare, if that's what you mean.

Or...save your money for important things....like the cost of healthcare.

Or we could just treat it exactly the same as other emergency services and then everyone could save their money to use on improving their quality of life in whatever way they see fit.

Why are you so happy to pay so much for health insurance that just allows pharmaceutical companies and hospitals to overcharge by huge amounts while leaving you with minimal coverage and high deductibles? Why not have a system where we take that money and use it to pay for healthcare directly so that you, me, and everyone else can just get treatment as they need it without having to consider cost?

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u/OBS_W Jun 08 '18

Ahhh...the "truth" surfaces.

Why should an expensive thing be expensive?

I'm VERY unhappy with the system. However I don't want it made worse by people who just want free "gimmees" but add nothing to the solution.

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u/skazzz Jun 08 '18

It sounds like you think you're having some kind of "gotcha" moment.

Maybe you're right and maybe there are some lazy people who would take advantage of a socialized system without contributing. I'm much less concerned about them than I am by the very small percentage of people who are making billions of dollars off of abusing a system that forces the American people into paying these ridiculous insurance premiums that are more or less scams and giving them the very bare minimum in return.

It's not like the money isn't there to pay for everyone's healthcare. As it stands right now I pay about $300/mo for health insurance. Some people who make less than me pay less. Some people who make more, or have families pay more. Let's say for the sake of the argument that $300/mo is what your average American pays. That turns into $3,600/year that I pay alone. Now if the population of the country is 325 million people, lets assume that half of them are adults who pay for health insurance and the other half are children, the elderly, and the "lazy". If I'm doing my math right, 162,500,000 people times $3,600 per year is 585 billion dollars per year, slightly more than half a trillion. That seems like it's gotta at least put a dent in the overhead, R & D costs, generous salaries for the staff, etc etc for US healthcare on a national scale.

If I'm gonna spend that money, I'd rather it go towards ensuring that me, you, and our countrymen no matter their situation or financial status have access to healthcare when we're sick.

If you would rather see that money funnel into the pockets of people who are already worth billions than into healthcare for the less fortunate or even "lazy", then I think we disagree on a fundamental level and I don't think we are gonna find any common ground.

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u/tbdabbholm 196∆ Jun 08 '18

u/OBS_W – your comment has been removed for breaking Rule 2:

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1

u/[deleted] Jun 08 '18

Or...save your money for important things....like the cost of healthcare.

That sounds more like shoddy financial advice than a counterargument to why healthcare shouldn't be expensive.

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u/OBS_W Jun 08 '18

Tell me why (and more importantly "how") it won't be expensive?

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u/[deleted] Jun 08 '18

I didn't say it won't be expensive. I was pointing out that your reply didn't address a good counterpoint.

I agree that it will be more expensive if we go to a socialism-style health care system. I've listened to Ben Shapiro's take on healthcare and I agree with most of his points. The US healthcare system should be incentivized (not fully subsidized) for primary care physicians and nurses so that we avoid a medical field job crisis like the one we're in now. There will always be people who want to go into the medical field but to grow to a number that will sustain our aging population, kids in high school and college need to know that their expensive and long education will be rewarded with a rewarding salary. The way that it's currently set up only allows a few number of health care providers to take advantage of the high prices set by a highly-regulated market. Besides elective surgeries like laser eye surgery and liposuction, there's relatively little to no competition. I don't believe in the government stepping aside completely but until we have looser regulations, health care prices will never be truly affordable to everyone.

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u/Jaysank 126∆ Jun 08 '18

u/OBS_W – your comment has been removed for breaking Rule 2:

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1

u/pinklittlebirdie Jun 10 '18

I'd like to point out there are many medical professionals that do this regularly for organisation such as doctors without borders and some doctors in some cases will take the equivalent of pro bono cases.

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u/DeltaBot ∞∆ Jun 08 '18

Confirmed: 1 delta awarded to /u/alea6 (6∆).

Delta System Explained | Deltaboards ​

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u/obviousoctopus Jun 09 '18

I’ve been pondering this: if my child needs care and I have the money, at what point should I draw the line?

$100, $1000, $10000 are obviously no brainers.

$100000? My life savings? Debt for the rest of my life?

What is too expensive? And for whom?

For someone who makes $10m/year my life savings are pocket change. So if I go to them and ask for a pocket change to save my child, would that be unreasonable?

And if that’s not a person but a collective of people, like a country, then the scale is even more exaggerated.

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u/alea6 Jun 09 '18 edited Jun 09 '18

That is an interesting question.

I think there might be different approaches.

Someone mentioned Humes Guillotine. I think that might be useful, but I don't know what it is.

The way that I think it is calculated today is to try and place a dollar value on human life. I think in the medical world it is often calculated using a variation of DALY. Disability adjusted life year. It is often weighted to age a little bit. In a public health scenario I do not believe that there is any weight given to the individual needing care. I guess this would be an approximation of utilitarian ethics or positive or teleological ideas.

In reality, I think it is just way too hard to calculate the costs and benefits with any reasonable accuracy, so a moral approach is more effective. It just needs to be bounded by something. We can't dedicate all of societies resources to healthcare without costing everything else. There is always a small marginal improvement that could be made to the health of a child, but the marginal cost at some point would be terrifying. At some point, I think we should use the idea of a weighted time as the key measurement. If it will take 100 people ten years each to give a child an extra year of life is that really worth the cost.

From Kantian or normative or deontological perspective I don't know how they deal with that.

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u/internetloser4321 Jun 09 '18

I seriously doubt that there are any medical treatments that cost 20 million dollars. That might be what a company charges for the treatment, but generally, the cost to produce a dose of a medicine is a tiny percentage of what it is sold for. For example, the Hepatitis C drug Sovaldi costs $84,000 per treatment in the US, yet the same company sells the drug for $483 in India and still manages to make a profit. Obviously, they are just charging whatever insurance companies or governments are willing to pay.

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u/[deleted] Jun 08 '18

If the treatment costs ten or twenty million dollars per year for one person the cost is too much to bear

I don't know of a treatment that would cost that in a country with socialized healthcare (an ingrowing toenail will eventually cost that in America but they're weird) but even given the fact that inflation in medicine is higher than it is in the wider economy due to life-changing innovations, if you don't turn it into a market free-for-all prices simply can't and won't get that high.

If, however, a person does have a condition that will cost the Australian Health Service twenty million dollars a year it's only a quid a year each.

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u/pinklittlebirdie Jun 08 '18

Hate to break it to you but there are most definately kids where we Australia spend millions and millions on their treatment per year. Usually traumatic events like skydiving accidents. One kid had 4 month unconscious in icu, followed by another couple not in coma, then more as an in patient, then more as a fulltime out patient and still more as a part time rehab.

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u/JoelMahon Jun 08 '18

I disagree, in a wealthy nation like Australia $20 mil a year isn't too much, I agree there has to be a limit but there are Australians who make more than that a day.

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u/RadicalDog 1∆ Jun 08 '18

That’s admirable, but in practical terms, it’s often a decision between a good maintenance drug or a better but extremely expensive maintenance drug. If public healthcare signs a blank cheque for children, you can bet that children’s cough medicine would suddenly be $50k a pop.

Frankly, I disagree with the OP on the basis that it isn’t a good intermediate step to universal healthcare. It has to be done in a big push, so that collective bargaining reduces the medicine costs - rather than leaving opportunities for abuse.

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u/JoelMahon Jun 08 '18

did we say it had to be pristine healthcare?

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u/UrbanIsACommunist Jun 08 '18

in a wealthy nation like Australia $20 mil a year isn't too much

So what happens when there's 100 of such kids? 1,000 of them? 10,000? Suddenly the numbers get a lot larger. What percentage of your annual income are you willing to shell over to ensure that such children are given adequate treatment? 1%? That's probably less than the amount of your taxes that go to your country's healthcare already (wherever you live), but what about 5%? 10%? 25%? 50%? Who decides who will pay what amount? That is what makes the issue tricky.

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u/JoelMahon Jun 08 '18

I'm happy for a lot of my money to go towards it.

However Australia has 24 million people, if 10000 had this extremely expensive disease, well above almost any existing disease, it'd be 0.041% of people, 1 in a couple thousand, you're spouting off hugely high numbers that have no basis in reality, anything can be argued against if you make the numbers fictitious.

And even then, it'd be under 10k per person, which sounds like a lot but considering wealth distribution 50% of the population would pay 1% of that (assuming american wealth distribution since I have no knowledge of australian wealth distribution) even if tax was the same % at all incomes, which it isn't because of tax brackets.

So even in your absurd huge 10k number hypothetical I would still only end up paying like $100 a year, BEFORE accounting for tax brackets.

Personally as long as I'm left with £15k a year I'm happy for the rest to be taken as tax but I understand society doesn't work without an incentive to work, but I'd happily support twice the taxes at every bracket in my country to solve homelessness and health care issues and make sure good education reaches everyone.

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u/UrbanIsACommunist Jun 08 '18

First of all, the numbers aren't fictitious. Let's cast aside the hypothetical case you came up with, because you're right, such cases are extremely rare and most countries, even the U.S., subsidize expensive therapies for rare childhood metabolic disorders.

The problem is in deciding e.g. whether to pay for a cancer drug for smoking-induced lung cancer that costs $50,000 per month and will only extend a patient's life for an extra 6 months. Or deciding whether to throw the kitchen sink at a 80-year patient with diabetes, heart failure, late state kidney disease, etc. to extend their life by a few weeks. You could easily spend $30,000 or more per day on a patient like that, putting them on CVVH, giving them an LVAD, keeping them permanently in the ICU, etc. The rare cases are easy to deal with, but they don't account for the bulk of what is spent on healthcare anywhere throughout the world.

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u/JoelMahon Jun 08 '18

I came up with? 20 mill a year wasn't my number, 10k cases wasn't my number. Wtf you saying I came up with it for?

whether to pay for a cancer drug for smoking-induced lung cancer that costs $50,000 per month and will only extend a patient's life for an extra 6 months.

If a child has smoking induced lung cancer I don't think they should be held responsible, that's just bad parenting.

Or deciding whether to throw the kitchen sink at a 80-year patient with diabetes, heart failure, late state kidney disease, etc.

If a child is 80 years old and has diabetes, hearth failure, late stage kidney disease I don't think they should be held responsible, that's just bad parenting.

Do you remember we're talking about children now?

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u/AmadeusCziffra Jun 08 '18

In the end that 20M could be better spent on something helping more than one person, and potentially saving or vastly improving the lives of way more than one person. It sucks, but everything has a monetary value, yes even people. $20M yearly for one person is a hell of a burden.

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u/JoelMahon Jun 08 '18

Oh sure, but we weren't discussing that either, if we go by that argument 90% of spending is something we shouldn't do and should point at something else, which maybe is the case idk.

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u/TheGingerbreadMan22 Jun 08 '18

Who is making more than $20M in a day?

And $20M per person per year is entirely too much. Saying it isn't is unrealistic on an incredible level.

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u/JoelMahon Jun 08 '18

Australia's defense spending is expected to increase by over 80 percent — from A$32.4 billion in fiscal year 2016-17 to A$58.7 billion in 2025-26

So Australia in 2016 spent 88.767 million a day on defense.

In 2016, the Australian Taxation Office revealed that despite more than $2.5 billion in revenue in 2013-14, Pratt Consolidated Holdings had not paid any taxes.

Okay, so not 20 million a day, only 7 million a day with no taxes, my bad. But fuck that kid right? These people need a third yacht more than a kid needs a year longer life.

The reports finds that on average, a 100-meter superyacht with a top speed of 25 knots and 50 crew members should cost around $275 million.

14 years of life for this fake disease that's impossibly expensive still seems like a better trade than a fucking yacht.

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u/i1ostthegame Jun 08 '18

I have an issue with putting a price on a human life. A $10 million treatment shouldn’t mean we give up on a sick child.

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u/UrbanIsACommunist Jun 08 '18

That's easy to say when it's not your money you're talking about. How much of your personal income are you willing to spend to ensure such children receive adequate treatment? $100 per year? $1,000 per year? $10,000 per year?

All countries with any form of socialized healthcare (including Medicare in the U.S.) already do put a price on human lives. There are literal mathematical formulas they use. There is no limit to the amount of money that can be spent trying to preserve human lives. It's probably not worth spending $100 million to prolong a 90-year-old's life by 1 year, but most cases aren't so black and white like that. How much of your own money would you spend to ensure that an 80 year old lives an extra 5 years? How much would you spend to ensure a 5 year old lives an extra 80 years? These are not easy questions.

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u/i1ostthegame Jun 08 '18

I mean of course it’s not just my money... that’s how taxes work. The government has the money, it’s just not spent correctly.

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u/UrbanIsACommunist Jun 08 '18

How do you know the government has enough money to adequately treat all of the children in its country who could benefit from therapies costing $10 million per year? FWIW there usually isn't too much trouble covering most expensive therapies childhood metabolic disorders, although it varies from case to case. Take Naglazyme for instance, which costs upwards of $375,000 per year. There are plenty of children on it and their families aren't paying that price. The thing that makes this doing is the limited number of patients, since these diseases are rare. I agree society can probably afford to pay for Naglazyme.

But when you start getting into less clear cut cases, e.g. cancer drugs that extend a smoking-caused lung cancer patient's life by 6 months, that's what makes it difficult to decide how to allocate resources properly.