Single-Payer Health Care: As Goes Canada, So Goes Vermont

The Something Awful Forums > Discussion > Debate & Discussion > Single-Payer Health Care: As Goes Canada, So Goes Vermont

Slobjob Zizek: Jun 20, 2004

Slobjob Zizek fucked around with this message at 00:03 on May 12, 2014

# ¿ May 11, 2014 23:13

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# ¿ May 22, 2024 10:19

Slobjob Zizek: Jun 20, 2004

Toning down the weird, eugenicist overtones, here's the crux of my argument: we spend most of our healthcare dollars on the chronically ill and the elderly. These people are not flukes, they do not suffer from freak genetic diseases or barely survive horrible car accidents.

The quadriplegics and those with cystic fibrosis are who traditional insurance is meant for. They, randomly, suffered bad luck and now, we as a society provided for them (via insurance of some sort, public or private), because we, too, could suffer from bad luck.

Those with non-severe mental illnesses, chronic cardiovascular diseases, diabetes, cancer (in some cases), or old age do not suffer from bad luck, but from social diseases. People are overworked, overfed, overexposed to carcinogens, or simply too old. If we could absolutely cure the aforementioned conditions, great, I'm all for it. We solved the problem we created. Hopefully we came out even.

However, we usually can only merely treat the aforementioned social diseases, instead of cure them. So, more and more people develop chronic conditions and get older as social conditions are not addressed, and we keep dumping money into the medical-industrial complex. It's practitioners are all too happy to take it. And patients are "happy" that they can take a pill instead of change their life or think about the reality of death.

This would all be fine if people had to pay for their own healthcare when really sick. They don't, though (and couldn't afford it anyway). So, if we give carte blanche to every chronically ill/elderly person for their treatment, and stick the tab to those paying insurance premiums (private) or the taxpayer (public), we are essentially making a social decision. And instead of providing universal daycare, subsidizing college tuition, or raising the wages of younger workers, we are dumping ever-increasing amounts of money into healthcare. Is this really the future of the welfare state? Everyone holding on so desperately to life that it isn't actually lived? That's depressing.

# ¿ May 12, 2014 03:25

Slobjob Zizek: Jun 20, 2004

^^^^
Yeah, QALYs are great, but we are prohibited by law to in using them as of now to recommend/not recommend treatments.

My point is that "universal healthcare" is merely insurance and only addresses one side of the healthcare trilemma (access). Cost and quality are ignored. Cost and quality are also mostly ignored by most politicians/political groups for some reason.

GomJabbar posted:

Good luck trying to find out how much something will cost to treat even if it is not an emergency. Hospitals and clinics are some of the most opaque when it comes to prices, with some exceptions.

Or you know, we can dodge the issue entirely by having single payer collective bargaining power like every other country but noooo. That would impoverish publicly traded firms with powerful lobbyists.

What do you mean? Medicare already unilaterally sets prices and private insurers usually reimburse some percentage of that price (usually more).

Slobjob Zizek fucked around with this message at 03:39 on May 12, 2014

# ¿ May 12, 2014 03:35

Slobjob Zizek: Jun 20, 2004

Nessus posted:

You didn't really get rid of the overtones I was talking about.

There are two criticisms I have of this argument of yours.

The first is: Where, exactly, are you going to decide someone has a 'social disease' and is therefore implicitly unworthy of treatment? At what point does my unforeseen disease become something that was not due to a deficiency of bootstraps, but rather an honest accident? As an ancillary question, how are you defining "old age" - is there some point at which you just stop receiving medical care? What is that age threshold, how did you arrive at it, and is it subject to amendment in light of later improvements? I would also point out you are basically saying that someone who has a mental illness outside of a certain threshold needs to just deal with it, and society isn't interested in assisting them (which, in that case, is basically the current situation - but now you've made it explicit!)

The second is the question: Do you believe that the savings from cutting the former, would be applied to the latter? For that matter, do you think that they are mutually exclusive? The resources are there, just not the political will, at least in America.

First, I'm just going to share this chart from a famous study on the opinions of end-of-life care by physicians:

From here: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2389.2003.51309.x/abstract

Second, I'm going to say that we implicitly medicalize all poor states of health in our society (Foucault talks about this for all you leftists), and that instead of imposing responsibility on patients or asking them to examine their values, we tell them we can fix them (or will at least try). Patients are treated like children instead of being responsible for their own health and health choices. Why? Because it's easier and because there are less complaints. Change your life? No, have a SSRI. Stop eating so much and start exercising? No, have some statins and insulin. Face your own mortality? No, try every treatment, no matter how effective.

You can debate whether or not this line of thinking is moral, but it is certainly not cost-effective. If we don't get the outcomes we want, and we spend tons of money on treatment, we are wasting money as society.

Third, no I can't say that savings from healthcare will be spent on something socially useful, but I can say that it might be. It's ridiculous to claim that we must spend money on socially useless endeavors because the alternative is too hard to consider.

Last, you ask about the brightline between diseases we should treat and diseases we shouldn't. This is not an easy question, and will require a societal discussion, and changes in cultural norms. But the reality is that we already have a brightline between spending money on healthcare and not spending other socially useful endeavors. We just never consciously made the choice.

# ¿ May 13, 2014 18:53

The Something Awful Forums > Discussion > Debate & Discussion > Single-Payer Health Care: As Goes Canada, So Goes Vermont