[Chrysostom]

What does it mean to have "healthcare"? Every day I hear someone say that "healthcare is a human right," but I have no idea what they mean by "healthcare." If you have access to aspirin and penicillin then you've got more "healthcare" than just about everyone in the history of the human race, but obviously no one is even nearly satisfied with that (these things, after all, are as affordable as McDonald's), so what does "healthcare" really mean?

My suspicion is that "healthcare" just means "access to medical technology" (and accompanying personal services -- doctors, nurses, etc.). But medical technology can do just about as much as we can pay for. The reason that medical costs have gone up so much in the last few decades is not that evil corporations somebody is hiking up prices to squeeze money out of people, but rather that medical technology is able to do exponentially more than it could a few decades ago and people are trying to make use of that capability as much as they possibly can.

Under the view that healthcare is access to medical technology, then, you reach two conclusions. First, it is impossible to actually have "healthcare" as such because it is always possible to have more technology and service; there is no one "healthcare" that I may have access to, but rather there are only quantities of it. Second, because "healthcare" is something that is measured by quantity, at some finite point we finite beings must deny access to it.

So then, is this what "healthcare" is and must be, and therefore any talk of "universal healthcare" is simply naive? I think that that is what is actually the case: "healthcare" is just another consumer good. But what else might "healthcare" be? And how would that look?

[BillSPrestonEsq]

Originally Posted by Chrysostom

What does it mean to have "healthcare"? Every day I hear someone say that "healthcare is a human right," but I have no idea what they mean by "healthcare." If you have access to aspirin and penicillin then you've got more "healthcare" than just about everyone in the history of the human race, but obviously no one is even nearly satisfied with that (these things, after all, are as affordable as McDonald's), so what does "healthcare" really mean?

My suspicion is that "healthcare" just means "access to medical technology" (and accompanying personal services -- doctors, nurses, etc.). But medical technology can do just about as much as we can pay for. The reason that medical costs have gone up so much in the last few decades is not that evil corporations somebody is hiking up prices to squeeze money out of people, but rather that medical technology is able to do exponentially more than it could a few decades ago and people are trying to make use of that capability as much as they possibly can.

Under the view that healthcare is access to medical technology, then, you reach two conclusions. First, it is impossible to actually have "healthcare" as such because it is always possible to have more technology and service; there is no one "healthcare" that I may have access to, but rather there are only quantities of it. Second, because "healthcare" is something that is measured by quantity, at some finite point we finite beings must deny access to it.

So then, is this what "healthcare" is and must be, and therefore any talk of "universal healthcare" is simply naive? I think that that is what is actually the case: "healthcare" is just another consumer good. But what else might "healthcare" be? And how would that look?

In most people's vernacular, "healthcare" boils down to the highest standard of care, scientifically possible.

Now, take for example, the current state of affairs. My wife saw a nurse spend literally over 250k on a homeless woman whose position was hopeless in the SICU.

The issue is people of this coming generation feel they have an inherent right to the very best, for free. However, healthcare is not free by any means. There are physical and ethical costs to every treatment. The other factor is hospitals are going under. They are losing money. Somebody shoulders the bill for that homeless woman. There are 2 options to lower cost. We lower the standard of care or we increase the cost of medical care to all. Neither are good. Pick your poison. Currently, nobody pays that 250K, and the hospital eats it. To keep their doors open, you help defray her cost slowly.

[JerryLove]

Originally Posted by Chrysostom

What does it mean to have "healthcare"?

Access to a reasonable medium of medical intervention.

If you have access to aspirin and penicillin then you've got more "healthcare" than just about everyone in the history of the human race, but obviously no one is even nearly satisfied with that (these things, after all, are as affordable as McDonald's),

Funny note: penicillin is not available without a perscription, which requires a visit to a doctor, which is far less affordable than McDonalds... so it's actually a good example of needed and not universal healthcare.

But medical technology can do just about as much as we can pay for.

Funny thing, I hear a lot of the right saying tat abortion is more important than the economy... that human life is beyond value.

So what is an adult life worth? Or, for that matter, a child?

The reason that medical costs have gone up so much in the last few decades is not that evil corporations somebody is hiking up prices to squeeze money out of people, but rather that medical technology is able to do exponentially more than it could a few decades ago and people are trying to make use of that capability as much as they possibly can.

My grandmother once got charged $20 per-pill for Tylenol, which the manufacturer provides to the hospital for free.

The doctor my GF works for charges $9000 (and is talking about raising his prices) for a surgery that he makes a profit on at what Medicare pays ($1200).

A MRI, that costs about $25 in Japan, costs hundreds (or thousands) here.

Many medicines are far cheaper in Canada, despite drug companies making a profit there.

Some of what I pay to a hospital is to offset expensive emergency care for those who cannot pay. It would cost me far less to pay for preventitive coverage for them.

First, it is impossible to actually have "healthcare" as such because it is always possible to have more technology and service; there is no one "healthcare" that I may have access to, but rather there are only quantities of it. Second, because "healthcare" is something that is measured by quantity, at some finite point we finite beings must deny access to it.

At what point would you cut the funding for the medical treatment of a president (say Reagan after he was shot)?

When do you stop paying for a soldier's medical care?

I'm fine with limiting guarenteed healthcare to that level.

So then, is this what "healthcare" is and must be, and therefore any talk of "universal healthcare" is simply naive? I think that that is what is actually the case: "healthcare" is just another consumer good. But what else might "healthcare" be? And how would that look?

There are some inconsistancies in your position, if I assume some things about your answers to the above questions. If you do answer them consistantly, it would make you the exception not the rule.

I suspect that most on both sides don't have a nuanced answer. Like porn vs art "they know it when they see it". Few want to provide the homelss with botox, but few want kids to die because they had to choose between penicillin and eating dinner.

[Chrysostom]

Originally Posted by JerryLove

Access to a reasonable medium of medical intervention.

What is "reasonable"? I'm saying that there is no such thing.

Originally Posted by JerryLove

Funny note: penicillin is not available without a perscription, which requires a visit to a doctor, which is far less affordable than McDonalds... so it's actually a good example of needed and not universal healthcare.

I guess I'm spoiled, because I just cross the border and buy it in Mexico. But, okay, let's say it costs you $150 for a bottle of decent antibiotics, which is a fair estimate if you have no insurance. (At least where I live? I don't know if this is geographically relative.) You were just cured of a disease that would have killed anyone in almost all of history for just $150.

Originally Posted by JerryLove

Funny thing, I hear a lot of the right saying tat abortion is more important than the economy... that human life is beyond value.

So what is an adult life worth? Or, for that matter, a child?

That's exactly my point. This view of healthcare is inherently utilitarian and therefore requires that basic questions be literally unanswerable.

Originally Posted by JerryLove

My grandmother once got charged $20 per-pill for Tylenol, which the manufacturer provides to the hospital for free.

The doctor my GF works for charges $9000 (and is talking about raising his prices) for a surgery that he makes a profit on at what Medicare pays ($1200).

A MRI, that costs about $25 in Japan, costs hundreds (or thousands) here.

Many medicines are far cheaper in Canada, despite drug companies making a profit there.

Some of what I pay to a hospital is to offset expensive emergency care for those who cannot pay. It would cost me far less to pay for preventitive coverage for them.

This looks like an extremely long rabbit hole that would take the thread off-course. If you disagree that the increased expense is primarily due to increased consumption, then let's just take that as an unarguable block and move from there. When I wrote it I though I was offering an uncontroversial premise, since I've seen it repeated by all sorts of economists, including self-declared liberal apologist, government healthcare-proponent, and recent Nobel Prize winner Paul Krugman. If what is relevant to my argument is controversial to you then let's just move on from there.

Originally Posted by JerryLove

There are some inconsistancies in your position, if I assume some things about your answers to the above questions. If you do answer them consistantly, it would make you the exception not the rule.

I suspect that most on both sides don't have a nuanced answer. Like porn vs art "they know it when they see it". Few want to provide the homelss with botox, but few want kids to die because they had to choose between penicillin and eating dinner.

I'm saying that "both sides" operate on the same view of what healthcare is and on that view are forced to deal with basic questions that are unanswerable.

[bravesfan007]

Originally Posted by Chrysostom

The reason that medical costs have gone up so much in the last few decades is not that evil corporations somebody is hiking up prices to squeeze money out of people, but rather that medical technology is able to do exponentially more than it could a few decades ago and people are trying to make use of that capability as much as they possibly can.

You are one of the few people that I have seen that seems to even notice this fact. I have a few friends who have argued for universal "healthcare" (as you say), but they fail to state what a competitive healthcare system has got us this far.

I know this post may have been a little off-topic because it didn't really answer your question, but just wanted to throw out that point.

[JerryLove]

Originally Posted by Chrysostom

What is "reasonable"? I'm saying that there is no such thing.

I argue merely that it's argueable. Much like the requirement to feel threatened as a "reasonable person" to plead self-defense, or taking "reasonable precation" against causing an accident.

Just because it takes guidelines rather than a dictionary to define doesn't make it fictitious.

You were just cured of a disease that would have killed anyone in almost all of history for just $150.

And if you pay for universal healthcare with your taxes, you will still enjoy a standard of living equally elevated above history... yet here we are arguing it.

That's exactly my point. This view of healthcare is inherently utilitarian and therefore requires that basic questions be literally unanswerable.

But we answer them every day.

When it's your money, assuming you have it to spend, you still make the same judgements. When do I give up on mom's life-support? What is fixing this back pain worth?

This looks like an extremely long rabbit hole that would take the thread off-course. If you disagree that the increased expense is primarily due to increased consumption, then let's just take that as an unarguable block and move from there. When I wrote it I though I was offering an uncontroversial premise, since I've seen it repeated by all sorts of economists, including self-declared liberal apologist, government healthcare-proponent, and recent Nobel Prize winner Paul Krugman. If what is relevant to my argument is controversial to you then let's just move on from there.

Since you choose to put in some support for your argument in addition to the "let's move on", I'll agree only if I get a trading shot. Healthcare in Germany costs half what it costs here, and less still in Japan.

I'm saying that "both sides" operate on the same view of what healthcare is and on that view are forced to deal with basic questions that are unanswerable.

Unanswerable or just disagreed upon?

If the latter, let's start with common ground. As proof of my claim that the GOP doesn't want to stop abortions, I point out that they have not offered up measures which would be accepted by their opposition (bans with health exceptions), even though that would lower abortions.

Similarly, though we may not agree completely on what might constitute "reasonable" (if we agree in pricniple that providing "reasonable healthcare" is good), we can find some minimalist grounds on which we do agree.

For example, do you think that the millitary should provide a soldier with antibiotics if he has an infection? I suspect "yes", so I think there's one point of consensus. We could move from there.

[Chrysostom]

Originally Posted by JerryLove

I argue merely that it's argueable. Much like the requirement to feel threatened as a "reasonable person" to plead self-defense, or taking "reasonable precation" against causing an accident.

Just because it takes guidelines rather than a dictionary to define doesn't make it fictitious.

I do understand that some things are easily to pinpoint and other things are more indefinite, and I'm sensitive to that. Words like "reasonable" are always toward the latter side. But I'd say -- "reasonable" to do what? Under the conception I'm dealing with I'd suggest that what's going on is not merely healing the sick but "curing" us of all discomfort and even mortality. (This is why hospitals are set up so much like temples.) And because there is no end of possible discomfort or mortality, there can be no limit to what is "reasonable."

Originally Posted by JerryLove

And if you pay for universal healthcare with your taxes, you will still enjoy a standard of living equally elevated above history... yet here we are arguing it.

I'm not particularly arguing about universal healthcare. I'm just talking about "healthcare."

Originally Posted by JerryLove

But we answer them every day.

When it's your money, assuming you have it to spend, you still make the same judgements. When do I give up on mom's life-support? What is fixing this back pain worth?

They are questions that we answer, but I don't think that they're questions we answer well if we have in mind the understanding of "healthcare" that I outlined above. It's like when a villain in a movie asks whether he should kill your son or daughter -- it's a question that, when push comes to shove, you may have to answer, but it's not one that you ever answered well.

Originally Posted by JerryLove

Since you choose to put in some support for your argument in addition to the "let's move on", I'll agree only if I get a trading shot. Healthcare in Germany costs half what it costs here, and less still in Japan.

Parting shot acknowledged.

Originally Posted by JerryLove

Unanswerable or just disagreed upon?

If the latter, let's start with common ground. As proof of my claim that the GOP doesn't want to stop abortions, I point out that they have not offered up measures which would be accepted by their opposition (bans with health exceptions), even though that would lower abortions.

Similarly, though we may not agree completely on what might constitute "reasonable" (if we agree in pricniple that providing "reasonable healthcare" is good), we can find some minimalist grounds on which we do agree.

Let's back the train up for just a second. I completely agree that the GOP doesn't want to stop abortions. If it did it could end the vast majority of abortions overnight without having to get a law passed -- adoption. But I'm not quite following your line of thought from there. Let me try to trace it:

According to its abortion rhetoric, the GOP should view life as either beyond or of infinite value. This should mean that any expense should be worth it to save a human life. But of course, it isn't willing to go to any expense, so it's gotten into a big mess. Is that what you're saying?

Originally Posted by JerryLove

For example, do you think that the millitary should provide a soldier with antibiotics if he has an infection? I suspect "yes", so I think there's one point of consensus. We could move from there.

I'm assuming you would put the "guideline" as something like this: It prevents death and is fairly cheap and extremely effective.

Okay, I can understand those. But what about, "It prevents discomfort"? What about, "It extends lifespan"? Start getting into those -- which I think is inevitable under the view of "healthcare" I'm talking about -- and there will never be an end to the questions.

And when we're talking about cost and effectiveness, what do we say about R&D? How much money do you put toward R&D? Because we know that that is a bottomless pit -- enough R&D can never be done, because there will always be some other discomfort, some longer lifespan, some potential threat of death. So while it might be possible to answer a bunch of questions today, if we're going to have a good definition of "reasonable" we've got to have some vision for the future. We've got to know what we should try to make "reasonable" tomorrow. And that trajectory is something that you can't pin down.

[Chrysostom]

Maybe it would be more fruitful to just summarize that post as follows:

1. I think it's certainly possible to give some good exemplars, such as aspirin and antibiotics, that would uncontroversially fall under the "reasonable" umbrella, but I don't think it's possible to give good limitations on what is "reasonable." By converting human health into monetary units we're pushed up against the fact that there is no monetary value high enough to outweigh life, therefore there can be no limit to what is "reasonable." Instead, when we limit healthcare spending we are necessarily making a bad choice, even if it is necessary. (Again, should the villain kill your son or daughter? You do make a choice, but it's necessarily a bad one.) But we have to limit healthcare spending, meaning either that we'll have to be wrong or we have to think of "healthcare" in a different way.

2. But even assuming that we can say what is reasonable today, the criteria that can get us there won't give us a trajectory for tomorrow. Aspirin is cheap, effective, and stops stuff that matters, so it's pretty easy to say that it's reasonable. But what do we develop for ten years from now? How much expense is reasonable? Things that are cheap today were impossible or unbelievably expensive twenty years ago, and it cost a whole bunch to develop the products and the infrastructure for producing them cheaply, so what is reasonable to invest for the future? This question, I think, doesn't have the seemingly intuitive answer that the former (viz, what is reasonable today) does.

[Bryan]

Originally Posted by Chrysostom

I do understand that some things are easily to pinpoint and other things are more indefinite, and I'm sensitive to that. Words like "reasonable" are always toward the latter side. But I'd say -- "reasonable" to do what? Under the conception I'm dealing with I'd suggest that what's going on is not merely healing the sick but "curing" us of all discomfort and even mortality. (This is why hospitals are set up so much like temples.) And because there is no end of possible discomfort or mortality, there can be no limit to what is "reasonable."

reasonable would be bypass surgery or a pacemaker, unreasonable would be an artificial heart. Come on man, it's not that difficult, the only people who try to make it difficult are those who oppose universal healthcare.

[Chrysostom]

Originally Posted by Bryan

reasonable would be bypass surgery or a pacemaker, unreasonable would be an artificial heart. Come on man, it's not that difficult,

I seriously and honestly don't see why. Are you saying that this person who will die without the heart is worth less than money? Or is it that you are being forced into making what is really the wrong decision?

Originally Posted by Bryan

the only people who try to make it difficult are those who oppose universal healthcare.

It's not so much that. Krugman (whom I mentioned earlier) is very supportive of universal healthcare and makes basically the same argument.

[JerryLove]

Originally Posted by Chrysostom

According to its abortion rhetoric, the GOP should view life as either beyond or of infinite value. This should mean that any expense should be worth it to save a human life. But of course, it isn't willing to go to any expense, so it's gotten into a big mess. Is that what you're saying?

According to the "life is sacred and must be protected" axiom expoused by "pro-life", some effort greater than none should be expended to promote continued life.

1. I think it's certainly possible to give some good exemplars, such as aspirin and antibiotics, that would uncontroversially fall under the "reasonable" umbrella, but I don't think it's possible to give good limitations on what is "reasonable." By converting human health into monetary units we're pushed up against the fact that there is no monetary value high enough to outweigh life, therefore there can be no limit to what is "reasonable." Instead, when we limit healthcare spending we are necessarily making a bad choice, even if it is necessary. (Again, should the villain kill your son or daughter? You do make a choice, but it's necessarily a bad one.) But we have to limit healthcare spending, meaning either that we'll have to be wrong or we have to think of "healthcare" in a different way.

I think when people say "healthcare", they mean "some healthcare". I might go so far as to say "reasonable healthcare".

"healthcare" is "things that promote health". In this instance, it refers to medical intervention aimed at bringing your condition toward nominal (few believe botox is "healthcare").

Not everyone will agree on where the limits of "reasonable" are, and not everyone will agree on where the line between "health" and "vanity" lies... but there's certainly some consensus ground.

2. But even assuming that we can say what is reasonable today, the criteria that can get us there won't give us a trajectory for tomorrow. Aspirin is cheap, effective, and stops stuff that matters, so it's pretty easy to say that it's reasonable. But what do we develop for ten years from now?

Then we change the standard to reflect the conditions.

How much expense is reasonable?

One of the more controversial questions. Ho much expense is reasonable for the millitary? What is a human life worth?

Despite the rhetoric, it has a real numeric value... though what that value is varies.

If the US could "save the world" for $1, would you support it? I suspect so.
If $100-trillion might save one person would you support spending that? I don't think any of us would.

Where in between we draw the line is complicated.

Things that are cheap today were impossible or unbelievably expensive twenty years ago, and it cost a whole bunch to develop the products and the infrastructure for producing them cheaply, so what is reasonable to invest for the future? This question, I think, doesn't have the seemingly intuitive answer that the former (viz, what is reasonable today) does.

And that change is why the question is here. It's one reason that UHC wasn't an issue 200 years ago, and why every industrial countr except the US has it now.

[BillSPrestonEsq]

Originally Posted by Bryan

reasonable would be bypass surgery or a pacemaker, unreasonable would be an artificial heart. Come on man, it's not that difficult, the only people who try to make it difficult are those who oppose universal healthcare.

why would one be unreasonable and the other reasonable. (Especially given the stats on bypass surgery)

Let's say for example that someone were to say, make an artificial heart that was less expensive than bypass surgery with greater effectiveness. (My older brother has seen proposals to do just that actually, to design an inexpensive artificial heart, in the same way he was involved in the inexpensive functional prosthetic leg project. (There are aesthetically ugly options with functionality of those that cost $8 to produce for example. I got the numbers from him, he is a biomechanical engineer)

Say someone succeeds at making an artificial heart that costs less than a current pacemaker. (and I bet this will be in our lifetime if it doesn't already exist) What makes this less reasonable than bypass surgery, which often does nothing to increase longevity or quality of life according to a study I read.

[Danny]

What does it mean to have "healthcare"? Every day I hear someone say that "healthcare is a human right," but I have no idea what they mean by "healthcare." If you have access to aspirin and penicillin then you've got more "healthcare" than just about everyone in the history of the human race, but obviously no one is even nearly satisfied with that (these things, after all, are as affordable as McDonald's), so what does "healthcare" really mean?

To me, the definition breaks down into two distinct segments: preventive care, and emergency care.

Preventive care is pretty simple: It is access to products and services which help to prevent serious problems from occurring. This includes regular checkups and counsel from a doctor, and access to certain preventive medications (blood pressure and cholesterol medication, smoking cessation aids, etc.) as recommended by a doctor.

Emergency care is equally simple: It's access to prompt corrective action after **** hits the fan. Surgery, wound dressing, diagnosis and treatment of illnesses, etc.

Preventive care is a lot cheaper than emergency care in many situations (cholesterol medication and good advice on lifestyle changes is a hell of a lot cheaper than coronary bypass surgery, and a prescription for Chantix is a lot cheaper than chemo), and allowing access to the former will dramatically decrease demand for the latter, freeing up more money and resources to be utilized for the latter when it is necessary.

And furthermore, although it may be outside the scope of this discussion, the practical real-world evidence is heavily in favor of this. Countries with single-payer healthcare which includes preventive care enjoy higher life expectancy numbers, lower rates of preventable illnesses and health conditions, and (and this is definitely beyond the scope of discussion here, but still worth mentioning at least in passing) overall higher quality of life and better economies.

And when we're talking about cost and effectiveness, what do we say about R&D? How much money do you put toward R&D? Because we know that that is a bottomless pit -- enough R&D can never be done, because there will always be some other discomfort, some longer lifespan, some potential threat of death.

R&D is an area where the U.S. is doing pretty well, with the exception of funding restrictions for stem-cell research (which will be lifted as soon as Bush leaves office, as his veto pen is the last remaining road block on that front). Keeping it at current levels is sufficient, as far as I can tell.

I'm assuming you would put the "guideline" as something like this: It prevents death and is fairly cheap and extremely effective.

Okay, I can understand those. But what about, "It prevents discomfort"? What about, "It extends lifespan"?

This is the difference between preventive care and emergency care. The first scenario - penicillin for an infection - is emergency care. Preventive care will automatically lead to higher life expectancy and be cheaper than treating problems after they occur. As far as treating "discomfort" goes, you have to define "discomfort," which can get fuzzy.

[Bryan]

Originally Posted by BillSPrestonEsq

why would one be unreasonable and the other reasonable. (Especially given the stats on bypass surgery)

Let's say for example that someone were to say, make an artificial heart that was less expensive than bypass surgery with greater effectiveness. (My older brother has seen proposals to do just that actually, to design an inexpensive artificial heart, in the same way he was involved in the inexpensive functional prosthetic leg project. (There are aesthetically ugly options with functionality of those that cost $8 to produce for example. I got the numbers from him, he is a biomechanical engineer)

Say someone succeeds at making an artificial heart that costs less than a current pacemaker. (and I bet this will be in our lifetime if it doesn't already exist) What makes this less reasonable than bypass surgery, which often does nothing to increase longevity or quality of life according to a study I read.

i guess I should have noted (and I was thinking this) that some point in the future, artificial hearts will be reasonable and some new experimental medical treatment will be unreasonable.

Option A is accepted and common and approved for use, this would be reasonable.
Option B is still experimental and hasn't been proven to be effective or safe.

[BillSPrestonEsq]

Originally Posted by Bryan

i guess I should have noted (and I was thinking this) that some point in the future, artificial hearts will be reasonable and some new experimental medical treatment will be unreasonable.

Option A is accepted and common and approved for use, this would be reasonable.
Option B is still experimental and hasn't been proven to be effective or safe.

I think artificial hearts are pretty normal. I know several people who have had them have gone to my wife's unit. Usually, her patients are not upper crust OC. So I think they might have reached that point. But thats the thing with drawing lines, its always moving.

My brother works in fields where they do things you would not believe. weird experimental stuff, but thats where our treatments that get mundane come from.

What is and is not reasonable changes on a daily basis.