Why people are afraid of universal health care

[Loren Pechtel]

Morality should be included in all economic discussions. By pure economic standards, we would just kill all prisoners who get a life sentence. Incurable disease? Kill the patient. Disabled child requiring lifetime care? Kill the child. Slavery? Sure!

I'd prefer to address this via ethics rather than morality.

For most of my life, I supported capital punishment. I still have no moral objection to the death penalty in some very particular situations. At heart, I still think it's more compassionate for both the prisoner and the public to execute those who would otherwise be held without liberty for their entire remaining life. You know why I support LWOP? Because it actually costs less than the various options the US uses for execution. That's the only reason.

I have one problem with no death penalty: it means there's little incentive for the lifers to behave.

Thus I support the death penalty in two cases: 1) A life sentence on top of a life sentence. You're already serving life and you do something that would get another life sentence. 2) Those too dangerous to keep. You're doing life, your supporters do something that would warrant a life sentence to try to free you, your sentence is promoted to death.

Incurable diseases that can be effectively managed are certainly no reason to euthanize the patient - but terminal disease, especially ones that cause either immense pain or significant cognitive deterioration? Those I 100% support a person's right to choose to end their own life with support and compassion. I think it's an absolute travesty that we treat our pets with more care and dignity than we do humans.

Yup--there are a lot of things which can't be effectively managed. The deniers always say pain can be controlled--but it's not always pain. And I saw my father at the end--the pain was controlled but at the cost of the ability to form long term memory. What life can you have when you can't remember anything? (Not that he would have been in a state to consent to euthanasia at that point.)

For most situations, parents are happy enough to care for a severely disabled child. But there may also be instances where an infant is so disabled that they won't have any meaningful quality of life, and requiring that their parents must suffer twofold seems to lack compassion. It's certainly not something I would support being used with abandon, but I also don't think it should always be disallowed. I'd prefer that such decisions be made prior to birth whenever possible. Consequently, that means allowing for medically justified terminations of pregnancy after viability, which I fully support.

Yup, as far as I'm concerned quality of life can be negative. It's tricky to prevent abuses but I consider "never" to be an abuse so there is no scenario with no abuse, all we can do is seek to minimize it. And note that the current situation means that there are people who choose suicide while they still have some quality of life left because they know that at the point they would choose to exit they won't be capable of it.

 

[Loren Pechtel]

IIRC some economist did a calculation, based on observed tradeoffs, that the U.S. government valued a citizen's life at $6,000,000, the Japanese government valued a citizen's life at $60,000, and the Vietnamese government valued a citizen's life at $600.

Life insurance pretty regularly applies a dollar value to a person's life. For some people, they purchase universal life while they're young, with COL inflators etc, and end up in a pretty good spot. Most people get their term life through their employer... and then the value of your life is some multiple of your annual wage.

Disagree. Life insurance is about replacing your contribution to your family, not about your value. I have nobody financially dependent on me so I have no life insurance. Does that make my life worthless?

 

[Loren Pechtel]

Where does your morality fall on putting tens of thousands of people out of work because you've intervened to eliminate an entire sector of the economy? Where does your morality fall on figuring out how to fund UHC, and which people are harmed by increased cost burdens that they would be faced with in the form of taxes they don't currently pay?

The buggy whip manufacturers would like to have a word with you about the first part of this.

 

[Loren Pechtel]

In my experience, much of "new" drug development consists of finding ways to make a bioequivalent molecule to an existing 'blockbuster' medication, that has sufficent differences from the original so as to persuade the regulators that it doesn't infringe the patent.

This can be anything from making a new molecule that fairly well duplicates the active segments of the original, creating a new drug in the same class, which may have subtly different effects on patients; To finding a way to make an anhydrate of an existing drug, which while it is distingushable in the lab from the original, is biologically identical, as exposure to living tissue immediately causes it to absorb water and convert to the patented formulation.

Every actual breakthrough makes for some copycats but if you don't spend the money you don't get the breakthroughs, either.

 

[Loren Pechtel]

No nation on Earth spends as much per capita on healthcare as the USA, and no OECD nation has such a low life expectancy for each per capita dollar spent.

That’s the inconvenient truth that billions of dollars are spent to conceal, despite being as plain as black and white.

We could save a whole bunch of money as a country if we 1) stopped funding the vast majority of research for new drugs and treatments that the rest of the globe benefits from and 2) stopped subsidizing the cost of drugs for the rest of the planet and 3) stopped counting abortions and miscarriages against our life expectancy calculation.

What we should do is say that manufacturers have to offer us the best deal. It can be offered to others at the same price, but not at a lower price. The market could fix things.

And what are you talking about with abortions/miscarriages with life expectancy??? Since when are they counted? We do have a big counting problem but it is with infant mortality vs stillbirth. The combined category [infant mortality, stillbirth] shows a far more regular pattern than either by itself. That says that the line between them isn't as clear as is claimed.

 

[Loren Pechtel]

What the fuck laws do you think I support?

I’m assuming you haven’t changed your mind? Still need a law against optional late term abortion?
Why? Or did I misunderstand you?

You've been willfully misunderstanding me from the beginning.

Perhaps my comprehension is lacking, as is yours regarding my “willfulness”.
Absent a more comprehensible articulation of your position, telling me my understanding is defective doesn’t contribute to improving it.

I've told you what my position is repeatedly. And you've mischaracterized it repeatedly. And it's not like I haven't provided a well-articulated position on the topic.

I'll go through it again... but bear in mind that my patience is nearly at an end with this.

I support the exact same abortion policy that was in place prior to RvW being overturned: Fully elective terminations within the first two trimesters; terminations on the basis of medical need in the last trimester, based on the health of the mother or the viability of the fetus. I think that's an entirely reasonable position to take, because in that last trimester infants are generally viable outside the womb with medical assistance. At that point, it's no longer a blob of cells, it actually is a baby.

I do NOT support any complete bans on abortions. I merely want limitations on third trimester abortions. Anything that would endanger the mother's life would be a reasonable exception to that limitation - as it was throughout the vast majority of my life, and presumably yours.

We don't have good indications of problems with third trimester abortions. We have big problems with politicians trying to backdoor ban abortions. Thus, while in general I agree with you (but I would put the dividing line at 7 months) in practice I would prefer an absolute line that the politicians can't touch it.

 

[Loren Pechtel]

Your position as written above is that we shouldn't have laws that address very rare occurrences... even though that was exactly what the law was until RvW got overturned. You assert that such laws have dangerous and detrimental unintended consequences, even though they did NOT have dangerous and detrimental consequences for the 50 years that it was in place.

Both you and Elixir are arguing that a return to what worked very well and was widely accepted for 50 years isn't feasible or reasonable.

Furthermore, you both insist on pretending that I support a BAN during the third trimester, which is not what I have said, and it's a willful mischaracterization of my position.

Before the QOP started chipping away at abortion there wasn't a problem. Now there is.

The problem is you seem to be arguing for something more strict than Roe without specifying the specific problem.

 

[Bomb#20]

This is true, but it's not the whole picture. Part of the reason the U.S. pays so much per unit health improvement, and the other OECD countries pay so little, is that the American people's expenditures are massively subsidizing health care consumption in the rest of the world. The U.S. does a disproportionate share of medical research, because the crazy-ass prices we pay incentivize it. All the countries with cheap medical care are free-riding on a train of innovation that would dry up if America adopted those countries' models. In exchange, our sick people tend to get newly invented treatments first. Is that a bargain worth making? Depends on point of view. Just be careful what you wish for. ...

USA is not the only country that does medical research, so that part of your argument is massively wrong factually.

What Emily said -- which part of "disproportionate" didn't you understand? But the case is even stronger than that -- we'd still be subsidizing the whole world's sick people even if every other country were doing its proportionate share of the research. What, you think a British company doesn't have its eye on the overpriced American market when it's considering whether to invest in developing a pharmaceutical, or a procedure, or a test, or a medical device?

Plus American research is very inefficient as they always pad costs tremendously.

True, but padding costs is a necessity given the regulatory system. If a company couldn't pad the costs of drug A to recover the billion dollars it spent trying and failing to get drug B approved it'd go broke, unless it magically knew up front which drug was going to pan out. (That's not to say a better system isn't possible. I'm sure one is, and I hope some country comes up with it one of these years and takes over the job from us.)

 

[Elixir]

I would prefer an absolute line that the politicians can't touch it.

So would I.
Aborting a viable fetus is a terrible thing.
But not even close to how terrible it is to slowly and painfully kill an actual person.
And THERE IS NO ABORTION RESTRICTION POSSIBLE THAT WILL NOT BE USED BY EVIL RELIGIOUS TYPES TO KILL INNOCENT WOMEN.
Abortion laws don’t benefit anyone, they just kill people. Even third trimester “restrictions”.

 

[Emily Lake]

Morality should be included in all economic discussions. By pure economic standards, we would just kill all prisoners who get a life sentence. Incurable disease? Kill the patient. Disabled child requiring lifetime care? Kill the child. Slavery? Sure!

...
Slavery? I suppose no post is complete without a leap into absurdity, so I guess I shouldn't be surprised.

All those are the most economical ways to pay the least money support society, unless you include morality.

Who are you defining as "society", rich slaveholders? All slavery does for the majority of free members of society is provide them an opportunity to kill and die for a bunch of draft-exempt leading citizens. "Rich man's war, poor man's fight." as the saying went. Slavery is not an economical way to support society even if you don't count the slaves as part of the society. It's economically inefficient. Adam Smith was an abolitionist fifty years before it became a popular movement, and not only for moral reasons -- in his book he explained why slavery detracts from the wealth of nations that practice it.

That's all well and good but it didn't stop the practice.

That's a really weird thing to post.

Abolitionist writings, from both moral and economic perspectives, contributed to a shift in beliefs that ultimately led to the end of slavery. I mean, it's not like Martin Luther nailing stuff to a door stopped the practice of Catholicism either... but it definitely contributed to a major split within Christianity. And I think we'd all have to agree that saying "It's all well and good that Luther did that, but it didn't stop the practice of Catholicism" is a pretty short-sighted thing to say, and comes across as rather obstructive.

 

[T.G.G. Moogly]

Abolitionist writings, from both moral and economic perspectives, contributed to a shift in beliefs

More likely a shift in beliefs contributed to abolitionist writings. Abolitionist writings are simply part of the shift. Lots of factors caused that shift but I don't think abolitionist writings were one of those causes.

 

[Emily Lake]

True, but padding costs is a necessity given the regulatory system. If a company couldn't pad the costs of drug A to recover the billion dollars it spent trying and failing to get drug B approved it'd go broke, unless it magically knew up front which drug was going to pan out. (That's not to say a better system isn't possible. I'm sure one is, and I hope some country comes up with it one of these years and takes over the job from us.)

So... about this...

A significant portion of the primary research into novel drugs is done by universities, and paid for by government grants. Companies will pick up rights to drugs that are promising based on that initial research. It's not uncommon for the very earliest trials to be conducted at a university, and a company only picks it up after it's passed that phase. Pharma companies aren't funding the core research; US taxpayers are.

 

[Emily Lake]

IIRC some economist did a calculation, based on observed tradeoffs, that the U.S. government valued a citizen's life at $6,000,000, the Japanese government valued a citizen's life at $60,000, and the Vietnamese government valued a citizen's life at $600.

Life insurance pretty regularly applies a dollar value to a person's life. For some people, they purchase universal life while they're young, with COL inflators etc, and end up in a pretty good spot. Most people get their term life through their employer... and then the value of your life is some multiple of your annual wage.

Disagree. Life insurance is about replacing your contribution to your family, not about your value. I have nobody financially dependent on me so I have no life insurance. Does that make my life worthless?

One might argue that it makes your life financially worthless... but money isn't the only measure of worth. The obligation to your family and your creditors is the only thing that can have a financial value placed on it. All of the rest is emotional value.

 

[Emily Lake]

Where does your morality fall on putting tens of thousands of people out of work because you've intervened to eliminate an entire sector of the economy? Where does your morality fall on figuring out how to fund UHC, and which people are harmed by increased cost burdens that they would be faced with in the form of taxes they don't currently pay?

The buggy whip manufacturers would like to have a word with you about the first part of this.

Did buggy whip manufacturers all get forced out of their jobs in the space of just a couple of years by an intentional act of government?

 

[Emily Lake]

We don't have good indications of problems with third trimester abortions. We have big problems with politicians trying to backdoor ban abortions. Thus, while in general I agree with you (but I would put the dividing line at 7 months) in practice I would prefer an absolute line that the politicians can't touch it.

I'm open to some reasonable negotiation about where to place that line. But like you, I do think there should be a line. And politicians should, in my view, have no investment in that line - it's sole purpose is to define the stage at which a fetus is considered to be a human life rather than a lump of cells. For anything before that line, the government is prohibited from interfering, and the decision is entirely up to the mother (and whoever she decides to take advice from). After that line, the government still doesn't get a say, but it does need to be medically justified.

That later period termination would be similar in concept to assisted suicide. A ban on late period terminations would make it so that any doctor and mother having that abortion would be considered to have committed murder. Similarly, if assisted suicide is banned, any doctor who helps a patient end their life is considered to have committed murder. Limitations on late gestation terminations would do nothing more than require that there's a medical justification for it - if there is no medical justification then it is tantamount to murder. Likewise, when assisted suicide is not banned, it still requires medical justification - if there's no solid medical reason for a doctor to euthanize a patient then it's just plain murder, even if the patient really wants to die.

I see these two situations as very similar.

So to the rest of the thread participants, I have two questions:

1) A healthy person with no terminal illness and no significant pain comes into a doctor's office and says "hey doc, I don't want to live anymore". The doc says "alrighty then" and pumps them full of fentanyl until they overdose. Do you consider this to be murder?

2) A healthy mother comes into the doctor with a healthy fetus at 8.5 months into a pregnancy, there's no risk to the mother's health or wellbeing, there's no deformity or health risk for the infant. Mom says "Doc, I changed my mind, I don't want to have a baby anymore". Doc says "No problemo" and aborts the infant. Do you consider this to be murder?

If you gave different answers to those two questions... what do think makes them meaningfully different?

 

[Emily Lake]

Your position as written above is that we shouldn't have laws that address very rare occurrences... even though that was exactly what the law was until RvW got overturned. You assert that such laws have dangerous and detrimental unintended consequences, even though they did NOT have dangerous and detrimental consequences for the 50 years that it was in place.

Both you and Elixir are arguing that a return to what worked very well and was widely accepted for 50 years isn't feasible or reasonable.

Furthermore, you both insist on pretending that I support a BAN during the third trimester, which is not what I have said, and it's a willful mischaracterization of my position.

Before the QOP started chipping away at abortion there wasn't a problem. Now there is.

The problem is you seem to be arguing for something more strict than Roe without specifying the specific problem.

I'm not though - I'm asking for exactly what Roe was! What do you think is different?

 

[T.G.G. Moogly]

Did buggy whip manufacturers all get forced out of their jobs in the space of just a couple of years by an intentional act of government?

That all depends on what your definition of "government" is? I find it quite refreshing that you did not say "the government" when you responded.

 

[Elixir]

Did buggy whip manufacturers all get forced out of their jobs in the space of just a couple of years by an intentional act of government?

No, they were forced to change the market they were trying to address.
How many years do you think insurance industry parasites professionals need? It’s not like we’d be outlawing insurance.

 

[Elixir]

Your position as written above is that we shouldn't have laws that address very rare occurrences... even though that was exactly what the law was until RvW got overturned. You assert that such laws have dangerous and detrimental unintended consequences, even though they did NOT have dangerous and detrimental consequences for the 50 years that it was in place.

Both you and Elixir are arguing that a return to what worked very well and was widely accepted for 50 years isn't feasible or reasonable.

Furthermore, you both insist on pretending that I support a BAN during the third trimester, which is not what I have said, and it's a willful mischaracterization of my position.

Before the QOP started chipping away at abortion there wasn't a problem. Now there is.

The problem is you seem to be arguing for something more strict than Roe without specifying the specific problem.

I'm not though - I'm asking for exactly what Roe was! What do you think is different?

I’d be happy with reinstatement of Roe JFTR.
But even those few “restrictions” do not do anything useful IMO, and in this climate I’m not at all sure they couldn’t be leveraged by religious extremists to mess with people’s reproductive health. But it would be a YUUUGE step forward to get us back where we were.

 

[bilby]

Where does your morality fall on putting tens of thousands of people out of work because you've intervened to eliminate an entire sector of the economy? Where does your morality fall on figuring out how to fund UHC, and which people are harmed by increased cost burdens that they would be faced with in the form of taxes they don't currently pay?

The buggy whip manufacturers would like to have a word with you about the first part of this.

Did buggy whip manufacturers all get forced out of their jobs in the space of just a couple of years by an intentional act of government?

The British Coal miners did.

Do you think there should still be coal mining jobs in the UK?

The suffering in the major coal producing areas was incredible - I grew up with it, and myself spent several years unemployed in Yorkshire, as a direct result of the massive labour oversupply it caused, when hundreds or even thousands of people were applying for a single vacancy.

In the short term, it was a massive disaster. The Soviet Union was sending food aid to families in Barnsley. The implementation of the change was deliberately cruel, for political reasons.

But the unintended long-term consequences were a great global good - indeed, the shutting down of coal mining should be a priority for governments worldwide, if the long term consequences for humanity as a whole were our primary concern.

It may be one of the responsibilities of a good government to provide an economic environment wherein any unemployed person who wants it can obtain paid work, and perhaps even to provide education and training to make unemployed people more employable, when the economy shifts such that their previous skills are redundant.

It is not the responsibility of government to keep open industries that are no longer required, or that increase prices without adding value to customers, or that are only economically viable because of massive externalisation of costs, just because those industries employ a lot of people.

A transition to UHC would doubtless render vast numbers of medical insurance workers redundant - they already are redundant, but the current system keeps them doing their work that at best achieves nothing useful for patients, and at worst makes patients worse off.

Whether that mass loss of employment turns into a disaster, is dependent on how it is managed, and what is done to ensure that alternative and more useful jobs are made available for this surplus labour, and what is done to assist those surplus workers to become qualified for those alternate employment opportunities.