National health care [was Re: Medical technology and cryonics]

Robert Bradbury bradbury at sftwks.UUCP
Thu Jun 4 04:02:04 EST 1992

This discussion started out involving the rights of individuals to spend
their money on cryonic preservation and the degree to which limited research
funds should be spent on cryobiology.  In the bionet.molbio.ageing group there
is a consensus (among some of us) that funds should be spent to reduce
the overall rate of aging, thereby reducing disease incidence and long
term health care costs.  This lead to some discussion of the best way to
allocate health care resources and a debate over who is entitled to them.
This is fundamentally related to the issue of national health care.
To enlarge the audience to non-scientists I am cross posting this in the
hope that people with other perspectives will contribute.   Please delete
the first two newsgroups if the discussion strays too far from ageing and
its costs.

... entering midstream ....

>I wrote:
>>The politicians and the medical community need to start
>>making it clear to people that if we are going to use "public" monies they
>>should be used to provide the greatest benefit to the greatest number of
>>people possible.  However this in no way should preclude individuals from
>>investing/spending their own monies on life preserving/reanimation
>Gordon Banks replied:
>So anyone who is poor and has some rare condition can just go off
>in a corner and die, eh?  

I did not say that.  Anyone who is well informed knows that cost effective
technologies such as prenatal care for people in inner cities and vaccines
are *excellent* uses of public funds.  Every dollar spent on prenatal care
saves about $3.00 in costs for premature infants.  Dollars spent on smoking
prevention reduce long term health care costs many times over.  These all
could be considered providing the "greatest benefit to the greatest number"
and would tend to benefit the "poor" more than the "affluent".

Rare conditions are a sticky issue.  Each and every person probably has
defective alleles and I would hate to think that those of us with the
worst of them would not receive some medical attention.  On the other hand,
if you tell me that we can spend $500,000 to keep me alive 10 years
and as a result 100,000 children will not be vaccinated or 1000 will not
receive prenatal care and as a result a few of them will probably die
prematurely, then I have a problem in saving my life at the expense of others.
Medical treatments should be subjected to cost-benefit analysis with
society deciding exactly how much of their productivity they want to
devote to health care (13% of the US GNP and rising) and people knowing
up front that their illness cannot be treated cost-effectively then, well,
"life is tough".  As it is now we are keeping alive large numbers of people
who don't even know we are keeping them alive or what it is costing us.
This cost is expected to run into the *trillions* in the early part of
the next century while the benefit is virtually zero.

  I challenge all of you who feel that unlimited medical care should be
  a "right" to explain how you plan to pay for it!

>Gordon says:
>Thank you, but no thank you.  The public doesn't agree with you, fortunately.

I submit that if they understood the system and where it is going they
would agree with me.  National Health Care such as is found in Canada
and other countries perform rationing and politically modified cost-benefit
tradeoffs but in many cases these "facts" are not clearly explained.
The doctor simply says, "This isn't treatable" or "You will have to
wait 8 months for treatment" instead of "We cannot afford to treat you."
Proposed/enacted changes to the health care systems in Oregon and Vermont
seem to indicate that people are discussing and deciding that when funds
are limited that 100 of treatment X may be better than 3 of treatment Y.

Gerald Phillips wanted to know how old I am.  The answer is 35.
He also made an extensive case about the productivity of older people
and their value to society and how a large amount of medical intervention
may necessary to keep some people alive.

I agree to a point.  I consider productive older individuals who still have
their mental capacities at their disposal are a vital national resource.
My father is almost 70 and is still teaching.  In a time when the world
is facing so many potential problems we need people who provide the extensive
knowledge and perspective only many years more than mine can offer.
I would offer as a counterpoint the elderly couple who live up the street
from me who as far as I can determine rarely leave their home and spend their
days watching TV.  Now, given the relative contributions made to our society
by G.P. and the couple I mention, do they deserve the same access to the
limited medical resources our society is able to provide?  If you want
the society to provide you with health care then indicate what you are
going to provide to society.  Or are you content to be a leech?
 (Don't flame me on the example, respond to the issue...)  

This is not a problem which can be resolved by changing from a private
insurance based system to a single payer system.  That would result in
a one time savings which will be consumed in 1-2 years by the increasing
numbers of elderly in our society.  The real moral issue here is what
"right" elderly individuals have to transfer the costs of their health
care onto future generations and whether it is just to provide health care
for the elderly at the expense of the young.

Now, unlike some politicians (and other respondees :)) I will propose an
alternative and let you take shots at it.  I would argue that it is
"morally wrong" to require future individuals to pay for youur choices in
life.  I would also argue that it is unjust to consume more than your "fair
share" of health care.  Your fair share would include coverage for
those things which can happen equally to all of us (primarily accidents,
communicable diseases and genetic defects).  These should all be covered
under "national health care".  Many other diseases (most heart disease,
cancer, diabetes) appear to be related to lifestyle decisions (smoking,
lack of exercise, poor diet, etc.) because their incidence shows a high
correlation with the affluence of the country.  For these diseases you
would be lumped into a group of people of similar risks (known as assigned
risk pools in automobile insurance) and insurance costs would be based
on the expected health costs associated with your lifestyle.   You and
the other individuals within these assigned pools could decide how much 
coverage you would be willing to pay for.  If you could "prove" a genetic
cause for these "diseases of affluence" you could receive a reduction
in your insurance payments.  Companies would be prevented from paying
for added insurance costs associated lifestyle risks to allow people to
realize the full costs of their "choices" and have an incentive to
be more concerned about their personal health.

This plan has a number of overall benefits.  If national health care
has to pay for those health problems which can happen to all of us
there would be emphasis on preventing accidents and communicable
diseases and finding cures for the most severe genetic diseases.  Groups
who were assigned to high risk pools would have huge incentives to find
cost effective ways of preventing and treating their "illnesses".
I could envision groups of people with heart conditions forming and
choosing to use less expensive and more effective treatments such
as those proposed and proven by Dean Ornish at UCSF instead of the
current practices pushed by many cardiologists and drug companies.
These groups would be able to command greatly reduced insurance rates.
Ultimately the insurance companies could specialize in the effective
management of specific pathologies by developing cost effective programs
combining patient education with physician specialization which would
reduce the costs associated with these diseases.

This system would "fair", you are covered for "acts of god" but not for
your "addiction" to ice cream, alcohol and TV and you do not get to
put your children into debt.  Personal responsibility for one's own 
health and economic benifits (feedback loops) are built into the system.
The insurance and medical communities are encouraged to become more cost 
effective through competition and innovation.

If you don't like these ideas then offer some other suggestions as to
how you would encourage people to take more responsibility for and
actively participate in the care and maintenance of their health.
Probably over half of our current health care bill is due to the fact
that people have little incentive to adopt behaviors which support their
long term health. 

[This was written last week but news bottlenecks prevented it being posted
 previously.  It may seem out of sequence with of my more recent postings.]

Robert Bradbury			uunet!sftwks!bradbury

Death is an imposition on the human race, and no longer acceptable
				Alan Harrington, The Immortalist (1969)

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