Of all the interventions they looked at, only two were truly cost-saving: childhood immunizations (a no-brainer) and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were cost-effective, meaning that they cost less than $50,000 to $100,000 per quality adjusted life-year gained.
They’re not against paying for things, just not paying uncapped amounts.
It does sound barbaric, but just take it to the extreme. Is, say, $4M of federal taxpayer money for one quality-adjusted year of life gained a good trade off? Someone has to make that call.
I'm still on the fence about the issue of euthanasia, but I think the Overton window is shifting. In time, I think that debate will make the debate on abortion look cordial.
I think assisted suicide should be legal. But even setting that aside, we spend a massive amount of money on prolonging people's lives for a few more miserable weeks at the bitter end. That money would clearly be better used on patients with better long-term prognoses, but this is unfortunately the stuff that gets people screaming about death panels.
Edit: GenX, not baby boomers.
The youngest Boomer has been past the AARP full membership age for more than 20 years; newly eligible AARPers are in the younger half (nearly the youngest third) of GenX. Plus, AARP offers full membership for free for a spouse without age qualification, and associate memberships for under 50s. Which is to say, there's not a lot of reason to expect that Boomers interested in “joining the club” haven't all done so a long time ago, and are now exiting by death more than entering, while new members are coming from the relative baby bust of GenX.
On the one hand you have an entity which is not born yet and which cannot make a choice.
On the other one, you have someone with vast experience deciding about himself (directly or indirectly via a will).
For clarity, I am completely and strongly pro-choice in both cases.
The first one is strongly faith based and weakly science based (when does life starts?)
The second one is way more objective and somehow quantifiable.
By the way, if we want to "cut costs" we could just blow up the planet and be done with it. No more "costs". What bizarre discussions we are having these days. "Cost cutting" makes sense in narrow(er) contexts, when the goal is clear and various paths to get there are explored, but for societal meaning-of-everything goal setting? If we didn't have health care we would not need to pay for it. That's true for everything ever made by humans. On this planet one person's cost is another persons's income, until we find aliens to trade with.
People already exist (and in huge numbers!) - what do we do with them? They may as well work as doctors and nurses and in the many industries supplying the health care sector. Or they could just hang around and play games, produce meme videos for Youtube, or become insurance agents or financial advisers (but of course, without "costs" somewhere there is not much to invest in... unless we become more of a "virtual society" and just have "money" building and feeding on itself without actual real-world connection).
[0] http://www.imdb.com/title/tt0074812/
[1] https://youtu.be/sax6J8n1AiE
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PS: Completely unrelated issue, just for fun search for "Logan's run" on Youtube, filter by "length > 20 minutes", and check out a few of the many results. You can do that for lots of movies, especially popular older ones. Does it seem like Youtube is overrun by millions (must be millions overall, for all kinds of movies) of fake "movies", hours-long fake movies? Doesn't that waste huge amounts of Youtube storage? Why does Google not do anything about it, ML algorithms should have an easy time finding most of those uploads?
This is done intentionally by studios and fully sanctioned by Google, the intention is to pollute search results of known titles so that users ultimately become frustrated enough to simply purchase the movie.
It's been prevalent for many years now. The files are typically a single image for the majority of the video, so compression should alleviate the storage issue.
These videos are likely very profitable for YouTube if ad-supported, given that they'll take very little data to store and serve.
I doubt the movie studios significantly care about removing them; the videos significantly frustrate pirates, likely causing a slight conversion to actual sales. To note: these results often appear on the ContentID dashboards (causing frustration for the studios), so this may be subject to change in future.
[0] https://torrentfreak.com/fake-pirate-movies-annoy-pirates-an...
[1] http://www.voxindie.org/ywhy-is-youtube-such-a-garbage-dump/
[2] http://www.voxindie.org/why-doesnt-youtube-address-the-real-...
They say that the costs are barely offset by cigarette tax revenue but that doesn't take into account all future tax revenue that would be generated by letting these people live.
The original post that I replied to said but what doesn't make sense to me is that you loose all future productivity and value that these people create.
Most of my cousins -- all female - stayed in my home town because it really helps having their parents around so they can work and not have to worry about childcare because they have their parents.
When I was growing up, my grandfather or aunts would come pick me up if I was sick, take me to doctors appointments, etc. My dad worked in a factory and it was harder for him to get off of work in the spur of the moment and my mom could not just take time off in the middle of the day as a teacher.
I've been married for a little while and have a teenage step son. We never really had extended family that lived around. We had to arrange our lifestyles to give us the maximum flexibility. My wife got a job that would allow here to be on the school system schedule and I have a flexible job that allows me to me work from home, work odd hours if I need to, etc.
We also are fortunate enough to have teenage sons. When we really just can't get to our son in time to pick him up or take him somewhere we just tell him to order an Uber. I wouldn't do that if I had a daughter.
I do see people in similar situations to ours who aren't so fortunate, when they need to take time off of work to deal with family issues, they have to use vacation or sick time or even worse take unpaid time off. If they had their parents around and healthy, it would make their life easier.
I think the trap here is that productivity entails the exchange of hard currency. In some societies activities like childcare, household work, shopping, gardening, etc. are uncompensated labor often done by seniors. Historically, they have also been conduits for preserving knowledge and educating new generations. But things are changing. Seniors' productivity as a cohort today will probably diminish with increasing lifespans, decreasing healthspans, and being a larger proportion of society than has historically been the case.
They can do well as a two income family without having to choose between a demanding to career and taking care of their kids because a lot of them have their parents close by to help.
Even when the wife is pregnant, the husband can still chase after his career without missing a beat because he can count on either his mom or mother in law to move in and help.
Perhaps a useful way of looking at things would be to imagine we had access to a graph of the function from (preventative health care, emergency health care) → life expectancy, and see what it looks like for constant life expectancy.
If you could increase the preventative part by less than you decrease the emergency part, then I think in one sense it's fair to say that preventative care saves money.
You cannot put a pricetag on ones health when other lives depend on it.
Preventative health care isn't prescribed by a Doctor in a world not driven by insurance and pharma.
Western map for edification: https://en.m.wikipedia.org/wiki/Western_culture#/media/File%...
>In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked.
>In the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit from health care — barely offset by the revenue from taxing cigarettes.
So yes, if our goal is to “reduce healthcare spending” letting people die younger, faster would indeed do this.
However if our goal is to “improve quality of life for people at the lowest possible cost” we most likely need to invest in preventative care.
I would like to hear more from the authors on their synthesis.