The answer to your question is simple. We pay $1,000,000 not to keep one person alive, but because that person is part of a risk pool which only works if it pays out when something catastrophic happens. The pool would quickly fall apart if it could say, "your parents paid in, but we don't think you're worth that much money."

I'm not an expert, but I believe that Obamacare removed lifetime maximums and the ability to deny coverage based on preexisting conditions. Anderson is probably angry that his costs per individual aren't capped anymore. He happened to pick the least sympathetic way to get that message across.

Most likely the added costs he is complaining about are caused by various low cost, high probability events that Obamacare mandates coverage of. When I worked there I had a cheap high deductible plan, which is the sort of thing Obamacare makes illegal.

I don't know of a good way to solve it. I would like to prioritize solid evidence-based decisions as much as possible, but those have a tendency to come across as unfeeling, or worse (one might even gloss such decisions as amounting to "death panels"). I think part of it is that intellectually all of us agree that we cannot spend infinite resources on every possible health problem, but it's difficult to decide that this specific person should not be treated because it's "hopeless" (a gloss for "poor likelihood of success relative to costs"). That would mostly not be babies, but mostly would be a mixture of elderly people (prognosis for nearly anything declines with age) and people with terminal illnesses that are statistically very unlikely to be cured. But even still, difficult to stomach. In part, because it goes against the psychological messages we're sending at the same time, which is that people should never give up hope, etc.

I don't actually know what I personally think about it, given some recent personal experience. One of my friends died a few weeks ago (in his early 30s) of melanoma, which was discovered in Stage 4, and treated unsuccessfully for about 9 months. The prognosis wasn't very good to begin with, given the advanced stage at discovery. Probably, this treatment had little statistical likelihood of success, though redeeming factors included: 1) at a young age, it was at least distinguishable from zero likelihood, and 2) it was part of a clinical trial, so may give some scientific information even if unsuccessful. However in a psychological sense both he and his friends/family seemed to benefit from the treatment, and would have been much less happy with a "not treatable" decision. Enough to be worth the cost, given the low odds of success? Difficult to say, and anyone who tried to say "no" would end up with a tough sell. And yet intellectually I obviously realize that if I were to advocate that we must "pull out the stops" to the maximum extent possible for every sick person, this isn't going to work under any economic system, whether it has a more right- or left-wing flavor.

It is a discussion everyone should have with their family, _today_, before you or your loved ones are not lucid enough to make the call.

I would love to see the healthcare space, along with the government, advocate for these difficult, yet vitally important, conversations.

I assign a utility score of negative infinity to my own death. If the outcome for no treatment is zero percent chance of survival, but the outcome for a treatment that costs some large finite amount C [1] and raises survival chance to epsilon percent chance of survival for some epsilon (nonzero but potentially small), then I would opt for C every time.

This means if there's a way I can convince people to spend a billion dollars to try to cure me, I'd do it. Even if there's a 99% chance I die anyway and it means all that money couldn't be used on a better project, even if successful treatment meant I was in debt to a billion dollars which I could never repay, so I became bankrupt and my entire family would go to debtors' prison for life [2], that's still better than being dead.

Even if I had to kill a healthy child with my bare hands and drink their blood for the treatment [3], I'd still do it even though this scenario results in net negative utility for the human race (one for-sure dead child and one living adult with a 99% chance of dying is clearly a worse outcome than one living child and one dead adult.) Because I'm not interested in the utility of the human race; I'm interested in maximizing my own utility (one percent chance of being alive is still infinitely better than zero percent chance of being alive).

So my advance directive would be "hold at all costs: Liquidate everything, put me through prolonged medical torture if you have to, but the top priority is to keep me alive at any price."

[1] In "costs," I include not just money but my own prolonged pain and suffering; emotional distress of family members; violation of ethical standards; etc.

[2] This hasn't been a real thing for over a hundred years. I guess the modern equivalent is spending your childrens' college fund.

[3] If you believe that life begins at conception, this is basically what stem cell treatment entails.

Get it in writing. Make your wishes known while you are still able to do so.

And regarding [2], some states do have some modern forms of "debtors prison" [2a], at least for fines imposed through the legal system, although are not as overarching as debtors prisons were leading into the modern age.

[2a] http://en.wikipedia.org/wiki/Debtors%27_prison#Modern_debtor...

Likely rather more than that. Your economic contribution isn't your lifetime earnings, but your lifetime value contribution. That's the productivity-of-labor side of the equation.

Your salary/income is (generally) some small fraction of that.

Look up revenues or profits at a company on a per-employee basis for a proxy of this.

Especially coming from this clown, who, if had just paid that out of his annual salary would still have $10M left to party with.

But the bigger question is why we spend so much money to prolong the life of someone who's in their 70s or 80s (and often suffering and in pain) for another couple of years, or even just months.

Yap, it does

> why, in a world with billions of people, we would spend a million dollars to keep just one human alive?

Because part of what makes us, "us" is keeping one human alive. That one human, one baby is someone's baby. If it was your baby, wife, sister, friend, how quickly you'd tell the insurance company and hospital, nah, don't pay for it, let them die. You wouldn't have to pay. That is why you joined AOL maybe and have "great" insurance. For not having to go bankrupt or make such decisions in cases like this.

I can see how someone in a poor country might be offended, but I am offended when a CEO who makes millions of dollars per year says that. Saving those 2 babies was just 15% of his annual salary. You can turn that question around and then ask: "I know it will sound unfeeling but I have to wonder why, in a world with billions of people, many making under $100/month, many sick and starving, we would, as a society even let one single CEO of some washed up Internet company that used to mail stupid cup coasters in CD form, make tens of millions of dollars / year?".

Isn't it the other side of the coin? I think it progresses the discussion pretty well. The profit pool a company makes is a finite resource. Let's talk about that then too if we are going to bring in logic fallacies and game theory into the game.

So let's look at it this way -- You have a thousand employees and $5 million. And you spend $4 million as salary to the CEO and then spread around the rest to everyone else and it only leave $1 million for everyone else. It is a tricky dilemma? Or is it?

What is the sum, for this "0 sum" game? Whoever set up that insurance pool might have been pretty incompetent and stupid for not accounting for such events. I am assuming there is no explosive epidemic of expensive-baby-threatening-diseases amongst AOL employee's families. So there is one person to fire on the spot during a "town hall meeting"

Q2: Would you consider working your rear end off for years on end to pay medical expenses necessary to save the life of your own daughter?

The reason AOL pays these expenses is the same reason it pays its own employees and the same reason those employees spend money on things like "television" and "dining out" and "silicon valley rent" instead of spending it on improving the fate of third world nations. People spend money on themselves and on people they care about!! There is more to life than the welfare state!! And it's a good thing, too, because taxation of an individual's economic output in favor of redistribution damages his incentives to work, and eventually you see the Laffer curve in action and the welfare state isn't doing as good a job of providing for peoples' welfare. (See also: abject failure of Communism, and associated famines).

The part I keep increases my incentive to work.

"You know, I really want that promotion, but since the government is going to take some percentage of the associated raise, fuck it, I quit," said no one ever.

Consider working mothers in two-income families. Consider those who quit work to spend more time with the kids. Do you think that maybe there's one of these women who, if she were granted immunity from taxes and made an extra 50% in take-home pay, would choose differently?

The rest of the reductio-ad-absurdam is left as an exercise to the reader. I'll remind the reader we seem to be dealing with a hypothetical redistribution of such a scope that we must lift the third world out of poverty before we can spend money on our own kid's cancer treatment or whatever.

In all seriousness, it is a challenging question though. The issue of how to spend healthcare dollars wisely is one that as a country we are currently unwilling to address honestly.

It's all a crapshoot.

If parent sounds unfeeling, frankly your post sounds hypocritical. Everyone implicitly makes a decision on how much to give away vis-à-vis spending on less noble things. Parent's not a worse person for acknowledging it.

    Do you give all your disposable income to poor kids?

But while I'd like to see our society become much more altruistic I don't see how we're going to get away from people considering their child to be far more important than a stranger's child. So if you hear from your company that they think some amount of money was too much to pay to keep your child alive, or to keep a coworker's child alive, you hear it as "you're not family to us, you're not special to us, your family doesn't matter".

(Running through all of this is that people, and especially Americans, are really unwilling to think of healthcare as a system of trading large-but-finite amounts of money for better health. Any sort of statement like "we should not be willing to spend $X to keep one person alive" makes people very upset for even considering the tradeoff, even though there must be some sufficiently high level of $X at which it doesn't make sense.)

FWIW, I do give a significant portion of my "disposable income" to World Vision. Be careful next time you call a stranger a hypocrite.

It was the "we" part that got to me. We don't spend millions of dollars on every human, we (as a society) don't need to. But we do spend that on the few humans that it does cost millions to keep alive. There are a lot of research projects that costs millions of dollars to keep going, and often they find breakthroughs that influence other areas.

And I wasn't really disparaging him. He said himself that he thought it might sound unfeeling. To me, it did.