One person did say “pain” (or quality of life) may be hard to measure. Not only is it entirely subjective, it leaves the plan entirely defenseless against hypochondria. And not only full-blown hypochondria, but any variant thereof.

People respond differently to stress. A car accident may put one person in the hospital for a night, and another in a wheelchair (or with a cane) for 30 years.

So we need them to feel their pain, too. We don’t want to penalize them for being healthy (pay for health). I agree that rewarding the healthcare system when people are sick is also dangerous, so perhaps a blended approach is warranted.

-Carl

You might be surprised; the government can do many things more efficiently than industry ever can, because the government is not required to seek profit – so it doesn’t have to include the inefficiencies whose only goal is profit.

Of course, it needs other reasons to avoid inefficiency – which typically happens when it’s forced to be open and transparent. (Again, something industry never does …)

But when somebody has the job of choosing who lives and who dies, that person has too much power to suit us. So we have to hide how it happens. Sometimes the choice is made by a woman with a high-school education working in a windowless office building in chicago, who’s supposed to apply an insurance company’s guidelines and who has a degree of flexibility within the general guidelines that spending has to stay in reasonable bounds. She decides individual cases based on a few lines of coded medical information and a company database and her quota. Will your treatment be disallowed? Nobody knows until she pushes the keys. If you’ll die without treatment you can sue and hope you don’t die before the court resolves the issue.

We certainly don’t want to have a known individual who can make that choice and have it be final. If he cuts off the care you need to survive, what would you offer him to restore it? What would your wife and daughter offer him? Don’t go there.

Possible solutions include — project the costs of new treatments before you finish developing them, and defund the ones that will be too expensive. Keep careful statistics on alternative treatments and promote the ones that are cheaper but work just as well. Perhaps there could be subtle encouragement for that sort of thing — like, MDs who discover cheaper treatments that work just as well get a fraction of the savings for their further research, but MDs who discover better treatments that are more expensive get nothing but praise. Fund public health approaches to improve the public’s health. Promote hospices for people who’ve already enjoyed as much medical care as they can stand. Etc.

Admitting that we are telling people to go off and die, we don’t think they’re worth keeping alive, is mostly workable only during popular wars. We could have told old people they needed to take their chances just like the boys at the front during WWII. We can’t be so blunt today.

When I was in Alabama I heard about some chain letters. One of them worked very well — instead of just sending money to strangers and hoping other strangers would send you money, they had a deal where you recruit 2 people and get each of them to give you $50 and you watch them mail $50 to the guy at the top of the list. You tell them that when they recruit 2 people they get their whole investment back and all the money they get from strangers is just gravy. Lots of people bought into that. I told a med tech why it was bogus. “What’s to keep you from putting your mother’s name at the top of the list and recruiting as many as you can? Every one gets you $50 and your mother $50.” “But that would be cheating!” “Who gave the guy who started this more right than you have to start your own?” Three days later the newspapers denounced it as a scam and it all fell apart. An undergraduate working in the lab thanked me. “I made $350 off that chain letter and so did my mom.” And I didn’t make a cent. The point is, fuzz out the decisions. Make it look safe. People will volunteer to get all their medical benefits cut off if you can make it look like they win.