As an aside, is there not some elasticity to medical care? People demand more health care for small problems when the price is lower.

We need a payment conduit/tax structure for the elastic portion and something that actually behaves like insurance for the inelastic. The system we have now does neither well at all.

And the left says: "Health care is a human right." And they're right.

BUT! this is important. Less serious medical conditions are much more elastic. If the price is $15, maybe you'll go to the doctor for a hurt collar bone. If the price is $750, you wouldn't. I didn't.

And the right says: "we can't provide unlimited health care to everyone, it's too expensive." And they're right.

But we don't _need_ to provide unlimited health care for everyone.

Care in a life-threatening situation (cancer, stroke, heart attack) should be considered a human right and subsidized by society. Care in any other situation should be considered "elective" and be subject to market conditions.

What do you think?

-- Edit: there IS an upper bound to how much someone can pay for health care, obviously. But it's high.

> And the left says: "Health care is a human right." And they're right.

Probably they are, but what people don't pay enough attention to, IMO, is that there are different kinds of human rights. There are positive rights, and negative rights. The left wants for human rights to be considered positive rights, in that the state (or others) are obligated to provide them for you. The libertarians want more rights to be considered negative rights, which is to say that that state should be disallowed from intervening in your pursuit of them.

The Constitution establishes that the right to keep and bear arms is a human right, but nobody on the left (and probably nobody on the right) would suggest that the state is now obligated to provide firearms to those who want them. Similarly enumerated is the fourth amendment right to privacy, but nobody on either side seems to be jumping to ensure that the state provides that for us.

Why then is healthcare the exemption? Why is it the right that the state must provide to us?

I don't know if we should or shouldn't have it, or what systems are workable, and what systems aren't, so ignoring all other political arguments that apply here, I only take issue with the idea that even if it as a human right, that should obligate somebody to ensure that we have it, especially as it's only a small leap away from getting everybody to agree that the internet is a human right, access to a computer is a human right, etc., etc. And it's not so far-fetched, as there are already those suggesting it.

For what it's worth, I don't disagree with the premise that it is.

Your comment was salient though, and thoughtful, and definitely got my upvote.

Off the top of my head, public education and voting are two. Public safety comes to mind, as does disaster relief. Children have a great variety of positive rights where the state backstops parental providers. Those accused of crimes have the right to a fair trial. You could argue that a lot of regulatory activity comes from rights. E.g. a right to clean air, or a right to access a fair and free marketplace.

And that's just in the US. the UN Declaration of Human Rights includes "food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control." I expect that many European governments see those as rights as well.

Voting is, at least the way I'm thinking of it, not necessarily one though. The state's job on voting rights is simply to ensure that it and nobody else interferes with your exercise of that right.

Your other points stand as stated.

The way I see voting as a positive right is that it's a lot of work to implement. Keeping people from interfering with your right to vote is definitely part of that, but a small part. The actual holding of elections, which takes a lot of time and money, is something the state does because people have a right to it.

Geez, their human rights declaration is pretty broad. "you have a right to security in the event something outside your control happens."

But it's the UN...not really accountable to anyone.

Many Americans believe that all human rights should be equally available to everyone. (Entitlement, I suppose). Education reform leads to "common core" in an attempt to give everyone the same education. Which is why many people would take issue with what you're saying. Health care isn't equally available to everyone.

(though I'm not sure giving everyone the same education, or health care is a good idea at all)

Thanks for your thoughts.

1) It doesn't matter how we allocate it, there are going to be losers. The moral thing to do would seem to be to diffuse the loss onto the greatest number of people, not let it break the unlucky randomly: "we're all in this together". Sidebar: Anyone who says that they can provide healthcare for all is lying.

2) We're actually ridiculously bad at providing healthcare. We spend most of our time (and political might) trying to find some sucker class to pay for it without trying to take the more rational step of trying to make it cheaper. This is because the latter is freaking hard.

The only thing that will finally put this thing to bed is to figure out a way to care for ourselves that is within our means and then agree on a political system that will distribute it (if not fairly) evenly. Hard?

"We choose to ... do these things not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win."

Someone needs to have a financial incentive in minimizing cost. For example by paying them based on the number of people in their area, and on good outcomes, rather than by the number of procedures etc. carried out.

GPs in the UK are paid this way - the practices are almost all private, but all practices that takes NHS patients (the vast majority) are paid mainly by a formula that makes it really bad business for to shirk on preventative care.

And since the NHS is not paid by the procedure as a whole either, they put massive resources into running ad campaigns to get people to recognize symptoms of various problems earlier and go see their doctor, rather than wait until things leads to expensive hospital visits.

NHS hospital trusts are given budgets based on demographics, and will find themselves placed in special measures and have their top management fired if they compare too unfavourably with other trusts or keep running over budget, so they too have incentives to minimize cost of providing health care in the areas they serve.

Meanwhile, in the US, for large parts of your health care system there is no benefit at all to reducing health care costs.

Your incentives are all wrong.

The NHS costs each UK tax payer on average less than the US government spends on health care, never mind private insurers....

I live in New Zealand, and I have Ulcerative Colitis. We have a public/private system somewhere along the lines you propose (although a little more forgiving), and are really quite lucky:

* There's a strong tendency for doctors to work both publicly and privately. They'll put in time at the public facilities, but those facilities are generally pretty highly loaded -- turnarounds can be slow. If you've got the money, you can see most privately (that's generally not overly expensive).

* Thanks to a Government agency known as Pharmac, we bulk buy all our drugs -- so, I pay $5/prescription (prescriptions can last up to 3 months), instead of $120+/prescription. For someone with a chronic condition like myself, this is fantastic. It also works out cheaper for the Government too: we have the market power to negotiate much better deals from pharma companies.

* If you do get into a critical state, the public system will provide care. Alternatively, if you've got insurance, you can go private (but private care for critical stuff -- where surgery/non-Pharmac drugs are required -- is generally prohibitively expensive).

* Elective/preventative care is also available publicly. This means you're in a queue ("we'll get around to it sometime in the next year"), but does mean you're able to maintain a higher quality of life.

Medicine is hard: reconciling care with expenses is a moral quagmire. There are absolutely inefficiencies in the NZ system, but I've come to really respect it.

Health care can not be considered a fundamental right for a couple of reasons.

1. It requires taking more basic rights away from others. 2. If it is a fundamental right, then we would necessarily spend all of our money to preserve it. At no point could we decide to stop paying for care with no chance of success.

Additionally, you create perverse incentives to avoid preventive care which is probably orders of magnitude less money long term.

We can easily afford to heal collar bones, cataracts, flu, hernias, and a whole bunch of nonlethal issues for everyone regardless of ability to pay - wherever there are common, simple procedures that are done once to cure the problem permanently.

We can't afford to do top of line cancer or heart treatments to everyone all the time - because often a successful treatment will simply mean that you'll need another, more complex treatment in a year or five; and again, and again, until you have a society where 100% of people work in medicine.

To put it bluntly, perhaps this is a problem. There's all sorts of articles you can find about "how doctors die". They spend neither their last penny nor their last six months dying slowly in hospital beds. Forgo treatment, die with dignity, and pass a little something on to your grand kids. (Such heartless ROI calculations are probably best reserved for old people. Cancer treatments for the young are likely more popular.) Anyway, it's an idea to think about, not a concrete suggestion.

It's true that if we see the purpose of life as arriving slowly at death, we'll do some really wacky stuff. Like spend every last dollar trying to grasp for anything that will keep us alive.

That's a worldview issue though and a big one.

Trivially true if you define 'medical care' to include cosmetic procedures, which then gets you into case-by-case debates on whether this or that orthodontic or dermatological procedure is 'cosmetic' or required to live a normal life. Which then gets into debates about what pressures society places on people to have a certain look, and just how much social damage is done to someone who has a visible port wine stain, for example.

There's also a certain elasticity of demand for preventative care and palliative care as well. For example, flu shots and pseudoephedrine: Most of us here are not going to die of the flu, and most of us aren't around people who can die of the flu and cannot get vaccinated. Similarly, most of us here can get through a cold without taking symptomatic treatment for it. So there's a certain elasticity there, depending on the person.

But giving flu shots to everyone is likely a lot less expensive than losing even a single person to a serious flu infection. A similar case can be made regarding cheap pseudoephedrine versus losing some productivity to feeling like crap without the pills.

Wait, what?

So in principle flu shots like mine are "worth it" if it has a greater than 15 in 10 million chance of saving a life -- either mine or someone I might infect.

So, yes, for the price of a single life we could immunize about 600 thousand people. That's probably enough for herd immunity in an entire population for some region (like an entire state). Such a measure is bound to save more than one life.

If you're paying someone minimum wage, and they're a profit center for the company, their productivity over the week a flu would take them down is worth a lot more to you than a single flu shot. Extrapolate that to a whole department, which is likely to be lost because the flu is so contagious, and you're looking at a potential loss which is a lot more expensive than a department's worth of flu shots.

Still seems preferable to dying.

While, in the sense of being part of the ACA this is part of "ObamaCare", its not part of the regulations and mandate for private insurance that most discussion of ObamaCare focusses on.

Inheritable, too, what with all the old people dying with medical debts their whole estate can't cover.

(The way it works now is this: When someone dies, their estate is responsible for paying their debts. Once their estate is gone, however, that's it. The creditors can try to convince the heirs to pay the debts, but they have no legal leverage to force them to. Lying about having such leverage is apparently fair game, however.)

You can't. Once the estate's gone, the creditors can pound sand because the person they contracted with is gone and all their assets are gone, too. They can't come after anyone else.

> Luckily she was able to somehow get her name off of the inheritance after the fact.

I seriously doubt this is possible even in theory.

so why couldn't they just transfer all assets from their estate prior to dying? meaning, if you were about to die, there is never any need to pay down any debt, despite having the assets to cover it - it is better to give it away to charity or children/relatives imho.

Compared to 1913 this situation is fantastic. All you have but you get to live.

Compared to what we should aspire to for 2113, I agree that it is barbaric.

For 2013, in every single developed country bar one the situation would be called barbaric.

That is not good enough.