“The health of Americans should not be a profit center. Health care is a right. Full stop.”
.. Almost everyone feels that there is something fundamentally wrong about making money off of someone else’s illness.
.. No, don’t sputter and tell me that it’s obvious, that people need health care. People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”.
.. We are evolved, he suggested, to provide costly forms of care to members of our community when they get sick, not just in the interests of making them better, but to demonstrate loyalty.
there are two different economic systems
market exchange:
Market exchange is impersonal, explicit, and limited: I know exactly what I’m getting, and once we walk away, we have no further obligations to each other. Market exchange is what modern societies use for most of their economies, but what foragers use for dealing with strangers.
The second form of exchange is “reciprocal altruism,” and you’re also familiar with it, though you may never have given it a name. It is a system of mutual obligation: I do a favor for you now, and you do a favor for me at some unspecified point in the future.
.. Hanson is suggesting that we have a strong intuitive preference for altruistic health care — for an enormous, practically unlimited amount of altruistic health care — because health care is a way to demonstrate loyalty and caring to people you love.
.. Bringing money into an altruistic exchange taints it (as you’ll quickly find if you try offering your spouse cash to get romantic when they say they’re not in the mood).
.. The issue, in other words, is not necessarily profit — health insurers are not particularly profitable as industries go, and hospitals and other care organizations are often nonprofit. The issue is making decisions based on money.
.. If it costs too much per year — at the time, they were leery of treatments that were above the 20,000 pound to 30,000 pound range — then NICE will generally not recommend it.
.. Britain had achieved cost-effective treatment for everyone, at the cost of some people missing very expensive treatments that might help them.
.. I had not called NICE a death panel, or said that it was bad; I had simply described what NICE does, which is keep the NHS from blowing its budget on very expensive treatments that deliver relatively little value per pound spent.
.. people don’t want to think their health care system might let them die because it’s too expensive to keep them alive.
.. Before the internet, most people had no way of knowing whether there were other treatments than the ones their doctors recommended, so as long as doctors only prescribed treatments that were approved, the government could maintain the fiction that there was no calculation going on.
.. because most doctors take a lot of different kind of insurance, and they don’t know what will be covered until after they’ve discussed treatment options
.. Americans could hear about a treatment, find out it wasn’t covered, get outraged, and call their congressman. This may be one reason that our system is so expensive.
.. Health care cannot be a right, full stop; it has to stop before we run out of wallet. Which means that no matter how much it horrifies, we have to stop hoping for a system that will make those hard decisions and unhappy trade-offs go away.