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Lessons of a $618,616 Death
theodp writes "Two years after her husband's death, Amanda Bennett examines the costs and complex questions of keeping one man alive. The bills for his seven-year battle with cancer totaled $618,616, almost two-thirds of which was for his final 24 months. No one can say for sure if the treatments helped extend his life, and she's left with a question she still can't answer: When is it time to quit?"
Though it may not have done much for him, the same treatments may have better results on others on average, and therefore be worth it. Or maybe not. Also, medical bills tend to be grossly inflated, so the real cost may have only been something like $150,000. It's a quadruple the price and give the insurance company 75% off scam (but still charge the cash customer the over inflated price, partly to make up for cash customers who don't pay).
Maybe she can decide at this point "hey, we should have stopped fighting here and just put him in hospice care", because she knows when he finally succumbed. But sometimes people beat cancer (rarely or often, depending on the cancer). Let's say early on they decided to go the hospice route, and he died. What is she going to think when she opens up the paper and find a story about a guy with the same cancer who lasted another 20 years?
It's really easy to draw a line on a chart and say "anybody on the right side of this line has such a bad prognosis it's just not worth the money to treat them. It's a lot harder when it's your mom.
I would ask at what point did HE stop wanting to go through all the medicines and procedures?
If you ask me, that's when it should have stopped.
Moved to http://soylentnews.org/. You are invited to join us too!
There is a HUGE amount of overhead in US health care starting with a massive markup on medicine which isn't seen elsewhere and ending with the support of a lot of middlemen.
It doesn't matter if it's private or public - what matters is removing the leeches and profiteers from the system and turning it back into medicine instead of a protection racket pretending to be insurance and hospitals where care is an afterthought. The doctors are not the ones getting rich and if you want to see a nurse laugh ask them if they are rich.
I doubt that the same amount of care elsewhere with the same treatments under a public system would have cost the taxpayer anywhere near one fifth of that. Remember folks, it's still a drain on the economy even if rich sick people are the ones getting ripped off instead of the taxpayer - it still hurts everyone to an extent.
You should _not even have to_ ask yourself this question - healthcare should never put such responsibility into an affected person's hand!
The US seriously needs to fix its healthcare system.
The truth is sometimes the exact opposite and usually somewhere in between.
My mum suffered a seven year death with cancer. It certainly didn't cost anywhere near that. Dad has just retired this week, I shit you not, with his new wife (of one year, mum died 2001) and is very healthy with money. Mum would have died in that first year without the excellent public health care system that Australia has (or rather, used to have).
You really need to focus on the important things and stop bitching about the little, meaningless crap.
Time to quit? I never got to have the 'now I'm older, what made you the person you are?' talk with my mum. Dad focuses on the future and won't talk about what used to be. Kids will eventually want to know.
Quit when you are sick of fighting or when your kids are ready for you to go.
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It's easy to attack an economic analysis of health care as cold and calculating, but at some point we need to admit that it's not worth spending half a million dollars to keep an 80 year-old-man alive for an additional month.
Admittedly, it's harder in some situations (like in the article where the person is 67) than in others.
``Your life is worth your salary.''
Actually, my life is worth a lot more than that. The boss only pays for what I give him, but there is a lot more I do in life.
Please correct me if I got my facts wrong.
Dude, the work you do is not anywhere near as important as what you think it is.
Take a holiday!
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It is a sad day when one decides to value the dollar worth of a human life.
Only make $15/hour? I'll assume that you make considerably more than that. If that's the case, you become a bigger loser for trolling around on /. for what "you're worth" versus what "he's worth". He's wasting $15/hour and you are wasting considerably more.
When did hourly income become the value of an individual?
I can only use words like "inevitable." I've lost loved ones in various ways... the inevitable grandparents, a parent, a son, friends... It's just another ending among many types of endings just as there are many types of beginnings. I'm neither happy nor sad about either. I just can't think in those terms any longer. Have I grown up or have I simply grown numb or indifferent. As I still enjoy life in general and can't help but smile at the antics of my youngest son, I doubt numb is what I have become. I think I have learned better than many how to let go and say goodbye. That lesson came easy when my mother died after a long agonizing time of waiting... for the inevitable. When I got word she died, the first word that came to mind was "finally" and I was happy... well, relieved is a better word. I didn't want her to die, but it was better than the suffering she endured for several years.
I think it would be good for everyone to get it through their heads that life always ends. It is merely a matter of time and circumstance.
The parties wanting more than half a million dollars from all of that will likely never see all of it. Insurance may cover some of it, but who knows what manner of weaseling they will muster up to lighten their own damages. The wife will not be able to cover the difference unless they were particularly loaded and I don't really care. I think the money could have been better spent on happier things. My favorite gifts are the ones I give to others and that are truly appreciated and enjoyed. I can't imagine someone spending that much money prolonging my own suffering.
Where I live, we have a saying among the population:
"You can afford to die, you cannot afford to fall sick."
After glancing at the article, I can't stand to read it. I don't think I can hold back my tears. So, no RTFA for me.
The amount of money spent on healthcare during the lifespan of a person in Europa is normally divided as follows. 50% for the last year of someone's life and 50% for all years up to the last year. The problem is trying to determine when the last year of someone's life starts.
Yeah, it sucks for him, but I bet I could find ten other people who could live six years longer on average with just $60,000 to spend on their health care. Medication they couldn't afford, living conditions that are toxic, not having enough food, being in need of rehab, hell, just finding cancer early so it can be treated. Not to mention what impact that money would have in third-world countries. $600,000 kept him alive for seven years...That could be two reasonably-paid people working full-time on HIM ALONE, for seven years straight. Think of what else they could do, what other benefits they could bring to the world. Or hell, that money could pick a smart but poor high-school graduate out of Wal-Mart and put him through medical school to become a doctor. Yes, there's a point where the money ought to be spent on someone else...especially when it's public money.
How twisted have you Americans become that you even ask yourselfe this question! When a mans(or womans) life is at stake, money has no value! That's why we have Universal helth care, so that you dont have to care! (I'm pissed but I'm going to stop now.)
I'm guessing from that comment you're fairly young because the truth is there's a lot people do after 45. Many people (including CEOs, judges and surgeons) reach the peak of their career after 45. If you had kids at 28, they still wouldn't be adults by the time you turn 45.
Yes, this is a problem with any sort of expensive care, especially the long-term kind.
Yes, that's always important.
I'm going to have to go with no. In the end, it is not your position, my position, or the loved one's position to choose how or if a patient should continue treatment. It is the patient who will have to live with the consequences of their choices and to take away those choices with a mantra that one must "keep on trying" regardless of the futility of the action condemns people to situations where they are forced to endure needless suffering to placate the wishes of others. If it is wrong to coerce or steer people to give up, it is certainly as wrong to coerce or steer people to keep on trying.
Eurohacker European paranoia, gun rights, and h
If you are gonna die anyway, what's the point in keeping you alive if you don't want to? It's stupid to artificially extent the life of a terminal patient just for him to be miserable a little bit more time. Just stupid.
Since it's less than the price of Carly Flonina's stupid Devil Sheep advertisement who are we to say it's more of a waste of money?
There must be quite a few health care executives with no medical training or medical experience at all that get paid far more annually than that. There's a vast industry and only a tiny proportion of it is focused on health care, most of it is about carving out monopolies to maximise profit - you can forget about the "free market" because it does not apply.
It's pretty easy to say that when you're not facing a terminal illness. No one can truthfully say how they will react to a very difficult decision like that until it actually happens. We can say how we would hope to react, but to suppose we would make a better choice than someone else is dishonest and arrogant.
Try saying that when the man in question is your father.
Try saying that after watching your father's last week of life on hospice protocol.
Intellectually, you know there's nothing more that can be done but make him comfortable.
At gut level, it isn't the same.
(And in case you're wondering, the above is not hypothetical. I wish to God it was.)
I was struck by the information provided in TFA about the billed prices and the negotiated payments.
(If you didn't bother reading it) several times she mentions that her insurer paid a negotiated rate for a procedure or drug, and that negotiated rate varied when she switched jobs and changed insurers. Discounts she mentions varied roughly from perhaps 20% to sometimes far more than 50%; individual insurers would negotiate what they were willing to pay for something and the hospital would agree to consider that amount to be paid in full, regardless of the hospital's standard billed amount for that "something".
It led me to wonder whom, actually, pays the full amount? Then it struck me. The uninsured do.
What Americans and right wingers don't get, is that some people prefer a humane society over low taxes in a hellish environment were there is a dollar amount for every human life.
Some of us value humans more then money. You clearly do not. To bad. Maybe one day you will decide to join the human race. Usually about the time when it is your life that is being represented by a dollar amount.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
Some of the comments refer to a life as "invaluable". Money has no meaning, etc.
People in Africa get AIDS, and we all sit at home watch them die. We do nothing. The people who post these types of comments could send all their money to save as many people as possible, but they don't. The US government has the resources to save these people, but the US government withholds the money and watches them die.
The reality is that resources are finite. A society could devote all its resources to health care and do everything possible for everyone, but where does this leave the rest of us?
I could not buy anything for the next 20 years and save up an extra 500K USD ( this is above and beyond normal retirement saving ). This way, when I eventually get to my last year or two, I will have the money on hand to handle my own "spare no expense" end of life care. What impact does this have on the economy and my quality of life when I'm healthy? One needs to multiply this number by 300M people to get the scope of the entire US health care problem. These are real problems with a huge impact on both the living and the dying.
Finally, Europe is no panacea. For instance, England deems many new cancer drugs as too expensive. Cancer survival rates suffer due to England's cost cutting.
Being happy is a small and IMHO sometimes a petty or selfish reason. I AM dying from liver failure. I do not want to have a transplant or go through the expenses. I don't want my wife to struggle through the remainder of her life because I love her too much to see her suffer by being poor again.
I'm very happy even with everything that is happening to me. I'd rather live a good life of quality than a long one without.
I think your premise is wrong. People make decision all the time without full knowledge of all of the underlying facts. So called "experts" who know enough to know the outcome rarely exist. Another thing to consider is that it is my life. I would never want to give up freedom to some "expert". I may listen to the "expert's" advice, but I still may choose to want to try to win despite the odds. Tim Tebow's mom was told that she should abort him by a so-called expert, but she didn't. Look at him now. If I want to go for it, and it is my money, then I should. If it is someone else's money, then they should be able to decide. That is why you should never let the government run your money for you--you give up your freedom to decide.
You're actually willing to torture your victim indefinitely to please your sense of righteousness?
The inability of some people to put kneejerk emotional reactions aside and rationally consider whether it's reasonable to spend a considerable fraction of many people's total lifetime earnings for the sake of extending the life of a very sick person for a few months or years is disconcerting. It's fine and good to pretend money is no object when you aren't the one paying for it, nor the one suffering bedridden and perhaps barely conscious. When you consider your typical middle class American spends most of their life working to pay off a few hundred thousand dollar mortgage, burning through that much or more on a person with a terminal illness is in some sense like throwing the life's work of another person away. Unless you're willing to be that person, pipe down.
Which studies?
Because Sweden's health system is ranked much higher, life expectancy is much higher, and preventable deaths are much fewer.
And the justification for that when those that still have decades of productive life left, were they to be able to access affordable healthcare, is? If it's your own money that's your business, but as soon as it robs those with a better chance of survival and producing the resources necessary to provide help for others you'd have to be a pretty bad person to even consider the proposition seriously.
I think the big question is not so much whether you think your life is priceless.
;).
If you're going to pay for all the treatments etc yourself, hardly anyone else will care.
It's how much should other people pay for you, to keep you alive for X years longer.
And that includes total strangers - assuming your country has some sort of health care system.
Some may say ZERO, but in my opinion, if we want to pretend that we are living in this human construct called civilized society, then yes we SHOULD pay more than zero to help keep others (even total strangers) alive. Not doing so would be uncivilized.
But beyond a certain point it becomes unreasonable and unfair to expect others to keep paying for you. And I think this should be related to how rich the country is and how rich the average person in that country is. There just won't be enough money/resources to go around.
The issue is as technology improves, there will be more and more advanced treatments, and many of those will be more and more expensive. The billionaires of this world might be able to pay for replacement body parts (say a whole leg) to be custom made for them (in fact maybe 1000 could be made and the best one used), but you can't provide this to everyone who wants it. If they want others to pay for it they'll have to make do with a cheaper prosthetic. Of course if that "organ printing" stuff becomes affordable, then OK.
To me a fair healthcare system would give everyone a quota, say USD500K/lifetime (or maybe something else per time period, let the economists and actuarists work it out). Once you've used that all up, no more automatic help from strangers. Sure it's unfair to let you die/suffer, but past that point, it is even more unfair to make others keep paying for you. What makes you so much more important than them?
So beyond that point you have to pay for yourself or convince others to help pay for you. Perhaps others can donate some of their quota to you (subject to regulations and approval - otherwise there'll be too much swindling).
FWIW, I don't think it's fair to have other people to pay USD600K to keep me alive for a few more years or decades. I live in a 3rd world country and earn a 3rd world wage, so USD600K is a lot here, maybe if I live in a rich country it'll be different.
Nor should they pay USD600K even if it'll keep me alive indefinitely. Given a long enough time, the odds are I'll become a nuisance (since I am imperfect)
No one said the decision is easy. That's why it's so important to have living wills, so that your loved ones know what you expect and can be freed from making gut wrenching decisions when the time comes.
God invented whiskey so the Irish would not rule the world.
This is so weird to me. At a gut level, I want people to end their suffering. What bizarre torturous form of "love" demands that you keep dying (sometimes zombified) people in struggling in pain until their last breath?
Ok, time to sacrifice some karma I guess...
You suggest that the desires of the patient are the ONLY thing that should be considered when deciding on treatment plans.
However, there are others who have a legitimate stake in the matter. In particular is whoever is paying for it.
Suppose that for a cost of one billion dollars I could extend somebody's life for one year, completely devoid of any pain or suffering. It would be a very fulfilling year, one that anybody would want to live.
Who wouldn't want that? One more year with their family, one more year to accomplish whatever it is that makes somebody feel happy about living. If left up only to the recipient of such care, everybody would elect to have this treatment.
However, at a cost of one billion dollars each the entire human race would essentially be enslaved to providing for the care of maybe a few thousand or tens of thousands of people who manage to receive the treatment before the entire planet runs out of resources.
Obviously a billion dollars is a contrived example. The opposite contrived example would be ten dollars - I think virtually everybody could agree that for taxpayers to balk at spending ten dollars to extend somebody's life for a year sounds very stingy (although one could debate that we do this all the time when we ignore starving people in poor nations).
So, at this point we're just haggling over price. At what point do those actually paying for care get to say "enough is enough?" That is exactly what this article is about. Talking about putting a price on life sounds barbaric, but the fact is that everybody does this every day - they just don't talk about it.
Here is something else to think about - if you really do consider my life to be worth a million dollars per year, or whatever, can I elect just to receive the cash for two years of life right now and then thirty years from now you can just let me die in peace?
I'd say when the person is suffering 24/7, and the odds of them ever getting any better are pretty much zero, it is time to seriously consider letting them make their peace and just letting them go. Look at it this way, if it was a dog suffering that bad, would you put them out of their suffering? Then why the hell subject someone you love to that much pain?
When my sister passed away last year they probably could have kept her around for another 4, maybe 5 years, first by hooking her to a vent followed by an iron lung. But her nervous system was already shot, her bones were as brittle as twigs, she hurt pretty much 24/7, and if they would have continued she would have ended up unable to speak, move or even communicate. What kind of "life" is that? In the end we were lucky that sis had a compassionate doctor, who gave her enough morphine she just drifted away in her sleep. A hell of a lot nicer death than the slow suffocation or being nothing but a slab of meat wired to machines, unable to even speak.
So I would say when there is no hope and they are suffering it is time to seriously think about just letting them go. Forcing them to soldier on with nothing to look forward to but more pain is simply cruel. And I know they are talking about an economic standpoint here, but I wonder how many of those were the choice of the patients, or the NOMW (not on my watch) docs? Before my mom retired as a nurse she worked a NOMW case, where a doc kept a 22 year old girl "alive" for 9 days because he refused to give up and told the family there might still be hope. This poor girl hit a guard rail with her head at nearly 70 and my mom had to put towels around her head when the family visited so they would see her brains slowly leaking out from the swelling.
So I would say someone needs to step in when it is obvious we are at 0% hope and have everyone seriously look at what the future holds. with technology we can keep a human body often going long past the point of failure, but not only is it expensive as hell, it is seldom a pleasant or an easy way to go.
ACs don't waste your time replying, your posts are never seen by me.
People need to talk about this, and we need to reach a consensus to where the line is.
Actually, first we need to agree that there is, and has to be, a line!
No health care setup can be fully funded, whether private or public, as there will always come a time when someone needs something new and leading edge and they tend to be expensive. Not that money can always be thrown at the problem - I remember feeling particularly sorry for Paul McCartney when Linda died because I think I would have been looking for any and all treatments regardless of cost ... and yet she died!
So assuming we can agree that any health system has a budget we need people to administer that budget and that involves wieghing up the relative merits of treatment A for one (very sick) person vs treatment B for several (not so sick) people: eg Heart Swap vs Hip Replacement.
The people making those decisions HAVE to be cold and calculating about it. This means none of the (now normal!) "how does it feel" style reporting we're now too often saddled with by lazy reporters. The argument of "what if it was your father" is a ridiculous argument - of course you want the best for you and yours but that isn't necessarily the best for 'society' - in much the same way with kidnapping/hostages. As an individual I would say pay them what they ask for to buy my freedom, but as part of 'society' I would say you should NOT pay for my release because I recognise that paying them off encourages more kidnappings!
Eclectic beats from Leeds, UK
handmadehands.co.uk
It is hope. People hope to see their relative healthy again. They remember seeing a person healthy. They miss it, and they want to see it again.
Unfortunately, some of the treatments are ineffective. They might extend life, but they will never restore health. Medical procedures are graded by mortality rate over periods of time. Ex: 50% survival at 5 years. The goal needs to be different. Effectiveness should be judged by time outside the hospital without extensive medical intervention. 50% of the time, this procedure gets you 3 more years with your family. A subtle and significant improvement.
Your time alive is worth more than your family's home, education and future? You would give the children to the state because all of your income above the barest essentials goes to pay current and back medical bills that cannot go away because bankruptcy only works once? You would transform 20 years of your spouse's retirement into 20 years of working at Walmart so they can eat for another week of life?
If you don't have a family then I agree, your life is worth everything you have and everything more you can borrow or talk out of someone. Unfortunately although it's true you can't take it with you its also true you can take other people down before you go. "My life is priceless" makes sense when the decision is between not buying a nice car or a new video game vs. dying but that's not the amount at stake when you pay for medical care. To choose imposing financial ruin and associated suffering on people you presumably love to put off for a few months something that we all must eventually do is simply selfish.
It's not until you consider these implications that you can really say "I would pay any price for one more day of my life."
I'm going to repeat a point one other person made, just to make it again: In addition to the direct societal costs (which, I realize, can't even be easily quantified based on TFA: 600K? 400K? The amount charged, the amount paid, the amount paid less the patient's insurance premiums, divided by the number of people paying into policies for the two insurance companies?) and benefits (a few more years for 2 kids to have their dad around, an article investigating health care costs, a discussion on Slashdot on healthcare economics) there is also the advantage of having one more data point.
Because this guy was willing to keep trying, going through significant suffering for the benefit of his wife, his children, and a few more months of life, the medical community knows that a given group of drugs can extend the life of a kidney cancer patient by up to 17 months. The next kidney cancer patient, and the next cancer patient, and the next doctor looking for a way to treat this person who just walked in,and the next researcher investigating how these drugs work, all have a bit more information than they did before. They may decide that it's a goal to shoot for, or they may decide that the regimen is not quite useful. Either way, it's more than they knew before.
Of course, we can't determine the value of that, any better than we can determine whether the rest of the money spent was worth it. It's still a benefit we all get and should consider.
TSG
A co-worker was an ER nurse.. She would tell me stories of people that insisted that they revive grandma, even though she had signed DNR letters. If there is any question or argument, their legal team says to always revive.. So they would get someone that wanted grandma revived, which the process of CPR would usually break ribs, and lots of other bad stuff to a frail 80 year old.. She got really frustrated trying to explain that yes, they could revive her, but she was going to die in the next week or possibly 2, and that she was going to need so much pain medicine that she wouldn't be able to talk to them anyways...
People just can't cope with death very well.
What are we going to do tonight Brain?
Yeah, but language in health care legislation to encourage people to create living wills (when they are neither demented nor unconscious and can still make such rational decision on their own) was eliminated because people referred to such discussions as "death panels".
So, instead, more people have made no such indications until they have severe dementia or are in a coma, and then next of kin (spouse usually) have to make the choices, because otherwise the doctors would be making them on their own.
It doesn't hurt to be nice.
Hmm, so I'm a troll for pointing out what people with an actual intellect all realize. Making cannon fodder of the young to prolong the lives of the elderly by what might be as much as a few months is stupid. Perhaps we can turn the youth of the world into a soylent green paste so that the elderly don't have to chew while we're at it.
Life can be worth infinity and you'd still need to take into account the cost.
In particular, opportunity cost of NOT spending that money on someone else, perhaps in a more efficient manner.
Bear in mind that resources devoted to keeping one person alive are resources that cannot be devoted to keeping other people alive.
Withholding services can kill a terminal patient just as easily as withholding comparatively much cheaper food and water from healthy people can get them starved to death, or worse into a bed right next to that terminal patient.
Respect for human life aside, I think money is better spent on prevention, and on keeping that "patient" from winding up in an expensive hospital bed in the first place. That saves their life, and to boot lets them live happily, and with enough money left over to similiarly save a dozen other people as well.
Lives versus dollars will never make a good comparison. However, lives versus lives might.
What you're talking about it exactly what is done in healthcare rationing. It's also been used as a football in the US healthcare debate (I think some idiot called the UK system that decides this 'death panels'). They way it's done is to ask a representative sample of the population to rate the value of a year in a certain condition. It's based on QALYs - Quality Adjusted Life Years. So, for instance, someone might say that 1 year in a wheelchair has the same ' value' as 2 years able to walk unaided, so you would say that a year in a wheelchair has 0.5 QALYs. Bear in mind, this isn't done by a panel but by survey of the population.
What a group of experts / managers / politicians / etc. does do is decide how much the health service is prepared to spend per QALY. So, a certain type of cancer treatment might buy 0.01 QALY per treatment, at a thousand pounds a treatment. A cutoff can then be set over the whole population, for every type of treatment, to say that as a society we agree not to pay more than e.g. GBP 500,000 per 1 QALY.
The whole idea is of course terrible, grotesque, but also elegant and necessary in the job it does. Of course, people with enough money can buy whatever health insurance and private healthcare for whatever treatments they desire. Every so often, there's a big media storm about a certain treatment (usually for a cancer) that has been deemed too expensive, and you get lots of protests over putting a price on life. Of course, if there's a cap on public healthcare spending then to provide that expansive treatment, something else would have to go.
The one thing I can remember of my father dying was the useless suffering of brain cancer in the last two months. Even when he cried out that he wanted to die doctors said he was not "able to decide". This even though he did in fact already put this on paper, and had the support of everybody around him.
My mother died two years after that, struggling with the same disease fortunately in a different spot. After a while she stopped the normal medical treatment and decided against a second surgery. She died peacefully after having taken time to say goodbye to everybody she loved. It did take a long time for her to accept her fate though, and choosing to end your life that way is certainly not for the weak of heart.
If anything is wrong with the current medical system is that it tries way too hard to safe lives. It should focus on the quality of life instead. It should certainly be able to make hard choices in this matter. And most certainly it should allow patients to make their own decisions (and stop religious groups interfering with such matters.) With the savings we can make the life of a whole lot of persons a lot better.
As your body ages, it responds to surgery differently and heals much slower. Its not just that insurance wont pay for them, often its the case that surgery would do more harm than good.
No health care setup can be fully funded, whether private or public, as there will always come a time when someone needs something new and leading edge and they tend to be expensive.
Expensive for a while, anyway. My thanks go out to everyone who paid $50K each for flat bigscreen HDTVs; while I was just drooling over them, you were subsidizing the R&D on the model I got for $1500 years later. And to those people who held out until today, when prices for that quality are under $800, I'm happy I did my part.
It's a good thing people don't actually care as much about TV as they do about healthcare. We'd either be using CRTs or $5 trillion further in the hole, depending on whether the better models had been categorized as "excessive" or "a human right".
This is the question of "death panels", restated.
"I just had to pay $1300 in out-of-pocket expenses for my daughter to get a single stitch (emergency room visit because it was after hours). And the doctor was on the fence as to whether nor not she needed one. Had I known it was going to cost me $1300, I would have used a band-aid."
Maybe the reason the health care system is overburdened is because some people bring their kid to the freaking emergency room for a single stitch.
It might suck to see macroeconomics in these terms. Recessions are ultimately caused by poor capital allocation or risk management. Industries recede to sustainable levels -- because the capital allocation before then was unsustainable (or was sustainable but has become unsustainable through circumstance). This isn't "laziness", but poor planning. The "victims" of poor planning were like hogs at a trough before their unnecessary jobs were eliminated.
Yes but you leave out something very important : WHY is capital poorly allocated ? WHY is risk management screwed up ? After all, especially in agricultural matters, we've got close to 5000 years experience with it. Surely we'd have found a way to deal with the risk and surely we know what capital to allocate ?
Yet we regularly hear about famines, even huge ones. What is going on ?
The simple truth is that the world changes. It changes the conditions of agriculture : a new plant disease, ground erosion, water changes. Despite the constant barrage of propaganda to the contrary, land does not have constant productivity if we were to just do things the natural way. In fact, that would cause much more massive fluctuations in the food supply. Fluctuations that would kill millions.
The problem with allocating resources, wether capital, or redundancy (to avoid risk), is that finding a good resource allocation involves predicting a huge number of variables into the future. Nobody knows the future, and nobody knows the consequences of a particular allocation of finite resources. Especially the downsides tend to come as a surprise. And when it comes to resource allocation, small mistakes cost dearly, mistakes cause recessions and big mistakes cause famines, civil war, and worse.
Recessions are caused by wrong capital allocations or risk management issues, yes, absolutely true. But one wrong prediction about the future pretty much guarantees wrong capital allocation and mistakes in risk management. In other words, every failed prediction brings us closer to recession. Of course that's for a capitalist system, where many actors have variances in how risk is spread. If we had a single entity doing that, whether said entity is the government, or monsanto, we'd be one wrong prediction from close to zero available food.
So heres a situation my niece has junior rheumatoid arthritis. It takes her from being a typically healthy teenager to one thats in constant pain and in a wheel chair. There are injections which she has which bring her back to normal health.
The cost of these injections is more than twice my sisters take home pay but its paid for by the NHS through everybody's National Insurance contributions. You are looked after by this system from before you are born and through to your last breath and you contribute to this system throughout your working life. There is a maximum contribution so its never totally unreasonable.
but put this in your situation and its your son or daughter with this illness and it costs twice your salary to keep him or her normal. In the UK that government bureaucrat actually pays out more than you could pay for.
so your welcome to a system where you have to accept and see the pain of your family suffering because you can't afford it.
ah but you have insurance part of your work package but hey you are almost certainly not immune to redundancy even with a solid company like IBM. HR doesn't care about you and your family especially so if your raising premiums. If your selfemployed and you lose a major contract you can end up unable to pay to keep your family safe and well.
so tell me how you manage to pay more than you earn to look after the medical needs of your family and while currently your a major bread winner a small clot of blood can stop the flow of blood to your heart or worse still to your brain and recovering from this stroke and the brain damage it caused your now caught in a world of pain and debt and misery. Even if your in perfect health someone could hit your car on your way into work tomorrow and change your life forever are you really prepared for that?
http://en.wikipedia.org/wiki/History_of_the_National_Health_Service_(England)
the above link gives a little of the history of the founding of the NHS and why it was done
Blarney Quality Restaurant, Plants
Why is it when we have health care discussions, the media tends to quote widows and widowers? They are not experts in health care and they are not unbiased. Sure, her story is interesting and compelling, but does it tell us anything useful about medicine in the US?
Yes it does. This article is excellent. This widow asks more probing questions about the economic underpinnings of our broken medical system than our leaders do while trying to overhaul it. RTFA-A(gain).
cheers, ben
Never miss a good chance to shut up -- Will Rogers
Look, let me let you into a secret, insurance is "N random people paying into a system to finance your family's problems ".
H-e-l-l-o-o-o-o ! Anybody there?
The difference with socialized medicine is that the aim of the system is to get best outcomes for the most patients.
With the sorry excuse of a system in the US the aim of the system is to make rich the insurance companies and ancillary businesses (hospitals, doctors) at the expense of the US people, who pay way above the odds for care that is often denied on the flimsiest of excuses.
Think: how it comes Cuba, one very poor country, which has been prosecuted mercilessly by old U.S. of A. , can boast several health indicators (life expectancy, child mortality) which are pretty similar to the US's in s shoestring of a budget?
But whatever, if you think it is a good idea to be at the entire mercy of for profit organizations when it comes to health care be our guest. The rest of the civilized word knows better (the brand of Ayatolic capitalism espoused by half of the US population is frankly illogical and stupid, but that is what happens when blind faith clouds sound judgement).
IANAL but write like a drunk one.