DEBATEitOUT.comDebate online with people!

We should probably have funded the so-called death panel provision, that being: living will consultations.

But "rationing" should be up to consumers and providers. If the cost is too high relative to the potential gains, people will make their own choices. If they make these choices ahead of time, it will not noticeably harm the ability of patients to live out their last months but it will save money. This is not the same as rationing out care so much as responding to incentives (prohibitive costs).

Get real, will you?

I don't care what you call it, this sort of thing is just not negotiable for any reason. If I can afford to pay for the health insurance that I want, I should be able to receive the insurance covered treatments at any age or medical condition. And just whose money will be saved? If I can pay for it, why shouldn't I receive it?

All this talk about "rationing" health care based on someones age is pure communism at its ugly worst!

What exactly are you arguing with me over?

"whose money will be saved" That would be the consumer's (the patient's) or their families. If you or your family want to spend it on health care procedures that offer no likely or tangible benefits, you may do so. People often do so even through living will arrangements. The reason to have those arrangements ahead of time is that it stops people from spending money on hero treatments that may be good for the hospital, but not so great for the patient by making a few crucial pre-arranged decisions.

I am describing "rationing" as a market behavior. This is hardly "communism". People make these sorts of cost benefit or opportunity cost assessments all the time through the price mechanism. The problem is that they are not doing so in health care costs, in particular with terminal care, because, in large part, the costs are not borne by the consumers in the first place. You might be able to afford the health care or the insurance plan that will pay any price to keep you alive. This is not the case for most people.

In an ordinary market behavior, this would mean these would be people who would have to deal with scarcity and go without. We already don't let them. We DO pay that price. That, if you want to describe some economic system as communism is pretty much what you are describing (the system we have now for "rationing" care). The costs for someone else's medical care are paid by you, if usually indirectly (by increasing your costs). Since this is the case and doesn't appear to be changed by anything in the "reform" pipeline, it would make sense to keep those costs lower, if possible.

Well we're already all paying for older people's medical care in the form of medicare. So rationing is just the gov admitting that they're not getting the bang for their buck by dumping cash into an elderly person right before they die. So why not ration medicare. You can't possibly ration care that people pay for out of pocket, only government (see taxpayer) supplied care. And I think that's a wonderful idea, as it will show people the harsh reality of the limitations of government run care AND be more fiscally responsible.

We're talking about HUMAN BEINGS here! Not some abstract "marketing behavior" . . . . . .

THAT is what the argument is all about, and yes it IS communism when you start discussing that the older folks have no right to live so that the younger ones can reap the benefits.

I don't know how old you are or how long you plan on living, so when someone in some obscure cubicle somewhere decides that you no longer deserve to live because your health care is too costly to maintain, just think of how YOU would feel!

You really need to read my statements more carefully.

I did not say anything about "rationing" care such that older people will have to die off. I said people should make those decisions themselves. I also said nothing about some person in a cubicle making those decisions. I said that it is necessary that more people should actively, proactively, consider those hard end of life care choices THEMSELVES. Something which at present costs us (taxpayers and consumers of health care) more money than is necessary to attain the same level of health care outcomes because they don't make those decisions (ie they don't "ration" their resources efficiently themselves).

I don't see how your proposed consideration at the end applies to anything I said as a result.

I also didn't say "marketing behavior". I said market behavior. Market behavior is the behavior of human beings making decisions in a market. It is the method of selecting products and services in a relatively free society such as we have for most things. Other than health care.

It is definitely not the actions of a few people trying to sell something. That whole "-ing" part, try not to add it onto important words next time so as to twist what I said into something I did not.

It gets really tiring to try to hold a conversation about free markets with people who claim that "communism is evil", which is accepted as true by people who study economics, but then go on to not understand markets in their most basic functions. Meaning the objection to communism part is merely a titular function rather than an understanding of what is and is not communism or, more importantly, what is and is not sensible free market economics. I blame Republicans for having so distorted the meaning of "free markets" by doing things like expanding Medicare and then defending it against cuts whilst claiming to be the party of limited government intrusions with a preference for markets. I suggest reading Adam Smith or Milton Friedman sometime.

What we find when we look economically at the health care system we have now is that it not only "rations" care but that it does so in a socialistic manner, through a public distribution system like medicare and also by distributing the costs of health care across paying consumers because of enormous free-riding aspects to how we consume health care (through third parties like employee based insurance). I propose that it should "ration" care through a market based system by allowing individuals to make appropriate decisions with their own resources. I do not understand how this position is taken to mean that bureaucrats will exert new and onerous powers, but if you insist on having an argument with something I did not propose, be my guest. I prefer to actually look at fixing the health care system we have to more aptly resemble a market economy and not indulging in ridiculous platitudes about Red Scares.

One way to do that is to have people communicate officially what decisions they want made in the event of major life threatening events, in particular in their advanced age. Living wills (and powers of attorney) are contracts that allow people to do this, to delegate certain authority to others in the event they cannot make these decisions themselves. In the cases where there are not living wills, where people do not communicate their desires to others, those others must assume, under difficult circumstances, what those desires would be and make decisions. This is not an efficient scenario under which to assign our resources because it will frequently make errors (this is the same logic that is used to decry governmental authority in the political economy by Hayek or Friedman or Smith reduced down to an individual economy, local knowledge is often superior to centralised authority in terms of producing desired outcomes). Some people would prefer their families use the money that could, under unlikely circumstance, save or revive them from a dreadful injury or illness to provide for educations or home ownership for their progeny for example. Just as others would prefer to spend as much energy and money as possible exhausting the possibilities of their continued life. There is nothing inherently "wrong" with either of those views and either course being followed under a market based scenario (assuming adequate resources to provide for either course). The problem is that other people already must make assumptions about which view someone would hold. All that is required to remove this uncertainty and inefficiency is a simple and enforceable contract and the communication over its contents to the vital parties (usually family).

In other words, your supposed scenario that I am supposed to dread occurring in my future already happens now to people every day. And the offenders are usually well-meaning loved ones, followed closely by bureaucrats working for insurance companies or HMOs who are usually the ones actually paying or providing care. I do not fault these two parties for making mistakes. The mistake is that we do not have a marketplace that encourages people making prearranged decisions over something that's pretty obviously universal (as Keynes said, "In the long run we are all dead").

This is to say that last year's distortion for the "death panel" in the place of a simple contract law was an embarrassment to market economics. There are no evil geniuses working for the government presuming to skim a few bucks off by killing off the old folks by making them get living wills that could say only that they should die off. For one thing, old folks vote disproportionately and thus any politician who does so would be shunned out of politics. The townhall hysteria last summer was nothing compared to what would happen if someone actually proposed taking away any significant social welfare programs for the elderly and not merely was implied to have done so by partisan media with an axe to grind. All of this is obvious from the amount of social resources allocated to the welfare of the aged through taxation rather than through collective market actions of concerned citizens. As Andrew pointed out, we already pay directly for a huge amount of the care of the elderly through social costs (which is precisely this evil "communism" you're so worried about which I did not advocate and seek instead to moderate and reduce), then it is appropriate to allocate some of those resources that we spend in a way that would save us money without reducing quality of care outcomes. Namely by allowing individual people to make private contracts over their terminal care decisions in any way they see fit. It is hardly logical to refer to this as socialistic to want to ascribe more market power to individuals and their decision making power even over socially reserved resources like health care for the aged and poor. Anything which allows the health care market to behave more like a market would be an improvement over the current scenario.

Just took the time to skim through your book here . . .

I have no further comment.

Then why bother commenting.

Very good. I can't say I understood some of it, but that's OK. I got the gist. ^.^

I do think living wills are the way to go. For me myself- if I were in such a situation where I wasn't going to wake up again, I would prefer they just pull the plug. Why? Well, I'd rather just go to Heaven instead of sitting around in some sort of netherworld/purgatory. But that's just me. There are probably people who would prefer their loved ones keep them alive until they die a natural death. That's fine.

I think that, if the decision is being made by the person (as you advocate) then there is nothing wrong with "rationing" (if that's the right word) care.

I realize I did not spell out that it is about 20-25% cheaper to use living wills and other binding arrangements to designate what sorts of decisions will be made for major terminal care, with no decrease in expected life span under terminal care (ie, people live just as long on average).

Other than that, what wasn't clear?

My brain doesn't do well with technical/eloquent language first thing in the morning. That's all. ^.^