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[Niraia]

Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.

I don't think we need you in it either.

From a standpoint of efficiency and reason, I eat well, I don't smoke, I contribute a lot to the economy, I pay my taxes, and I rarely impose costs on others. Kill me, and you'll be poorer, on the net. 

Cost isn't always measured in currency. You're pathetic.

[Makkal]

I'll point out here that there are many people who work but lack healthcare. The continued characterization of those without healthcare as economic parasites is unnecessary.

I'll also give a personal example: My mother has worked all her life, and while employed, she was diagnosed with breast cancer. After surgery, she had to do radiation and chemo therapy, which meant she was too ill to work fulltime, but still came in on a part-time basis.

So her boss fired her and she immediately lost her health benefits. We ended up having to pay for the rest of her treatment out of pocket.

Decades of working and paying taxes mean nothing when it comes to health care. All that matters is that you're employed at the moment.

[Morwen Lagann]

Decades of working and paying taxes mean nothing when it comes to health care. All that matters is that you're employed at the moment.

And even then, being employed often means nothing when your employer is unwilling to give you the hours to qualify for (or afford) health care.

[Makkal]

Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.

Right.

I'm going to skip explaining how eugenics is biologically unsound and just point out that 'obesity, smoking addiction, and chronic illness' usually kill you long after childbearing years. 80% of people with lung cancer are 60 or older. Heart disease rarely effects anyone under the age of 45.

Dying does not remove you from the gene pool. Not having children is what does it.

While I'm at it, if you wanted to remove those "genes" from society, you'd need to kill a lot of healthy people who don't smoke, aren't overweight, and aren't suffering from any terminal illnesses. For example, while diabetes only expresses itself in 8% of the population, 98% of Europeans carry one of the genes that causes it.

[Lyn Farel]

Decades of working and paying taxes mean nothing when it comes to health care. All that matters is that you're employed at the moment.

And even then, being employed often means nothing when your employer is unwilling to give you the hours to qualify for (or afford) health care.

Retired people are not covered if I understand correctly ?

[Morwen Lagann]

They can be through what we call Medicare. Medicaid is supposed to help low/no-income people/families with healthcare. People often get the two confused.

The problem Makkal is speaking about is that many people in the US are covered through their employers - but this coverage is dependent on having that job. Lose the job, lose the benefits.

I'm referring to the common practice by employers to only give workers just under the hours where they are required, by law, to provide benefits to those employees. So if the threshold is 30 hours a week, they'll give you 29.5 hours a week and force you not to work any more than that so that they can avoid giving you benefits.

[Nmaro Makari]

You know, the NHS and others like it aren't just a drive-thru heal-ya-up.

In their countries, they also tend to be the biggest health advocacy groups, responsible for programmes which improve general health across the board.

So, Vikarion, they'd actually be saving you money, by prevention. Not just treatment.

[Kasuko]

Even if there is no choice in the matter, we don't need genetics for obesity, smoking addiction, and chronic illnesses in the gene pool.

I don't think we need you in it either.

[Safai]

There are times when I really wish I could 'like' a post here on Backstage, because this whole page is full of em.

[Katrina Oniseki]

There are times when I really wish I could 'like' a post here on Backstage, because this whole page is full of em.

Your avatar really ruins the serious atmosphere of any thread, you know.

[Vikarion]

I think that this is an emotion-laden issue, or, at least, I'm guessing it is. I don't find it to be so. Nonetheless, after talking with a friend today, I think I've not been entirely clear on what I mean by some of these things. I'm going to try to rephrase.

First, let me clarify what I'm not in favor of. I'm not in favor of simply letting people die because they don't have enough money. Were it up to me, people like Kat would get treatment. An efficient use of resources is to distribute them where they do the most good. When the private market accomplishes this (as in most goods) the private market is best. However, there are areas where services and some goods are best allocated using other models, such as government.

Second, let me clarify what I'm worried about. What I'm worried about is the perception that moving to a different model will solve for resource scarcity. That is to say, there are only so many resources to go around. It is quite alright to agree that the current distribution is, to say the least, not the best. Yet, even if resources are redistributed, there will only be so many to distribute. And even if we tax people more to pay for them, at some point there will arise a reluctance on the part of the taxed to do any more work. Or, to put it another way, people aren't willing to give all of their discretionary income to health care.

Thus, as economists recognize, we are left with the problem of distributing scarce (as in, not unlimited) health care resources. We don't have enough doctors, drugs, and machines to take care of everyone as much as everyone would like to be cared for. It would be nice if this were not so. But it is, and it will remain so for the foreseeable future.

Now, many seem to be angry that our current U.S. system largely distributes health care on the basis of ability to pay. That is to say, the more money you have, the better you will be cared for. I agree that this is not a recipe for good things. But it does not follow that because we move to a system which does not utilize financial capability as a sorting machine, therefore we will no longer have shortages. We will.

Consider Britain's NHS. The National Health Service is an interesting model. Some prefer it, some prefer a simple single-payer system, and some, such as myself, think that Obamacare is probably worth exploring on a practical level. The NHS largely avoids the problem of people dying for lack of treatment, but the large waiting lists for electives seems to imply that this is not without cost. In other words, there are only so many beds and doctors, and only so many hours in a day. As well, there have been questions over rationing and denial of services to some people:

http://www.telegraph.co.uk/health/healthnews/9706918/50000-denied-treatment-to-save-NHS-cash-claims-Labour.html
http://www.theguardian.com/society/2012/apr/28/doctors-treatment-denial-smokers-obese
http://www.theguardian.com/society/2011/apr/18/nhs-cost-cutting-surgeon-warning

Who, in this thread, was noting that we might need to deny some people treatment? Ah, yes. It was me. Apparently that makes me a horrible person. That's fine, but it also appears that I may also be a correct horrible person.

Given limited resources, there are tough questions to be asked. One I gave my debating friend, for example, was the following: suppose you have a thirty-year-old meth addict, a total burden to society, who needs drugs and an operation to save his life (a life-saving operation). On the other hand, for the same cost, you have three forty-year-olds who could be provided with the hip replacement surgery (an elective) which they need to keep their jobs and not live a pain-filled life.

My friend, who has an emotional attachment to the "sanctity of human life" (this is a phrase that makes me laugh - try that on a hungry tiger or vicious disease) chose the meth addict. I chose the three forty-year-olds. This is what I mean when I say that we don't necessarily need genes for addiction in the gene pool - a statement I made when someone argued that addictions were not choices. It doesn't mean that I think we need to weed people out - that is inefficient and stupid, and I have the sneaking suspicion that moralists would consider it wrong.  What I mean is that I don't see those who indulge such things as more important than the functional and useful members who also need treatment. Or, to put it in another way, we don't need those people as much as we need other people - people like Dex, and Kat, and, frankly, myself, who are functional, working members of society. In a "fairness" sense, from the example above, why should you be required to pay, by giving up an elective that you need, for someone else's bad choices? Why should they get to take an out-sized portion of resources?

This is cost/benefit. I'm sorry that you don't like it, but it rules this world, because this is a world that exists on the knife edge of entropy. It doesn't really matter if the addict chose to be addicted or not. What matters is that switching to a different system of distributing health care is not going to solve the problem of there being scarce resources - and arguing that we should switch to a different system because it will solve for scarcity is to lie to oneself and others. A better distribution, it may be.

Now, Pieter has said that, last he checked, making unwise health decisions is not a death penalty. It seems that the sentiment that we should save people from their bad behavior is popular. Well, I disagree, at least, somewhat. Jumping off a bridge, for example, is a decision with drastic health ramifications. As is smoking. As is reaching into a running garbage disposal. In fact, most of the things we consider to be fairly stupid decisions are such because of their potential for...immediate and drastic health ramifications. And yet, the person who smokes is embracing a repeated and informed pattern of self-destructive behavior, while the farmer who dies as a result of forgetting to turn off the wood-chipper machine before maintaining it is guilty of a momentary lapse of judgment. Yet, who here would cry about how unfair it is that the wood-chipper did what a wood chipper does? Probably no one. That's just life - the result of making a bad decision. But to suggest that the person who embraces an entire lifestyle of health-destroying behavior might well be held responsible for it...that is apparently monstrous. I make no other claim than that, if I have to choose between treating the cancer-ridden smoker and the non-smoker, I'm of the opinion that the latter is a more efficient use of resources.

As well, we must be watchful for the "tragedy of the commons" situation. This is a problem that occurs when costs for behavior are a burden to an entire community, rather than just an individual. For example, suppose that I have to pay for my own car. In that case, I am likely to take care of it, because I am invested in it. On the other hand, suppose my community maintains a fleet of cars. In that case, I'm less likely to take care of it, because I bear no significant cost if it is damaged. Now, rationally, this may not be true - if everyone acts like that, soon we will be out our fleet of cars. Nonetheless, that is how humans tend to act, and this has bearing on health care. If you have to pay for treatment yourself, you are more likely to take care of yourself than if others have to pay for your treatment. How much of a problem you see this as probably depends on your view of human nature. I take a somewhat dim view, personally.

And I'm not willing to give up too much of what I value to ensure health care for everyone, and I'd bet that you aren't, either. For example, if you could cure one child of cancer by eliminating Eve Online from your life, permanently, and devoting the subscription costs to that child's care, would you do it? What if you could save ten children by never buying or playing a game again, and using that money? Would you do that? What if you could save a hundred children by devoting all money you did not physically need to their care? (Peter Singer wrote an essay about this, here: http://people.brandeis.edu/~teuber/singermag1.html .) Would you do that? Because, if you would, you could do that now - in fact, you could save many more than one child with the fees you pay to Eve Online. But I have the suspicion that you aren't willing to do that. Therefore, I doubt that you would be willing to pay enough into a system for everyone to get as much healthcare as they need. And I'm using children as an example and a real thing, here - how much less would you be willing to pay for every drug abuser, smoker, and drunk?

TL;DR: There is no TLDR. Except this: there is no free lunch, and changing things does not necessarily fix them.

[Arnulf Ogunkoya]

The problem with reducing people to an analysis of how much they consume versus how much they contribute is this.

Economic systems are supposed to be there to support people. People are not supposed to be spending all their effort in supporting a particular economic system. If the system isn't working well for most people then it is broken and needs to be repaired or replaced.

As for your earlier example of someone who is very disabled and needs a lot of care; what can they contribute? Ever hear of a man named Stephen Hawking? Granted, by the time Hawking started to deteriorate he was already studying his doctorate. But if you reduce a person to simplistic economic terms you are likely to miss a good part of what they can offer.

[Vikarion]

Economic systems are supposed to be there to support people. People are not supposed to be spending all their effort in supporting a particular economic system. If the system isn't working well for most people then it is broken and needs to be repaired or replaced.

As for your earlier example of someone who is very disabled and needs a lot of care; what can they contribute? Ever hear of a man named Stephen Hawking? Granted, by the time Hawking started to deteriorate he was already studying his doctorate. But if you reduce a person to simplistic economic terms you are likely to miss a good part of what they can offer.

Not to be offensive, but that's a rather simplistic view of what an economy is. What economists have come to realize is that economic systems are essentially organic, and not limited solely to humans. The idea that you can just "decide" to have a different economic system is essentially a fairy tale, from a modern economist's point of view. There is a very good reason why every successful nation in the world today is capitalist, from Sweden and Norway to Japan and South Korea.

The constraints and impositions we place on a capitalist economy are not, on the other hand, necessarily bad things. They are things we want, driven by the incredible economic power of human trading and production in a capitalist economy. But there is only so much burden you can place on a capitalist economy - it is not an endless fount of bounty to be reaped. As for socialism and communism, they are dead in terms of scientific viability, and have been for some time. Keynes and Friedman have won that argument.

It is interesting to note that the economic expenditure on government services of a country like Germany (43.7 percent) is not all that different from, say, the United States (38.9 percent). How the money is spent, of course, is a different matter.

As for Stephen Hawking, I tend to believe that those who have managed to get Ph.Ds in physics are more useful than, say, meth-heads. But hey, let's say that a cost-benefit analysis ruled him out. So what? This is like arguing that we should ban abortion because we might miss out on another Beethoven. Well, yes, we might. We might also miss out on millions of unwed mothers in poverty. Are millions of mothers and children living in poverty worth a Beethoven? Well, maybe, to Beethoven lovers. But, hey, we might be missing out on another Beethoven just because you aren't getting pregnant right now!

You can see where that sort of thinking leads.

[Arista Shahni]

I hate that americans are measured by their jobs.

I have a degree.  I had a career.  I worked since age 13(work permit) and paid into Social Security for all of those years.

I became disabled while working.  I kept working.  I went to get epidurals on my lunch breaks.  Doctors I sat in conferences with were the ones who tried -and failed - too repair my spianl and neurological damage.

I'm now on medicare.  I no longer "contribute to society".  But I did.  For over twenty years.  My SSD benefit is based on the number of "work quarters" I contributed and the amount of my check that was removed and put into the pool.  From that base number, approximately 150 a month is removed for SSD.   Another 135.00 a month is removed from my work's long term disability insurance as a "medicare handler" PPO insurance.  I paid for my pension, and I pay for my healthcare out of said pension.  Medicare is not free.

But still,I am considered a "useless member of society, leeching off of the system",bebcause that is an American thought-form -- we are judged by what we do for a living, and when we no longer do something for a living, we are considered worthless and no longer "deserving".  We were required to pay into a system that we are cursed when we need to draw from it.

I worked for a decade trying to cure cancer.  Now no one gives a flying fuck about a 'leech on the system' when we are getting *the same government mandated retirement earnings/pension someone who retires at 65 earns, with the same benefits they earned* - but because we couldnt hack it until age 65 because something terrible happened, fuck us.  And we get to do it in agony every day. 

Yeah, wee, I get "free money" - when it wasn;t free - I PAID FOR IT?  And the tradeoff is endless, incurable, unstoppable pain, nomatter how many injections they give me or surgeries they do or pills they feed me, and its barely enough money to live on anyway?

I'd trade this for a job with no insurance any fucking day of the week. 

http://youtu.be/LnoD3NUux3M?t=50s

[Lyn Farel]

It may be naive but from a foreigner pow the US system looks really like "As long as I have a good job I pay for the social cover of the other ones like me with a good job. If something bad enough happens to me, and I lose my job/cover/insurance it's bad luck, and i'm fucked."