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Journal benhocking's Journal: Fairness and medicine 15

I was recently having a discussion with a friend about whether our "system" of medicine in the US is better than ones in Canada, the UK, the EU, etc. For sake of argument, I took the position that it arguably was (although I'm definitely not convinced of that). We came upon an interesting hypothetical example: assume that in system A, half the people get treated right away for disease X and half the people never get treated (because they can't afford to). In system B, everyone gets treated 6 months after being diagnosed with disease X. Now, it turns out that if you're treated for disease X right after first being diagnosed, your survival rate is 90%. If you wait 6 months, however, your survival rate is only 25%. In this hypothetical situation, 45% of the population under system A will survive and only 25% of the population under system B will survive.

My friend agreed that, for this case, system A was a better system—but only if the 50% were chosen randomly and not by whether or not they had more money. I argued (again, really just for the sake of arguing, although I think I have a valid point here) that what family you are born into is random and from there on making good choices (or possibly unscrupulous choices) will make you more likely to be rich, hence using money as a means to divine who gets treated isn't any worse than choosing at random.

I'm curious, what are your thoughts?

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Fairness and medicine

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  • I will add more later.

    And of course in neither system are people simply: Able to choose for themselves?

    Seriously, I don't mean doing a heart bypass with household materials, I'm talking about taking the initiative and making sure you eat good clean food, you get the proper exercise (and not TOO much or too abusive on yourself), you take the initiative to care for yourself BEFORE you need to go into the hospital. (And here's one for the Jews and Israelis who have state sponsored DNA tests... how about NOT IN
    • My unscrupulous comment was definitely meant as an "OR" and not an "AND". I.e., you can work harder and earn more money, you can be smarter and earn more money, or (not an exclusive or) you can be unscrupulous and earn more money. It was actually meant as a self-criticism. My initial claim was that the factor of "having more money" was just as random as a lottery, with the lottery being drawn at birth (including accidents of family connections and genetic endowment). For those who believe in free will, howe

    • (And here's one for the Jews and Israelis who have state sponsored DNA tests... how about NOT INBREEDING SO DAMN MUCH!?!?)

      Sheesh. Someone has an attitude problem.

      I am not aware of the DNA tests. Perhaps you mean the Tay-Sachs blood testing, to discourage marriages between two carriers?
  • ...that a huge problem is that having to pay more for care up front acts to diminish hypochondria.
    When the state just doles out the health care, people will abuse it. She cited the example of the person who doesn't like the first diagnosis, and keeps surfing the doctors until they get what they want.
    If absolute power corrupts absolutely, then free health care triggers hypochondria absolutely, for the latter is a variation on the former.
    • Of course, the flip side of hypochondria is delaying a visit to the doctor until the cost of treatment goes up and/or the likelihood of survival goes down. This has been suggested as one reason why men do not live as long as women on average. The key is finding the right balance. I think co-payments can be one method of finding that balance. They should be expensive enough to discourage hypochondria but cheap enough to not encourage delayed treatments.

      Naturally, there is no perfect system. The hypothetica

      • I maintain that "less is more", and the people who want more government involment are a) making money off it, b) haven't thought through the ramifications, or c) a blend of a) and b).
        • Does that apply universally, and does it also follow that there should always be less government involvement (until there is zero government involvement)?

          If no, then how is it clear where to draw the lines?

          If yes, then how is it different from anarchy, which would be soon replaced with most likely an even worse form of government?

          I often see gray where others see black and white. That's why you'll often find me arguing both sides of an issue. In this case, I am always skeptical of government involvemen

          • The (admittedly fuzzy) line is between the words 'acute' and 'chronic'.
            Also, a heavy dose of federalism. There may have been economies of scale in the pre-Information Age, I'll grant, but absolute power corrupts absolutely and concentrations of power create elite, unaccountable groups.
            • I agree whole-heartedly with the federalism statement. I really like the idea of each state being its own experiment. Yes, there are economies of scale that are lost out on, but they are less significant than the ability to perform multiple "experiments", as well as your concern about absolute power.
  • I'd say, our system of medicine is worse.

    But then, I just work in the Department of Medicine at the top US Medical school, the University of Washington, and most of my colleagues are MDs, so what do I know ...
    • You're assuming the systems of medicine are the deciding factor in the differences in longevity. Other obvious suspects include differences in crime (including fatalities) and differences in culture (including, but most definitely not limited to, diet and exercise habits). To muddy up the waters, diet and exercise habits are not separate from systems of medicine. (Of course, differences in crime are not separate from differences in culture, either.)
      • I'm assuming that a country (US) that spends twice as much of a percentage of its GDP as another country (Canada) on medical care, should have a longer lifespan and better health.

        By all objective MEDICAL standards, the US medical outcome per capita is worse than the Canadian medical outcome.

        But, then, at the UW, we are also in the top 5 global universities, and have a Global Health department as well, they could give you statistics on that, if you really cared.

        The diet and exercise habits of the US and Cana
        • By all objective MEDICAL standards, the US medical outcome per capita is worse than the Canadian medical outcome.

          To be clear, I'm not disputing this. (OTOH, I don't really have enough knowledge to agree with it either, but I believe it to be true.)

          I'm assuming that a country (US) that spends twice as much of a percentage of its GDP as another country (Canada) on medical care, should have a longer lifespan and better health.

          The diet and exercise habits of the US and Canada are not that different.

          This as

          • Look, I've lived in both countries.

            Originally, in the 70s, Canadians did NOT live longer than Americans.

            And, yet, now they do.

            The major change has been our failing US health care system.

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