Oh boy, yet another "actshually" filled with emotions that supposed to give "another view".
You precisely know what Emanuel and Lee mean when they quanyify that someone with 25 years is a greater loss than someone with 60 years. This emotional story about grandmother does nothing to change their statement.
That's not the point that the article takes issue with. Not the difference in time, which the author acknowledges is important, but the classification of those later years as being inherently less valuable than the younger ones.
The problem is that insurances pool everyones money for treatment. No death can be prevented, only deferred.
Is it justified to extend the life of a terminal cancer patient for another miserable few months with chemotherapy, at full cost to everyone else in the pool?
I dare say not, and QUALY is the measure we use to calculate this, imperfect as it may be. It also is worth noting that QUALY is not conditioned on worker productivity, as suggested in the article.
Everyone wants their grandma to get the most treatment possible, just no one else's. When it's "society" - people will say we're spending too much money. When the shoe is on their foot, people won't like it and say they "deserve the best care."
> for another miserable few months with chemotherapy,
My grandfather hated chemo. But he did it for those few more months - and he got to see my cousin get married. How do you account for this? You can't.
Indeed, you can not emotionally account for individual tragedies or circumstances with a statistical measure. Unfortunately, somebody has to financially account for it, because as I said, this is a pool of money that everyone chips into.
If you are willing to pay extra, or out of pocket, to have your life extended to the absolute limits, that is fine with me, but please do not push this attitude as the “morally right one” unto everyone else.
> but please do not push this attitude as the “morally right one” unto everyone else.
I will push whatever I want to, thank you. Insurance is supposed to provide healthcare. It isn't supposed to judge what is a good life. I shouldn't have to pay extra for care that I was always paying for because you're mad your rates went up. Don't like it, don't buy the care. Ridiculous assumption to let society decide when people should live and die.
It's also unnecessary to. On the populations we are talking about, individual cases like people living long on chemo in miserable lives to die are counteracted by people who died way younger. It's easy to calculate the risk and spread that among insurance holders.
Let me rephrase that: When making an emotional appeal, you aren't making a sound argument. It's effective, but also intellectually dishonest.
> Insurance is supposed to provide healthcare.
Healthcare providers provide healthcare. They need to get paid. Insurance providers offer the insured the possibility to spread the risk of large individual healthcare costs among many participants.
If you have the opinion that health insurance should be a universal right, you will also have to consider that those countries who have such systems also put strict limits on the extent of end-of-life healthcare.
> I shouldn't have to pay extra for care that I was always paying for because you're mad your rates went up.
If costs go up, rates go up. As your individual risk goes up, your individual rates go up. The more you pay, the better your insurance is going to be able to cover you. You're going to pay extra either way.
What are you going to do if you can't afford insurance anymore, except the most basic plans that are capped at the top? You're not going to be able to afford that last round of chemo.
> Don't like it, don't buy the care.
So... let the prices rise until nobody can afford insurance anymore, then blame the people for not buying it? Medicare-for-all? I'm afraid that won't pay for everything either.
> Ridiculous assumption to let society decide when people should live and die.
That's the way it works either way. If you lived in a hypothetical society that goes to any length to extend everyone's life to the maximum extent possible, then that society decided that.
> On the populations we are talking about, individual cases like people living long on chemo in miserable lives to die are counteracted by people who died way younger.
People who died way younger also stopped paying way younger. It's also rare. The chance of developing cancer in your lifetime is 1 in 4.
Furthermore, in many cases, the effectiveness of chemotherapy is quite low, especially considering its severe impact on QOL. Many doctors refuse chemo after receiving a terminal cancer diagnosis, opting for palliative care instead.
> It's easy to calculate the risk and spread that among insurance holders.
It's easy to calculate the cost, it's not so easy to actually get it paid. Suppose your cost rises by 10%, so you raise prices by 10%. As a result, revenue goes down 5%, because people drop out of insurance. You need to raise prices again, or reduce coverage, increase co-pays, and so on.
It's not later years per se but level of health which is adjusted for.
We tend to think of this in terms of whether we should extend life with poor years or not but if you think about treatments or devices which won't extend life but might well have a dramatic effect on level of health, mobility etc during those years then it becomes clearer why this is an important consideration. I think most people would say that in a resource constrained world there still ought to be room to fund those things.
Surely, this evaluation relates to the public sphere perspective. Along with insurance companies, every single relevant government action that requires estimations of life value, tacitly or explicitly agrees that later years are indeed less valuable than the younger ones and likely, always will. NICE - the UK medical board that decides which medicines can be used in the NHS, constantly makes calculations on quality of life for all ages. This is inevitable if public funds are involved.
In the private sphere, it’s a completely different matter. This seemingly 'uncaring' stance only applies where public decisions are involved. No reason for this evaluation to necessarily work at a personal level if the state (taxpayer) does not pay for it.
You precisely know what Emanuel and Lee mean when they quanyify that someone with 25 years is a greater loss than someone with 60 years. This emotional story about grandmother does nothing to change their statement.