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At what cost a human life?


How much should our healtcare system pay per person to save a life from a terminal disease such as AIDS, cancer, or a critical injury?  

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The thread on healthcare got me thinking. We have a finite set of resources which we can spend on treating people. There is currently no set limit on the amount of resources which can be expended to save a life, yet if we spent all our resources on saving lives of those who need it, we would impovrish the system (and ourselves).

What if there were a cure for AIDS, or Cancer, but the cost was enormous? What if the cost was so high, that if we cured everyone we would impovrish ourselves, should we still do it?

Answer the poll with the understanding that if the cost of saving a life is high, each of our taxes must go up to meet the need.

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Can you really put a dollar amount on this? In terms of terminal diseases and afflications I think the limit should be whatever it takes to keep the person in relative comfort.

If we put a specific amount on something like this we are playing corporate healthcare, and to be honest I don't think any of us want anything like that.

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When a topic like this is raised, the platitudes start flowing. "Can you put a price on a human life?" "We're talking about people, not numbers."

Well, our healthcare system has no choice but to look at numbers, and they have to put a price on a human life. If providing exotic treatment for just one person costs a sum of money that could have hired 5 nurses or opened 10 hospital beds or provided home-care for 200 people, then providing exotic treatment for that one person has come at the expense of others who need healthcare.

-k

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.....all that plus the issue of smokers, for instance. Do we spend the same amount of resource capital on a smoke induced lung cancer as the lung cancer of a second hand smoke patient?

Dollars for lives? Can't answer that. Our dollar may change value with the markets tomorrow so the issue is what percentage of our actual resources should be used perhaps.

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If the cost were that high, no one could pay it, privately or publicly. This topic reminds me of studying Lawrence Kohlberg, and his Heinz dilemma. If a man's wife is dying, and the pharmacist has rare medicine she needs but has inflated the price so much the husband can't afford it, is he morally justified in breaking in to the pharmacy and stealing the medicine, curing his wife? I think there was a Hollywood movie not long ago (Denzel Washington comes to mind) along the same lines, where the hospital is taken hostage until an organ transplant is arranged, even though insurance wouldn't cover it.

I am not advocating criminal action, just pointing out that people become desperate and resentful, especially when they know treatment is available to others, but not to them. Also, people who are chronically ill may not be able to work, and therefore wouldn't be able to pay the increased costs, even though they are the ones who would need it the most. I think we would end up with a society that says stay healthy, because once you are sick you are just a burden to yourself and everyone else.

Having said that, I agree with crazymf that people need some incentive to take more responsibility for their own health. It does bother me that we are on the hook for paying for emphesima (sp?) treatments for people who smoke two packs a day, and continue to do so even after they get sick. Its the abusers of the system that perhaps could be targetted, not the legitimate users.

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Survival of the fittest would apply if there was no health care at all.

Care should be applied to those who need it to the extent of the resources.

Survival of the fittest would apply again after that.

The issue of withholding care to abusers is an issue that can't be solved and frankly would be wrong imo. Where is the limit? Skiers can't get treatment for broken legs?

We have to care for our sick and dying. That's what I'd want if I was sick.

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Let me rephrase. I'm not in favour of withholding care from "abusers" of the system, even if we could define what "abuse" consists of. But is there a way to encourage people to take more responsibility for managing their own health? Not with a cut off, as Renegade suggests, but with more recognition of how our choices impact our health. As I think about it, we have had things like Participaction, and there are the warnings on cigarette packages; the liquor mart has an extensive campaign against drinking during pregnancy, as well. Seat belt laws are in effect in every province, I think (correct me if I'm wrong). Some of these interventions have had an impact, and others maybe not so much. But people can take more control themselves to reduce their health problems.

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Can you really put a dollar amount on this?

While it is uncomfortable to do so, of course we can. We do so everyday whether we choose to acknowledge it or not. Our govenment makes choices in deciding it will fund a cheaper treatment, over a somewhat more effective but considerably more expensive treatment. Is that not making a valuation on the worth of a life?

No doubt, people die while on waiting lists for treatment which could save their lives. Has the govenment not already made a value judgement by choosing not to more extensively fund this treatment?

Don't we all subjectively value a life when we choose to buy a new car rather than contribute to alleviate starvation in Africa?

Of course each valuation is subjective, and we tend to value our own lives and those of people close to us higher than strangers, or people in other countries, but our actions prove that we make valuation judgements on the worth of a life every day.

Do we spend the same amount of resource capital on a smoke induced lung cancer as the lung cancer of a second hand smoke patient?

A smoker makes a voluntary choice to smoke despite knowing the risks to their health. They do so for their own reasons, not to abuse the health system, yet despite this, I don't really see why all of us should be forced to subsidize the cost of a choice which is made by the smoker alone.

I would have the same stance for participation in high-risk sports. If someone decides to engage in a high-risk activity, all the costs (including the healthcare) should be their's alone to bear. BTW, I do personally participate in sports and frequently injure myself. I'm fine to assume the costs of those injuries as I don't make reckless choices.

As I have proposed before, one fairer system is for users of the system to pay based upon risk (just as we do with auto, or life insurance). In this case, contributions by smokers, and others who engage in high-risk activites would help offset the costs that they incur.

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So perhaps someone who drives a car shouldn't get free treatment for injuries due to an accident? There's no clear cut line there so I'm not sure we can endorse a policy of self abuse waivers.

But, a smoker could buy health insurance at inflated premiums to cover his own health care. That would lead to a general trend toward a system just like the USA.

Tricky subject....hmmm.

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Of course there is no clear line, however if you have ever filled in a life or disability insurance application, you would see that insurance companies have found a line. They do ask you about your smoking habits, they do ask about your history, and they do ask about your participation in high-risk sports activities.

They do NOT ask about your driving habits, because they generally assume virtually everyone is involved in automobiles in some way, and it is a relatively minor risk factor.

Filtering on major risk factors doesn't handle every case of course, but it goes a long way.

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Insurance companies are different than general health care though. They are businesses that are there to make money off you and if they can't, they'll change their rules until they can. I compare our public health care system to government where the bottom line is not profit, but service to the citizens.

One pet insurance company isses a policy of $12k worth of coverage for the life of your pet. Perhaps our health care system could put a dollar value on that for people. Maybe they already do when considering funding for it.

Mr. Jones has used all his $12k worth of coverage, but Mrs. Jones has not. She can voluntarily let Mr. Jones use her remaining coverage.

?????/

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We not only CAN put a limit on health care cost per person, we DO.

The limit being the resources available in the area where the person is hospitalized.

For example, a patient in Timmins, Ontario will be cared for within the limits of the resources in the Timmins hospital system, with the exeption of a few who might be sent to a dedicated cancer-care center.

Outside of a Terri Schiavo-type case wherein the person has been declared brain-dead, we should endeavour to keep patients alive as long as the resources are in place to do so.

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But, a smoker could buy health insurance at inflated premiums to cover his own health care. That would lead to a general trend toward a system just like the USA.

It has become quite in vogue to suggest that smokers be forced to cover the cost of related cancer-care, etc, through buying their own medical insurance.

But I would suggest that when you consider the fact that every pack of cigarettes is taxed to the tune of about $3.00-$4.00, and that if all that money was diverted by the government into health care instead of pissed away elsewhere, then the smokers would have already covered their butts.

The beauty of this consideration is that the more you smoke, the more you are contributing to the system through your taxes. So, in essence, as your risk rises, so does your contribution.

Consider also that a 1-pack/day smoker will be putting between $1,095-$1,460/year into the system. (Figure based on tax rates at $3/pack and $4/pack, figures from 2002. Apparently, the tax rate has gone up again, but I'm too lazy to research it right now)

This is in addition to whatever contribution to health care that smoker is already making through paying income tax, etc.

A fairly substancial contribution.

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I'm not inclined to accuse smokers of not paying their way. Besides the points you raise, smokers have a shorter life expectancy then the non-smoking population. This shorter life expectancy translates to less cost to the health system because as people age they use a disproportinate amount of healthcare resources.

Hmmm. Maybe we should be paying smokers higher CPP pensions since they don't live as long...

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I compare our public health care system to government where the bottom line is not profit, but service to the citizens.

IMO, that statement should be qualified as "government where the bottom line is not profit, but service to the citizens AT AN ACCEPTABLE COST".

Afterall if cost was not an issue, we could arguably provide the best available service.

One pet insurance company isses a policy of $12k worth of coverage for the life of your pet. Perhaps our health care system could put a dollar value on that for people. Maybe they already do when considering funding for it.

I like it, even a family coverage amount woudl be ok.

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As I have proposed before, one one to have a fairer system is for users of the system to pay based upon risk (just as we do with auto, or life insurance). In this case, contributions by smokers, and others who engage in high-risk activities would help offset the costs that they incur.
Insurance companies are very arbitrary in their calculations of risk. They exclude many people who are not high risk because it is more convenient to group people into large categories than small. For example, young men are high risk drivers and pay a lot more in premiums but if they looked more closely they would probably find that different groups of young men (in college, working, unemployed, etc) have different risk profiles.

Another aspect of insurance risk assessments is the fact they must choose categories that cannot change easily or be faked. So for example, statistics may show that people who attend church regularly have lower risk profiles but if there was financial incentive to go to church you would see that many people would start attending church and, there by, eliminate church going as a useful measurement. This means people who are really low risk have to pay more than they should just because the things that make them low risk are not 'durable'.

Yet another problem with insurance risk assessments is it always assumes that past behavior is an accurate measure of future behavior and does not take into account that people are capable of change. Take the example of a drug addict who seeks treatment and is able to start a drug free life. This person would be very high risk in terms of statistics because there is a high likely hood of relapse. An insurance company who wanted to could determine whether a specific individual is staying clean or not with random drug tests - something that is never done because it is easier for the insurance company to just to reject coverage.

The last problem with insurance based measurements is there is a very blurry line between what is a personal choice and what is a genetic predisposition. Take the example of the drug addict/alcoholic: there are numerous studies that show a genetic link to people with substance abuse problems yet most people assume that addiction is completely a result of personal choice. The reality is somewhere in between. A similar issue exists for diabetes and other diseases that can be aggravated by lifestyle choices but are not caused by those choices.

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Sparhawk, you make valid points. What you are pointing out is that it is hard to properly assess risk. This is true. I disagree with your assertion that insurance companies are arbitary in their calculations of risk. They spend a lot of time analyzing claims to determine risk factors. They do reject using risk factors that are not quantifable or verifiable. In some cases there are risk factors which may be not socially palatable to use. (As an aside, isn't it interesting that they do use age and gender as discrimminating factors, but not race)

What you are pointing out (and I agree with) is that we will never have a perfect system for assessing risk, neither for insurance, nor for healthcare. However if we decide in principle that risk should be a determining factor, then we should take steps in implementing a system based upon assessed risk, despite that it cannot be perfectly assessed.

Personally, I feel that it should be irrelevant whether the causative factor for the risk is genetic predisposition, personal choice, or factors beyond anyone's control.

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What if there were a cure for AIDS, or Cancer, but the cost was enormous? What if the cost was so high, that if we cured everyone we would impoverish ourselves, should we still do it?
You raise a very important question that I think that many people are afraid to ask because of the ethical and moral issues that come with it. Health care is probably the only area of human endeavour where new technology actually increases costs because as soon as a new treatment becomes available there is a moral imperative to use it no matter what the cost.

To answer the question: what is a human life worth? I would say it depends on the person. Giving a cancer treatment to a 90 year old who may live for a year or two is considerably less important that treating a 9 year with a long life ahead of them. On the other hand, spending huge sums of money keeping a child alive with a completely debilitating illness like cerebral palsy is probably a waste (at least from the point of view of society not the child's parents).

Perhaps a solution could be found in the concept of 'end-of-life' insurance. In other words, the health care system would pay for 100% of the costs of care until someone reaches a point where medical professionals agree that treatment is simply delaying death for a short time. Many people choose to stop treatment at this point anyways, but it would likely save the health care system billions if people who insist on clinging to life for as long as possible are required to buy private insurance in advance.

I would also extend this concept to 'extreme-disability'. If someone needs treatment and either already has or is likely to end up with an extreme disability that leaves the person permanently unable to care for themselves then they would need have private insurance to cover the treatment. The definition of 'unable to care for themselves' will be tricky to work out a consensus. I would argue that a paraplegic who still has use of their arms is capable of looking after themselves because they can still feed themselves. A quadriplegic would not be capable of caring for themselves.

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I shudder to think what a parent of a child with cerebral palsy would make of your post; cerebral palsy is actually often caused by an accident at birth, and often is the result of medical error - who is responsible then? But here is another scenario: a child born with Fetal Alcohol Syndrome. This is wholly the result of the mother's choices during her pregnancy, and is irreversible. Estimates are that the health care and social costs this child will generate will top 2 million dollars. Is it likely that this mother will have purchased the extra health insurance to cover this baby's care? Do we just turn our backs on these babies, on the grounds that they are damaged beyond repair anyway? Denying the child interventions is likely to end up costing us even more in the criminal justice system in the end (and may anyway, even with interventions).

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I shudder to think what a parent of a child with cerebral palsy would make of your post; cerebral palsy is actually often caused by an accident at birth, and often is the result of medical error - who is responsible then?
It is not about who is responsible it is the cost vs. benefit to society as a whole. My understanding is that most kids with cerebral palsy would not live past their first birthday without extensive medical interventions, however, FAS kids quite likely to live without these medical interventions and, as a result, need what ever support is necessary to ensure they can function in society. However, I did not intend to start debate about exactly which cases should be covered and which would not - just a discussion about the need to make choices.

Please keep in mind that our heathcare system makes these kinds of brutal ethical a choices today because public health care is a finite resource and there is not enough money to pay for every possible treatment. The only question is whether we as a society want to get honest about the choices we make and, more importantly, require that people who insist on absolutist moral positions regarding life and death understand the costs of taking those positions to themselves and society.

The Terri Schiavo case was an interesting example. She would not have lived as long as she did if it was not for medicare payments from the state. Yet the same politicians that advocate cutting education funding to inner city schools were insisting that she be kept alive with tax payer's money. These were extremely misplaced priorities in my opinion.

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I agree, Sparhawk, I'm not trying to debate who is more worthy of care, just giving an example based on Renegade's idea of increased health care premiums charged to those who engage in risky behaviour. My point is, is it likely that a mother who drinks enough during pregnancy to have a baby with FAS would purchase the extra insurance? And if she doesn't, what do we do for that baby? This can apply to any risky behaviour; FAS was just an example.

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is it likely that a mother who drinks enough during pregnancy to have a baby with FAS would purchase the extra insurance?

Probably not, since if she was responsible enough to buy extra insurance, she would also likely be responsible enough to avoid alcohol during pregnancy. Regardless, some people irresponsibily choose to drive without car insurance, does that invalidate the entire auto insurance system?

And if she doesn't, what do we do for that baby?

Where there are worthy humanitarian causes, we as a community should fund it as such, but it should not be confused with insurance. I think this would fall into that category.

An interesting question regarding FAS is whether the child as a victim of FAS, can sue the parent for the damage caused.

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Personally, I feel that it should be irrelevant whether the causative factor for the risk is genetic predisposition, personal choice, or factors beyond anyone's control.
A couple points to ponder:

1) I can see the rational for introducing risk-based premiums into the system in order to control costs by encouraging people to make healthier choices. This means the factors that are beyond a person's control should not be part of any risk assement in a publically funded system because it defeats the purpose of a public system.

2) New genetic tests are being developed constantly which can be used to discover new risk factors. You may be self-confident enough to believe that you and your family would not be affected by such risk based premiums, however, some new genetic test could render your or someone you care about un-insurable in the future.

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Guest eureka

Risk based assessment is based on revenues and expenses. It could only work where there is a known revenue against accurately estimated proscriptive expense. That means that the acceptable total expense must be politically decided beforehand and revenues geared to that,

Much like actuarial based insurance but the decision is still a political one of how much are we prepared to spend and what are we prepared to cover.

We are left with the same choices as we started. They are moral, social and political: I include economic in those.

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This means the factors that are beyond a person's control should not be part of any risk assement in a publically funded system because it defeats the purpose of a public system.

I guess it depends on what you see the purpose of the public system is. I believe the purpose of the public system is to share the risk of unforseen future events which would be cost prohibitive for us to handle individually. There are many cases in society where we expect individuals to incur the cost of factors beyond their control. (Eg If your house floods due to heavy rainfall, you are not really expecting your neighbours to help share in the cost of repairs, are you?)

New genetic tests are being developed constantly which can be used to discover new risk factors. You may be self-confident enough to believe that you and your family would not be affected by such risk based premiums, however, some new genetic test could render your or someone you care about un-insurable in the future.

Its not that I'm self-confident enough to believe that I or my family would not be affected by such risk, it is that I believe I should be the one to incur the increased (or reduced) costs of my own genetics. If I have a genetic pre-disposition to a disease, it is because my parents chose to accept the risk and procreate. I should assume the costs of that decision not society.

Risk based assessment is based on revenues and expenses. It could only work where there is a known revenue against accurately estimated proscriptive expense. That means that the acceptable total expense must be politically decided beforehand and revenues geared to that,

Of course there need to be projections on revenues and expenses. That is no different than today. However, any system, whether risk-based or not is somewhat self-balancing. Cost overruns one year cause a change in rules or premiums and result in a surplus the next year. A risk-based system doesn't change some of the choices which need to be made, however it does help control costs by incenting people to stay healthy, and it more fairly allocates the cost-sharing of the public heath system

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