You see, if you dial up the security knob on your products, you'll get to a point where some of the functions are turned off because sometimes they simply can't be secured. An insecure protocol is insecure, by definition. If you want to turn security up, this protocol will get shut off.
It's a feature, not a bug. That's exactly what was intended to happen.
Too Old To Work Too Young To Retire looks at some well meaning person yammering on about Sweden's "wonderful" socialized health care system, cutting them slack for their sometimes slow ambulance service. TOTWTYTR points out that it's not a mistake when this happens, it's a choice by the people who design and fund the health care system in Sweden:
The conceit that "sufficiently smart people" can design a system that will not fail is precisely that - a conceit. We spend a ton of money on heroic measures; they focus strongly on preventive health. We are willing to allow people to get by without health insurance, but spend astonishing amounts of money trying to save very sick people; they choose the opposite approach.Don’t get me wrong; I’m not making any broader suggestions that Sweden’s health care system should look more like the US’s. My point is just the opposite: if a country with such a fractured health care system can make ambulance services work, shouldn’t Sweden be able to as well?Sorry MS Ahlfeldt, this is not a bug, it’s a feature of the Swedish health care system. All socialized health care systems feature rationing, especially of emergency care. That’s the most expensive part of the system because it can’t be scheduled and cost contained.
It's not a bug, it's a design decision. You can rationally argue that one way is superior to the other, and rational people can find themselves on opposite sides of that debate.
But what you cannot do is to say that there are not health consequences to your decision. Sweden chooses to spend their money in a way that causes some people to die. As do we. The systems work the way they work because that's how the incentive structure is designed.
TOTWTYTR nails the issue. Socialized medicine (including ObamaCare) is sold as helping other people who don't have coverage without hurting those that do. Sorry, that's just not possible. Capacity has to stretch, which means that some people who have care today will get less. If that makes some people feel uncomfortable, that's not a bug - it's a feature, too. Because the Progressives who are so happy about ObamaCare need to understand that services are finite. Giving more of those finite services to one group of people means that there will be less for others. And quite frankly those others include:The intentions behind the Swedish process are good: a more careful screening of emergency victims is intended to cut down on wait times and guarantee care… and possibly save money. But in a twist of irony, instead of feeling as though the care I need is guaranteed, the current model has undermined my confidence that I will get that care at all.I’m not so sanguine as MS Ahlfeldt about the rationale behind the Swedish system. Again, socialized health care is fine, until you need get really ill.
- Their parents, who will need much more expensive care because the elderly are disproportionate users of health care services. Old people are in much poorer health than younger people, because that's what happens to all of us as we age. The $500 Billion taken from Medicare to partially fund ObamaCare will mean that Senior Citizens will live sicker lives, and will die sooner. The resources are being diverted to other people. That's not a bug, that's a feature.
- Very sick children, whose care costs vast sums. Premature babies can cost $100,000 or more during a 2 month stay in the Neo-natal ICU. We're told that our infant mortality rate is higher than European countries', but the dirty secret is that we spend vast amounts of money on heroic efforts to save these babies, and Europe mostly lets them die - and counts them as stillborn. That's not a bug, it's a feature of their system that chooses to apply resources to other patients. We choose differently, but that's almost certainly going to change as cost cutting moves to the fore under ObamaCare. Those babies will be considered expendable.
- Everyone who currently has health insurance will get reduced benefits. This will be driven by two forces. First, costs of their current program will rise to offset the cost of insurance for those with pre-existing conditions. The math is inescapable. Since employers pay much of these costs, benefits will be cut to keep payroll expenses manageable in a tough economy. Second, the pool of people using health care services will go up as more are insured, but the supply of health care providers will remain the same (or possibly go down; it seems that a lot of doctors are nearing the "aw, screw it" stage where it's no longer financially sensible to stay in business and older doctors choose to retire). It will be much, much harder for everyone to get a doctor's appointment.
Because kill it must. There's no magic wand that will increase the number of doctors, there's no health care fairy who will keep lines from lengthening. There's no untapped pool of money to keep Senior's care from having to be raided for your different set of priorities. These people must die, because you want to spend that finite set of health care resources a different way.
That isn't a bug, it's how your system is structured. Some must give up, so that others may have. And the ones who now get the most must give up the most. I guess they're being called on for heroic measures.
You must be so very proud of your higher morality.
Nailed it, you did.
ReplyDeleteWell said, and truly thought provoking... Especially for us old farts...
ReplyDeleteTOTWTYTR really deserves the credit. His post is an outstanding explanation of the problem.
ReplyDeleteYes, the babies and old people will die first. I think it is Germany where they count as stillborn--and refuse lifesaving measures to--babies born prior to 26 weeks. Meanwhile here in the US, the youngest surviving baby was born at 21 weeks 6 days, and I know of a 23-weeker who is going home from the hospital this week. (Twenty four weeks is considered the threshold of viability, by the way, but hospitals here routinely try to save babies born at 22 weeks.)
ReplyDeleteI will admit to some bias in this particular concern, as I'm married to a man who required heroic measures at birth (though he was born at 32 weeks). Many countries with socialized medicine would have considered him better off dead; obviously I disagree.
Sabra, I must say that I get angry at ObamaCare supporters who think they're nicer than I am.
ReplyDeleteOh. My. Gawd.
ReplyDeleteCut right to the bone this time, Borepatch. Dude, I'm in awe.
It is exactly the point I've been trying to make all along, but just couldn't put it to words the way you did - everything has a tradeoff. Everything.
YOu get routine care for everyone, you lose the heroic care for everyone, also. Death panels begin to decide who should be taken care of and who should not. Because really, when society pays for it, it becomes societies decision how much care you get. Sorry, so sad, you lose - we've decided not to foot the bill for your drugs, Mr. Goober, because it is cheaper for us to just give you painkillers and suggest a good end-of-life transistion therapist. You get to live the rest of your short, painful life in misery now, but just think of how much better off we'll all be not having to foot your bill for you!
As I've said before, and will continue saying - leave me the hell alone, and let me pay my own way.
Well said: it is by design that some lives are more valuable than others, and the state reserves the right to not treat whomever they don't think is valuable enough. The very young and the very old aren't valuable and may be disposed of at will. This was all discussed in the open, if you knew to look for it, published by Rahm Emmanuel's brother, Ezekiel. He was co-author of a paper on the Whole Lives system. More info and links to it here - and sorry about the self-linking. It's the only place I know how to get the data instantly.
ReplyDeleteFact: infants will be left to die if something goes wrong and they're not someone's version of perfect.
Fact: older people will die if they're not considered valuable enough to the collective. If you're 80, still working a high paying job and paying taxes, you may get that replacement hip, otherwise, not so much.
When my wife had her second hip replaced, she asked when she could get it done, and they said, "how about day after tomorrow?" Those days are ending.
The recent series of articles in the Journal of Meidical Ethics examining just when it's acceptable to kill is an indication of where this is going.
The other explanation of the "problem" (¿bug/feature?) is: it's SWEDEN. As a half-Swede the old stories remain. They're not new to eugenics, Deathpanel goes way-back to Viking-times.
ReplyDeleteFact: If a newborn showed signs of something wrong the infant was left out in the cold/snow/ice to die.
Fact: Old people who were deemed a burden and "another mouth to feed" were also abandoned in the cold/snow/ice to die. Sometimes it took a push, or a barred door to prevent re-entry.
The whole "Gather Together Kum-Bah-Jah Friends" collectivist-crap is a recent and modern affect of the (now) affluent culture, perhaps a response to years of callous treatment.
In the old days in Sweden/Norway, things wasn't so nicey-nice.
You also have to take into account all the money that will be wasted on the "health care bureaucrats". You got to pay all those people to decide who lives & who dies. Remember they already doubled the size of the IRS to collect the Taxes-Fines whatever you call it.
ReplyDeleteExcellent post. I would add one thing though.
ReplyDeleteBack before I retired, I was an executive who administered health insurance plans for large employers.
One perennial topic of the employee committees I worked with was lifestyle issues that affected health and therefore, health insurance rates. Smoking was the big issue back then but other issues were starting to enter the discussion. The committees always wanted to create some differential rates but the discussion always foundered on the topic of who is to be the lifestyle police. And what are we going to do if an employee lies about their lifestyle. There was really no answer to those questions. Clearly, the national (I am no longer using the word "federal") government has more enforcement powers than we did but do they have the capacity to police all of this. I would expect enforcement to be spotty with occasional examples made of people gaming the system. Experience tells me that the examples will be chosen on political grounds. But as you say, this is a feature, not a bug.
And in the end, everyone suffers.
ReplyDelete