While I agree that what you call "statistical murder" needs to be handled differently, I see problems with doing so that need to be solved. Namely, what counts?
Your example of statistical murder is prioritization can be abstracted as profit over life. A first thought might be to condemn any prioritization of anything over life, but this leads to likely unwanted consequences: it is illegal to drive, ever; it is illegal to feed someone food that is not of the optimal health for their particular situation, ever; it is illegal to sell a product, even used, that California has determined a carcinogen. All of these are related to leading causes of death: traffic accidents, low quality food causing obesity and its myriad of consequences, and cancer. We could use improvement in all of these cases, but such absolute bans go too far.
So, how do we determine when it is legitimate to prioritize something over life, or when it's statistical murder?
So, how do we determine when it is legitimate to prioritize something over life, or when it's statistical murder?
A necessary first step is to hand that decision over to someone who does not personally gain from choosing death. Life-or-death care almost certainly needs to be a government-run, single-payer system.
If giving another kid their cancer meds means one less gold-leaf-covered item in the presidential ballroom, so be it.
We have that in canada and it does not work that way at all. Single payer turns into a big en(ugh line item that there is political "otivation to limit supply and it all goes to crap just in a different way than it has in america. The solution is way simpler: ensuring there is enough supply that price raising bs fails. That gives you a bunch of different ways to get to the solution that will all work vut they all have ensuring enough supply to limit shenanigans at their base.
> If giving another kid their cancer meds means one less gold-leaf-covered item in the presidential ballroom, so be it
I agree. I want to expand on this and make my question more explicit. In my previous post I tried to give one extreme (where we clearly do not want restrictions on behavior). This is the other extreme (where we clearly do want restrictions on behavior). There must be some line drawn in between in order to enforce either of these extremes (that we clearly want to enforce).
It's the beauty of a commercial system, no? Businesses have a duty to make a profit for their shareholders first, second to their clients (keeping their customers happy), and no obligation to the wider society, other than following regulation.
If a private hospital figures out that by jacking prices up by 50% they make more profit, keep their fewer customers happier (not even necessarily more alive!) and treat less people, they are 100% following their mission as a private business.
A European PoV might be that you can counterbalance a private system with a public system, whose goals are explicitly to keep the society healthy and help as many people as possible. The NHS, admittedly not the gold standard for anything good recently, optimises for maximising "quality-adjusted life expectancy improvement" over the whole society.
It's not a metric you could ever replicate with private businesses.
> Part of the problem of modern society is that statistical murder of thousands is treated as less of a crime than a normal murder of one person.
Society is actually quite consistent on that point (unfortunately). The body doing the statistical murder here is the regulator of the hospital system and it is part of the same organisation (the government) that handles the direct murder through the army. People tend to treat horrible missteps in war and medicine about the same.
It might be nice in a moral sense if there was some consistency. It isn't too late to disgrace George Bush and make the rest of his days a living hell, for example. But as political strategies go that seems like a bad idea.
The study you linked concerns whether the hospital is owned by a nonprofit or by a private equity group.
The question in this study is whether physicians work for their own practice or for the hospital directly, regardless of the ownership of the hospital.
Denying categories of potentially life-saving treatments due to provincial laws causing hospitals to value legal considerations over medical decisions is one example.
Perhaps the phrase "statistical manslaughter" is a better description however.
If you engage in behavior with known and predictable risks, which then kills somebody, it is manslaughter. Like recklessly operating a vehicle or blindly throwing knives.
That sometimes your behavior doesn’t kill people is immaterial — manslaughter is being intentionally risky in your actions which leads to a death.
Or in the case of UnitedHealthcare, felony murder: their felony fraud in issuing false denials for their clients resulted in deaths — and deaths that result from a felony have a special charge.
Every health system in the world makes decisions that result in deaths that could have been avoided had other decisions been made. I don't like many of the decisions our shambolic health system makes. But none of it is "murder".
I want to highlight your point because you're correct and this is something that a lot of people don't understand about economic systems. We exist in a resource constrained system. There are finite medical workers, finite time, finite medicine, finite medical facilities, finite medical equipment, and just finite resources in general. There will always be shortages and surpluses in such a system as resource allocation is never perfect. If you have a shortage you must ration supply through some mechanism. It can be by prices, by queue, by need, by lot, by status, or countless other mechanisms or combinations of mechanisms but you must ration regardless. This will lead to people dying under certain conditions who may not have died if some other rationing mechanism was used, but if a different rationing mechanism was used then a different set of people would have died. The only thing that can be done is to select the system that allocates resources more efficiently than other systems to minimize this failure mode. This whole idea of "statistical murder" would just lead to the banning of medical care entirely as no system has perfect allocation at all times, although some are certainly worse than others.
Plus I have no idea what the word "statistical" even means in this context...
An insurer having an auto-deny policy for care claims (procedure/medication/etc) and then fighting a physician’s explanation/reason for their recommendation to the extent the patient expires while this battle plays out, is evil and premeditated and arguably meets the legal criteria of murder in many jurisdictions.
I think you mean murder via diffusion of responsibility is good for business. Its like the trolley problem, but instead of one lever thete a chain of them and at least one of them is the final one, any number of them are like tumblers in a lock.
Interesting. The cost to save a human life is about $4k. Anyone with $4m then is a statistical murderer. Acting to enrich themselves over saving these 1000 lives. Fascinating. Donations to the Rust Foundation have statistically killed thousands. By setting up the Rust Foundation I wonder how many have been murdered statistically.
I hate the US healthcare system but I don't support using the word murder in this context. Murder is very very different from trying to help a person but being greedy while doing it.
I think murder is an appropriate term. There is a long history of company leadership making decisions that they know will lead to the death of thousands of people. See tobacco, opiates, leaded gas and many others. And they are not trying to help people while being greedy but they are only greedy without being motivated to help people.
Yea, we have to stop villainizing people who are making "a better part of a million dollars." The real villains are the ones making a better part of a billion dollars or more.
I agree it's really sad and fucked up. But the way we deal with murder is long prison sentences and the death penalty. If we introduce horrible incentives for investing in medicine, we won't get compassionate care, we will just eliminate investment in healthcare.
We need really thoughtful incentives and simple policies that let doctors run hospitals. Idk it's hard - I was going to say we should reward them for providing better care but I know the pay for performance system in place also hasn't worked that well.
Single payor system would solve a lot of problems as insurance companies and the economic system/incentives they’ve created in healthcare is the root cause of a lot of the issues. Also, it’s such a large and relatively unnecessary value extraction layer (middleman) that we’d immediately have many more dollars going towards providing care than to running of insurance companies and their owners. Even the hospitals and other providers have to employ armies of people just to understand how to bill things properly in this unnecessarily complex ecosystem. It’s a massive waste of resources in the name of capitalism that does nothing to improve the care provided.
It’s even worse when considering these companies profit more by denying care altogether.
It's always astounding that no-one in the US mentions the elephant pooping in the living room - that the US spends more tax dollars than Australia and IIRC the UK, and Canada.
Per capita, or as a % of anything reasonable. The US is such bad value that Medicare and Medicaidel, VA, as well as othe government programs cost IIRC more than Canada's system. And Canada has a huge area with poor economies of scale.
Republicans don't want to admit that they're taxing as hard as the French (for healthcare), Democrats don't want to lose the gold plated Medicare system that old people vote for, and literally everyone from nurses to band aid makers to doctors to healthcare CEOs makes more than in other countries.
Maybe I have missed something, but universal single payer healthcare (especially with a hybrid system like Ausralia) seems cheaper than what the US does.
Your mistake is assuming that the U.S. is targeting “cheaper cost of care” as a goal. The target here is “profit for business”. Usually that’s done by businesses withholding wage increases over decades, but occasionally some regulation is canceled or some private capture opportunity is found that jumps profits and prices rapidly. Australian healthcare generates a lower share of private business profit, both per AUD spent on healthcare and per total AUD spent, and so is seen as inferior to the U.S. model by our leaders.
Seen in that light, the increased prices are a universal winner for us: profits go up -> inflation goes up -> GDP goes up. Wages do not go up, and so as a whole we’ve surpassed 25% of all households unable to afford a one-bedroom home. Economists are taught to only model inflation in terms of price level —, inflation = profit increases + wage increases, with no way to model their separate impacts — and so our policies are economically sound, so long as one disregards the growing poverty. Despair is, as Demotivators figured out ages ago, highly profitable. :-(
The primary reason that this happens is that medical billing and patient management systems are so complicated that it's cheaper for private practices to outsource this to a hospital that already has a contract with Epic or similar extractive vendors.
If the US had a simpler billing/insurance system (or these extractive middlemen were removed entirely), this wouldn't be happening to the same extent.
Everybody needs healthcare. It’s a clear win for society if private actors can’t make it more inefficient by parasitizing a profit. The answer is single payer on the dime of the rentier capitalists. That’s how you reinvest in your society, not crypto and secret police.
Well now you're shifting the goal posts. There's an enormous difference between having the government buy food for a few poor people (which I support) versus being the single payer for food for everyone.
There's agricultural subsidies that help farmers to nominally ensure that the US doesn't need to import foodstuffs. That practically guarantees that food is available, but it isn't "single payer" in terms of obtaining that food.
That "single payer" for obtaining food is food stamps. You have to be poor, to very poor, to qualify. But you get stamps, you bring to your grocery store, and you get free essentials, paying with food stamps. The market then redeems the food stamps to the government to get paid. And, guess who prices these essential products? Well let's just say that the government is generally rather stingy about it, but markets that sell these essential items are practically required to accept food stamps, even if only to keep products moving so they don't rot on the shelves.
When I was on food stamps there was a long tail where I qualified for a few dollars worth. Always seemed odd.
My understating is the dynamic have changed over time. But for much of its history it was as much about “what are farmers having trouble selling” as it was about “who needs food.”
We do. We subsidize agriculture, and virtually everybody gets at least a subsistence level of food. Beyond that level, it's easy to let people decide what they're willing to pay for, because it's based on what they want, and not what they need. Wants are easier for individuals to figure out than needs. Health care is a need.
Why not? What would you want for yourself or your children if you found yourselves destitute and without other people to fall back on? Would you be comfortable with them starving?
Let’s get back to the original point, which is that the motive for profit in healthcare is at odds with the stated goal that everyone should have healthcare by right. Trying to make it about something else is a distraction.
Buying food for your family is a quintessential market transaction that works great with the government at arm's length. Healthcare.. less so. I'd rather deal with the DMV than a private insurer.
How much would it cost? I could stomach a pretty big tax increase if it meant no children in my home country would ever go to sleep starving again. That seems like a social good to me.
You don't need single payer. There are plenty of examples of working health systems in developed countries that don't rely on single payer. You just need some regulations that ensure that the system works mainly for patients and not for shareholders.
The US has reached an almost comical level of insanity and blatant inefficiencies but somehow there is no political will to address anything. Even the current fight over the ACA subsidies is basically about throwing even more money into the fire without addressing any structural issues.
> doctors are rather good at providing care across corporate boundaries
I’ve found that to not be universally true. I say that as someone with eight different health systems in MyChart and who has been treated by two additional hospitals who don’t use MyChart in the past year.
Some systems are very competent about sharing across borders and good at it. I’m lucky my primary hospital is one of those. Others are god awful at it and take multiple calls to get them to even fax records.
Ironically, there are two nationwide networks for sharing patient data - CareEverywhere and Carequality. They even have a bridge between the two, so in effect it's one large network.
But that's all predicated on the provider's EHR being able to talk to it, or at least talk to an interface engine that can be configured to talk to it. And money. It costs money.
"Nonprofit" is extremely misleading. Most nonprofit hospitals are as greedy as for profit hospitals. The money just doesn't go to shareholders but to executives and their friends who have businesses the hospital hires.
Moot. When private equity and conglomerates get involved, operational concerns like waste and quality of service no longer matter. The only thing that matters is making money.
Local regional hospitals and air ambulance companies are being bought up by private equity. And, surprise surprise, privately-owned regional hospitals are cutting critical care specialty services and so air ambulance life flights have increased 900%. I expect mortality has increased too logically because of delays in care.
Costs go up on paper because now they need to charge people more while pretending they are starving. Costs in all other industries go down with mergers.
Go up too. https://hms.harvard.edu/news/deaths-rose-emergency-rooms-aft...
Part of the problem of modern society is that statistical murder of thousands is treated as less of a crime than a normal murder of one person.
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