Given finite dollars to spend on healthcare, how to prioritize it is a fair question, though answering it ends up very emotionally and politically loaded. Just in terms of where the money goes, though, money spent on babies is not really a huge problem in the western world: the biggest part of our "heroic care" medical spending is in the last few months of life of elderly and/or terminally ill people.
I don't know of a good way to solve it. I would like to prioritize solid evidence-based decisions as much as possible, but those have a tendency to come across as unfeeling, or worse (one might even gloss such decisions as amounting to "death panels"). I think part of it is that intellectually all of us agree that we cannot spend infinite resources on every possible health problem, but it's difficult to decide that this specific person should not be treated because it's "hopeless" (a gloss for "poor likelihood of success relative to costs"). That would mostly not be babies, but mostly would be a mixture of elderly people (prognosis for nearly anything declines with age) and people with terminal illnesses that are statistically very unlikely to be cured. But even still, difficult to stomach. In part, because it goes against the psychological messages we're sending at the same time, which is that people should never give up hope, etc.
I don't actually know what I personally think about it, given some recent personal experience. One of my friends died a few weeks ago (in his early 30s) of melanoma, which was discovered in Stage 4, and treated unsuccessfully for about 9 months. The prognosis wasn't very good to begin with, given the advanced stage at discovery. Probably, this treatment had little statistical likelihood of success, though redeeming factors included: 1) at a young age, it was at least distinguishable from zero likelihood, and 2) it was part of a clinical trial, so may give some scientific information even if unsuccessful. However in a psychological sense both he and his friends/family seemed to benefit from the treatment, and would have been much less happy with a "not treatable" decision. Enough to be worth the cost, given the low odds of success? Difficult to say, and anyone who tried to say "no" would end up with a tough sell. And yet intellectually I obviously realize that if I were to advocate that we must "pull out the stops" to the maximum extent possible for every sick person, this isn't going to work under any economic system, whether it has a more right- or left-wing flavor.
One huge thing that the average citizen can do is to write down (and properly file and certify, as needed) their end of life wishes. Too often it is that people end up in the later stages of their life (young or old) without formal directives as to their wishes. It then falls upon impassioned family members to make decisions: do they ventilate, for how long, and do they tube feed, and under what circumstances do they resuscitate?
It is a discussion everyone should have with their family, _today_, before you or your loved ones are not lucid enough to make the call.
I would love to see the healthcare space, along with the government, advocate for these difficult, yet vitally important, conversations.
This would not reduce costs if there are enough people like me. Let me explain:
I assign a utility score of negative infinity to my own death. If the outcome for no treatment is zero percent chance of survival, but the outcome for a treatment that costs some large finite amount C [1] and raises survival chance to epsilon percent chance of survival for some epsilon (nonzero but potentially small), then I would opt for C every time.
This means if there's a way I can convince people to spend a billion dollars to try to cure me, I'd do it. Even if there's a 99% chance I die anyway and it means all that money couldn't be used on a better project, even if successful treatment meant I was in debt to a billion dollars which I could never repay, so I became bankrupt and my entire family would go to debtors' prison for life [2], that's still better than being dead.
Even if I had to kill a healthy child with my bare hands and drink their blood for the treatment [3], I'd still do it even though this scenario results in net negative utility for the human race (one for-sure dead child and one living adult with a 99% chance of dying is clearly a worse outcome than one living child and one dead adult.) Because I'm not interested in the utility of the human race; I'm interested in maximizing my own utility (one percent chance of being alive is still infinitely better than zero percent chance of being alive).
So my advance directive would be "hold at all costs: Liquidate everything, put me through prolonged medical torture if you have to, but the top priority is to keep me alive at any price."
[1] In "costs," I include not just money but my own prolonged pain and suffering; emotional distress of family members; violation of ethical standards; etc.
[2] This hasn't been a real thing for over a hundred years. I guess the modern equivalent is spending your childrens' college fund.
[3] If you believe that life begins at conception, this is basically what stem cell treatment entails.
If that's what everyone wishes, so be it – but it should be in writing, and discussed with your friends and family, regardless of if you wish gung ho end-of-life treatment or simple palliative care.
Get it in writing. Make your wishes known while you are still able to do so.
And regarding [2], some states do have some modern forms of "debtors prison" [2a], at least for fines imposed through the legal system, although are not as overarching as debtors prisons were leading into the modern age.
I don't know of a good way to solve it. I would like to prioritize solid evidence-based decisions as much as possible, but those have a tendency to come across as unfeeling, or worse (one might even gloss such decisions as amounting to "death panels"). I think part of it is that intellectually all of us agree that we cannot spend infinite resources on every possible health problem, but it's difficult to decide that this specific person should not be treated because it's "hopeless" (a gloss for "poor likelihood of success relative to costs"). That would mostly not be babies, but mostly would be a mixture of elderly people (prognosis for nearly anything declines with age) and people with terminal illnesses that are statistically very unlikely to be cured. But even still, difficult to stomach. In part, because it goes against the psychological messages we're sending at the same time, which is that people should never give up hope, etc.
I don't actually know what I personally think about it, given some recent personal experience. One of my friends died a few weeks ago (in his early 30s) of melanoma, which was discovered in Stage 4, and treated unsuccessfully for about 9 months. The prognosis wasn't very good to begin with, given the advanced stage at discovery. Probably, this treatment had little statistical likelihood of success, though redeeming factors included: 1) at a young age, it was at least distinguishable from zero likelihood, and 2) it was part of a clinical trial, so may give some scientific information even if unsuccessful. However in a psychological sense both he and his friends/family seemed to benefit from the treatment, and would have been much less happy with a "not treatable" decision. Enough to be worth the cost, given the low odds of success? Difficult to say, and anyone who tried to say "no" would end up with a tough sell. And yet intellectually I obviously realize that if I were to advocate that we must "pull out the stops" to the maximum extent possible for every sick person, this isn't going to work under any economic system, whether it has a more right- or left-wing flavor.