Sam Harris

camanintx - 16 August 2009 02:17 PM

Antisocialdarwinist - 15 August 2009 04:52 AM

I agree that the allotment figure (which is the same for everyone) is arbitrary and subjective.  That doesn’t change the fact that everyone gets an equal portion.

When only 20% of the population requires 80% of the healthcare resources, I would be interested in hearing you explain how giving everyone an equal share is fair.

I think you missed the part about letting only impoverished hemophiliacs bleed to death. That’s not exactly in the Heinlein quote, but let’s ignore inconvenient details. We know that is what Bob H. meant. Economically-productive hemophiliacs can pay for their own blood transfusions if need be. The pity is that so many impoverished individuals don’t just die of their own accord. They’re so unsightly. But we have to keep them around; otherwise how would anyone turn a profit?

Yesterday, I walked past a house obviously valued at about $750,000. The hill it’s on is now dotted with nearly-seven-figure homes that have had for-sale signs in front of them for months. On the driveway, a man in his 40s was displaying a bunch of consumer electronics (mainly new) for sale, as in “yard sale”. I asked what the deal was, and he said it was his inventory from his second career of selling on E-Bay. The further story was that the guy had been working at the medical center farther down the hill and had lost his job. Now the bank is selling the house out from under him and he’s having a moving sale. Obviously, a bet on continually-rising real estate values has gone bad, and the guy has no equity, either. It certainly appears as if he bought borrowed more house than he really needed. What’s the world coming to?

I thought of offering him a lump sum for his inventory, as I am cash-heavy right now, but I would probably way undervalue junk sitting on a driveway relative to what the guy thinks its worth rather than paying the mover. Furthermore, I don’t wish to rent the additional real estate to store consumer electronic goods I have no guarantee of selling as other than the crap they are. There are good business plans and there are shitty business plans. No need to insult people that way. I’d rather do it online.

camanintx - 16 August 2009 02:17 PM

When only 20% of the population requires 80% of the healthcare resources, I would be interested in hearing you explain how giving everyone an equal share is fair.

I find it interesting that a doctor can become board-certified in plastic surgery but not in cerebral palsy, epilepsy or autism. M.D. specialists in the U.S. until recently could rely on making a much more comfortable living than they now enjoy. They still do okay, of course, but plenty has changed in the past couple of decades that has resulted in drastically shrunken income for MDs. Maybe such a condition will result in medical colleges paying closer attention to typical ailments of indigents. I deal with a neurologist who used to refer to my child as having CP and epilepsy, but now he only has epilepsy. The condition that this neurologist used to refer to as CP has not been alleviated, but in the short span of 2 years, the CP diagnosis has mysteriously evaporated. My boy’s pediatric orthopedist has him down for club feet, which worked fine when it was time to get a handicapped placard, but it sort of makes me wonder what sort of expert she is, since his feet are not clubbed in the least according to his other doctors and therapists. Maybe in time economics will drastically change the study and practice of medicine, as the sickest people are very often the poorest, as well.

goodgraydrab - 15 August 2009 06:49 PM

Antisocialdarwinist - 15 August 2009 04:52 AM

I agree that the allotment figure (which is the same for everyone) is arbitrary and subjective.  That doesn’t change the fact that everyone gets an equal portion.

I’ve never argued that they don’t. But you’ve argued your complete objectivity.

I’ve argued that my plan distributes free health care objectively.  Whether or not you prefer a plan which distributes free health care objectively is subjective.

goodgraydrab - 15 August 2009 06:49 PM

Dividing the pie into equal pieces is hardly a random fashion!  And what do you mean by, “redistributing?”  Isn’t it just distributing?

I don’t think so. Healthcare is distributed now (ie, costs are incurred), in its own somewhat random fashion. There is a total figure expended consisting of those that can pay for medical care no matter the cost; those that can’t pay anything no matter the cost; those that can meet their needs; and those that can pay something but not satisfy all the costs. Incorporated into that is the amount of care needed in dollars by an individual in any group, which is randomness or varies to a great degree (ie, luck of the specific illness draw-greater or lesser expenditures required).

You are taking the average amount (ie, the middle most figure of expenditures) to be redistributed amongst everyone equally. But IMO, here’s where your equality ends and randomness and inequality begins because across the board, some people will produce deficits and some will produce surpluses. That was the case before, but now individuals simply may be transferred across categories. Where they were in one category before, you may have reassigned them into another. This is determined by the specific needs of the individual which you are not taking into account. In other words, the guy who was at the top of the expenditure scale who was able to meet the costs, now may not be able to do so, thus incurring a deficit. The guy at the bottom who normally operated at a deficit, may now incur a surplus in allotment dollars.

I see what you mean by “redistributed” now.  I agree:  I’m taking our existing supply of healthcare (which, as you point out, is currently distributed in a somewhat random fashion), and redistributing it to everyone in equal portions. 

The “luck of the specific illness draw” reflects the inequality of life, not my plan.  Of course I’m not taking the specific needs (or wants) of the individual into account.  That’s what makes my plan so objective:  there’s no favoritism or special treatment for people who want more than their share.  There’s no complex, subjective methodology for deciding how much to give this person or that person.  There’s no need to try and differentiate between whether so-and-so “needs”  treatment or “wants” it.  The biases and prejudices of the insurance company claims adjusters and the government bureaucrats and the doctors and the “Death Panelists” are all taken out of the equation.  Everyone gets an exactly equal amount to use as he or she sees fit. 

goodgraydrab - 15 August 2009 06:49 PM

You bring up “unaffordable”, yet you have nothing in your plan that addresses controlling costs, efficiencies, etc.

There are two different costs that come into play:  the total cost of the program to taxpayers and the price of the actual medical procedures and prescription drugs.  The cost to taxpayers would obviously be limited by the program’s budget.  And the price of treatment would be set by supply and demand.  Unlike a program where everyone gets as much as they want for free, which would increase demand and place upward pressure on prices, my program would encourage participants to spend their dollars wisely. 

goodgraydrab - 15 August 2009 06:49 PM

As I explained above, I think your plan creates winners and losers just by your shifts in apportionments. And if you’re not changing the status quo of winners and losers, only reassigning them, then that’s what I mean by a meaningless exercise.

My plan wouldn’t create winners and losers.  Life creates them.

goodgraydrab - 15 August 2009 06:49 PM

I forgot that part of your argument when I laid it out for you, didn’t I?  Not only will you have to give me more than the next guy to make up for my unequal genetic treatment, you’ll have to give me even more on top of that because I insist on living where the cost of healthcare is highest.  Is that your idea of “delivering all the necessary individual medical care” to me?

I’m sorry, but this is as ridiculous as I should allow this conversation to go. I’ve had enough. Now, we’re going to pack up and move to a new city, city after city, following the least charge for a single medical procedure.

Do you really think that?  Do you “pack up and move to a new city, city after city,” chasing the lowest cost of living around the country?  I didn’t realize the lowest cost of healthcare was so elusive, anyway.  Like the Road Runner avoiding Wile E. Coyote:  every time you think you’ve caught up to the cheapest MRI, just as you’re about to climb inside that big tube—whoops!  Someplace else has a lower price.  Put your clothes back on and pack up the kids, quick.  Head for Phoenix—the cheapest MRI is there now!

goodgraydrab - 15 August 2009 06:49 PM

Like you said before, it all depends on what your definition of equal is, and IMHO, how meaningful the change is worth making.

Equal:  Divide 100 into 20 equal parts.  They all equal 5.

Well, look:  I’ve tried my best to convince you, but I’ve obviously failed.  I appreciate your taking the time to hear me out.  I’ll just have to tell President Obama tomorrow that I don’t have a workable plan after all.