The financial costs of healthcare costs, or, is keeping me alive worth it? • Hacker News Board

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#21

Post by derbOac » Fri, May 17, 2024, 2:40 PM UTC

AnimalMuppet wrote: post #17

antisthenes wrote: post #11

One thing about keeping sick people alive that financials don't cover - keeping up the social contract. A society must take care of its weak and old, unless you want these people to reneg on the contract and start being destructive. Marginalizing and neglecting a social group is step 1 towards fostering terrorism.

Yes... but not at unlimited cost. In a society with limited resources, is keeping one old person alive worth 10 child/years of education? Worth heart surgery for a 50-year-old? Worth basic medical care for a dozen poor families? Yes, the social contract says that we have to care for old people, including medically. It also says we have to educate children, and care for the poor, and provide medical care for everyone…

The tricky part though is everyone will be part of that group unless they die young.

So reneging on the social contract with the old means reneging on the social contract with essentially everyone.

"Them" being destructive in response doesn't necessarily mean 85 year-olds burning things down, what it means is the 20, 30, and 40 year-olds seeing what's coming and burning things down.

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#22

Post by bittercynic » Fri, May 17, 2024, 2:40 PM UTC

antisthenes wrote: post #11

One thing about keeping sick people alive that financials don't cover - keeping up the social contract. A society must take care of its weak and old, unless you want these people to reneg on the contract and start being destructive. Marginalizing and neglecting a social group is step 1 towards fostering terrorism.

>must take care of its weak and old

Agreed, but taking care doesn't necessarily have to mean extending life as long as possible, all other factors be damned.

In some cases close to me, I believe people were kept alive through treatments that they were unable to consent to, and I believed they experienced a lot of extremely unpleasant things at the end of their lives for no benefit, and were robbed of the chance to say a peaceful and dignified goodbye.

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#23

Post by s1artibartfast » Fri, May 17, 2024, 2:43 PM UTC

paxys wrote: post #4

I recommend anyone who is interested in this area read "Being Mortal: Medicine and What Matters in the End" by Atul Gawande. Not just for the financial aspects, but an overall deconstruction of the broken end-of-life care system in the country. By making "extend one's life for a few days/weeks by any means necessary" as the gold standard for good medical care, we have lost sight of what healthcare should actually be…

I think a huge part of it isnt even corporatism, but social and cultural avoidance and fear of death. US culture, the only one I claim to speak for, is in denial about death. We hide it away, pretend it wont happen, and then when it does, we lie to the children and try to suppress it ourselves. We drag death out medically, and then have no time to be with the dying. Doing this leads to not only neurotic choices from the living, but strips some of the poignancy, beauty, and urgency from life itself.

One of my saddest, but also most powerful, raw, and formative memories was watching my grandmother die when I was 12. Her lymphoma had relapsed and she chose to put her effort and energy into preparing for her death instead fighting medically. She was a strong woman and fully prepared her estate. She collected every document, listed every account, and wrote detailed instructions (Later, my dad would still find things like the pinkslip pre-signed and in the glove box of the car when he went to sell it.)

When her time was close, my family pulled me out of school for two weeks and we went to stay with her until she passed. I mostly played in another room, but when it was time, I was called in and we held hands and watched her last breaths, and listened to her death rattle together, and cried together. That was the first time I saw my father cry.

It was tremendously sad, of course, but also beautiful, because it was the culmination of a life well lived. I learned a lot that day about the fleetingness of our short lives , the value of agency, and the human endeavor. It is the greatest gift my grandmother ever gave me and she did it from her deathbed. Sometimes when I lack motivation and struggle, I consider what I would want, think, and wish from my own deathbed. I consider the impact I want to have on my loved ones, and the cultural legacy I want to leave.

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#24

Post by rqtwteye » Fri, May 17, 2024, 2:43 PM UTC

llamaimperative wrote: post #14

paxys wrote: post #4

I recommend anyone who is interested in this area read "Being Mortal: Medicine and What Matters in the End" by Atul Gawande. Not just for the financial aspects, but an overall deconstruction of the broken end-of-life care system in the country. By making "extend one's life for a few days/weeks by any means necessary" as the gold standard for good medical care, we have lost sight of what healthcare should actually be…

And fear. Our culture is not good at death. Thanks for the book recommendation, definitely going to pick this up! Edit to excerpt a great review from Goodreads: "If you think you might get older as time goes by and/or think you might even die at some time (or have relatives or other loved ones to whom this might apply), I urge you to read this book."

It would great if we had a better culture around dying. My parents are in their 90s. When I get to the senior home they live and talk to people it’s pretty clear that it would often be better if people could just say “enough is enough” and go out with dignity and respect. A lot of people there just live day by day and wait for it to be over.

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#25

Post by 3523582908 » Fri, May 17, 2024, 2:48 PM UTC

s1artibartfast wrote: post #23

paxys wrote: post #4

I recommend anyone who is interested in this area read "Being Mortal: Medicine and What Matters in the End" by Atul Gawande. Not just for the financial aspects, but an overall deconstruction of the broken end-of-life care system in the country. By making "extend one's life for a few days/weeks by any means necessary" as the gold standard for good medical care, we have lost sight of what healthcare should actually be…

I think a huge part of it isnt even corporatism, but social and cultural avoidance and fear of death. US culture, the only one I claim to speak for, is in denial about death. We hide it away, pretend it wont happen, and then when it does, we lie to the children and try to suppress it ourselves. We drag death out medically, and then have no time to be with the dying. Doing this leads to not only neurotic choices from…

I had the opposite experience when my grandparents died -- I watched everybody in my family cling on to ventilators, invasive treatments, and chemotherapy, for both of them to die painfully attached to tubes in an emergency hospital ward. My aunt whispering maniacally to my grandma: "don't go towards the light!" Family members talking over my grandmother's last words.

It taught me a lot too; that I want to be like your grandmother, and not like my family, when my time comes.

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#26

Post by foobarian » Fri, May 17, 2024, 2:50 PM UTC

s1artibartfast wrote: post #23

paxys wrote: post #4

I recommend anyone who is interested in this area read "Being Mortal: Medicine and What Matters in the End" by Atul Gawande. Not just for the financial aspects, but an overall deconstruction of the broken end-of-life care system in the country. By making "extend one's life for a few days/weeks by any means necessary" as the gold standard for good medical care, we have lost sight of what healthcare should actually be…

I think a huge part of it isnt even corporatism, but social and cultural avoidance and fear of death. US culture, the only one I claim to speak for, is in denial about death. We hide it away, pretend it wont happen, and then when it does, we lie to the children and try to suppress it ourselves. We drag death out medically, and then have no time to be with the dying. Doing this leads to not only neurotic choices from…

I have every intention to do the same. The only thing that gives me nightmares is to lose mental capacity, which it seems your grandmother was lucky to keep to the end. My aging friend circle keeps throwing around ideas of various dead man switches to cut short any kind of mental decline.

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#27

Post by pjc50 » Fri, May 17, 2024, 2:52 PM UTC

antisthenes wrote: post #11

One thing about keeping sick people alive that financials don't cover - keeping up the social contract. A society must take care of its weak and old, unless you want these people to reneg on the contract and start being destructive. Marginalizing and neglecting a social group is step 1 towards fostering terrorism.

You're not going to see a rise in elderly and disabled terrorists. No, the elderly have far more subtle ways of being destructive at the ballot box.

The politics of infirmity always comes with some categories of who's allowed to be infirm, and who can safely be blamed for their own infirmity. Quite a lot of people advocate for worse treatment of the weak not to save money particularly but because they think it's ""deserved"".

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#28

Post by n8henrie » Fri, May 17, 2024, 2:53 PM UTC

paxys wrote: post #4

I recommend anyone who is interested in this area read "Being Mortal: Medicine and What Matters in the End" by Atul Gawande. Not just for the financial aspects, but an overall deconstruction of the broken end-of-life care system in the country. By making "extend one's life for a few days/weeks by any means necessary" as the gold standard for good medical care, we have lost sight of what healthcare should actually be…

I'm a physician. I offered to buy a copy of Being Mortal for anyone in my family that promised to read it!

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#29

Post by bdcravens » Fri, May 17, 2024, 3:11 PM UTC

antisthenes wrote: post #11

One thing about keeping sick people alive that financials don't cover - keeping up the social contract. A society must take care of its weak and old, unless you want these people to reneg on the contract and start being destructive. Marginalizing and neglecting a social group is step 1 towards fostering terrorism.

Correct, but this is why we need living wills, and for those without them, we need sane and humane defaults. There is a point where being alive is its own form of suffering.

Re: The financial costs of healthcare costs, or, is keeping me alive worth it?

#30

Post by gadders » Fri, May 17, 2024, 3:14 PM UTC

paxys wrote: post #4

I recommend anyone who is interested in this area read "Being Mortal: Medicine and What Matters in the End" by Atul Gawande. Not just for the financial aspects, but an overall deconstruction of the broken end-of-life care system in the country. By making "extend one's life for a few days/weeks by any means necessary" as the gold standard for good medical care, we have lost sight of what healthcare should actually be…

It could be worse, you could be in Canada.

Canadian Paralympian: I asked for a disability ramp - and was offered euthanasia

https://www.telegraph.co.uk/world-news/2023/09/02/canada-par...