Love and Death: “Quality of life” calculations leave out much that matters • Hacker News Board

Re: Love and Death: “Quality of life” calculations leave out much that matters

#51

Post by Filligree » Fri, Jan 29, 2021, 12:28 PM UTC

ggm wrote: post #50

Filligree wrote: post #32

Earlier quoted context omitted.

Completely off topic, but... it does take a village to raise a child. I understand that instinctively, and I suppose I've read enough factual articles about it to believe it, but I'm missing a real explanation. Something I could point people at in lieu of trying to explain why that is, myself, which covers everything from "A higher diversity of 'parents' is helpful" to "it's not good to segregate children by age, act…

Depends who you ask: It doesn't: * https://phys.org/news/2011-09-child-doesnt-village.html It does: * https://www.demographic-research.org/volumes/vol34/34/34-34.... * https://link.springer.com/chapter/10.1057/9781137386724_5 * https://theconversation.com/it-takes-a-village-to-raise-a-ch... I think, if you go into genetics, you would be looking to the altruistic benefits to the gene pool of non-gene transfer roles in…

It's got to be cultural, right? In humanity's case...

Anyway, my personal opinion isn't so much about long-term outcomes. Those seem almost wholly determined by genetics, anyway. It's instead a question of--

How happy is the child? How much do they enjoy life?

I feel like that's a question which researchers tend to miss, and/or assume doesn't matter -- perhaps because it's harder to measure -- but isn't enjoyment of life the entire goal, in the first place? And childhood is a significant fraction of life.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#52

Post by incrudible » Sun, Jan 31, 2021, 12:49 AM UTC

ntsplnkv2 wrote: post #35

incrudible wrote: post #31

Earlier quoted context omitted.

The problem is that insurances pool everyones money for treatment. No death can be prevented, only deferred. Is it justified to extend the life of a terminal cancer patient for another miserable few months with chemotherapy, at full cost to everyone else in the pool? I dare say not, and QUALY is the measure we use to calculate this, imperfect as it may be. It also is worth noting that QUALY is not conditioned on work…

Everyone wants their grandma to get the most treatment possible, just no one else's. When it's "society" - people will say we're spending too much money. When the shoe is on their foot, people won't like it and say they "deserve the best care." > for another miserable few months with chemotherapy, My grandfather hated chemo. But he did it for those few more months - and he got to see my cousin get married. How do you…

Indeed, you can not emotionally account for individual tragedies or circumstances with a statistical measure. Unfortunately, somebody has to financially account for it, because as I said, this is a pool of money that everyone chips into.

If you are willing to pay extra, or out of pocket, to have your life extended to the absolute limits, that is fine with me, but please do not push this attitude as the “morally right one” unto everyone else.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#53

Post by ntsplnkv2 » Sun, Jan 31, 2021, 3:27 AM UTC

incrudible wrote: post #52

ntsplnkv2 wrote: post #35

Earlier quoted context omitted.

Everyone wants their grandma to get the most treatment possible, just no one else's. When it's "society" - people will say we're spending too much money. When the shoe is on their foot, people won't like it and say they "deserve the best care." > for another miserable few months with chemotherapy, My grandfather hated chemo. But he did it for those few more months - and he got to see my cousin get married. How do you…

Indeed, you can not emotionally account for individual tragedies or circumstances with a statistical measure. Unfortunately, somebody has to financially account for it, because as I said, this is a pool of money that everyone chips into. If you are willing to pay extra, or out of pocket, to have your life extended to the absolute limits, that is fine with me, but please do not push this attitude as the “morally right…

> but please do not push this attitude as the “morally right one” unto everyone else.

I will push whatever I want to, thank you. Insurance is supposed to provide healthcare. It isn't supposed to judge what is a good life. I shouldn't have to pay extra for care that I was always paying for because you're mad your rates went up. Don't like it, don't buy the care. Ridiculous assumption to let society decide when people should live and die.

It's also unnecessary to. On the populations we are talking about, individual cases like people living long on chemo in miserable lives to die are counteracted by people who died way younger. It's easy to calculate the risk and spread that among insurance holders.

Re: Love and Death: “Quality of life” calculations leave out much that matters

#54

Post by incrudible » Sun, Jan 31, 2021, 12:32 PM UTC

ntsplnkv2 wrote: post #53

incrudible wrote: post #52

Earlier quoted context omitted.

Indeed, you can not emotionally account for individual tragedies or circumstances with a statistical measure. Unfortunately, somebody has to financially account for it, because as I said, this is a pool of money that everyone chips into. If you are willing to pay extra, or out of pocket, to have your life extended to the absolute limits, that is fine with me, but please do not push this attitude as the “morally right…

> but please do not push this attitude as the “morally right one” unto everyone else. I will push whatever I want to, thank you. Insurance is supposed to provide healthcare. It isn't supposed to judge what is a good life. I shouldn't have to pay extra for care that I was always paying for because you're mad your rates went up. Don't like it, don't buy the care. Ridiculous assumption to let society decide when people…

> I will push whatever I want to, thank you.

Let me rephrase that: When making an emotional appeal, you aren't making a sound argument. It's effective, but also intellectually dishonest.

> Insurance is supposed to provide healthcare.

Healthcare providers provide healthcare. They need to get paid. Insurance providers offer the insured the possibility to spread the risk of large individual healthcare costs among many participants.

If you have the opinion that health insurance should be a universal right, you will also have to consider that those countries who have such systems also put strict limits on the extent of end-of-life healthcare.

> I shouldn't have to pay extra for care that I was always paying for because you're mad your rates went up.

If costs go up, rates go up. As your individual risk goes up, your individual rates go up. The more you pay, the better your insurance is going to be able to cover you. You're going to pay extra either way.

What are you going to do if you can't afford insurance anymore, except the most basic plans that are capped at the top? You're not going to be able to afford that last round of chemo.

> Don't like it, don't buy the care.

So... let the prices rise until nobody can afford insurance anymore, then blame the people for not buying it? Medicare-for-all? I'm afraid that won't pay for everything either.

> Ridiculous assumption to let society decide when people should live and die.

That's the way it works either way. If you lived in a hypothetical society that goes to any length to extend everyone's life to the maximum extent possible, then that society decided that.

> On the populations we are talking about, individual cases like people living long on chemo in miserable lives to die are counteracted by people who died way younger.

People who died way younger also stopped paying way younger. It's also rare. The chance of developing cancer in your lifetime is 1 in 4.

Furthermore, in many cases, the effectiveness of chemotherapy is quite low, especially considering its severe impact on QOL. Many doctors refuse chemo after receiving a terminal cancer diagnosis, opting for palliative care instead.

> It's easy to calculate the risk and spread that among insurance holders.

It's easy to calculate the cost, it's not so easy to actually get it paid. Suppose your cost rises by 10%, so you raise prices by 10%. As a result, revenue goes down 5%, because people drop out of insurance. You need to raise prices again, or reduce coverage, increase co-pays, and so on.