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What Atul Gawande Got Wrong about U.S. Health Care Spending

bostonreview.net

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Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#71

Post by zaptheimpaler »

darawk wrote: post #70
zaptheimpaler wrote: post #65

Earlier quoted context omitted.

Consider a poor or indebted person that owns a car, and needs some benefits from social security. Many republicans would argue (as they do now) that they should "lift themselves by the bootstraps" and sell their car, use public transit instead as a first step to increasing their income right ? Now what do you think will happen when that poor person suddenly has the option to sell their kidney for $50k? The same thing…

Ok. And then what? Where do the problems start?

Doesn't seem like you even read my response but if you see no problems in the scenarios I described then i'm not wasting any more words.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#72

Post by darawk »

zaptheimpaler wrote: post #71
darawk wrote: post #70

Earlier quoted context omitted.

Ok. And then what? Where do the problems start?

Doesn't seem like you even read my response but if you see no problems in the scenarios I described then i'm not wasting any more words.

No, it doesn't seem like you read anything that i've said thus far. You have not articulated any problems. You have gestured at them. Someone's kidney being removed is not, in and of itself, a problem. Play the scenario all the way through. Where do the problems start? You seem to want to imply that there will be latent health consequences to the people doing this. But even the slightest amount of research would quickly dispel that myth.

So, i'll ask again: What if any, specific, negative consequences will accrue to individuals or society at large as a result of a market in kidneys?

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#73

Post by zaptheimpaler »

darawk wrote: post #72
zaptheimpaler wrote: post #71

Earlier quoted context omitted.

Doesn't seem like you even read my response but if you see no problems in the scenarios I described then i'm not wasting any more words.

No, it doesn't seem like you read anything that i've said thus far. You have not articulated any problems. You have gestured at them. Someone's kidney being removed is not, in and of itself, a problem. Play the scenario all the way through. Where do the problems start? You seem to want to imply that there will be latent health consequences to the people doing this. But even the slightest amount of research would quic…

Yeah no you didn't read shit. One "latent health problem" I specifically called out is what if your other freaking kidney fails later? Any shred of common sense would tell you that yes, having one of your organs removed IS a problem. And you ignored everything about perverse incentives that it creates. As if you. in your infinite wisdom, can predict every single "specific, negative consequence" caused by those.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#74

Post by darawk »

zaptheimpaler wrote: post #73
darawk wrote: post #72

Earlier quoted context omitted.

No, it doesn't seem like you read anything that i've said thus far. You have not articulated any problems. You have gestured at them. Someone's kidney being removed is not, in and of itself, a problem. Play the scenario all the way through. Where do the problems start? You seem to want to imply that there will be latent health consequences to the people doing this. But even the slightest amount of research would quic…

Yeah no you didn't read shit. One "latent health problem" I specifically called out is what if your other freaking kidney fails later? Any shred of common sense would tell you that yes, having one of your organs removed IS a problem. And you ignored everything about perverse incentives that it creates. As if you. in your infinite wisdom, can predict every single "specific, negative consequence" caused by those.

> I specifically called out is what if your other freaking kidney fails later?

Yes, that's a problem. However, it does not impact life expectancy for kidney donors. Kidney donors do not have significant health complications.

> Any shred of common sense would tell you that yes, having one of your organs removed IS a problem.

Yes, it does seem that way. Until you read about it, and realize that it isn't.

> And you ignored everything about perverse incentives that it creates. As if you. in your infinite wisdom, can predict every single "specific, negative consequence" caused by those.

"Perverse" incentives are not, in and of themselves, negative consequences. Perverse incentives may cause negative consequences. I am asking you what those consequences are. You enumerated one: kidney failure. A great start. However, it's not something medical practitioners in the area worry particularly much about.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#75

Post by SketchySeaBeast »

darawk wrote: post #68
SketchySeaBeast wrote: post #63

Earlier quoted context omitted.

> Or perhaps that, in general, the government should step in to prevent people from taking undue risks in exchange for money? Yes, literally why OHS exists and should continue to exist. > $4,000 seems like a perfectly reasonable and fair price for someone to undertake the risks associated with kidney donation. Who is going to need that sum, but also afford all the post-op medical care and time off? In case of complic…

> Yes, literally why OHS exists and should continue to exist. I'm not familiar with any agency by the name of OHS. Do you mean OSHA? Because they don't regulate employees, they regulate employers. > Who is going to need that sum, but also afford all the post-op medical care and time off? In case of complication, who is responsible? Something tells me if you're needing that sum, you're not going to have the medical co…

> I'm not familiar with any agency by the name of OHS.

Sorry, I'm not American, assumed you'd figure it out from context. And you can frame it how you would - either way it's rules about what's safe and not.

> First of all, 'time off' isn't a thing for many people. Many people are unemployed, so time off costs them nothing.

Sweet, so now we're giving unemployed desperate people a couple grand.

> Secondly, obviously the person purchasing the kidney would cover all aspects of care related to the operation.

How is this guaranteed? If this becomes a buyers market, what's stopping the buyer from saying they won't cover it? Are you suggesting government regulations as such, or hoping that the free-market capitalism of organ trading will do it just because they are decent people?

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#76

Post by darawk »

SketchySeaBeast wrote: post #75
darawk wrote: post #68

Earlier quoted context omitted.

> Yes, literally why OHS exists and should continue to exist. I'm not familiar with any agency by the name of OHS. Do you mean OSHA? Because they don't regulate employees, they regulate employers. > Who is going to need that sum, but also afford all the post-op medical care and time off? In case of complication, who is responsible? Something tells me if you're needing that sum, you're not going to have the medical co…

> I'm not familiar with any agency by the name of OHS. Sorry, I'm not American, assumed you'd figure it out from context. And you can frame it how you would - either way it's rules about what's safe and not. > First of all, 'time off' isn't a thing for many people. Many people are unemployed, so time off costs them nothing. Sweet, so now we're giving unemployed desperate people a couple grand. > Secondly, obviously t…

> Sweet, so now we're giving unemployed desperate people a couple grand.

Well, two couples. But that's a lot of money to a lot of people. It would allow someone to get a car so they could drive to job interviews, pay several months of rent in many places, etc..

There is a very, very large number of people in the world who's lives would be substantially improved by obtaining $4,000 right now. There is also a very substantial number of people in the world who have $4,000 that they do not need, but who's lives would be substantially improved by having a new kidney. It is currently illegal for those pairs of people to help each other out.

> How is this guaranteed? If this becomes a buyers market, what's stopping the buyer from saying they won't cover it? Are you suggesting government regulations as such, or hoping that the free-market capitalism of organ trading will do it just because they are decent people?

For one, i've never suggested that the market should be completely unregulated. So solving this by regulating the process is fine with me. However, it stands to reason that nobody is going to sell their kidney for less than the process costs them in medical costs. That'd just be a money losing trade that wouldn't make sense.

Re: What Atul Gawande Got Wrong about U.S. Health Care Spending

#77

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