> I do think our medical system needs some rethinking though.
You probaby don't want to hear it, but if I were running a medical system I'd decree that gestating one-and-a-half-pound globs (from the article: "One doctor, visibly shaken, described [the fetus's skin] as 'gelatinous'") outside the womb is a waste of resources. To me, if miscarriages aren't the end of the world, neither are "babies" that die of natural causes within a few minutes of being delivered.
There's just no way spending a million dollars to raise a fetus up to the age of zero passes any kind of cost-benefit analysis. The cost of replacing the thing is much, much lower.
If the child lives to 80, she only needs to contribute an additional $12,500 worth of value to civilization per year for this to make economic sense.
Another way to look at this: the government has various estimates for the value of a human life. It averages about $7MM. The "extraordinary" expense of this child actually only requires a 14% increase in value over the average citizen to make sense.
Most importantly though, we must recognize that the actual cost is actually just the cost of risk spread across society, so instead of one person taking the brunt of this cost, we as a society take it together. As a whole, it is negligible on all of us, and it's a risk that any of us can fall into. The value of having a system that supports each other is invaluable. Way more valuable than a measly $1MM. We have strength in numbers and we all benefit when a society supports each other. If we ostracize the statistical outliers in this support system, then the support system itself (the one which we all benefit from) falls apart.
In short, more important than the economic argument (which I argue, still makes sense to spend $1MM on a baby), is the argument that the value to society from supporting each other results in a negligible cost for individuals and a near-priceless benefit to everyone within that society. It's exceptionally difficult to put a price tag on that, and it's orders of magnitude higher than $1MM.
That still doesn't maximize overall benefit. What if the money were instead spent on 10 individuals that needed 1/10 the money to save their lives? The cost benefit analysis to determine what medical issues make most sense should try to maximize the number of person-years-lived across the entire population.
The money spend where '1/10 the money' was needed to save their lives is additional money spent, not 'instead money'.
In this particular case, the 'instead money' was pure profits for a company (and some taxes for the government).
Do you really think that the 'instead money' would have been a better choice?
Money is just money and is completely replaceable. Actually, we have machines to make it: it's printable. Actually, we don't even have to physically print the money to 'print the money'... It's a number in a computer file.
Every dollar is the same as every other dollar.
Each and every life, on the other hand, is unique.
Unfortunately, I wasn't clear in my comment above like I was in other comments in this thread. I am specifically referring to a not-for-profit focused healthcare system. If the choice is between profits and the care necessary to help a life, then it boils down to the contractual obligation of the insurer given the level of coverage purchased. In a nationalized healthcare system where costs are spread across all of society and the government has more or less determined the pool of healthcare dollars available by specifying the premium spent per citizen, there most certainly is a cost benefit analysis to consider.
You're assuming that we're at capacity on spending, but we're not. Instead, we can afford to bring 11 individuals into the world. The absolute gain to society is still greater than simply bringing 10 into the world.
Maximizing number of total person years is not sufficient because a population 100x as large but living 1/5 as long would be superior to a population of the current size but living twice as long.
I'd argue in favor of maximizing population size and average lifespan. Of course this ultimately leads to the requirement that humanity moves off of this little rock of ours.
Given X amount of money paid per person as a in premium and Y number of people paying those premiums, we should have XY available to spend on healthcare. That is a hard cap on healthcare spending.
While we can afford to maintain* 11 individuals in the world. There reaches a point where over that entire population, we need to triage the medical issues in that population into the people whose issues maximize human-hours-lived given the X*Y healthcare dollars available to spend treating those issues. Maybe it's not the first person that requires treatment costing a million dollars we need to triage, but you eventually will run out of money if you don't triage because we simply don't pay unlimited premiums to meet the unlimited demand for healthcare.
The issue about overpopulation is a red herring, and in this case isn't just of function of helping people live longer. Many countries once they reach a level of prosperity stop having children at the necessary replacement rate of 2.1 children per couple once that society becomes affluent. The dropping replacement rate often correlates with societies ability to spend more money on helping their population live longer through spending on medical treatment.
> The "extraordinary" expense of this child actually only requires a 14% increase in value over the average citizen to make sense.
Ok, fair enough, we'll ignore the question of whether average really makes sense, but there's a bigger problem: there's absolutely no reason to expect this hugely premature baby to have >14% increase of value. Why? This is completely unfounded, completely unjustified. In fact, as a premature baby with massive expensive health problems, wouldn't we expect the opposite? Early childhood trauma seems like it'll matter to their future prospects: https://en.wikipedia.org/wiki/Preterm_birth#Prognosis (As makes sense. If babies could be born months premature with no negative effects, why aren't they being born that way already so they can start growing up quicker?)
It was one of three points made, the last point being the most significant. Our humanity should take priority over negligible costs.
> there's absolutely no reason to expect this hugely premature baby to have >14% increase of value
Without a standard deviation on the average, there is no way to say whether or not 14% is reasonable. Regardless, I was simply pointing out that it's a small fraction rather than orders of magnitude greater. Even if the child winds up providing 50% of the value of an average person, it can still be a net gain.
Economic reasoning is just one (minor) aspect to this situation though. There is very real value in simply helping a fellow human survive.
> as a premature baby with massive expensive health problems, wouldn't we expect the opposite?
The stats you cite are for extreme cases on the edge of viability and the odds still slightly favor normal or near-normal development.
This particular baby was born with a 66% chance of living and deserves more than a quick dismissal.
> If babies could be born months premature with no negative effects, why aren't they being born that way already so they can start growing up quicker?
That's horrible reasoning. The human body has evolved over millions of years for birth. It is the optimal gestation machine. We're working on approximating this optimal machine with artificial machines and continue to rapidly make progress. In the rare situation where the human body fails for some reason, we attempt to augment it with the best artificial machines we've got. Nobody claims that premature births are better, but a hiccup during pregnancy shouldn't mean the end of a life if we can avoid it.
Humanity progresses when a society looks out for each other. In particular, without bias. That starts at birth.
What you're proposing is barbaric and borderline infantcide.
> Without a standard deviation on the average, there is no way to say whether or not 14% is reasonable.
There is no reason to expect the expectation of preemies to be above average, never mind 14%, never mind standard deviations. And there is substantial empirical evidence which I linked you to expect it to be far below average. Rescuing a preemie, even if it were free, would be a bad idea compared to alternatives like simply trying again.
> Even if the child winds up providing 50% of the value of an average person, it can still be a net gain.
And we're right back to your original problem: you are not thinking on the margin. The alternative to spending millions on premature babies is not no babies ever. (And even if it was, there's still superior alternatives: for example, lobbying for Open Borders. Think of all the millions of immigrants who'd love to come to the USA, for free! We wouldn't even have to pay them! Why, even if they're 99% below average, it's still a gain!)
> The stats you cite are for extreme cases on the edge of viability and the odds still slightly favor normal or near-normal development.
Which is what we are discussing, is it not? Or do even slightly premature babies come with million-dollar pricetags...?
> That's horrible reasoning. The human body has evolved over millions of years for birth. It is the optimal gestation machine. We're working on approximating this optimal machine with artificial machines
I'm not seeing any disagreement here. Yes, the human body is the optimal gestation machine. That's why premature babies come with all the penalties. (And note that those citations are just the penalties sufficient to be documented with small samples; there's not much reason to expect the penalty to abruptly cut off somewhere, it's just the long-term effects shrink enough to be hidden by noise and methodological problems and researcher careers' limits.)
> That starts at birth.
An arbitrary line is not a good basis for a system of ethics and governance.
> What you're proposing is barbaric and borderline infantcide.
I'm happy to own to that. It is infanticide. Premature fetuses are not humans in the moral sense: they have no hopes, they have no dreams, they have no desires or preferences, they do not think, and they have the moral status of a puppy or kitten. Given the disabilities they come with, throwing away hundreds of thousands of dollars in heroic medical measures is a crime against society and the person the parents could have raised instead.
I agree with your parent and thus don't want you in charge of "running the medical system," either. But we don't have to have one or the other. You buy your insurance policy that covers whatever it takes to save your fetus and I'll buy my policy that doesn't (and spend the difference on improving the lives of my healthy children).
Failure to think critically about how to value life results in harmful abortion and euthanasia laws and is contributing to the high cost/benefit ratios of our healthcare system. We have quite enough people thinking only emotionally about these issues.
This is pretty obviously preferable to the situation we have in health care today in the U.S., where you're (more or less) forced to get employment and health insurance from the same company.
No it doesn't - these are not mutually exclusive choice. How are expenses for US health care and aid to foreign countries related? You could just as well budget the money for the latter against the expense for a coffee, an aircraft carrier or Armstrong's salary.
I totally agree that health care is too expensive at the moment.
There's just no way spending a million dollars to raise a fetus up to the age of zero passes any kind of cost-benefit analysis
If you look at the cost in dollars per QALY, it's not that bad. That million dollar treatment probably produces 40 QALYs, for a cost of $25,000 per QALY; Americans typically pay $50-100k per QALY.
I see the logic here, but I don't really agree with it. Obviously, if the fetus had a million dollars of its own, it would happily spend them for the purpose, and that would be a sensible investment. But it doesn't, and I don't think it's a sensible investment for any third party, even the parents.
I suggest you inform yourself about the gestation process. I used to think the same way, but when we had my daughter I was surprised how early everything happened. First, embryonic age is measured from the date of the last missed period. So even people who find out early are already several weeks along. By six weeks, before many women even realize they are pregnant, the embryo has a heartbeat. By 13 weeks, most of the basic functionality is already there. By 24 weeks, or the time the baby is a pound and and a half, the fetus isn't a glob, but a fully recognizable, if fragile, human. Much of the development after that is external: hair, subcutaneous fat, etc. I don't know what you consider a coherent thought, but at our 24 week ultrasound our baby already responded as we tried to push her into a position to check her gender. I don't think infants who are born full term are more intellectually sophisticated in some fundamental way.
Yes, this has implications for abortion. I support abortion rights, but the "its just a ball of cells" is a rationale that isn't convincing after week 6-9. And lines drawn on intellectual abilities don't justify in a principled way why it isn't okay to abort full term babies. Lines based on viability are susceptible to the progress of medical technology. The typical 24-26 week line we use is fairly arbitrary in all three regards.
You know I don't agree with the point you've tried to make but it's good to read arguments from various perspectives. Having said that, your last sentence is unnecessarily and (perhaps intentionally?) hurtful to Paul. Would you really call someone else's child "the thing" in person?
Just curious, do you have kids? I might have agreed with you before I held my preemie (only 5 weeks, nothing like the baby we are talking about) in my hand:
It's easier to make the calls before you have a kid, they are calls in theory. After you have a kid you are changed, what was an obvious call becomes much much more complex.
If you can make that call after holding your own kid, wow.
I don't have children of my own. When I was 16, my mother gave birth to twins, so I have more parenting experience than the typical childless American, including that of holding closely-related infants.
> It's easier to make the calls before you have a kid, they are calls in theory. After you have a kid you are changed
Very true, but I don't see myself reversing on this.
Not sure if this helps or not but before we had our first my wife and I sounded a little like we were on the same page as you, more black and white. For example, we were mid 30's when "we" got pregnant so there were concerns about Downs and other stuff that happens when the eggs are older. We were pretty darn sure that if there were any "major" problems such as Downs, we would abort. It seemed pretty obvious what the right call was.
After having the first one? Things changed. Downs really didn't seem that bad compared to a life. I'm still pro choice and I don't think you could pay me enough to judge someone else's decision, that's their choice and it's hard enough without my irrelevant opinion in the mix. But for me personally? The bar on where I would go with an abortion went WAY up after having a kid. Way up.
Just trying to say having a kid really changed my thinking and I suspect I'm not that unusual in that respect.
There's no comparison. I don't think it's possible to understand parenting without actually being a parent. I certainly wasn't able to understand it before, and I thought more as you do now.
I was once a childless single white male programmer. Oh, and an asshole. Didn't realize it at the time but I wised up. Give him time and cut him a little slack, he's entitled to his opinion.
He's entitled to his (ignorant) opinions, but he's not entitled to be so pointlessly rude and cruel with his method of expressing it.
If this was a dinner party, I'd quietly ask him to excuse himself, and he'd never be invited again. His choice of language was pointlessly cruel and outrageous.
I suspect he didn't view it as being rude, he viewed it as doing the right thing. He probably truly believes what he is saying, I used to think stuff sort of like that. My guess is he is somewhere between 23-32 years old, that was my stupid range :)
I guess the point is don't assume he's being an asshole, a real asshole would troll harder. I think he believes what he is saying. Yeah, it's rude but I'm not sure I'd be willing to write the guy off.
If all conversations were limited to dinner-party politeness, we'd remain trapped in a state of childlike obliviousness about the real disagreements and difficulties of the world.
(My dinner party would welcome both paul and
thaumasiotes, as people able to speak about a difficult topic calmly, with strong and contrasting perspectives based on real experience. In contrast, yscale would be asked to apologize or leave for content-free name-calling.)
I agree with your point of view, but I don't think you've phrased it productively, let alone respectfully. I know it's a touchy topic, but you'll be a better advocate if you avoid flying off the handle.
I don't necessarily agree, but I don't think your opinion should be downvoted.
Consider this: We as a society have more than enough wealth to give ICU care to every infant that needs it. Our medical system is what makes it expensive.
> We as a society have more than enough wealth to give ICU care to every infant that needs it.
I'm not particularly informed here, but this is a claim I'm willing to accept.
> Our medical system is what makes it expensive.
This isn't right. Giving intensive care to extremely premature infants is inherently expensive, in much the same way that mining is expensive because you have to move tons and tons of dirt. It's difficult, and it requires a very large quantity of dedicated resources; it will not be cheap at any point in the foreseeable future no matter what organizational changes we make. We'd need technological changes.
How many tons of dirt do you need to move to give intensive care to an infant? I spent quite a bit of time in the NICU and was never able to locate the $10,000/day expense. Medical expenses have more to do with billing codes and reimbursement rates than anything fundamental.
This information comes from consulting my mother (who is an obstetrician):
The most "direct" cost of NICU care is 24-hour supervision by a nurse. In the best (cheapest) case, this will cost the same as 12 hours of minimum wage per day, as nurses might be in a 1:1 or 1:2 ratio with patients. More realistically, the nurse will be making higher than minimum wage.
The NICU fee also covers the amortized cost of three major pieces of capital: the ventilator, which causes the baby to breathe, the incubator, which keeps it at an appropriate temperature, and the negative pressure room. A particular infant may or may not need the negative pressure room, but it exists as a (physically separate) part of the NICU, the hospital must have one, and it's hugely expensive to create.
Additionally, the baby is expected to suffer various bodily failures which will require treatment. Diagnosis and treatment of these will be charged separately; they are not covered in the NICU fee. But they do reflect that these babies would really rather die, and it's difficult and expensive to get them to live.
My mother says (paraphrased), "if you are the army, you buy all the machines yourself, you pay everyone army salaries, and you just assign them 'you'll do this job, you'll do this job', etc., I don't know what it would cost to run an NICU. There's definitely room for it to be cheaper."
From what I've read, it is the very nature of the beast (purely private, for profit health insurance) that causes the costs to be higher.
As I said in another comment, an earlier claim of "13 to 18 $K" for health insurance seems ridiculous, coming from a country where $6k gets top-level private insurance (to cover electives, get a private room vs shared, etc) on top of "free" health care) for a family.
You place more importance on $1M than on a human life? What if it was your child, would you be doing a cost/benefit analysis and turning to your wife and saying "sorry honey, it will cost more than $100,000 to save our child. might as well get her put down"?
This depends on how much I need $100K (odds are I can pull this together if I'm attached to the child), and, crucially, on the age of the child. I place essentially no value on a child at negative eighteen weeks old.
I mean, would you personally pay a million dollars to save my child? I'm no more attached to a new nonviable fetus than you are to my (imaginary) 11-year-old.
If I ran a business that turned over $1.05B, and you and I had some form of relationship be that employment or friendship, of course I would. If I had any reasonable number of resources I would prioritise saving lives over building a collection of sports cars or properties. Especially so if I ran a hospital.
Of course this perspective is easy to take from the UK where we don't have to face tough financial decisions over healthcare.
The thing is, children's medical care as a whole is not relatively expensive. Elderly care is.
This kind of event is super rare. However,it's not nearly so rare to have an older person go through tons of procedures and spend months in the hospital.
As callous as it is, this is the best solution under a not-for-profit health system. The cost-benefit analysis in such a system is not 1 million dollars in shareholder value versus 1 million dollars to save a life, but instead is 1 million dollars to save one life (just the first year to save the child. there most certainly will probably be a lot more money spent over the entire life of the person born under such conditions) versus splitting that million dollars over procedures and medicines to save several lives.
At the end of the day, you need to value all person-years-lived equally, and determine who gets treatment and for what based on what maximizes the number of person-years lived over the entire pool of people.
I have no numbers to back this up, but I would expect the greatest benefit from a fixed amount of healthcare dollars spent will be on people between the ages of 4 and 20.
Once you've figured out roughly the cost per medical issue, frequency per capita of each medical issue, and a distribution graphing that issue against the age at which most people are afflicted and number of years left in their lives given their demographic, you can probably come up with a reasonable algorithm for maximizing person-years-lived at a certain health premium per person per year (assuming all dollars go back into the system).
Then the only remaining question that is left for society and individuals to answer is what level of premium will be paid and the medical issues that will be covered at that premium.
Furthermore, I think it would be interesting if we gave people in medical situations the following choice:
"The procedures necessary to save this person's life are estimated to cost 1 million dollars. You can choose to save this person's life, or you can choose to donate $800 thousands dollars to save X number of lives by donating it to procedures that maximize the number of lives saved."
People choosing to exercise their right to spend healthcare dollars on a lifesaving procedure for one individual are the ones that should have to face that philosophical and ethical dilemma of deciding to value one life over many.
If I were running a healthcare system, I would make it policy that everyone put in such a position would have to knowingly have to make that hard decision. It's the only sane way that would put the burden of callousness on the people with the right to to those health services. Just because you have the right to those services, doesn't mean you should exercise them in a not-for-profit healthcare system.
> There's just no way spending a million dollars to raise a fetus up to the age of zero passes any kind of cost-benefit analysis. The cost of replacing the thing is much, much lower.
Second-order emotional (and nth-order social and monetary) costs are part of a comprehensive cost-benefit analysis.
The cost of even thinking in terms of "replacing the thing" is predominantly the cost of complete societal ostracism.
It is impossible to do a cost-benefit analysis on something like that. It is worth any amount of money if the child can be saved. I'd go to the ends of the earth for my children.
Who knows what these children could end up being or doing as adults? Who knows what value they could end up bringing the world? What they might invent? What health issues they could solve? What priceless works of art they may create?
No it's not. We're dealing with the scarcity of goods and services here. Healthcare needs are unlimited and supply of the goods and services is constrained. Whatever the amount of money needed to save that child's life, you need to consider how many more children, not your own, could be saved instead had the money been spent on other people's children with life-threatening issues that are cheaper to treat.
Who knows what those other children who didn't get treatment so that this one could end up being or doing as adults? Who knows what value they could end up bringing the world? What they might invent? What health issues they could solve? What priceless works of art they may create?
What if this couple had been given the choice to forgo saving their own child's life and instead donate that $1 million to saving many children's lives in some other country that don't have the resources we have here in the US. Every time society chooses to save one life at considerable cost, it is also choosing to condemn others. What if you had to make the same choice, what would you do?
This is a human being we are talking about. A child.
I like to think of myself as someone who can usually empathize with folks who hold a different point of view, but I have never been able to understand someone who looks at a human life in terms of a "cost-benefit" analysis.
> This is a human being we are talking about. A child.
This glob we're talking about has less in common with a (prototypical) human being than does a 29-week fetus still implanted in the womb. You're taking a strong stand here in the abortion debate; is that intentional?
You probaby don't want to hear it, but if I were running a medical system I'd decree that gestating one-and-a-half-pound globs (from the article: "One doctor, visibly shaken, described [the fetus's skin] as 'gelatinous'") outside the womb is a waste of resources. To me, if miscarriages aren't the end of the world, neither are "babies" that die of natural causes within a few minutes of being delivered.
There's just no way spending a million dollars to raise a fetus up to the age of zero passes any kind of cost-benefit analysis. The cost of replacing the thing is much, much lower.