> As I sit here writing and calculating this I have this question in the back of my mind - Is it worth it?
Well, it's insurance. It's there so if you have twins in the NICU for two months because they were born in the second trimester (like I did) you don't wind up with a multi-million dollar bill to pay. Most people will incur more premiums than benefits. That's normal.
Let me ask the relatively cruel question though for the purposes of prompting further discussion:
At what point does subsidizing other people's outlier events become unacceptable? I will never have kids (biological issues). I will likely die from a one off critical heart failure (also genetic in my family) rather than anything that will cost me significant amounts of money. I do not drive, leave the house much, or do any risky activities, yet as the parent said, I pay _hilarious_ amounts of money each year for insurance.
And the real kicker for me, I've developed some conditions related to stress-side effects, sedentary behavior, and joint issues because of my work. So the insurance money would be BETTER SERVED being reinvested so I could stop working in such a way that damages my body.
Now, you can say this is selfish, but as I said, I'm taking an intentionally selfish point of view for this argument. At what point do we draw the line of "I need this money for me now" or "someone else needs the net effect of re-balancing costs across a society?"
I will openly admit that as I've gone through a decent chunk of my career without incurring any major events, but while incurring major costs, where I sit on being OK with the current arrangement has shifted.
Let me ask an even crueler question. Let me preface by saying I am a parent of a child that needed some minor postpartum care in order to survive, so how horrible this sounds is not lost on me:
At what point do we stop holding up infant mortality as the gold standard of medical care? Spending untold resources on keeping alive infants who would otherwise die is inherently dysgenic, and allowing whatever conflagration of genetic anomalies that contribute to the necessity of postpartum care will inevitably lead to higher incidences of these cases in the future, as these genes are allowed to propagate into future generations.
Infant mortality is emotionally devastating, but preventing it will almost certainly increase our society's long-term medical costs.
Along this topic, if we are spending so much on these infants why is our rate higher than other first world countries?
Finland which is number one, "used the least resources and attained average results, making Finland the most efficient public sector health service producer according to the study's authors"
Spending is unevenly distributed. Poverty and drugs have a negative effect. Basically, spending 100 million on one baby born without a heart doesn't save twenty other crack babies.
But it also selects for empathy and parenting. Both will help build a better society. In fact we've been sacrificing physical skills for emotional ones, as long as human societies have existed. This is nothing new for sure.
On the other hand, something that is trivially treatable can be borne without issue, which, who knows, could enable later advancement.
Just look at the established tradeoff our species makes- our children are born helpless. Isn't caring for them dysgenic? But, being able to care for & protect them enables significant brain development to happen outside the womb.
Swaddling, clearing a wrapped umbilical cord, suctioning the nose & mouth... there are lots of things we do that improve mortality that are trivial.
Childhood mortality has to have imposed a tremendous selective pressure, on both the immune system and general congenital defects. I've been reflecting on what lifting this selective pressure means. Also on the fact that this lifting is nonuniform across cultures -- infants in less-developed nations are still subject to most of these effects.
That said: most of the improvement is through public health measures (clean drinking water, sewerage systems, municipal waste collection) and nutrition. Heroic measures are very much the outlier. That may be an even stronger argument against them -- other than as a learning experience, the resources they consume relative to providing much more basic, and effective, outcomes interventions is difficult to defend.
From the CDC: Infant mortality in the US <1 year was "up to" 30% in 1900. Maternal mortality was around 0.8% in 1900.
Wasn't this line of thinking discredited with the Nazis? Is eugenics back now? Do you also have a modest proposal for solving the problem of all those excess poor children?
> Spending untold resources on keeping alive infants who would otherwise die is inherently dysgenic, and allowing whatever conflagration of genetic anomalies that contribute to the necessity of postpartum care will inevitably lead to higher incidences of these cases in the future, as these genes are allowed to propagate into future generations.
Well, cystic fibrosis patients are encouraged not to have children. Is that eugenics? In the extreme, with enough time and money we could even harvest eggs and sperm from CF patients to ensure they can procreate even if they don't live long enough to do so. Is it eugenics to not spend those resources?
It's a pretty big gap between "don't treat preemies who might be perfectly normal once stabilized" (case in point: my kids) and "you should think about not giving a kid a death sentence" that CF entails.
That question is pretty close to home for me. Our family's highest yearly billing was about $3M, and we've hit $100k every year in the last 8. If you were writing a textbook about healthcare outliers, we'd be in it.
The closest thing I have to an answer for you is single-payer like the rest of the developed world, where they pay substantially lower medical costs for similar health outcomes.
I do hope to see our society mature a bit on end-of-life care. Dying is disproportionately expensive (http://time.com/money/2793643/cutting-the-high-cost-of-end-o...) and that money often results in little benefit to the patient (and at times, probably causes active harm).
Patients who'd like to undertake euthanasia and can't would get a DNR order. Medicare isn't spending massive billions on folks with DNRs - it's the folks that won't accept a terminal cancer diagnosis and put grandma through intensive chemo instead of prioritizing quality of life that costs.
To me, that's what health insurance is. Insurance should be for rare (or at least uncommon) events. Flood, fire, car accident, etc.
But health "insurance" has crept into regular health maintenance. But that's not really insurance; that's more like an extended warranty for your life.
That's true for various reasons such as benefits expectations (some of it the result of union negotiations historically) and tax effects. [1] There's also the theory, which may not be especially true as I understand it, that preventative medicine like regular physicals can cut healthcare costs down the road. In any case though, I'm pretty sure that annual physicals and the occasional stitches or urgent care visit aren't huge contributors to overall healthcare costs.
[1] And certainly things like dental insurance are pretty much just "extended warranties" rather than insurance against catastrophic expenses.
Well, it's insurance. It's there so if you have twins in the NICU for two months because they were born in the second trimester (like I did) you don't wind up with a multi-million dollar bill to pay. Most people will incur more premiums than benefits. That's normal.