"""
...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects.
"With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or does not need screening -- and it avoids the sometimes uncomfortable discussion with the patient about why they have been labeled as high risk and needing further screening."
"""
I think the fact that high risk populations rock the medical boat so globally already makes medicine awkward regardless of avoiding uncomfortable discussions. All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place. It's the next immediate question that gets raised when you evaluate 'why do I need another HIV test' or whatever other blood test it is that medicine pushes on you. Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to. But from the patient who knows what virtue they live or don't live some of these tests just come off as absurd knowing your own life history and the absolute absence of risks you deliberately avoid in life. One step of indirection is not much to jump over for one who naturally asks the next immediate question.
> Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to.
The question is not which subpopulations the patient may belong to, but which ones they may have had contact with. It doesn't matter how well-off you are if you ate dinner last night in a restaurant where the staff cannot afford to be screened and treated for hepatitis. That particular transmission vector is more relevant to Hep A than Hep C, but the general point for public health policy at a high level is sound: you cannot ignore under-served populations that live amongst you, because people you don't care about can still get you sick. Yes, there are some nasty diseases that for now appear to be limited to only sexual and needle transmission, but we shouldn't shape our entire approach to public health around blaming the victims of those particular diseases.
All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place.
Sure, some portion of people in distress contribute overall very disproportionately to health care cost. This includes people who make poor health choices (over-consumption of sugary beverages, unhealthy drug and similar things), people who are homeless and people who chronic health problems (through work-related injuries, random chance or actual poor decisions).
There seem to be two reaction: "OK, then just don't allow them health care, problem solved" or "we need to prevent people from getting into that position in the first place."
I would say the first reaction is counter-productive, poorly thought-through and morally indefensible. Obviously, I think the second approach is crucial (obviously requiring quite a bit of effort). The first position is very common, however and it's kind of sad, for both the people who think this way but much more for the consequence.
I think the only reason people jump to the first position is: A. The situation is presented in isolation and these people aren't considering the consequences. B. There's a human tendency to jump to a belief without fully exploring the evidence. C. Defending a belief often just makes the defender more defensive, especially since changing would make them admit they holding a fairly cruel and immoral position.
I think the article from a couple days ago about human belief formation is very relevant for this discussion.
This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals.
As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems.
On the other hand, as someone with chronic mild obesity, I'm grateful for government-funded research for treatments of hypertension, stroke, idiopathic cancer, etc. And to some extent I could, if motivated enough, keep my bodyweight down.
I guess there are two issues then. The politics of shared costs/benefits, and attending my personal struggles with only being empathetic to problems that I myself experience.
On the subject of shared costs/benefits: The wealth that allows us modern healthcare is not so much the wealth we are producing today, but overwhelmingly more the wealth that the countless generations before us have created. That one person should benefit disproportionately from this wealth, just because by some narrow financial measure their small contribution is slightly less small than another's, is surely against natural justice. Healthcare is our birthright, part of the Universal Basic Stake that we each inherit simply by being born.
"This seems related to the political question of how much healthcare costs should be socialized, i.e. spread across a group rather than shouldered by individuals"
But that story isn't about costs of healthcare - the NHS will treat her for free precisely because the costs are socialised. The social care system will also ramp up rapidly given she's a vulnerable new mother who has now been admitted to the local maternity hospital.
> As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems.
Then you'll be happy to know the morbid truth: smokers and alcoholics have lower healthcare costs over their lifetimes because they tend to die earlier. If everyone smoke and drank to excess, your insurance costs would be lower.
However, this truth ignores another morbid truth: some people you love, maybe one of your kids, a relative or even perhaps even yourself, are statistically likely to smoke, drink or do drugs to excess.
> I guess there are two issues then. The politics of shared costs/benefits, and attending my personal struggles with only being empathetic to problems that I myself experience.
I mean, at least you recognize the irony. Empathy is learned, and perhaps you could learn to be empathetic towards others.
And the moral one. You could have gotten any conceivable illness while having had optimal healthy habits forever.
The US pays around 2x the cost compared to any other country, and just as much as the others from taxes, presumably just to be able to say 'F YOU' to those who can't afford care.
This is a gross mischaracterization of the position I and mamy others hold. Fundamentally, I will pay twice as much to avoid the state dipping its slimy fingers into another aspect of my life. More practically, our screwed-up healthcare system resulted from state involvement (FDA bureaucracy, wage & price controls, etc.), so I don't think more state involvement will fix a thing.
You know what really screwed things up? The ability for people to pay (two times, ten times, whatever) to get whatever they want and not give a f about how this affects society, and in particular the people without the ability to pay $$$ to get their will.
What on earth are you dreaming that could give you the right to pay for the ability to deny health care to the rest of society??
Because without that society, you too, are nothing.
I am not paying to deny any one any thing; rather I am simply not paying for them to receive it. What is wrong with paying to get what I want? How does my purchase of medical treatment harm another?
> Because without that society, you too, are nothing.
This reflects a profound ideological difference between you and me. I believe the individual's value is a unique, personal thing that exists independent of society; you seem to think individuals are without value on their own. You are evidently a much more collectivist person. That's fine, go form your collective, but don't force others to enter at gunpoint.
But you said you would rather pay twice as much for healthcare if it avoids that money would also be spent to help others. Sounds to me like you'd be paying extra so others don't receive it.
I'm probably misunderstanding something you said here, because even accounting for that profound ideological difference, that still seems really weird.
And speaking of that, well first let me deny that I think individuals are without value on their own. Indeed I am apparently much more of a collectivist person; but it is because I believe in every individual's value that we all should take care of each other, in order for that value to prosper. What I meant was, without a society, you are just some weirdo without a bank account, knocking on a doctor's door, twice. Which was probably a bit hyperbolic.
I was going to argue my side of this ideological divide, but I should really be spending my energy elsewhere (what I had half-written was getting way too long) ... so I'm gonna leave it at that.
> But you said you would rather pay twice as much for healthcare if it avoids that money would also be spent to help others. Sounds to me like you'd be paying extra so others don't receive it.
No, I said that I'd pay more for a private vs a cheaper _government_ alternative. My objection is to government involvement, not to helping out my fellow man. I give to private charities because I believe they are more effective and more moral.
Well, it's what happens in practice to real people. So go you.
Edit: It also doesn't make sense. You are giving the government just as much money as people do in northern europe, and the government gets to play around with it and decide JUST AS MUCH about you and your care.
> As someone who doesn't smoke, barely drinks alcohol, doesn't take illegal drugs, and (I hope) is in a lifelong-monogamous relationship, I hate having to cover healthcare costs specific to those problems.
You should try some compassion--they say it's also a healthy life choice.
And, that must be pretty convenient, how the legality of drugs just happens to line up exactly with how you judge people on whether they're worthy and deserve health or not.
High prevalence of hcv isn't just due to lifestyle factors. Baby boomer age group for example have a very high prevalence primarily due to spread by unsafe medical practices before the medical community knew about hcv:
""" ...clinicians are now able to successfully cure at least 95% of patients with the chronic condition with oral medications that have little or no side effects.
"With such an effective means for cure, it only makes sense to universally screen patients," Cheung said. "Implementation of universal screening will also decrease the likelihood of primary care physicians forgetting who does or does not need screening -- and it avoids the sometimes uncomfortable discussion with the patient about why they have been labeled as high risk and needing further screening." """
I think the fact that high risk populations rock the medical boat so globally already makes medicine awkward regardless of avoiding uncomfortable discussions. All these blanket treatments and tests just paper over the fact that there are wide impacting subpopulations with poor health in our populous driving the need for these things in the first place. It's the next immediate question that gets raised when you evaluate 'why do I need another HIV test' or whatever other blood test it is that medicine pushes on you. Eventually it dawned on me that these blind blanket decisions are simply because these doctors don't know anything about a patient's personal life and what risky subpopulations they may or may not belong to. But from the patient who knows what virtue they live or don't live some of these tests just come off as absurd knowing your own life history and the absolute absence of risks you deliberately avoid in life. One step of indirection is not much to jump over for one who naturally asks the next immediate question.