If you're 80 years old, you probably should not receive a subsidized hip replacement.
If you can't afford it on your own, there should just be a palliative care mandate after some age. We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon.
Or, we should pay doctors far less. I don't think they're multi-millionaires in other countries. Not all of them are in America, but many of them are.
I think you need some empathy and life experience.
> We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon.
Easy enough for someone who thinks they have a “long time horizon” to say.
What other choice is there? About 10% of all US healthcare spending is on end-of-life care [1]. It's not pleasant to talk about, but it is a discussion that needs to take place.
[1] https://www.wrvo.org/health/2019-09-30/ten-percent-of-all-he...
Speaking only of the financial aspect, not any other ethical issues:
Those end-of-life patients paid into the system, earlier in their lives, financing the cost of earlier generations of end-of-life patients. It would be unfair to change the social contract now.
In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation.
You may be able to alleviate this financial issue (and not any other ethical issues) by phasing-in this policy change with the youngest generation of Medicare taxpayers, somehow.
> Those end-of-life patients were paying into the system, earlier in their lives, financing of the cost of earlier generations of end-of-life patients. It would be unfair to change the social contract now.
> In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation.
This hits upon the core issue: the next generation is substantially smaller than the last and relative costs have ballooned due to greater availability of therapies. The generational contract is that you pay your taxes a percentage of wages -- in effect, a PAYG mechanism. If wages do not rise sufficiently to cover increased costs, that does not imply that the generational contract was unfulfilled; the taxes were paid.
The demographic pyramid and weaker than necessary wage growth really renders the care demanded burdensome to the point where we have already provided elderly cost advantages in insurance in the form of cost premium multiple maximums and medicare from payroll taxes while beggaring the rest of the population in the process.
> In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation.
Fundamentally, children are an investment. They produce cash flow (taxes) from increased public health. The end-of-life are not; by definition, they will be dead soon. It's a horrible thing to say, but in the face of ever increasing elder care burdens and weak public debt/gdp ratios, what real choice is there?
> If wages do not rise sufficiently to cover increased costs, that does not imply that the generational contract was unfulfilled; the taxes were paid.
That's an interesting alternative view I had not considered. I think it is debatable. I believed the generational contract to be "healthcare for 65+ with 20% copay, etc., no gov. expense spared" whereas you argue the generational contract to be "Medicare payroll tax of X% is constant over all time; spend it wisely." I would argue the first option was the original intent of the Medicare law.
> Fundamentally, children are an investment. They produce cash flow (taxes) from increased public health. The end-of-life are not
You could argue the same for the end-of-life, in at least two ways: * the end-of-life patient has already produced cash flow to the government, just in reverse order from the student * Good education produces a higher taxpaying adult, the investment you refer to. I would argue the assurance of end-of-life healthcare also produces a higher taxpaying adult.
I acknowledge the costs have gone up faster than wages+population.
> I believed the generational contract to be "healthcare for 65+ with 20% copay, etc., no gov. expense spared" whereas you argue the generational contract to be "Medicare payroll tax of X% is constant over all time; spend it wisely." I would argue the first option was the original intent of the Medicare law.
I appreciate this view, but it is ahistorical and does not reflect the history of Medicare law.Taken from [1]:
> By the late 1970's, the growing expenditure trends and the changing demographics (an increasing proportion of the U.S. population 65 years of age or over) combined to endanger the solvency of the Medicare Trust Fund. The rapid increases in expenditures for the Medicare program, as well as health care services in general, constrained the ability of the Federal Government to fund other health and social programs. To a certain extent, the growth in expenditures also endangered the Nation's overall economic productivity.
> At the same time as health care expenditures were escalating, some say uncontrollably, the political landscape began to change dramatically. The national mood brought calls for fewer taxes, for reduction of budgets, and for deregulation of market sectors, such as transportation and health. This conviction of less general involvement by Government was reinforced by mounting public pressures surrounding growing budget deficits; Medicare, like other Federal programs, increasingly competed with more global policy objectives. In the space of a few years, the Nation moved from an era when health care was considered a right for all citizens to an era when cost considerations became the dominant issue.
And bear in mind, this was just ~10 years after Medicare was introduced. The nation has always prioritized the future over the past, and has either reduced or restructured benefits to ensure a healthy economy ahead of Medicare.
> You could argue the same for the end-of-life, in at least two ways: * the end-of-life patient has already produced cash flow to the government, just in reverse order from the student * Good education produces a higher taxpaying adult, the investment you refer to. I would argue the assurance of end-of-life healthcare also produces a higher taxpaying adult.
This lacks an understanding of Medicare. Medicare is fundamentally a PAYG mechanism; the trust fund was a short term surplus which is slated to be depleted by 2033 [2]: a mere 8 years from now. Part of this occurs due to poor investment strategy (treasuries only, effectively) but the biggest contributing part of this was the demographic boom. The time for "more cash flow to save for Medicare" isn't today it was 30 years ago. A failure to raise taxes 30 years ago should not constitute an obligation on the youth of today and placing the burden of an excessive tax because of poor demography and unwillingness of prior generations to raise taxes on themselves only harms economic growth at the expense of the elderly.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC4195088/#:~:text=By...
[2]https://www.cms.gov/oact/tr/2025
> If you go to a hospital in the United States, it's a lot of old people getting expensive care.
You think hospitals aren't full of old people getting care in other countries? And do you think it's possible that young people in the US don't go to the hospital because they can't afford to?
I took that out because I didn't think it was relevant. And yes, that is my point. Young people can't afford insurance in America. It's terrible. I think the GLP-1s are going to make things better. A huge problem, as everybody knows in America, is obesity. That's also a major tax on the system.
Oh look, we've found the Sociopath, who got mistreated as a children and now suffers from being Libertarian
This is such a painfully American response.
Nobody can ever imagine a better system, even if it’s used in literally every advanced nation in the world. Nope, instead we have to let Grandpa die painfully to keep those stock prices up.
I’m starting to think Capitalism as it’s practiced here is a death cult of some kind.
Well, I mentioned palliative care, but in general, I agree with you.
I would much rather doctors just get paid less. I took my son to the ER. He had a very high fever. They gave him a child's aspirin and me a $700 bill.
I just don't know what the answer is. And really, if you go into a hospital, you get the sense that there's people basically taking advantage of subsidized health insurance providers and patients both. Health insurance in America is absolutely atrocious. Next to gun fanatics, it's the worst thing about this country.