Likewise:
Chris Farley wrote:
Comments are inserted below:
Chris Farley
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Stephen
Hay
Sent: Thursday, February 16, 2006 3:31 PM
To: [email protected]
Subject: Re: [Hardhats-members] A Pill, a Scalpel, a Database
(SNIP)
And people who make policy tend not to be subject to that
policy - at least, where I live that's the case... Likewise,
the people who demand the information be made public are
usually in a position, I say usually, that doesn't require
that their own records are open to public display... or
they're currently in a situation in which it doesn't matter.
Funny how the onset of disease affects people's perspective
on things like this...
CBF: Ultimately, no one is exempt. If you abuse the power the people give
you, you won't be in a position to make policy very long.
True. But the policies remain. It's rare that these things
are reversed.
(SNIP)
There is also the possibility to profile and apply user-pays
to those who have a non-contagious disease which treatment
costs a lot. So suddenly if you're sick, you're financially
responsible for that too. So much for *public* health.
CBF: I don't see an issue with this. Why shouldn't sick people pay for
care? When I was a child, I hardly ever went to the doctor. My mother
didn't want to pay for it. I only went when I was very ill. That is the
idea of co-pays today, just a little hurtle to make sure you really are sick
- though that doesn't seem to be working very well.
But there's insurance. For a start, the life insurance
companies would be VERY interested because they'd have a way
of checking the truth or not of insurance applications. In
fact, you wouldn't even need to fill in the application.
They could just send you a bill based on your life expectancy.
CBF: This is a perfect way to handle life insurance. The idea of life
insurance is to help the survivors should you be taken before you have a
chance to plan for it. Those who are going to die early, should live life
in that manner and plan appropriately - and pay more for life insurance. If
my life expectancy is 80, I don't want to pay more because someone with a
shorter life expectancy wanted to lie to the insurer so they could live high
off the hog.
It's one way of looking at it. Up to now, life insurance
premiums spread the risk across all policy holders. Basing
it on individual circumstances reduces the need to spread
the risk. And places it all on the individual carrying the
condition. How do you deal with congenital illness in this
case? Is the individual to be financially penalised for
carrying a condition he didn't "choose"?
Employers would be interested because they'd be able to pick
and choose employees based on health factors as well as
competence. Meaning, if you had the choice between two
candidates and one suffered from a condition that might
affect their work, which would you choose? Is that legal?
Maybe not now, but just wait until the next downturn...
CBF: This should definitely be legal. Why should the employer be saddled
with the cost of your lowered productivity due to illness?
>
So the sick become the unemployed, who can't afford the
insurance for the treatment they need. No problem, you say.
That's what happens now...
And it goes on.
You'll be able to check whether or not people are carrying
the gene that makes them pre-disposed to a certain disease.
You could even sterilise them so that they don't propagate
the gene, in the interest of the common good, of course.
CBF: The points you made in the previous paragraphs closely align with the
eugenics debates of the 1920s. The same debates that Hitler used to justify
his final solution. While history does tend to repeat itself, I think we
can all clearly see that sterilization and selective abortion is wrong - and
we have Hitler as a prime example of just how wrong it is.. Plus, the
Republicans would never let this happen, so most of that part of your
argument is too fantastic.
It was said "tongue-in-cheek" - difficult to see on a
mailing list, I realise...
Whether or not the Republicans would or wouldn't let
something happen is out of my domain. I don't live "there".
But, fantastic or not, you can, incidentally, achieve the
same results by neglect. You just have to know which parts
of the population you wish to neglect.
The advantage of this approach is, of course, no-one can
point the finger later. Because there's nothing to point at...
The typhoid/AIDS argument is valid as an example of the
contagious disease-type policy. It's a valid public health
argument. For *after* the disease makes itself known...
CBF: Why would we wait until after an epidemic starts? Isn't that the
ultimate failure of the government's response to AIDS - they waited to act.
"After" is too late. The disease made itself known by either killing
someone or making them very ill.
We have the same definition of "after". After the first one,
or enough to be sure that it's a epidemic we're looking at,
not a one-off case...
The diabetes argument is largely a financial one, I think
billions was mentioned. And no, I don't live in Brooklyn.
But we do have a huge diabetes problem...
CBF: You state this as if the financial considerations just don't matter.
But, they certainly matter. Unless you are an economist and fully
understand the full implications, you probably shouldn't brush the costs off
so quickly.
SH: I'm not brushing off the costs. I'm trying to tease out
that there are two arguments. One is disease-related and
public health policy. The other is also disease-related and
also public health policy but it's not contagious. Yet.
It could be that they can be treated similarly but it's more
sound to treat them separately in the first instance. The
context is the making public of health records.
I think one of the issues in all this is the potential for
the misuse of this information in making *predictions*. If
you moved to a town in which 40% of the population didn't
live to 60, would you feel obliged to die?
CBF: I don't really understand this point. Can you clarify it's meaning
for me a little?
That statistics and predictions are based on the past. And
intentional or unintentional misuse is rife in making
predictions. If your model is wrong, your predictions are wrong.
The bit about the "obligation to die" was more that
predictions are based on aggregate data and can't affect the
individual, as an individual.
Put another way, if you know that that x% of people with a
certain condition would go on to develop a more serious
condition, and your policy is to try to prevent that, how do
you choose the individuals that make up that x% for treatment?
It was an aside that perhaps should have been left out...
Though Kevin's picked up the distinction while I've been
writing this.
Cheers,
Stephen
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