Chris Farley Independent Consultant 540-722-2143
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Stephen Hay Sent: Thursday, February 16, 2006 4:32 PM To: [email protected] Subject: Re: [Hardhats-members] A Pill, a Scalpel, a Database 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. CBF: I agree. The policies are also very slow moving and this is something to guard against. We the people, so to speak, need to keep our politicians in line. > > (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"? CBF: Yes, the individual is to be penalized. I understand that there are moral differences in this regard. However, I don't feel that I should be forced to pay for another person's illness. I may choose to do so, philanthropically, but I don't want to be forced. > 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... CBF: Okay, I'm a bit dense and I get it now. I agree, neglect can achieve the same results, but our nation has a way of balancing itself out in the long run. > > 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. CBF: I disagree that the two issues can be teased apart. The driver behind the entire discussion is financial. The primary driver behind the debate on public health is two-fold - financial and quality of care, but the financial issues and quality issues are too intertwined to separate at this point. > 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. CBF: Since Kevin gets it, I'll defer to him, as I didn't really disagree with anything he said. Cheers, Stephen ------------------------------------------------------- This SF.net email is sponsored by: Splunk Inc. Do you grep through log files for problems? Stop! Download the new AJAX search engine that makes searching your log files as easy as surfing the web. DOWNLOAD SPLUNK! http://sel.as-us.falkag.net/sel?cmd=lnk&kid=103432&bid=230486&dat=121642 _______________________________________________ Hardhats-members mailing list [email protected] https://lists.sourceforge.net/lists/listinfo/hardhats-members ------------------------------------------------------- This SF.net email is sponsored by: Splunk Inc. Do you grep through log files for problems? Stop! Download the new AJAX search engine that makes searching your log files as easy as surfing the web. 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