Even in PPP terms, British GDP is about 75% of America's, not half. Why do they value their lives so much lower?
Well, one possibility is that they don't--when assessing environmental threats, which is where that cost-per-life-saved was developed for the US. But this makes no rational sense; a life saved by environmental regulation is no more alive than a life saved by surgery. The difference is, of course, that in one case, the government actually has to spend money, while in the other, the government is simply halting economic activity, or forcing a private actor to spend money. While economically, these are no different, they seem very distinctive indeed to people with tax budgets.
Winterspeak noticed an even uglier irrationality:
But this makes no sense:Britain's National Health Service provides 95 percent of the nation's care from an annual budget, so paying for costly treatments means less money for, say, sick children. Before NICE, hospitals and clinics often came to different decisions about which drugs to buy, creating geographic disparities in care that led to outrage. (Such disparities are common in the United States, even for federal Medicare patients.)Sick children provide excellent return on investment for treatments. A positive intervention in a child can yield years of benefits. Why don't children always win?After consulting a citizens group, the institute decided that the nation should spend the same amount saving or improving the life of a 75-year-old smoker as it would a 5-year-old.Ah, that makes sense. It is also highly informative about the value of consulting citizens' groups.
So, so far the salutory effects of this laudatory public works project are to undervalue all human life, but especially that of small children, because the seniors kicked up a fuss. The moral logic of this is appalling. In these liberated days, "women and children first" has sensibly changed to "children first", but I hadn't realized that we'd gotten so advanced that we'd abandoned even that elementary moral calculus. I've never seen it made so starkly clear that the job of any senior's lobby is to cannibalize the future in order to pay for their past or present.
Welcome to the real world. We've been robbing children to pay seniors for decades. With the baby boomers reaching their 60's, it's about to get really ugly. This is an example of the strength of lobbying and voting, the strength of groups like AARP.
Seniors are getting health care and prescription benefits; my kids -- ages 20 and 22 -- are uninsured. They will spend their lives paying for senior insurance, plus the debt boomers ran up.
Now, with economic collapse, my kids will have to compete against those aging boomers for jobs. So I'm all for putting a ceiling on care, and for giving preferential treatment to the young.
But I think we could do better at bringing new treatments and medicines to market. My husband worked for many years with a group that performed oncology trails; I have some appreciation of how expensive developing new medical treatments is, and of how few people participate in clinical trials because of private insurance.
Welcome to the real world. We've been robbing children to pay seniors for decades. With the baby boomers reaching their 60's, it's about to get really ugly. This is an example of the strength of lobbying and voting, the strength of groups like AARP.
Seniors are getting health care and prescription benefits; my kids -- ages 20 and 22 -- are uninsured. They will spend their lives paying for senior insurance, plus the debt boomers ran up.
Now, with economic collapse, my kids will have to compete against those aging boomers for jobs. So I'm all for putting a ceiling on care, and for giving preferential treatment to the young.
But I think we could do better at bringing new treatments and medicines to market. My husband worked for many years with a group that performed oncology trails; I have some appreciation of how expensive developing new medical treatments is, and of how few people participate in clinical trials because of private insurance.
Neato: one link to an old page of comments on the EPA's changing of the value of a human life. Topical and informative. V. nice.
For those who like links to the actual, you know, subject of the post or to the quoted blogposts...
NY Times Article on the NICE that Winterspeak is commenting on (thankfully, Winterspeak is findable through the Google and actually provides links to his subject matter):
http://www.nytimes.com/2008/12/03/health/03nice.html?_r=2&em=&pagewanted=all
And Winterspeak's blogpost:
http://www.winterspeak.com/2008/12/not-so-nice.html
Well, at least there were no logic-negating errors in this post...
The generational neutrality fallacy continues.
Is a 5 year old now worth more than a 5 year old in 2040? Yes, unless you think the population will contract.
In 2040, a 5 year old from now will have a 5 year old and 10 year old and a 15 year of his own.
aaron said:
Not if he's English, he won't. They are below the replacement birthrate. (Well, excluding the birth-rate of those "English" who are actually Pakistani or other relatively recent immigrants.)
If you look at the demographics for most of the modern world you have to assume the population will contract.
the nation should spend the same amount saving or improving the life of a 75-year-old smoker as it would a 5-year-old.
This is a weird sentence. If 'saving... the life of' means changing a terminally ill patient to someone who has the same life expectancy as a healthy person of the same age, than it's obviously nuts, because you're buying so many more healthy years of life for the five year old than for the 75 year old. But if the math includes life expectancy -- that "the same amount" means "the same amount of money per expected year of healthy life produced by the treatment", it's questionable, but not clearly wrong. Is there any really good reason that a treatment that will allow a sick five year old to live to eight is more valuable than a treatment that will allow a sick seventy-five year old to live to seventy-eight?
You can't tell from the Times article which situation is being described.
I suppose you feel that people are like taxis. When taxis are driven alot, they begin to fall apart and it just don't make sense to repair them. Better to kill the old taxi, recycle its dead carcass and put a brand new taxi into service.
Based on this logic, the only medical care Medicare should provide is assisted suicide because people on Medicare are either retired or can't work because they are disabled.
Children are the future. Used up workers and other deadbeats harm the health and well being of society.
Until the 20th century, most old people were not allowed to live. Among primitive tribes, unproductive old people would pass along what few possessions they owned to the younger members of the tribe and then walk out into the dessert (or swim out into the ocean, or walk into the forest, or walk out on the ice) and pray for a quick death.
In 19th century London poor old people simply starved or died of exposure. Wealthier ones died of neglect in "old folks" homes. Gold teeth and dentures were recycled.
In every case it was customary to kill off the old people privately so as not to upset the young ones.
Unproductive people, whether old or otherwise, are a luxury only the insanely rich can afford.
On average we spend 50% of our lifetime health care money during the last 6 months of life. How can that make sense?
At the same time we're drowning in government debt. Something's gotta give.
Thanks to blighter for pointing us to the article being quoted.
Megan
The NYT slid into ambiguity in the sentence that enraged you:
"After consulting a citizens group, the institute decided that the nation should spend the same amount saving or improving the life of a 75-year-old smoker as it would a 5-year-old."
What the NICE guidelines actually mean is that the same amount should be spent to secure an extra year of life (at a given standard of quality of life) for a 75 year old as for a 5 year old. This is not gross discrimination against the children. It means that for a treatment which is likely to lead an otherwise terminal patient to reach a normal life span, it will be worth spending about six times as much on the child as on the 75 year old.
As a 75 year old, I beg to differ from the guideline. An adjustment should be applied for the declining utility of extra years of life as one's years accumulate. At age 5, a year is a very long time and should be valued as such. At age 75, years pass swiftly. Their value to the passer should be discounted for that. No doubt NICE acted properly in asking its citizen jury (for such its panel is)to assess the question, but I am afraid that the question was not put in a form that would allow the alternative of a systematic discount for extra age.
NICE is a formidable attempt to address the ethical dilemmas posed in attempting to supply universal health care within a fixed budget. Reading their guidelines on "Social Value Judgements" at:
http://www.nice.org.uk/media/C18/30/SVJ2PUBLICATION2008.pdf
is a saluary experience.
Robert Heinlein said, in The Notebook of Lazarus Long (1973) the following:
How different would the world look if we gave the vote to children from birth but allowed parents to cast these 'extra' votes until the children reached 18? After all, parents look out for the interest of their children in all other matters -- why not politics, too? Surely children would be far better served by having votes cast in their names by their parents than in having no representation at all.
And yet I know nobody who has insured his life for a sum anywhere near a million dollars. Where do all these highly valuable people live?
And yet I know nobody who has insured his life for a sum anywhere near a million dollars.
You must not know any partners in businesses. It's common to insure partners at this and higher levels, partly because the loss of a key employee would impact the business, but also because most partnerships have a buyout clause in the event of death or incapacitation. The business would need the money to do the buyout.
Though technically your point is still valid - these policies are typically purchased by the company, not the individual.
Old folks vote. Children do not. Of course old people are going to vote themselves the majority of the dollars.
I look forward to spending the rest of my working life supporting whiny, entitled Boomers. What's not to love there?
And yet I know nobody who has insured his life for a sum anywhere near a million dollars. Where do all these highly valuable people live?
But life insurance is not intended to cover the value of the whole life -- only a fraction of it. In particular, I don't insure my life for the value *I* place on it -- that would make no sense, since once I'm dead I can't spend the insurance payment. What I insure is only the value my life has for my family. And then only the financial value (not the emotional value) and only for a limited time (the time during which my children are dependent on me).
@Larry: On average we spend 50% of our lifetime health care money during the last 6 months of life. How can that make sense?
Because you don't know when that last 6 months starts? As far as I know, Hugo Pinero's machine to measure your "life-line" hasn't been invented. The usual example for this is a 90 year old Alzheimer's patient given heroic measures so they can live a few months more.
But, if a 20 year old gets in a car crash, and has probably fatal injuries, should the hospital refuse to do trauma care and surgery? Do we decline to do chemotherapy for mostly-fatal cancers? How do you know? Right now we err on the side of extending life. We let the decision making progress be decentralized and decided without the help of bureaucrats most of the time.
I've had to confront this in my own life and had to help my mom decide when to have my dad put on DNR/minimal life support. He went from a relatively healthy, productive 72 year old (who still had a functioning small business) to dead in 6 months, using 90% of the health care dollars he'd used as an adult. Yet until the last collapse, he appeared to be on his way back to longer life.
How do you know? Does a bureaucrat in DC know? Or one in the state capital?
I don't know that I'm so high value, but I've got well over a million in life insurance. (And, happily, my husband hasn't pushed me under a truck yet, so it must be love.) But life insurance is about income replacement, not some existential valuation of human life, so I'm not sure how apt a proxy it is. Most people are probably underinsured regardless of how they value themselves (though life insurance is less of an issue than disability insurance, since that's much more likely to be needed. I've got $1 that says whatever your employer offers isn't enough for your family to live on if you can't work, particularly if you don't die fast).
I'm the primary bread winner, and I'm fairly young, so I've got life insurance to replace 70% of my income until I would have hit 65, plus university for the kids, plus mortgage pay-off. It adds up fast, particularly since we want the kids to have no educational restrictions. But we started not with the vague question "what is my life worth?", but with the specific question "if I get hit by a bus, what lump sum of cash does the family need so they can keep their current lifestyle until I would have retired." The answer was "a hell of a lot." We also carry a fair amount on my husband to cover the replacement of his Mr. Mom services. It's not anywhere near a million, but it's a lot more than you'd think.
I don't think the article has accurately described how NICE works. NICE uses QALY (Quality Adjusted Life Years) to determine if a treatment option is used. The value at the moment is something like 30,000 pounds per QALY.
This means that if a 5 year old will die without treatment and will be completely cured then assuming they are now going to live a further 70 years then NICE will approve treatments costing up to 70*30,000. Take a 75 year old and assume they will now live a further 5 good years then figure of 5*30,000 will be used. If treatment only provides some sort of partial improvement towards a 'quality year' then a further scaling factor is used.
But we started not with the vague question "what is my life worth?", but with the specific question "if I get hit by a bus, what lump sum of cash does the family need so they can keep their current lifestyle until I would have retired." The answer was "a hell of a lot."
True. On the other hand, if you are an unemployed vagrant, or a minimum-wage laborer, your life is worth a lot less in financial terms. If you haven't got any money, it doesn't matter what value you place on your own life - you can't spend anything to save it or to insure your family against its loss.
This, ultimately, is where the "value" of a QALY comes from. For rare illnesses, one can go to heroically expensive measures to prolong life without putting a dent in the NHS budget, but that's not true in the case of common illnesses faced by a significant fraction of the population.
Megan - "Even in PPP terms, British GDP is about 75% of America's" should read "Even in PPP terms, British per capita GDP is about 75% of America's"
There PPP GDP is more like 15% of our GDP.
Megan, I'm going to take a flying guess that you mostly know younger people with fewer or no children. $1 million in insurance isn't that uncommon for people with more than one small child and a non-employed spouse. The most conservative but still rational target would be insurance to completely replace a lost income @ the 5% rate assumed over time for endowments, which would take a $50k salary-earner to $1 million in insurance.
"I read this article on NICE a little while ago. What jumped out at me was just how low a value the Brits place on human life: ... "
For a moment I thought you were making a C.S. Lewis reference. But probably not.
http://en.wikipedia.org/wiki/NICE_(disambiguation)
Rich in PA: I think your name reveals more than you might realize.
Tell me again why far more federal health care dollars are spent on women's complaints than men's conditions.
Remember, it's called "women's liberation" not "children's liberation." Women are still living high on the hog because they hold children hostage to women's whims.