It turns out we value health care for others more in rhetoric than in reality.
As a thought experiment, imagine that government support for health care consisted of a matching grant for GoFundMe solicitations, up to half the cost of a procedure. So, if you want other people to pay for your medical procedure, you use GoFundMe. If you can get enough money to pay for half the procedure, the taxpayers will fund the rest.
This changes the model from one of getting insurance company approval for a procedure to one of getting peer approval. Think about the pros and cons of this.
“Survival of The Most Popular Kid in High School”
Good idea. Have people put their money where their mouths are. (Planned Parenthood should be completely funded this way…)
People support conscription in war, including their own potential conscription, even when they wouldn’t volunteer themselves. There is a sort of a “we need to do this but I don’t want to be left holding the bag while you shirk.”
I’m not saying that “put your money where your mouth is” isn’t a good guideline for making public policy. Only that there are several items where people are OK with paying but only if they can be assured everyone else will also pay. Lots of rich people support higher taxes, but don’t give donations directly to the IRS. This appeal isn’t very new.
I think you need to convince people that current medical spending is bad for the nation as a whole. If you concede that its a good thing then wanting to opt out of a good thing just seems like being a selfish jackass, which isn’t going to sell.
It is also easy to say that not wanting to die “for the country” is selfish, when it has been the patriotic position probably since WW2.
Take a cue from the anti-war movement.
“Conscription is slavery” doesn’t get many adherents.
“This war is an unjust war” does get support.
Wanting to shirk from ones duty in a just war really is selfish. How would you judge a draft dodger in WWII. You have to get into the thick of proving a war is unjust.
I would probably judge a draft dodger in WW2 to be as likely as not someone who logically concluded that their own and their family’s immediate welfare was more important than the hypothetical but unlikely threat posed to a bunch of strangers we call our country.
I’d say conscription is only warranted when a community is under actual invasion and voluntary forces are already being exhausted; it is not enough that the war be ‘just’ to warrant it.
Of course I’m one of those people that thinks nationalism is both irrational and in net harmful and find the idea that I owe my life or freedom to my country try (or my city or county for that matter) under any circumstance both stupid and offensive.
leaving it till then is a little late. Sounds like the economist’s ‘assume a ladder.’
They are also inter-related. A more just war is likely one with popular support.
And WW2 wasn’t as cut and dried as you think, in my opinion.
And then we spent the next century worrying about Russians, when in the end they should have been more worried about global revolutionary capitalism.
I do understand your point. Coordination and first movet are an issue. But there are lots of moving parts. Conscription might get us into unnecessary wars. Third payer probably makes us overpay go poorer quality and affects innovation, depending on how the incentives are arranged.
‘People support conscription in war, including their own potential conscription, even when they wouldn’t volunteer themselves. There is a sort of a “we need to do this but I don’t want to be left holding the bag while you shirk.”’
Conscription is generally a bad example as most people know they won’t be drafted.
ww2 drafted almost an entire generation of young men, and ~30 years later when they were the dominant political force the draft was abolished.
Maybe their views on the draft are shaped by the circumstances of the war they are being drafted for.
Pros:
1. If you are on the receiving end of the medical treatment, it doesn’t matter if the cost-effectiveness of the treatment you require is horrendous, as long as you can put together a heart-warming and inspiring GoFundMe campaign that goes viral, there’s a chance that you’ll be able to obtain the funding for this treatment.
2. Costs of medical treatments would be a lot more transparent.
Cons:
1. People who are particularly popular / well-liked / famous / well-connected are more likely to be able to solicit funding than those who are unpopular / disliked / obscure for otherwise comparable conditions with similar costs of treatment / prognoses / etc.
2. Not unrelated to 1. people who are reasonably well-off and have plenty of reasonably well off friends, family and colleagues who would be willing to help them out are more likely to be able to solicit funding than those who are less well off.
3. People deciding whether or not to fund your treatment presumably are doing so for altruistic reasons. However, they don’t have a strong incentive to favour cost-effectiveness of treatment options. As opposed to an insurance company who have ‘skin in the game’.
I suspect that people would generally assign too much weight to criteria such as the perceived ‘neediness’ of the recipient, or to combat high-profile diseases and conditions, or ones with which they have personal experience and not enough weight on cost-effectiveness.
(As an example, in financial year 2015, the charity Cancer Research in the UK received donations of £635 million, whilst the charity Against Malaria received donations of $14 million – Cancer is a big concern in developed countries, Malaria not so much.)
4. This could result in an arms race as people attempt to make the most moving / saddest campaigns and videos to solicit funding.
5. Following on from 1. – 4. this will likely lead to a very inefficient allocation of medical resources. With some being denied cost-effective treatment at the expense of more popular / more moving / higher profile cases.
It seems like a great way to kill off people with chronic conditions, like ESRD. No one would ever do dialysis because no one can afford $1K a week for the rest of their lives. The 6 most popular you-tubers would get kidneys and the other few hundred thousand unphotogenic, mostly seniors, would be dead within months of their diagnosis. So, yay to cost savings. Just don’t call it a “death panel.”
“The Thousand Points Of Light” lives again!
Course, in the history of the world it has never been effective on any kind of large scale. But there is always a first time.
Right, and neither has any new technology until it is. Taxing people is effective, which is a bug not so much a feature.
???
Just an update.
The entire US donates about $350 Billion to charity every year. The majority of those donations are not even cash and do not go to groups that use a substantial part of the donation for charitable purposes(see Boone Pickens and every donation to a religious group).
The math is pretty easy to do, even without “new technology”.
I would not necessarily scoff at this idea. If you use Kiva (https://www.kiva.org/) you already see this. many people take out loans for medical care. I think if you set something up that was dedicated to funding medical care, and made it a charity – i.e. limiting the income of recipients, it could potentially work well. I do not think it would work for a general funding mechanism for medical care. Rich people would not bother, unless there was some tax advantage – it would take time and be uncertain. Insurance is easier.
I suppose the religious health cost sharing programs (eg, samaritanministries.org) are sort of like GoFundMe health care.
They’ve seen an explosion in growth since Obamacare, I understand, but Obamacare also only granted insurance mandate exemptions to the health care sharing ministries that existed at the time it went into effect, so would not expect to see any new ones start up unless the law changes.
This sort of thing is a great idea, for several reasons. Of course, heterogeneity, accountability, and efficiency are all elements of it. Here, the doctors end up needing to prove to the funders that the therapy is a good idea. Further, funders can fund different things, depending on values. They can fund locally, diseases of interest, etc.
But also, people who are funded get to feel … grateful. And people who fund get to be generous. And people may get to be both, at different times. Instead of being tax evaders, bitter, entitled, and so on.
This is truly good medicine.