Wednesday, November 06, 2013

An even more modest healthcare proposal

Whilst writing my rant on healthcare this afternoon, with its special attention to the Libertarian "don't tread on me" line that goes "Why should I pay for healthcare? I don't need any healthcare so all my money will be spent on you," I vaguely remembered an old science fiction story.

I contacted James Nicoll, of the rather wonderful science fiction LiveJournal blog More Words Deeper Hole with three half-remembered concepts from it, and literally four minutes later he wrote back to let me know it was Michael G Coney's The True Worth of Ruth Villiers, from New Writings in SF in 1970. (It was a relatively obscure British magazine.)

It is, amazingly, online.  Mr. Coney's utopia is a little more strict than my own modest proposal. In mine, if you have no money you are not treated to healthcare. In True Worth, if you have no money, you are not treated to health care or any other services, and it would be an unfair advantage to allow relatives or friends to give or lend you that money. Never fear though. In the story, the establishment recognizes you can incur some costs before you earn enough to pay, so it gives each individual a certain amount to be going on with - specifically a "Birthright" of 600 credits.

Here is an excerpt:
Suppose someone is in the hospital, awaiting an expensive operation. The obvious question poses itself: is the patient worth treating, bearing in mind his value to the community? So the hospital sends me a claim based on the estimated cost. 
Then I call the National Bank and find that the patient has accumulated savings totaling (say) Cr. 2,000 to date. 
And I consult my own punch-card index and find that he has a Social Value Cred Rating of (say) Cr. 1,500. 
That person, therefore, is worth Cr. 3,500 to the community. Nothing more; nothing less. 
So if the operation costs up to Cr. 3,500, the scalpels will flash and he will be healed, presumably. 
But if the operation (including pre- and post-operational care and treatment) is estimated at Cr. 3,501, his flesh will remain uncarved. He can, however, receive lesser treatment and drugs to the value of Cr. 3,500, at which point he will be discharged from the hospital. What he does then is up to him; but assuming he is able to start work again he must repay the loan of Cr. 1,500 on his Social Value Cred Rating before he can start to accumulate any personal savings again. In repaying this amount, he will be allowed the bare minimum of his wages for living expenses. In fact, he will probably be fed and lodged by his friends, provided they are not caught doing it.
The story gives an example of how well this works in practice. The eponymous Ruth is trapped after a mineshaft collapse. Her social worth is not enough to pay the rescuers to dig her out, though it does pay for an airshaft to be drilled. And yet, months later, Ruth is rescued, proving that the system works and wishy-washy liberal "compassion" and "social responsibility" is not needed.

How can this be? You can learn the answer here.

(It's a very quick read.)


Penelope said...

This has nothing to do with your post, but I was curious about the name of your blog. As someone who spent the day checking actual live peromyscus for pinworms and fur mites, I wondered why you chose to name your blog for these #$@*! little speed demons.

Peromyscus said...

Hello Penelope,

One of my jobs in the early nineties was testing patients' serum for Lyme Disease antibodies. It was early days for Lyme testing and I got sent to a couple of symposia, where I learned that the cute little mousie was a vector of transmission. (And now of course they're implicated in Hanta virus transmission.) For some reason that stayed with me all this time. But you're ahead of me - I've actually never handled a peromyscus!

Thanks for asking.

Jessica Alba said...

Nice post, Does a health care system based on a dissolving social norm of employer-provided health care make sense? The social norm is rapidly eroding between, as health care becomes too expensive.

Peromyscus said...

Hi Jessica,

I don't think employer-provided health care ever made sense. I'm no libertarian but I don't see why a company should have to shoulder the administrative costs of providing insurance. I wouldn't be surprised to see the custom disappear in smaller companies. They can regain their "benefit-offering" status by giving their employees cash to buy insurance instead. Companies understand cash and how to get hold of it.

As for expensive, health care in the US is literally twice as much as in the UK and many other similar countries, without the US having measurably better outcomes. Whether that's defensive medicine, end-of-life heroics, more (but not better) diagnostic testing or what, I don't know but it certainly should be possible to knock the per capita expense down by literally 50% for a start.


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