Comment by sgk284 | Hacker News Reader

Comment by sgk284 | Hacker News Reader

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If the child lives to 80, she only needs to contribute an additional $12,500 worth of value to civilization per year for this to make economic sense.

Another way to look at this: the government has various estimates for the value of a human life. It averages about $7MM. The "extraordinary" expense of this child actually only requires a 14% increase in value over the average citizen to make sense.

Most importantly though, we must recognize that the actual cost is actually just the cost of risk spread across society, so instead of one person taking the brunt of this cost, we as a society take it together. As a whole, it is negligible on all of us, and it's a risk that any of us can fall into. The value of having a system that supports each other is invaluable. Way more valuable than a measly $1MM. We have strength in numbers and we all benefit when a society supports each other. If we ostracize the statistical outliers in this support system, then the support system itself (the one which we all benefit from) falls apart.

In short, more important than the economic argument (which I argue, still makes sense to spend $1MM on a baby), is the argument that the value to society from supporting each other results in a negligible cost for individuals and a near-priceless benefit to everyone within that society. It's exceptionally difficult to put a price tag on that, and it's orders of magnitude higher than $1MM.

That still doesn't maximize overall benefit. What if the money were instead spent on 10 individuals that needed 1/10 the money to save their lives? The cost benefit analysis to determine what medical issues make most sense should try to maximize the number of person-years-lived across the entire population.

The money spend where '1/10 the money' was needed to save their lives is additional money spent, not 'instead money'.

In this particular case, the 'instead money' was pure profits for a company (and some taxes for the government).

Do you really think that the 'instead money' would have been a better choice?

Money is just money and is completely replaceable. Actually, we have machines to make it: it's printable. Actually, we don't even have to physically print the money to 'print the money'... It's a number in a computer file.

Every dollar is the same as every other dollar.

Each and every life, on the other hand, is unique.

Unfortunately, I wasn't clear in my comment above like I was in other comments in this thread. I am specifically referring to a not-for-profit focused healthcare system. If the choice is between profits and the care necessary to help a life, then it boils down to the contractual obligation of the insurer given the level of coverage purchased. In a nationalized healthcare system where costs are spread across all of society and the government has more or less determined the pool of healthcare dollars available by specifying the premium spent per citizen, there most certainly is a cost benefit analysis to consider.

You're assuming that we're at capacity on spending, but we're not. Instead, we can afford to bring 11 individuals into the world. The absolute gain to society is still greater than simply bringing 10 into the world.

Maximizing number of total person years is not sufficient because a population 100x as large but living 1/5 as long would be superior to a population of the current size but living twice as long.

I'd argue in favor of maximizing population size and average lifespan. Of course this ultimately leads to the requirement that humanity moves off of this little rock of ours.

Given X amount of money paid per person as a in premium and Y number of people paying those premiums, we should have XY available to spend on healthcare. That is a hard cap on healthcare spending.

While we can afford to maintain* 11 individuals in the world. There reaches a point where over that entire population, we need to triage the medical issues in that population into the people whose issues maximize human-hours-lived given the X*Y healthcare dollars available to spend treating those issues. Maybe it's not the first person that requires treatment costing a million dollars we need to triage, but you eventually will run out of money if you don't triage because we simply don't pay unlimited premiums to meet the unlimited demand for healthcare.

The issue about overpopulation is a red herring, and in this case isn't just of function of helping people live longer. Many countries once they reach a level of prosperity stop having children at the necessary replacement rate of 2.1 children per couple once that society becomes affluent. The dropping replacement rate often correlates with societies ability to spend more money on helping their population live longer through spending on medical treatment.

> If the child lives to 80, she only needs to contribute $12,500 worth of value to civilization per year for this to make economic sense.

No, that's not correct. You're not thinking at the margin.

Still makes sense at the margin. Updated wording slightly to clarify.

Have you looked around lately ? Worldwide, I'd say at least 50% of the population does not make economic sense. That number is going up, fast.

What do you intend to do about them ?

That's still a terrible argument.

> The "extraordinary" expense of this child actually only requires a 14% increase in value over the average citizen to make sense.

Ok, fair enough, we'll ignore the question of whether average really makes sense, but there's a bigger problem: there's absolutely no reason to expect this hugely premature baby to have >14% increase of value. Why? This is completely unfounded, completely unjustified. In fact, as a premature baby with massive expensive health problems, wouldn't we expect the opposite? Early childhood trauma seems like it'll matter to their future prospects: https://en.wikipedia.org/wiki/Preterm_birth#Prognosis (As makes sense. If babies could be born months premature with no negative effects, why aren't they being born that way already so they can start growing up quicker?)

> That's still a terrible argument.

It was one of three points made, the last point being the most significant. Our humanity should take priority over negligible costs.

> there's absolutely no reason to expect this hugely premature baby to have >14% increase of value

Without a standard deviation on the average, there is no way to say whether or not 14% is reasonable. Regardless, I was simply pointing out that it's a small fraction rather than orders of magnitude greater. Even if the child winds up providing 50% of the value of an average person, it can still be a net gain.

Economic reasoning is just one (minor) aspect to this situation though. There is very real value in simply helping a fellow human survive.

> as a premature baby with massive expensive health problems, wouldn't we expect the opposite?

The stats you cite are for extreme cases on the edge of viability and the odds still slightly favor normal or near-normal development.

This particular baby was born with a 66% chance of living and deserves more than a quick dismissal.

> If babies could be born months premature with no negative effects, why aren't they being born that way already so they can start growing up quicker?

That's horrible reasoning. The human body has evolved over millions of years for birth. It is the optimal gestation machine. We're working on approximating this optimal machine with artificial machines and continue to rapidly make progress. In the rare situation where the human body fails for some reason, we attempt to augment it with the best artificial machines we've got. Nobody claims that premature births are better, but a hiccup during pregnancy shouldn't mean the end of a life if we can avoid it.

Humanity progresses when a society looks out for each other. In particular, without bias. That starts at birth.

What you're proposing is barbaric and borderline infantcide.

> Without a standard deviation on the average, there is no way to say whether or not 14% is reasonable.

There is no reason to expect the expectation of preemies to be above average, never mind 14%, never mind standard deviations. And there is substantial empirical evidence which I linked you to expect it to be far below average. Rescuing a preemie, even if it were free, would be a bad idea compared to alternatives like simply trying again.

> Even if the child winds up providing 50% of the value of an average person, it can still be a net gain.

And we're right back to your original problem: you are not thinking on the margin. The alternative to spending millions on premature babies is not no babies ever. (And even if it was, there's still superior alternatives: for example, lobbying for Open Borders. Think of all the millions of immigrants who'd love to come to the USA, for free! We wouldn't even have to pay them! Why, even if they're 99% below average, it's still a gain!)

> The stats you cite are for extreme cases on the edge of viability and the odds still slightly favor normal or near-normal development.

Which is what we are discussing, is it not? Or do even slightly premature babies come with million-dollar pricetags...?

> That's horrible reasoning. The human body has evolved over millions of years for birth. It is the optimal gestation machine. We're working on approximating this optimal machine with artificial machines

I'm not seeing any disagreement here. Yes, the human body is the optimal gestation machine. That's why premature babies come with all the penalties. (And note that those citations are just the penalties sufficient to be documented with small samples; there's not much reason to expect the penalty to abruptly cut off somewhere, it's just the long-term effects shrink enough to be hidden by noise and methodological problems and researcher careers' limits.)

> That starts at birth.

An arbitrary line is not a good basis for a system of ethics and governance.

> What you're proposing is barbaric and borderline infantcide.

I'm happy to own to that. It is infanticide. Premature fetuses are not humans in the moral sense: they have no hopes, they have no dreams, they have no desires or preferences, they do not think, and they have the moral status of a puppy or kitten. Given the disabilities they come with, throwing away hundreds of thousands of dollars in heroic medical measures is a crime against society and the person the parents could have raised instead.

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