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Comment by stavrianos | Hacker News Reader

You're thinking of a pharmacist.

MDs and politicians should absolutely be doing cost-benefit tradeoffs. I'd go so far as to say that's basically their job. I go to a doctor because they have skills and knowledge I don't possess.

That doctors (being experts) so often don't apply their judgment, and politicians (often being charismatic amateurs) so often do is lamentable. Politicians should be required to be experts. Doctors should be (aren't they?) required to exhibit judgment on behalf of their patients.

Expecting everyone to be able to exhibit the judgment of a professional in every field is so wildly implausible that I've obviously mistaken your meaning.

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In my experience there's a difference between European and American doctors. I guess it has something to do with how much American doctors get sued, or how much American patients expect to be "in charge", or something like that.

My wife and I are both from Europe originally, and going to the doctor in the US is sometimes really frustrating for us. We go with the idea that we're consulting an expert for their advice, but sometimes find them quite unwilling to make any kind of judgment call. Sometimes they just offer a bunch of options and say "pick one". When pressed for an opinion, they'll sometimes just hint in one direction or another. Compared to a British doctor, who will almost always confidently tell you exactly what he or she thinks should be done, it can be quite an unnerving experience.

Doctors are taught in American medical schools that they are supposed to provide all options to their patients and explain to them the cost benefits and not try to make or even bias their decision.

I'm not sure if it's simply for fear of lawsuits or if it's coded in the law itself (although I think I read that it's the latter somewhere).

It is coded in the ethical principle of autonomy, which some would say is more important than either the fear of lawsuits or the laws of any particular country.

> MDs and politicians should absolutely be doing cost-benefit tradeoffs.

No, they shouldn't. If I'd rather spend my money on hookers and booze, that's my decision to make. If I'd rather spend all my money on health care so I've got a chance to see my first grandchild, that's also my decision to make.

I expect MDs to be experts on health benefits ("your knee won't be stiff in the morning") and health costs (like "you'll limp if you let this slid"). I expect someone associated to have a handle on how much money is involved.

However, that's not enough information to make a health care decision. Someone has to decide the relative value of those things, to decide if the costs are worth the benefits.

I am the expert in deciding how much these things matter to me. Booze vs grandchild is my call for me. It's your call for you. It's okay that we make different decisions.

If you think that I'm not "the expert" wrt those things for me, who is?

Or, do you think that those decisions shouldn't be made wrt my values for me? I'll be happy to make them for you if you want, but I don't want you making them for me.

> Expecting everyone to be able to exhibit the judgment of a professional in every field is so wildly implausible that I've obviously mistaken your meaning.

Either I was unclear or you don't understand what experts are experts at.

> Politicians should be required to be experts.

It's easier to require them to be unicorns.

As a general rule, you don't get to assume unobtanium even if that's the only way to make your preferred approach work. Any approach that requires unobtanium is, by definition, wrong, no matter how many ponies that you think that we'd get if it worked.

I hadn't considered the economic tradeoff involved in health care (I'm canadian, didn't occur to me). Obviously doctors shouldn't control your spending. Or politicians, for that matter.

Doctors obviously shouldn't have access to your wallet, but they SHOULD tell you without pussy-footing around, this will save your life, that is stupid and unnecessary, that one over there will kill you.

If you want to buy drugs without a doctor interjecting good sense, it really is a pharmacist you need.

And since libertarian governments are forged from pure unobtainium anyways, they might as well be competent. I think it's a smaller jump from here to qualified politicians than it is from here to politicians who don't meddle in people's lives.

> And since libertarian governments are forged from pure unobtainium anyways

No one said anything about libertarian govts.

Different govts meddle in different amounts. Some don't meddle much at all, providing an existence proof.

Where are govts with qualified politicians?

Fair challenge. I don't think there have been any democracies that promoted competence, so any examples I can think of will be monarchies that happened to get a good king that one time, or something to that nature. Tightly centralized government isn't dragged down to the average, so they can pull stunts like that from time to time.

Yes, there have been "expert" politicians (including monarchs) in one or two fields, but unless their govt only meddled in those areas, they were "not experts" in the rest of the things that their govts did.

Govts select for the ability to stay in power. Anything else is a coincidence. (Yes, I'm blaming "the people" here for not connecting expertise to survivability more strongly.)

And, as you point out, that's a temporary state of affairs.

BTW - Tightly centralized govts are pulled to the comptence/expertise of the center, wherever that is. It may be average, it may not be. See North Korea for an example. (And yes, you can point to Singapore.)

Argh. The "And ..." paragraph should have been before the "Govts select" paragraph.

If the patient is paying, then why shouldn't he be making the decision?

I'd certainly hope the MD would provide guidance in that decision, since it's the MD who knows what the costs and benefits are. But the MD knows neither the patient's marginal valuation of the costs, nor of the benefits. That is, he doesn't know how precious each dollar is to the patient, nor the fact that, e.g., he is resigned to his terminal illness but just wants to live long enough to see his daughter graduate.

Since nobody else knows how much those things are worth to the patient, nobody is qualified to balance them.

Most especially not politicians, who ought not to have a horse in the race at all. The availability of the treatments ought to be metered by the price of providing them versus the patient's (or the patient's contracted insurance provider's) willingness to pay (given an understanding of the treatment as guided by the MD). Period.

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