If we look at the total energy–direct assistance plus taxation plus any transfer of payments–that we extend to others in altruistic efforts, there has to be a line, a sort of watershed, above which we begin to hurt ourselves and our own families more than we help others. The C/B shifts. If we give too much we subtract from ourselves too much. Should we jump into shark infested waters to save our cousins or should we only jump in to save our brothers? Some would say that modern social democracies have about reached that line.

Shouldn’t we at least talk about this trade-off line? And study where it should be? We can’t just have a sector of the economy that eats everyone else, that consumes all our altruistic instincts and gifts, like some kinf of predator, can we?

Your mortality studies are obviously true, although the differences are small. The University Hospitals generally do a much better at following standards of care more reliably as a group. Their total cost-per-insured-per-month are quite another matter. As we eventually move to capitated Primary Healthcare and all-other-care risk-pools (stop-loss protected), the span of control within medical school institutional governance will be difficult to manage. Hint: Pay the PCP (or a PCP associate) fee-for-service out of the risk- pool to act as the attending for any hospital admit.

The transition out of ACA 2010 will move quickly and the pressure to lower our nation’s healthcare spending from 18% of the economy to 12% will be intense. With an increased economic growth rate by 3% to 5% and the progressive increase in the number of Medicare eligible citizens (it doubles between 2000 and 2030), we only need to keep healthcare spending to $4.0 Trillion or less. It was $3.17 Trillion in February 2015,
$3.31 Trillion in February 2016 and $3.47 Trillion in February 2017 ( according to Altarum Institute). The only precious STALL in the growth of healthcare spending was from 1994 through 1998 during the intense HMO era. The last Altarum Institute demonstrated a continuous percentage change in healthcare spending growth from 12-2007 through 12-2016. It was tracking at 2.0% more than economic growth until 2013 and has progressively worsened since then (as per ACA 2010 implementation). Note also, that the continuing increase, worsening, of our nation’s maternal mortality ratio seems to follow the same pattern (see Obstetrics & Gynecology, Sept 2016).
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One of the most important attributes of our nation’s maternal health problems is its direct correlation, state by state for 2001-2006 (the only data set available), with the level of poverty with each of the 50 states. From a larger viewpoint, the content of the Common Good, community by community is probably the most important factor underlying maternal health and many of the other adverse determinants of health. Our nation’s healthcare industry cannot and should not assume the burden of our disintegrating extended families. And yet, the cost of healthcare spending is, in part, related to this problem. Any renewed attempt to form a basis to build universal health insurance will degenerate in to rationed government controlled healthcare without an improvement in the Common Good of each community.
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To avoid this scenario will require a means to manage the Common Good of each community by reinvigorating its Social Capital asset. Be aware that this is NOT a financial asset. It IS the prevalence of ALTRUISM that dominates the networks of caring relationships that occur within extended families, their neighborhoods, and within their community’s institutions. This is the only means to fortress our communities with the will to take care of each other in the face of the unrelenting Social Dilemmas that occur daily. For us all, we must risk ourselves just a bit more everyday to care for and about our family, neighbors and the other citizens within our community.