So the idea of the program was to find these people and coordinate services for them to minimize their use of the emergency room. In the article the program which serves just 37 patients is estimated to have saved $14M over two years without even counting the fact that these people also had fewer police and ambulance interactions.
I remember reading about a pilot for a program like this in the past. It took people who were costing the system over half a million a year each, some of them more than a million, and instead spent about $250k to $300k each. It produced better health results for less. When the pilot ended, the program was scrapped.
Usually better-results-for-less-money is an easy sell. But the program was also doing something else - it was changing which pocket was paying for the program. Instead of the money coming out of a general pot that pays unfunded emergency room visits, it came from a specific fund allocated to serve specific people. It was now easy to say that those people had been made a priority and that they were being treated preferentially. Especially in a place where healthcare isn't free for all, it's a tough political sell to say to a majority who have an average of only a few thousands dollars allocated to their care that a tiny minority ought to have $300k of healthcare a year.
If it were for people who had the most serious illnesses, maybe it could be sold. But the highest users of healthcare aren't even the sickest people, they are usually homeless, often with mental health issues, and simply rely on the emergency room for everything.
You work hard, you pay for health insurance, you pay for your home, for your clothes, for your food. Out there somewhere is a person who has massively more expensive healthcare than you, who is being given a home and clothes and food. It seems unfair.
I'm a technocrat by nature. My instinct is that the best way to run a society is to use the best tools we have available to determine how to produce the best results and then do whatever we need to do to produce those results. If we are going to save $7M a year by providing intensive care to a handful of people and produce better results for those people at the same time, it seems obvious to me that we ought to do so. If someone disagrees, I think that person is allowing pettiness or selfishness or hate for the poor to cloud reason. Reason says that you always pay less for better if you can.
So let's say we've got 40 people who are simply going to cost the healthcare system over $1M a year with their current care. Nothing is going to magically change how those 40 people behave. We can't simply tell them to stop being lazy and get a job. We have to think of solutions that work, that are practical.
Now lets say we have 60% of the population that thinks those solutions feel unfair. Nothing is going to magically change how those people feel. We can't simply tell them to stop feeling so jealous or angry or victimized. We also, here, have to think of solutions that work, that are practical.
California has a population of 39.5M people. If it really is 50 or 60 percent of their population who feel that way, then an extra $14M in healthcare costs is not even a dollar a year for each person. What if they argue that it's worth the state spending a 50-70 cents a year per person to reduce their sense of anguish over what feels like inequitable distribution of resources towards people who aren't contributing to society?
Economic calculus values emotions at zero until those emotions start producing measurable damaging eternalities. The intolerable emotional problems of a person that keep them homeless and sick and using the emergency room twice a day produce a dollars and cents effect on expenditures, and a minutes and seconds effect on emergency room wait times. The everyday small jealousies and resentments of people who feel like they are getting less from society than others are seem hard to measure. We can't draw a straight line between them an a specific cost. Then again, it's not much of a stretch to say that, added together, those hurt feelings are responsible for the US trade war with China, or Ontario's refusal to acknowledge environmental realities, or the mounting catastrophe of Brexit.
Thinking that the large group of people who resent others for getting what they see as handouts should develop empathy is probably even more ridiculous than saying that the 100 top healthcare users ought to get over whatever psychological trauma is contributing to that status. Sure, it's easier for one middle class person to learn empathy than for one homeless person to recover from trauma that has stayed with them for decades, but is it easier to shift empathy up one and a half standard deviations for 400,000 people than for one person to get over trauma? That's not easy to quantify.
And let's not get into the numbers.
No one
cares if facts show that one course of action is better than another. I may change my feelings when exposed to numbers that prove it is foolish to feel the way I feel, but I have a toxic bullying relationship with my feelings that few people can replicate and they find ways of getting me back for it in the end
.More and more I feel we have to accept that technocracy just isn't possible. There isn't a right answer to problems. There's no such thing as strictly better. Someone always wants it a different way. We pay for everything - by having to endure our emotions about it if in no other way - and people's individual calculi weight things differently. I think it is probably possible to build a consensus that it's better to pay less money to provide better medical treatment to people. But it's also possible to build a consensus that we need a civil war to sort out our problems. The trick is actually building that consensus, not saying that the numbers prove you right.
I've got a coherent morality system that says we should help each other instead of kill each other, but we do live in a democracy.
