How are incentives perverse? Would it be better to have a system that only incentivizes life extension, no matter the suffering it causes, no matter that it will still ultimately end in death?

▲

snapplebobapple 7 hours ago | parent [-]

It's not about whether the person should live or die, it's that the Canadian government has vested responsibility to provide healthcare in itself while making other options illegal. I can't make my own choice to, for example, buy my own medical insurance to ensure I live for as long as possible with the most effective (and likely expensive) treatments. The government has said they got this and limited everyone's choice to government only.

They screwed this up via multiple mechanisms, because that's what government seems to do, and now there is a pretty decent shortage of healthcare up here. This makes the incentives highly perverse because the government can't provide the world class health care it promised even if it wanted to, which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives (which I would actually support if the underlying incentive structure was different, or if the government was at least honest about what was happening and compensating the MAID recipient's estates for forgoing treatment the government is obligated to provide but would be better for said government if they didn't). The most concerning bit here is the lack of provision of other life improving services like joint replacement, the latest experimental drugs, etc. and the likelihood that that is funneling people into a situation where MAID is the obvious best choice sooner than it otherwise would be. This is certainly happening with cancer treatments (although probably not intentionally, just incompetently) as people get detections for cancer and then find a months long wait list instead of days to weeks long wait list to see someone who can progress their treatment.

▲

Eddy_Viscosity2 5 hours ago | parent [-]

> which leads to political pressure to bring in MAID and chop tens to hundreds of thousands of dollars of medical liability off the end of many patient's lives

So this is an assertion that requires some evidence. The political pressure was instead from a majority of Canadians (across political lines) who want there to an an end-of-life option in situations when life becomes intolerable. People do not want to be forced by the state to stay alive and suffering via extensive medical interventions. Nor do they want to have to suffer through the alternative of slow and debilitating conditions that science is powerless to stop. This is the where MAID came from. Thinking of it in purely economic terms is already acting in bad faith.

> compensating the MAID recipient's estates for forgoing treatment

If you paid for private medical insurance, would you expect the same from them? To compensate your estate if you choose to end your life early rather that receive invasive and expensive treatment to temporarily forgo the inevitable? Even if you did expect that, insurance companies would never go for it. An even by the widest stretch they did then you're back to the same economic incentive but now with private industry. This is even worse I would say, because now people would be given a cash bonus to commit suicide (either by the government or private insurance, the same applies if people were compensated for foregone treatments). People with families in financial trouble may even consider this a way out to help loved ones. That is a crazy perverse incentive if you ask me.

On the side of offering better services, you have my whole-hearted agreement. Even something as simple as mandating an increase in the number of available seats at medical schools that corresponds with the population growth would be a start. Lots more to that list.

	▲	snapplebobapple 2 hours ago \| parent [-]
		The political pressure is budgetary and care related. Are you claiming MAID does not save money and decrease usage by ending expensive care earlier than it would otherwise be ended? I would expect private care to uphold whatever I agreed to when buying insurance from them. You continue to miss the point that there is no other option in Canada because the government made the other options illegal, which is what creates the liability. They can't make care in any other form illegal and also not provide care. I am also talking about the specific case where the person is terminally ill, not the way more crazy version we have rolled out letting people with no impending doom opt for suicide. Limiting this to the defensible type of MAID limits the perverse incentive you are concerned about to almost nothing. You trust the government to do the right thing when they have continually proven they will choose the wrong thing if it is convenient or the outcome most likely under incompetent management.