The Cost of Humanity?

[SYZ]

A rare set of conjoined twins have undergone surgery to
separate them after they were airlifted to Sydney from
Papua New Guinea a couple of days ago.  One of the twins,
named Tom, has died while his brother Sawong has survived,
and is now in intensive care at Sydney Children's Hospital.

And I know in advance what I'm about to say will be condemned
by some people here, but so be it...

The estimated cost (to the taxpayer) is estimated at being up
to AU$1 million, or more, depending on Sawong's long-term
rehabilitation.

But... at the moment there are around 32,300 Aussie patients in
a queue awaiting hip replacement surgery, which can be 3 years
or more(!) from date of GP referral to the date of surgery.  The
cost is around AU$23,000 as an out-of-pocket expense—which is
subsidised by our Medicare system to 85% or AU$19,550.

So... my question is:  Who should have priority in this scenario?
A couple of babies from a foreign country, or Australians in need?
Would anybody in Australia have ever known if these babies had
died in a primitive, isolated PNG village?  Why were these babies
chosen in particular—considering that out of every 100,000 live
births, 192 babies die in PNG?  (In Australia it's 2.3 —WHO, 2022.)

Could it be politically motivated even?  Recent debate over the
PNG Pukpuk treaty has focused on China and whether Australia’s
military might one day use Papua New Guinea’s geography or fight
alongside PNG forces in a regional contingency involving Beijing
and Washington.

[Thumpalumpacus]

How do you feel the bite? Where would you prefer your taxes be spent?

These decisions aren't very different from those taken in insurance boardrooms.

[Paleophyte]

When humanity becomes too costly you probably don't concern yourself very much with hip replacements for the elderly. It's not like they're going to be around for long after all. But you're right, they should get all the damned foreigners out of Australia.

[brewerb]

I'm a greater good pragmatist, politics wouldn't matter.

Edit: I wonder about the long term prognosis for the surviving twin and the extent of suffering. Hope the medical teams are learning something.

[Dānu]

Experimental and cutting-edge medical procedures may have benefits beyond the utilitarian good produced by the surgery itself. Techniques and knowledge gained can impact other care.

[Gawdzilla Sama]

One procedure wouldn't be a noticeable dent in the surgical backlog, right? One adult has to wait a while longer for a hip replacement?

[Unsapien]

The PNG Prime Minister said that his country will be paying the medical bills, so it's not about the money.

I'm pretty sure that the doctors that performed the surgery here were not pulled away from the line of doctors that are doing hip replacements.

And if nothing else it will help us learn how to do these rare surgeries better, and adds to our knowledge.

It's one of those arguments like why do we spend so much money in space when there are people starving on earth?

[Gawdzilla Sama]

The PNG Prime Minister said that his country will be paying the medical bills, so it's not about the money.

I'm pretty sure that the doctors that performed the surgery here were not pulled away from the line of doctors that are doing hip replacements.

And if nothing else it will help us learn how to do these rare surgeries better, and adds to our knowledge.

It's one of those arguments like why do we spend so much money in space when there are people starving on earth?

I never said anything about "money".

[Unsapien]

The PNG Prime Minister said that his country will be paying the medical bills, so it's not about the money.

I'm pretty sure that the doctors that performed the surgery here were not pulled away from the line of doctors that are doing hip replacements.

And if nothing else it will help us learn how to do these rare surgeries better, and adds to our knowledge.

It's one of those arguments like why do we spend so much money in space when there are people starving on earth?

I never said anything about "money".

the OP did.

[Gawdzilla Sama]

Just being clear, given that he followed me.

[Rhythmcs]

Compared to the cost of inhumanity it's a steal. Nativist ideologies and policies have a tendency to backfire - harming the economy, qol, and political stability of the host nation. These sorts of questions are often posed as a conflict between altruism and self interest, but that's not actually why we engage in such behaviors. We make our groups and tribes (or nations) welcoming and helpful, insomuch as we do, because that benefits -us- primarily. The signs are all there even in your summary of the issue as you see it. The relatively large number of people awaiting care they will get, the ability of octors to perform such surgeries in one country and not the other. The poor health outcomes in the country of origin. These are all products of your greater ability to drain talent and make sweetheart trade deals with your neighbors. Of being the kind of place people want to go to, and not just for medical care. Even the cynical possibilities, of increased defense cooperation, are benefits to your nation, not a detriment, and at the low low cost of a little help with healthcare.

Consider the current predicament in the us, for a less charged example (to an australian). Nativists contend that immigrants are stealing our healthcare and houses, and so they enact policies that they believe will make it difficult for immigrants to access healthcare and housing - but the effect is a reduction in healthcare and housing access for the nativists themselves - as both industries depend on those same immigrants. Nativists contend that we're suckers, handing out treasure in notheristan while failing our people at home. So we crater usaid and shoot up boats on the high seas, losing global intelligence sharing as a consequence. The kind of intelligence sharing we might need to stop actual acts of terrorism that just might be engendered by our having starved somebody's kid elsewhere.

[pattylt]

Experimental and cutting-edge medical procedures may have benefits beyond the utilitarian good produced by the surgery itself.  Techniques and knowledge gained can impact other care.

This is my opinion as well.  These are a type of surgery few surgeons will ever see but the knowledge gained can be immeasurable.  

I’m mixed on hip replacements as it’s becoming a go to surgery for all hip pain.  I’m eligible but, in my case, it’s not just my hips but my SI joints as well which a hip replacement either won’t help or make worse.  The age is a big factor here as well as osteoporosis.  I’ve heard the talk from orthopedic surgeons talking about how difficult a replacement can be on an elderly osteoporosis patient…they have a hell of a time getting the screws to hold in porous bones.  If you’re in your 60-70s with no or little osteoporosis, it’s very successful but doing surgery on 80 year old women is costly and often of little benefit.  Here in the US, the wait is short but the procedure is overdone…and we can’t really change that.  If Medicare pays for it (and they do) it’s a moneymaker.  Our healthcare is so broken…

[mordant]

Here in the US, the wait is short but the procedure is overdone…and we can’t really change that.

Same for knee replacements. My wife had both done about 3 years ago (at age 64) and has very mixed feelings about it. She first encountered a doctor with a production line pushing her to get the procedures several years prior to THAT and my bullshit detector went off and the acute pain episode she was in at the time resolved itself about a month later (probably a torn meniscus that slid back into place or something). Later a more sensible doctor said "we treat symptoms, not X-Rays -- you decide when you want to go ahead". But even there, they don't tell you everything so that you can make a truly informed decision. Even other patients relating their experiences online don't talk much about what happens past the early recovery phase.

What my wife doesn't like is the "feel" of the implants. You can tell you have artificial parts in there. Her legs don't feel "right". Her proprioception is off and she has a tendency to overbalance forward when going down a steep hill. There's some permanent skin numbness on one side of each leg where they cut nerves. There's a little less mobility even if you're really good about post-op therapy; few people will ever comfortably kneel (say, to weed the garden) again. She has had to re-learn how to get back on her feet after a fall.

Her pain wasn't fun, but wasn't really unbearable, either. Sometimes she wonders if she should have just left well enough alone. My guess is that she would have gotten into "unbearable" territory in another year or two and there was value in Just Getting It Over With, but ... there you have it.

I think your point that it is a money machine is the main take-away here. In an ideal world people would be given more info, and not just glowing reports of success.

I just went through a 2nd prostate surgery in 5 years, this one more invasive, and while I was told things will get better before they get worse and I'm only 4 weeks out, I have a feeling this is another money machine situation that isn't going to move the needle very much and I will end up finding my main problem was a spastic / overactive bladder. Except they won't treat that until they have treated any detectable obstruction, and you have the constant niggling fear that you will at some point get into acute urinary distress, unable to pee, waiting hours for relief in one of our overburdened emergency rooms. Plus the sleep quality issues. So more of a Hobson's choice than my wife arguably faced, but I still think it's a racket and needs reform.

[brewerb]

Here in the US, the wait is short but the procedure is overdone…and we can’t really change that.

Same for knee replacements. My wife had both done about 3 years ago (at age 64) and has very mixed feelings about it. She first encountered a doctor with a production line pushing her to get the procedures several years prior to THAT and my bullshit detector went off and the acute pain episode she was in at the time resolved itself about a month later (probably a torn meniscus that slid back into place or something). Later a more sensible doctor said "we treat symptoms, not X-Rays -- you decide when you want to go ahead". But even there, they don't tell you everything so that you can make a truly informed decision. Even other patients relating their experiences online don't talk much about what happens past the early recovery phase.

What my wife doesn't like is the "feel" of the implants. You can tell you have artificial parts in there. Her legs don't feel "right". Her proprioception is off and she has a tendency to overbalance forward when going down a steep hill. There's some permanent skin numbness on one side of each leg where they cut nerves. There's a little less mobility even if you're really good about post-op therapy; few people will ever comfortably kneel (say, to weed the garden) again. She has had to re-learn how to get back on her feet after a fall.

Her pain wasn't fun, but wasn't really unbearable, either. Sometimes she wonders if she should have just left well enough alone. My guess is that she would have gotten into "unbearable" territory in another year or two and there was value in Just Getting It Over With, but ... there you have it.

I think your point that it is a money machine is the main take-away here. In an ideal world people would be given more info, and not just glowing reports of success.

I just went through a 2nd prostate surgery in 5 years, this one more invasive, and while I was told things will get better before they get worse and I'm only 4 weeks out, I have a feeling this is another money machine situation that isn't going to move the needle very much and I will end up finding my main problem was a spastic / overactive bladder. Except they won't treat that until they have treated any detectable obstruction, and you have the constant niggling fear that you will at some point get into acute urinary distress, unable to pee, waiting hours for relief in one of our overburdened emergency rooms. Plus the sleep quality issues. So more of a Hobson's choice than my wife arguably faced, but I still think it's a racket and needs reform.

bold: That's kind of what I'm waiting for. MRI of my left knee shows a complete tear of the acl and partial tear of the meniscus. I've been living with it for years because there is little pain, bad days it's a dull ache. Based on my old fart activity level I can do most walking activities with a compression sleeve (PhysFlex) but there is still some instability which is more frequent on inclines. If I go off road (flat surface) or am pushing/pulling extra weight then I need a heftier brace that has an extension stop (Thuasne rigid with a 5-10 degree stop). It's inconvenient taking on and off but gets the job done and fits under my jeans. Recently I tried barefoot shoes, basically swim shoes. They definitely help with tactile/proprioception, the drawback is that there no cushion or insulation. And I do have OA and ortho expects that to continue to get worse, a total knee is probably in my future.

Didn't you have UroLift? I may be confused with someone else. An acquaintance recently had steam ablation (Rezum), the whole process took at least a month before he was back to functioning/feeling 'normal'.

[mordant]

Didn't you have UroLift? I may be confused with someone else. An acquaintance recently had steam ablation (Rezum), the whole process took at least a month before he was back to functioning/feeling 'normal'.

Yeah the first attempt, in 2020, was UroLift. It did exactly zero for me.

My current surgeon explains that a surgeon cannot know until he sinks the first anchor, whether a UroLift will be successful. Depending on the exact makeup of your prostate tissue, it can result in the prostate wall falling away (where did it go?!) or in very little movement. If the latter, you know it's not going to accomplish much.

The original surgeon only told me if it didn't work he might need to repeat the procedure and add a few more of the devices in there.

This time it's aquablation, essentially a TURP procedure modified to work around the aftermath of the UroLift.

I've been told total healing takes 2 months. Tomorrow marks the one month mark.

I was also promised things would get worse before they get better, and that I may still need medication or treatment (botox?) for my bladder if I still have symptoms.

At this point I would say I'm getting up about the same amount as before the procedure [sigh].