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But the term isn't just about "allocating scarce resources and who should get them", it's "allocating them in such a way, that you are predictably causing more deaths than an alternative, traditional allocation".
Again this is NOT new. In Public Health policy we already take into account things other than just number of lives saved. If we didn't then you would just abandon huge rural areas because the investment there simply gets a worse return on lives saved than adding another hospital in a dense city where the ED is packed every day.
We ALREADY choose to cause more deaths in certain places for certain reasons. We trade off speed limits on safety vs efficiency and on and on. That doesn't mean any particular reason is a good one of course, it has to be examined in light of what you are trying to accomplish, but choosing to predictably cause more deaths is a valid trade-off. If you think poor or rural people should get healthcare resources that could save more urban people that is a valid option. If you think the economic benefits of faster commutes is worth 10 deaths a year, that's also a valid option. At the population level deaths are a trade off for other things.
In fact many people argued here that we should have allowed more deaths from Covid in order to not tank the economy as much and disrupt schooling and the like. It's already established that deaths are tradeable for other values. We're just quibbling over which ones and why. So the fact it predictably causes more deaths is not in and of itself a useful critique. Whose deaths? Why? You have to look at the object level not the meta level.
You don't think we invest in urban hospitals until the point where diminishing returns make it so that it saves more lives to open a hospital in a more rural area, rather than another one in a city?
No. Not at all. The formula used by the NHS explicitly has a rural weighting so as to offset the population densities. Not entirely of course but somewhat. You can argue that's because politically telling rural voters "Hey you're too expensive to treat, so just fend for yourselves" is a bit of a non starter, but the effect is the same.
In the US about 35% of hospitals are in rural areas but about 83% of people live in cities. Just to be clear rural healthcare is still often poor because the US is really, really big. But it is still getting more than simple population would suggest. Which is probably correct, you want your farmers et al to have access to healthcare even if there aren't very many of them. They are pretty important, whereas a Starbucks worker or what have you is likely not adding quite as much value at a societal level (sorry baristas).
But that is kind of the point, at high levels you do have to take into account other factors than just the number of lives you can save/treat. You have to consider economic factors, political factors and plenty of others. If 1000 bucks would save 3 baristas or 1 farmer. Well it might be you should save the farmer. If 1000 bucks saves Elon Musk or a farmer, well you should probably save Elon Musk.
In fact I might argue the US still needs to skew it's healthcare even more rurally than currently. I'd probably want to do a lot of research to confirm that but it's certainly possible.
You don't think a your caveats are doing a lot of work here? How big is the weighting, and do they compare to vaccinating the young and healthy vs. the old and the infirm?
That's not a massive disproportion, and it says nothing about actual resource use. I've been to rural hospitals (in Europe) they're not comparable to city hospitals.
You don't think it's possible to patch someone up locally, and send them to a bigger hospital if they need more complex care? Or are you saying this is not being done?
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