Adrian von Bidder raises an interesting discussion on why public health care is difficult. Basically, it comes back to the challenge:

How much money should be spent on this person's illness? which is a very, very bad question. We try to sidestep it by only taking about statistics etc., but no matter how you look at it, you either do 20'000€ per week medications for 80 year old patients who will die soon anyway and get a system society can't pay, or you don't and you get a system where the rich are better off than the poor.

The problem is, the majority of health costs are in the last few years of a persons life: when the body is breaking down. If viewed from the problem of health-care funding vs. eg. education, you have an ethical dilemma: is it worth it ? Here there are no easy answers.

Nick Bostrom wrote a very interesting and persuasive essay a while back, The fable of the Dragon Tyrant. In short, we are getting somewhere with regenerative medicine While cures are hard to come by at this stage, there is a growing realization in medicine that senesence, what we used to call "old age", is curable. But we have a lot of psychological defensive mechanisms to help us cope with the carnage of old age that make us deny the problem: if we look afresh at "old age" knowing it to be curable, any delay in doing so is abhorrent.

From a public, societal perspective, we spend a fortune every year on health. But we do so in a very disjointed way: we pay colossal amounts for health care, but also for basic health science: in the US, for example, the budget for the National Institutes of Health is about 30 billion dollars. Nearly twice that of NASA. Similar figures are spent in Europe, but there is this strange gap in the middle: the drug companies and medical industry. We start the development of new drugs with public money, and we buy the drugs with public money, but the choice of what drugs and treatments are developed are left to private industry, that is, a profit motive. This results in many cases in expensive treatments to treat symptoms rather than necessarily cure the problem. Faced with the huge costs of geriatric medicine and senesence, the response should be co-ordinated: funding a cure will be expensive, but save a fortune (Think, instead of a pensioner slowly dying and 'being a drain on resources', of 'experienced citizen in the prime of their productive, tax-paying years'). Instead of funding the basic science alone, we should be funding the complete drug and treatment development publically, only farming out the actual manufacture to private industry.

It is silly to spend a fortune to keep merely keep someone alive at the age of eighty or so, when we know for a larger investment (bigger than a private company can do), we can cure them properly. The solution to the dilemma, then, is to stop thinking of the elderly being a drain, but actually applying our public efforts in a co-ordinated manner to solving the carnage of old age.