Health care: a science fiction story

We spend fifty percent of gdp on health care.

We spend most of the rest of gdp monitoring the quality of health care institutions, let's call them clubs.

At birth your parents buy you membership in a highly capitalized health care club.  It takes very good care of you.  Some of them are set up as mutuals.

Your club monitors what you put in the toilet, feeds you drugs through your drinking water, and manipulates your DNA to counter incipient health care problems.

At some point the club refuses to spend any more money and it lets you die (kills you?), depending how costly it is to treat your ailments.  At some cost it could keep you alive forever, though not in a very happy state.  It won't.

Society has two main issues: discovering new medical advances, and monitoring the performance of health care clubs.  For each individual a computer record is kept of his health, his ailments, and when and how he is killed.  Specialists judge the performance of the clubs in deciding when to kill people (oops, let them die), and in turn those specialists are judged by other specialists who in turn are judged by specialists as well.

Some dissidents won't participate in this system at all.  They die natural deaths, and for a while are much wealthier than they otherwise would be. 

There is a lot of spying on health care clubs.  Some brave club members accept huge sums to be given fatal diseases, so that intermediaries may measure whether they are killed at the proper time and in the proper manner.  These voluntary victims often use the money to save hundreds of lives in India, where the standard of living is no higher than that of contemporary America.