This is what a free-market death panel looks like
During the debate over health care reform, Sarah Palin and others successfully convinced a lot of Americans that the bill included sneaky “death panel” provisions that allow government bureaucrats to make life-and-death decisions.
It was, in a word, baloney.
But as we’ve learned in the last two weeks, death panels really do exist.. It’s called the marketplace.
When the state of Arizona stopped subsidizing organ transplants for poor patients, some very sick people were thrown back on the free market.
In future, those Arizonans who can pay will live. Many of those who can’t pay will die. This from the New York Times.
“The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine.
“The frustration is tremendous. It’s more than frustration.”
The Times stories recounts how one donated liver — which had been intended for a 32-year-0ld father named Francisco Felix — went instead to a patient who could fork over $200,000.
“I know times are tight and cuts are needed, but you can’t cut human lives,” said Mr. Felix’s wife, Flor. “You just can’t do that.”
As Slate’s reporting makes clear, this kind of cash-for-life reality plays out over and over again in American society, not just in Arizona.
Economic rationing of transplants occurs in other ways, too. Hospitals routinely reject candidates for new organs or bone marrow if they have no insurance or if their coverage will not guarantee payment for the anti-rejection medications that a patient must take for the rest of his life.
The crucial point here is that this isn’t an abstract, ideological debate. Without some kind of intervention in the marketplace, people will die.
So what do we do about it? Does laissez-faire libertarianism mean that people of lesser economic means should be allowed to (literally) drop off the bottom of the ladder?
Should some other institution or entity foot the bill? Or does this cross a moral line that we’re uncomfortable with?
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Fortunately, Arnold Schwarzenegger provides the needed documentation to make this point. He is declaring a state of emergency in California and includes the following:
“The governor also is asking the state to limit prescriptions and cap physician visits to 10 a year for Medi-Cal recipients.”
That is the kind of death panel that government health care leads to.
Concerning organ transplants, you are trying to use the most contrived extreme to make your point. It actually can be simplified as the following:
People make health choices all the time, when they have to pay the bill. Not everyone can afford a Cadillac. If all of health care was market based, everyone could make choices, and work hard to provide the best they can for their families.
The notion that “health care is free” or “organs are free” only comes from the left.
Said another way,
Because the need for organs exceeds the supply, either the market must decide, or a death panel must decide who gets them.
And the concept that there are death panels only comes from the right.
My oh my.
No Brian, govenment intervention won’t do crap. If there is only one organ and 2 people need it to live then one will die. There is no paradise to be reached by government intervention.
The question is how do you allocate scarce resources? In a free economy the resources go to the highest bidder. In a political economy the resources go to the one with political connections. In a free economy the one’s with the most money are also the one’s that have produced the most wealth. I
[fumbled fingers submitted previous post before completion]
In a political economy wealth is transferred to the politically connected who don’t actually contribute to the generation of wealth. So not only will the wealth be transferred to the political leaches so will the best medical care.
Free markets are not perfect but they are better than the alternatives.
Notinthevillage –
No, actually, if you read the articles you’ll find that the problem here isn’t availability of organs. (That was the old version of rationing.)
Now people in Arizona are being taken off the list regardless of whether organs are available or not.
Regarding your larger argument: Surely you’re not suggesting that Francisco Felix — a working class guy — is more ‘politically connected than the person who can afford to pay $200,000 for a liver?
In fact, we know from experience that when money is taken off the table, hospitals are very good at prioritizing and making medical decisions.
Organs go to people on fair waiting lists, to people with the greatest need, and with the greatest likelihood of a successful transplant.
Bluntly, I think there are more moral approaches to these life-and-death questions than “highest bidder.”
-Brian, NCPR
The unvarnished truth is that healthcare rationing in some form does and will continue to exist. The discussion should be about how, not if.
Healthcare economics doesn’t conform nicely to the laws of supply and demand because the commodity being bought often isn’t discretionary (the decision can dramatically affect the quality of life or whether one lives or dies). The Cadillac analogy breaks down because it implies that there is a the ability to choose the heathcare equivalent of a less luxurious car. In many cases, that option doesn’t exist. The existing system of making heathcare choices economically painless to the vast majority of recipients doesn’t help.
The issue of rationing is a complex, difficult, and emotionally charged one. On the other hand, left unresolved, it has the potential to bankrupt the country (see the recent report on the dramatically escalating cost of military healthcare and the Pentagon’s reaction).
Like seemingly every other issue of national importance, this one will be used to score partisan points, and it’s unlikely that there will be a groundswell of popular support to force politicians to address it like adults.
Bluntly, I think there are more moral approaches to these life-and-death questions than “highest bidder.”
I think the market-place approach is better – because it leads to game-changing innovations.
Jarvik-7
Jarvik-7 was developed at a publicly funded university in Utah. Funding for artificial organ development came in large measure from the Federal NIH.
Some of the latest innovations in artificial heart technology have been made in Canada, where the health system is largely publicly funded.
My point isn’t that the marketplace isn’t an important player here; merely that it’s not the only legitimate player.
–Brian, NCPR
I am not advocating this.
But a true free market would also include a robust market in organs which would greatly increase the number of organs available in the market.
But all valuable services are rationed as there is a limited amount of those services. The private market will solve that one way the public provision will solve it another way. It is false for us to think that health care will not always be rationed.
Brian, you are correct. Don’t forget where the government gets the funds that it gives to the NIH, NSF, USDA,……
Those at universities often forget where the money comes from. Not from the government but from the private sector.
We need real death panels who can make rational decisions about allocation of health care dollars. The “free market” just makes things worse.
If we let death panels decide who gets organs and who doesn’t, the only people who will get organs are…
the relatives of the people on the death panel.
It is a problem not only in the U.S. but internationally. Never heard of “transplant tourism”? Brian, read the articles again, shortage of organs is indeed part of the problem.
Please take note of Jobs story.
No Brian I am not suggesting that at all. What I am suggesting is that in a political economy the person that can afford to pay will be politically connected. That in a political economy the politically connected obtain wealth not by producing economic value but by virtue of their political connections.
So why would anyone want to transfer that power to a bureaucrat in Washington?
Only in fairy tales. From the Slate article:
The simple reality is the wealthy and politically connected move to the front of the line. In Steve Jobs case at least it was someone who has contributed a great deal to the wealth of the country.
Just make sure you have regulations that prevent the kind of abuse that went on in AZ. It is not an all or nothing question.
Brian, wasn’t this NOT a free market scenario? It sounds like it was something controlled by the state?
If the state can’t even deal with one organ in a fair way why would you want the federal government to control the whole system?
If the insurance companies and the states don’t want to pay for transplants, they should just say so and do with transplants what they do for abortions.
On while we are on the subject of health care, I just paid to have three teeth pulled. My insurance provider and many other health care providers don’t pay for dental or eye care. So here you have yet another case of pay to play.
I’m sure if the insurance companies had their way, everyone would be required to have health insurance but the insurance companies wouldn’t be required to pay for anything.
By the way, I wouldn’t miss Steve Jobs. All he does is make toys for children and adults.
MAybe what we need are professional negotiators for transplant patients. The ‘closer’, can assess his clients strengths and weaknesses in the competitive transplant marketplace. Perhaps he/she will decide that while the client doesn’t have deep pockets that perhaps some other type of, ‘exchange’ might work. So we’re down to 2 finalists, one with deep pockets, one who is drop-dead gorgeous. I mean, if we’re going to let the, “marketplace’ decide, isn’t it arbitrary to say that only money is the only, ‘currency’, that can be exchanged to tip the scales? Sounds tacky, right? Well, to much of the above, I would quote the punchline from an old joke, “Madame, we’ve already established who and what you are, now we’re just haggling over the price” … and perhaps method of payment.
The marketplace is already deciding. It will be even worse after the healthcare bill takes effect, what will happen then is an increase in costs for health care and a reduction in availability.
To follow up on NITV post- Mickey Mantle. So my one of my boyhood heroes finds out one day he needs a liver. Livers don’t grow on trees. I know, I checked Wikipedia. What was it, 3-4 days later The Mickster is on the table having a fresh liver installed. Pay to play, and some poor slob someplace who wasn’t a famous ball player didn’t get a liver that go around. Do you really think it’ll be any different if some gov’t agency can make the decisions? With the costs involved they will have to ration health care, it’s already being talked about and it’s already done in private health care policies.
I just want to see health care at lower costs. Why does US health care cost so much? I have yet to hear a decent explanation for that.
There will always be an unfairness in life most of us can accept that, but when it goes too far is when a society runs into trouble.
US health care costs so much because we dont ration it and there arent any death panels.
Its an all-you-can-eat buffet where the doctor-patient relationship determines what you get. Neither (doctor or patient) is interested in reducing costs. Why should they?
I’m well-educated and inclined toward logic and rational discussion. I’ve read this thread, carefully and twice. And I am, quite simply, baffled by such pundacity (my word and I like it). What, for example, could this possibly mean: “In a free economy the resources go to the highest bidder. In a political economy the resources go to the one with political connections.” All that verbiage aside, I’m simply astounded that so many words have billowed forth on this topic. The situation in Arizona is, quite simply, unfair. It is inhumane and it is wrong. Somewhere I got the notion, as well, that selling human organs is also illegal. And a PS to Bret: you ask: “Do you really think it’ll be any different if some gov’t agency can make the decisions?” The answer is Yes.
Does the massive health care reform bill just passed, the centerpiece of this administrations accomplishments; reduce health care costs? Does it solve the situation in Arizona?
Notinthevillage,
“In a free economy the one’s with the most money are also the one’s that have produced the most wealth.”
Sorry, but I think that’s pretty niave. Has Lebron James produced the most wealth? John Kerry? Paris Hilton? Bernie Maddoff?
I think not.
But the rich deserve better health care, especially Paris. They earned it.
I mean isn’t this debate over? Don’t we have health care reform isn’t that what just happened? Why is what is happening in Arizona still happening?
I guess the only way it could be happening is if the new health care reform bill was simply bogus, more hot air out of commander in advocate and organizers mouth. That is what advocates do they talk and talk and don’t really do or take responsibility for anything.
mervel,
the main provisions of the affordable care act don’t kick in till 2014.
haahahahah, of course!!!!
Mervel, they kick in AFTER the next Presidential election you’ll note. I’m sure that was simply a happy coincidence.
Mayflower, as a person who is “well-educated and inclined toward logic and rational discussion” perhaps you could outline your reasoning behind your belief that having a gov’t bureaucrat making your medical decisions rather than, say, your doctor would be so much better?
Mervel – this health care reform bill doesnt do much for health care costs. It provides access for more people, and reduces costs in the long run slightly. The major cost-reducing features were dumped at the insistence of the Republicans via demonizing e.g. death panels and health care rationing (and no public option). They insist on using only “free-market” Republican approaches for reducing costs.
Bret,
Currently a bureaucrat at an insurance company is making medical decisions for you. How is that better? Let’s not be naive, these companies are in existence to make money, and the bottom is enhanced by denying expensive procedures.
Your example of Mickey Mantle is a good one. He ruined his liver with years of “unfortunate life style choices”, yet because of money and prestige he moved to the front of the line for a new liver. Is this fair sensible or even wise?
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Health care costs in this country is yet one more example of how we have painted ourselves into an economic corner.
We are so afraid of dying that we will do anything to extend our lives just one more minute. Every year there are more and more expensive wonder drugs coming onto the market. Every year there are more and more exotic and expensive tests and equipment. We want and demand more and more procedures. Guess what? It costs more and more every year because as you add more and more people to the numbers demanding more and more, plus throw in inflation because everyone wants to be paid more and more the result should be obvious.
Health care costs will drop only when people demand less.
So from the sound of things, it looks like a lose-lose situation. We can let a nameless bureaucrat at the healthcare company make the decision or the nameless bureaucrat at the gov’t agency make the decision. Either way it’s going to be an economic decision.
Like I said some threads back, the answer to this issue- outlaw healthcare “insurance” programs. No more insurance companies, no more future gov’t meddling, put it back like it used to be, you pay to play. I would imagine that that would break the medical industry overnight and prices would plummet. Why not? People are apparently dying now and it looks like they’ll die in the future. Why not just cut the purgatory period out and deal with it?
There is something fundamentally wrong with a healthcare system that has inferior outcomes (as measured by life expectancy and infant mortality) and cost 40% to 50% more than all other major developed countries. Yet, many insist that we have the best healthcare system in the world.
During last year’s debate, in support of the existing system, anecdotal evidence about the shortcomings of the French, the British and the Canadian systems were regularly trotted out. At no time in my recollection did anyone on either side of the debate propose to look at the dozen or so successful healthcare systems in the developed economies to see what were possible best practices that we could adopt that might improve our system. In most walks of life, and certainly in the business world, the identification and adoption of the best practices of competitors is commonplace and generally critical to the ability to effectively compete. We seem as a nation to reluctant to consider that somebody else might have healthcare policies and practices that are superior to ours.
As a result, the lobbying strength of the insurance and pharmaceutical industries, among others, ensured that costs remained high while coverage was expanded and the basic model was maintained. (Just one example: we pay about twice as much for the same branded drugs as those used in Canada, Europe, and Japan and those drugs will get wider distribution as a result of the new healthcare law.)
In the short term, most Americans will remain ‘fat and happy’ about their own healthcare but the dirty secret is that we have an unsustainable model. Like many of the problems we face as a country, it will only get more painful to address as time goes by.
Maybe this is what publicly run “death panels” look like:
http://www.nytimes.com/2010/12/08/health/policy/08health.html?_r=1&scp=1&sq=orphan%20drug&st=cse
“In an unintended consequence of the new health care law, drug companies have begun notifying children’s hospitals around the country that they no longer qualify for large discounts on drugs used to treat rare medical conditions. ”
“Joshua D. Greenberg, vice president of Children’s Hospital Boston, said that loss of the discounts “jeopardizes our ability to care for some of the sickest children with the most complex health care needs.”
The difference is that under Obamacare it will be ILLEGAL to buy the services yourself. You will be literally forbidden from accessing the medical procedure, you will be told to just take a hike and die, by a “commission” that is so totally not a “panel”.
I think your logic is good bill. I think the tipping point will come when most American’s health insurance becomes much worse than it has been. If the new health care bill actually makes health insurance for most American’s get even more outrages than it already is that is when the “fat and happy” will become fat and mad and we could get an even worse solution.
Its a bad bill. They should have just mandated that you can’t deny coverage for someone with pre-existing conditions and extended medicaid to cover those who want it. (many of the uninsured are uninsured by choice).
Alright, we all agree medical care is expensive. Why is it so expensive? Why is it less expensive elsewhere? I know the threat of a malpractice suit results in needless testing that runs costs up. I know a doctors malpractice insurance costs run costs up. I know unionized workers in the medical field run costs up. I know a lack of competition among healthcare plans runs costs up. I know the medical industry has no peers when it comes to charging for every little thing and the kickbacks and old boy network between healthcare companies and the medical industry is just as real and insidious as anything in Washingtons back rooms.
What else drives the costs? Instead of looking someone to pay for everything, what can realistically be done to lower costs?