This op-ed in today’s Gray Lady is great. Not because its content is wonderful — it’s quite depressing. But it’s also dead on, and it forces the reader to confront some very stark issues.
We ration health care now. To some extent, we ration it out now to people who are the best able to pay for it, with a private insurance and for-profit medical care system. To another extent, we ration it out to the people who are lest able to pay for it with medicare, medicaid, and a variety of charity cases. The rest of us in the middle get some, too, based on a combination of what our employers, the government, and we are all willing to pay for. Money is the token of allocating any scarce resource in a capitalist system, and right now we as a society have decided to use capitalism to distribute medicine.
How much money do we spend on treatments that are not anticipated to extend life very much? The answer has to be greater than zero. Zero is both inhumane and deprives science of necessary data that can be used to develop more effective medicines. The answer has to be less than, say, a hundred million dollars per patient, because medical care is a limited resource and money to pay for it is a limited resource and that much money deprives other patients of those resources. $100,000,000 per patient is clearly an unreasonable number. So is $10,000,000 per patient. One million? A hundred thousand? Ten thousand? Hard to say where the line is.
Right now if you have the money, you get to decide how much your own life is worth. Different people make different decisions and in my line of work, I occasionally have to deal with people who have confronted this issue. You’d be surprised at the decisions some people make — in both directions.
If the government gets into this business, it will have to decide how much money life is worth. This is not so difficult a decision to make, really — insurance companies do it all the time. It is callous. To those people who say life is precious, irreplaceable, and invaluable in every instance, and mean it, it’s no wonder that the issue causes them intellectual and emotional paralysis. But the truth of the matter is, the market resolves this problem the same as it does anything else.
In a California court, a life is worth — as a rule of general rule of thumb — between half a million to a million dollars. That’s what we are told a jury will award in a “typical” wrongful death suit. Of course, there is no such thing as a “typical” wrongful death suit, but that’s sort of beside the point. In some cases the jury awards nothing. In others, you get eight figures. Averaging verdicts is not always the right way to do it. So lawyers — the people who have to anticipate these sorts of things and counsel others to respond to those anticipated facts — seem to use these numbers as their rough guides. So maybe the way to go is to say that everyone gets $1,000,000 to spend on health care, in their lifetime. After that, you’re ass-out.
Hey, we’ve got to draw a line somewhere.
