is raised by Greg Mankiw in an Op-ed, "Why Health Care Will Never be Equal" in The New York Times where the Harvard economist talks about cost-benefit calculations in deciding which lives might be saved through healthcare. Mankiw does not take a position on how health care should be rationed out or the value of a life calculated, but suggests that such rationing is not unreasonable, even if it makes many squeamish. I quote two paragraphs from the article: one where Mankiw, through his own example, raises the question of value, and two, the inevitability, in a sense, of inequality in healthcare.
"An optimist might hope that my doctor, or someone higher up in the health care hierarchy, made a rational cost-benefit calculation on society’s behalf. To figure out whether my treatment makes sense, one would have to weigh the cost of the drug against the benefit of an extended life. And to do that, one would have to put a dollar value on my life — the kind of calculation that makes everyone but economists squirm."
The push for universal coverage is based on the appealing premise that everyone should have access to the best health care possible whenever they need it. That soft-hearted aspiration, however, runs into the hardheaded reality that state-of-the-art health care is increasingly expensive. At some point, someone in the system has to say there are some things we will not pay for. The big question is, who? The government? Insurance companies? Or consumers themselves? And should the answer necessarily be the same for everyone?"
But, there is another ready example we can find in the US where such realpolitik calculations do not apply in the name of cost-saving--- and that is the justice system. We do not say that some lives are worth less than others and that, accordingly, it is okay for such people not to get justice or to get a lesser quality of justice.
Obviously, the justice system functions differently from the healthcare system, but justice (and the larger machinery of law and order) is not a profit-oriented system in the way that healthcare is, even though there are plenty of private agencies that make a fortune off the criminal justice system. The justice system does incur significant costs- the cost of housing one prisoner in California, I learnt from the local news yesterday, is $ 49,000 per year. The state of California spends this money even as it cuts funding for teachers, education, mental health patients and the like.
The justice system is not perfect, but-- and this is key-- it aspires to perfectability, to the ideal of justice for all. And American society seems to agree that this is a worthwhile objective. Why not treat healthcare the same way? Better still, why not treat healthcare as a matter of justice?
Tuesday, September 22, 2009
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1 comments:
A good argument, though God send we don't get a health are system that operates like the actual, as distinct from the ideal, criminal justice system.
But I think mankiw makes a misstep here:
The push for universal coverage is based on the appealing premise that everyone should have access to the best health care possible whenever they need it.
The quality and equitable distribution issues--which are themselves not the same--are at least partly independent of the coverage issue. It's not hard to imagine a system in which everyone gets roughly equal, bad health care, every penny of which is paid out of a insurance fund. Or we could have a wildly nequal system in which only a few get the best care, and no one is covered by insurance. Atul Gawande's New Yorker article a few months ago, comparing health care outcomes and costs, addressed this; he stressed the difference between what gets paid for (and who gets it) and how it's paid for. The right-wing loonies keep yelling about "government-run health care," but no such thing is on the table; the left-liberal proposal, "single payer" or "Medicare for all" addresses only the funding question.
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