The video below (H/T Professor Bainbridge) of a Milton Friedman lecture on the health care finance system is as timely now as it was in 1978 when he gave it at the Mayo Clinic. I was reminded of the Friedman lecture when a doctor friend of mine passed along the following front-line observations triggered by this article reporting on the recentt death of a young British man who died while waiting on a liver transplant:
Unless we, as a society, decide that we are going to pay for everything for everybody, there will have to be some form of rationing of health care services. And, into the 21st century, we now can do so much (with some having questionable efficacy) that we can no longer afford to do everything for everybody.
We can ration by age — this is what Obama was suggesting when he said that "maybe you’re better off not having the surgery, but taking the painkiller". No more knee or hip replacements if you’re over a certain age. Perhaps the first step toward a "Soylent Green" society?
Or we can ration by disease, which is what happened in the UK to the fellow who died awaiting a liver transplant and here we get into morals and away from science. It’s kind of like the game we played in psychology courses in high school or college — you’re stuck on a desert island with a bunch of folks who represent a cross culture of society, so who do you choose to get on the life raft? Medical care actually was easier when we did not have the technology to do things like liver transplants. Folks such as this guy just died.
Now, as a society, with the finite resources we are willing to spend on health care, we have to decide if we want to spend $250K to give this guy a new liver (which he may or may not trash through further drinking), to which is added the $25K per year for his follow up care and (very expensive) anti-rejection drugs. Or, do we decide that it would be better to treat 1,000 people who have hypertension by giving them cheap generic meds for $250 per year each? Who is more deserving of a "second chance", as the referenced patient’s mother asks — the one or the thousand? There are no right or wrong answers, but remember, it’s now a zero-sum game. When you spend money on one group of patients, there will be less to spend on others.
what a shame mr reagan did not heed this advice before he allowed medicare to restrict, by law, doctor and hospital payments to non-market, fixed, too low rates. this, more than anything, created the cost shifting to younger people that gave us today’s “crisis”.
to prove reagan not the only “conservative” who can wreck the country, 2nd bush adds prescription drugs to be paid for by government.
mr friedman, we still need you.
I don’t see what an insurance company in the free market would have done differently? Resources, be they livers or generic meds, are not infinite in any system. My insurance company in the US responds to rising costs by increasing premiums and limiting access. This leads to outcomes every bit as, if not more, unfair than this one.
A system that invested a small amount of money up front to ensure an 11 year old didn’t become an alcoholic would be far more efficient than one that wanted to see the actual disease, alcoholism, under control before investing in an expensive cure of one of the effects.