Tuesday, September 8, 2009

Anecdote of the Day

From John Kingdon's excellent Agendas, Alternatives and Public Policies:

One example of the principle of equity as the driving force [in the policymaking process] is the case of the government's renal dialysis program. As soon as the technology for convenient dialysis was perfected, it became clear that some people were receiving this life-giving treatment and others were not. The selections of patients to receive treatment were made on the basis of ability to pay, qualification for experimental study groups, proximity to the few centers where dialysis was being performed, and the happenstance of personal health insurance coverage. Gripping stories appeared in the popular media about "death committees" of physicians that were charged with deciding whose lives should or should not be saved.

Such a fundamental, dramatic difference of treatment was more than decision-makers could bear. The Senate passed a short rider introduced right on the floor which provided that renal dialysis and kidney transplants be financed by Medicare, and the House quickly followed suit. So compelling was the inequity that had thrust this item onto the agenda that Congress really did not consider the cost of the program in any detail, a cost that exceeded a billion dollars within a few short years. As one knowledgeable respondent summarized the forces that lead to such sudden agenda status and passage, "When there is serious inequity, that is politically and socially unstable. Once a technology is developed, everybody will want it." The moral pressure to avoid letting people die, when a procedure was available to save them but for a cost, was simply irresistible.

Another great example of why the "death panel" protesters are missing the real problem with increased government intervention into the health insurance market . . .

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