Wednesday, September 2, 2009

I Got the Rationing Blues . . .

Julian Sanchez writes:

It's one thing to say there's a shared obligation not to let people suffer or die when we know how they could live many years longer, or in much less pain. I find it a whole lot less compelling to suggest that people are entitled to public provision of, say, Tacerva—which . . . was approved to treat pancreatic cancers because it improves survival time by a whopping 12 days at a monthly cost of $3,500.

This, I think, is the basic problem with health care reform. If you were dying from pancreatic cancer and you could pay $3,5000 to extend your life by 12 days, wouldn't you do it? I certainly would. From an individual perspective, this seems like an entirely rational decision. But from a social perspective, does it really make sense?

If we want to consider health care reform, I think we have to begin talking about rationing. Unfortunately, Republicans are only interested in using the idea of rationing as a scare tactic, while most Democrats refuse to even speak the word . . . .

Update: Megan McArdle has a long-winded post on this. I think she's right that it's a bit silly to frame the question this way -- these drugs don't expand everyone's live expectancy by 12 days, rather they extend the average life expectancy by 12 days.

Thus, some people may enjoy a few extra months of life, while others may die sooner because of an adverse reaction to the drugs. The point is that when you're facing death, a chance to prolong your life even by a few days (and possibly a few months) is probably worth it. The possible upside benefits of the treatment far outweigh the potential side-effects. And it's not easy to deny people drugs that could potentially extend their last few days of life.

McArdle writes:

I'm not saying that this is the standard we should adopt. But I actually think that it has a fair amount of emotional resonance, which is why appeals from cancer patients are so effective when they're denied marginal treatments.

I'd say that's true. And I suspect cost becomes less of an issue for these patients as they approach the end of their lives.


petpluto said...

If you were dying from pancreatic cancer and you could pay $3,5000 to extend your life by 12 days, wouldn't you do it?

I wouldn't. What is 12 more days? What would those 12 more days be like, pain-wise? What would those 12 days give me that I would really miss out on?

mikhailbakunin said...

Well, it would give you more time with your family and friends. Children, if you had them. It would give you more time to say goodbyes, to do the things you love.

You're right, if your quality of life is terrible, that's a different story. But there are ways to manage pain.

I don't know. I just think 12 days sounds like a long time. People pay a lot more than 3,500 dollars for a week-long vacation.