Monday, January 26, 2009

Daily: It's Not Wrong to Put a Price on Health

Stella Daily has written an excellent commentary responding to the recent New York Times article, "Putting A Price on Compassion".

I am reposting her piece here in its entirety, with her permission:
It's not wrong to put a price on health

In yesterday's New York Times, Pauline Chen lamented our growing comfort with the role of money in medicine. She refers to healthcare as "the gift of life," which cannot be reduced to a mere commodity that can be quantified and analyzed. And she cites the example of a man suing his estranged wife for either the return of the kidney he donated to her or $1.5 million as evidence that medicine has become too commoditized, saying that there "should have been outrage over putting a dollar value on human life." Is she right?

It's telling that Ms. Chen calls healthcare "the gift of life." Throughout the whole article, the tone is: Healthcare is getting easier to assess and quantify in monetary terms, and that's a bad thing. She would prefer "compassionate care" and "patient-centered partnerships." The implication is clear: Altruism needs to play a bigger role in medicine. Thus, healthcare is not a trade between individuals to mutual benefit, but "the gift of life."

But bringing altruism into medicine harms patients rather than helping them. If we allowed people to buy and sell organs in this country, we would see the supply of available organs increase; is it more "compassionate" to allow thousands of patients to die waiting for an organ, just to keep money out of the equation? If we go toward a freer market in medicine, rather than move in the direction of price controls and government mandates for lower payments to doctors, more bright young people will want to go to medical school; is it "compassionate" to create a shortage of doctors, or to tell someone who has spent many years in extensive postgraduate training that he doesn't deserve to make money just because people need his services?

It's true that quantifying the cost-effectiveness of healthcare has caused dissatisfaction in some ways: The insurance company decides that your doctor's time is worth a lower amount this year than last year, so he shortens the length of a visit and sends you off feeling as though you were rushed through the appointment. Your policy raises the copay for prescription drugs, so your asthma medication costs more, but delivers you no more value than it did when you were paying less. And so on and so forth.

But such examples do not prove that altruism is the solution. They only illustrate the problem with trying to pretend that healthcare has no monetary cost. When patients have to pay for their own care, they become cost-conscious: They evaluate for themselves whether it's worth it to pay more money for a doctor who has more time to spend with each patient, or whether the cost savings is worth a quick visit with less time to discuss medical issues. When a third party is introduced, the patient is insulated from the true cost of care. He starts to want the best of everything, regardless of how much it costs -- because his insurance company is covering the cost. The insurance company, on the other hand, wants to reduce costs as much as possible, even if it means that some patients are dissatisfied with their care. Thus, instead of mutual trade to mutual benefit, we get a system nobody is happy with.

Doctors, medical researchers, and pharmaceutical company executives do not work for the benefit of others. They work because of the pleasure they get from tackling the problems of human disease -- and because of the financial rewards they stand to gain. And nobody can be expected to donate an organ to a stranger out of brother-love alone. The fact that there's money in medicine is not a sad fact to be lamented -- it's the reason that we can enjoy good care.
If you liked her piece, check out her blog ReasonPharm.