Thoughts, essays, and writings on Liberty. Written by the heirs of Patrick Henry.

“Don't handicap your children by making their lives easy.”     Robert A. Heinlein

October 19, 2009

When the Government Controls Medical Care …

by tarran

… patients are an expense or liability to be gotten rid of rather than a source of profit who must be served.

Much of the problems with government supplied health care can be traced to this truth concerning incentives.  A hospital is not paid more if they treat people well.  They don’t lose money if they do a poor job.  They face no liability; any judgment the government permits to be levied against them is made up by taxes looted from the productive classes.

And, the goal of a medical care provider is to please his pay-masters rather than the patients he treats; and all to frequently when the interests of patients and the government clash, the patients will lose out.

This phenomenon is quite evident in the sad case of British Corporal Matthew Millington of the Queen’s Royal Lancers who died at the age of 31 from lung cancer, after receiving – in a transplant – the cancerous lungs of a smoker who averaged 30 – 50 cigarettes a day.

Why would a hospital implant the lungs of a person who smokes so many cigarettes a day into a patient?  Was it the result of an inexperienced surgical team making a ghastly mistake?  No.  The surgery was performed by Papworth Hospital in England,  which is the main transplant hospital in the United Kingdom, whose spokesmen claim that in fact everything was done properly!

A spokeswoman for Papworth, the UK’s leading cardiothoracic hospital, said that it was not unusual to use smokers’ lungs, adding that all organs are “screened rigorously” before a transplant. “We have a strong record of high quality outcomes and this is an extremely rare case.”

In the past year there were 146 lung transplants in the UK, and 84 people died while waiting on the transplant list, she added. “If we had a policy saying we did not use the lungs of those who smoked, then the number of lung transplants would have been significantly lower.”

Let us ignore the fact that the supply of organs is kept low by the superstitiously premised laws outlawing people from selling their own organs. Let us pass over the laughably implausible claim that transplanting smokers’ lungs results in acceptably good outcomes.

Let us, instead, focus on the question of how the hospital handled the case of Corporal Millington of the Queen’s Lancers and compare it to how a hospital that saw him as a customer would have treated him.

Often the detractors of free markets accuse it of being a dehumanizing system of cut-throat competition.  What they do not realize is that when two people engage in trade, they are cooperating.  The competition is between actors striving to be the best cooperators with prospective trading partners.  In a free market, the providers of health care services would be competing to see which one of them could better care for a prospective customer.

Thus, in a free market, Corporal Millington would have contracted with the hospital that sought to cooperate with him most effectively.  He would have chosen a hospital that committed to satisfy his need for undiseased, functional lungs at an affordable price.   In a free market, the availability of disease-free lungs would have been much higher; people would be far more likely to sign up to supply  their organs for transplant if their heirs or estate would be paid a fair market price for them, and the hospital would not have to worry about waiting lists.

However, had the new lungs developed cancer (and let’s not forget occasionally non-smokers get lung-cancer too), the hospital would have had a strong incentive to make it right, either out of a sense of obligation or out of fear of retribution; In a free market, there are two incentives to keep unscrupulous people treating their customers well.  The first is, of course, the fear of lawsuits.  the second, though, is their greed for future profits and their fear of losing these future profits should they ever develop a bad reputation.  The latter can particularly devastating.  The McDonald-Douglas Aircraft Company, for example, was nearly driven into bankruptcy by the perception that the DC-10 was an unsafe aircraft.  To this day, the Massengill corporation has never returned to the drug-making business after the debacle of 1938.  The yellow press would love nothing better to go after a hospital for transplanting diseased organs into a patient; the readership and viewership of such pieces would bring in a tidy sum in advertising dollars.

Thus the hospital, if nothing else to avoid the collapse of their business after a widespread accusation of incompetence/malpractice, would face a huge opportunity cost if they forewent transplanting in a new, second set of lungs.

But, unfortunately for Corporal Millington, he wasn’t the customer of Papworth.  Rather, some officials of the NHS were. The desire of the actual customers (NHS) were to keep costs down by a) cutting corners on the type of lungs transplanted into patients, b) concerning themselves with patient outcomes in the aggregate, and reducing seemingly unnecessary, redundant duplication of services by centralizing transplants as much as possible.

Thus they faced no economic loss for allowing him to die of cancer.  There was no profit to saving him; in fact, saving him would have been an expense.  They didn’t have to cooperate with Corporal Millington and so they didn’t.

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1 Comment

  1. Patients are a liability in all third-party payment systems. That the government pays instead of an insurance company changes nothing.

    As for your “shop and save” example, it doesn’t work when you go over the handlebars on a motorcycle. You need the trauma center as soon as possible. Much more medicine works like this than works like your example.

    I also don’t understand your “centralization” argument. Hospitals in the US have general areas and areas of specialty, such as cancer, burn, trauma, orthopedics, etc. I don’t see why it’s a problem if a hospital has a specialty.

    Comment by Joshua Holmes — October 20, 2009 @ 8:38 pm

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