David R. Henderson  

Hugh Grant on Ends and Means in Medical Care

Market Failure or Market Succe... Elizabeth Warren...

Warning: Spoilers for the movie, Extreme Measures.

In the 1996 movie, Extreme Measures, Hugh Grant discovers a plot to purposely destroy the health of healthy homeless men in order to use them for medical experiments. He confronts the doctor who is leading the experiments, who has just tried to persuade him that the experiment is worthwhile.

Maybe you're right. Those men upstairs, maybe there isn't much point to their lives. Maybe they are doing a great thing for the world. Maybe they are heroes. (Pause.) But they didn't choose to be. You chose for them. You didn't choose your wife or your granddaughter, you didn't ask for volunteers. You chose for them. And you can't do that, because you're a doctor and you took an oath and you're not God. So I don't care, I don't care if you can do what you say you can. I don't care if you can find a cure for every disease on this planet. You tortured and murdered those men upstairs. And that makes you a disgrace to your profession. And I hope you go to jail for the rest of your life.

Later, the widow of the man Grant's character was talking to says:

I believe my husband was trying to do a good thing--but in the wrong way. Perhaps you could do it--in the right way.

I think we can agree with Hugh Grant about this extreme measure. What about the next step? If it's wrong to make people sick on purpose, is it also wrong to forcibly withhold medical care from them that they're willing to pay for? If so, then much about Canadian health care is wrong; ditto for the Food and Drug Administration, which forcibly withholds drugs from residents of the United States.

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CATEGORIES: Economic Philosophy

COMMENTS (12 to date)
Sonic Charmer writes:

I'll bet not everyone agreed with Hugh Grant, deep down.

Matt C writes:

You bring up two separate elements when referencing the Canadian health care system and the FDA. While their actions may have deleterious effects, the motives behind them are different.

If and when the Canadians forcibly withold medical care from invididuals willing to pay for it, it is done in the spirit of cost-control; this is an inevitable feature of state-run medical care. I think most Americans understand this, which is why they do not want a government-run health care system that emphasizes cost-control.

The actions of the FDA take on another form (however, we could see them become a cost-control apparatus in the future - in Obama's America, anything's possible!) The government is authorized to regulate interstate commerce, and does have a legal role to play in ensuring that drugs and devices sold on the market are not lethal. We can tout free-market rationalism as a solution to the heavy-handed FDA policies, but there was a time when anything and everything was sold to clinicians, and many people suffered needlessly.

I would agree that the government and the FDA overstep their legal role when they approve drugs and devices for sale based on safety AND efficacy; the government has no role in regulating commerce that it deems to be "effective." That is a job for the market and our clinicians.

Joey Donuts writes:

If the FDA declared a potentially fatal, is one thing. However, there is no reason to prohibit it from the market. Some drugs used in chemo therapy are fatal in certain doses but physicians use them frequently. Arsenic and other "drugs" have poison labels, isn't that enough? The FDA doesn't always discover all the risks before it permits a drug on the market. They take no responsibility for those mistakes.

Would we be better off with one or more private drug monitors that have no power to restrict drugs from the market but do have responsibility for mistakes?

Tom West writes:

Matt C
If and when the Canadians forcibly withhold medical care from individuals willing to pay for it, it is done in the spirit of cost-control; this is an inevitable feature of state-run medical care.

I think he's referring to the fact that the gov't *doesn't* allow a second, private tier. You can spend privately for services not provided, but not for services that are provided.

This is more or less necessary to maintain the system as it stands, but it is true, it means that you cannot spend your own money to in Canada to "jump the queue".

In a lucky accident for Canada, most of it is reasonably close to the USA, so travel costs are dwarfed by the medical costs. As I've written about before, a good part of the success of the Canadian system is that we have the USA's open medical system close by.

Going to the second tier in the USA allows those .01% of Canadians to get what they want (the opportunity to use their wealth to get unfettered access to care), and it allows the other 99.99% of Canadians to get what they want: a system that does not effectively value your life by your wealth.

To be honest, it seems like a win-win to me (albeit at some small extra cost to those wanting to use the second tier).

David R. Henderson writes:

Tom West writes:
Going to the second tier in the USA allows those .01% of Canadians to get what they want (the opportunity to use their wealth to get unfettered access to care), and it allows the other 99.99% of Canadians to get what they want: a system that does not effectively value your life by your wealth.

I bet the percent of Canadians going to the U.S. is much higher than you say. Any basis for your data?


Troy Camplin writes:

One should apply this logic to everything the government tries to do. Even if the thing they want to do benefits mankind, if every person in the system didn't volunteer to do it, then it should not be done, as it is a violation of liberty. Always.

Kevin writes:

Sounds like a good argument against animal experimentation to me.

Billy writes:

I think the same could be applied to issue of national security. Many conservatives say that wiretapping and imprisoning people without a warrant saves lives and is good, even though it may trample over the rights of some individuals.

Conversely, many libertarians would say that government shouldn't be allowed to violate the rights of some for the supposed security benefits.

It seems that conservatives apply this logic to security issues but deny it for social welfare issues and liberals apply it to social welfare issues and deny it for security issues. Libertarianism, then, may be the most consistent philosophy.

Tom West writes:

I bet the percent of Canadians going to the U.S. is much higher than you say. Any basis for your data?

No. Only the anecdotal. I have no friends, relations, or relations of friends that have gone to the USA for health-care or even contemplated it (that I know of), and the general rank of family income for my peers would be the ~90th percentile. To forestall the obvious response, while there have not been not a whole lot of serious health issues for my cohort, there have been a number of severe health problems in the parent's generation, so I'd have expected to see at least one case heading southward if it was at all common.

However, using my Google-fu turned up http://content.healthaffairs.org/cgi/content/full/21/3/19, which seems to peg Canadians purposefully seeking medical care in the United States at 0.11%, admittedly 10x my WAG but still a pretty low number.

One interesting aside about government provided health-care is I suspect it makes people a lot more accepting about paying taxes. It's one big ticket item that Canadians can point to and say, "well at least I'm getting something for my taxes that *I* value", which makes them a whole lot less resentful. (This was brought up more than once by a number of Americans I've spoken with who were living in Canada for a while.)

Troy Camplin writes:

Actually, 0.11% is a pretty high number. We have to presume nobody is crossing the border for regular checkups. Or for minor things. People will cross the border if they are certain the Canadian system will let them die. What percentage of people in a given year have that kind of illness? 1%? If true, then 11% of those with some sort of chronic illness come to the U.S. from Canada to get treatment. And that is likely from the wealthiest 20% or so, adjusting for irrational nationalist sentiment.

jorod writes:

In as little as six months, Washington has gone from Brother Love's Travelin' Salvation Show to Hotel California. Why are they trying to rush through legislation that no one knows what it says or means to individiuals like you and me?

Tom West writes:

Troy, the statistics don't bear you out:

From the paper:
Over the five-year observation period from 1994 to 1998, 2,031 patients identified as Canadians were admitted to hospitals in Michigan; 1,689 to hospitals in New York State; and 825 to hospitals in Washington State. During the same period, annual inpatient admissions to hospitals within the bordering provinces of Ontario, Quebec, and British Columbia averaged about 1 million, 600,000, and 350,000, respectively.12 Thus, Canadian hospitalizations in the three U.S. states represented 2.3 per 1,000 total admissions in the three Canadian provinces. Furthermore, emergency/urgent admissions and admissions related to pregnancy and birth constituted about 80 percent of the stateside admissions. Elective admissions were a small proportion of total cases in all three states: 14 percent in Michigan; 20 percent in New York; and 17 percent in Washington.

There was an interesting study done by a bunch of American & Canadian hospitals trying to achieve best outcomes. They looked at survival rates on a bunch of common diseases with significant mortality rates. What did they find? Not terribly surprisingly, the rates where comparable for all hospitals. While the hospitals themselves where looking at the number one hospitals and then trying to study the practices there, the media, of course, immediately aggregated by country. The results: the American hospitals where a little more numerous in the study and had a slight edge in aggregate survival rates on a a slight majority of diseases, the Canadian hospitals a slight edge on the rest.

Or, as a spokesman for the study said: You can expect to receive equally good care at any of the hospitals in the study.

For the most part Canadians recognized this. You don't go states-side simply to be hospitalized there. The costs of American health-care are unbelievably high by Canadian health-care standards for essentially indistinguishable care.

You go stateside for quicker diagnostics (get your MRI in 2 hours instead of 2 months), and for non-critical surgeries that are rationed (like David Henderson's father). For both of these, the costs are contained and not likely to bankrupt the typical 90th percentile Canadian.

(Of course, there's the few that go for million dollar health care treatments unavailable here.)

I think if you want to argue against the Canadian health system being a disservice for Canadians, one needs to argue it on the basis that the freedom that is costs the few Canadians is philosophically more important that the happiness of all the other Canadians. Although I *don't* agree, I could make a pretty good argument in that direction.

The other justification for dismantling the system is a little more controversial, but has been made. The philosophy that all lives are equally valuable is false. The lives of people with more money *are* more valuable. Money (or I think it was 'property' was the term they used), is, in a non-coercive society, a metric of the amount of value that you have provided to others (at least to those who also have money, which they have obtained by providing something of value to others, etc., etc.)

Thus, money *is* the only valid measure of your contribution to society, and thus the value of you as a human being.

(Personally, If I was going to try and dismantle the Canadian health-care system, I'd go with the first :-).)

Really, in the end, I think the health-care systems' primary purpose is to make people happy (within limits of acceptable human behaviour, if one's feeling pedantic). This includes *all* citizens, not just those currently using the system (although their happiness will heavily influence the happiness of the citizenry). For me, this means that the happiness provided by the system through security (Canadians generally don't lose sleep about being wiped out by medical costs or losing insurance), and the happiness provided by knowing your fellow Canadians are covered as well *are* important drivers for my support even at the real cost of those needing medical care in the system. (My being on a wait list for a few months didn't destroy my support for our system.)

That said, unlike a lot of Americans, I don't think our system would be a good fit for the USA at this time. The things that the American populace values are different than Canadians. (Loss of freedom cost more happiness, coverage of the less fortunate garners less happiness, theoretical ability to get the best medical coverage in the world garners more happiness, etc., etc.) This may change as the years progress. Who knows?

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