David R. Henderson  

John Goodman on Equality in Health Care

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John Goodman did a nice job yesterday in his blog on health care. Here is an excerpt:

Suppose the Cleveland Clinic announced an opening for surgery tomorrow morning at 8:00 a.m. (prepping begins at 6:00 a.m.). I have a better chance of getting there if I own a private plane. Even if commercial air travel allows, I must be able to pay for airfare, a hotel room the night before, and a hotel room for the period of recovery. The higher my income, the more affordable these options are. More generally, travel requirements and the need to be flexible on time favor the affluent.

This may be one reason why there is a major racial gap (and one presumes a socio-economic status gap) with respect to organ transplants in the U.S. -- even when the federal government is footing the bill (as in the case of kidneys) and even when there is a legal prohibition against buying organs.


The whole thing is worth reading. Here's a particularly good comment after his post:

When I was an MD in government service, (drafted) we were told RHIP, Rank Has Its Privileges. Can you imagine a public figure or "important person" waiting for an unimportant person? Other systems developed within the politically equal system, a covert barter system. The underclass found chips to bargain with at government expense.

This commenter goes further than Goodman, pointing out that in a socialized system, you will have, in essence, a nomenklatura. I'm not sure what his last sentence means, although it seems to undercut the commenter's first point.

One thing I often enjoy about Goodman's blog is the tone. Goodman will often criticize Princeton health economist Uwe Reinhardt, for instance, and Reinhardt will sometimes come on and comment. Although they twit each other a little, the disagreement is often good-humored.


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COMMENTS (8 to date)
MikeP writes:

I don't know if you caught the article in the Mercury News about Steve Jobs campaigning for more a active donor registry in California.

The relevant bits...

Inspired by his brush with death last year, Apple CEO Steve Jobs on Friday made a surprise appearance at Stanford's Lucile Packard Children's Hospital to describe how a liver transplant saved his life — and why patients with less wealth and fame should have the same opportunities.

"I was almost one of the ones that died waiting for a liver in California last year," said Jobs, whippet-thin but healthy. He appeared at a brief event with Gov. Arnold Schwarzenegger to unveil a new legislative effort to greatly expand the number of California organ donors.

In his first public description of his much-rumored but long-secret crisis, Jobs said "there were simply not enough livers in California to go around, and
my doctors here advised me to enroll in a transplant program in Memphis, where the supply-demand ratio of livers is more favorable than it is in California."

"I was very fortunate," the notoriously private Apple icon shared with an audience of doctors, transplant patients and media. A Tennessee donor was a match — and Jobs had a jet available to rush cross-country within the four-hour window needed for successful surgery. "Many others died waiting to receive one." ...

Methodist Hospital in Memphis said Jobs did not receive favored treatment — rather, he received a transplant because he was the sickest patient on the wait list, with a matching blood type, when a donor organ became available.

But it takes money to be added to an out-of-state transplant list. A prospective patient must go to the hospital for evaluation and testing. If accepted, they must be able to fly to the center quickly — which means renting or buying a nearby home, or owning or renting a jet....

Commending Jobs, the governor said "What I like about Steve is, because he is a wealthy man that helped him get the transplant. But he doesn't want that — that only wealthy people can get the transplant and have a plane waiting to take him anywhere he needs to go.

"He wants every human being, if you have no money at all or if you're the richest person in the world," he said, "everyone ought to have the right to get a transplant immediately."

Judging by the complete absence of any discussion on donor markets, however, apparently neither thinks such right extends to the right to spend or have your insurer spend $15,000 for an organ to save your life.

David R. Henderson writes:

Thanks, MikeP. I had missed this. I especially like your last line. Have you heard of LifeSharers?

John Goodman writes:

Thanks for the kudos, David. I had fun writing that piece.

MikeP writes:

Nope. I hadn't heard of LifeSharers. Just looked them up.

That's a market of sorts, I suppose. To wish for the legality of a LifeBuyersAndSellers...

James gaulte writes:

I was a physician in the Air Force for two years and had several caries that the dentist told me that he would just fill them and while I needed 2 crowns the colonels and the colonels's wives were first in line and they rarely got to the second in line.

Howard Jacobson writes:

Professor Roberts. Below is my post to John Goodman's blog to which you refer:

Your post is a thought-provoking exploration of the reasons any of us might support, or at least appear to support, some sort of system that equalizes access to health care. The last of your theories seems to come closest to the reason I believe to be most accurate but does not quite go far enough.

[The remainder of this comment has been elided and may be found at
http://www.john-goodman-blog.com/is-health-care-different/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#comment-58771
Pasted repeats of entire comments already posted elsewhere are not generally allowed on EconLog. In the future, please summarize your comment and link to it; or better still, write something uniquely relevant to the EconLog blog post, which among other things highlighted a different comment. Also, I think you meant "Professor Henderson." That's what happens when you wander around pasting the same comment all over the place.--Econlib Ed.]

mulp writes:

I suggest a slight change to part of his commentary:

Even if we could make access equal, would that be desirable? Suppose you were a for-profit emergency room physician on triage duty and chance forced you to choose between saving one of these two patients:

(a) An insured 90-year-old or an uninsured 20-year-old

(b) An uninsured scientist or an insured derelict

(c) An insured brain-damaged child or an otherwise uninsured healthy child

(d) An uninsured successful entrepreneur or an insured day laborer

(e) An uninsured concert pianist mother or an insured welfare mother

Just remember, Steven Hawking is some who conservatives assume would be uninsured because he has lots of health problems, by choice, and it would be unfair and unprofitable to spread the wealth from the 20 year old, healthy, day labor, and drug dealing entrepreneur who sees no reason to give up his fast cars and weekend partying to pay for health insurance.

Evan writes:

I believe overall our healthcare system does a good job, and that it will only get worse if we end up with government health care. As of right now anyone could go into the emergency room and receive the care they need. If you go into the hospital and you need a double bypass immediately they will not refuse you the surgery. However, our health care system is flawed in some ways. For instance, if you can barely walk and you need a knee surgery to help you, only the person with the money to pay for the surgery will get it. Like the blog says in a lot of situations the more money you have the better health care you will receive. No one will be turned away from an emergency room if they need help.

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