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Running the numbers - rationing and tort reform
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One thing that drives me absolutely up the wall is a refusal to confront the obvious. Somehow, in the discussion about rationing and tort reform, conservatives seem to miss the obvious point – both of these ideas involve the government putting a price tag on the value of human life. And from a strictly accounting, unemotional point of view, both of these are responsible ideas, at least in the abstract. There are some differences, but they actually seem to discredit much of what most conservatives work for.
First, a quick examination behind the idea of rationing. The fear is that someone in a government position will decide whether or not a person should receive treatment. In a bureaucracy, the decision will likely be made by simple numbers: how much life will be extended versus how much treatment will cost. If the treatment is inexpensive enough or extends your life for an “acceptable” period of time, the government will allow it. If not, you die.
From an emotional perspective, that is a frightening thought. From a fiscally conservative perspective, however, it should make total sense. One assumes that a government run health care provision (if it is even an option) would only have a finite number of dollars to work for. Those dollars, incidentally, come from the taxpayer. And – again, this is strictly fiscally and disregarding the emotions – with a finite supply of money, I would rather have it go to help one person live longer (or extend the lives of two people) than to help a third person live for two months at the cost of the life of the first person. With a finite amount of money, decisions have to be made, and the government has the responsibility to make choices that will have the greatest long-term benefit. (If you want the rundown on the argument of “well, insurance companies already make that decision,” see Ken Petrini’s article from last month.)
Emotionally, of course, if it is my daughter or my mother, or me, then I would pour every dollar I had into gaining treatment. And of course, a great deal of the fear comes from the idea that a government option will ultimately evolve into a single-payer option, which means that we, like those in Britain, won’t even be able to pay cash for our medical treatment if the government refuses us. All of that aside, however, I think almost every conservative agrees that, in the abstract, the government should be making wise financial decisions.
Ironically, one of the biggest Republican-supported reforms to HR 3200 is the idea of tort reform. Many conservatives – and I’m on the fence – believe that tort reform should be a part of the health care package. What is tort reform? It places a cap on the “pain and suffering” part of a lawsuit. If a doctor took actions that cost my husband his life, the government would determine what I could sue the doctor for. In essence, the government would decide how much my husband’s life is worth.
I think the part that concerns me the most regarding tort reform is the slam against juries. A jury is there, on the ground, and can see just how malicious or accidental the misconduct of a doctor was, while a government bureaucrat in Washington only sees the numerical facts of my husband’s life: age, salary, dependants. On the flip side, I also think that decisions made in the heat of emotion are not particularly the best ones. I also think that lawsuits against doctors are getting ridiculous – actually, lawsuits in general. I actually lean in favor of tort reform, but with a hesitation to allow the government to decide how much a person’s life is worth.
The biggest difference in the two, of course, is that one decision determines whether a person lives or dies, and the other affects the grieving family. And, as I mentioned, there is the fear that HR 3200 will eventually turn into a government run health care system, thus allowing the government to make the only decisions about who lives or dies. As it stands now, I would beg, borrow, or go completely bankrupt to get the money to pay for my daughter’s life-sustaining treatment if the insurance company were to deny us. Under a single-payer system, that may not be an option. But ultimately, the question conservatives must face is: do we want the government to determine the value of human life? We must recognize that both tort reform and health care rationing allow the government to do so.
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