Health Care as Zero-Sum Game?
posted by Frank Pasquale
Dr. Thomas Fisher has a fascinating editorial in the WaPo entitled “I Treat the Patients Michael Moore Forgot.” Moore’s movie Sicko focuses on the problems of the insured; Fisher works in an inner-city hospital primarily serving patients who have no way of paying. Fisher points out that the underfunding of his hospital occasionally has terrible results for those insured patients who accidentally end up there. For example, one accident victim suffered unnecessary disfigurement when no surgeon was on-call to help him:
[T]he young driver in the car accident essentially had the misfortune of getting hurt in the wrong part of town. At the time, I was an emergency medicine physician fresh out of residency, working in a community hospital system in the Midwest that consisted of two very different hospitals. Hospital A (where the patient started) served a blighted, post-industrial city of about 100,000 residents, about 85 percent of whom are black and largely poor and uninsured. Hospital B (the one we couldn’t get him into) is 15 miles away, in a more affluent community of about 30,000 people, about 70 percent of whom are white. Although technically the two comprised a single hospital system, physicians were allowed to choose to work at one or both of the locations. Most chose Hospital B, leaving few specialists on call for emergencies at Hospital A. By dumb luck, my patient wound up at the wrong hospital, and that made all the difference.
Fisher concludes, “Many Americans do get the Mercedes-Benz of health care. But given the scarcity of resources, they may be doing so at the expense of many others.” This was the dynamic I worried about in a piece on boutique medicine, and one Canada is facing right now as the Chaouilli decision is reckoned with. I have a few thoughts below . . .
Jonathan Cohn’s excellent book Sick begins with a similar (if graver) scenario: a woman ends up dying after an overloaded ER diverts her. After chronicling city after city where similar crises occurred, he sums up with a Texas neurosurgeon’s lament:
The city’s two level-one trauma centers, the hospitals capable of dealing with the most dire emergencies, were simultaneously on diversion for extended periods once every two days. “I’ve been in this business for twenty-five years,” Clifton said, “and I’ve never seen anything like this.”
I think stories like Cohn’s and Fisher’s are essential to getting reform in the health care system, but I don’t think the situation necessarily has to be characterized as a zero-sum game. As many conservatives warn, getting too much (inappropriate) health care can be as bad as getting too little. A society with better ER capacities (or which provides care to those uninsured who tend to crowd ERs due to a lack of a “medical home”) is better for us all. Even the most insular resident of a gated community has to drive across town sometime.
(Though those rugged individualists at Cato will always be on the look-out for the Christian Scientist who doesn’t want to opt in! Perhaps their solution to the problem would involve worried individuals perpetually traveling in RV’s with courtier-doctors always ready to meet their needs. I suppose there’s a market solution to everything.)
July 2, 2007 at 9:46 am
Posted in: Health Law
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