Do The Poor Deserve Life Support?

Please read the article “Do the Poor Deserve Life Support?” Please discuss scarcity, as well as information that you gain from this article, I would like you to compose an essay that addresses what we should do with patients who are unable to pay their bills for the services that they require. Please use the scoring rubric as a guide for your essay.

Do the Poor Deserve Life Support?A WOMAN WHO COULDN’T PAY HER BILLS IS UNPLUGGED FROM HER VENTILATOR AND DIES. IS THIS

WRONG? By Steven E. Landsburg Posted Tuesday, Jan. 3, 2006, at 6:30 AM ET

Tirhas Habtegiris, a 27-year-old terminal cancer patient at Baylor Regional Medical Center in

Plano, Texas, was removed from her ventilator last month because she couldn’t pay her

medical bills. The hospital gave Ms. Habtegiris’ family 10 days’ notice, and then, with the bills

still unpaid, withdrew her life support on the 11th day. It took Ms. Habtegiris about 15 minutes

to die.

Bloggers, most prominently “YucatanMan” at Daily Kos, are appalled because “economic

considerations,” as opposed to what the bloggers call “compassion,” drove the decision to

unplug Ms. Habtegiris. I conclude that YucatanMan either doesn’t understand what an

economic consideration is or doesn’t understand what compassion is, because in fact the two

are not in conflict.

Here, for the edification of bloggers everywhere, is an example of an economic consideration:

If you ask people—and especially poor people—what their most dire needs are, you’ll find that

“guaranteed ventilator support” ranks pretty low on the list. OK, I haven’t actually done a

survey, but I’m going out on a limb here and predicting that something like, say, milk, is going

to rank a lot higher up the priority list than ventilator insurance.

In fact, I’ll go further. The back of my envelope says that a lifetime’s worth of ventilator

insurance costs somewhere around $75. I’m going to hazard a guess that if, on her 21st

birthday, you’d asked Tirhas Habtegiris to select her own $75 present, she wouldn’t have

asked for ventilator insurance. She might have picked $75 worth of groceries; she might have

picked a new pair of shoes; she might have picked a few CDs, but not ventilator insurance.

She might even have picked something health-care related—a thorough physical exam, or, if

there were better markets for this sort of thing, $75 worth of health or disability insurance. I

doubt very much, though, that with $75 to spend, she’d have chosen to insure against

needing a ventilator as opposed to any of the other minor and major catastrophes to which we

mortals are susceptible.

Now let me remind you what “compassion” means. According to Merriam-Webster Online

(which, by virtue of being online, really ought to be easily accessible to bloggers), compassion

is the “sympathetic consciousness of others’ distress together with a desire to alleviate it.” By

that definition, there is nothing particularly compassionate about giving ventilator insurance to

a person who really feels a more urgent need for milk or eggs. One might even say that

choosing to ignore the major sources of others’ distress is precisely the opposite of

sympathetic consciousness.

There is room for a great deal of disagreement about how much assistance rich people should

give to poor people, either voluntarily or through the tax system. But surely whatever we do

spend should be spent in the ways that are most helpful.

Therefore there’s no use arguing that the real tradeoff should not be ventilators versus milk

but ventilators versus tax cuts, or ventilators versus foreign wars. It’s one thing to say we

should spend more to help the poor, but quite another to say that what we’re currently

spending should be spent ineffectively.

This is not to deny that the health-care system needs a massive overhaul; it does. But that’s

not the issue on the table here. The issue is: Given the current system, should or should not

the federal government (or Baylor Medical Center, or somebody) effectively guarantee that

nobody will ever die for lack of a ventilator? In other words, should poor people be given

ventilator insurance?

The bloggers at Daily Kos say yes. But for the same cost, we could give each of those people a

choice between ventilator insurance on the one hand or $75 cash on the other hand. If it turns

out that I’m wrong and they all want the ventilator insurance, so be it. But why not at least

ask them?

You can’t do that with every government service. You can’t offer people a choice between

police protection and its cash value, because police patrols tend to protect entire

neighborhoods at once, not just specific individuals. You might not want to offer people a

choice between a flu vaccine and its cash value, because you’d really prefer to have

vaccinated neighbors. But critical life support isn’t like that; the benefits are targeted to

specific individuals. There’s no reason those individuals shouldn’t be allowed to choose

different benefits if they want them.

Tirhas Habtegris would probably have taken the cash. Then she’d have gotten sick and

regretted her decision. And then we as a society would have been in exactly the same position

we were in last week—deciding whether to foot the bill to keep Ms. Habtegris alive a little

longer.

At that point, there’s a powerful human instinct to come to the rescue. Well, more precisely,

there’s a powerful human instinct to demand that someone else come to the rescue. (I’m

guessing that in the wake of the Habtegiris case, nobody at the Daily Kos has taken to funding

ventilator insurance for the poor.) Be that as it may, choices have to be made. A policy of

helping everyone who needs a ventilator is a policy of spending less to help the same class of

people in other ways. Accounting for “economic considerations” means—by definition—trying

to give people what they’ll value the most. In other words, economic considerations are the

basis of true compassion.