Libertarians Do Care About Patients

Friday night, at a 4th of July-eve BBQ, I got mixed up in a health care debate as can tend to happen at social events in the greater Washington DC area. At one point a truly undecided individual stopped and asked me point blank, “Assuming you’re right about the ineffectiveness of universal health care, are libertarians just comfortable with people being uninsured and dying in America?”

It’s a valid question, particularly because classical liberals tend to fall into the Party of No on this issue. But, like my reasoning for getting rid of minimum wage laws and decriminalizing prostitution, I’m opposed to a single payer system for health care (and anything that resembles it) because I think people are better off with out it. I don’t want to see life or the quality of life rationed by Uncle Sam because I actually do care about people, American and otherwise.

Minimum wage suppresses wages in some areas and increases unemployment elsewhere, laws against prostitution push the age old practice into the shadows and black market, putting women in serious danger without legal recourse to fight violence and pimps, universal health care forces the government to ration treatment and pick winners and losers in terms of who gets what medical treatments.

The Wall Street Journal makes my case better than I did at the BBQ last week. The British National Institute for Health and Clinical Excellence (NICE) was established in the 1990s to “ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere.” If that sounds a lot like Comparative Effectiveness Research—you’re right. But as the Journal puts it:

What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive.

Rationing is expected, given that even government has limited (at some point) resources and can’t provide treatment to everyone for everything all the time. Like the case of Debby Smith, even the president can’t promise the Public Option insurance company will have the funds to cover everyone’s liver cancer. Could we really expect the government to pay for the removal of everyone’s brain tumors, all the appendectomies, and each wisdom tooth extraction? That’s not how it works in the “successful” systems of Canada and Britain; that’s not how it would work here.

Instead, the government winds up picking winners and losers, and we’ve seen how well that works out in the economy. How does it do this? The Journal runs down a nice list of examples, but two stand out:

  • In 2008, NICE ruled that certain drugs like Sutent that help terminally ill kidney-cancer patients are too expensive, running around $50,000 After the ruling, Peter Littlejohns, NICE’s clinical and public health director, noted that “there is a limited pot of money,” that the drugs were of “marginal benefit at quite often an extreme cost,” and the money might be better spent elsewhere. Is this a decision government bureaucrats in Washington should decide?
  • In 2007, NICE restricted access to two drugs for macular degeneration, which leads to blindness. The drug Macugen was completely banned, while the other drug, Lucentis, was limited to about one in five sufferers. “Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other.” NICE director Andrew Dillon explained at the time, “When treatments are very expensive, we have to use them where they give the most benefit to patients.” Perfectly logical reasoning, but again, who should have the power to make this choice?

There are others, including the rejection of a drug for rheumatoid arthritis, limiting use of Alzheimer’s drugs, and banning medicines for myeloma and sclerosis. Ultimately, it comes down to what the value of life is. How much does it cost to extend the quality or actuality of one’s life? Who decides whether person A should get the last treatment of a medicine or person B? The number the British health care system has come up with is $22,000 per six months:

NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn’t adjust for either overall or medical inflation.

Is a year of your life worth more than the monthly mortgage payment on a high rise midtown Manhattan apartment? I favor choice in the medical field because I believe that if rationing need be done, it shouldn’t be arbitrarily decided by those who don’t know what they are doing in Washington. It is not the politician’s fault, they can’t know better. No one can fully know what the best rationing of care should be, who should be saved and who shouldn’t.

Again, I don’t want to see life or the quality of life rationed by Uncle Sam because I do care about people.