Sunday, November 19, 2017

Life Is Not a Budget Item

Thanks in good part to Senator Bouchard, we have been informed about the proceedings of the Labor and Health Committee meeting this week. One of the bills discussed in by committee has to do with organ donations (allegedly 18LSO-0302). What we know so far is that this bill would change the presumption of consent: unless you opt out, you would be an organ donor.

With the reservation that I have not seen the actual bill - it is not available on the committee website - it is worth taking a closer look at what motivates the very idea that we should all be presumed organ donors.

On the face of it, this sounds like a good idea. After all, who needs his body after death? 

The problem is that this is not what the organ-donor conversation is about. In fact, even the question is moot, since organs are not harvested from dead people.

The practical meaning of the presumption of consent is that government now becomes the owner of your organs. While not the legal meaning, it is de facto how the organ-donation segment of the health care industry will work. This is a fundamental shift in the relationship between individual and government: it now means that government by default has the right to claim your body.

And not in death. When you are alive:
Dr. Paul Byrne, an experienced neonatologist, clinical professor of pediatrics at the University of Toledo, and president of Life Guardian Foundation, said ... “All of the participants in organ transplantation know that the donors are not truly dead,” ... “How can you get healthy organs from a cadaver? You can’t.” Byrne affirmed that giving pain medication to organ donors is routine. Doctors taking organs from brain-dead donors “have to paralyze them so they don’t move so when they cut into them to take organs, and when they paralyze them without anesthetics, their heart rate goes up and their blood pressure goes up,” he observed. “This is not something that happens to someone who’s truly dead.”
Why is this suddenly becoming an issue in Wyoming?
The problem is, there simply aren't enough donors to meet demand. Most states have tried to bring attention to the issue by giving drivers the opportunity to become donors upon getting or renewing their driver's licenses. In May [2015], the U.S. Senate introduced the Organ Donation Awareness and Promotion Act of 2015 ... it would fund efforts to further promote organ donation and raise awareness of the ongoing shortage. Despite those efforts, according to the U.S. Department of Health and Human Services (HHS), the number of donors available nationwide has remained stagnant over the last decade. In 2005, there were 14,497; last year, there were 14,415. And the number of living donors from whom organs were recovered actually dropped over the same time period, by more than 16 percent.
In a country that does not have a single-payer health care system, it should be none of government's business how many people donate organs, and how many don't. Yet the push to change organ donations is driven by the same general economic and utilitarian calculations that go into all health care production in single-payer systems.

So far, here in America we do not apply those calculations to health care itself; thanks to the hard work of friends of life and liberty, the so called QALY method for estimating the economic value of a person's life has been kept out of the U.S. health care system. It is, however, used in several countries with government-run health care. Anyone interested in what that application looks like should read the "Fiscal Eugenics" chapter in my new book, The Rise of Big Government.

However, the push for a shift in organ donations, from no by default to presumed consent, is a clear indication that our health care system is drifting in the single-payer direction. In fact, the shift in presumption of organ-donor participation marks an important symbolic step, away from free-market health care and toward a government-run system.

The reason is in how the change in presumption alters the relation between supply and demand. In a free-market economy, buyers can only buy as many products as sellers are willing to provide. If there is more supply than demand, then buyers are in the luck: they can buy everything they want. By contrast, if there is more demand than supply, buyers are rationed and will have to put up with whatever producers want to provide them with. In either case, the market drifts toward a price that balances out demand and supply over time; if there is a supply shortage, it is defined by the interaction of buyers and sellers on the free market.

This is why, for example, buyers of the Shelby GT350 often have to pay twice the sticker price - and keep doing it. It would be absurd if everyone who wanted a Shelby GT350 could force Ford and Shelby American to build them a car. We would call that "dictatorship" and "slavery". 

In a free society, the supply of human organs is limited by the same principles of liberty that keeps Ford and Shelby from building more high-performance Mustangs. If there is a shortage of organs, it is because only a limited number of people are willing to donate. Any attempt by government to force an increase in the supply of organs is similar in kind to government forcing a car manufacturer to increase the production of cars.

The application of free-market principles to the organ market immediately draws criticism with reference to price: if that market were unregulated by government, the argument goes, only the rich would be able to afford a new kidney or a heart transplant. In other words, only the lives of the rich would be saved. However, this is as much of a myth as it is that "only the rich" would get health care under a free-market system (although Obamacare does a fine job at making insurance unaffordable to middle-class families). A health insurance plan that covers catastrophic health care can easily include coverage for organ transplants as well. 

In other words, we already have an economic infrastructure in place for a working, privately provided, privately funded market for all sorts of expensive health care, including organ replacement. 

In fact, if there has ever been a system that puts a price on organ transplants, it is a government-run single-payer system. There, all non-trivial health care procedures - including but not limited to elective surgery, cancer treatment and organ transplants - are folded in under the aforementioned QALY cost-benefit system. 

For the organ transplant part, this works in two directions. The person in need of, say, a new heart or a new kidney is evaluated based on expected future contributions to the economy. Those contributions fall into two categories: expected workforce participation and expected future tax payments. If the expected contribution to the economy, and to government, exceeds the cost of the transplant procedure, and of expected future health care needs, i.e., if the QALY calculation ends up positive, the patient receives a green light for an organ transplant. If the QALY calculation results in a negative balance, the patient is not recommended. 

On the organ-donor side, the calculation is easier, depending on two factors: the presumed donor's status as a "dead" individual, and the presumed positive QALY calculation for the receiving patient. Since there is a shortage of organ donors in general, there are more patients with a positive QALY (again where those are applied, in countries such as Britain and Sweden) than there are patients presumed dead enough to become donors. 

In a system with an excess demand for organs - in other words, with an unsatisfied balance of expected tax payments from prospective organ replacement patients - the only obstacle in the way of more organ donations is the presumption of a patient's death. It is in this context that we should view the bill that the Labor and Health committee discussed last week.

Even if the United States does not have a formal QALY system for the distribution of health care, the survival of Obamacare means that we are close - uncomfortably close - to a single-payer system. The survival of the individual mandate (based on the "universal coverage" principle) is a milestone retreat for the free market and individual choice. Once government has the right to define "universal coverage", it also has the right - or might - to define what that coverage consists of. This means that government can define what health care we get, but also what health care we don't get. 

On the negative side of that balance, in other words the list of procedures we cannot receive, also comes a list of conditions under which we cannot receive treatment. This opens the door for euthanasia (called "death with dignity" in Oregon) and for the denial of care to patients whose organs are deemed a good fit for transplants. 

Since a body has to be alive when organs are harvested, all it takes for a patient to end up on the donation side of the organ transplant equation, is that he or she is "dead" by some criterion that government has created - for the very purpose of facilitating organ harvesting. LifeSiteNews again:
The neonatologist [Dr. Paul Byrne] said he has personally studied the theory of “brain death” since 1975, seven years after the first vital organ transplant in 1968, and has found that death criteria has continually been changed to accommodate a demand for fresh organs. The idea of a “dead donor rule” did not even emerge until the 1980s, he said, and didn’t enter common parlance until years later. “There really is no dead donor rule, although they’re trying to make it seem like there is,” said Byrne. Byrne led a Vatican conference on “brain death” criteria in 2008 in which a large group of international experts, many of whom are world leaders in their fields, attested to the illegitimacy of “brain death” as an accepted criterion for organ removal. 
With government in charge of our health care system, the positive QALY calculations for those who receive organ transplants will guide the allocation of health care resources in the system. Put bluntly, this means:

a) A hospital that harvests organs will receive more funding;
b) A hospital that performs organ replacement surgery will receive more funding; and
c) Hospital managers who push for more of both procedures will get bonuses or pay raises as reward for having dutifully carried out the will of the government.

Since we, again, do not have a single-payer system, all this may seem like a straw man argument. It is not. Government involvement in our health care system is already deep, in fact deeper than it has ever been. By mandating certain features for health plans, and by mandating health insurance coverage for private citizens, government has already moved deep into our health care needs. By changing the presumption definition, government gets itself even more deeply involved: it takes de facto proprietorship of our organs, by defining us as willing donors without explicit consent. At that point, it matters less if government itself takes control of the actual organ, or simply delegates the harvesting - and thereby killing - of a presumed donor to a private-sector entity. 

But make no mistake here. The end goal with the gradualist expansion of government's presence in our health care is a complete government take over. It has been the wet dream of the left for decades to create a single-payer system; in fact, the leading architect behind the War on Poverty, John Kenneth Galbraith, proposed a single-payer health care system in his public policy writings. (As much as I admire Galbraith for his prolific and intelligent contributions to political economy, he drew the wrong conclusions on the policy side of things.) Every presidential candidate nominated by the Democrat party since at least Governor Dukakis has advocated single-payer in one form or another. Now that Republicans have finally given up and accepted that government is the default provider of health care - that is the practical definition of the individual mandate - it is only a matter of time before we have a formal single-payer bill in Congress. 

When that bill bears a president's signature, everything from abortions to euthanasia to organ harvesting will become tax funded, and performed based on QALY estimates. Government will put a price on your life; if you can pay more in taxes for the remainder of your life than you will cost government, then you will be treated. If you can be expected to be a net cost to society, you will be discarded. If your organs can be of use to secure a net flow of tax revenue from someone else,  then government will take one final contribution from you to society. Or two. Or three.

This is not a horror story from a future dystopia. It is reality in some countries already today. It is close to becoming reality here. Step by step, the welfare state takes charge of every aspect of our lives. 

I know. I grew up in it. Once it does, our lives will become pawns in one giant macroeconomic game, played by government, on terms decided by government. One of our many sacrifices will be the right to our own lives. Literally, the very definition of life will become an item in the government budget.

It is called Fiscal Eugenics. Read more about it in chapter 5 of my new book. Educate yourself, before it is too late. 

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