The Covert Rationing Blog

John Edwards and the Distribution of Livers

January 10th, 2008 by DrRich

DrRich has not yet decided who he will support in this year’s presidential election. Whoever he ends up supporting, though, it will not be because he admires their policy on healthcare. No candidate from either party even begins to approach the fundamental problem facing our healthcare system, which is (of course), rationing, and how best to do it. An honest candidate would be saying something like this:

Healthcare rationing, my fellow Americans, is an economic imperative. We can’t avoid it, and indeed we’re not avoiding it. And the manner in which we’re currently not avoiding it - by doing it covertly - is producing most of the disasters we’re seeing today within our healthcare system. So here’s how I propose that we organize that unavoidable rationing in order to make it as equitable, as effective, and as efficient as possible (thus to limit the necessary rationing to the minimum possible amount), and in such a way as to support (rather than undermine) the autonomy of individual Americans.

DrRich does not expect to live long enough to hear any major politician say anything like this.

By avoiding the rationing question, obviously, each of our presidential candidates (by simple default) continues to endorse covert rationing. Their disagreements on healthcare policy, then, necessarily devolve mainly to arguing about which group of special interests will get to control that covert rationing. The Wonkonians hope to move toward more governmental control, either through ever stricter laws and regulations to force doctors and insurance companies to do their bidding, or by simply taking over the entire healthcare system. The Gekkonians, on the other hand, wish to rely on “market forces” (such as the gentle ministrations of truly avaricious, cold-hearted insurance executives) to manage the covert rationing. Either way, the rationing (being covert) will be conducted not according to what is most fair, effective and efficient, but rather, according to what they (the Wonkonians and Gekkonians) can most easily get away with.

And as readers of this blog will understand, DrRich does not have a clear preference as to which of these two species of covert rationing will finally be used to dispatch him and his loved ones and friends. We’ll all end up just as dead, either way. Fire and ice, as the poet says.

So, given this synthesis of the issue, it may be a bit unfair of DrRich to single out any single presidential candidate for criticism on an issue related to healthcare in general, or rationing in particular. But in Mr. Edwards’ case, DrRich cannot refrain.

It was John Edwards’ quasi-victory speech after the New Hampshire primary this week that finally did it. Finally, DrRich has had quite enough of hearing Mr. Edwards suggest he is the one who knows best how to distribute livers.

The now infamous case of Nataline Sarkisyan, the 17-year-old girl who died a few hours after her health insurer finally approved her for liver transplantation, has become the rallying flag for the Edwards healthcare platform. If not for the corporate greed of the CIGNA company, Edwards suggests, this wonderful young person would still be alive. It is completely obvious that she ought to have received a liver, and the fact that she did not is a signal travesty, a clear marker for everything that is wrong with our healthcare system today. CIGNA wanted to save some money; a young person is dead. A compassionate Edwards healthcare system (fully 100% Wonkonian) would have prevented this tragedy.

DrRich does not pretend to know whether Ms. Sarkisyan should have received a liver transplant. Her youth and her fighting spirit mitigated for it. Her odds of survival after a liver transplant (being a patient with leukemia who, according to CNN, had been in a vegetative state for weeks prior to her death) may have mitigated against it. DrRich cannot adjudicate this question.

What DrRich does know is this. Livers, as well as all other transplanted organs, are truly and openly rationed. Demand far outstrips supply; there simply aren’t enough donor livers to go around. So most people who need liver transplants in order to survive will die without ever receiving one. As of this morning (according to the Organ Procurement and Transplantation Network) there are 17,143 Americans officially on the waiting list for livers. In the year 2007, only 5398 patients from this list received liver transplants, while 9286 were “removed” from the transplant list without being transplanted.

So each time a person from the transplant list is selected to receive a liver, there’s necessarily another person on that same list who will, as a result, not get a liver and will die. This means that we should be pretty careful about distributing donor livers. They ought to go to patients who have at least a reasonable chance of surviving after they’re transplanted, so that in making the selection we have a fighting chance of dooming only one person, and not two. It seems clear that such decisions should be made, to the fullest extent possible, based on objective medical criteria, and not subjective political criteria.

Edwards asserts that CIGNA executives were acting solely out of corporate greed (i.e., were behaving like Gekkonians) when they initially denied Ms. Sarkisyan a transplant. CIGNA (all evidence to the contrary aside, they being an insurance company) denies it, and claims they were using objective medical criteria to make their decision. (While lying comes as easily to insurance executives as swatting mosquitoes does to sharecroppers, in this case there’s at least some evidence to suggest they have a point.)

Edwards also declares that under his healthcare system, in which the Gekkonian insurance companies would either cease to exist or would behave according to the humanitarian rules of the Wonkonians, Ms. Sarkisyan would certainly have gotten her liver. However, since no matter how you cut it livers need to be rationed - some patients will get them, some will not - then the blithe willingness of a politician to declare from a remote distance, for his own political gain, that this or that particular person is deserving of a liver fully reveals the conceit of the Wonkonians. Wonkonian rationing only seems more humanitarian; in truth, it’s not. (Edwards, of course, has no words of comfort for the unnamed individual, one of the 17,143 now on the waiting list, who would have died as a result of his awarding a liver to this particular patient.)

Rationing healthcare is bad. It means that at least occasionally, at least some healthcare will be withheld from at least some patients who need it. We should not leave such rationing decisions to the Gekkonians, who will always be inclined to make those decisions arbitrarily, from the position of corporate greed. We also should not leave those rationing decisions to the Wonkonians, who will be inclined to make them arbitrarily, from the position of political greed. Rationing healthcare equitably is too important to leave to either variety of greed.

Thanks to Mr. Edwards for reminding us of the second, less-talked-about variety.

Posted in General Rationing Issues

4 Responses to “John Edwards and the Distribution of Livers”

1. SamEyeAm wrote on 01/10/08 at 11:38 pm :

   Dr. Rich,
   The CIGNA rationing gate keepers are fairly unsophisticated and Mr. Edwards is a highly sophisticated plaintiff medical malpractice attorney. Mr. Edwards speaking out is no more second nature than Pavlov’s dog salivating at the bell. The only thing missing is the 800 number, website, and end commercial slogan. Such cases are what that son of a mill worker lives for, from the people for the people!

   The CIGNA health care denial rationing gatekeepers will never make that mistake again. The next time they will approve the liver and roll the dice knowing that this patient most likely would never survive the rationing for a liver.

   Medical sensationalism is the only non-anechoic aspect of healthcare news.

   Sam

2. Dan wrote on 01/11/08 at 5:13 pm :

   It’s fair to say that Dr Rich will need to be blogging about covert rationing for at LEAST another four years.

3. Dr. Val wrote on 01/15/08 at 9:12 pm :

   Dr. Rich - just so you know, I led a break out session at the 2007 BlogHer conference about the upcoming elections. It was called, “Earn Our Votes” and the goal was to nail down 10 key questions to ask presidential candidates (on behalf of women). I was in charge of the healthcare group. And wouldn’t you know, but the most important question (according to the BlogHer women) was related to rationing. “How will you allocate scarce healthcare resources?”
   http://www.blogher.com/blogher-politics-looking-ahead#readmore

   Some people really “get it.” And I submit that women may be some of Dr. Rich’s best allies.

4. DrRich wrote on 01/16/08 at 8:16 pm :

   Val,

   Thanks for the info, the interesting link, and suggesting that women might be particularly ready to face the truth - and to begin figuring out the best way of dealing with it. Judging from the interactions I’ve had on this site for 8 months, and on my heart disease site for 8 years, I do not find this the least bit surprising.

   Rich

TrackBack URI

Leave a Reply