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A Man Needs A Fish Like A Woman Needs a Bicycle
Wednesday, January 04, 2006
DO THE POOR HAVE AN UNCONDITIONAL RIGHT TO LIVE?: I ask this question because that seems to me to be at the heart of the argument that I perused at The Washington Monthly concerning the case of "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." These are the opening words of Steve Landsburg's latest column on everyday economics. The title of his piece is actually "Do the Poor Deserve Life Support?" rather than what i wrote above as the title of this entry.

I could have easily written, "Do we have an unconditional right to live?" Steve's answer, in line with his views that there is always a trade-off is: "No." And wearing my "economist hat", I can certainly understand that reasoning. After all, the decision to save this woman a few more days, weeks, or months, of life has to be weighed against the alternative allocation of resources that would allow someone (or someones) else a chance to live. Steve doesn't really pursue this utilitarian route, but rather focuses on the idea of the availability of ventilator insurance and the rational choice of this cancer patient to forego it, when 21 in order to buy other things more valuable to them at the time. Basically, by refusing the insurance, Tirhas basically said, "Sorry, I value my steak dinner today more than the right to a ventilator tomorrow." On this logic, again, Steve is right from an economist's perspective.

Yet I have two observations. First, why does Steve make the test one of the 21 year old and the steak dinner? What if I age the person a little, so that they have become more aware of their mortality, something we tend to become aware of once we hit the 40s? In other words, it is possible that Steve's patient is horribly unaware of the real odds for her ending up this way. If this is so, this could be an example of a breakdown in individual rationality and an example of market failure. The point I am making here is that young folks tend to have thresholds for knowledge (self-awareness). We do not face the real odds of our circumstances until we hit a certain threshold of information and age (i.e., we move from zero percent awareness to finite awareness, which allows us to then make bets of the kind that Steve says that we should).

The second point is that if Steve had couched his bet this way: Pay $75 now, at 21, so that you will have catastrophic health insurance for medical emergencies later in life, my guess is that most people take that bet. The reason that most people don't take that bet is because it isn't offered. My guess is that that bet is very expensive. Why? Because in real life, catastrophic events are a very real possibility at the end of one's life--and very expensive. And covering the bet that Steve wants a rational person to make might only be possible--especially if one is poor--by being willing to trade-off something else, like housing or a subsitence level of food intake, or something else of a like nature. There are problems attached to that trade-off.

I think it is OK to make the thought experiment that Steve does. However, I think it is also important to remember the context in which this experiment is carried out. It is one thing to say, "[t]his 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. " But it is the issue. Steve assumes that people can take his bet, either because they have full knowledge or because they have the income. He has not convinced me that his assumptions are reasonable. Why? In our society, there are plenty of people who politely refuse the opportunity of medical insurance because they cannot afford it, if they want to put enough food on the table to keep body and soul together.

Finally, I found Steve's definition of compassion spot on: "compassion is the "sympathetic consciousness of others' distress together with a desire to alleviate it."" I find it interesting that he shows no sign of this kind of thinking feeling in talking about Tirhas' situation qua human being and actual corporeal person. Tirhas is an abstract atomistic agent calculating odds and making choices for Steve. And this makes sense as this is the level of humanity that Steve is interested in in making his economic analysis. And yet, I wonder what Steve would say about the conditional nature of a human's right to life, if it had been his own close family member in Tirhas' situation. I wonder how much this alters the calculus for Steve. In any case, Steve is an economist and probably able to afford the insurance that he would offer to Tirhas, who might not have been able to pay for it, even if offered. And if he had not been able to afford it, would his arguments advanced in his article have given him comfort as he sat by a bedside, waiting for someone to turn off a switch?
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