A study published last November found that treatment similar to what Cheney received costs $167,208 for every year of life saved. Treatments that “buy” a year of life for $50,000 or less are considered cost-effective, and those costing $50,000 to $100,000 are generally considered acceptable. (A European study in 2011 found the device much less of a bargain, at a cost of $414,275 for year of life saved).
Who gets a donor heart when one comes available depends on many variables, including body size and blood type. The most important one, however, is a person’s clinical condition and immediate availability for surgery.
There are strict guidelines for placing someone in the most urgent category and the decision is made by a team of many specialists. Moving someone to the top of the list who shouldn’t be there would be hard to do and would open a hospital to major sanctions. Both Bull and John said they are confident Cheney got no special breaks.
From the quoted passage: Treatments that “buy” a year of life for $50,000 or less are considered cost-effective, and those costing $50,000 to $100,000 are generally considered acceptable. [My italics.]
The unstated assumptions here are that 1) third parties will pay for transplants and therefore get to decide which patients will be considered to receive transplants, and 2) third parties will allocate the limited supply of transplantable organs.
Points left undiscussed are the likelihood (assuming that the supply of human organs is like the supply of everything else) that allowing payment for donor organs would increase the supply, and the possibility that price allocation of transplantable organs would make it easier for people who aren’t Dick Cheney or Steve Jobs to get transplants.
I myself am reluctant to be an organ donor because on the margin I don’t want to give agents of the current hospital-administered organ-distribution system that benefits from my organs any additional incentive to decide that I am dead. But if being an organ donor meant that agents of transplant prospects or their insurance companies could negotiate with my agent to pay money that would go to my family, I might reconsider.
It is true that a price-based organ allocation system would allow rich people to pay more for organs than poor people could afford but rich people have tremendous advantages under the current system. Does anyone think Steve Jobs wasn’t able to game the current system if he needed to? In a price-based system a poor person can buy insurance or solicit donations or find a patron, and there would probably be institutions to subsidize transplants for poor people in the same way that private charities operate hospitals and subsidize other types of medical care. The current non-price organ allocation system is based on committee decisions and nominal considerations of fairness. Inevitably, on the margin it will be arbitrary and probably (if it is like most systems for making non-price allocations of scarce goods by committee) subject to political and other influences.
The current organ-allocation system is a bit like college athletics. The owners of something valuable (athletic talent or organs) are not allowed to sell it but may only donate it to institutions that then use it for their own purposes. Obviously this situation is acceptable to current organ donors, many of whom get substantial psychic benefit from putting themselves on donor lists. Their willingness to donate their organs to help other people live is highly admirable. But how many more people would offer themselves as organ donors if by doing so they could give their families the possibility of a substantial payout in the event of their untimely death? And how many more people would be able to get transplants who now die while waiting?
One good thing is the technological innovation that results from the chronic shortage of transplantable organs. Cheney and other people are able to keep going with the help of mechanical pumps until donor hearts are available. And it looks as though eventually mechanical hearts will replace transplants for people with heart problems. But the new technology isn’t cheap, so the issue of third-party payment is important. I would certainly be willing to pay $150k/year (or whatever Cheney’s pump cost) to keep myself alive if I could afford it. Maybe an insurance company would pay that if I could purchase the right policy in a relatively deregulated insurance market that catered to such risks. Would the government pay it under Obamacare? Maybe for some people; probably not for people above some arbitrary age as determined by a committee. But remember, the idea that there will be “death panels” is a right-wing canard.