Health care reform and kidney donation

I haven’t had much to say on the health care debate because, well, I haven’t given it a ton of thought. It seems to be self-evidently bad — impossible to pay for without hiking taxes on the middle class, always a great idea in a recession; will almost certainly lead to a reduction of care for those who already have insurance; will lead to massive governmental interference in everyday health decisions in ways that we can’t yet foresee — that I didn’t have much to add to the conversation.

But I was reading the New Yorker article by Lisa MacFarquhar about kidney donation (subscribers only) at lunch, and something tickled the back of my brain. Let’s see if I can work this out in a way that makes sense for everyone. Please excuse any rambling.

MacFarquhar’s piece kicks off with a vignette about a man who decides to give his kidney away to a stranger. After the procedure, a woman calls him at the hospital:

A woman on the other end, who had heard about him on the local news, told him that she hoped his remaining kidney would fail quickly and kill him, because her husband had been next in line to receive a kidney and he, Wagner, had given his to someone else. Wagner asked the hospital to turn his phone off after that, but then someone wrote an article about him in the Philadelphia Daily News, wondering whether it was fair for him to pick his recipient, choosing who lived and who died.

This struck me as odd. I’m not necessarily in favor of allowing people to sell their organs — it would almost certainly create a system prone to abuse (but then again, what system isn’t?) — but can see nothing inherently objectionable about people donating kidneys for no compensation. Then, later in the story, we read this:

UNOS [the United Network for Organ Sharing] takes the position that MatchingDonors.com [the website the guy above used to find someone to give his kidney to] “exploits vulnerable populations and undermines public trust in the equitable allocation of organs.”

The “equitable allocation of organs.” That’s an interesting phrase. Because what UNOS really means is that they want everyone to have to wait their turn on a master list for a cadaver organ (the organs harvested from car crash victims, etc.). It is, in part, about control — it’s a nonprofit that, one can assume, gets a fair amount of funding and pays a fair number of bureaucrats because they control the system that distributes cadaver organs — but it’s grounded in this vague idea of fairness. It’s the same vague idea that compelled the woman who made that phone call to wish death upon a donor of kidneys. It’s the same vague idea that compelled someone to write a column condemning a kidney donor for choosing a stranger instead of giving his kidney to the next person on the list.

It’s the same vague idea that drives many clamoring for health care reform. “Who are you,” you often hear proponents say, “to question the government giving health care coverage to those who don’t have it? You sit there with your fancy company-provided insurance and have the gall to say other people don’t deserve what you have, a basic shot at hospital care and equitable treatment? Who are you to question rationing? We already ration based on ::shudder:: who can pay. How can that be considered equitable?”

I think these complaints are overwrought (the number of problem-uninsured is nowhere near the 45 million proponents of health care reform claim, and people aren’t exactly dying in the streets from lack of penicillin). But let’s take all those arguments at face value as accurate. Taking them all under consideration, I’m tempted to reply “Life isn’t fair.” Why should we make it a goal that your ability to receive health care depends on your placement on a list that serves people first-come and can only service a small number in a year? How is this an improvement on the system? No system will ever be fair: There will always be winners and there will always be losers in any realm of human endeavor. Sometimes it’s your own fault; sometimes nothing anyone could have done could have prevented what happened. Are we really comfortable with the government creating a multi-trillion dollar program that will enforce same random bureaucrat’s notion of what is “fair”? Because that’s what we’re headed for.

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