Killing People to Help Them

When statists try to defend government regulations in disputes with  libertarians and others,  they  often point to the Food and Drug Administration as an exemplar of the good regulations  do in society. This is odd, because the FDA kills lots of people and causes many others unnecessary suffering. That the FDA does this is indisputable. If there have ever been new drugs or devices which save lives, and there have been, then the people whom they would  have saved who died in the time between when they would have been available otherwise and when the FDA allowed them to be used were killed by the actions of the FDA.  Similarly if there have ever been new drugs or devices which prevent suffering, and there have been, then the suffering of the people  who would  have been helped by  them in the time between when they would have been available otherwise and when the FDA allowed them to be used was caused by the FDA. The FDA may also save lives and prevent suffering. This is not as clear or obvious (at least in recent times when fear of lawsuits offers such strong incentives for caution)  and depends more on conjecture, but it may be so. It is certainly not clear that the lives saved match or exceed the number of people killed  or that the suffering averted matches or exceeds the suffering caused.

A proponent of regulation could argue that a proper version of the FDA would operate so as to prevent more deaths and suffering than it causes and thus deliver an aggregate utilitarian benefit to society. The first criticism of this is that such an FDA probably could never exist. The deaths and suffering the FDA causes by delaying use of drugs and devices do not cause sensations in the media or problems with legislators. The deaths and suffering caused by approving a drug or device which later turned out to be dangerous would. Bureaucrats have no incentive to worry about the former and every incentive to avoid the latter, and people respond to incentives.

A more serious objection is that  the employees of the government do not own the citizens lives and have no right to dictate to a dying or sick person what actions he may not take or what risks he may not run in an effort to recover.  It is his life, not theirs. (The so called social benefits are irrelevant.  A person being killed by the FDA is being killed, irrespective of what benefits the agency may produce for some other people.)

A more reasonable system would be for each drug and device to have a full disclosure of the protocols and procedures followed in its testing and manufacture and for doctors and patients to be free to make informed choices to try experimental or unproven therapies when they think a particular situation warrants the risk. People who were averse to risk or not desperately ill could consider only drugs and devices which had gone through the same trials the FDA imposes today (or ever stricter ones). Others including desperate people with little to lose would be free to take chances. Individual patients and not their civil masters would have control over the decisions affecting their lives.  There would still be a role for an FDA to verify the tests and disclosures and recommend best practices and a role for trial lawyers to keep everyone aware of the costs of dishonesty or gross incompetence.

Such a scheme would not be perfect. Mistakes and bad choices would be made, and people would suffer and die from them. However, the system would no longer be structured to produce suffering and death, and we would be recognizing that each person, and not his betters in government, owns and controls his own life.  

A Simple Reform

Most people agree that there is a great deal wrong with the way people purchase and pay for health care in the United States.  There is one thing in particular that strikes me as grossly unfair and even idiotic that is rarely mentioned. I will illustrate with an actual example from a real patient – me.  In conjunction with my annual physical, I had blood drawn and a number of laboratory tests performed.  The amount billed for the tests by the lab was  four hundred fifteen dollars and change.  My health insurance is administered by Blue Cross of Texas. Blue Cross calculated the tests were worth forty four dollars and eighty two cents. The laboratory company accepted this as always. My insurance paid a shade under thirty six of it, and I was on the hook for eight dollars and ninety five cents.

There are several points to make here. The first is that the lab did not lose money on the forty four eighty two. The second is that my real savings were not so much  in what my insurance paid as in the rate structure it had obtained from laboratories.  The third is that there are poor suckers out  there without insurance who get  real bills, not phony ones as I did, for the whole four hundred and fifteen. This strikes me as wrong.  I understand that large groups have purchasing power and that the rate charged  a single person might well be somewhat larger than that charged a member of a large purchasing group. I do not understand a factor of almost ten.

This is not a particularly unusual example as people can tell by looking at their own statements. In office procedures and other things often show similar differences. Cheap catastrophic insurance with high deductibles could  solve many of the problems of the many of the uninsured, but not this one.  It is not that the labs or any other providers of services are necessarily villains in this.  There may be rules or perverse incentives that have led to these practices. However things needs to be fixed, and fixing them does not seem that difficult.  There should be a way for people with no or only catastrophic insurance to participate in some sort of group that negotiates cheaper rates for them just as Blue Cross does for those it represents. That would be a reform worth considering after Obamacare is gone.