A Government of Losers
MichaelW on Nov 14 2006 at 7:42 pm | Filed under: Domestic Politics, Economics, Foreign affairs, Libertarianism, MichaelW's Page
It is axiomatic in libertarian circles that government should not be in the business of picking winners and losers. The mantra is most often heard in laments regarding the sclerotic and overbearing regulatory state (here, in Europe, etc.). One concrete example of the truth behind this axiom, one that is not so obvious, is in the area of health care.
Glenn Reynolds highlights a Betsy McCaughey op-ed in the NYT that points to a leading cause of death in the United States, which cause simmers on the perpetual back burner of our collective conscious:
WHAT kills more than five times as many Americans as AIDS? Hospital infections, which account for an estimated 100,000 deaths every year.
Yet the Centers for Disease Control and Prevention, which are calling for voluntary blood testing of all patients to stem the spread of AIDS, have chosen not to recommend a test that is essential to stop the spread of another killer sweeping through our nation’s hospitals: M.R.S.A., or methicillin-resistant Staphylococcus aureus. The C.D.C. guidelines to prevent hospital infections, released last month, conspicuously omit universal testing of patients for M.R.S.A.
That’s unfortunate. Research shows that the only way to prevent M.R.S.A. infections is to identify which patients bring the bacteria into the hospital. The M.R.S.A. test costs no more than the H.I.V. test and is less invasive, a simple nasal or skin swab.
So why is it that AIDS research receives so much government backing, and M.R.S.A. tests aren’t even mentioned in CDC guidelines? The answer lies in the political consequences of promoting one over the other. There is no “infectious diseases lobby” (or, at least to the extent that McCaughey represents one, it is very small), but there is a huge AIDS lobby that exacts a great deal of influence on US and global politics. Politicians ignore AIDS at their own peril since, if they do not step up and provide a voice to the issue, and the funds to fight it, an opponent will do so on the hustings.
The problem is not that fighting AIDS is not a worthy cause, it’s that fighting diseases that are more egalitarian in who they afflict does not garner the same sort of political clout as fighting AIDS. Ergo, politicians and bureaucrats the world over focus on a funneling attention and money to a “cure” for a disease that does not afflict nearly as many people (although, to be sure, it is one of the deadliest) as other diseases such as malaria, diarrhea, hepatitis and cholera. And since AIDS is the disease with so much political clout, then other diseases, such as M.R.S.A., are ignored to everyone’s peril. In fact, advocates for the eradication of other diseases, mindful no doubt of what happens when the government decides that certain maladies are more important than others, learned well from how the AIDS lobby got so much attention. For example, the political movement to fight women’s breast cancer really began in earnest in the early 1990’s, following the prescription for success laid out by the AIDS lobby:
Women with breast cancer are taking a lesson from AIDS advocacy groups and using political action to urge the Federal and state governments to pay more attention to their disease.“They showed us how to get through to the Government,” said Shiela Swanson, a breast cancer patient in the Bay Area who helped organize an advocacy group called Y-Me. “They took on an archaic system and turned it around while we have been quietly dying.”
In cities like San Francisco, Dallas, Washington, Berkeley, Calif., and Cambridge, Mass., breast cancer advocacy groups have recently been formed to press demands for more action on the disease, which strikes one in 11 American women and kills almost a third of its victims.
The groups are lobbying for more money for research, broader insurance coverage for mammograms and experimental treatments and the resumption of stalled studies into the possible dietary or environmental roots of breast cancer. The groups have been particularly successful on the state level in requiring insurance companies to pay for mammograms.
[...]
But the lessons of AIDS provide the immediate impetus for the growing activism around breast cancer. Until the AIDS epidemic, advocates for people with a certain disease had never had such a broad influence on public policy. Advocates for people with AIDS have forced an overhaul in the way AIDS drugs are tested, released and financed and have successfully lobbied the Government for billions of dollars for research, treatment and education at a time of fiscal restraint. In fact, the Government spends nearly as much each year on AIDS research as it does on all cancers combined.
The federal government decided which diseases were “winners” and gave those the most attention. The “losers” then were forced to do their begging at the federal trough. Is that what we want in health care? Is that how we really want scientists and drug makers to decide which diseases are priority to fight and which will have to wait?
Of course, doctors and hospitals are not prevented from pursuing methods to prevent M.R.S.A., and indeed many are now doing so without any help or guidance from the government.
A growing number of hospitals in the United States have proved that such precautions work here, too. Recently, a pilot program using screening at Presbyterian University Hospital, in Pittsburgh, reduced M.R.S.A. infections by 90 percent. At a Yale-affiliated hospital in New Haven, screening reduced M.R.S.A. infections in intensive care by two-thirds.
And a recently completed nine-year study at the Brigham and Women’s Hospital, in Boston, found that screening led to a 75 percent drop in M.R.S.A. bloodstream infections among intensive-care patients and a 67 percent decline throughout the hospital.
Even so, as resources are continually directed towards those diseases that the government believes should be attended to first, other more commonly infectious and more curable diseases are given short shrift. The average person may have a greater chance of contracting malaria, hepatitis or deadly diarrhea than AIDS, but because the lobbying forces have been so effectively aligned in favor of AIDS research and cures, little attention is paid to prevent the more common illnesses. This is what happens when the government picks winners and losers.
As the din calling for universal health care coverage grows ever louder, it would behoove people to think about the consequences of such an action. Giving government the power to dole out health care is giving government the discretion to decide which diseases, ailments and afflictions are to be treated and how, not to mention which patients deserve treatment and which will be left to suffer. When the time comes, and universal health care is among us, you had better hope that you have a politically viable ailment or you will be forced to lobby for your medicine.
Technorati Tags: health care, universal health care, picking winners and losers, libertarianism, economics, AIDS, politics of health care
Sphere: Related Content17 Responses to “A Government of Losers”
Trackback URI | Comments RSS
Excellent post. I am working on something now that I will use this as a lead in for. Great points.
Pertinent example here.
err,
Thanks for the link. We love that kind of stuff. Feel free to send us more. We are always on the lookout for people willing to make our lives easier.
The astounding thing about the AIDS lobby is that it has NEVER mentioned how easy it is to completely stop the spread of AIDS. All that’s necessary is monogamy (heterosexual or homosexual).
I assume that they feel it s “right†to go around screwing like a bunny and then have the rest of the US spend zillions to fix things.
The same liberals who call for more AIDS funding – caused by the sexual actions of the AIDS sufferers – are the same liberals who call for, actually shout for, all sorts of bans, taxes, etc on smoking, which can also lead to lethal diseases. Yet you never hear any mention of how to absolutely, 100% avoid AIDS.
While we are putting up links, I suggest in addition to the link to Jane Galt’s post something I saw at Cafe Hayek from the Washington Post.
Congrats on the Insta-link guys. This is a great point Michael, and one that a lot of people forget.
Hmmm.
As someone who had flesh carved from my arm that got infected with MRSA I can agree with your points.
It’s like how people treat some animals better than others. We all love cats and dogs because they’re cute. However we eat cattle.
Exactly. I’ve weighed in on this debate over at QandO, as well.
As someone with a knowledge of the NHS (more correctly termed an extortion funded treatment rationing scheme) I can tell you one thing.
By having an NHS you suck in people accross the world with AIDS, and, because treatment is rationed, it treats them at the detriment of people who have paid in.
It also removes an incentive to actually maintain your health as “the NHS will pay for it”.
Beware! Implementing an NHS is nationalising your own bodies, don’t make the mistake the U.K. made.
Exactly. Right now, Americans are paying customers with the ability to take their business to other providers if they do not like the treatment that they are receiving. We can also pay a higher price if we would prefer more prompt or efficient service. Once the NHS rolls into town, we aren’t customers anymore so we certainly will not be treated like we are. Instead, we’ll be treated the way we are at the local DMV.
Or Canada or France or nearly all of the industrialized world. Or so we’re told by proponents of the NHS system who swear that the US is the only callous, unfeeling barbarian nation that refuses to adopt this highly compassionate, responsible, “it’s for the children” system.
Nicely done, Michael.
It has long been gospel in my family that hospitals will kill you. I think you’re dead on about why AIDS gets so much attention. You know,
Squeaky wheel… grease … store oily rags in fire proof container…
And perhaps that is one other reason there is such contempt for the so-called “gay agenda†- that a minority of a minority has such a loud voice.
There is wonder as to why the CDC has such lax guidelines. It is not as though there is a lobby against having such guidelines, right?
Well, maybe…
In an interview I saw this morning on ABC’s GMA, your Betsy McCaughey discussing such guidelines, suggests,
The news piece did not go further into that query. Piece can be found here. (Interview transcribed for your pleasure by the
vaingloriouslybenevolent PogueMahone.)Cheers.
I think that’s exactly right, Pogue.
My guess is, and it’s only a guess, that it comes down to an availability of funds. According to the NYT op-ed by McCaughey, the M.R.S.A. tests costs about as much as AIDS tests. I think the hospitals usually have the choice of one or the other, and they aren’t going to opt for no AIDS test now are they?
You better watch it Pogue, that is the kind of comment that taken out of context and ignoring everything you have ever written on the subject could be portrayed as anti-gay. Being the big time bloggers we all are around here we have to know we are on the radar!
I smell a Pogue on a spit, a veritable Ceilidh Cowboy barbecue, a Brazilian churrascaria. And yes Pogue, he is watching deep from within the \”Unclaimed Territory\” of the Amazon. Deep in my stats the all seeing eye-p pops up and keeps his close tabs. He sees little Pogie and his dark thoughts, yes he does.
Hey, I thought this was a smart post with a relative lack of agenda. Thought I’d get that out of the way.
Having said that:
There is no “infectious diseases lobby†(or, at least to the extent that McCaughey represents one, it is very small), but there is a huge AIDS lobby that exacts a great deal of influence on US and global politics. Politicians ignore AIDS at their own peril since, if they do not step up and provide a voice to the issue, and the funds to fight it, an opponent will do so on the hustings.
Okay. But it’s a mirage to think of this as if it was somehow divorced from a) causation or b) economics. Most of the reason we have a huge AIDS lobby and not the other is that AIDS has killed upwards of 100 times more people - with the highest growth rate of any virus in the second half of this century. Staph inspections have less of a lobby because they do less damage, at least in part. The other part is the phoenomenon of path dependence, which is in no way unique to government. It’s a function of insitutional behavior in general.
For example, markets fail in the same way as you describe all the time. If you have a software bug that affects 100 people, your chances of successfully petitioning a corporation to write a patch for it are vastly smaller than if the problem affects 100000 people. If you have a unique error, your chances of a meaningful fix are close to zero.
This is, therefore, a poor argument to use against nationalized health care. Governments are the only institution incentivized to actually specifically make voters happy at all. Markets are organized to extract money from consumers. If staph infections were profitable, absent the possibility of government action, you would see markets be(in aggregate) deliberately inefficient at completely solving the problem, so as to perpetuate the profit. And even if they weren’t deliberately inefficient, they would be vulnerable to inherenty inefficiency, as in the case of vaccines, which can only eradicate diseases when very high percentates of the population use them, which doesn’t happen when the market is left to sell vaccines on its own.
Two years ago my Dad was involved in a bad wreck, crushing bone in his leg, hip and back, and breaking every rib in his body in spite of the air bag.
He was hospitalized for a long time, but was well into his rehabilitation when he contracted Strep G. The bug ate it’s way through more than half his spine before they surgically removed the infection. He’ll probably be in his wheelchair and diapers for the rest of his life.
Needless to say I find your report that effective hospital infection control is available and not used in American hospitals very disturbing.
yours/
peter.
Breast cancer recieves nearly four times the research dollars per patient as prostate cancer, despite a slightly higher incidence of prostate cancer and a nearly-equal annual death rate, according to CRS.
I see no reason why the ‘beauty pageant’ aspect of medical research funding in this country wouldn’t carry over to decisions about what a national health insurance plan would cover or emphasize. Maybe us guys need to start wearing little brown ribbons or something.
[...] Note the implicit assumption. If we have a desire as consumer that does not fit some third parties definition of a ‘public need’ we do not just not deserve public funding, we cannot even choose to pay for such a thing ourselves or assess its risks and benefits on our own. Public Citizen is supposedly a consumer advocate, but they do not wish to enable or even allow us to make choices for our selves, but to make them for us with the government as its enforcer. Michael Wade here at A Second Hand Conjecture has warned of the political aspects which distort what types of research actually gets funded and the implication of ceding even more authority for such decisions to the political process, I fear even more what choices we will have denied us in the name of our own good. [...]