Sunday Forum: Should some profit from others' medical misfortunes?
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In the current health-care debate, many have asked if it would be wise for us to move toward some form of "socialized medicine." At the same time, relatively few have raised concerns about health care as a profit-driven enterprise. If we're going to have a real debate about health care, we should at least consider how appropriate it is to address health concerns using a for-profit model.
Don't get me wrong. There are certainly many unique advantages to for-profit medicine.
Perhaps the most obvious shows up in the pharmaceutical industry, where the promise of profits drives an amazing amount of research and development. But even in the case of R&D, the search for profits cuts both ways. Consider the fact that we have numerous treatments for erectile dysfunction, while drug companies have resisted putting resources into finding a cure for malaria, a disease most prevalent in poorer countries.
But the advantages of for-profit medicine are at least balanced -- if not outweighed -- by the fact that health care is anything but a typical product or service. After all, it's not like we're talking about iPods or handbags or car washes here.
Health care is fundamentally important in a way no other product or service is or can be. And it's fundamental importance is what makes health care such a touchy issue: You're a lot more vulnerable if your pacemaker stops working than if any of your other electronic devices do. But does its singular importance represent a good reason to take health care out of the free market?
Among social/political philosophers, this kind of concern has driven some to try to distinguish between "public goods" and "private goods." Private goods are those things we buy and enjoy individually, like cars and hats, while public goods are those we share and do not open up to the free market, like parks, roads and police protection.
There are a number of considerations that weigh in favor of health care being treated as a private good, including the fact that health is an intensely personal issue. But other considerations lead in the opposite direction. In fact, with respect to some aspects of health care, we have already decided that a free-market approach is inappropriate.
First, we tend to think it inappropriate to profit from others' misfortunes, whether they are illnesses or accidents. This also helps explains why our police and fire departments are all either government-funded or volunteer. So when it comes to protecting lives or saving them, we disapprove of those who profit from others' misfortunes because they take advantage of others when they are most vulnerable.
Second, we have laws against buying and selling human organs. We do not allow individuals to buy or sell organs because we think it is inappropriate to put a price tag on such things as bodily organs. This also explains why we do allow individuals to donate organs.
In other words, we cannot translate the value of organs into dollars in any sensible way, or at least not without running a serious risk of cheapening them in the process. Also, outlawing organ sales is a way of making clear that, as a society, we think individuals should never have to face certain decisions -- say, between filing for bankruptcy or selling a kidney. As a result, we have good reason to disallow a market for such things. After all, a market for human organs would devalue them and us along with them.
Both of these examples highlight concerns we already have about treating health care like most other products or services in the free market. But does this mean we should start thinking of health care as a public good?
I'm not sure that it does, because our views on profiting from others' misfortunes and selling human organs reflect only some of our values with respect to health and the market. We also endorse some of the values behind for-profit medicine. The problem is that those two sets of values are not wholly compatible.
We need to be willing to ask tough questions about all aspects of our health-care system, including our values and whatever commitments those values entail. The more willing we are to ask these sorts of questions, the more likely it will be that we will have a meaningful and productive debate, not just political grandstanding, about health-care reform.
First Published September 27, 2009 12:00 am