When Money Is No Object

Arnold Kling has another great post today on the economics of healthcare. He explores some of the reasons why it will be hard to bring down Americans' healthcare spending, with a story about how he would react if his daughter had cancer:

Imagine it were my daughter. What would be my attitude? I imagine that I would be walking into the oncologist saying, "Look. There has to be something you can try. I don't know whether it's bone marrow transplants or stem cells or some clinical trial somewhere. But we can't just sit here and watch her die. Either you give us something that has a chance of working, or we'll find another oncologist who will."

Next, imagine that the best hope is a treatment that costs $100,000 and offers a chance of success of 1 in 200. Would I want her to get that treatment? Absolutely.

But look at the issue from a rational, bureaucratic perspective. You have to treat 200 patients at a cost of $100,000 each in order to save one life, for a cost per life saved of $20 million. Is that what a rational bureaucracy would do?

Arnold's point here is just to show how hard it will be to get most Americans to accept any arrangement in which they are not more or less guaranteed the utmost that can be done, while paying out of pocket only a fraction of the cost.

Since I'm a lawyer in private practice, discussions like this always put me in mind of how Americans handle legal emergencies. The legal analogue of contracting a life-threatening disease is, I suppose, being charged with a crime. We don't have legal "insurance" comparable to healthcare "insurance" for such situations. No one assumes that an insurance company paid by one's employer will provide whatever legal help one needs, with at most a relatively modest "co-pay."

Instead, families shoulder the costs themselves. They use their life's savings, mortgage their homes, borrow from relatives, and so on. They do whatever they must in order to get the best defense lawyer they can afford. Those who don't have any resources fall back on the safety net of a court-appointed public defender.

We find it unconscionable that anyone could be denied medical care regardless of cost, but we have little problem accepting the absence of comparable coverage for legal needs. I think this is merely a result of conditioning. We've become used to medical coverage as part of our employment compensation or government-provided retirement benefits. We're just not accustomed to such coverage in the realm of law.

It could be argued that law is different because being charged with a crime usually involves some fault on the defendant's part, whereas one can become ill through no fault of one's own. But the difference is not as great as it might seem. Faultless people are sometimes charged with crimes, and sick people have often knowingly done things that greatly increased the chances of becoming seriously ill.

"Free" healthcare is something we're used to. Any other arrangement strikes us as inhumane. Yet we're comfortable with privately paid legal representation. How real, then, is the perceived "inhumanity" of expecting most people to arrange to pay their medical expenses on their own?