The conservative media was all over the story of a dying 10-year old girl who was denied the opportunity to appear on the list to receive a lung transplant. For them, this was the perfect opportunity to shine a spotlight on callous government bureaucrats who cold-heartedly decide who shall be allowed to live. Obama’s Secretary of Health and Human Services didn’t disappoint, giving them a floater right over home plate with the quote: “this is an incredibly agonizing situation where someone lives and someone dies.”
Problem is – her analysis is absolutely correct, at least, so long as we operate under the yoke of an interventionist state which assumes the right to regulate and control our medical care. Now since this article was published, some federal judge decreed that she be placed on the transplant list after all. This was a big story, and many are now wildly celebrating that this girl will have an opportunity to extend her life. What conservatives might stop to ponder is that unfortunately, we live in a world of scarcity, where resources are limited. This includes viable human lungs suited for transplant. The demand for these lungs vastly exceeds the supply. As uncomfortable as this may be to talk about, lungs are a resource, just like oil, gold, Apple stock, and pork bellies.
So the question becomes, how are the lungs to be distributed? How are we to decide who receives access to a good that will almost certainly be the difference between life and death? The Austrian Economists identified two distinct methods for the acquisition of property – the political, and the economic. The political represents force, and the economic represents free trade. In the United States, the government has decided that free trade in human organs is unacceptable, and has made it illegal. This means that only the political method may be used. The political method consists of some person or group of people being in charge of deciding who will receive the goods in question. Often, they establish rules – written criteria designed to somehow ensure “fairness” and that those who are most in need of a particular good receive access to it.
The unfortunate realities of scarcity mean that, on a daily basis, individuals will be denied access to goods and services that may be critical to their continued existence. So long as there are more people who need lungs than there are lungs available, some will live and others will die. Regardless of whether the lungs are distributed by market forces (highest bidder gets the lung), a panel of doctors (set arbitrary rules to define who gets the lung), or political forces (judges and politicians pick and choose who gets the lung), some will live and others will die. This applies not only to lungs of course, but to all goods and services. Scarcity exists. Some will have, and others will go without. The only question really in play here is by what mechanism the goods and services are distributed.
In this case, the rules are established by some panel of doctors somewhere, and are presumably based upon the government’s best estimate as to who can potentially benefit the most from a transplant. This panel, comprised of experts, determined that children should not be eligible to receive adult lung transplants. The panel makes the rules that effectively decide who lives and who dies (gee, can we think of a name for this panel…. nope… nothing is coming to me…). Having your fate decided by a panel of doctors working for the government sounds pretty bad, but having it decided by judges and politicians is even worse. By ordering the girl to be placed on the list, the judge most likely has condemned someone else to death. Conservatives should keep this in mind while they celebrate the judge’s decision. They are celebrating the fact that the famous girl on the news will live, while some unknown person is now likely going to die in her place.
The failure of the media to emphasize this trade-off is a classic example of the seen versus the unseen. We see the little girl on the news begging for a lung so that she won’t die. We don’t see the marginal loser of the judge’s decision to place her on the list – the person on the list who just got bumped off of it so that this girl could receive a lung. That person isn’t famous. They have no Congressman fighting for them.
This is the classic example of what Ayn Rand referred to in Atlas Shrugged as “the politics of pull.” In our society, it is now political influence that decides who receives access to which goods and services. This girl is not getting a lung because her and her family were able to purchase one as the result of free and voluntary trade (note that due to her being famous and on the news, I consider it quite likely that had a free market in human organs existed, her family could have raised enough money from generous donors to purchase one), nor is she getting one because medical experts determined she was the best candidate for a transplant (in fact, they determined the opposite, that she shouldn’t even be on the list at all.) Rather, she is getting a lung because she’s somewhat famous, because Republican politicians are using her in an ill-conceived effort to embarrass government-run health care, and because some judge fails to understand basic economics. She has influence that the person at the bottom of the list before her didn’t have, therefore she will live and they will die. So in a way, Kathleen Sebelius was right.