JamulBlog

Let market forces work their magic, dammit!  Megan McArdle has a fascinating post up about the potential consequences of a robotic anesthesiology machine.  This machine handles routine anesthesiology at a fraction of the cost of a human anesthesiologist, and (so far) with similar or better outcomes.  But it's not the machine itself that's so interesting, but rather one of the potential consequences of it.  Says Megan:

...[one] possibility is that this procedure will dramatically control costs, at a slightly elevated risk of patient death. And that’s a tough one. Are we willing to pay billions every year to prevent a handful of deaths?

This is a key management decision in any top-down managed healthcare system, like ObamaCare or the British National Health Service.  The main way they have to control costs is by limiting what sort of services they'll pay for.  It's very easy to imagine that under ObamaCare, human anesthesiologists won't be covered for certain kinds of procedures, but the robotic anesthesiology machine would – even if the use of that machine killed (say) 10 people a year who would have survived with a human anesthesiologist.  If that decision saved $10 billion a year, the bureaucrats in charge would likely have no problem deciding that $1 billion per life “saved” was simply too expensive.  That, by the way, is exactly what Sarah Palin meant by her appellation “death panel” for these bureaucratic committees making these decisions.

What Megan misses, though, is the central moral problem with this sort of top-down decision.  It assumes that some authority knows better than any individual what is best for them.  I don't want some central authority making decisions like that – I want to make those decisions for myself.  If I was faced with this specific decision about anesthesiology, I'd inform myself about the extra cost for the human anesthesiologist, the extra risks for the robotic version, and then I'd make up my own mind. 

I've actually already had something very close to this happen to me, though the outcome was distorted a bit by our current crazy system of health “insurance”.  Some years ago my dentist informed me that I needed to have my wisdom teeth removed.  This would be done by an oral surgeon, who informed me that I'd be under anesthesia for the procedure.  Now I knew that there was a small risk of irreversible brain damage (usually minor) during general anesthesia, but not under local anesthesia – so I asked if the local was a possibility.  The surprised surgeon (who had never had anyone ask him this before) said that yes, it was – but that he'd have to get a different and more expensive anesthesiologist to do it.  This was arranged without any additional expense to me, as my company's insurance plan covered the costs either way.  The surgeon told me afterwards that the local cost about $1,100 more than the general.  If that extra cost had been passed along to me, I most likely would have made the same decision – though I'm certain I'd have thought more about it :)

Anyway, my main point here is that the robotic anesthesiology decision really should be made by the patient – and the cost difference really should be borne by the patient as well.  Different patients would make different decisions – and that market would provide two very positive incentives: (1) for the human anesthesiologists to reduce their cost, and (2) for the robotic anesthesiology machines to improve their performance.  This sort of distributed decision making is the essence of “market forces”, and everybody wins when it is freely employed.  The top-down decision-making inherent in systems like ObamaCare destroys those key incentives while forcing some bureaucrat's decision down our throats...