Ruth’s Mc’Chris by Pat Conrad MD
Last Friday night, we had a great dinner at Ruth’s Chris steak house. You know the drill, top shelf cocktails, excellent appetizers, sides from marinated mushrooms to sweet potato soufflé to lobster mac ‘n cheese, passed around over filets, strips, and porterhouses, washed down with excellent wine. And yeah, the bill was estimable, not mortgage crushing, but I couldn’t eat there every night. The point? Money buys things.
The bleeding heart known as the Associated Press has passed on another arterial spurt over how the wealthy have a better ‘in’ when it comes time to swap out an organ. The fat cats apparently are more likely to get on multiple waiting lists for organ transplants, and ““Multiple-listed patients were more likely to get transplanted and less likely to die,” said Dr. Raymond Givens at Columbia University Medical Center in New York.” NO! “It’s a rational thing to do” from an individual patient’s point of view, but it raises fairness questions, and the policy should be reconsidered, he said.” And here is where I throw my diamond-crusted TV remote against my platinum-bordered widescreen in anger, scaring the cat (who has his own stylist). Yet another doctor seeks to publicly trade on his own ostentatious compassion for the adoration of the masses.
Givens led a study that pertains to the “More than 122,000 Americans are wait-listed for an organ, including more than 100,000 who need kidneys. As of July, only 18,000 transplants have been done this year.”
“The United Network for Organ Sharing, or UNOS, the agency that runs the nation’s transplant system under a government contract, assigns organs based on a formula that considers medical urgency, tissue type, distance from the donor, time spent on the waiting list and other factors.”
And how exactly is a quasi-government organization MORE fair than the market? “UNOS has considered banning or limiting multiple listings three times, most recently in 2003, said spokesman Joel Newman.” What could be the rationale for banning multiple listings made by those with more intelligence, more drive, more connections, and yes, more wealth than their neighbors?
But some people think patients should be free to go wherever they want to improve their odds, and UNOS now requires that transplant centers tell them about this option.”
“Robert Veatch, a medical ethicist at Georgetown University Medical Center and a longtime member of the UNOS ethics committee who thinks the policy should be changed”, thinks money makes travel and searching easier for the rich. Yes, and it makes it easier to purchase a luxury car, get your kid into a private school, have a beach house, or create new corporations that create wealth and jobs for others. Come to think of it, one could make the argument that the wealthy having greater access to organ donations is of greater economic benefit to the general population, if one were willing to be pilloried by the herd media. Speaking of Jobs, Givens slams the former Apple CEO for being on multiple transplant lists and receiving a liver in Tennessee while he lived in California. Givens is intent on demonstrating his compassion: “Givens and colleagues studied UNOS records from 2000 to 2013 and found that multiple-listed patients had higher transplant rates, lower death rates while waiting, were wealthier and were more likely to have private insurance.” At this point I’m laughing, wondering whether Givens was a supporter of the ACA, telling listeners how it would promote fairness by increasing coverage…
Money buys things, and the rich will always do better than the rest. Fighting against that means fighting against the individual, which is – or ought to be – antithetical to the best of western medicine. Class warriors like Dr. Givens and the AP want to subordinate medicine to populist optics. That has been the basis for government interference in medicine, for capital cronyism with Big Insurance, and for the disaster that is the ACA. The logical extension is to serve one dollar burgers in Ruth’s Chris, and not require a jacket, all in the name of a nebulous fairness.
aw c’mon guys. you don’t need to be a raging communist or attitudinal altruist philosophy professor at Berkeley to argue that a wealth-based system for survival in the organ marketplace might need 2 b tweaked. the possible variations and factors u can add 2 make the case against an evil wealthy person (Mr. Scrooge) vs. the virtuous poor or middle class person (the single father raising 3 kids after wife died who won silver star in Iraq for saving whole platoon) are limitless. just becuz it is the way it is does not mean that’s the way it ought 2 b. Not every wealthy person who is saved is going to be a “wealth creator” whose success and goodness will trickle down to the great unwashed; and not every poor child who is saved will find a cure for leukemias. How about a lottery system ? pure chance. If 8 are a match for a kidney each has a 1 in 8 chance. wealthy will always have access to better care and care choices. but valuing 1 over another in life or death choice based on $$ seems antithetical to traditional morality and modern, American mores. Just becuz the rich women got into the lifeboats on the Titanic while the poor women drowned down in steerage 110 years ago doesn’t mean that we would accept that today.
Even if everyone made the same oney their would be other preferences. Politicians. Favored individuals. In Stalins Russia everyone was not equal. Did anyone read Animal Farm?
One of the greatest problems with altruism at a high level, is that it must be enforced all the way down the line.
Say that ACA mandates the issuance of a 24-hour pass to patients, once a year. If they present a 24-hour pass, they will be seen by their primary care physician in a routine clinic visit on the next business day. Sweet.
Everyone receives one in the mail. No charge, just part of the bounty of ACA. Well, these passes better have some “no-exchange” notification, because the chronically ill, sickly patients have just received an inadequate once-a-year pass to be seen for one (1) flareup. And the healthy patient, has something that will likely not be used, but has a value to other people. On their own, the healthy young patient will sell the pass to the sickly old. Altruism has failed on the next level down.
This will drive all sorts of finagles by the persons “being helped” to take their help as they desire to. Such secondary tuning is in violation of the interests of the state, of course.
Meanwhile, the provider’s usable treatment time is restricted, awaiting the unexpected patient. This is the purpose for which appointments were created, but the randomness of the walk-in has now spread to the clinic.
And the healthy young patient, frustrated from their “right” to trade the passes, will come to the doctor’s office anyhow before the pass expires. He/She will demand SOMETHING of value to make up for the inability to exchange the pass on the market. Some narcotics for the sore elbow, if you please.
Compassion and beneficence cannot be mandated, although they may be legitimately expressed by one’s self. We take walk-ins, although we “don’t have to.” If someone puts the fairness handcuffs on, we will simply have to stop.