WSJ.com - Commentary: Edwards and Organ Transplants

Argues that because Americans are more likely than Europeans to get a transplant, and more likely to survive it too, that this would not be possible in an American Single Payer system.

The author argues that, "Organ transplantation, like many areas of medicine, provides a poor basis for his political thesis that single-payer health care offers a more equitable allocation of scarce resources, or better clinical outcomes."

He is partially correct; a high tech treatment like organ transplant is not a good way to decide how to reform American Health Care. The staunchest advocates for Single Payer Healthcare never, ever, disparage American medicine's ability to deliver the best care in the world in areas such as organ transplant, trauma, intensive care and other high tech endeavors. But these areas are only a sliver of overall clinical outcomes. Even at the quoted 18.5 liver transplants per million done in the US annually, this is only 5000 or so patients. So, while not being dismissive of these patients, they are not reflective of healthcare outcomes of our population. They only reflect what we already know: We spend tons of money on advancing high tech medicine and we are darn good at it. As I view the transition to single payer, I see no reason, other than "conservatives" wailing about unnecessary spending on healthcare as the system matures, for us to continue to do well in our "American specialty" of bleeding edge healthcare.

Yet, the point about a single payer system not offering a more equitable allocation strikes me as intuitively, obviously false, and I don't believe the author tries to refute the point other than pointing out that we do more liver transplants in the US than elsewhere. A strange point is also made about the threat of the government deciding who gets the organs. I think most of us would gladly take a standard set of criteria developed by the NIH, UNOS, or other agency, applied fairly and equitably across all socioeconomic and ethnic categories by a Medicare-like agency, rather than the inherently conflicted interests of a private insurer!

And finally, since we spend twice as much on healthcare, shouldn't we do twice as much of everything, not just liver transplants? Preventive care and prescription drug benefits come to mind immediately, but you can pick your own favorite.

Cheers,

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