A Healthy Market

Wheaton College Philosophy Professor Stephen Mathis questions “how appropriate it is to address health concerns using a for-profit model”:

Consider that we have numerous treatments for erectile dysfunction, while drug companies have resisted putting resources into finding a cure for malaria, a disease most prevalent in poorer countries.

Professor Mathis might profit from a viewing of my video blog describing the effects of attempts at manipulating economic behavior. We have treatments for erectile dysfunction because people want them. Reformulating the healthcare system in such a way as to deny that sort of research and to force investment in other areas of less market demand will not have the intended effect and will require escalating infringements on freedom.
For the individual, the choice isn’t between cures for erectile dysfunction and malaria research, but between cures for erectile dysfunction and a new car (or whatever else the individual might spend his money on). Push hard enough, and the choice becomes one between funding malaria research and declining to work so hard or take financial risks with the hope of prospering.
Mathis has other misconceptions about medicine and the market:

First, we tend to think it inappropriate to profit from others’ misfortunes, whether they are illnesses or accidents. This also helps explain why our police and fire departments are all either government-funded or volunteer. So when it comes to protecting lives or saving them, we disapprove of those who profit from others’ misfortunes because they take advantage of others when they are vulnerable.
Second, we have laws against buying and selling human organs. We do not let individuals buy or sell organs because we think it is inappropriate to put a price tag on such things as bodily organs. This also explains why we do let individuals donate organs.

In the first case, I’d suggest that it isn’t an abstract sense of appropriateness at play, but of danger. Nobody begrudges financial gain for those who save lives; rather, we’re wary of circumstances in which lifesavers could leverage dire need at a crucial moment in order to extort greater payment. It’s not that we have a moral problem with police and firefighters making a healthy living for their services and the risks that they take; it’s that we fear a scenario in which they stand at the door with their hands out before collaring the murderer or dousing the flames. The former is a matter of compensation; the latter is a matter of complicity in crime and destruction.
Similarly, in the second case, we don’t fear that devaluing organs through sale will devalue their owners. The devaluation of the person comes first. If you’re a person with explicit dominion over your body, then others must approach you as a being capable of making decisions, a peer; if you’re a shell for valuable organs, then others can focus on plying those organs from you. Consider:

… outlawing organ sales is a way of making clear that, as a society, we think individuals should never have to face certain decisions — say, between filing for bankruptcy or selling a kidney.

Wrong. Outlawing organ sales is a way of preventing immoral actors from targeting your finances as a means of acquiring your kidney. Indeed, it cannot be moral, and it devalues organs, to declare that a man must watch his family suffer because we’ve erased his kidney’s market value. Not allowing individuals to “face certain decisions” doesn’t relieve them of the horror of their circumstances. In that case, organs are literally worthless, except insofar as they keep individuals sufficiently healthy to make of themselves workhorses. But it devalues the entire person — and his family, too — if constructing an economy full of pitfalls can push him toward harvesting his body. In other words, it isn’t the decisions of the individual against which we’re guarding, but the decisions of the entire society.
The implications for our healthcare system are straightforward. My premise is that we restrict acute freedoms (such as selling one’s organs) and circumscribe the profitability of safety in order to protect the vulnerable from the powerful. Consolidating healthcare decisions and handing the powerful a right to make them hardly alleviates that danger.

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Russ
Russ
12 years ago

“We have treatments for erectile dysfunction because people want them.”
Yes, unlike children dying of malaria which we clearly want more of (each year 250 million are infected, more than 1 million people die). Oh wait, you meant rich people. Talk about “devaluing” the individual.

Tabetha
Tabetha
12 years ago

There actually are some wealthy investors who are funding malaria research – of particular note, Bill and Melinda Gates:
http://www.gatesfoundation.org/topics/pages/malaria.aspx
I think that the issue is that the government should not be instructing private, for-profit businesses on how to invest their funds. Raising awareness for less outwardly profitable ventures will generally bring to light private investors who wish to contribute to a cause (like the Gates family). Plenty of private investors do support needed research and development in third world countries. I don’t think that we need to abolish a free market economy to get this kind of work to happen. We just need to pay more attention to problems worldwide and get the word out to those who are able and willing to help.

Justin Katz
12 years ago

And change the culture (a point that I’d intended to make in the post but neglected). If sex weren’t quite such an end-all-be-all of our culture, there’d be less demand for ED treatments.

Tabetha
Tabetha
12 years ago

Well, I don’t think sex should be an end-all-be-all but it is definitely a meaningful and important part of most relationships. I think it is probably very distressing for men and their partners who face this problem. It isn’t a life-and-death matter but ED treatments can certainly add joy to a person’s life and relationship.

Justin Katz
12 years ago

So can investment in ending other diseases, such as malaria. Our society treats sex as much more important than it ought to be.

Tabetha
Tabetha
12 years ago

Justin, you said: “Professor Mathis might profit from a viewing of my video blog describing the effects of attempts at manipulating economic behavior. We have treatments for erectile dysfunction because people want them. Reformulating the healthcare system in such a way as to deny that sort of research and to force investment in other areas of less market demand will not have the intended effect and will require escalating infringements on freedom. For the individual, the choice isn’t between cures for erectile dysfunction and malaria research, but between cures for erectile dysfunction and a new car (or whatever else the individual might spend his money on). Push hard enough, and the choice becomes one between funding malaria research and declining to work so hard or take financial risks with the hope of prospering.” I thought we were pretty much on the same page here. Of course malaria is a more pressing concern than ED, but in a country where people are making choices based on their personal economic freedom, the market must rise to meet the demand of the consumers. My take it that we should be raising awareness for world health concerns such as malaria, AIDS, etc. Raising awareness can cause an effect where donors with means will privately fund these causes (e.g., the Gateses). Some big drug companies may also make the choice to do so in favor of getting tax breaks. However, it seems that you are just as much opposed to government overregulation of private industry as I am. Thus I am wondering why this seems to be a point of argument at all. While you may feel the culture puts too much emphasis on sex (and I don’t disagree with this statement), people are not going to suddenly start embracing sexless marriages and insisting that… Read more »

Justin Katz
12 years ago

We’re not arguing. I was merely amplifying your point by suggesting that people can find joy out of helping others, not just through physical intimacy. You can raise awareness all you want, but those who privilege erectile dysfunction treatments, within the context of our sex-besotted culture, will still think curing their own ailment to be a more important application of their money.
Of course, there are a great number of luxuries that each of us, in the West, might be ashamed to admit are more important to us than the lives of distant children, and I’m by no means exempt from that. I was merely going with the examples given, stating that trying to force redistribution of funds won’t have the effects that social engineers desire, and suggesting that working on the culture would be a less-coercive and ultimately more effective means of changing behavior.

Tabetha
Tabetha
12 years ago

I agree with that. Perhaps the world would be a better place if people were more focused on helping one another than on indulging themselves. It can’t and shouldn’t be enforced, but perhaps it could be encouraged.

Stephen Mathis
Stephen Mathis
12 years ago

Thanks Justin for your thoughtful response to my op-ed and the wonderful conversation that has followed in the comments here.
The ED/malaria point got a lot of play here, but I didn’t put nearly as much emphasis on it in my piece as you made it seem, and I’d certainly agree with your concern that trying to influence markets is an endeavor fraught with peril. I was just trying to give an example of how a market-based model of health care, one that appeals to preferences, can lead to skewed priorities in some areas like pharmaceutical research. It’s not that I want to force companies not to develop ED treatments–it’s more that if the goal of the system is health, a market-based system driven by preferences may not always promote that goal in a straightforward way.
But I totally agree with your very nice point about our culture making sex into the end-all/be-all.
As for your last point, I don’t think our views are that far apart: I think the ultimate problem with devaluing people or their organs is problematic precisely because it makes them vulnerable to more powerful folks. But I do disagree that disallowing a price tag on organs makes them worthless: I think it simply makes them incommensurable with money, which marks off their special status as things that are unlike everyday commodities. The same goes for laws outlawing the selling of sex. Making it impossible to buy or sell sex doesn’t make it worthless, rather it delineates it as something so special it shouldn’t be open to the pressures of the market (that usually come from the powerful/rich).
Thanks again for your blog post!

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