America’s medical system has flaws, but government control is no cure
Last December, Nataline Sarkisyan, a comatose leukemia patient, failed to receive a liver transplant potentially in time to save her life. Politically motivated opportunists such as former presidential candidate John Edwards have been exploiting the 17-year-old’s tragic death to promote government health care. If anything, this case should turn us away from that course.
The standard-bearers in this public fight, including the California Nurses Association, filmmaker Michael Moore and the young woman’s family, lay her death at the door of CIGNA, a for-profit health insurer. CIGNA, which covered Nataline under her family’s employer-provided insurance plan, initially recommended not paying for the “experimental” transplant, and then changed its decision too late.
Liver transplants have been conducted since 1967 with rapidly increasing sophistication and success. Why the operation was experimental remains unclear. And we may never know why because CIGNA is legally prohibited from disclosing any information specific to Nataline’s condition. The gag on CIGNA only encourages organizations such as the nurses association to transform this tragedy into a demand for government-controlled, so-called universal health care.
The facts say otherwise. First, under any system, there are just not enough organs donated to satisfy the need.
Like every other Canadian, I belonged to a universal government-monopoly health plan before I moved to California. The organ shortage is so acute in the province of Ontario that the government formed a special commission, the Citizens Panel on Increasing Organ Donations, which reported last March that “people do die while on the waiting list.”
Who gets on the waiting list? In 1999, the Canadian Coordinating Office for Health Technology Assessment surveyed transplant units across the country. Age, mental competence, alcohol or drug use, HIV and other illnesses were all factors in getting on a waiting list. That certainly falls short of the universal concept so beloved of presidential candidates.
In Britain, where the government also promises universal health care, guidelines indicate that liver transplantation should not be performed when the chances of surviving for five years are less than half. According to the media, Nataline’s doctors figure she had a 65 percent chance of surviving six months after the transplant, and an 85 percent chance of staying in remission from leukemia. Overall, that’s a 55 percent chance of long-term survival — not much more than the British guidelines.
These are dreadful decisions, and those of us who do not have to make them should be glad of it. In 2007, there were 629 liver transplants in California, but there are still 3,712 Californians on the waiting list, according to the Organ Procurement and Transportation Network.
Extraordinary innovations in transplantation and donation have created an upward spiral: more transplants, more donations and longer waiting lists in the United States. Nataline, however, had beaten the waiting list. There was a liver for her.
According to the American Liver Foundation, the sickest patients go to the front of the line in the United States, which is not the case in other countries. Indeed, a peer-reviewed medical journal article reported that many more livers were available in the United States (21.3 per 1 million people compared with 13.1 per 1 million people in Britain, in 2000).
Consequently, American patients with chronic liver disease were almost two-thirds more likely to receive transplants.
On the other hand, more U.S. patients died on the waiting list (7.61 per 1 million) than British patients (0.96 per 1 million), and there was a longer waiting time for a transplant in the United States than in Britain (218 days versus 34 days). The reason for this is not that the British are healthier; they also suffer and die from chronic liver disease. Indeed, the authors’ conclusion suggests that sicker British patients simply never get on a waiting list at all.
There is more rationing — and most of it hidden — under British universal health care than under American health care, which is more aggressive and transparent.
Advocates of a universal, government-run health-care system cite Nataline’s story as evidence in their favor. But if such a system were already in place, it’s unlikely that even this small part of her story would have emerged.
This young woman, and many others like her, would be nameless victims of a government bureaucracy that never gave them a chance, a far harsher judge of who lives and dies than CIGNA or any other private insurer.
John R. Graham is director of health-care studies at the Pacific Research Institute.