April 11th, 2006


The Value of a Human Life

telnar got a copy of In Our Hands and picked one up for me while he was at it. That's Charles Murray's book outlining his arguments for "the Plan" (or, as zaimoni put it much more catchily, "an existance wage").

The book is surprisingly readable; it took me less time to read than two of the four novels I've read this year. Mr. Murray is an economist, but this book is written for laymen. It's more a call for further experimentation and study than a study itself. Even so, it's well-researched for the most part, and extensively footnoted. Some chapters are more speculation and argument-from-logic than from studies, but the early portions -- particularly his analysis of the costs of the Plan -- are solidly grounded in publicly-available facts.

One of the most interesting aspects of this is that there's no question that an existance wage would be quite affordable in the near future. It's surprisingly close to affordable right now. Mr. Murray proposes to eliminate all current state, local, and federal entitlement and income-transfer programs. He details all of these, line by line, for 2002 (presumably because at the time he started the book that was the most recent year for which all necessary figures were available) in Appendix A of the book. Existing programs for 2002 come out to $1.385 trillion. In 2002, the existance wage would have cost $1.78 trillion. (These are Murray's figures, and his version of the existance wage is slightly cheaper than a pure $10,000-per-citizen-over-21 plan would be because Murray's plan includes a 20% surtax on income between $25000 and $50000 -- which works out to paying back up to $5000 of the grant. The Plan he proposes otherwise assumes no changes to existing tax revenue.)

Now, even by the standards of the US government, the shortfall of $355 billion is a lot of money. But that was in 2002. And even in 2002, we were spending enough to give a check for $6900 to every American citizen over the age of 21. Wow. That's a lot of entitlements.

Projecting forward, the existance wage gets increasingly more affordable in comparison with the present system of entitlement programs. By 2011, the costs of the two are comparable. By 2020, the existance wage is over half a trillion dollars cheaper.

There's no question that this would be affordable in raw dollar terms. Even the direst predictions for Social Security and Medicare (the largest fraction of the income-transfer programs to be eliminated) won't go bankrupt for some decades to come. The existance wage program wouldn't go bankrupt at all -- assuming no changes in economic growth. Which is, I will grant, a big assumption. Still, it's interesting, because I thought question of "could we pay for it?" was at least as big as the question of "would it destroy our economy if we did?" But it turns out the answer to the first is a pretty straightforward "yes, in the near future". The answer to the second is obviously up for debate. >:)

The book spends a chapter on health insurance, making some interesting proposals. Like a good libertarian, he emphasizes the individual's right to choose over the state's compulsion to make everyone do whatever it thinks is best. He gave human examples like "If someone chooses not to get insurance that will cover costly end-of-life care, they will not receive hundreds of thousands of dollars of care in the last few months of their life."

This talks around another point.

No one wants to be the one to put a pricetag on a human life. No one wants to say "Grandma can't have 24-hour care because we can't afford it." No one wants to say "You can't have this drug that will keep you alive and relatively healthy for the next 20 or 30 years, instead of dead within 4 or 5, because it costs $200,000 per year and we can't afford it." (This example is based on a real course of treatment.)

And we can say "that's why the government should socialize medicine, so that no one will have to put a price tag on how much care you get." Or "that's why everyone should have insurance".

But you know what? It doesn't matter. It doesn't matter if you say it's my choice, or the governments, or a hospital's or an insurance company or all of the above: in the end, there is always a price, and someone, some human being somewhere, has to decide whether or not to pay it.

Does it make it better if it's a government bureaucracy deciding not to fund research on a promising treatment for a dehibilitating disease that only effects one person out of two million? Or a hospital charity that decides not pay for the treatment that will let a near-blind child see because they need the money for a program to vaccinate hundreds more? Is it better if it was you deciding ten years ago not to pay that extra premium for care you figured you'd never need -- but now you do?

Mr. Murray points out one hopeful fact: mainstream, ordinary health care is getting better and cheaper. Surgeries that cost tens of thousands decades ago and required hospitalization can be done as outpatient procedures at a fraction of the costs. Technology helps here, too: getting better, getting more common, getting cheaper.

But at the margins, it spirals ever upwards. Conditions that would've killed infants a hundred years ago can be treated, staved off for years, decades -- for an average lifespan, even. There is more that could be done, more avenues that might be researched, more treatments that might be tried.

But there's a cost.

There will always be a cost.

You can change who decides, and you can change how they decide -- but you cannot change the fact that somewhere, some human being, will have to choose.