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(HealthNewsDigest.com) – Death panels, public options, and raucous town hall meetings: The language of our health care debate grows contentious. Disinformation, dissimulation, and disruption rule the day. Despite a recession that proves free markets cannot solve every problem, people yell: “Keep the government out of my health care!”
But the government has been involved in health care for decades. Medical practice, hospital operations, and insurance companies—as well as Medicare and Medicaid—have always been regulated. Under any version of health care reform, the government will still be involved. Issues like preventing denial of coverage for preexisting conditions and providing coverage for 46 million uninsured Americans dominate today’s agenda.
Many of these issues focus on the growing disparities between the health care options available to the rich and the poor.
Into the breach comes Pennsylvania Senator Arlen Specter. His town hall meetings have resembled bloody wrestling matches more than Q-and-A sessions. Yet he represents the vanguard of health care reform, not only in the broader context that captures the headlines, but also in the context of our organ transplant crisis. Over 100,000 Americans wait “on the list” for life-saving organs; 18 die every day. That’s 6500 per year—over twice the number lost on 9/11. And each of those deaths is preventable.
Our organ transplant system desperately needs reform. Though ostensibly neutral, it is in practice skewed in favor of the rich. Its dysfunctions epitomize what is wrong with our health care regime.
When Steve Jobs, cofounder of Apple, received a liver transplant recently, the inequities of the system returned to the spotlight. Didn’t he jump to the top of the waiting list overnight? What reason could be given, other than wealth or influence?
The issue dates to the days of Mickey Mantle, the Yankee slugger accused of receiving favoritism when he needed a liver transplant. But reality is more complex than myth.
In reality, no amount of money, power, or influence gets you “moved up” on the official waiting list. Steve Jobs could not pay to get moved up. But he could take advantage of the differences between the rules governing livers and the rules governing kidneys. With livers, medical necessity is the critical factor. With kidneys, which account for over 3/4 of all organ transplants, it’s all about your time spent waiting on the list.
What’s more, Steve Jobs could take advantage of his wealth to pursue opportunities not available to others. Knowing the waiting lists vary by region, he could travel to those parts of the country where the lists are shortest. He could ignore the limits of typical health insurance policies and sign up for a transplant at multiple hospitals. And he could board his private jet and fly to the hospital on a moment’s notice when an organ became available.
We must distinguish between myths and realities when it comes to organ transplants. Only then can the inequities be addressed. The United Network for Organ Sharing, which administers America’s organ transplant system, will meet next spring to address the issues of geographic variation and socioeconomic variation.
Meanwhile, Sen. Specter is sponsoring the Organ Trafficking Prohibition Act of 2009. This legislation would tighten the prohibition against the buying and selling of organs for transplantation while authorizing the States to experiment with non-cash benefits for donors. The bill intends to boost organ donations by allowing incentives to donors.
The difference between providing incentives for donation and making a “free market” where buyers and sellers would bargain for the price of transplant organs—is critical.
The benefits authorized by Specter’s bill would include tax credits, health insurance, life insurance, burial costs, and similar incentives. The draft legislation states the “provision of a gratuitous benefit to organ donors is not commercial in nature and does not constitute a commercial sales transaction.”
Israel already has a law, enacted in 2008, that provides benefits to organ donors, such as increased health care and social security. Such innovations are essential to close the gap between the number of people needing organs and the number willing to donate.
Americans should embrace this type of law. In the case of kidneys, for example, it is far less expensive to give an ailing person a transplant than giving him dialysis for years on end. While we debate the contours of health care reform, we should not ignore the specific problem of fixing our failing organ transplant system.
HARLAN ABRAHAMS is the writer and co-author of ON THE LIST: Fixing America’s Failing Organ Transplant System (RODALE 2009). In it he describes the growing global markets for human transplant organs while telling the stories of two men, one rich and one poor, who find themselves lost in America’s organ transplant labyrinth.
A Denver-based lawyer, author, and former professor of law, Abrahams earned his BS and JD from the University of Nebraska and his LLM from the Harvard Law School. He began teaching at age 24 and has taught at five law schools. At age 29, he was the youngest professor to be granted tenure at his university. As a law professor he has taught many courses including Constitutional Law, First Amendment Rights & Liberties, Administrative Law, Antitrust, Regulation of the Competitive Process, Jurisprudence, and Intellectual Property.
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