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I have to admit that as a relatively healthy late middle-aged male, I don’t think a lot about my own death. My own physical exercise is undertaken, I guess, to stave off death as long as possible but as I suffer from no chronic ailments at this time and come from a very long-lived gene pool, I would rather focus on  other things.  I am a little worried that “they” want to take away my Medicare but don’t dwell on my upcoming but distant 7th decade at this time. The discussion over the “sustainability” of Medicare has downplayed the provisions in the Affordable Care Act that should lead to reduced cost in Medicare, discussed here. Instead, the discussion has focused on the House proposal to give patients a sum of money (tied to the consumer price index so effectively being reduced every year)  under the assumption that “the market,” when unregulated, will lead to better, less expensive health.

I found myself reflecting on life, death, the human condition, and the health care market today while reading the paper. There was an article about “medical tourism,” but not the good kind. This author interviews the mother of a gentleman who died. He was paid for a kidney (perhaps why God gives us two, kind of a savings plan for poor people who in their time of desperate need can have $5,000 US “withdrawn” from their back) but unfortunately died post-operatively. The recipient, after returning to the US, also died of complications of the procedure.

Per this article:

For decades, wealthy Brazilians, Mexicans and Saudis have gone to U.S. and European hospitals for medical care they couldn’t get at home. In the past decade, that pattern has changed. Hospitals from Puerto Vallarta, Mexico, to Medellin, Colombia, now lure middle-class Americans with promises of high-quality care at a fraction of what it would cost them at home.

Medical tourism company MedToGo, based in Tempe, Ariz., says it will offer kidney transplants in Mexico and Costa Rica for about $50,000, a fifth of the cost in the U.S.

In the illegal organ trade, brokers scour the world’s slums, preying on the poor with promises of easy money in exchange for a kidney.

In Colombia, 321 foreigners got transplants from 2005 to 2010, according to the country’s National Health Institute. Juan Lopez, a doctor who oversees Colombia’s organ transplant system as director of the NHI, says many of these surgeries are driven by profit for hospitals, doctors and brokers.

Turns out that a poor person from the slums is willing to sell a paired organ (a kidney, for example) for what seems like a lot of money to them ($5,000) and a non-poor person is willing to pay what seems like a reasonable amount of money ($150,000) for that same organ. The market works, and not in a way that makes me feel good. I am afraid that the Title Pawn industry will have nothing on the organ procurement industry when it comes to market forces and unsavory behaviors. I am convinced that vouchers will not lead to a reduction in health care costs. On the contrary, it will lead to more folks seeking out more health care as they approach death and are made promises that will never be kept. It may result in  people entering into contracts which reduce human dignity and increase the suffering of others.  People in ill health who are desperate will not only supplement their vouchers with their personal fortune, but will potentially pay with their shortened  life as the burden of iatrogenic illness increases.
The Affordable Care Act includes strong market regulation. The market prior to the passage of the Affordable Care Act, although poorly regulated, at least had sufficient regulation to prevent trafficking in human organs. When our friends return from another country with their brand new kidney, will we congratulate them on getting quite the bargain? If vouchers were enacted for Medicare, would we allow those who can afford it to get the same bargain here?