Suppose you were an emergency room physician on triage duty and chance forced you to choose between saving one of these two patients:
- (a) A 40-year-old college graduate or a 20-year-old high school dropout?
- (b) A 50-year-old scientist or a 30-year-old derelict?
- (c) A brain-damaged child or a healthy young adult?
- (d) A 40-year-old successful entrepreneur or a 30-year-old day laborer?
- (e) A 30-year-old concert pianist mother or a 20-year-old welfare mother?
I believe that most people, most of the time would choose to save the patient who is likely to make the greatest contribution to national well-being. That is, most people will allocate care in order to maximize national output broadly defined. (Broadly means, considering not just GDP, but also things that aren’t well measured by GDP, such as contributions to the arts and sciences.)
The problem is that no one gave him the authority to make that value judgment. In the ER the triage nurse makes decisions based on the criticality of the presentation, often cardiac problems, GSW and the like get first place. Now a GSW on a known criminal presented at the same time as a police officer, perhaps in the same incident even then take precedence often based on criticality.
But the new position of Comparative Clinical Effectiveness Czar, for Medicare, in the case of Dr Berwick could raise these questions to a higher plane of reality, personal reality.
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