One source of life-saving technology for people seriously hit by the flu is a ventilator. From Wikipedia:
A medical ventilator is a device designed to provide mechanical ventilation to a patient. Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesia (as a component of an anesthesia machine).
In its simplest form, a ventilator consists of a compressible air reservoir, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable "patient set". The air reservoir is pneumatically compressed several times a minute to deliver an air/oxygen mixture to the patient; when overpressure is released, the patient will exhale passively due to the lungs' elasticity. The oxygen content of the inspired gas can be set from 21 percent (ambient air) to 100 percent (pure oxygen). Pressure and flow characteristics can be set mechanically or electronically.
One problem we might very well face in the not-too-distant future is that if there is an
Avian Flu pandemic, the quantity demanded of ventilators will greatly exceed the quantity supplied. From the NYtimes [reg. req'd, h/t to Jack]:
Right now, there are 105,000 ventilators, and even during a regular flu season, about 100,000 are in use. In a worst-case human pandemic, according to the national preparedness plan issued by President Bush in November, the country would need as many as 742,500.
Economists know what to do when there is a shortage: let the market price rise until the quantity supplied increases and the quantity demanded declines. Right?
Of course if/when the flu hits, the short-term price elasticity of supply will be really close to zero. Where will the additional ventilators come from?
And so the result of letting market forces determine who gets a ventilator would be that price would rise until some relatives told the doctor, "Forget it. We'd rather have a plasma HDTV than have Dad stay on the ventilator."
Or something to that effect. After all, in the spot market for ventilators, the sick person won't be negotiating for the ventilator, the sick person's relatives will be.
Consequently, spot markets will probably never be allowed to emerge. Instead we will sit back and blame various levels of gubmnt for not making sure more ventilators are available in our community. And we will let physicians and public health officials decide who gets to use a ventilator when. As one of my physician friends says, so typically,
Ideally, issues such as prospects for survivability, expected number of years to be lived, would apply. Then more important issues such as potential social contribution (e.g. education) , good-looking index, gender, hair color (no blondes) , and race, would enter the equation.
Tom Cruise no doubt has his own ventilator as well as a stand-by staff to run it.
When I asked him making life-and-death decisions, he followed up with:
This actually happens all the time with those on transplant lists. And folks who need a hospital bed are booted out of emergency and ward beds in ALL major hospitals here daily because a more 'seriously ill' person is the successful competitor.
This approach and attitude is unfortunate, in a way. This model for allocating scarce resources ignores the long-run benefits of using market forces.
If we were told now that the only way we could get the use of a ventilator is if we paid the going rental price, a lot of us would start taking more precautionary actions now [and encouraging our children and grandchildren to take more precautionary actions now:
see this].
- To reduce the risk that we or our heirs might be forced to shell out for a ventilator [or that they might be forced to make a decision to let us die rather than be on a ventilator], we would wash our hands frequently and, when the pandemic hits, we might tend to isolate ourselves more.
- Insurance markets would develop. "Buy your ventilator insurance here!" I can just see the local newspaper ads. "We guarantee that if you pay us $X, you will have the use of a ventilator for at least a week and up to a month." I haven't found an insurance company that makes such an offer ... yet. But the providers of such insurance would already be placing more orders for ventilators, and the anticipated shortage would be much smaller as a result.
- Life insurance companies would have a large incentive to place orders for more ventilators for use by their own policy holders.
Suppose you are hit by the avian flu. Your life insurance company would like to keep you alive, and so it sends a letter to all its policy holders: Go to ABC hospital or medical centre or warehouse or whatever if you are hit by the avian flu because we have extra ventilators and staff on hand there to care for you.
- The long-run price elasticity of supply of ventilators is probably very high. If the demand grows now, and/or if current and potential producers expect to receive a market price for their ventilators (rather than have them commandeered by gubmnt officials who decry profiteering during a disaster of their making), then there will be lots more ventilators around in the future.
And yet, you and I both know that people who didn't buy the ventilator insurance would successfully convince many politicians that those who have the ventilators must provide them to those who are sick and "need" them.
This is a good situation in which we can ask the two important questions from economic analysis of law:
- What is the risk?
- Who is the least-cost bearer of that risk?
What is the risk?
The risk is not just that avian flu will spread and become transmitted between humans; in this situation, the risk is also that there will not be a ventilator available when you or I would like to have access to one.
Who is the least-cost bearer of this risk?
The answer to this question has two components. First, who is the least-cost preventer of the situation? and second, if the situation cannot efficiently be prevented, who is the least-cost insurer of the risk?
Who is the least-cost preventer of the situation? If we left health care to markets, the answer would be consumers and ventilator producers. With reasonable information and expectations, the efficient number of ventilators would be available later.
The reality is, I expect, many people do not have reasonable information and reasonable expectations. We expect "someone" to make sure ventilators will be available; we do not assume responsibility for anticipating the risk or for doing anything about it. I.e., we assume that someone else is responsible for reducing the risk by making sure more ventilators are available.
In other words, we expect gubmnts to be providers and insurers of last resort, and we eschew private insurance. If I were a consultant with insurance companies, I would be lobbying, strongly, for hospitals and gubmnts to acquire more ventilators and provide training on how to use them to a lot of people. I'm not convinced this would be an economically efficient way to deal with avian flu (and it still doesn't answer the question of who would have priorty access to them), but it seems like a realistic way that politicians and insurers will deal with the potential problem.
Update:For more on ventilators, see
here for a brief discussion of the rationing [aka "triage"] decisions to be made.
[h/t
Emirates Economist]