Selected
Links with Internet Citations
Back to
Targeting in Social Programs Home
Or Select
Another Chapter:
Chapter 2,
Chapter 3,
Chapter 4,
Chapter 5,
Chapters 6 and 7
Chapter 4
2. See Ron Haskins and
Isabel V. Sawhill, “Work
and Marriage: The Way to End Poverty and Welfare” Policy
Brief: Welfare Reform and Beyond no. 28 (Brookings,
September 2003). The simulation indicates that if every
family head had a high school education and earned what high
school graduates earned, the poverty rate among families
with children would decline by nearly two percentage points.
5. Donald Shepard and
Richard Zeckhauser,”Where Now for Saving Lives?” Law and
Contemporary Problems 40, no. 4 (1976): 5–45. See also
Matthew D. Adler, “QALYs
and Policy Evaluation: A New Perspective,” Yale Journal
of Health Policy, Law, and Ethics, vol. 6, no. 1, 2006, p.
1.
7. See generally Orley C. Ashenfelter, “Measuring
the Value of a Statistical Life: Problems and Prospects,”
IZA Discussion Paper No. 1911 (Bonn: Institute for the Study
of Labor, January 2006).
8. W. Kip Viscusi and
Joseph E. Aldy, “The
Value of a Statistical Life: A Critical Review of Market
Estimates Throughout the World.” Journal of Risk and
Uncertainty 27, no. 1 (2003): 5. These same authors
compute the value of a life year at various ages, finding a
value of $263,000 at age 30. W. Kip Viscusi and Joseph E.
Aldy, “Age
Variations in Workers’ Value of Statistical Life,”
Harvard Olin Discussion Paper 468 (Cambridge, Mass: National
Bureau of Economic Research, 2004).
11. Gardiner Harris, “Panel
Unanimously Recommends Cervical Cancer Vaccine for Girls 11
and Up,” New York Times, at A10.
12.
Allen
R. Myerson, “Ideas and Trends;
Final Stats: Mantle’s Law Medical Bills,” New York
Times, Aug. 20, 1995, at A5.
13.
Idem.
14. One prominent surgeon refers to the allure of “those
pesky little miracles” in an email from
Dr. Randolph Reinhold, Chairman of Surgery, Hospital of
Saint Raphael, New Haven, CT, to Peter Schuck, July 11,
2005.
15.
American Medical Association, Code of Ethics, §2.03
Allocation of Limited Medical Resources. Appendix One,
infra, contains all excerpts from the code of ethics
related to futile care determinations.
16. The Supreme Court of
Canada has held that the government’s health agency may not
bar individuals from purchasing private health care in
situations when receiving care in the public system would
take too long.
Chaoulli v. Quebec, 1 S.C.R. 791 (2005).
The European Court of Justice has ruled that the British
government must pay the costs of patients who seek treatment
elsewhere in the European Union because of undue delay in
getting treatment at home. Sarah Lyall, “Britain:
Delayed Patients Can Have Operations Abroad,” New
York Times, May 17, 2006, p. A8.
17. See, for example,
Stephen Breyer, Breaking the Vicious Circle
(Harvard University Press, 1993). Breyer reports a
government study of a variety of regulations intended to
save lives. The costs (in 1990 dollars) for a premature
death avoided ranged from $100,000 (ban on unvented space
heaters) to $92 billion (atrazine and alachor drinking water
standard). One regulation actually cost 60 times as much as
the $92 billion standard, but the estimate seemed out of
line. Ibid., pp. 24–27. Breyer’s analysis seeks ways
to overcome vast inefficiencies in regulations, by placing
such extreme bad bets at the top end of the cost
distribution. Since only statistical losses are involved in
regulatory policy choices, such reforms are likely to be
politically and psychologically easier to adopt than
decisions to withhold benefits from the identified bad bets
who are our subject.
18. Lisa A. Prosser and others, “Cost-Effectiveness
of Cholesterol-Lowering Therapies according to Selected
Patient Characteristics,” Annals of Internal Medicine
132(10) (May 16, 2000), pp. 769-779.
20. Henry J. Aaron and William B. Schwartz with Melissa
Cox,
Can We Say No? The Challenge of Rationing Health Care
(Brookings, 2005), pp. 36–37 and 42.
22. Eric Nagourny. “Transplants:
For Kidneys, Age Matters Little.” New York Times,
March 15, 2005, sec. F, p. 6.
23. James Lubitz, James
Beebe, and Colin Baker, “Longevity
and Medical Expenditures,” New England Journal of
Medicine 332 (April 10, 1995): 999–1003.
24. All figures are from
James D. Lubitz and Gerald F. Riley, “Trends
in Medicare Payments in the Last Year of Life,” New
England Journal of Medicine 328 (April 15, 1993):
1092–96.
25. See Daniel Altman, “How
to Save Medicare? Die Sooner,” New York Times,
February 27, 2005, Business sec., p. 1 (citing Dr. Gail
Wilensky, Project HOPE).
29. See
John A. Robertson, “Schiavo and Its (In)Significance,”
Public Law Research Paper No. 86 (University of Texas Law
School, 2006).
30. This oft-quoted threshold originated from Lawrence J.
Schneiderman and others, “Medical
Futility: Its Meaning and Ethical Implications,”
Annals of Internal Medicine
112 (1990): 949. They defined quantitative futility
as a situation when physicians determine that a particular
medical treatment has been useless in the past 100
(presumably similarly situated) cases, through empirical
data, information from other physicians, or personal
experience.
32. See, for example, Rurik Löfmark and Tore Nilstun, “Conditions
and Consequences of Medical Futility—From Literature Review
to a Clinical Model,” Journal of Medical Ethics
28 (2002): 115-119.
33.
Ibid., 115, 117. The authors do acknowledge that these
differing decisions maintained within the same article “may
reflect the complexity of the situation arising when trying
to decide who should decide: the doctor or patient.” Ibid.,
118.
34. Catherine M. Breen and others, “Conflict
Associated with Decisions to Limit Life-Sustaining Treatment
in Intensive Care Units,” Journal of General Internal
Medicine 16 (2001): 283.
40. Thomas J. Prendergast and John M.
Luce, “Increasing
Incidence of Withholding and Withdrawal of Life Support from
the Critically Ill,” American Journal of Respiratory
Critical Care Medicine 155 (1997): 15.
42. Gina Kolata, “Medicare
Says It Will Pay, but Patients Say ‘No Thanks,’” New
York Times, March 3, 2006, p. C1.
43. We thank
Samuel Osher, MD, Harvard University Group Health Plan,
for this example. We assume that few patients would make
their decisions on the basis of the additional information
that such a choice would free up the resources for better
bets.
44. See Daniel Altman, “How
to Save Medicare? Die Sooner.” Apparently, there is
little research about whether hospice care saves money.
Ibid.
46. Donald Berwick, “As
Good as It Should Get: Making Health Care Better in the New
Millennium (Cambridge, Mass.: Institute for Healthcare
Improvement, 1998).
47. The most extensive studies have been undertaken by a
research group at
Dartmouth. They found that higher-spending regions of
the country received approximately 60 percent more care,
with no gains in outcomes.
48. See, for example, Ron Winslow, “Care
Varies Widely At Top Medical Centers,” Wall Street
Journal, May 16, 2006, p. D1.
50. Gary L. Gaumer and
Joanna Stavins, “Medicare
Use in the Last Ninety Days of Life,” Health Services
Research 26, no. 6 (February 1992): 725–42.
52. See Alan S. Gerber and Eric M. Patashnik,
Promoting the General Welfare: New Perspectives on
Government Performance
(Brookings, forthcoming), chapter 3; John
Carey, “Medical Guesswork,” Business Week, May 29,
2006, p. 72.
53. See Alex Berenson, “Cancer
Drugs Offer Hope, but at Huge Expense,” New York
Times, July 12, 2005, p. A1.
60. See, for example, Gardiner Harris, “Money
for Vaccinating Children Is Diverted for Experimental Adult
Flu Shots, Officials Say,” New York Times,
December 16, 2004, p. A28.
61. Jacob S. Hacker, “False
Positive,” New Republic, August 16 and 23, 2004,
pp. 14, 16 (citing research of Julia Lynch). See also
Gardiner Harris, “Money
for Vaccinating Children Is Diverted for Experimental Adult
Flu Shots, Officials Say,”
New York Times, December 16, 2004, p. A28.
62. See, for example, our
discussion above of the use of statins to lower cholesterol,
which tends not to be given to low-risk groups, even though
they receive some positive benefit. With other drug
treatments, there is a failure to avoid bad bets. There is
a choice in drugs given post-heart attack, to reduce future
risk, namely streptokinase versus the much more expensive
TPA. TPA offers significant additional benefits to some
groups, but virtually none to others. Nevertheless, it is
almost always the drug that is given.
David Cutler, Harvard University, private communication,
July 6, 2006.
65. Department of Education
Press Release, Secretary Spellings Announces New Student
Loan Default Rate, Sept. 15, 2005, available at
http://www.ed.gov/news/pressreleases/2005/09/09142005.html.
Fortunately, default rates
have been moving in the right direction. In 2003, apparently
the latest year for which figures are available, default
rates were only 4.5 percent, down from it’s peak of 22.4
percent of student borrowers in 1990. Jon Marcus, “Debt Up
But Defaults Down,” Times Higher Education Supplement,
Sept. 30, 2005, no. 1711, p. 13. Trends in default rates
are also available on the
Department of Education website.
67. Jonathan Kahn, “How
a Drug Becomes ‘Ethnic’: Law, Commerce, and the Production
of Racial Categories in Medicine,” Yale Journal of
Health Policy, Law, & Ethics 4 (2004): 1. See also
Economist, “Not a Black and White Question” April
15, 2006, pp. 79–80.
