Compassion for Unidentified Lives

COMPASSION FOR UNIDENTIFIED LIVES
“Statistics are people with the tears washed off.”

Paraphrasing economist Kenneth Boulding, one of the basic dilemmas of public policy is that all of our policy experience deals with the past, and all our decisions relate to the future. These policy decisions will be exacerbated by the very successes of our past. The incredible bounty of the interaction between a sparsely populated continent filled with abundant resources and an energetic people has masked the need for making hard choices. It has allowed us to fool ourselves that we can satisfy more desires and expectations than we realistically can afford.

Public policy is too often driven by identified needs and identified individuals to the exclusion of other public goods. One of the great challenges of the 21st Century will be to learn the wisdom of George Bernard Shaw’s aphorism; “The mark of a truly educated man is to be truly moved by statistics.” Public policy is burdened by the difficulty of making unidentified lives equal to identified lives. Statistics often represent people not numbers. But, as a nun once told me, “Statistics are people with the tears washed off.”

Professor Alan Wertheimer raises the following provocative questions: Suppose the following were true, he asks:

At least some of the money spent on open-heart surgery could be used to prevent heart disease. True, patients in need of such surgery might die, but many more lives would be saved.

Some money spent treating tooth decay among low-income children might be used on fluoridation and dental hygiene. True, some decay would go untreated, but fewer children would ever need such treatment.

He points out “all involve choosing between a policy designed to help specific persons and one that seeks to prevent the need for such help.” These choices are especially difficult because we know who needs the help. “...we must often choose between helping identifiable lives and saving statistical lives.”

Public policy inevitably has to accept casualties. We do not ban automobiles, guns, or alcohol despite annual loss of life, because we judge their utility to be greater than their cost. It is seldom an equal weighing. Identified lives loom so much larger because they have a human face. Statistical deaths, no less human and no less dead, do not have a face — only a number. Not nearly as visible, but human nevertheless. It is not good public policy to ignore these “statistics.” As one author observed:

"The statistical life is one of the fifty lives that will be lost in a year because of a government decision not to pursue a particular mine safety regulation. The identifiable life is the one miner trapped in the collapsed mine. We are held hostage to these identified lives — much like a kidnapper holds his/her victim's hostage. It is hard not to give in to a ransom note. What seems cruel in an individual case is often actually the most lifesaving and compassionate for the general society." (David Eddy)

Joseph Stalin once said: "One man's death is a tragedy; a million men's deaths-- is a statistic." In a horrible way, Stalin was right, and his reasoning applies to the American health care system. "We don't mind throwing people overboard," says one wag "we just don't want to hear the splash." In the same spirit, Governor Kitzhaber has said: “Legislatures have never had to confront the victims of silent rationing or be accountable for the very human consequences. It is like high level bombing where the crew never sees the faces of the people they are killing." George Bernard Shaw had it right: we must be educated and compassionate enough to be moved by statistics

We do many things at great expense to avoid having to say no to identified lives. The United States has approximately three times the percentage of intensive care beds than other industrial nations and yet we don’t save any more of the critically ill. We have far more specialists than other industrial countries. We spend billions of dollars to avoid having to make the everyday life and death decisions that other countries make routinely. Then we turn around and leave over 40 million Americans without health insurance.

We spend more billions on expensive neonatology units, often to save preemies who will cost more millions and have little or no quality of life, but we do not give prenatal care to many American women. That is neither good nor compassionate health policy.