Tomas Philipson on Family Choice in Cancer Care

Tomas Philipson's appointment to a position on the Council of Economic Advisors has me thinking back on some of his more interesting health policy and health economics pieces for Forbes.

i especially remember his assertion that families who bankrupt themselves for cancer care, admittedly a choice put to them by poor health insurance coverage, are the best choosers of the value of a cancer patient's life, as distinct from some bureaucratic or regulatory calculation. 

I am troubled by the thought that the woefully underinsured are somehow best situated to place the most accurate value on health care. "What's it worth to ya?" is a measure, after all, of what you have to spend as much as of what you choose to spend. Celebrating the freedom to achieve familial bankruptcy in the pursuit of health care is an interesting way to celebrate freedom. If it is a powerful celebration of freedom, it is one that many Americans have experienced, although an exact number is difficult to calculate.  

But I am even more troubled by the easy assertion that "families" make these value based care or  bankruptcy decisions — whether to hold 'em, fold 'em, or double down with a household's financial future.  Is that how it really works? Families caucus, lay their cards on the table (one more year of life for Dad compared with a year of college tuition for Junior) with everyone from Dad to Junior voting their preferences or striving for consensus while reaching a "family" decision?  Even without any kind of serious health care price transparency?  Even when the role of families in cancer care decision making is not always uniform or consistent?


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