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Spring 2002
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Who Has First Claim on
Health Care Resources? State Bill 529 calls for the
establishment of community-based homes for the care and education of the
mentally retarded. The bill provides one home for every fifteen persons
presently institutionalized in four state institutions for the mentally
retarded at a cost of $55.8 million. The estimated costs for the new
care for the present population of 7,600 will be $70 million in a year. The bill was introduced by
Representative John Sheehan, who spoke in favor or it. He painted a
dismal picture of antiquated institutions bereft of basic human
necessities or amenities. Thousands of human beings, many unclothed,
spend their days huddled in dark, drab rooms, where they are supervised
y an overworked staff, many of whom have no professional training.
Sheehan, who has the support of the parents’ organization, the State
Department of Mental Health, the local ACLU, and the religious
leadership, concluded his case by pleading, “Justice requires that we
extend this token contribution of these citizens, burdened by physical
and psychological suffering, and by the degradation of our society’s
past inhumanity to its fellow humans.” Representative James Hudson and
Dr. Robert Simons, while emphasizing their concern for the care of
retarded, spoke in opposition to the bill. Representative Hudson, noting
that he was elected representative of all the citizens in his district,
argued that he had an obligation to examine the alternative uses for the
$14 million in additional funds called for by the bill. But first, he
pointed out that the new total sum of $70 million equaled 1.5 percent of
the state’s budget, a budget raised by all its citizen, while the
institutionalized population equaled 1/10 of one percent of the
state’s population. The proposed increase of $14 million could buy hot
lunches for all the state’s school children; it could also provide job
training for productive members of society. Hudson argued that the
fairest thing to do would be to spread the money evenly among those who
would be productive. “Our task as legislators, “ he concluded, “
must be to serve the greatest good of the greatest number.” Dr. Simmons, as a physician,
argued that the money could be used more efficiently in providing health
care for three groups: normal or more nearly normal children (thousands
of whom could be reached for every mentally retarded child), those
potentially engaged in productive labor, and pregnant women. He showed
that much mental retardation can be eliminated through prenatal
diagnosis which he estimated to cost $200 per case for Down Syndrome
compared to $60,000 for each institutionalized child. Even allowing that
some of the institutionalized retarded might be gainfully employed if
they were in high quality, community-based homes, the savings from
spending the funds on detection rather than on more expensive forms of
institutionalized care are enormous. The legislative committee must now make its decision on the bill. Case involves : Allocation
of Resources Background – Many patients with acne vulgaris receive much benefit if they take tetracycline antibiotic. Some patients do not respond. Other types of treatment can be effective, but are much less easy to administer and require reasonably diligent attention and cooperation of the patient.
Case: A dermatologist consults at a state institution for the retarded. Many teenage patients from the institution are brought for his care because of mild to severe degrees of acne. Only rarely does the patient seem to exhibit any awareness or concern whatsoever about his or her acne. Tetracycline is easy to administer, while other routine types of care are especially difficult in such a setting. Tetracycline is relatively abundant and inexpensive and safe. Yet the physician wonders about the cost-benefit factors to society that buys the drug, and the merit of “treating” mainly the patient’s family and the physicians regularly working at the institution, while seeming to treat the patient who seems not to care.
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Course
Overview