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Do We Spend Too Much on Sarah Murnaghan?

Sarah Murnaghan is the 10-year-old girl Pennsylvania girl suffering from cystic fibrosis who received a lung transplant—but only after a public outcry, a congressional hearing, and then a court order. The girl is now recovering from the surgery.

Sarah’s story can be seen in many dimensions, but here are three to usefully consider: first, the compelling human—and humanitarian—interest of the case; second, the positive role played by advancing medical science; and third, the implicit repudiation of the bipartisan health-policy orthodoxy of Washington, DC.

First, and most obviously, it’s a cheering moment, a triumph for the human spirit. It’s the story of a community—and a country—rallying in Frank Capra-esque manner to help save a life.

Of course, the modalities of rallying the public have been upgraded since the ’40s. Sarah’s mother, Janet Murnaghan, led an active effort on Facebook; Mrs. Murnaghan never gave up, even after the Obama administration, in the person of Health and Human Services Secretary Kathleen Sebelius, declined to waive the arcane rules forbidding the transplant for Sarah.

Cable news, too, picked up the story. Such Fox News Channel figures as Sean Hannity and Peter Johnson Jr. made the girl’s cause their own. Some might suggest that Fox has ideological motivations in championing Sarah’s cause in the face of Obama administration opposition, but media campaigns on behalf of an underdog, of course, are as old as the penny press of the 19th century.

Stories such as Sarah’s get media traction for a simple reason: People care about other people and want them to have a chance in life. This reality of human solidarity on life-issues might seem obvious, but evidently it comes as a revelation to Washington DC officialdom.

Indeed, nobody forced Secretary Sebelius to say “no” to saving Sarah’s life. She declared the issue to be “incredibly agonizing,” but then added cold words of cold comfort: “Someone lives, someone dies.” That’s exactly what ordinary people fear: some bloodless bureaucrat in a marble palace following a rulebook to make life-or-death decisions. So Sebelius ended  up looking like Mr. Potter, the bad guy in Capra’s most famous happy-ending tale, “It’s a Wonderful Life.”

Second, Sarah’s case is a triumph of science. Not so long ago, there was no such thing as  transplant of any kind. The first human organ transplant of was the implantation of thyroid tissue in 1883. The first full organ transplant—a cornea—was done in 1905; the first vein and skin transplants were over the next decade. The first attempt at a lung transplant was made in 1963, and it was not until 1983 that a patient survived for any significant length of time. Thus we are reminded that the course of scientific progress is lengthy and bumpy. But we’re worth it.

We might further note that had science not advanced so far, the Sarah Murnaghan story could have been told swiftly and tragically: dying young.

Third, Sarah’s case tells us that the healthcare policymaking elites of Washington DC, on both sides of the aisle, have been guided by a politically unpopular worldview. More precisely, we could say that Sarah’s case reminds us yet again that Washington’s healthcare worldview is unpopular.

Let’s consider: the DC elites declare that we should be spending, and doing, less on healthcare—at least for the masses—while the masses themselves think we should be doing more. The masses might lack the articulate policy voice—there aren’t elite journals of opinion springing from the heartland—and so the folks have to wait till election day to speak their piece, and that’s what they have been doing. Yet because the elections every two years are a blunt and broad instrument, it’s possible to miss their meaning—or for those so inclined, to dismiss their meaning.

For those interested, this gap on healthcare policy, between the governing and the governed, has been evident for a long time. A 2009 study from the Kaiser Family Foundation found that “experts” believed that up to 30 percent of all US healthcare spending was “unnecessary”; yet at the same time, the public as a whole, by a more than 4:1 margin—67 percent to 16 percent—wanted more healthcare, not less.

By “more healthcare,” we can safely presume that the folks don’t simply want more poking, prodding, and form-filling-outing. We can presume, instead, that they want better care, including cures—just as they see on TV medical dramas. And they want more happy endings in the real world, too, such as little Sarah Murnaghan getting her lung transplant.

Whoa now, some might say. Aren’t lung transplants expensive? Aren’t they way up in the six-figure range, assuming that everything goes well? Sure they are, and so are other kinds of life-saving treatments. But the American people want them, and so the nation’s politicians—if they were alert to their self-interest, among other considerations—should want them, too.

We can observe that whenever the public truly wants something, money is not an object. If political leaders are implementing a public wish, the needed money can always be found somewhere—by borrowing, by reallocating, or even by taxing. The key is public support: As goals change, an engaged electorate will tolerate hard choices being made on its behalf.

Moreover, the history of technology shows that when something is popular, and there’s more of it, the price comes down as the benefits of mass-production and continuous innovation kick in. That’s the story of both the scientific revolution and the industrial revolution. Treatments and cures that once didn’t exist, even for kings, are now freely available to everyone. Does the public understand those particular technological and economic realities? Yes, it does: Everyone intuits that tech things get cheaper over time, because we have all seen it happen in our own lives. Indeed, every day, we hold endlessly less-expensive technology in our own ands.

Thus it is that doing the right thing for one—in this case, for Sarah Murnaghan—means spreading the ultimate benefits to many. That is, to all of us.

Yet strangely, both parties seem to have set themselves in opposition to these public wishes. Instead of going with the flow of technology, the elites have let themselves get snared in ideology.

The Democrats, dominant in DC over the last four-and-a-half years, have been convinced by their policy advisers that the country wants to spend less on healthcare, even as health insurance is expanded, and that it also wants bureaucrats to oversee the new contraption called the Affordable Care Act–even as those bureaucrats pursued their own ivory-tower vision of healthcare, including such scarily utilitarian concepts as Quality-Adjusted Life Years and Disability-Adjusted Life Years. Whatever their merits as intellectual concepts, QALY and DALY are sure to creep out ordinary Americans—and voters.

Yet for elected Democrats, the political warning signs were always there: In August 2009, Sarah Palin declared that bureaucratic management would lead to “death panels,” and while the elites dismissed Palin’s argument, the public did not. The public agreed with Palin because horror stories of bureaucratic neglect and contempt have a way of crossing even the wide Atlantic. So there was  plenty of evidence that Palin was right at the time about national health programs as they were implemented in Europe, and there’s plenty of evidence that she is still right today.

As we all remember, the Republicans made major gains in the 2010 elections, based in large part on their opposition to “Obamacare.”

Then, in 2011, the resurgent Republicans interpreted the election results as a mandate not only to seek the repeal of “Obamacare” (which was never possible with a Democrat in the White House) but also to seek the cutting and transforming of Medicare (which was never possible if the American people had a voice). Republican wonks might extoll the reign of free market, but when the American people hear such abstract talk, they think in concrete terms of their dealings with private health insurers, and the resulting image is a loser for the GOP.

And so as we also remember, in 2012, it was the Republicans’ turn to be drubbed at the polls.

Yet even now, in 2013, the policy elites in both parties—joined by centrist “deficit hawks”—continue to push their respective visions of healthcare cost-reduction. That is, Democrats want to plow ahead with their bureaucratic vision, Republicans want to uphold their free-market ideal, and the deficit hawks are in favor of doing anything that will reduce the deficit, according to their calculations, no matter what the human cost in the meantime.

It’s revealing that no prominent think-tank in DC stepped up, at the crucial moment, to declare that the Sarah Murnaghan case indicated the need for a major rethinking of our approach to healthcare policy—a rethinking based on doing more for people, not less. And that’s why Sebelius felt free to say “no” to little Sarah Murnaghan; in her world, what she did was fully in keeping with the “advanced” thinking in her party.

Happily, outside-the-Beltway populist politics intervened to bring the oxygen of human compassion into the airless world of Washington wonkery. A pair of Republican backbenchers from Pennsylvania, Reps. Lou Barletta and Patrick Meehan, stood up for Sarah and helped turn the tide in her favor.

And House Majority Leader Eric Cantor (R-VA) has been pushing his Kids First Research Act, which would redirect federal money from political slush funds to pediatric medical research. The amount of money involved is relatively small, but Cantor has been willing to make the crucial intellectual leap: Curing disease is the best way to save money on healthcare costs.

Still, the silence from DC wonks is notable; the idea of using healthcare policy to implement medical cures to save lives—as opposed to saving money—is simply not a part of the DC discourse.

We might pause to note here that in a way, the elites are correct: The country does, in fact, spend a lot on healthcare—and in some ways, we spend too much. Healthcare costs are roughly double those of other industrialized countries; even after we make adjustments for population demographics and lifestyle choices, it’s still possible to conclude that Americans are overpaying for basic procedures. However, the place to start such cost-saving measures is not with the lives of little girls.

Indeed, a truly enlightened elite would embrace the cause of Sarah Murnaghan, and of others, if only to gain good will with the masses. That is, if the elites were in favor of expenditures for heroic medicine, then it might be easier to save money on routine medicine. In fact, history—and common sense—says that that’s the only way. After all, if Sarah Murnaghan is cured and can go on to enjoy a normal life, then over the decades to come, the cost of her lung transplant will look small.

That’s another bit of intuitive folk-wisdom that DC ought to absorb: Healthy people do more for the economy than sick people, to say nothing of dead people. Indeed, it’s only by absorbing such obvious folk-wisdom that the DC elites can gain true wisdom about a sustainable healthcare policy for the nation.

In other words, if Kathleen Sebelius is the face of the Affordable Care Act, President Obama and the Democrats have an ongoing problem. What the Democrats need instead is a figure pushing for more life-saving lung transplants. And if that means more cost, so be it—people will pay. And yet, as we have seen, once the nation sets out on a course to do something, costs have a way of falling, even as productivity rises.

For their part, Republicans might take note of the moral and political success of Reps. Barletta and Meehan. They helped save a girl’s life. Among other considerations, that’s a vote-getter.

So both parties could work together on a post-scarcity healthcare vision in which innovation and abundance go hand in hand. The two parties could start by working jointly to expand the supply of lungs and other organs. More organ-donors would be great, but even greater would be a new biotech industry of organ production, through non-embryonic stem-cell cloning, maybe, or 3-D printing.

Is all this the stuff of science fiction? Not any more. It can be real, if we as a nation want it to happen. New medical science is the stuff of human hope, and it’s also the basis of new jobs and industries here in America.

And yes, it’s even the basis of a politically winning healthcare agenda—for one or both parties.

James P. Pinkerton is a contributor to the Fox News Channel and a TAC contributing editor. Follow him on Twitter.

about the author

James P. Pinkerton is a longtime contributing editor at The American Conservative, columnist, and author. He served as longtime regular columnist for Newsday. He has also written for The Wall Street Journal, The New York Times, The Washington Post, The Los Angeles Times, USA Today, National Review, The New Republic, Foreign Affairs, Fortune, and The Jerusalem Post. He is the author of What Comes Next: The End of Big Government--and the New Paradigm Ahead (1995).He worked in the White House domestic policy offices of Presidents Ronald Reagan and George H.W. Bush and in the 1980, 1984, 1988 and 1992 presidential campaigns. 

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