### Should we treat inexpensive diseases first?

August 11th, 2010
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How would you answer this question:

Imagine two illnesses X and Y. People get them through no fault of their own. The illnesses are equally serious and leave the patients in a state of severe disability if untreated. They both occur in about 100 people per year in your country. You yourself are equally likely to get either of them.

A basic care is offered to everybody who gets either of the illnesses. Beyond this basic care, there are treatments available for both illnesses that are equally effective and will improve the patients' functioning considerably. The treatment costs, however, depend on the illness:

Illness X: \$ 20,000 per patient
Illness Y: \$ 100,000 per patient
Imagine that society decides to allocate 1 million dollars per year to these treatments. This is not enough to treat all patients, so a rule must be decided as to who should have priority. Two different rules are suggested.

Rule A would be to spend all the money on people with illness X. This would lead to the following numbers of people being treated per year:
X: 50
Y: 0
Sum: 50
Rule B would 'first come, first serve'. On average, this will would lead to the following numbers of people being treated per year.
X: 10
Y: 8
Sum: 18
Advocates of rule A argue that it would allow more people to be treated and thus all in all lead to less disability and suffering in the population. It would also give each of us a better chance of actually benefiting one day, since more people would be treated and the illnesses are equally common.

Advocates of rule B argue that it is unfair to discriminate against those who happen to get a high cost illness through no fault of their own. They argue that this concern for fairness should override the concern for treating as many as possible. The two groups should therefore be treated on a first come, first serve basis, even though fewer people would then be treated.

You are yourself a member of the society in which one of these rules would apply. Which of them would you vote for? Take a look a look at this summary and think carefully before you answer.
This question was asked in a 1995 study in Australia, Who Cares About Cost? Does Economic Analysis Impose Or Reflect Social Values. Out of 119 people surveyed, 82 or 69% prefered rule B, the first come first served choice. I don't understand this at all. Is there someone who would choose rule B that would be interested in explaining their position to me?

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