Cost-Effectiveness

I've been trying for the past few years to reread my copy of "Pathologies of Power" by Dr. Paul Farmer, one of my living heros. Having first read this book 5 years ago while finishing my undergraduate degree at ASU, it is marked up with my notes from class. Reading through it you can see the voracity with which I devoured it on initial read - the first few chapters are nearly illegible due to my underlines, cirlces, and arrows connecting the ideas across the pages. It got to the point where my markings ceased because almost all of it was being marked as something I should remember. Comical in hindsight, but it still stirs my excitement over the subject and reminds me that this is something I have a passion for and would like to pursue.

Anyway, I finally picked it up again after a good 10 months of inactivity and was once again thrown into the world of MDRTB (multi-drug resistant tuberculosis) and structural violence against the poor. This particular chapter's conversation of cost-effectiveness in terms of health care I find particularly timely, as today the nation averted a near financial meltdown.  Specifically, Farmer talks about the distribution of technological developments and the use of the phrase "cost-effective:"

"In the name of cost-efectiveness, we cut back health benefits to the poor, who are more likely to be sick than the nonpoor. We miss our chance to heal. In the settting, we're told, of scarce resources, we imperil the health care safety net. In the name of expedience, we miss our chance to be humane and compassionate. ... how can we glibly use terms like cost-effective when we see how they are perverted in contemporary parlance? You want to help the poor? Then your projects must be self-sustaining or cost-effective. You want to erase the poor? Hey, knock yourself out. The sky's the limit." (Chap 7,pg 176-7)

Farmer's distaste for the status quo is palpable, even infectious. We can not just sit by and let those in power inform us that certain humans are worth the money to take care of and others are better off dead. We've had quite the political discourse the past few years about the need to cut excess from operating budgets for programs no longer deems "cost-effective"; sadly many public health and social programs have been on the chopping block because those in power are divorced from the reality of the disenfranchised who acutely feel the effects of these decisions. As someone who grew up for the majority of my childhood without health insurance and therefore not going to the doctor unless I was really sick (which thankfully was rare), I can't help but think that those who view public health and social safety-net programs, such as emergency shelters and walk-in clinics, as expendible are blinded my their own affluence. 

But enough griping. There are, of course, successes that have emerged from the process of stream-lining. Although I find it hard to think of an example, there must be, otherwise the concept would not be so widely accepted.

 My hero, Dr. Paul Farmer - picture from the back cover of "Pathologies of Power"