What A Toothache Says About National Healthcare

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Last week, this story about a man dying of a tooth infection spread across liberal blogs who used it as evidence of the failure of the US health care system.  Conservative bloggers quickly pointed out that this made no sense: emergency room doctors had given the man a prescription for painkillers and antibiotics, and he had chosen to fill the prescription for painkillers.  Though you can't really tell from the story, he may have thought that the painkillers had been enough--as I understand it, once a tooth infection has killed the root, the pain may stop.  Then the infection spread to his brain, and he died.


Matt Yglesias argues that while he may have made bad choices, you shouldn't have to choose. And while I personally know enough to know that the antibiotics will make the pain stop almost as quickly as the painkillers, having had a terrible dental infection myself, I'm not exactly surprised that he chose the thing that made the pain stop.

However.

I can't believe he had to choose.  As far as I know, the antibiotics commonly prescribed for dental infections are all generic.  Amoxicillin and penicillin, two of the antibiotics that the web thinks are most common, are available from Wal-Mart for $4.  Erythromycin is probably pricier, but we're not talking about a $100 antibiotic here; the generic form is cheap enough that at least one supermarket gives the stuff away for free as a loss leader.

The slow decline in drug discovery has been even more pronounced in the antibiotic arena--we've gone from discovering about four a year, to producing about one.  I have an article coming out on why this is really worrying, but a happy side effect is that there aren't a lot of great antibiotics out there which are out of an uninsured American's reach.  If you need antibiotics, you can afford them, or else you've been checked into a hospital for emergency care of your raging drug-resistant infection, and they are pumping you full of whatever they think will kill your infection.

(Before you ask, no, this is not a good example of letting cheap things get expensive by not treating them; the way you find out that your particular bug is resistant to whatever you're taking is that you don't get better.  And some of the second-line drugs are kind of toxic and/or need to be dosed intravenously--it's hard to kill germ cells without killing people cells too.  So they're given in the hospital.)

If this guy had had health insurance, his drugs would not have been free.  They're not free in much of the UK; they're not free in Canada.  People with insurance in the US have co-pays.  If this man was not willing to spend perhaps $25, and more likely less than that, on life-saving antibiotics, it's not a failure of the health care system.  It may be a failure of the job market, the welfare system, or his own decision making, but it is not a problem that any feasible health care reform is going to fix.

Update: A commenter says that according to local news reports, he was quoted a price of $27 for the antibiotic (sounds like erythromycin, then), and $3 for a painkiller.  I believe the former, but I have a very hard time swallowing the latter.  I mean, I guess I could be wrong, but I am very skeptical that there is a pharmacy out there that sells more than a dose or two of any prescription painkiller for $3.  If he chose to take two vicodin over antibiotics, when he must have known that this was not a long-term solution, I have to question his decision-making even more deeply.

A couple of commenters are arguing that many poor people simply can't afford an $80 extraction, or a $27 antibiotic.  But as I said above, that may be a problem in other parts of the economy, or the safety net, but it's not actually a problem of the health care system.  As far as I know, Canada doesn't cover dental work either--and the last time this happened, it happened to a kid who was actually eligible for Medicaid dental coverage, but whose mother had somehow fallen through the cracks of the renewal process.

It is not true that national health insurance will mean that no one ever dies of something that could have been prevented.  Human error, we will always have with us.
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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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