Peter Singer: There Will Be Rationing

Count on the always controversial Peter Singer, professor of bioethics at Princeton, to bang a gong on  the issue that many  people are soft-pedaling in the health-care reform debate: the R-Word,  rationing. Singer says a reformed system  will have some form of rationing (just as the current system does),  and, further, he  says that we should have it, and that if we don’t, we’ll never slow or stop  increasing  medical costs:

“The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?”

I’m sure Congressional Dems and Obamaites regard Singer as the skunk at the picnic, since the more the public believes that some form of rationing–that is, some new form– will be instituted, the more support for reform will decline.

I’ve been surprised at the number of people who seem to believe that it’s possible to construct a health care system in which there is no rationing at all by any means at all.  To get a little perspective,  we need to step back from the fearmongering sound of the word “rationing” and ask ourselves when, in the course of human events, there has been any good thing or service that was available in unlimited quantities and high quality  to everyone who wanted it exactly when they wanted it in the manner they wanted it. (Except for air, I suppose.)

I was speaking with an intelligent woman the other day, a quite well-informed person, who believes that a reformed system can operate without any form of rationing. So I asked her to consider a hypothetical  situation in which 20 people need heart transplants by this coming Wednesday or they will die. Only 15 hearts are available for transplant by Wednesday.

How do we decide who gets the 15 hearts and who dies?  Age? Gender? Money? Locality?   Number of dependents? Lifestyle?  I don’t know, but  however we decide, we will be employing a form of rationing. (Unless we draw straws? But then aren’t  we rationing by chance?)

Singer, whose past writings about the value of human life have ruffled feathers across the political spectrum, proposes that we use the QALY standard, for “Quality of Life Adjusted Year,” a term I cannot imagine any member of Congress  looking into a camera and saying. Then, in making  choices about granting or denying some kind of service or medicine, the QALY gives  some basis for deciding whose need is greatest:

We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years.

More thought-provoking stuff here . Needless to say, Singer’s not running for office.


The GatesGate Summit: Can It Help?

Okay. Call me naive, mysteriously optimistic, whatever, but I do think some good can come out of the Obama-Crowley-Gates  Beer Summit at the White House tomorrow, despite the political cartoonist who depicted Crowley and Gates shouting “Great Taste! Less Filling!” at each other.

Yes, I know that commentators like the  estimable Juan Williams have said “you can’t base a teachable moment on a lie,” and I know that some fear Crowley’s presence will somehow amount to an admission that “racial profiling” was in fact involved here, when it seems crystal-clear from the evidence that it was not. And some sources say that Gates does not drink beer, so perhaps a nice Puligny-Montrechet can be procured for the professor while Obama and Crowley hit the Mooseheads. UPDATE: White House serves only domestic brews.

But despite all these flaws, maybe some good will come if the participants  just talk together like human beings, not symbols or walking lists of grievances. And perhaps Obama can exercise his skill as a reconciler and builder of bridges between races, which is what made it possible for him to be elected in the first place.

GatesGate: Are We Still the Prisoners of Race?

With the Performing Daughter in a big show downtown this weekend, and relatives in town for the occasion,  I’ve been too busy playing tour guide and bottle washer to  blog about GatesGate. I’m definitely late to the party, but a few post-mortem thoughts:

1. Obama’s premature lurch into GatesGate  during his press conference last week was a classic case of what old friend and fellow blogger TheFabSage dubbed ETSOTTGO(eht-SAHT-go), one of my favorite acronyms. It stands for “Easier to Stay Out Than to Get Out,” and man, was that true with Obama.

How easy it would have been for him to stay out by  saying  something like, “I’m troubled by what I’ve heard, and I have great  respect for Professor Gates, but I want to hold off commenting for a while until I can get more details about this incident.”  Period.

2. Alas, Obama’s insistence on going to bat ASAP for his fellow member of the  Talented Tenth led him into a real swamp in which he seemed to be doing two objectionable things: A) Presuming that a member of his own class cohort could not share any blame  in the matter, which shows us that Good Ol’ Boys’ Clubs exist among all kinds of people, and B) playing into the creaky but still nastily alive party line about White Oppressors fighting to  keep Black Victims down forever.

It seems I’m always pointing this out, but one of the most curious phenomena of our time is the Paradox of the Powerful Victim: Minorities who wield enormous power via wealth, celebrity, or position who reflexively, dishonestly behave as if they are illiterate Alabama  sharecroppers in 1949.

We see it with Sonia Sotamayor,  when she was on  the power path at  Yale Law School, embracing “the Third World Community” on campus. We saw it in the recent death of Michael Jackson, with Al Sharpton and others trying to portray “Nothing Strange” Jackson as the victim of a vampiric white tabloid press. And now we see it with Gates, who, the day after the incident, uttered these tragically misguided words:

“What it made me realize was how vulnerable all black men are, how vulnerable all people of color are, and all poor people, to capricious forces like a rogue policeman, and this man clearly was a rogue policeman.”

For a man of Gates’ accomplishments, privilege and power to say this is just heartbreakingly cynical.   I don’t do much gazing into people’s souls, but I’d be astonished if he actually believes that. (Though, alas, many impressionable young blacks may believe it.)  I think Gates knows that he lost his cool and  provoked an ugly national incident, and instead of accepting a chunk of the blame, he  decided to go all in with the scorched-earth race rhetoric, knowing that at least he’d please “the base” among professional rights  activists and the black talk-radio cadre.

3.  Can we get a happy ending? Yes. Obama’s suggestion  that the three men have a beer at the White House is a nimble recovery and a  super idea–a fine gesture of reconciliation that can be done without investigating committees, marches, and lawsuits.  The three of them can get together and  acknowledge that, like everyone else, they’ve made some mistakes. Maybe Gates can at least hint that life in America is a wee bit better now than it was during the Montgomery Bus Boycott of 1955.

And how about a handshake on the White House lawn? Hey, if Rabin and Arafat can shake, I bet these guys can work it out.

Clinton’s Bush-League Rhetoric on N. Korea

God knows–I don’t–what the U. S.  should do about North Korea (a question nobody ever asks of Paraguay or Finland), but isn’t the latest  quote from Secretary of State Hillary Clinton precisely the kind of dismissive, dead-or-alive “cowboy” foreign policy rhetoric we were going to drop once the Bombastic Bushkin  retired to his Dallas cul-de-sac? Quoth Clinton of that isolated  prison-nation:

“What we’ve seen is this constant demand for attention…And maybe it’s the mother in me or the experience that I’ve had with small children and unruly teenagers and people who are demanding attention — don’t give it to them, they don’t deserve it, they are acting out”

As it happens, I actually agree with Clinton that Kim Jong whazzisname does seem to act like a spoiled brat, albeit a scary  one with a huge army and  nuclear ambitions. And I’m actually in favor of more stick and less carrot with the frizzy-haired, Hennesey-swilling  dictator who reportedly owns more than 20,000 movies, assuming we have any money left for those nuke-preventing sticks. But Clinton’s gibe  sounds just like something we’d hear in the Bad Old Days from Condi Rice or Don (the future McNamara) Rumsfeld. What happened to hitting those reset buttons?

AWOL Blogger: “So This is Hell”

Of the thousand mortal shocks that flesh is heir to, a really ripping sinus and/or migraine headache has got to rank near the top, especially if you’re the kinda guy who somehow made it past a number of Significant Birthdays unplagued by such ailments.

I mean, I just never, ever, have  headaches, not even on mornings when (shift to passive voice) activities have been undertaken that are known to produce same.  I didn’t even know where the aspirin were until my wife, reluctantly pressed into nursing duty, found them.  And all this sensitivity to light, noise, etc? Alien to me.

Anyway, today seems slightly better than yesterday, so perhaps I’m on the mend. Now, just one other  worry: Is this a pre-existing condition?

Neil Armstrong Heads Dignity Hall of Fame

I spent some time last week talking about the lack of dignity and restraint that’s so evident in our society today, contrasting not just trashy celebs but  people like fallen Guv Mark Sanford with class acts like Joe DiMaggio, who maintained a proud sense of himself despite endless opportunities to sell his private life to the public.

Another man who belongs in the Dignity Hall of Fame is Neil Armstrong, whom everyone is remembering today. The man is so averse to publicity, so loath to cash in on his historical significance, that I was trying to remember the other day whether he was still alive. I asked my wife if she recalled Armstrong dying. She said no, but neither of us could remember the last time we heard anything about him.

A good WaPo feature on Armstrong today explains the silence: The man has always refused to play the celeb game, unlike his more garrulous co-pilot Buzz Aldrin, shown here in a Louis Vuitton ad. Even for this 40th Anniversary (and who knows if he’ll make it to a 50th?), the 78-year old Armstrong had to be persuaded to show up in Washington for the ceremonies, at which he spoke only briefly, dishing credit to everyone else in the Apollo program.

Why the reticence? The WaPo writer has a solid theory, I think:

In a culture that crushes and disfigures the famous, Armstrong was Olympian in his discipline and humility, never tarnishing the grand moment that fate handed him. The ultimate professional, he did what was asked of him, and then went home, spurning the laurels.

Isn’t that a great line–“never tarnishing the grand moment that fate handed him”? How many of our famous people can resist doing that?

PS–depressing footnote: When I sought a Google Images pic for this page, the majority of photos returned were attached to stories charging that the entire moon landing was a hoax.  The Americans who believe that have one vote,  just like the rest of us.

“Shop Class” Book Builds Major Buzz

Can’t recall a serious book in a long time that’s generated more opening buzz and chin-stroking than  Shop Class as Soul Craft: An Inquiry into the Value of Work by Matthew Crawford.  The book seems to have diagnosed a problem that’s been bothering a lot of social critics and thinkers, some of whom discuss it  here. One opiner calls the tome  “one of the finest, most philosophically informed and challenging books I’ve ever read.”

I guess I’ll have to break down and buy this one since I’m not reviewing it and it won’t hit the libraries for months. Maybe I’ll consider it for our next book club meeting.