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.


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