Rationing health care as both the most ethical and the most pragmatic choice
Jul 28, 2009
Peter Singer, a professor of bioethics at Princeton University, makes the case for rationing health care, arguing that rationing is both the most ethical and the most pragmatic choice. He claims that rationing is the most effective way to bring the greatest good to the greatest numbers, and the only way to make the hard ethical decisions that need to be made as part of the health care debate.
Singer starts by laying out the case for rationing, demonstrating how we must make decisions, either explicitly or implicitly, over how to allocate our resources to saving lives. He points out that we have a relatively easy time making those decisions when we aren't faced with a decision to save a specific person -- for example, in deciding whether a particular safety measure is worth the expense. Say that you know a particular safety measure will save one person a year, and cost $40 million dollars (in this case, adding seat belts to school busses) -- generally, people have an easy time agreeing that we should implement all other safety measures that save more lives more efficiently first. So, we might implement changes that make mattresses less likely to catch fire, saving an estimated 270 lives a year at a cost of $343 million, well before we take other more expensive actions that save fewer lives.
The difficulty we have is when we are faced with a $40 million decision to save a single life, where we have a real person in front of us, rather than an abstract statistic suggesting that we could save an unknown life through a safety measure. But Singer argues we must make the same decision in both cases if we want to help as many people as possible -- effectively, we must be willing to let someone die rather than treat them. Because we aren't willing to do this, we spend millions of dollars to save a single year of life, but don't allow for certain obvious treatments that would save far more people.
Since I had already bought into the idea that we must ration health care, Singer's initial arguments were interesting to me, but not compelling. The part I found completely novel and fascinating was Singer's explanation of the best way to go about this rationing. First, how do you decide how much to spend to save a single life? It turns out you don't -- you instead measure treatments by how many quality-adjusted life-years they save (QALY). If you can give someone 80 more years of perfect health through a treatment, that should be worth considerably more to you than a treatment that just extends your life by a single year, and has you in the hospital for that entire time. QALY is a way to measure the impact of a treatment.
Singer also discusses the best way to let people opt out of this system, going into detail on how health care works in Australia as an example of how to combine personal choice with a government health system.
I found Singer's arguments well reasoned and his explanation of other systems and their benefits very informative. That said, I would like to hear a critique of his rationale from other ethicists. I disagree with a variety of Singer's other positions, and I feel like I might be missing some of the potential downsides of his approach.
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About the reviewer
Ari Miller (ari1974)
I mostly write about my main obsession, tennis. When I'm not experimenting with new tennis racquets, I love to watch a good movie or read a great book. I'm a fan of both non-fiction (especially books … more
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