Thursday, July 30, 2009

Peter Singer: Both Right and Abominably Wrong

It is said by many that health care reform is a social justice issue - and I agree. As soon as the government takes over your healthcare, your name is forgotten and you are reduced to a set of statistics on a bureaucrat’s actuarial table. Government encouraged (read "counseled") euthanasia for the old and infirm increases as do abortions in tricky pregnancies (in all nations with government run health care), death rates for curable diseases and cancers rise because the medication is “too expensive” for the “people” to pay, doctors get paid less, lines increase at emergency rooms, and on and on.

Peter Singer, ethics professor at Princeton, recently wrote a long piece in the New York Times Magazine on “Why We Must Ration Health Care.” As a radical utilitarian, Singer believes that most, if not all, ethical decisions can and should be reduced to a kind of numbers game. If X number of people are benefited, a few less than X are hurt, and the cost is proportionate to X, then the action is ethical. Both famous and infamous for many things, Singer certainly has one thing right: decisions made on the governmental level are by their very natures utilitarian. People are stacks of numbers to be weighed against budgets and other stacks of numbers. I have argued in my ethics classes that this is not only the most feasible form of decision making for a federal government, it is likely the only one they use.

So Singer is right – a government run health care program would be utilitarian in nature, making health care decisions according to charts and graphs. And then Singer is wrong – this is not the best way to handle human beings.

Tellingly, Singer chastises President Obama for not using the word “rationing”:

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform.

You have to give Singer credit for telling it like it is. Then (ironically) Singer raises one issue that opponents of expanding government health care raise often. If the current government run plans are awful and bankrupt, what good will expanding them do?

In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

Then a couple of fundamental ideas from his argument:

Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse.

If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.

Singer agrees that deciding who gets the meds and who doesn’t is not an easy thing to do, but luckily he has an equation to help us.

Nevertheless this approach to setting a value on a human life is at least closer to what we really believe — and to what we should believe — than dramatic pronouncements about the infinite value of every human life, or the suggestion that we cannot distinguish between the value of a single human life and the value of a million human lives, or even of the rest of the world. Though such feel-good claims may have some symbolic value in particular circumstances, to take them seriously and apply them — for instance, by leaving it to chance whether we save one life or a billion — would be deeply unethical.

In other words, it makes us feel good to believe that every human life is of “equal” or “infinite” worth, but in reality we know better.

As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved.

The next several sentences go on to do the grim utilitarian math of ages of the patients, their average life expectancies, and how “we” get a bigger bang for our buck saving a 17-year old instead of a dozen 85-year olds.

Singer’s article is replete with half-truths, loaded language (all the bad guys are labeled “conservative” and all the good guys have no political monikers and work at respected Universities), and massaged conclusions. But here is what we can take away from what he writes. He is absolutely right that government run health care is by necessity the rationing of a scarce resource, and that disembodied bureaucrats will be making health care decisions for you. He is abominably wrong that this is OK.


Phil R said...

It is hard to underestimate the social changes that are in store for the U.S. with health care reform. As someone who works in the current hospital system, I am very nervous about what -may- happen. Society today does a very poor job talking about, and preparing people for end of life issues. I don't see how an imposed government system can possibly make that better. Looking into the crystal ball, I do not see how it is possible to change our current system without going to social medicine. We shall see.

Steve said...

Hey Phil-

Great post! Thanks for bringing this to attention.