Sunday, July 19, 2009

Peter Singer : Ration Health Care

Peter Singer, Princeton philospher, is infamous for being a rather outspoken animal rights activist. But his piece in today's NY Times Magazine's right on point. It is hard to read if you're completely, absolutely, 1000% pro-human life, but his logic is iron-clad.

If you can afford [Sutent, an expensive drug for advanced kidney cancer], you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed...

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care...

There’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way. But if the stories of Bruce Hardy and Jack Rosser [(patients given decisions to deny treatments)] lead us to think badly of the British system of rationing health care, we should remind ourselves that the U.S. system also results in people going without life-saving treatment — it just does so less visibly. Pharmaceutical manufacturers often charge much more for drugs in the United States than they charge for the same drugs in Britain, where they know that a higher price would put the drug outside the cost-effectiveness limits set by NICE [(the UK's National Institute for Health and Clinical Excellence). American patients, even if they are covered by Medicare or Medicaid, often cannot afford the copayments for drugs. That’s rationing too, by ability to pay.

Singer's 100% right here: An allocation based on economic power is still an allocation, and it can't possibly be an allocation based on maximizing the number of people's well-being.

So when the righties start bleating about "rationing" - which is an allocation after all, mention to them these points.

It's better to allocate based on maximizing people's well-being than on maximizing the money held by a few, which is the system we have now.

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