Comments on: Peter Singer on Health-Care Rationing

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By: jamesvonderhaar

jamesvonderhaar — Fri, 24 Jul 2009 15:41:36 +0000

I think the objection here is largely a result of different people that you tend to be around. The notion of putting a price on human life and preferences for reducing risk of death in the future is uncontroversial for economists, but is likely to elicit revulsion in the general populace, and especially among Singer's detractors in the field of moral philosophy.

What's old hat to you has to be explained and argued painstakingly for Singer's audience.

None of which is to say that your argument that the government can't read price signals effectively enough to get an "objective" value of human life isn't valid.

By: Greg Billock

Greg Billock — Wed, 22 Jul 2009 18:12:10 +0000

Did you read the entire article? Singer does argue that public healthcare benefits be assigned on a utilitarian basis (as would be expected). That's what the article is about.

The next-to-last paragraph (beginning “Rationing public health care limits free choice if private health insurance is prohibited.”) points out that this in no way needs to impede the ability of individuals to spend however much they wish on treatments which don't seem to be proven or cost-effective enough for the public to provide. Singer points to the Australian system, with which he is familiar, as a model.

By: tlwest

tlwest — Wed, 22 Jul 2009 13:28:04 +0000

Actually, I'll go out on a limb here and defend the Canadian system.

But first, Will's quote:
Individuals do it all the time through their rationing–through occupational choices, consumer choices, residential choices, transportation choices, and health and medical choices, all of which reveal how much the individual is willing to pay to avoid an X% risk of death..

The term willing is loaded. Most of the time, the term you actually mean is able. I don't think that anyone could seriously claim that someone who has only $50 to his name really only values his life at $50.

And that is crux of the argument. Do the wealthy value their lives say a thousand times more than the homeless? I don't think there are many who would claim that they do. Perhaps a better way of evaluating how much you value your life is by what fraction of your overall net worth you'd sacrifice. But then the homeless would value there life *more*.

In the end, there's no way of easily having people value their life that *isn't* really a proxy for how wealthy they are.

In other words, those economists that would use value human lives by how much people are willing to spend to save them are essentially saying that a human life is valued by its wealth.

While wealth means a lot, in many countries, like Canada, most people would be unwilling to say that the lives of the wealthy are more valuable than the lives of anyone else. Wealth may buy you more toys, and your children a more comfortable life, but it should not buy life itself.

And that is what underlies Canadian-style health care systems to Canadians.

By: uknowbetter

uknowbetter — Tue, 21 Jul 2009 20:30:49 +0000

The guy is a moron. I knew that when I was studying philosophy years ago and he has only proved it even more in recent years.

By: Why we must ration health care « (the) health informaticist

Why we must ration health care « (the) health informaticist — Tue, 21 Jul 2009 12:51:04 +0000

[...] debate will run and run… [...]

By: Maggie's Farm

Maggie's Farm — Tue, 21 Jul 2009 10:23:50 +0000

Tues. morning links…

Image above via Tim Blair
I heard on the radio news today "The US is the only of the advanced industrial nations without government medicine." I wondered "What’s wrong with that?" No NHS, Please. We’re Americans.
The O’s Gree…

By: Peter Singer in NYT on rationing health care « The Philosopher's Eye

Peter Singer in NYT on rationing health care « The Philosopher's Eye — Sun, 19 Jul 2009 20:47:03 +0000

[...] Singer in NYT on rationing health care By davidkilloren Check it out here. Will Wilkinson excerpts this part: If the Department of Transportation [followed the principle that it was impossible to [...]

By: Will Wilkinson

Will Wilkinson — Sun, 19 Jul 2009 02:13:35 +0000

I think you missed the comment above where I said I was confused and admitted I had it wrong. I guess I should flag that in the post.

By: Richard

Richard — Sun, 19 Jul 2009 01:20:10 +0000

Will - please read hilzoy on the utter dishonesty of this "rationing" rhetoric. I usually like your stuff, but this is just embarrassing.

By: dusty

dusty — Sun, 19 Jul 2009 00:26:21 +0000

“Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.” Thats just sickening. (pun not intended, but HA!)

By: ducdenemours

ducdenemours — Sat, 18 Jul 2009 12:09:12 +0000

The Singer article is a very well written definition of QALYs complete with the rationale behind them which is fair enough I suppose.

Nevertheless, I hope fellow readers will find it useful to know that in England (other bits of the UK are still to make a final decision I think) you can buy extra drugs such as sutent, avastin, herceptin and the rest to top up your NHS care. The rationing body has also adjusted its QALY calculations to allow some of these drugs to be provided on the NHS.

In short, the social solidarity principle that governments of either stripe spent a long time upholding has been ceded - as it had already in dentistry (North American readers stop sniggering) and prescriptions among other aspects.

I also think it is important that we should not get fixated by these expensive drugs. Sutent and the rest are very expensive but are still pretty marginal in terms of overall health spend.

Costs of diseases such as diabetes, Chronic Obstructive Pulmonary Disease COPD, heart disease generally, dementia and all the other illnesses associated with modern developed world will dwarf the spend on these drugs.

What is more they do not cure anything. They might keep some people alive a bit longer and often with pretty terrible side-effects.

In short, although it raises some interesting overall issues around healthcare and risk-pooling, there is a danger, i fear of becoming fixated on the debate around these drugs that misses out the other important healthcare questions.

By: Paul_G_Brown

Paul_G_Brown — Sat, 18 Jul 2009 09:05:51 +0000

Of course, the government, like individuals and families, has a limited budget. So if the government is going to pay for medical care, it has to ration. And that very fact is an argument for limiting the government to only paying for the care of people who are unable to pay for a minimum of care themselves.

And how do you propose we decide how much to spend on these people?

All Singer is saying is that there are more or less reasonable ways to answer questions about whether a HMO should spend money on 'treatment X'. This is precisely the same calculation that was made by car companies with respect to air bags, shoulder belts, and central gas tanks. Engineers building airliners go through the same process. It's a methodology for deciding how to allocate resources to get 'bang for buck'.

In fact, it's the same decision health insurance companies make every day about whether or not to "cancel Will's policy". They're all putting a price on life. All Singer is saying is that we might as well just be explicit about it.

On another note: When Singer says something, and it seems stupid? My working assumption is I'm the dumb one. Not him.

By: LemmusLemmus

LemmusLemmus — Sat, 18 Jul 2009 04:37:16 +0000

As for other countries' systems, apparently in Britain you can be denied NHS treatment if you purchase additional care. One source for such a story, another: "Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones."

But, as others have pointed out, yours is only an argument against the above sick logic, not against universal health care per se.