Peter Singer: ‘We must ration health care’
July 16th, 2009
Writing for this weekend’s New York Times Magazine, philosopher Peter Singer argues for rationing health care.
He says rationing is already taking place — we deny treatment to those who can’t pay — and it must be formalized within public insurance plans like Medicaid because the public can ill afford to pay limitless prices for treatments that will only extend life by a few months, or to care for individuals with severe conditions that are very expensive to treat.
Singer acknowledges that his argument will draw criticism from disability advocates, who say health care rationing implicitly discriminates against people with disabilities. The basis for Singer’s argument is an economic measure called the QALY (Quality Adjusted Life Year), which measures disease burden by assigning numerical values to the quality and quantity of a life lived.
(Graphic from the New York Times Magazine)
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January 23rd, 2010 at 5:11 am
I would like to see the Quality Adjusted Life Year on Bernie Madoff, assigning numerical values to the quality and quantity of the life he has lived.
It’s true we don’t have unlimited resources, but the devastating shortfalls in healthcare for many of us is because extreme profit is going into the pockets of those who have the least interest in the well-being of the average person.
It’s not that others go without care so that you can have the care that you need or want; they go without so that certain groups of people have the income and profits they need/want.
If a ship is sinking, maybe the person who should be thrown off is the one poking holes in it.
PS: We do not ‘put down’ people – the appropriate term is ‘murder’
January 18th, 2010 at 2:47 pm
Jessica,
We just need to make sure that there are enough “resources” for you and Dr. Singer, right?
January 16th, 2010 at 9:30 am
Singer’s reasoning is dangerous, not just because he believes that there are people capable of determining the value of others (and that he is one of them), but because it changes the focus of the situation.
Starting with the statement “in the current situation there are limitations” the next logical step is the question is “what do we do about those limitations?”
The easy answer is definitely “embrace them.”
But is that the only possibility? Really??
The assumption that the resources we have are all we could ever have, that those resources can only ever be directed the way they are now, or that the current system is the only possible system are all completely illogical. If the collective geniuses applied themselves to changing any of those, they could achieve amazing things.
When people focus on getting to the moon, curing a disease, harnessing electricity, etc, etc, etc, they do.
Focusing the healthcare dilemma on determining who should be ‘in’ and who should be ‘out’ rather than on making healthcare better is a sad waste of intellect and energy. It’s the easy way out… not the only way out.
January 15th, 2010 at 12:32 pm
If a ship is sinking and only so many people can be saved, you have to make some hard choices. This is also the case with health care and this is what Singer is trying to get at.
In an ideal world, everyone would get the care he or she needs, but we don’t have unlimited resources. Someone is going to have to sacrifice and not get everything he or she wants or needs.
So for those above who ask the ridiculous question of whether he/she should be put down, I return the question of whether you think your life is more valuable than another person’s or several people’s. Do you think others should have to go without care so that you can have the care that you need or want?
The thing is that we are all in this together and yes, some are going to have to sacrifice more than others, but when the ship is sinking, do you save the child or the senior citizen? Do you save several people or the heaviest person in the boat?
September 1st, 2009 at 9:23 am
peter singer has caused me to be unhappy and depressed. i have learning difficulties, anxiety problems. i am very unhappy. should i be killed then? according to him. this makes my anxiety worse so now he’s causeing it. listen, anyone who agrees with peter singer — have you ever thought us disabled people might think you should be aborted?
July 18th, 2009 at 7:25 pm
This is a repetition of a tired argument Singer uses to try to show that people with disabilities are inherently less valuable, and have a lesser quality of life than people without disabilities. His argument is that anybody with a disability must want a cure. If disabled people don’t want to be disabled, it must be an inferior state. If disabled people are satisfied with their position in life, why spend any money to “cure” them?
In his “rationing” essay Singer hypothesizes that a person with quadriplegia has half the quality of life as a person who doesn’t have this condition. Says who? Not people with quadriplegia. Then he assumes he has proven this point and quotes himself as the source. It seems to me that Jerry Lewis made a similar comment about people in wheelchairs being half a person years ago. Maybe Singer can quote Lewis as a source.
Quality of Life is not an objective statistic, and it should not be the basis for life and death decisions. Singer could make similar comments about the qualify of life of poor people, Africans, women or people with a different sexual orientation than himself. If he did, people would label him as a bigot. Singer’s bigotry is in his disdain for people with disabilities, old, young and in-between. Why does the New York Times give him this platform?
July 17th, 2009 at 8:18 pm
I’m on the fence about Singer’s article as he does provide good information. However, he tends to leave out the alternatives under the current system of for-profit private insurance companies. He neglects to say private insurance companies do ration health care through the use of ineligibility determinations such as “pre-existing conditions” amongst a whole arsenal of other reasons to deny care. He just gives the dirty facts about a potential national health care system.
Private insurance companies have rationed health care for decades under the guise of “rooting out fraud.” I’m sure there is fraud within the system, but those same “fraud” investigators also determine how to deny legitimate hefty claims under one of their many rules (i.e; “pre-existing condition.”) Chief medical physicians within insurance companies get large bonuses for finding ways to deny coverage on large claims as well. This is the reality of private insurance companies.
Private insurance companies have built-in QALY systems which help them determine whether or not they’ll pay on certain claims; this would be no different than what he suggests a nationalized system does. I do partially agree with this, but the “profit” the private insurance companies would take in for shareholders should be put in some kind of reserve fund for years of health crisis and for preventative maintenance. As well, the QALY system should not be as rigid as is under for-profit entities. In theory, this system would run a zero balance, paying out every dime in takes in minus reserves payments.
The industrialized nations that provide nationalized health care are much healthier than we are because they allow for preventative maintenance in keeping their citizens healthy, rather than letting it get to the point of “no return.” Unfortunately, within the US, we pay such high premiums for health care and many carriers do not offer “preventative” care; we shoot ourselves in the foot. An ounce of prevention is worth a pound of cure.
This is on top of the negotiations of pharmaceutical companies which take in money hand over fist and invest it in R&D and changing minor things about a drug and renewing its patent. This is an issue because the most simple of drugs will stay under patent for decades upon decades, which never allows the “free market” to introduce competitive alternatives. Singer addresses this in his article saying something to the effect of “other nations simply won’t pay what pharmaceutical companies want, so the company either loses out on business or they give in to receiving less. Companies give in to receiving less in order to keep the business.”
Medicare used to negotiate the price of drugs from the pharmaceutical companies, but that changed in the early 2000s when our former President signed into law legislation which not only allowed them to charge what they want, stopped medicare from negotiating prices, and allowed “Direct to Consumer Advertising.” This is why we see so many drug commercials on television and in the media these days. Prior to the Medicare changes, the drugs had to be FDA approved AND they could not describe both cause and cure in the same commercial.
The commercials (prior to 2002) could advertise something like “Do you have allergies during the spring? Consult your doctor about a cure that may work for you.” Post 2002 commercials may simply say “Do you have allergies? You need ! Side-effects noted have been: nausea, headaches, etc.” It was a whole shift in the paradigm of medicine. Rather than consulting a licensed practicing physician, people consult their television for medical advice.
This in-part is also what has driven up our health care costs. Who needs a doctor? I got all the information I needed in a 30 second spot during my favorite TV show. On top of putting insurance companies between doctors and patients, we also now have a television.
July 17th, 2009 at 10:39 am
Peter Singer is a notorious polemicist rather than the ethicist he claims to be.
I’m always intrigued by his advocacy of Nazi-style eugenics (for humans) and yet he is an extreme advocate for animal rights.
He’s a whack job but one who – unfortunately – gets headlines.
July 16th, 2009 at 7:42 pm
How do you assign a numerical value to the quality of life???
And Pete Singer doesn’t care about people with disabilities. He wanted to put his own mother down. Thank goodness he had a sibling who disagreed.
July 16th, 2009 at 6:38 pm
When I read that article I found myself wondering what the alternative is to providing care for expensive conditions. Should I just be put down because I’m high maintenance?