Free Markets, Free People

Rationing Health Care

Peter Singer has popped up again and he engages in telling us a simple truth about health care – no matter what system you have, health care will be rationed.  Well, for those of us who understand supply and demand we’ve always known health care would be rationed.  When you have 800,000 doctors in a country of 300 million, it isn’t really that difficult to figure out.

However, that’s really not Singer’s point.  If you read through his multiple page piece, you’ll find that he is of the opinion that government bureaucrats would be much better at rationing than would private bureaucrats.  And he attempts to make his point by selectively offering facts that will back his position.

But this amazing paragraph pretty much represents where he believes we must go with our health care reform (and indications are our politicians implicitly agree given the goals they’ve set for “reform”):

Of course, it’s one thing to accept that there’s a limit to how much we should spend to save a human life, and another to set that limit. The dollar value that bureaucrats place on a generic human life is intended to reflect social values, as revealed in our behavior. It is the answer to the question “How much are you willing to pay to save your life?” — except that, of course, if you asked that question of people who were facing death, they would be prepared to pay almost anything to save their lives. So instead, economists note how much people are prepared to pay to reduce the risk that they will die. How much will people pay for air bags in a car, for instance? Once you know how much they will pay for a specified reduction in risk, you multiply the amount that people are willing to pay by how much the risk has been reduced, and then you know, or so the theory goes, what value people place on their lives. Suppose that there is a 1 in 100,000 chance that an air bag in my car will save my life, and that I would pay $50 — but no more than that — for an air bag. Then it looks as if I value my life at $50 x 100,000, or $5 million.

Frankly, this paragraph should make your skin crawl. Because what Singer is doing here is presuming we all accept that others, those nameless bureaucrats he’s so fond of if they happen to be from the government, now have the job (and duty) to decide what your life is worth. Not you. Not your family.

No, what Singer proposes is reducing your life to an arbitrary worth beyond which “they” are not willing to pay to save it. Whether you are or not is apparently not a factor in such calculations.

Singer goes on:

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.

“Deeply unethical” for whom? Certainly not the person with the desire and means to do what they feel is necessary to extend their life or the life of a loved one. They, of course, would value human life above the arbitrary level which Singer and “economists” calculate.

But Singer’s premise here is they shouldn’t have that right. Because other’s don’t have the same opportunity. It would be “deeply unethical” for some to be able to “buy” what others can’t afford. So instead, the ethical thing to do is have everyone held to the economically calculated standard, whether they have the means and desire to do otherwise or not.

Of course we can argue this philosophically for decades, but the point remains that rationing is a feature of any health care system. What isn’t a feature of every health care system is choice. What Singer is actually proposing is taking the choice that now exists in our health care system away and putting everyone under the arbitrary rationing guidelines calculated by government.

He says as much in his next paragraph:

Governments implicitly place a dollar value on a human life when they decide how much is to be spent on health care programs and how much on other public goods that are not directed toward saving lives. The task of health care bureaucrats is then to get the best value for the resources they have been allocated. It is the familiar comparative exercise of getting the most bang for your buck.

The best bang for “your” buck? It’s no longer “your” buck at that point. It is the government’s buck and you have no choice in how it will be spent or “saved”. You will, however, be on the receiving end of any decision.

And where that leads (and where Singer was going with all of this to begin with) is found here:

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. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds.

Pretty darn predictable, no? This is the logical end of Singer’s rationing policy. Utilitarian calculation based on arbitrary worth. And the inevitable decision to ration in such a way as to deny the elderly because they just aren’t “worth” it anymore.

And that, per Singer, would be very ethical.

Trust me, those collectivist premises are what will drive government run health care’s rationing. Given the goals (more coverage, less cost) they must. Choice will eventually be driven out of the system and, as they must, bureaucrats will decide how long you will be allowed to live.

Count on it.


35 Responses to Rationing Health Care

  • This is exactly what Erb said the other day when he posted his strange rant against how private interests needed to be subverted for the greater good. Two peas in a pod.

    “The death of a teenager is a greater tragedy than the death of an 85-year-old”

    Actually no. And nobody with a shred of humanity can argue otherwise.

    • SHARK – “… nobody with a shred of humanity…”

      Well, that excludes liberals, doesn’t it?


      What we see here is a collision between morality and logic. As McQ points out, rationing OF SOME KIND is inevitable in a country where the patients outnumber the doctors. Presently, we have a de facto rationing system based on time (how long are you willing to sit in a crowded ER or waiting room?) and money (can you afford the cost of the procedure you want?). Though this is the same “rationing system” (free market) that has existed in our society for centuries, some people find this situation abhorrent: shouldn’t EVERYBODY in a rich country like ours have equally quick access to equally good medical care? This is the stated idea behind universal coverage. Unfortunately, reality intrudes and eventually even the most empty-headed do-gooder comes up with a thud against the plain fact that there simply isn’t enough money to give everybody the same level of care that (for example) TAO, George Soros, or Slick Willie* enjoys. So, some sort of rationing becomes mandatory. Somebody has to decide how much money is available and how best to spend it. Somebody has to decide who lives and who dies. How does one make that decision?

      There are two basic paradigms that govern how the decision is made. The first is that all people have equal worth and equal opportunity, and that “need” is treated on an individual basis. The second is that the needs of the many outweigh the needs of the few (to borrow a phrase!). One cannot intellectually refute the second paradigm: why should the many suffer and do without to provide for the needs of the few? This is Singer’s position in favor of government rationing of government health care.

      What he doesn’t realize is that the tension between many and few is an argument AGAINST “universal” health care in the first place. Why should the many pay for the health care of the few? How is this more ethical or “just” than having each person look out for his own interests? If Peter is sick, why should Paul have to pay for it? There is no moral problem about saving the teenager or saving the octogenarian if THEY AND THEY ALONE are responsible for their own health. If the old man is willing to spend all his money to keep the Reaper at bay for a few more months, it’s his business. If the teen (or, actually, his parents) are NOT willing to spend the money, that’s their business, too.

      This perhaps seems cold and heartless as it casts us all as individuals who cannot count on the aid of his fellows. But this is not so: a society of individuals free to chart their own destiny are also free to help each other (clearly shown by the staggering sums donated to charities after Katrina and the Indonesian tsunami). Universal care takes this choice away and in effect FORCES people to be charitable; the government WILL rob Peter to pay for Paul.

      Unless, of course, the rationing body determines that it isn’t “cost effective” for Paul to have the medicine or procedure he needs. Then, Peter won’t be able to help even if he wants, even if Paul is his teenage son or aging grandfather.


      (*) I can only speculate that the costs for his antibiotic prescriptions alone is greater than the GDP of many countries.

      • I assume our Congress will still maintain their fantastic healthcare plan? Again, you want to make this more palatable, at least give me a plan where Teddy Kennedy and Malia Obama have just as much of a chance to die due these various factors than my 85 year old grandmother whom is not deemed important enough anymore.

        I’ll sit in a waiting room and suffer as long as I can see Teddy Kennedy suffering right there along with me.

        • “‘You have heard then, comrades,’ he said, ‘that we pigs now sleep in the
          beds of the farmhouse? And why not? You did not suppose, surely, that
          there was ever a ruling against beds? A bed merely means a place to sleep
          in. A pile of straw in a stall is a bed, properly regarded. The rule was
          against sheets, which are a human invention. We have removed the sheets
          from the farmhouse beds, and sleep between blankets. And very comfortable
          beds they are too! But not more comfortable than we need, I can tell you,
          comrades, with all the brainwork we have to do nowadays. You would not rob
          us of our repose, would you, comrades? You would not have us too tired to
          carry out our duties? Surely none of you wishes to see Jones back?’

          “The animals reassured him on this point immediately, and no more was said
          about the pigs sleeping in the farmhouse beds. And when, some days
          afterwards, it was announced that from now on the pigs would get up an
          hour later in the mornings than the other animals, no complaint was made
          about that either.”

          George Orwell
          “Animal Farm”

          While you’re suffering in the waiting room waiting for Teddy to show up, shark, just remember that some pigs are more equal than others and keep telling yourself that, “Obama is always right.”

  • Recently Hospitals in certain regions of the UK determined they had more patients with kidney failure than they had available dialysis machines. Hence notices were recieved by people over the age of 50 who were recently diagnosed with Kidney disease and were in need of starting a regimen of dislysis. The notices read: “We regret . . . Therefore we recommend you get your affairs in order.”

  • No no, let’s go with Peter’s logic.  If old people are worth less because they have less time to live, Peter’s not worth much and thus I can discount his ideas as worthless.  In fact, his worth is so low, we’d be better off without him. Just thinking of the other billion of us Peter; I’m sure you understand.

  • The vast majority would say a teen’s life is worth more than an octo’s.    More to the point, a rich dude’s life is not worth more than ours.

    • No, clown, you’re right it isn’t.   But here’s something for you to think about – Micheal Jackson’s money didn’t SAVE him, did it.
      Under the proposed system YOU won’t have any say in the matter at all, rich OR poor.
      If you think people dislike the empty suits at the insurance company denying you coverage, wait until the faceless government not only denies you coverage, but prevents the doctor from even considering treating you or someone you love.
      A faceless government jobo is an even LESS than adequate substitute for a faceless private business jobo.  At least I can sue the insurance company if it’s warrented, let me know how that works against the government.
      Clearly though Tommy you’re one of those people that think ‘equality under the law’ means exactly equal in social standing, wealth (or lack of it) and all other things.  While grown ups understand we can’t be and never will be ALL exactly equal in life and it’s not the job of the government to see to it that we are.
      So grow up and accept the premise that some people have a better jobs, are better looking, can run faster, are smarter, etc,  than you are.  Conversely, accept that fact that somewhere on the great ladder of life there’s someone who thinks YOU have it made.
      The only time we’re truly all equal is when we’re dead.

    • The vast majority would say a teen’s life is worth more than an octo’s


      Eh. My “octo’s” life is more important than your teen.

    • Like 18 year old Charles Manson vs. 85 year old Albert Einstein?

  • Singer flies in the face of Obama himself on this when he responded that he’d do everything he could to save a family member with some catastrophic medical condition that the ‘managed’ care system didn’t cover.

  • TomD, the ‘vast majority’ would not.  The vast majority, if asked clearly, would assert them as equal.  Your second point is a non sequitur.

  • checkout

    The house bill makes it illegal for private insurers to get new customers. So in short it will be govt health care one way or another.

  • We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved.

    By that logic, outlawing abortion would save an average of 72 life-years for each instance.

  • Of course the real question is how much does a faceless government bureaucrat value your life.

  • It’s actually a fallacy that a price system is “still rationing.” It’s simply not true: prices allocate who gets goods and services, but it still isn’t rationing. Rationing implies an attempt at equal shares, whereas allocation can be unequal. As it should be, too, because life is unequal: I think it was you who stated a while back, Bruce, that income inequality exists, and only because some people aren’t producing (enough) of their fair share.

    I’ve said on a friend’s blog that when given the choice between government choosing how much to give me, and the freedom to pay for it myself, there’s no question for me: as someone who is an economic producer, I’d much rather depend on myself. At least it’s up to me to develop my talents, go to school, etc., to improve my situation in life and afford more (including health care). Therefore I have influence over how much I earn, perhaps not complete influence, but I can’t say I have any influence at all over how much a bureaucrat will decide to give me.

    I make no excuses whatsoever for liking that “money talks.” My wife recently got bitten by some sort of insect, and the bite got infected. It just wasn’t healing on its own, so one morning we called around and got an appointment for that very morning. Our usual doctor was busy, but his partner could fit us in. And why not, considering we were paying cash?

  • Mr. Singer’s use of the phrase “generic human life” kind of says it all, doesn’t it?

  • Our ‘representaives’ and their bereaucratic brethren won’t care that the elderly will be asked to die to ‘balance’ the balance sheets so to speak. It will be considered a feature, not a bug, as it gives them a twofer: one less citizen collecting social security payments will help ‘balance’ the entitlement funding problem as well.

  • Left unsaid in all the health care discussion is the effect on Roe v Wade.
    Lost on many is that Roe v Wade spelled out that the government had no interest or business in the health decision, therefore it was a “private’ matter.  The whole privacy argument disappears under Obamacare, most especially under the “public option”.

  • To add to my prior post. I don’t doubt that the elite will still be able to get care for THEIR family and loved ones, they always give themselves an exemption on the restrictions and/or compulsory effects of their policy that enslaves the rest of us hoi polloi.



    Baracky’s healthcare plan = 60% tax bracket in New York, which will lead to a right quick exodus of the “rich” and small businesses.

    And then the city will effectively die.

    And though I’m in the City (ready to bolt the second I can) I can’t help but feel a huge dose of schadenfreude also. New Yorkers are about to get what they wanted, and they’re going to get it good and hard. And I hope they have the good graces to STFU and suffer in silence.

  • Shark

    Look at Detroit. They have homes for sale for under $1000 and yet noone wants to move there.

    • Retired Military-

      Detroit is such a massive failure of every sector, it is mind-boggling. That’s another city that gets what they wanted. Hope they’re enjoying it.

  • I think that when we consider denying care based on life expectancy and efficiency, we should not stop at making such an obvious comparison as an 85-year-old versus a 15-year-old.  We should be asking where that dividing line really is.  What if the choice isn’t between your grandmother and your grandson?  What if it’s between the 35-year-old and the 48-year-old?  The argument that uses extremes is designed to cause as little “moral discomfort” as possible by making a (very creepy) appeal to cold rationalizing.  Make the examples hit closer to home for more people, and suddenly “rationing” becomes a four-letter-word.
    When you’re trying to sell the public on a questionable deal, you always use examples from the extreme ends, and hope that people don’t recognize that the examples that you aren’t using are the ones that are likely to be the norm.  That is, IMO, what we’re seeing here.

  • What a load of bull cookies! That moron is the kind of Useful Idiot that only serves to confuse and obfuscate to the point that frustration takes over and people just turn away and—ironically—wonder how in the hell these people ever got into a position of power. But they can’t turn away from this monstrosity for it will consume them.
    IF this thing gets passed, the ONLY good thing is that somday I might get to stand in line to have my colonoscopy with the likes of John Kerry and when I do, boy, Pow! he’s gonna get it. And I can’t wait to see Shrillary hanging out waiting for her annual breast exam (ewwww…I just threw up a little in my mouth) and just think about Queen Pelosi…huh? What? WHAT do you mean they won’t have the same program and have to agonize like the rest of us? Yeah, I certain Orwell must be laughing somewhere upstairs…..

  • My fear is that all those lefties who voted for hopeychangitude and find that it costs them too much will move down here and bring their lousy voting patterns with them.  [Brooklyn accent] “Well, back in Brooklyn we had X or we did Y, and I don’t know WHY youse can’t do the same down here.”

  • Some commenters have noted the distinction, how much taxpayers should spend (as a safety net) versus how much individuals have the right to spend on themselves, inalienably.  Or not.  I may forego a procedure based on many factors, including risk, cost, and perceived benefits.

    No one has yet mentioned the critical issue of internal consistency and coherence.  Government must use the same values when it sets regs and issues unfunded mandates.  How much or little can we spend to  get this toxin to that level?  What is the cost/benefit tradeoff to this safety standard? 

    I challenge this readership to find any two different government regs that use comparable methods. Any two, ranging from mine safety, to airline rules, to traffic cones.

  • Bear in mind that Singer is a “bioethicist”. If you rank bioethicists somewhere below used car salesmen and ambulance chasers, you’re still aiming a little too high.
    Singer’s views contribute nothing to the health care debate, because they’re not based on the real world: they’re based on his theoretical moral framework that no real person holds to. If he were commenting on a libertarian blog rather than being discussed in one, a man who does not believe in inalienable human rights would be deemed a troll.

  • Missing in all of this debate, and shame on the right/conservatives/libertarians for not bringing it up…is it is none of Peter Singers, Barack Obamas
    or any federal beaureacrats business what I do for my healthcare. Go read the Constitution and do the job it says is yours and leave the rest to all the other government we already have, state, county, municipal, etc.

  • I’ve been thinking about the House plan making new health care insurance policies illegal and have begun to think that it is unconstitutional.
    Frankly, it’s time that all opponents of Obamacare to embrace “Roe v Wade“.
    Don’t think of it as having anything but a cursory attachment to abortion, but rather think of it as a proven endorsement of health care privacy from the intrusion of the government into your health care decisions.

  • Are you proposing that the ideal health care system should make coverage decisions based on the character/race/income level/whatever of its patients?

    • I think most here would have the ideal health care system as a voluntary contract between doctor and patient without government intervention. That’s obviously not happening so the answer is back government out to the point where it can happen. The compromise, if there has to be one, is insure the uninsured – period.