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Why We Must Not Ration Health Care
By Eleanor Canter
In last Sunday�s edition of the New York Times, Peter Singer made a lengthy attempt to convince the American public that health care must be rationed, supported by classic utilitarian bioethics. Utilitarian bioethics is based on the premise that the distribution of resources is a zero-sum game, meaning that the losses of one individual can be neutralized by the gains of another.
Through his meandering examples, he seeks to convince us that utilitarian bioethical principles are a given and that anybody who has any common sense at all agrees that when the cost of medical treatment exceeds a person�s � value�, it is economically efficient to withhold treatment.
But he does not only believe that it is economically efficient, Singer believes that this barbarous philosophy would lead to an overall net increase in wealth and happiness. His conclusion is that it is morally tenable to apply monetary considerations to the value of individual lives.
I will put aside for now the fact that he is a proponent of eugenics, the practice of eradicating people with undesirable traits from the general population by a variety of means, and focus only on the arguments he presented in this opinion editorial. Singer�s first assumption is that is impossible not to ration health care; that rational people simply disagree on the degree to which it should be rationed.
He argues that health care is already rationed because of the inherent scarceness of the resource and cites the woeful inadequacies of our current system as evidence that rationing is inescapable. Is it patently ridiculous to portray health care as an inherently scarce resource in the richest and most powerful nation in the world. The current state of our health care system and the crushing effect its having on our economy have a direct correlation to the choices we have made and the priorities we have chosen as a nation.
Since we have chosen to make war, corporate subsidies, and tax cuts to the wealthiest Americans a priority, health care is indeed a scarce resource that is unfairly rationed. It does not follow, however, that government-endorsed rationing is the solution to the problem or that health care must always be a scarce resource.
Singer goes on to argue that measuring the good achieved by health care by the number of lives saved is �too crude�. To him, it is obvious that �saving one teenager is equivalent to saving 14 85-year-olds� and that �restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person�.
He must temper his argument in order to sound reasonable: �But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.� He has thrown this sentence in to let the reader know that some characteristics should not be taken into account when assessing the monetary value of an individual life, such as a violent criminal past.
From this point Singer digresses into the ethical morass the disability community has confronted him with throughout his career. He first presents his opponents� arguments: quality of life judgments about life with a disability made by people without disabilities are inherently flawed and reflect ignorance and prejudice, and people with disabilities invariably rate their quality of life much higher than people without disabilities imagine it.
He imagines that we can �survey� people with disabilities and simply ask them �How many years of life are you willing to give up to have your medical condition cured?�. Once we have completed the survey, he posits, we can then, free of any ethical concern, deny them life saving treatment based on the average answer.
With that little ethical glitch out of the way, Singer throws in one last jab at the disability community, �Disability advocates, it seems, are forced to choose between insisting that extending their lives is just as important as extending the lives of people without disabilities, and seeking public support for research into a cure for their condition.� This is a classic logical fallacy.
Singer is suggesting that if people with disabilities support research for a cure, then they are acknowledging that their lives are less valuable, and implicitly supporting his argument for rationed health care. He also suggests that people with disabilities cannot both place an equal value on their own lives and expect quality health care (of which research is only one aspect).
Disability advocates, who do by and large persistently insist that their lives have equal value, have never been opposed to comprehensive health care or research. We are opposed to a �cure or kill� mentality, the idea that our lives only have potential value, based on our ability to be cured, which is exactly what Singer is advocating. To claim that anyone should have to choose between health care and their basic human dignity is disingenuous of Singer and deeply offensive.
But Singer goes even further to suggest that the United States government should adopt his public plan to treat people with disabilities as only a fraction of a human life, forcing them to purchase private insurance for equal access to health care. �Rationing public health care limits free choice if private health insurance is prohibited. But many countries combine free national health insurance with optional private insurance� Those who opt for unrationed health care will know exactly how much it costs them.�
This is ethically outrageous, but Singer is confident the public will adopt the proposed bigotry and integrate it into a government-run program when they observe the economic utility of discrimination. He states, �Will Americans allow their government� to decide which treatments are sufficiently cost-effective to be provided at public expense and which are not? They might, [if] the option of private health insurance remains available� and they are able to see, in their own pocket, the full cost of not rationing health care.�
The fact that the discourse surrounding the health care discussion has actually sunk to the level of debating whether or not human lives have equal value makes me terribly sad. The first eugenics movement in America began because of chaotic social and economic conditions after the civil war. We must be very careful not to abandon our principles in uncertain economic times. We must answer Singer�s selfish and un-American ideals with a resounding NO.