Singer on Rationing Health Care

Here's Peter Singer in the New York Times on the rationing of health care. (Everything comes down to money, doesn't it?)

Comments

[Michael Bauman]

The inevitable rationing of health care is one of the chief reasons against turning it over to the government. When you are reduced to looking up the dollar value of a human life in your copy of The Bureaucrat's Health Care Handbook, the essential compromise has already been made, and people will die -- for money.

[Margaret]

How much should we spend on Pete?

[mark of brighton]

The Democratic party has regularly scared the elderly for their own advantage. Under the present system of health care, the elderly get what they need. It may not be perfect but they get the care they need.

It seems to me that the elderly have been riding at the front of the bus and when the new system is enacted, they will be moved to the back of the bus. A bureaucrat will determine their level of care and when they die depending upon the cost.

[robert]

Fear of rationing by the government is nonsensical. The market, by definition, rations care. The question before us is to what extend will the government step in to negate the market's rationing.

[TimC]

Robert,

It would be helpful if you would define what you understand "ration" to mean. Rationing is generally defined as "restricting the consumption of" some good. By this definition, your comment is simply wrong. The market only "rations" health care in the sense that it "rations" food or any other purchasable good. In other words, the market doesn't ration anything. It sets prices for goods that you or I may purchase. If we have the money, we are free to consume as much as we wish. If we don't have the money, we are free to earn it.

On the other hand, a government-run system will necessarily ration health care. Because, unlike your or I or any private actor, the government cannot create wealth, it is limited to spending only what it can obtain from its constituents through taxes, etc. With this limited amount of money, if there is to be anything resembling equity in the disbursement of health care benefits, the consumption of those benefits must be restricted.

This is not non-sensical; it is Economics 101.

[robert]

"It would be helpful if you would define what you understand 'ration' to mean."

Ditto to those who use this scare tactic in the debate. I don't, in fact, think the market rations care. Saying so, though, points to the absurdity of the argument that a communal health care system would. Both face the same limits of scarcity but manage resources in different ways. In neither case should the scarcity be labeled rationing, whether the label is being used by Michael Bauman or Peter Singer. The government placing some portion of people's health care needs outside of pure market forces is no more rationing health care than is the government's WIC and food stamps programs a rationing of food.

Two points:

1. In reference to the article on Singer, the question of rationing (erroneously called) is framed there as a fill-in-the-blank: "Public health insurance should pay up to $____ for a treatment that would extend a patient's life for one year." Free market advocates imply that consideration of such "rationing" is morally reprehensible. They neglect to note, though, that they have not only already considered the question but arrived at an answer: "zero." The moralizing is laughable to any who have put some thought into the question independent of the ideologies that drive the two sides.

2. Assuming the government does not obtain a monopoly on the provision of health care, a government health care system does not fundamentally effect the market basis of the provision of care. As it is now, we are all free to get whatever health care we can afford. Under a government run health care system there will be some set of health problems for which anyone can receive treatment regardless of ability to pay. That likely will not be all conditions and all treatments. For those conditions and treatments not covered, we will be free to get whatever health care we can afford. I'm failing to see how this is some terrible moral break from the status quo.

[Michael Bauman]

Obama says he wants to hold down health care costs. By holding down health care costs, he will make it less profitable for companies to make drugs and medical instrumentation, and for young persons to become doctors. They then will re-allocate their considerable investments in other more profitable ways. This re-allocation leads to shortages, and to rationing schemes, just as it did in the 70s when the government put price controls on gasoline. The result was gas rationing and long lines. It will happen again, only substitute health care for gas and hospitals for service stations.

Obama also says he wants to bring many millions more persons into the system. By shrinking the pool of health care suppliers, on the one hand, and expanding the pool of health care consumers, on the other, he will make the shortages even more acute, and the rationing that results even more extensive.

[Chelie]

But Robert, you're assuming the government will not get a monopoly on health care. The current bill makes it more financially appealing for employers to drop private coverage and go the government one. This in turn will make individual coverage (for those who don't have employer-provided coverage) more expensive. If individuals can't afford their own policies, then you guessed it! They go to the government run one. Extrapolate it out and eventually it will be a monopoly. And I have no doubt that is the way this administration wants it. Follow the money and the power.

[robert]

Michael,
Health insurance companies have the same goal. Should they also be resisted? And why have the effects you predict not occurred in the countries that have already tread this path?

Chelie,
The government may well obtain a monopoly on health insurance coverage. That is not, however, a monopoly on health care. If doctors and hospitals are ever proscribed from taking cash for services and required to accept only government vouchers then, yes, my argument is made moot.

[Michael Bauman]

Robert,
We must be using completely different sets of data, because it seems to me that the very thing I am saying will happen here is already happening in places like the UK and Canada. Indeed, Canadians often come to the US, to places like Buffalo and Detroit (even Phoenix, which is, for some reason, a favorite destination for Canadian medical choices), to get the medical services not available to them in Canada.

Your reply to Chelie is, ironically, my reply to you about insurance, monopolies, coercion, and whether or not insurance companies ought to be resisted.

[robert]

There's no irony. That you would apply my observation to the status quo insurance regime but not to a government run health insurance program shows the incoherence of your argument. As for some Canadians coming to the US to obtain care, no doubt. On the other hand, of the Canadians and Europeans I know (immigrants or here for school or work), not a single one I've discussed this topic with, regardless of their political orientation or economic class, prefers our system to their home country's. Our competing anecdotes and outliers, of course, only take us so far.

[Michael Bauman]

Robert,
An interesting (anecdotal) article:

http://www.ibdeditorials.com/IBDArticles.aspx?id=300495064758477

[Steve K.]

A propos of anecdotes, I lived 10 years aboard, mostly in Germany. Nobody I knew wanted to use the public health system - everyone relied on private insurance. There was a reflexive pride in having the system as a mark of social progress, which was entirely aside from its actual utility. In other words, it was a fine thing as long as they didn't have to rely on it.

[Chelie]

Robert, here's something to ruminate:

http://www.ibdeditorials.com/IBDArticles.aspx?id=332548165656854

(Different from Michael Bauman's!)

[Emil]

I dislike much of what Peter Singer is noted for. But in this case, it seems that he has drawn an unavoidable conclusion. Even those with health insurance experience a form of rationing based on limits of payments and finally the patient's resources. I do not want to impoverish my wife with my medical costs.

Some suggest that we play God with comments such as his. But that argument just does not apply. In the not very distant past, many illnesses led to dysfunction and early death which now are treatable. Have we played God by providing for medical care? Advancements in medical care, blessings of God to be sure, have led to society having to ask when the costs are just too high.

[smithr]

One possibility - - take all 3rd party payers out of the healthcare equation. Governmental (medicare etc), private insurance, tax sheltered savings accounts . . take them all away. Providers provide, recipients' families pay for what is provided. Stop the loop of inflation. Providers will bring costs into line with the ability of recipients to pay. This is one case when the market will work perfectly. Morbidity rates will adjust to higher levels (people will on average die a bit sooner), though of course the long term death rate will remain at %100 'til the Lord returns. I believe that the existence of 3rd party payers is the problem, and there is no way for the system to be rationalized and returned to any state of cost/benefit/means equity so long as 3rd party payers are in the loop. Let the providers charge what the market can pay. Let the market choose the care it can actually afford.