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. Sometimes that can be relatively easy to decide. If two drugs offer the same benefits and have similar risks of side effects, but one is much more expensive than the other, only the cheaper one should be provided by the public health care program. That the benefits and the risks of side effects are similar is a scientific matter for experts to decide after calling for submissions and examining them. That is the bread-and-butter work of units like NICE. But the benefits may vary in ways that defy straightforward comparison. We need a common unit for measuring the goods achieved by health care. Since we are talking about comparing different goods, the choice of unit is not merely a scientific or economic question but an ethical one.On to quadriplegics:
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.
How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.
This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care...If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S.
Want to go out and buy your own healthcare program if a Singer type program kicks in. Well maybe. Here's Singer, again (my emphasis):
This would mean extending Medicare to the entire population, irrespective of age, but without Medicare’s current policy that allows doctors wide latitude in prescribing treatments for eligible patients. Instead, Medicare for All, as we might call it, should refuse to pay where the cost per QALY is extremely high...Those who want to be sure of receiving every treatment that their own privately chosen physicians recommend, regardless of cost, would be free to opt out of Medicare for All as long as they can demonstrate that they have sufficient private health insurance to avoid becoming a burden on the community if they fall ill...Every American will have a right to a good standard of health care, but no one will have a right to unrationed health care. Those who opt for unrationed health care will know exactly how much it costs them.Get that? Medicare treatments will be roped to stop "... wide latitude in prescribing treatments..." If you try and get treatment on your own, you will have to get bureaucratic permission to do so.
Who knows how far down the line Obama's thinking is in line with Springer? My guess a lot. Singer writes that Obama has told people not to use the word rationing. Is this because he is against rationing or because he knows the outward advocacy of rationing will justifiably alarm Americans? I think it is the latter. Obama thinks he knows what is good for all of us and will lie and mislead to force it upon us all.
The big problem with Singer's argument is that he makes the mistake of assuming
a fixed pool of healthcare services. This is a world where the evidence shows that in a free market economy, innovations are a daily occurrence. Cell phones, big screen televisions and personal computers get better and cheaper. Expensive new products that only the rich can afford are in many ways simply inferior "test" products before they get to the masses in better quality and much cheaper. Would you rather have the current cheaper jumbo screen televisions, cell phones and personal computers or the much more expensive clunkier jumbo tv, cell phones and pc's of yesteryear that only the rich could afford?
By rationed healthcare, and limited bureaucratic controlled access to "expensive" healthcare, new innovations, creativity and advancements in the healthcare industry will be greatly reduced, perhaps eliminated. The incentives will be gone. Remember, there are never any stats on what innovations, discoveries and advancements will have never been created. Those who argue that medical care works in national health care countries fail to understand the innovations that are killed off. This is, of course, in addition, to the usual problems of rationing and bureaucratic distortion of prices---and the government taking the role of decider on whether you deserve to walk or not, or whether you calculate out for life or death.