Monday, July 20, 2009

Obama Healthcare Step One: Killing Off the Old, Then They Are Going After Quadriplegics

Some cultures respect the old. Under Obama healthcare, we will kill them off. Here's Peter Singer, professor of bioethics at Princeton University, in a New York Times Magazine article, Why We Must Ration Health Care, already deciding who to kill off once national healthcare hits.


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.

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.
On to quadriplegics:


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.

27 comments:

  1. Ah, the perils of utilitarianism.

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  2. Wenzel,

    As geoih pointed out, Singer is an objective value theorist. And he fancies himself a philosopher (what is the deal with these multi-speciality scientists... "bio-ethics"... and their belief that they're so F*&%*#$ing smart they need to be philosophers, too?!). That's probably the most deadly combination on earth. For everyone who isn't Peter Singer, of course.

    In December of 2006, Singer authored a large piece in the NYT on "social capital" and charitable giving. You can find the article here: http://www.nytimes.com/2006/12/17/magazine/17charity.t.html?pagewanted=all

    The article begins like so:

    What is a human life worth? You may not want to put a price tag on a it. But if we really had to, most of us would agree that the value of a human life would be in the millions.

    Amazing. He somehow has the exact same idea about valuing human life looking at it from an economic/prosperity point of view as he does from a "bioethic" point of view in relation to healthcare.

    It's really hard to decide where to start with this guy. He commits so many idiotic fallacies and he lords his arrogance and egotism so mightily. I mean this guy thinks he is a god, putting a price on other people's lives. And this is "ethics"!

    Now, I thought that social capital piece was bad but this application to the healthcare "debate" -- where debate is a euphemism for a gun deciding the answer -- is an out-and-out catastrophe.

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  3. Wenzel,

    Teehee. I just realized, thanks to the NYT and it's snide, partisan "objective journalism," that

    (There is, in fact, no “Obama plan” — the president has yet to endorse any of the approaches being worked on by congressional committees.)

    in this article, here: http://www.nytimes.com/2009/07/21/health/policy/21health.html?hp

    Hahaha... you're SO dumb Wenzel, to think that there is even an Obama healthcare plan for you to criticize yet. He hasn't endorsed one! It's just a conversation, bro. Like that whole special news coverage by ABC from the White House... just a conversation, no one is talking about force, bro. You and Ayn Rand are kooks!

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  4. Singer makes it quite clear that he does not really understand economics when he writes "Since we are talking about comparing different goods, the choice of unit is not merely a scientific or economic question but an ethical one."

    Mises wrote "Unless Ethics and 'Economy' are regarded as two systems of objectivization which have nothing to do with each other, then ethical and economic valuation and judgement cannot appear as mutually independent factors. All ethical ends are merely a part of human aims. This implies that on the one hand the ethical aim is a means, in so far as it assists in the human struggle for happiness, but that on the other hand it is comprised in the process of valuation which unites all intermediate aims into a unitary scale of values and grades them according to their importance. The conception of absolute ethical values, which might be opposed to economic values, cannot therefore be maintained." (http://mises.org/books/socialism/part4_ch27.aspx) pt 2 "Eudemonistic Ethics and Socialism"



    About halfway through reading those excerpts I had to pause at the ghastliness of his analysis. Singer seems to truly believe that he can: 1) determine a workable method to actually accurately calculate his QALY, and 2) that there will truly be people benevolent enough to not abuse their positions in society to essentially determine who lives and who dies. This is the ultimate demonstration of what Hayek called the "Fatal Conceit".

    Will we ever be rid of these planners?

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  5. Ryan,

    Great job on the Mises quote. This is why I find people like Singer to be so frustrating to read. They write as if they're highly original thinkers (said flamboyantly: "I'm a philosopher!"), when most of their originality has already been covered by other thinkers, specifically economists and even more specifically Austrian economists.

    My assumption is that one of two things is occuring:

    1.) They're not the rigorous intellectuals they claim to be, and have no troubled themselves with reading up on lots of different thinkers before shooting their own mouths off in an 'original' manner.

    or

    2.) They're well aware of critical remarks on the subjects they write upon, such as those of Mises you shared, but ignore them in a "Naw, becuz" fashion that suits their emotional and psychological predilections for fastening onto the theories and worldviews they've fastened onto.

    As often as I encounter 1.), I seem to even more often encounter 2.) by itself, as well as 1.) followed by 2.), by which I mean, after bringing to the attention of someone suffering from 1.) some of the works that they might find enlightening, their eyes glaze over and they revert to 2.) and inform me that we'll have to 'agree to disagree' or something along those lines, because they don't want to or can't understand that the logic trumps their emotional-psychological based worldview.

    Of course, when you point something like that out, they typically fall back on the "well you just think what you think because of how you were raised/where you came from/how wealthy you are/etc." as if that somehow simultaneously discredits my argument and strengthens theirs.

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  6. This line of reasoning is faulty.

    Once we allow any life to be "more valuable" than any other life... for instance, one teenager is worth 14.5 85 year olds...

    The inevitable end of that line of reasoning is that a white male, who tends to live longer than a black one... is "worth" more.

    Can you say eugenics? I knew you could.

    Also, there is another fault in the reasoning. Not all years are equal. The teenager has more of them... perhaps... in front of him. But who is to say that the teenager won't be a slacker, doing nothing of value with those years, while the 85 year old will be active and driven?

    Finally, imagine if Congress and the Supreme Court were bound by this legislation... Bye, bye, Mr. Kennedy. Sorry about your brain tumor, but you're just not worth as much as a teenager...

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  7. We have a tendency in America to argue for or against a concept based on our own personal philosophy or view of the world, what advances our personal interests, or the interests of our party, family, organization, or region. Perhaps viewing the issue from a management or systemic perspective might result in innovative approaches to the issue. The American national mindset, citizen philosophy, lack of citizen motivation to be proactively healthy, and governance model make the socialization of health care in America very problematic, particularly at this point in time. A country needs to know its limitations.

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  8. Barack Obama will never say to your face what he actually plans to do -or achieve- with these huge new government programs.

    Rather, you get some specious auditory performance with styrofoam props to wow the plebes, like the tacky greek columns in Denver. To him, the revolutionary ends justify the Alinskyite means- so the Dear Leader just tells you whatever he needs to.

    And the truth is that Obama is out to nationalize health care.. they'll be no private insurance industry left after five years of Obamacare... but of course he's lying about it.

    As for the American public, the reality that Obama is not up to the job seems to finally be setting-in; the poll numbers are now headed steadily south- is he already facing his Waterloo on this legislation?

    http://reaganiterepublicanresistance.blogspot.com

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  9. I'll leave it up to GOD to decide when we each will die and how. Not Obama's government Plan. Could give an illustration as follows: What if the 15 year old was a drug cartel and the 85 year old was a rocket scientist????

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  10. "The big problem with Singer's argument is that he makes the mistake of assuming
    a fixed pool of healthcare services."

    AND, he has totally ignored the number of physicians who will take down their shingle when they realize the fee rates will not even cover expenses, much less a living wage.

    Quote:"Finally, imagine if Congress and the Supreme Court were bound by this legislation... Bye, bye, Mr. Kennedy. Sorry about your brain tumor, but you're just not worth as much as a teenager..."

    Mr Kennedy and his fellow legislators have decided they do not want coverage under the plan they are so carefully[NOT] crafting for their citizenry. He is one of the 'more equal than others' group, doncha know?

    Pitchforks and torches are available in aisle 3.... near the tar and feathers!

    tom

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  11. Just a question...what does Singer have to do with Obama? How can Singer's comments be called part of "Obama's plan?" Has Obama endorsed Singer's views? I'm sincerely confused about that.

    p.s., for the record, Singer doesn't "fancy himself" to be a philosopher any more than Tyler Cowan "fancies himself" to be an economist. It's what his academic degrees are in, and what he's taught in various universities for the last few decades. Agree with him or not (and most of his peers do not) he is in fact a philosopher.

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  12. Why do we assume healthcare is a zero sum proposition? Where is the creativity that will show us that healthcare can be profitable?

    http://heirsinhope.blogspot.com/

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  13. Why do we assume healthcare is a zero sum proposition? Where is the creativity that will show us that healthcare can be profitable?

    http://heirsinhope.blogspot.com/

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  14. The left loves to tout words like human dignity when talking about welfare programs and affirmative action, but could someone please tell me where is the human dignity in deciding whether or not a quadriplegic receives health care based on surveys of how much the general population would hypothetically want to live as a quadriplegic?

    Should the government also survey how the general population values living in poverty vs. wealth and provide health care to poor people accordingly? How about we survey people to see what the value of one race or religion is over another and provide health care accordingly.

    Mr. Singer is correct that rationing will exist in any health care system because of scarcity. But the ethical thing is to let individuals acting on a voluntary basis within a market (which does not exist in our current system) decide what care is worth it for them.

    Singer's proposal sounds more disturbing than anything I read in 1984.

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  15. Chris Macdonald ("PhD"),

    If you go to medical school, get your MD and proceed to engage in medical quackery like bleeding your patients to try to get their four humors in order... would you call that man a doctor, or a quack, regardless of how he refers to himself or what his academic background was?

    If I open an auto-repair shop and I work on cars, but all I can seem to do is wreck them further... does that make me an auto mechanic?

    Peter Singer can call himself a philosopher and "teach" philosophy all day long if he likes, that doesn't make him a philosopher if his thought doesn't seem to go beyond the common philosophical fallacies of yesteryear.

    He's a crank, and a dangerous one at that.

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  16. Peter Singer has a history, if you Google him. He makes you wonder exactly what kind of actual ethics underpin his 'bioethics.' He seems to be utterly utilitarian, treating life as a form of raw material to be used as any other material is. This is not ethics as I understand the word.

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  17. Given his Jewish ethnicity (google) he should be more circumspect at setting up monetary values on human life.
    He would be the first to scream bloody murder! if events - as it had happened already - would value him as worth no more than 1 cent.

    These people whom are being called by Thomas Mann as The Life delicate children will have a bitter awakening in due time.

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  18. I do believe that all the EXPERTS were standing behind the door when The Mind is a Terrible thing to waste classes were held.The experts should end their own life and quit trying to ruin mine.Soon there will one Nation under God and one nation under the chosen one.
    And I DO know which Nation I will live in!And will defend my right to do so!

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  19. From his CV, Peter Singer is 63 years old. Based on his stated philosophy, next time he has a medical emergency, like a heart attack, let's give his ration of emergency care to a 22 year-old NJ crack dealer from Camden who just took four bullets while working through a 'competitive landscape' situation. After all, the crack dealer is worth about 2.5 Singers, according to Singer's calculations.

    Sounds ethical to me. All we have to do is wait him out. . .

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  20. From his CV, Peter Singer is 63 years old. Based on his stated philosophy, next time he has a medical emergency, like a heart attack, let's give his ration of emergency care to a 22 year-old NJ crack dealer from Camden who just took four bullets while working through a 'competitive landscape' situation. After all, the crack dealer is worth about 2.5 Singers, according to Singer's calculations.

    Sounds ethical to me. All we have to do is wait him out. . .

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  21. Which of these two titles do you find more disturbing?

    "Killing off the old, then they are going after quadriplegics"

    or

    "Killing off the young and then they are going after the healthy"

    The second title is the one that Singer should have used. Maybe then people would actually understand his position. I can't believe people are complaining about putting a dollar value on human life. What, you think it's okay for insurance companies to do it but not the govt? We put dollar values on our own lives all the time. It's necessary.

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  22. TAYLOR -

    You are assuming that just because a philosophy is flawed, it is not a philosophy. This is known as the "no true Scotsman" ploy and is in itself a fallacy, logically speaking.

    I do not agree with Singer. I wouldn't defend his views if my life depended on it (and under Obamacare, it might), but this does not mean that he is not a philosopher. His views are noxious, and dangerous, but so were Plato's. Women can be philosopher kings too? Preposterous!

    I'm studying philosophy right now. I have encountered many with whom I do not agree. The key here, is making sure your own arguments defeat those of your opponent, not making arguments to besmirch your opponent himself.

    Peter Singer, unfortunately enough, is a philosopher. His views are much more acceptable in the academic world than I think any layperson would be comfortable with. Bioethics is a field of Ethics, which is a branch of Philosophy. Peter Singer pioneered it. And no one gets through an ethics class in college without reading him. I'd say that makes him pretty important, odious though his opinions may be.

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  23. Courtney,

    I don't deny the man is "important." As for pioneering Bioethics... okay, great. I am pioneering Anti-Philosopherism... now I'm a philosopher too?

    Philosophy is supposed to be the love of wisdom. There is nothing wise about Singer and his anti-human ideas. That's why I say he's not a philosopher.

    It's a rhetorical argument, not a logical one. You've certainly got me on that point.

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  24. I'm absolutely amazed that you would use some of Singer's work and tie it into the health care debate. Firstly, Singer is a philosopher, he may call himself a bioethicist, but he's a PhD of philosophy, NOT a scientist. His putting a price on a human life is the beginning of an argument for charitable donations in order to SAVE lives, and his discussion of healthcare is an attempt to arrive at a just system of healthcare for all. Just because you might be rich and not want to pay taxes doesn't make the system unjust. And as for the measurement standards he proposes, what standard would you use if you had two people in front of you, and one dose of whatever they needed to live? THIS is what ethics is about. Dumbasses.

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  25. Anonymous, what nerve you have calling anyone names. It is quite obvious that you are better than all of us, and would, of course, choose yourself to receive the one dose over the other person. Perhaps this is the measure that we should use to determine who receives the dose. The one willing to sacrifice their life should be on the receiving end of the dose!

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