In this weekend’s New York Times Magazine , Peter Singer, who’s said that it’s immoral to donate to the arts when children are starving , brings us another inconvenient economic truth: Any successful health care program must place a monetary value on human life.
Not every sick person should try every treatment. Most of us would agree with that proposition, especially if I cite the right example-say, a 93-year-old who might live an additional three weeks after undergoing a million-dollar treatment. But what about if that same million-dollar treatment offers six months to a 50-year-old? Or six years? We can't have national health care unless the program is equipped to make these choices, and, as Singer points out, we won't. No health care program, public or private, can function without some ability to ration financial resources. In truth, we already have rationed health care-rationed in favor of those who can afford it and away from those who can't. No emergency room in this country can turn away a patient in need of care, but those ERs don't necessarily provide the same care to all patients. Singer cites a study showing that uninsured car accident victims received 20 percent less care and had a 37 percent higher "death rate" than the insured.
President Obama has urged members of his team to avoid using the very word rationing for fear of giving opponents an easy hook on which to hang their arguments. He knows the electorate eats up stories of Britons and Canadians denied a treatment that would enable them to see their daughters’ weddings. Instead, the party line is denial. "There is no rationing of health care at all" in the proposed reform, according to Sen. Max Baucus, chair of the Senate finance committee.
But that's ridiculous. No one believes that the proposed program will give the million-dollar, three-week-life-extension treatment to the 93-year-old. All it means is that the decisions about rationing-or, more palatably, about how health care and financial resources will be allocated under a new program-will take place behind closed doors or be so disguised in rhetoric that we can't see what's happening. And that's not what I, or Peter Singer, or anyone wants. We're capable of having this conversation. If we don't, this reform, like the last, won't happen.
Photograph by Getty Images.