Cost of LivingSarah Palin is afraid Obamacare will put a price on human life. But we already do.

"Americans bristle at the notion of barring life-saving treatments just to save money. " But that's what happens to those who can't pay and aren't eligible for free care.

If I have to pay nothing, I am willing to spend any amount of somebody else's money to extend Grandma's life for another month. Since the amount of money the government (or any insurance pool) can raise isn't infinite, though, we can't do that for everyone's Grandma without not spending money on something else -- whether the something else is vaccinations for children, or higher pay for nurses, or a couple more bombers for the Air Force. Governing is choosing, and choice means doing some things but not others.

Modern day Americans have a childish refusal to make choices, which is why we demand ever more government services while refusing to pay for them in taxes and punishing any politician who tells us we have to choose. From a politician's point of view, the great thing about the present non-system of health care is that the market makes rationing decisions, which means that no identifiable individual, and certainly no elected individual, is responsible.

Here in NJ, we used to have regulated hospital rates, which were fixed at a level high enough to sustain all of the existing hospitals. The result was a surplus of beds and too many small, uneconomic community hospitals. Every time the Department of Health tried to close a hospital, the Legislature stopped it. In 1992 the system was repealed and replaced with a free market in hospital rates, under which the insurers squeezed all of the cushion out of the rates and only the strongest, most efficient hospitals could survive. We have gone from 90+ hospitals to the low 70s. As smaller hospitals went under or were merged, the local legislators would wring their hands but ultimately declare that there was nothing they could do. We wound up with a leaner and more concentrated system, and no individual had to take the blame for any hospital closing.

We do put a price, in the US, on compensation for death. Perhaps we shouldn't, but we do. In the case of compensation for disability or death, we attempt to figure out what a person would have been paid and give that money to the people who would have benefitted from the wages.

[Some deaths do not demand that kind of compensation. Violent deaths are criminal acts, traditionally paid for by the claiming the life of the person who committed murder - they took their blood 'on their own head' and it is not we who kill them, but they who have killed themselves, the justice system merely making that underlying reality a physical one.]

However, there is a significant difference between trying to compensate dependants for the loss of financial support in a wrongful death and the decision preemptively to value a person based on their economic potential - and nothing else. Even in the case of normal financial compensation, it is clear that emotional distress and other factors need to be included in the bill. People produce more than is evident on a balance sheet of wages.

Now, the QALY score may be useful as a normalization across health care resources - to try to make an apples to apples decision of how to ration a scarce resource - by giving it to the person most likely to benefit. If there is only 1 gram of a drug currently in existence and it will take 2 years to make more, you need to figure out how to ration it. But by far the best way is to ask people to volunteer - some people become heroic out of sacrifice, others through gratitude. The worst way is through greed and coercive power, with a cold economic calculus somewhere in the middle - lacking all the value of virtue but not quite with the inherent evils of greed. Unfortunately, the economic calculus is far enough along on the slope that virtue is forgotten and greed is the obvious logical end. This becomes more apparent when we start thinking about the QALY score of a Rolls Royce and a mansion - can we justify not purchasing more health care so that someone can live in luxury? What if the sick person has a year of solitude and the rich person is a tyke with a lifetime of gold plated luxury ahead of him? What if it is 3 months to live and the rich senator needs a corporate jet?

The US seems to have moved towards the QALY in the justice system, but that is a false analogy. Britain is using it actively. This doesn't mean it is a good idea. Or right, noble, elegant, good for humans and humanity, or just. We should ask for more from our government, we the people of whom this government should be - more than economics, even when economics is practiced intelligently - we should ask for nobility.