Peter Singer wrote an interesting article for the New York Times which makes a good case for rationing health care on the basis of a ratio of the amount of money spent to the health benefits provided [1]. It’s obvious that given a finite amount of money to spend on health-care and a limited portion of the working population who can be employed in providing it there will be limits to the care that each individual can receive. Therefore it seems inevitable that some people will miss out on care that they need – sometimes to the extent of significantly decreasing the length or quality of someone’s life – at least until we can manufacture fully autonomous medical robots or other futuristic technology to greatly reduce the amount of person-time involved in providing medical care.
The majority of the article concerns the need for rationing health care. Really this is obvious, and it’s also obvious that it takes place right now all around the world. The article is mainly focussed on the US where private health insurance for everyone is being considered and people are afraid of government rationing of health care. But right now they have health care being rationed not for the purpose of saving other people but for the benefit of share-holders and executive bonuses! I wouldn’t really be thrilled if a government agency told me that instead of paying the necessary money to save my life they would rather pay the same amount of money to save two other people, but if a private company wanted to deny me treatment in order to pay the down-payment on another executive Mercedes I would totally flip out! Dr Gabriella Coleman (who is famous for her Anthropology research on “free and open source software hacking”) has written Housebreaking Your Health Insurance [2] to offer some tips for dealing with private health insurance companies in the US with the first tip being “Ideally you should tape record all conversations” – I think that single point adequately demonstrates the problem with health insurance (but there is a lot more).
In the common culture of the US, Australia, and Western Europe it is generally regarded that children are inherently more valuable than adults to such a degree that a choice between saving the life of a child or an elderly person really requires no consideration. So Peter advocates having a measure of the expected years of life remaining before determining an amount of money to be spent – this is logical, reasonable, and fits with the common moral standards in our society.
Peter then goes a bit off track when talking about putting seat belts in buses. One significant thing to consider is that there is a world of difference between preventing an injury and curing it. If you cure an injury then there will be some pain and suffering during the process and the result probably won’t be a full recovery. Being able to walk away from a crash because of a seatbelt is a really good thing (been there, done that).
But things really go awry when he starts talking about medical treatment for the disabled. Firstly he mentions quadriplegia as an extreme case, but to differentiate on the basis of disability you would have to categorise the various disabilities in order of severity. Then of course there are awkward issues such as comparing a quadriplegic who is employed in the computer industry (such as a former colleague of mine) and someone who is apparently fully capable but sleeps on a park bench.
He expressed the idea that someone who would give up a year of their life to cure a disability assigns a lower value to their life. By using that logic anyone who undertakes cosmetic surgery (which has a non-zero probability of a fatal outcome and therefore statistically decreases the life expectancy of the patients) would also assign a lower value to their life, as would anyone who enjoys hobbies such as bungee-jumping and parachuting. But if someone would not be prepared to have their life shortened in exchange for curing a disability that doesn’t mean that there is no value in trying to cure the disability.
I think that the greatest problem in this area is that of making excessive attempts to reach some absolute standard of fairness. No matter what you do someone will end up not having the budget for their health care and they WILL consider it to be unfair. If the amount of money to be spent was strictly based on age then it would be a simpler system to operate which if nothing else would save on administrative expenses and therefore allow more money to be used on providing health care.
I believe that the health care problem is the biggest economic problem that first-world countries face (little things like a mortgage crisis are temporary while health care that is provided now will affect tax revenues in 40 years time). Even if you regard people as being merely assets which are owned by the government then you would have to consider such valuable assets to be worth protecting – particularly children as you never know which ones are valuable until about the age of 21!
I find that in such discussions it’s not uncommon for the more right-wing Americans to advocate allowing people to die if they haven’t taken out appropriate insurance – it’s supposedly their fault. There are two major problems with this, one is that children who are unfortunate enough to have parents who are too poor or unwise to get appropriate insurance will lose. Another is that most people have no ability to understand probability (everyone who has purchased a lottery ticket has demonstrated their inability to make good decisions on such matters). It seems to me that some minimal level of health insurance for everyone along with comprehensive health insurance for children aimed at preventing problems should be provided by the government from tax revenue, the moral and economical justifications for this are both independently compelling.
For the more selfish readers, even if you don’t care about other people becoming sick or dying and you don’t believe that economic benefits will help you there is still the issue of disease transmission. Every time you are in a city area and find yourself downwind of a beggar you have to hope that either they don’t sneeze or that decent health-care is available to everyone. Extremely drug resistant Tuberculosis sounds nasty…
