Jul 20, 2009
Controversial philosopher and bioethicist Peter Singer weighed in on the ethical underpinnings of dividing the healthcare pie in a Socratic-style essay on rationing in Sunday's New York Times Magazine.
He concludes that rationing has been with us all along. So, rather than divvy up healthcare and insurance by unspoken values, the values and choices should be argued openly.
Here's how Singer leads readers in:
You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?
If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn't going to be good. But suppose it's not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man -- and everyone else like him -- with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone's life? If there is any point at which you say, ''No, an extra six months isn't worth that much,'' then you think that health care should be rationed.
Singer's challenge to face up to the meaning of such choices came as the Obama administration deployed top players to the Sunday talk shows to discuss the healthcare reform needs and strategies. Many abortion-and-contraception opponents are pouncing on White House Budget Dirctor Peter Orszag's refusal to say on Fox News whether abortion will be a tax-supported "essential benefit."
Singer, professor of bioethics at Princeton University, is a utilitarian, weighing what is moral by a calculated balancing of preferences. Some of his best known, and most controversial views: He's argued for equating animal and human rights, and said the fetus and the newborn disabled infant don't have the same moral standing as a thinking person and therefore may be killed.
In the rationing essay he doesn't champion any particular one of the five plans currently in play. His point is that people need to be clear-eyed in recognizing that every plan has a human-life valuation calculator built in to it -- a kind of rationing.
The question is whose values will be built in to the "essential benefits" in health insurance choices. He's asking what life is worth to you, whether certain lives are worth more or less and -- since so much of the battle to come is over dividing the tax dollar pie -- for whose life are you willing to pay?
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