This afternoon I came across Peter Singer’s NYT Magazine article on rationing and health care.  Now, as a philosophy major in undergrad, I was required to read Singer’s book entitled “One World” for Dallas Willard’s class on the history of Ethics.  If you haven’t read him, I recommend it, because he certainly pushes the boundaries of what many would consider comfortable in the realm of ethics.  As I understand him, he considers and explores the realm of corporate or universal ethical challenges.  In One World, he explored the costs associated with dealing with world poverty and, if my memory serves me, concluded that those of us in the developed world have the capability to solve the problem if only we are willing to part with a small fraction of the comfortable lifestyle we are accustomed to.  He also was made infamous by his arguments on abortion, euthanasia and infanticide, in which his ethical positions centered around the question of whether it is in fact wrong to take the life of those who are old, insane, or unborn. 

He’s basically an ethicist with a whole lot of balls and a thick skin, because most of his thinking has been, shall we say, difficult to swallow for many people.

But I have to admit, I like him.  The old Princeton prof is one smart guy, and while his arguments are challenging to me on certain personal levels, I have to admit that much of what he has to say is compelling, and certainly has the power to refocus conversation around significant issues like poverty, life, and death.

Back to the article.  So I stumbled across Singer’s piece on health care reform, and I must recommend it as worth reading.  In the article, he deals with the problematic ethical concern of valuing life and rationing health care, both of which are visible concerns in the current health care reform debate.  Singer argues that, while most people decry the attempt to put a value on a human life, it is still the case that it happens.  He cites various instances in which human life has long had a price tag roughly equivalent to $5 million dollars, and that despite our uncomfortableness with the concept, it is one that drives insurance concerns. 

What is interesting about his article for me, however, is how he uses this information to argue that we need to ration health care.  Most people don’t like the concept of rationing, and Singer certainly acknowledges that when folks are deathly sick, they resent the notion that their insurance might not cover expensive live-extending treatments.  That said, these treatments often do not save lives, but merely draw them out, often at the cost of failing to save the lives of the non-insured, which he illustrates with a provocative study of health care received by insured and non-insured auto-collision victims. 

Ultimately, Singer argues for a rationing sytem for health care that operates along the lines of live-years saved and QALY, or quality-adjusted life years.  These measures of value are both interesting and worth consideration, and I certainly found his article worth a good ponder.

There are some questions that I came away with, as I read this article.  First of all, I was surprised to discover that I agreed strongly with Singer’s evaluation of prohibitively expensive life-extending drug treatments.  Basically, he noted that when insurance covers treatments that cost hundreds of thousands of dollars a year while extending lives by small increments, they aren’t worth it because they drive up costs for everyone else.  I have to say that I agreed with him.  Perhaps I don’t find death as frightening as I should, but I tend to believe that if your body is shutting down and you are going to die for certain, it is most important to spend your remaining time coming to terms with that and loving those moments you have left rather than frantically scrambling for a few more months.  But that’s just me.

Another issue of Singer’s that always seems to get him in trouble is his logically sound argument that saving a teenager’s life is worth more than an 85-year old because you are saving more life-years.  I have a hard time with this concept, but at the same time I have a difficult time disputing his claims. 

Ultimately, all my rambling amounts to the suggestion that you go and read him yourself.  I don’t expect everybody to agree with what I say, or even see the same things I do, but I do think that it is a valuable exercise to participate in the conversation, and I appreciate Singer’s bravery in entering the dialogue.