Ethical Health Care?

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.

Economics and Ethics on Eating

When I was in college, my pastor (Ben) introduced me to the slow food movement. At the time, I was struggling with questions about the practice of eating intentionally, of what it would mean to engage in the food cycle and to eat well.  I was immediately taken in by the movement, loving the philosophy and ethics behind participating fully in the process from the fields to the table. 

Since then, in fact, I have found myself focusing more and more on what it means to be a ‘locavore’, exploring the ethics behind food production seriously as I try to sort out where I stand.  The arguments for and against different positions on how and why we eat what we do are as interesting, to be sure, as they are numerous.  And after much consideration and deliberation, I have found myself coming out of the process with an understanding of sustainable eating that I find to be not only healthy but spiritual as well.  I dream of a day when I might have the space to produce more of my own food rather than buying it from others, but because I cannot do that now I have made the decision to participate in buying local vegetables and local meat (I belong to a meat CSA located 65 miles from my house). 

 Lately, however, people have been introducing me to arguments against local eating such as this one.

Being that this argument is from the Economist, it of course focusing on the economics and efficiency argument against eating locally, claiming that the environmental cost can be just as bad if not worse when eating locally because non-renewable resources (aka gas/oil) that are used less efficiently by distributers but also by those who drive out of their way to get to local foods. 

Now maybe it is just me, but that argument doesn’t seem to fully address the issues relating to local eating.  First of all, the argument supposes that local food can’t get to you– personally, I have discovered that even in BOSTON, if you look for it you can find it.  Most grocery stores stock foods that are grown in local farms these days and label it, which means that you don’t always have to go far to find what you need.  Places like my Meat CSA have distribution drop-offs, meaning that there are fewer trips being made by individuals, not to mention that the CSA drops once a month, not every other day as in the case of people driving constantly to their super-market. Sure,  food might be transported more efficiently over long distances in the global economy, but that is also a function of genetic engineering that alters a vegetable so as to make it transport more efficiently.  Take, for example, the genetic manipulation of tomatoes which leaves them in uniform, almost boxy shapes and alters their composition to make them less prone to crushing (consequently also making them taste less like tomatoes).  Sure, it’s efficient, but if you put a tomato like that next to your average heirloom tomato, you can taste the difference as well as see it.  The conventional, heck even the organic varieties sold in the store, begin to have less appeal.

Barbara Kingsolver, author of “Animal, Vegetable, Miracle’ ultimately makes the argument that some things are worth waiting for.  As the Economist article indicates, it DOES indeed take more energy to grow tomatoes in greenhouses locally–but that is because they aren’t meant to be growing there in the first place.  Eating locally ultimately doesn’t translate into just growing whatever you would eat from the store in your back yard.  It means educating yourself about what is supposed to be growing in your local landscape in the first place.  It means committing to a lifestyle that engages the place you find yourself in already rather than trying to transform it into a microcosm of the global food economy.  Its about inner transformation, transformation that includes giving up that which is not meant to be where you are (in my case, no bananas and avocados in Boston). 

 There are a million arguments on both sides beyond  the Economist, but until these arguments take up more than the economics, seriously considering the ethics behind the choice and the full implications of the transition, I think I will stick to my Kale and Collards and save the tomatoes for a warm June afternoon.