His argument, as often with Singer, is simple and not very original, but I find his recent article in the NYT is eminently worth reading. It is helping me to identify the real issues involved in the medical care debate.
"Health care is a scarce resource," he says, "and all scarce resources are rationed in one way or another." Free markets determine that some people get the good and some do not. The British National Health Service does the same thing. One difference is that it is obvious that the NHS is doing this:
Last year Britain’s National Institute for Health and Clinical Excellence gave a preliminary recommendation that the National Health Service should not offer Sutent for advanced kidney cancer. The institute, generally known as NICE [I love that acronym!], is a government-financed but independently run organization set up to provide national guidance on promoting good health and treating illness. ... NICE had set a general limit of £30,000, or about $49,000, on the cost of extending life for a year. Sutent, when used for advanced kidney cancer, cost more than that, and research suggested it offered only about six months extra life.The recommendation was later rescinded, after a public uproar. Not an attractive picture. That judgment would have been a death sentence of sorts for people with advanced kidney cancer.
But markets, he says, do the same thing. It is just much harder to figure out who the victims might be. He quotes a study of Wisconsin emergency room patients who had been in auto accidents. The study "estimated that those who had no health insurance received 20 percent less care and had a death rate 37 percent higher than those with health insurance."
[Rather confusingly, he also quotes with apparent approval a study that concludes "there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths in the United States." This seems to conflict with the Wisconsin study. Anyway, I am concerned with the moral principles that underlie his argument, and not with the alleged empirical facts.]
Both systems withhold care from some people, who die (or die earlier) as a result. The difference (this is not how he puts it, but this is what he means) is that when bureaucrats decide who must die, it represents a conscious decision, so that the people who die might actually be the ones who ought to die.
When the market makes the determination, more often than not, the wrong person dies. The Wisconsin ER patients had an average of 3o more years of life to live, if they had received the care that would have saved them. Compare the people sentenced by NICE: they had an average of only six months, and not a good six months at that.
Socialized medicine is superior because, in it, (at least if the right people are in power) it is more likely that the people who die are the ones who ought to die. What we need (again, this is my wording, not his) is a redistribution of death.
(I urge you to read his article to see if my characterization of it is unfair.)
My initial reaction to this:
To call both what the market does and what the English death panel does "rationing" is close to verbal trickery. It smuggles in the idea that these two processes are on an equal moral footing, without having to argue for it. I call what the market does "allocation" and only call what the government does "rationing." The reason I use different words for them is that I see a big moral difference between them.
Part of it is a matter responsibility. The death of the untreated English cancer victim is somebody's doing. This person dies because someone decided this person should die. The death of the American auto-accident victim is -- an accident.
There is another difference that underlies this one. Singer thinks it is good, and not evil, for NICE to take responsibility for deciding who shall die because he thinks there is such a thing as the one who ought to die.
This is what I deny. I deny that the cancer victim ought to die, but it is not because I think that the accident victim ought to die. I think it is monstrous to judge that any innocent person ought to die.
Further, it is monstrous arrogance the think you have the right to decide who ought to die. And to act on that decision is tyranny itself.