Rationing for dummies

Robert Knight - Guest Columnist - 7/21/2009 9:30:00 AM

It's beginning to sink in that Obama's nationalized healthcare will lead directly to rationing, which Americans desire about as much as a case of salmonella.

The president told five governors last month to avoid the term "rationing," since it might give away the game. But the word keeps popping up, so it was time for a more aggressive approach -- embracing it!

Out came one of the Left's big guns, Princeton ethicist Peter Singer, to fire away in the July 19 New York Times Magazine with a long article, "Why We Must Ration Health Care."

Singer -- known for such gems as, "The notion that human life is sacred just because it is human life is medieval," and "An animal experiment cannot be justifiable unless the experiment is so important that the use of a brain-damaged human would be justifiable" -- says rationing is already here in different forms. Hence, we have nothing to fear from men in white coats directed by government bureaucrats.

Written to allay our fears, the article instead provides plenty of insight into the rationality of rationing and why Americans might want to drop what they're doing, grab pitchforks and torches, and descend upon Washington to slay this Frankenstein monster.

Singer, who advocates the right of parents to kill their newborns even several days later if the babies disappoint them, poses a series of ethical dilemmas that resemble the lifeboat analogy. The boat is sinking and holds only so many. Who stays aboard and who's thrown to the sharks? Here's one of his scenarios, which should give cold comfort to senior citizens and those who love them:
"As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years."
He allows that some teens might be vicious felons and some 85-year-olds productive citizens, but you get the idea. To sort all this out, Singer says bureaucrats could employ the quality-adjusted life-year, or QALY, a unit of measurement used for 30 years by health planners. How else can you make Solomon-like decisions between disabled newborns, injured 20-somethings, and cancer-stricken seniors?

But Singer admits that QALY has drawbacks, such as being too ham-handed (my word). He raises the question of whether to spend thousands on a rare drug for Jack Rosser, a real-life British terminal cancer patient and the father of a young child: "Whether decisions about allocating health care resources should take such personal circumstances into account isn't easy to decide. Not to do so makes the standard inflexible, but taking personal factors into account increases the scope for subjective -- and prejudiced -- judgments."

This is precisely why we don't want bureaucratic bean-counters calling all the shots. Or someone like Singer, who sees people as talking animals, not precious, unique beings created in the image of God. Singer explores more ethical dilemmas, such as whether quadriplegics would choose to give up a year or two of life in exchange for a cured, shorter existence. He uses this to question whether all human lives are sacred.

"This method of preserving our belief that everyone has an equal right to life is, however, a double-edged sword. If life with quadriplegia is as good as life without it, there is no health benefit to be gained by curing it."

Huh? Singer seems to be confusing the value of life with quality of life, which can take us down the slippery path toward purification of the race and other horrors.

He follows with another false dilemma: "Disability advocates, it seems, are forced to choose between insisting that extending their lives is just as important as extending the lives of people without disabilities, and seeking public support for research into a cure for their condition."

Can't they do both? Why are they forced to choose?

In the movie The Princess Bride, the hero listens to a villain's bizarre, irrational rambling and generously says, "Truly, you have a dizzying intellect."

You need one of those to explain why Americans should give up a first-class health system and adopt one resembling the warm, inviting embrace of an IRS auditor's office -- complete with needles.