David Trinh

Peter Suderman at Reason objects to Peter Singer’s most recent New York Times piece in which Singer advocates for government rationing of health care.  While he recognizes the need for some mechanism to ration a scare resource like health care, Suderman claims that the government is the wrong agent to make these life and death choices:

Rather than let individual preferences and agreements work out prices and reach an equilibrium, the government simply sets the value of a year of good life for all people, without differentiating between them, and extrapolates from there. I agree that, in the end, we do have to make economic decisions about the value of life. But shouldn’t those be decisions made by individuals, their families, and their doctors? Do we really want bureaucrats in Washington handing down indiscriminate dictates on what a year of productive, healthy life is worth? Must everyone be blindly herded into the same pen? (Bold mine- DT)

This is a version of an argument that I’ve frequently heard on the right in the Yale Political Union but still don’t quite understand.  The claim goes something like this: the government should not be deciding who lives and dies because (1) government doesn’t have enough information to differentiate between who deserves medical care and who doesn’t (the stock example of choosing whether to save the life of a good father instead of a murderer) and (2) it is better for a person to be told by their family that they won’t receive medical treatment than by the government.

In my mind, the first claim is somewhat valid.  Government might not do the best job of choosing person who truly ‘deserves’ care based on their ‘goodness.’  However, I still have a problem with this contention because not only am I not convinced that we should ration health care based on a sort of moral triage but I’m unsure of what happens at the margins when you have two families requesting care for two people of approximately the same moral caliber.  It seems to me that in cases such as this, it’s entirely appropriate for some outside arbitrator (like the government!) to step in and make the final call.

The second claim in my mind is even more problematic, as it’s essentially an argument that is premised on the attractiveness of a certain type of aesthetic.  Maybe some would prefer to be told by their families that it’s simply not worth saving them, but I for one would very well prefer to be told this devastating news by the government.  After all, it seems as if the sort of discussion that goes along the lines of, “I’m sorry David, we just can’t afford to pay for your kidney transplant” could potentially, err, ruin familial relationships.

Finally, it’s not entirely clear to me that individuals would really make rational decisions when it comes to choosing if certain medical procedures are worth paying for—especially when they have their own skin or the skin of a family member in the game.  For instance, I value my own life highly and would be willing to pay an extremely high sum to continue living.  In fact, I love life so much I might be willing to part with all my assets in order to preserve my own life.   This means that the amount I am willing to pay corresponds to the amount I am able to pay.  Consider a scenario in which I desperately needed a medical procedure to stay alive; if I had a million dollars, I would certainly pay a million dollars for that procedure.  However, if someone else had two million dollars, and needed the same treatment, they would be able to price me out of the market—even though our lives our equally valuable to our families and to society!

In the end, that is the chief problem with rationing healthcare on an individual basis.  People are willing to pay any price they can conceivably afford to prolong their own lives or the lives of loved ones.  Therefore, under a health care rationing regime at the individual level, the people who will get the best care and the most care will be the wealthiest.  Wealth might be a fair way to distribute resources like cars or even housing, but my moral intuition tells me that net worth is not a fair metric to determine who is allowed to live and who must die.

Ezra Klein can’t figure out why some people view the $600 billion price tag for health care reform as an ‘extra cost:’

…it’s not clear that this is an “extra” cost, as Kinsley would have it.  If we take $600 billion we’re currently spending to subsidize the most generous health-care plans offered by employers and instead use it to subsidize the uninsured, is that an “increase” in cost? Or a change in priorities? If The Washington Post wants to build a new Web site, and that costs $1 million, and they decide to print few paper editions to fund that project, is it an increase in spending? Or a change in priorities?

Klein is right, insofar as he argues that changing our priorities won’t amount to a $600 billion cost for American society; it’s not an ‘extra cost’ to America writ large, but rather a change that will alter who receives the benefits from $600 billion worth of health care spending.  However, this is precisely the problem with passing health care reform.  Even if, on a whole, implementing universal health care may not cost our country another dime, such reform is going to affect the pocketbooks of millions of Americans who will no longer being able to benefit from this $600 billion subsidy for their health insurance plans.

In other words, the fundamental problem with trying to get any sort of significant healthcare legislation through congress is that, at the end of the day, you’re asking a large number of Americans to give something up.    Further, this group which stands to lose out tends to be wealthier, more powerful and votes at a higher rate than the 47 million people who will benefit from healthcare reform.  When is the last time that a politically weak, minority constituency forced a more powerful majority group to give something back through the American legislative process?  Answer that question and you’ll know the likelihood of substantive health care reform becoming a reality anytime soon.

A few months ago I posted an article and some commentary on the Timothy Dwight Blog, arguing that we should pass universal healthcare not only because it would provide higher quality care at a lower cost but also because passing universal healthcare could relieve some businesses like Mory’s which are hindered by high healthcare costs.   Well, Mory’s is apparently coming back in the fall, so no need to worry about them but I’d like to think that my original point still stands that universal healthcare would be cheaper and better.

Unfortunately, not many people buy my claim-everyone from my schoolmate Spencer Bradley (who took me to task for daring to think the government could do something better than industry) to John McCain seem to think that a government run plan would turn into a bureaucratic morass.  Indeed, John McCain recently claimed that “the idea that somehow the government can administer health care in a more efficient fashion than the private sector I think flies in the face of examples of other countries that have done so.”

The problem is the senator is badly mistaken.  According to Ali Frick of ThinkProgress, via Matt Yglesias, the United State’s ‘free market’ approach is really, really bad:

Compared with five other nations – Australia, Canada, Germany, New Zealand, the United Kingdom – the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.

Efficiency: On indicators of efficiency, the U.S. ranks last among the six countries, with the U.K. and New Zealand ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology and multidisciplinary teams. Also, of sicker respondents who visited the emergency room, those in Germany and New Zealand are less likely to have done so for a condition that could have been treated by a regular doctor, had one been available.

I know this is counterintuitive but it turns out that the Veterans Health Administration, which for all intents and purposes actually is socialized medicine, is, dollar for dollar, the best provider of healthcare in the nation.  You can quibble about rationing care or about whether government control of the healthcare sector is just one more step down the road to serfdom but please, let’s drop this tired rumor that the government-run care is grossly inefficient.  Thanks.