Controversial Princeton bioethics professor and philosopher Peter Singer is making waves with his article outlining the case for rationing in last week’s New York Times Magazine. This is the same Singer who advocated infanticide, proposing that abortion be made legal for 28 days after birth, in order to allow parents to decide whether to keep an “imperfect” baby.
Professor Singer’s latest piece, “Why We Must Ration Health Care,” should be a call to action for every American who cherishes personal freedom and self-determination. There is no doubt that health care reform proposals being rushed through Congress are the initial steps in government rationing of health care. As has been shown from experience in this country and others, under a government-rationed system the needs of the elderly, the disabled, and the unborn are pushed aside in the name of government bureaucrats seeking the “best value” from limited health care resources.
In talking about their plan to federalize health care, President Obama and his Democratic allies in Congress have been careful to avoid using the word “rationing,” choosing to focus exclusively on the supposed benefits. But amendments to prohibit rationing in the health care reform bills have been voted down thus far. As abhorrent as his positions on infanticide and other issues are, Professor Singer at least has the intellectual honesty to admit that the federal government rations health care now and that he believes it should ration health care much more in the future.
According to Singer, health care decisions should be removed from patients and their doctors and given to government bureaucrats who, using various formulas and calculations, will decide which lives are worth saving and which ones are not. Singer touts the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) in its decision not to cover a new kidney cancer drug for its citizens, saying “NICE had set a general limit of £30,000, or about $49,000, on the cost of extending life for a year.” Because the cancer drug didn’t meet NICE’s cost-benefit criteria, it was out—and so were the patients who needed it. (Singer relates that after Britain’s national media took up the cause, eventually NICE decided to cover the drug. But he doesn’t say how many patients died waiting for the decision).
Professor Singer’s argument, echoed by many on the left (including President Obama), is that rationing already takes place in private medicine in the form of inadequate care for the uninsured in emergency rooms and out-of-pocket costs that cause some patients to forego needed medical care. Rather than subjecting people to the decision-making mechanisms of the private sector (i.e., fixing the problem with consumer-driven reform of the health insurance markets and the redirection of existing government subsidies), Singer argues, it is much better to subject them to the decisions of government bureaucrats.
Professor Singer believes the worth of human life can be measured in terms of rationality, autonomy, and self-consciousness. He argues that because the abilities of infants and the unborn to reason, to take care of themselves, and to be self-aware have not developed, their lives have less value and they don’t deserve the same quality care. The same could be said, of course, for those who are disabled, elderly, or who suffer from diseases like Alzheimer’s or dementia. In Professor Singer’s world, the young, healthy, and autonomous must take precedence, while others may be rightfully neglected. Logically, following Professor Singer’s premises, one may ask, given scarce resources in areas other than health care, why stop there? Shouldn’t food, water, electricity, and clothing be similarly rationed?
In the name of expanding health care insurance to all, the administration and liberals in Congress are quickly leading the country down the road to government-rationed health care—where government holds the power of life and death over every American. In such a system, boards of “experts” will evaluate the relative values of human lives and make coverage decisions accordingly. What factors will they take into account? Look closely at the following exchange between President Obama and Jane Strum, an audience member at his televised town hall meeting on health care reform:
JANE STURM: Hazel Homer is over 105 now. But at 100 the doctor had said to her, I can’t do anything more unless you have a pacemaker. I said, go for it. She said, go for it. But the arrhythmia specialist said, no, it’s too old.
Her doctor said, I’m going to make an appointment, because a picture is worth a thousand words. And when the other arrhythmia specialist saw her, saw her joy of life and so on, he said, I’m going for it. So that was over five years ago. My question to you is, outside the medical criteria for prolonging life for somebody elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cutoff at a certain age?
OBAMA: Well, first of all, I want to meet your mom. And I want to find out what’s she’s eating. … I don’t think that we can make judgments based on peoples’ spirit. That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people.
President Obama’s evident problem, and the problem of members of Congress who voted down anti-rationing amendments in the House and Senate committees, is this: the government can’t consider “personal circumstances,” such as an individual’s joy for life, in making health care decisions. Therefore, the end result is a process of government decision-making over benefits and medical procedures that must be a set of rigid, objective rules enforced or applied by bodies of experts. If these decisions are tied to reimbursement or cost-effectiveness standards, they will determine whether or not someone receives life-saving or life-extending treatment.
There are many criticisms that can be offered for Singer’s view, including that it fails to grasp how the real world operates: the experience of health care in this country in programs like Medicare and Medicaid reveals that government attempts to rein in health care spending have failed miserably and led to greater fiscal crisis and waste. It also fails to recognize that medicine is becoming more and more personalized, and that doctors– not bureaucrats– are in the best position to diagnose and recommend the best treatment to suit an individual patient. But a more fundamental criticism is that his view is incredibly naïve at best and insidiously evil at worst; even if we could somehow create truly objective criteria for measuring the relative value of a human life, no government body, no matter how expert and insulated from politics, should be trusted to apply it free from bias or political influence.
If Congress wants real guidance on this issue, it should consult the man who wrote our charter of Independence. President Thomas Jefferson, in his First Inaugural Address, warned: “Sometimes it is said that man can not be trusted with the government of himself. Can he, then, be trusted with the government of others? Or have we found angels in the forms of kings to govern him? Let history answer this question.”
