View from the choir

I am a Catholic layperson and Secular Franciscan with a sense of humor. After years in the back pew watching, I have moved into the choir. It's nice to see faces instead of the backs of heads. But I still maintain God has a sense of humor - and that we are created in God's image.

Thursday, July 30, 2009

A troubling spin on health care reform

"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."

That's just one statement contained in a troubling op-ed in the New York Times, "Why We Must Ration Health Care," by Peter Singer, a bioethicist at Princeton

The article posits that one way to ration health care is to make use of "quality-adjusted life-year" as a unit of measuring whether it is cost effective to provide or continue to provide health care.

"This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care. The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money. If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S."

Take the teen vs. 85-year old. Rather than judging health care based on the number of lives saved, Singer says another more valid way to measure is "life years."

"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. That suggests that saving one teenager is equivalent to saving 14 85-year-olds."

He also makes some observations about health care for the handicapped.

"If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life."

I don't know if Singer has had any input into the efforts to reform health care down in Washington, but he is certainly the kind of academic that the Obama administration seems to like to tap. As it is, there are several different proposals floating around. But I strongly suspect that there are some folks down there who share some of his ideas (think of Nancy Pelosi's remark - I'm paraphrasing - that aborting the poor and unhealthy can save money).

Singer's essay is more nuanced that these excerpts reveal - so I suggest you go read the whole thing. And he is right, this sort of evaluating health care is already going on. But the thrust of it is still disturbing, especially as we consider government involvement in health care..

The Catholic Key blog has some analysis.


Anonymous Todd said...

Thanks for conceding that these sorts of immoral considerations are already part of the culture. Now let's keep moving toward insurance reform while we maintain vigilance against political interests who treat health care and its insurance as props for capitalism gone wild.

12:16 AM  

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