8/24/09 10:18 AM
Why We Must Ration Health Care - NYTimes.com
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http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1&sq=Peter%20Singer&st=cse&scp=2&pagewanted=print
July 19, 2009
Why We Must Ration Health Care
By PETER SINGER
You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called
Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of
$54,000. Is a few more months worth that much?
If you can afford it, you probably would pay that much, or more, to live longer, even if your
quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger
covered by your health-insurance fund. If the insurer provides this man — and everyone else like
him — with Sutent, your premiums will increase. Do you still think the drug is a good value?
Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any
limit to how much you would want your insurer to pay for a drug that adds six months to
someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that
much,” then you think that health care should be rationed.
In the current U.S. debate over
health care reform
, “rationing” has become a dirty word. Meeting
last month with five governors,
President Obama
urged them to avoid using the term, apparently
for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a
Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration
Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described
how in Britain the national health service does not pay for drugs that are regarded as not offering
good value for money, and added, “Americans will not put up with such limits, nor will our
elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator
Max
Baucus
, told CNSNews in April, “There is no rationing of health care at all” in the proposed
reform.
Remember the joke about the man who asks a woman if she would have sex with him for a
million dollars? She reflects for a few moments and then answers that she would. “So,” he says,
“would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you
think I am?” He replies: “We’ve already established that. Now we’re just haggling about the
price.” The man’s response implies that if a woman will sell herself at any price, she is a
prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that
it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?
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8/24/09 10:18 AM
Why We Must Ration Health Care - NYTimes.com
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http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1&sq=Peter%20Singer&st=cse&scp=2&pagewanted=print
Health care is a scarce resource, and all scarce resources are rationed in one way or another. In

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- Fall '08
- na
- Microeconomics, Universal health care
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