Health Care Rationing

Peter Singer and Conor Clarke want to know why there is such a problem with the concept of health care rationing--that is, assessing the value of an individual's life:

If the Department of Transportation [followed the principle that it was impossible to put a dollar value on human life] it would exhaust its entire budget on road safety. Fortunately the department sets a limit on how much it is willing to pay to save one human life. In 2008 that limit was $5.8 million. Other government agencies do the same. Last year the Consumer Product Safety Commission considered a proposal to make mattresses less likely to catch fire. Information from the industry suggested that the new standard would cost $343 million to implement, but the Consumer Product Safety Commission calculated that it would save 270 lives a year — and since it valued a human life at around $5 million, that made the new standard a good value. If we are going to have consumer-safety regulation at all, we need some idea of how much safety is worth buying. Like health care bureaucrats, consumer-safety bureaucrats sometimes decide that saving a human life is not worth the expense. Twenty years ago, the National Research Council, an arm of the National Academy of Sciences, examined a proposal for installing seat belts in all school buses. It estimated that doing so would save, on average, one life per year, at a cost of $40 million. After that, support for the proposal faded away. So why is it that those who accept that we put a price on life when it comes to consumer safety refuse to accept it when it comes to health care?

I haven't been as good a student of the health care conversation as I'd like, but I think I can take a crack at this one. We're not talking about creating a health care system from a blank slate here. We've already got a system. And it's predicated on utility. It determines the utility of covering particular individuals, the utility of paying for particular tests to diagnose symptoms, and the utility of paying for particular procedures to respond to diagnoses. And apparently we all hate this system. The galvanizing principle is the out of hand rejection of the cold, calculating, rational practice of establishing the value of a human life. It is no help to suggest that maybe we just instead give that power to a legislative subcommittee. The Dems have our ear because they've been talking as if we're all special wonderful snowflakes without whom the world can't possibly go on turning. If we wanted cost estimates, we'd just stick with the market.

Now, are we being silly? Of course. But if we're going to admit we're being silly about rationing, we may as well go the whole distance and admit we're being silly about a universal public option in the first place.