How to ration healthcare?

In my earlier post on Peter Singer's essay on healthcare rationing, I intentionally stopped with his observation on the reality of rationing.

I did not comment on Singer's solution, which was an utilitarian discussion of quality of life years. I did not care for it because that framework did not convince me about how we might deal with ailments that might not affect a whole lot of people. Furthermore, it seemed to offer a corollary that old people should be knocked off rather than be treated because it is generally way too expensive to treat the elderly than it is to treat the young.

Darshak Sanghavi comments on this very issue:

The typical solution to such medical waste (most recently described in a New York Times Magazine article by utilitarian ethicist Peter Singer) is to ration health care spending, often with dubious mathematical formulae—in short, to starve the beast.

Sanghavi's essay is way more interesting, and less rhetorical than others, because of observations like this one:

We now recognize and treat problems that were previously hidden or never diagnosed—which is a good thing. Consider these sample statistics, all from generally reliable federal agencies: One percent of the population has celiac disease, causing anemia and other problems, one in 150 children tests positive for autism spectrum disorders, 2 percent to 5 percent of adults have an eating disorder, 20 percent of children are overweight, one in 22 pregnancies is complicated by a minor or major birth defect, and 10 percent of people have asthma. The list goes on. In the past, people just lived with these problems. Today, for better or worse, we do not simply let them go—and that costs more and more money.

In other words, in the olden days, people lived (or died) with problems that hadn't been given names. And some problems are getting to be more common--like with prostate--because we have more and more men living very long years; in years past, rarely did a man live that long to suffer from prostate issues.

We seem to be chasing after rainbows in the rush to reform healthcare in the US. It is bound to make most unhappy, and a few who manage to get deals, well, they will be happy. The White House adopting Bush-style tactics is not helping either. I am glad though that they changed their approach and released the list of names of healthcare executives who visited the White House for meetings.