Rationing through "Medicare for All"

A few years ago, when I was at CalState, the Ethics Institute brought Peter Singer to campus. Oh boy, was there a crowd! It was not because there was a huge fan base; there were lots and lots of people upset with his arguments that did not agree with their interpretations of life, death and how to deal with them. I doubt whether the campus ever had such a security presence for a visiting philosopher :-)

To his credit, Singer does not shy away from controversies, and the recent NY Times magazine essay is an example of that. In discussing how "rationing" has unfairly become a dirty word in the healthcare debate, Singer asks:

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.

A simple question, right? How much are you willing to pay? We do this individually all the time, whether it is for the pets at home, or for the humans we love. Yet, this is practically an unspeakable topic, and how we arrive at these decisions is supposedly not because of dollar calculations.

It is something similar to a question I typically ask my intro class students when we discuss population. I ask them how many children they think they will have. Most think it will be 1, 2, or 3. I ask them then "why not six?" Their responses are, say, "I won't have time for that many", or "I won;t be able to go on vacations with that many kids" .... to which I then state that this is nothing but cold economic calculations: children are expense items that take money away from other possible spending options. We, therefore, "ration" kids.

Singer writes:

The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?

Indeed.