So Peter Singer – whose past writings have been, to put it mildly, odious to me – has an oped in the NY Times that’s triggering a bit of reaction: ‘Why We Must Ration Health Care‘
The reactions are, overall, kinda scathing:
From Tammy Bruce (Please, Tammy – finger outside the triggerguard until the sights are on the target, OK?):
Obama moral relativist begin making fascist argument for rationing health care which is what this has been about from the beginning – eliminating “costs” from the budget. For fascists, people are the budget.
From Don Surber:
I have been saying that the Democratic Party does not want to save lives with their hideous, expensive and bureaucratic plan to take over health care.
The plan is to “save” money….
He is a sick, sick man. He puts money ahead of human life. He may be bio, but he has no ethics – or at least any that I would want to be associated with.
From Steve Gilbert at Sweetness and Light:
…it is worth going to the link and reading the full tract.
It is great nightmare fuel.
By the way, in case Mr. Singer’s name doesn’t strike a bell, he is that famed bioethicist who believes in sex with animals and abortion, euthanasia and infanticide for humans.
Maybe Mr. Obama will make him his Health Care Czar.
…and so on.
So I’m gonna go pretty far out on a limb here, and say that while I may or may not agree with his prescription, I think that his diagnosis is one that we can’t afford to avoid dealing with in some way.
Here’s a personal – and painful story. This is how my dad died.
My dad had never been in great health – he’d had a heart attack in his 40’s, been a three-pack-a-day smoker until then, and a pipe smoker afterward. He walked, which was his form of exercise, but it didn’t make a huge dent in the family genetics. His dad had died of a heart attack in his late 50’s, the year before I was born, and his brother had a heart attack in his 30’s. His brother died – of a stroke – in his early 60’s, and my cousin, writer Paula Danziger, died of a heart attack at 59.
You get the picture. (In case you’re concerned, I get a treadmill test every two years – I got to do a technicium one this year – and pass with flying colors each time. My BP was 120/80 when I was checked two weeks ago, and so I’m assuming I got my mom’s cardiovascular system instead of my dad’s.)
So my dad had his first bypass when he was 53 – three years younger than my age. He had another about ten years later, retired at 64, and at age 67 had a major stroke, followed by a mild heart attack and kidney failure.
He started permanent dialysis, and spent about eight years in relative stability, until he had another heart attack and needed yet another bypass. At this point he was too frail to live on his own, even with the ongoing two shifts of help that had burned through his savings, and I moved him to a board-and-care facility near my house so the boys and I could spend time with him.
Then he needed another bypass, and we had a long debate about whether to do it or not. To be honest, I pushed him toward doing it, because I felt that withholding treatment would have been immoral.
After that he had two decent years, and then he began a series of abdominal bleeds, which led to three emergency surgeries in seven months. Two months after the third surgery, he started bleeding slowly again, and I had a conference with his doctors.
They could keep operating, and he’d eventually die on the table, or painfully from abdominal bleeding. He was sedated for pain, and when we roused him, not coherent.
When he’d started dialysis, the nephrologist had told him that he could stop any time, and that dying from kidney failure was one of the most painless ways to die. He’d noted that and frequently talked about just stopping dialysis when things became too much for him. So I made the decision to discontinue his dialysis, and a day later he went into a coma and a day later he died.
The day I made that decision and called my aunt and mother and informed them was one of the worst days of my life; my own responsibility still sits heavily on my shoulder.
But I didn’t see any alternatives, and really still don’t. Adulthood is, I’ve come to believe, a matter of making choices between terrible alternatives and moving forward.
And now to the point of this exercise. When I was talking to my dad about his second bypass – at 75, three years before he died – we discussed how lucky we were that money didn’t enter into the equation; between medicare and retirement insurance benefits from his employer, his healthcare was essentially free. We both wondered if he would have had the third bypass if I had had to take money from my kids college funds for it.
And that’s really where the nub of the problem becomes.
Because in the last three years of my life, my dad’s medical bills (not his chronic care bills, but his bills for physicians and surgeons) probably was close to three quarters of a million dollars. Figure close to $250K for each bypass and postoperative care, $125K each for the three operations and postoperative care, and about $1K/month for medical visits, tests, etc. (not including dialysis). So $500K in surgery, $360K in overall medical care. In the last nine months – during all of which he was in postoperative acute care – we probably spent (or his insurers spent) $370K – to what end, exactly?
And so that’s the question we’re looking at in rationing and talking about health care. Because we’re only willing to spend so much on healthcare overall; but as long as it doesn’t cost me anything, I’m prepared to spend whatever it takes until there’s no further point.
And so there’s the rub. On one hand, I’d be blowing buildings up if some cubedwelling functionary told me I couldn’t get treatment for my dad. On the other, I have to ask – as cooly and dispassionately as I can – if the money I caused to be spent on him in those final months – even those final years – is money he or I would have spent if we’d had to write the checks.
And there’s the rub; we have a system which largely removes cost as a factor either because you’re in a protected class like my father, where there are no costs – or because the costs are so great that they don’t matter and they are an insurmountable barrier. There is no “this much and no more” in healthcare as it’s structured today.
Should there be? Thinking about my dad, I honestly don’t know. But we need to talk about it, and so I have to – grudgingly, holding my nose – tip my hat to Professor Singer.