Obamacare

Should the Government Decide How Much Your Life is Worth?

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Want to know how much a year of your life is worth in cold, dollar terms? Just ask the government! And not only will they give you the value of your life, they'll tell you the value of everyone else's—because in the government's view, they're all the same. Sound frightening? It should. But if Princeton bioethics professor Peter Singer gets his way, that's essentially what will happen.

In a long article in the New York Times Magazine, Singer argues that, because it's a scarce resource, we must ration health-care. I actually agree. Where I depart from Singer, however, is that I think that, as much as is possible, rationing shouldn't be done by the government.

Singer's essay is basically just a long-form defense of the QALY (quality adjusted life-year) measure that government review boards like Britain's National Institute for Health and Clinical Excellence (NICE) use to determine what treatments ought to be funded. Governments that determine treatments using the QALY assign a dollar value to a year of perfect health (in Britain, it's about $50,000 a year) and then generally reject treatments that don't provide enough value. This means, among other things, that expensive treatments for older individuals are less likely to be funded. From a rational economic standpoint, spending, say, $200,000 to save the life of a 78-year-old only expected to live three more years really is less efficient than spending the same amount on a 30-year-old who's likely to live 40-some more years.

What's wrong with this approach? Beyond the inevitable disputes between economists about what a year of life is actually worth, the bigger issue is that the QALY standard results in an essentially command-and-control approach to health-care distribution: Rather than let individual preferences and agreements work out prices and reach an equilibrium, the government simply sets the value of a year of good life for all people, without differentiating between them, and extrapolates from there. I agree that, in the end, we do have to make economic decisions about the value of life. But shouldn't those be decisions made by individuals, their families, and their doctors? Do we really want bureaucrats in Washington handing down indiscriminate dictates on what a year of productive, healthy life is worth? Must everyone be blindly herded into the same pen?

To the extent that we have the government involved in health-care decision-making, we probably should expect some level of rational economic prioritizing. But this seems to me like an argument to keep the government out of these decisions as much as possible. Singer, on the other hand, argues that we should extend Medicare to all Americans, institute a QALY standard, and then let individuals buy supplemental insurance to cover any additional care they want. Never mind that in Britain and Canada, both of which use rationing boards, bureaucratic territoriality has made it extremely difficult to get private care, Singer's idea would still mean that most health-care decisions are made using the government's standardized, impersonal life-year valuation.

Singer, who's made his name as a contrarian bioethicist willing to take unpopular positions, seems to want credit for boldly admitting that we can come up with a dollar value to human life. But we all do this, implicitly, with every health-care and safety choice we make. The question isn't whether or not life can be assigned a value—it's who should do so.

Previously, I wrote about the problems with the QALY standard here.

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  1. Wow, tell me that aint the crazies thing you ever heard! Wow!

    RT
    http://www.be-anonymous.tk

  2. Singer is a nasty piece of work. If the government decides how much your life is worth and then determines your access to healthcare based on that calculation, then people are nothing but machines sent out to work and scrapped once they can no longer work. That is pretty sick. But since Singer is a sick fuck bent on killing sick and disabled, it is not surprising he would like the idea.

    Beyond the moral issues and dehumanization of such a system, it would never be implimented fairly. Right now Ted Kennedy is spending millions to live an extra year or to. I don’t hear many Dems demanding he die for the common good. The politically connected would always be allow to duck such a system. Meanwhile the poor and the vaunerable would feel the brunt of it. For leftists, it always ends with killing people. It is the only way to get to utopia.

  3. “From a rational economic standpoint, spending, say, $200,000 to save the life of a 78-year-old only expected to live three more years really is less efficient than spending the same amount on a 30-year-old who’s likely to live 40-some more years.”

    How about saving both? Further, why does age determine the value of life? Maybe the 40 year old is a serial killer serving life in prison and the 78 year old is the generous grandfather of 20. What is the calculation then?

  4. The scarcity of healthcare is artificial in a lot of places, so just remove the barriers and watch prices adjust accordingly downward.

  5. I think Singer is Anonymity Guy.

  6. Interesting how they hated rationing by HMOs but this is totally ok. Nothing Orwellian about the government making the decisions at all.

  7. Following up on John’s comment, I don’t believe that such a system will be (or is in Britain) run as impartially as represented. Something tells me that if the 78 year old is a U.S. Senator (or a major donor to a U.S. Senator) he will get the treatment regardless of the cost. It is the rest of us that will be blindly crunched like numbers.

  8. If a life is only worth about $50,000 a year, why are some people paid more or less? Obviously we should tax all income over $50,000 at 100% and set a minimum wage of $24/hr.

  9. Wait a minute… Let’s not be so hasty…

    Can you improve your score throughout your life by doing things more palatable to those in power? You can improve the quality of your health care simply by being a loyal subject. I can’t think of a better way to consolidate power?

  10. “If a life is only worth about $50,000 a year, why are some people paid more or less?”

    Corporate greed! Corporate greed!

  11. Can you improve your score throughout your life by doing things more palatable to those in power?

    Like when Clinton got a pass on committing perjury in a sexual harassment suit, because what he was doing was so important and so good as to make up for his misbehavior? One standard for those who work “for the common good”, and another for the rest of us. After all, if that 70 year old man is helping millions of children get govt ‘care’, shouldn’t we take that into account when deciding the value of his life?

  12. Singer, who’s made his name as a contrarian bioethicist willing to take unpopular positions

    Like pushing for approval of human-animal sexual relations? Nah, nothing contrarian there.

  13. “Like when Clinton got a pass on committing perjury in a sexual harassment suit, because what he was doing was so important and so good as to make up for his misbehavior?”

    FWIW, I’ve seen a lot of perjury in my legal career, and I’ve never seen anybody punished for it.

  14. Your life is worth what your estate is worth plus whatever life insurance you (or those who love you) take out on it. No savings, no health care, no term life? I guess you don’t value your life very highly.

  15. Isn’t this the guy who kickstarted the whole animal liberation movement and its subsequent shenanigans? Does he advocate soaking the rich to pay for squirrel ERs also?

  16. I value my life exactly as much as my beloved representative thinks I should. You guys are just whiners.

    (Ha! That ought to be good for a few extra life-saving surgeries! Don’t come crying to me from the waiting room, suckers!)

  17. There not being even one person who’s willing to kill this guy for the LULZ has destroyed my faith in humanity.

    So fuck it. Do what he says. We suck.

  18. FWIW, I’ve seen a lot of perjury in my legal career, and I’ve never seen anybody punished for it.

    I don’t think a Republican politician would have gotten away with it. Do you? One rule for Our Moral Superiors, and another rule for the cattle. After all, if you’re in control of billions of tax dollars, your life is clearly worth billions.

  19. It sounds to me like Singer’s rationale can be used for tort reform, too — any awards in personal injury lawsuits should be capped at $50,000 per year of life expectancy, with fewer dollars going to people who were simply disabled and not killed.

  20. It sounds to me like Singer’s rationale can be used for tort reform, too

    It also completely invalidates Social Security, since you only get paid that toward the end of your life, even after you retire and stop paying taxes.

  21. “I don’t think a Republican politician would have gotten away with it. Do you?”

    A Republican politician or Republican president? And ‘gotten away with’ what? Perjury or the sex scandal? Scooter Libby didn’t get away with it, but he wasn’t president. Bill Clinton got disbarred over it, but no jail time. I mean, I’m not sure what you’re getting at. Regular folks get away with perjury all the time.

  22. A Republican politician or Republican president?

    A Republican President. No way Bush Senior or Bush Junior would have survived a Monica.

  23. Iirc the some people advocating using this as a way to apply cost-benefit analysis to proposed regulation; if you can determine the amount of lives a regulation may save, the worth of the lives, and then the economic cost of the regulation to society, then you can determine if the regulation is worth it or not. I read an article by Sunstein advocating this as a way to get rid of some regulations that don’t meet the test…

  24. If we’re going to go further into this business of valuing life, we need a Life-Valuation Czar. There is too much variability on this measure. I’ve seen values from different federal agencies anywhere between $5 million and $8 million (WaPo article). That works out to range of about 60K to 100K a year.

    In Somalia, blood money is 100/50 camels (male/female). I think that works out to about $15,000/$7500 in local prices. That’s about $300 per year (maybe $600 after adjusting for PPP).

  25. Oh, and that conveniently works out to the PPP-adjusted GDP per capita of Somalia!

    We could just use the same figure for Americans(about $47,000).

  26. “A Republican President. No way Bush Senior or Bush Junior would have survived a Monica.”

    Clinton (D) got fined $90,000 and disbarred for 5 years.

    Michael Deaver (R) Deputy Chief of Staff to Ronald Reagan, pleaded guilty to perjury and fined $100,000.

    Ronald Blackley (D) former Secretary of Agriculture Mike Espy’s Chief of Staff, was sentenced to 27 months for perjury.

    James G. Watt (R) former Secretary of Interior, was sentenced to five years probation, fined $5,000 and 500 hours of community service.

    I would argue that big shots get nailed for perjury way more often than nobodies. Let’s stop this threadjacking.

  27. I’ve seen a lot of perjury in my legal career, and I’ve never seen anybody punished for it.

    Unfamiliar with Mel Ignatow?

  28. James G. Watt would have had a much harsher sentence if not for his crack staff consisting of a black, a woman, two Jews and a cripple.

  29. Peter Singer needs to die a very slow, very painful death.

    Singer is one sick fucker.

  30. I would figure the life of a wise latina would be worth more than just a white guy.

  31. Clinton (D) got fined $90,000 and disbarred for 5 years.

    Was he forced to resign like a Republican would have been? The relevance to the thread is that, according to the govt and media’s past history, your ‘worth’ is tied to your political connections and your liberalism.

  32. John | July 21, 2009, 10:46am | #

    “From a rational economic standpoint, spending, say, $200,000 to save the life of a 78-year-old only expected to live three more years really is less efficient than spending the same amount on a 30-year-old who’s likely to live 40-some more years.”

    How about saving both? Further, why does age determine the value of life? Maybe the 40 year old is a serial killer serving life in prison and the 78 year old is the generous grandfather of 20. What is the calculation then?

    You have to draw the line somewhere. For example, let’s say I came up with a procedure that cost a billion dollars and would extend a dying person’s life by ten minutes. Would you be in favor of either private or governmental insurance coverage being forced to cover said procedure? Of course not.

    That is to say, it’s likely that a private insurance carrier would make the same choice that a government one would-deny risky, expensive procedures on the very eldery and/or very sick.

    Nobody, including Obama, would ban somebody from then paying out-of-pocket for such a procedure after private or governmental insurance turns them down.

  33. Johnny Longtorso | July 21, 2009, 11:53am | #

    Was he forced to resign like a Republican would have been?

    Name a single politician that was forced to resign from any post. People can be impeached or arrested. People can screw up in such a fashion that they won’t be able to be re-elected. But no elected official can be “forced to resign”.

  34. Unless people are wealthy enough to pay for expensive treatments out of their own pocket, bureaucrats (public or private) will always be making these decisions. At least with public health care systems, the government is accountable to all the voters, not just the company shareholders (who don’t really give a shit about patient outcomes if profits are adversely affected).

  35. But no elected official can be “forced to resign”.

    Please, you know what I meant. They do resign because as a practical matter they have no other choice. Nixon had to resign.

  36. This means, among other things, that expensive treatments for older individuals are less likely to be funded. From a rational economic standpoint, spending, say, $200,000 to save the life of a 78-year-old only expected to live three more years really is less efficient than spending the same amount on a 30-year-old who’s likely to live 40-some more years.

    It’s reasonable to argue that Britain and other countries have to do this. They’re massive welfare states. Therefore, the state has to measure your input into the system. If your potential input to the system is minimal, then the state can only output so much for you. It makes sense. It’s the right thing to do.

    But for very, very wrong reasons.

    This is the path to slavery. What people like Singer are implicitly saying is, “The state now owns your healthcare and in turn, your health. Therefore your treatment is at the pleasure of the state.”

    This is freedom to the liberal. I want none of it.

  37. I stopped being able to take Singer in good faith 15 years ago. He seems to be nothing more than a crypto-misanthrope with nothing to add to any discussion. Kind of like Paul Ehrlich.

    I can find some common ground with his perspectives, but his prescriptive conclusions are always vile, no matter how much he has to twist the logic.

  38. Something tells me that if the 78 year old is a U.S. Senator (or a major donor to a U.S. Senator) he will get the treatment regardless of the cost. It is the rest of us that will be blindly crunched like numbers.

    This is known as a ‘good two-tier system’.

  39. Nixon resigned because there was bipartisan support to impeach him and remove him from office. That is, on a presidential level, it is always up to the President’s own party to deside to remove him or not via the impeachment process.

    Clinton’s party did not want him removed from office, therefore he wasn’t. If a Republican president would be removed via impeachment, it would require at least a significant minority of Republican senators to agree to the removal (unless you think the Democrats can get to 67 Senators at the same time there’s a Republican President).

  40. No way Bush Senior or Bush Junior would have survived a Monica

    Not the old man, for sure. She’d suck the life right out of him.

  41. You have to draw the line somewhere. For example, let’s say I came up with a procedure that cost a billion dollars and would extend a dying person’s life by ten minutes. Would you be in favor of either private or governmental insurance coverage being forced to cover said procedure?

    geotpf:

    Whoa, whoa whoa, Snoop Dogg, slow down here. You’ve mixed so many oxymorons here, I don’t know where to start.

    Of course I wouldn’t be in favor of government paying for such a procedure. That’s called “force”. If a private entity paid for the procedure, that’s between the private entity and the recipient of the procedure. But if a private entity is “forced” to pay for the procedure, then government is involved somewhere so the whole exercise gets reset to the question of force.

    Force is force is force. And we here libertarians take a dim view of it.

  42. Whenever NPR has a bio-ethicist on, I know the rubber hose is about to come out.

  43. it is always up to the President’s own party to deside to remove him or not via the impeachment process.
    […]
    Clinton’s party did not want him removed from office, therefore he wasn’t. If a Republican president would be removed via impeachment

    Wasn’t that the argument that the GOP was making in the 90’s? That if the Republicans in the Nixon era had acted like the Democrats in the Clinton era, Nixon never would have resigned?

  44. QALY (quality adjusted life-year)

    That phrase just creeps me out.

  45. “I don’t hear many Dems demanding he die for the common good.”

    He should have done that 40 years ago.

  46. “For leftists, it always ends with killing people. It is the only way to get to utopia.”

    They died to pay for Leftist sins. Very noble of them.

  47. Uh guys, hate to rain on the outrage party, but the government already decides how much a statistical life is worth. The EPA does it for cost/benefit analysis of environmental regulations.

    It currently stands at $6.9 million. In 2008, the Bush administration knocked down the value of a human life $900 K.

  48. “Like pushing for approval of human-animal sexual relations? Nah, nothing contrarian there.”

    What a nut job. And I say this as someone who has to wash his dog’s vagina several times a week (she has persistant vaginitis). And boy does it suck. I have to put on latex gloves and shampoo the damn thing and then rinse it clean inside and out. It is disgustingly gross (wet dog pussy feels just like wet human pussy) and my dog looks at me with an expression that screams – so when did we agree to take our relationship to the next level?

    I love my dog and it’s doctor’s orders. But she doesn’t really grasp all of that.

  49. “Regular folks get away with perjury all the time.”

    e.g., the Magic Latina

  50. “You have to draw the line somewhere. For example, let’s say I came up with a procedure that cost a billion dollars and would extend a dying person’s life by ten minutes. Would you be in favor of either private or governmental insurance coverage being forced to cover said procedure? Of course not.”

    It would be worth it if during those ten minutes he was able to tell us where he hid the $30B in gold.

  51. Not the old man, for sure. She’d suck the life right out of him.

    Why do I now have the mental image of an empty, deflated Capri Sun juice bag in my head?

  52. I say this as someone who has to wash his dog’s vagina several times a week (she has persistant vaginitis).

    That has got to be the all-time wierdest way someone has qualified their authority on a Hit and Run post.

    And I say that as someone who has eaten a bucket of spiders.

  53. TMI gunboat diplomacy, TMI!!

  54. Abdul,

    You owe us a bucket o’ spiders story.

  55. TMI?

    Too much information.

  56. At least with public health care systems, the government is accountable to all the voters, not just the company shareholders (who don’t really give a shit about patient outcomes if profits are adversely affected).

    King-Drew was an excellent example.

  57. Wet Dog Pussy would be a great name for a band.

  58. “Wet Dog Pussy would be a great name for a band.”

    Not from where I’m sitting…

  59. From a rational economic standpoint, spending, say, $200,000 to save the life of a 78-year-old only expected to live three more years really is less efficient than spending the same amount on a 30-year-old who’s likely to live 40-some more years.

    I suspect that superproductive 78 year olds such as future Bill Gates might place a much higher valuation on a few extra years of life than a broke, unemployable 30 year old, who might jump at the opportunity to trade a year or three of their life for $200K and the opportunity to live large for a bit.

    Hence the value of free markets sorting out these things.

  60. Wet Dog Pussy would be a great name for a band.

    Wet Bitch Pussy would be a better name.

  61. At least with public health care systems, the government is accountable to all the voters,

    That anyone can say this with a straight face saddens me, greatly.

    That most people who believe this also simultaneously believe that corporations and the wealthy exert a disproportionate influence on government baffles me.

  62. You have to draw the line somewhere.

    True. So why not let people decide where they want the line drawn for them, and pay for their health coverage (if any) accordingly?

  63. “For the longest time, we thought she could only say two words, which were “dog” and “pussy”. We thought that meant “dog” and “cat”, but then we found out that what she was really trying to say was “dog-pussy”, one big hyphenated word, which doesn’t come up much in conversation, especially amongst Baptists.”

    A day without a Dead Milkmen reference is a day I don’t want to live.

  64. “At least with public health care systems, the government is accountable to all the voters…”

    Yeah, just like the post office, Fannie Mae, Freddie Mac, vaccine purchasing system, Chrysler, GM, FEMA, levees in NO, Medicare, Medicaid, Veterans Administration hospitals, National Park Service, public housing, space shuttle (only two disasters!)…

    Should I go on?

  65. “At least with public health care systems, the government is accountable to all the voters…”

    Yea, thank God the voters kept us out of Iraq on the knowledge that Saddam had no WMDs.

  66. Damn you Matt Welch, why didn’t you run my (far less elegent) 6 page article that I sent you on this very topic 3 days ago!?

    If anyone gives a shit, it’s found here:

    Why We Must NOT Ration Health Care: A Rebuttal to Peter Singer

  67. “a broke, unemployable 30 year old, who might jump at the opportunity to trade a year or three of their life for $200K and the opportunity to live large for a bit.”

    Honestly – I’m neither totally broke, nor unemployed/able, but I’d take this deal right now. Well… I’d say -1 year of life for $200,000. -3 Years for say, $800,000 (it’s not linear, the more life gets taken off I should get paid far more…)

    Anyway, with that money, I would first be completely debt free, and second invest said money in such a way as to yield +20% and be fucking loaded by the time I’m 40. Then I will hire whatever doctors I need. BAM.

    Any takers btw? Pay me $200,000 and I’ll take up smoking and regularly go tanning at UVASun.

  68. Uh guys, hate to rain on the outrage party, but the government already decides how much a statistical life is worth. The EPA does it for cost/benefit analysis of environmental regulations.

    Big difference when the EPA says I have to wash my car on a non-permiable surface, as opposed to whether I’m going to get that kidney transplant. You do see the difference, right?

  69. Sean Malone, I just went to your article. Well written. Thanks for the addition to the debate.

  70. Governments that determine treatments using the QALY assign a dollar value to a year of perfect health (in Britain, it’s about $50,000 a year) and then generally reject treatments that don’t provide enough value. This means, among other things, that expensive treatments for older individuals are less likely to be funded.

    Like I called it last year. Government run health care will be used to eliminate the social security liability.

  71. What a second. It cost about $300,000 to raise a child for 18 years in an upper middle class lifestyle. If a year of life is worth $50,000, then every year that offspring lives past age 24 is pure profit. Logically, we should all start procreating.

  72. Alternatively, we could calculate the value of a year of life from it’s replacement cost. Figure a person lives to 78, giving us a nice round 60 years of adult life. It costs $300,000 to raise someone to adulthood. So, each adult year left is worth $5,000.

  73. Wait, why do we send people to prison for murder if they can afford to pay society back all those QALYs? I foresee the weregild coming back into vogue (except that it will be paid to the government instead of the next of kin, as it was the former’s property that was destroyed).

  74. “I agree that, in the end, we do have to make economic decisions about the value of life. But shouldn’t those be decisions made by individuals, their families, and their doctors?”

    Yes, of course they should; why is that even a question? Seriously, the government has its fingers in way too many personal pies.

  75. Comments like “But since Singer is a sick fuck bent on killing sick and disabled, it is not surprising he would like the idea” and “Like pushing for approval of human-animal sexual relations” make me want to cancel my email address, shut off my internet connection and pretend the web doesn’t exist. I don’t agree with Peter Singer that government should be running our health care, but you would think in a place like this we would be able to have a rational debate about the actual issue in question without running to smear the subject of the article as quickly as possible. I don’t think Ron Paul is a racist or a 9/11 truther, but is there ever an article about him on a left-leaning site where the rabid commenters don’t immediately fire off those accusations without bothering to discuss the issues of the article?

  76. The thing about Singer is that for a contrarian gorilla sex advocate he’s actually pretty dull and very predictable. It’s just your garden variety utilitarianism extended to include great apes, “the greatest good for the greatest number (of sapient beings)”.

  77. Johnny Longtorso,

    “Yea, thank God the voters kept us out of Iraq on the knowledge that Saddam had no WMDs.”

    If the public had *actual* control over this “democracy* then we would have been out of Iraq a long time ago.

    The problem isn’t that government=bad (a mind-numbing oversimplification), the problem is that government is controlled by a small concentration of wealthy Americans — not by the people.

  78. We have the resources available if we just develop and manufacture them. The solution is to mandate that they be built and made available so rationing other than requiring that something is actually needed for a health-related reason(improving quality of life or prolonging life) is unnecessary.

    I don’t think either the government or the market should get to decide how much my life is worth. I think it would be completely morally justified for a doctor to just thumb through and take what’s necessary in order to help a patient even if the patient doesn’t have the ability to pay and is denied by the hospital. It is a shame that there seem to be no doctors willing to take this course of civil disobedience. If there were not only could they challenge the current system of letting the market decide but would set a precedent for making a statement in case the government tried limiting people’s health care too.

    Another point the right-wingers in countries with universal health care are always the ones who try to argue against more funding and therefore the biggest supporters of “rationing” as opposed to expanding resources to meet everyone’s needs.

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