Ted Kennedy and Peter Singer on Health Care

Conservatives are now moving to block Obama’s modest health reform (miniscule to many of us) by charging his socialist government is out to ration health care, deciding who is to live and who is to die through bureaucratic decision-making.

William Kristol in a Weekly Standard blog post yesterday seizes upon a paragraph in Ted Kennedy’s powerful, emotional plea for health care reform–including a modest public option–in the current Newsweek to claim he’s into rationing. Here is a key excerpt from Kennedy:

We will bring health-care reform to the Senate and House floors soon, and there will be a vote. A century-long struggle will reach its climax. We’re almost there. In the meantime, I will continue what I’ve been doing—making calls, urging progress. I’ve had dinner twice recently at my home in Hyannis Port with Senator Dodd, and when President Obama called me during his Rome trip after meeting with the Pope, much of our discussion was about health care. I believe the bill will pass, and we will end the disgrace of America as the only major industrialized nation in the world that doesn’t guarantee health care for all of its people. … In the last year, I’ve often relied on that Congressional insurance. My wife, Vicki, and I have worried about many things, but not whether we could afford my care and treatment. Each time I’ve made a phone call or held a meeting about the health bill—or even when I’ve had the opportunity to get out for a sail along the Massachusetts coast—I’ve thought in an even more powerful way than before about what this will mean to others. And I am resolved to see to it this year that we create a system to ensure that someday, when there is a cure for the disease I now have, no American who needs it will be denied.

Kennedy’s piece is worth reading in full. I can’t find an argument for rationing health care anywhere in it, but if you can, please drop me a line and tell me where.

We all know the U.S. already rations health care, by denying insurance coverage to the poor and lower middle classes, by forcing people without insurance to wait hours in emergency rooms, limiting treatment for anyone who doesn’t have the kind of Cadillac insurance that comes mostly with high-paying jobs, allowing pharmaceutical companies to charge exorbitant prices for drugs—so high in many cases people just stop taking them. And in the current debate, politicians want to add to that rationing by cutting back Medicare, which the only thing close to a fair, classless, single-payer system the United States has ever seen.

The subject of rationing is a tricky one, but if you want to get into it, you might start with Peter Singer’s article in Sunday’s New York Times Magazine. I know Singer from his work on animal rights. As I’ve written before, as an old person I’m not keen on the implications of things like QALYs–which stands for “Quality Adjusted Life Years”–might have in the wrong hands.  (Advacates for the disabled have criticized Singer on the same grounds.) But Singer’s piece is valuable for pointing out that even the most bureaucratic and “socialistic” government-run system manages better, fairer delivery of health care than we do. His ideas also bring the plain fact of income-based health care rationing out of the shadows, which is where opponents of reform would like to keep them. Here is an excerpt from Singer’s conclusion:

Rationing public health care limits free choice if private health insurance is prohibited. But many countries combine free national health insurance with optional private insurance. Australia, where I’ve spent most of my life and raised a family, is one. The U.S. could do something similar. This would mean extending Medicare to the entire population, irrespective of age, but without Medicare’s current policy that allows doctors wide latitude in prescribing treatments for eligible patients. Instead, Medicare for All, as we might call it, should refuse to pay where the cost per QALY [a method of assessing cost benefit] is extremely high. (On the other hand, Medicare for All would not require more than a token copayment for drugs that are cost-effective.) The extension of Medicare could be financed by a small income-tax levy, for those who pay income tax — in Australia the levy is 1.5 percent of taxable income. (There’s an extra 1 percent surcharge for those with high incomes and no private insurance. Those who earn too little to pay income tax would be carried at no cost to themselves.) Those who want to be sure of receiving every treatment that their own privately chosen physicians recommend, regardless of cost, would be free to opt out of Medicare for All as long as they can demonstrate that they have sufficient private health insurance to avoid becoming a burden on the community if they fall ill. Alternatively, they might remain in Medicare for All but take out supplementary insurance for health care that Medicare for All does not cover. Every American will have a right to a good standard of health care, but no one will have a right to unrationed health care. Those who opt for unrationed health care will know exactly how much it costs them.

It is common for opponents of health care rationing to point to Canada and Britain as examples of where we might end up if we get “socialized medicine.” On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.” There is no particular reason that the United States should copy the British or Canadian forms of universal coverage, rather than one of the different arrangements that have developed in other industrialized nations, some of which may be better. But as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.

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