Our Health System - A Zero Sum Game?

"Utilitarian Philosopher" Peter Singer, who wrote "Why We Must Ration Health Care" in The New York Times Magazine, July 19, 2009 approaches several health care ethical issues. He starts with a traditional economist's view, observing that health care, a scarce resource, is to be rationed. Moving through examples of structured (i.e., Britain), unstructured (the American uninsured), and structured but not acknowledged publicly (American government), existing rationing systems, he notes several ethical issues inherent in each of these systems and suggests approaches to resolution.

Underlying Singer's observations is, what I interpret as, his belief that health care is a zero sum game. Reminiscent of Senator Ted Kennedy's 1960's physician payment proposals, a budget basket is established: those who qualify for allocation priorities leave less less for later claimants. As I have argued in many blogs, payment to insurers for 25% administrative overhead claims leaves significantly less in their treasuries to actually buy health care services and products.

But, as Singer recognizes, the problem is defensibly defining who is worthy, not in the Saturday-Night-Live sense, but in the sense of identifying humanitarian and socially beneficial criteria for worthiness. He and we run into the application of population statistics to individuals who may be cut-off from palliative or curative treatment because population statistics indicate that they will not live long enough, or well-enough, to justify spending scarce resources on them and thus depriving more "worthy" people of care. This is another form of rationing.

In my practice of hematology, I learned that I could not predict who would live and who would die, who would have lives incorporating many good days, and who would have lives focused on suffering. I could not tell whether my patient, riddled with cancer, would outlive his young wife who brought him to my office (he did). I could not predict that the sixteen year old would receive a remarkable new experimental treatment called kidney transplantation, and outlive many who had more mundane and less threatening illnesses. In short, I could not apply population statistics to my patients and I believe that health reform based upon the principle of such application is fraught with hazard and stinks of charlatanism. I worry that the zero sum game philosophy will yield tragic results.

If you want to know what Singer proposes, read his Times article. Your time will be well-spent.