Suderman: Singer Right About Rationing, Wrong About Who Should Do It

Suderman contra Singer:

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.

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About Daniel Fincke

Dr. Daniel Fincke  has his PhD in philosophy from Fordham University and spent 11 years teaching in college classrooms. He wrote his dissertation on Ethics and the philosophy of Friedrich Nietzsche. On Camels With Hammers, the careful philosophy blog he writes for a popular audience, Dan argues for atheism and develops a humanistic ethical theory he calls “Empowerment Ethics”. Dan also teaches affordable, non-matriculated, video-conferencing philosophy classes on ethics, Nietzsche, historical philosophy, and philosophy for atheists that anyone around the world can sign up for. (You can learn more about Dan’s online classes here.) Dan is an APPA  (American Philosophical Practitioners Association) certified philosophical counselor who offers philosophical advice services to help people work through the philosophical aspects of their practical problems or to work out their views on philosophical issues. (You can read examples of Dan’s advice here.) Through his blogging, his online teaching, and his philosophical advice services each, Dan specializes in helping people who have recently left a religious tradition work out their constructive answers to questions of ethics, metaphysics, the meaning of life, etc. as part of their process of radical worldview change.


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