As President Obama pretends (weakly) that his health care reform plans won’t involve health care rationing, bioethicists are chomping at the bit to see it instituted. Last Sunday, Peter Singer had a long apology for health care rationing in the NYT Magazine . Now, Dan Brock urges rationing over at the Hastings Center Report . He writes:
As long as there is some limit to the resources available for health care, health care will have to be allocated to those who need or want it – with not everyone getting all they need or want. Allocation in the face of scarcity is inevitable. The only to avoid scarcity in the health sector would be to provide all services to all patients who are expected to benefit, no matter how small and uncertain the benefits, and no matter how high the costs. This is clearly impossible.
Ah yes, the old “all or nothing” argument: Since everybody can’t have everything, we are supposed to believe, the state has every right to deny selected populations treatments they want based on their characteristics (age, disability, cognitive impairments, etc.) even if it means they will die.
But this is a false choice. Right now, we don’t allocate resources based on invidious discrimination. Rather, our primary problems are that some people– who are not legally denied treatment –often find themselves unable to get sufficient primary care due to lack of insurance. But even the uninsured are not denied life-saving treatment, but usually must obtain urgent care in unduly expensive emergency room settings. This needs to change. But creating greater access for the relatively few can be accomplished without overturning the entire health care system and legally enacting a rationing scheme that would almost surely be controlled by bioethicists of the ilk of Peter Singer and Dan Brock, based on quality of life judgments.
