The renowned and provocative bioethicist
starts by noting the obvious (well, obvious to anybody except a conservative who refuses to admit it): America’s private healthcare system right now rations healthcare. And, has for years. PPOs, HMOs, advance check-in before non-emergency medical visits and much more — they’re all forms of, and tools for, rationing healthcare.
The U.S. system also results in people going without life-saving treatment — it just does so less visibly. Pharmaceutical manufacturers often charge much more for drugs in the United States than they charge for the same drugs in Britain, where they know that a higher price would put the drug outside the cost-effectiveness limits set by NICE. … That’s rationing too, by ability to pay.
And, let’s not forget that doughnut hole Republicans deliberately put in the middle of Medicare Part D, speaking of rationing.
Singer goes on:
When the media feature (named British patients) like Bruce Hardy or Jack Rosser, we readily relate to individuals who are harmed by a government agency’s decision to limit the cost of health care. But we tend not to hear about — and thus don’t identify with — the particular individuals who die in emergency rooms because they have no health insurance. This “identifiable victim” effect, well documented by psychologists, creates a dangerous bias in our thinking.
Exactly, and at least some conservatives know that. Besides the Hardy and Rosser types tend to be middle-class; those with nothing but ER care tend to be poor and therefore not so deserving of being pictured anyway. However, their quality of life at end of life is never discussed; just their quantity of life. More on this below.
Here’s the bottom line, near the end of
what passes for a tome by today's normal newspaper website writing length:
Of course, it’s one thing to accept that there’s a limit to how much we should spend to save a human life, and another to set that limit.
Singer goes on to note how behavioral psychology has shined a light on how bad we are at making such risk assessments, too. That’s totally true. That’s how advertising works, and that’s how political grandstanding works.
Singer, unsurprisingly if you’ve read him before, ends by diving into quality-of-life issues, something that no politician will touch with a 10-foot pole. This is where Democratic politicians will say, “Whoa, now; wait a minute.”
Singer doesn’t delve into everything, of course; he doesn’t have room.
But, end-of-life expenses, here in America, especially is where quality-of-life runs head-on into quantity-of-life stubbornness.
Long since Jessica Mitford and other writers on the subject, America remains a deeply death-defying nation. While hospice is gaining ground, the allegedly most Christian United States is very much a nation of death-fearers.
And, it’s DEATH-fearing, not DYING-fearing, that’s the problem. Hospice, on both the physical and psychological side, well addresses the dying fears. But, the death fears are still there.
Beyond financial and quality-of-life rationing, Americans need to do some thinking about quantity-of-life issues (I have more in another post.)
Singer’s story is long, at five webpages, and
well worth a read; unfortunately, it will probably cross the eyeballs of nary a GOP member of Congress. And, the Democratic side of the aisle (or any Green types, if they were there, perhaps) would dodge wrestling with this in depth.
So, 
