The author, Peter Singer, is trying to make a stance that it is impractical to use rationing as a means to determine what a human life is worth. Singer cites examples of the high costs of drugs in relationship to how long these drugs can expect to extend the life of a person. In Great Britain, where there is national health care, the author reminds us that their policy does not pay for drugs that are not a good value for the money. Americans openly state that they do not agree, but they also state they should be required to supplement through their insurance premiums for people that cannot afford the drugs. While the author does not directly say, he is suggesting that Americans truly want a rationing system, but only to a point that does not effect the individual. Singer tells us how President Obama uses his mother as an appeal to an emotion which is a situation, we cannot validate and politicians are infamous for creating to help gain support. What the author does discuss is the high cost of medicines, but not what can be done to reduce the cost and make it more affordable for the common person. I am in the opinion that in this case he is over looking the root cause of why there is high cost for medicine. The author did not discuss the question of who makes the decision on rationing and I was left to question if there was an answer. Singer provided some interesting correlations to other country’s health care system but did not rationalize the differences in culture and acceptance of what a life is worth. My overall opinion is that for the topic the author discussed, he did an adequate job of explaining the issues but asked more questions than provided answers. Without additional information to know if his facts are creditable, I cannot realistic say he made a good case for rationing. Singer did not provide a sufficient answer to help me understand the ramifications of rationing.
In the article “Why We Must Ration Health Care” I believe that the author does make a good point on the rationing of health care because even though it is a very bad thing to think about but in the case of prolonged life due to some drug or treatment that only prolongs your life for a certain amount of time I believe is not a good use of our scarce health care. With the state of our economy being on the brink of a disaster Health care has become something close to extinction. The debate over which treatments and drugs should be used on someone that is near death should be put before an ethics committee and resolved to so that everyone wins. The prolongation of life for only 6 more months as heartless as it is for me to say is not and should not be an option for insurance companies. The risks taken by the people who allow for these treatments and medications is fatal to the rest of the population because it makes health care even less affordable for everyone else. As the co-pays rise there will be less and less visits to the doctor leading to the spread of many sicknesses. Also there is the risk of the avoidance by doctors to see public patients because of their already low pay that they will eventually receive and the limits on payments. Either way with this risk we are all pretty much taking by doctors administering drugs that only prolong the evident ending we are all at risk of getting shitty health care and ending up spreading such epidemics as swine flu and other horrific plagues. I understand that this is a hard decision for a parent to make because I don’t believe I could make it in the case of my daughter or son. My sympathy goes out to parents and families who have to go through this however, it must be understood that if the person who is reaching the end is only going to be given six more months to live with a miracle drug. I don’t think that a family should allow themselves to go through that pain of seeing hope once again hoping that the person who is dying will live longer. They should begin the grieving process and accept that that person is no longer with them as heartless as it may seem. I think that even though this article was written from an economic perspective that it brings up several good points that need to be brought to the general publics’ attention. The evaluation of medical treatment for terminally ill patients should be brought in front some sort of ethics committee or a committee brought together to decide what happens in these specific cases. Something needs to be done about our current health care state and if this is a necessary precaution that needs to be taken to help us maintain a decent health care structure then so be it.
Being from Canada, this is my first time hearing about the idea of rationing health care and the author, Peter Singer, does a great job, I believe, in explaining it. Therefore, I believe that the author made a good case for rationing in the article, Why We Must Ration Health Care. He does this in three ways. He fills the article with cited statistics, facts, and examples, does not let his “emotional” side effect his point of view, and looks at both sides of the argument but always being able to defend his. After telling the sad stories of Bruce Hardy and Jack Rosser, the author wrote, “There’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way” showing readers that he is not heartless and can view this difficult decision from the opposing side but would like to look at it realistically and logically nor basing judgment on emotions but more on fact. I believe he did a great job of this showing that there is more to this when and/or if you can get passed the emotional side of the argument. After this brief moment, he goes on to share with readers the rationing that is going on behind closed doors. He claims( I wouldn’t doubt it), “ 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”. Americans who are covered by Medicare or Medicaid cannot afford these drugs and therefore it can also be seen as rationing; people who are able to pay, and those who are not. Making a woman decide over life-saving medicine and feeding her children is something that no one should have to deal with and manufacturers should be held accountable for this and should be brought to the publics attention so maybe something can be done so no more children have to live without their mother who could not afford the medicine. Singer makes a great argument about basically getting your moneys worth/ get a better value for your money. Singer says, “If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades”. It’s sad to say but true. Along with the Wisconsin automobile accident statistics from Joseph Doyle, a professor of economics, I can see Singer’s view. Who wouldn’t want to pay the same amount and get more out of it? Who wouldn’t want to save ten people that could live for another 30, 40 years than a person who will, with time, eventually pass away at the same cost. It is very tough to put a “value” on someone’s life, however, it is realistic in this situation as Singer sees it as well. Finally, he does a great job of looking at both sides and possible questions from the opposing side. In his example of the quadriplegic, this can be seen. During this part, he goes on to talk about the QAYL and possible question from the opposing side such as, “ Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics”. He later goes on and puts aside any further questions about his view and QAYL by saying, “The problem, however, does not lie with the concept of the quality-adjusted life-year, but with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability”. This is Peter Singer makes a good case for rationing.
believe that the author did a great job in explaining the good and bad things about rational health care. He considered both sides carefully, and he finally states that rational health care is better for the public. At first, the author talked about the case of Bruce Hardy and Jack Rosser, who had advanced kidney condition, could live 6 months more with Sutent, a drug that cost $54,000 dollars. The author brought up a question: “Is the few months worth that much?” If we are the people who could be benefit from that drug, we may say that the drug is definitely worth 6 months of living. However, if we are not, and our insurance premium will go up if someone else benefit from that drug. Would we still think that the drug is worth 6 month of living? I acknowledge that it is a tough decision because we are not only look at the value of money, but we also look at the ethical issues in each individual case. However, if we consider about ethical issue too much, there would be more people in the U.S. live without health insurance. The author also stated the idea that in the U.S. we ration health care in many ways, but it is more implicit compared to Canada and England. The author mentioned about a case that the mother had blood pressure who refused to fill out a prescription because she rather used that money to buy foods for her children. We rarely see rationing in our health care system because it is not obvious, but it is there. Health care is a scarce resource, and I truly believe that the only way that we can provide it fairly is through rationing. Even though it seems to be heartless in the case of Bruce Hardy and Jack Rosser, but we also need to consider about the quality of life. Even Bruce and Jack can live for 6 months, but their quality of life may be really bad. Instead paying a large amount of money to extend their lives, we should use the money to save the people who would be more benefit from that. There are many people in the United State do not have insurance because our government do not regulate the money being used in health care efficiently. I do believe that if everyone in the U.S. has health insurance and with rationing heath care more people will be benefit from it.
The article by Peter Singer was very interesting, the process for how it’s determined how health services are rationed, how rationing is done in Britain and Canada and the effects, the way Quality-adjusted-life-years (QALY) factor into the process or could factor into the process is considered unethical. Also, the big one for me was the fact that healthcare services are already being rationed in the United States through the private insurers and the government with programs like Medicare and Medicaid. Mr. Singer presents a strong case for healthcare rationing with strong facts and personal cases. Britain’s government program NICE has a high approval rate and is a way for keeping the cost of medical treatment and services at an affordable rate. In doing this the pharmaceutical companies can not charge Britain’s outrages prices to get a very much needed prescription filled, which leads to decreased medical cost. Here in the U.S. there’s a lack of money because the U.S. is backwards or upside down when citizens can’t afford to purchase preventative meds such as antihypertensive, because they have to choose between putting food on the table and getting a prescription filled. There’s a high number of American citizens dieing from complications related to treatable disease because they couldn’t afford to pay for the prescriptions, this is totally unacceptable. Mr. Singer also touched on the fact that here in the United States healthcare services are already being rationed through the private insurers, since they are the ones who decide who receives certain expensive treatments. This decision can be based on a number of factors including QALY or they simply put a value on your life and if that number is lower than the needed treatment then they pay, but if not the insurer will not pay and this practice was adopted many years ago. The government programs on the other hand are little more subtle in there rationing. With Medicare and Medicaid it’s usually seen with long waits, and high co-payments, therefore according to Singer “inability to pay is a form rationing”, again this has been going on for years. In conclusion, I would have to say Mr. Singer makes a strong case for rationing, which is already happening in the U.S., we just don’t call it that. Therefore I think a hybrid is just what the healthcare reform bill could use. Granted nothing is perfect there are problems with Britain’s and Canada’s health systems, but ours is on the brink of collapse. We need reform now which may have to include rationing.
The author of the article makes an excellent case for rationing health care. He makes many good points and has the numbers of surveys to back it up. America’s health care system is in trouble. The costs of medical treatments have risen and are still on the rise. It is good to see that our leaders recognize the problem and are considering ways to deal with it.
The author puts into perspective other countries ways of dealing with healthcare. America should learn how these countries make their system work effectively. Having everyone covered under a national healthcare plan is a great idea. There will be no discrimination against absolutely anyone from billionaires to homeless people. Other countries are implementing national healthcare coverage with success so America should consider this option also.
There can never be a monetary value on any human life. In order to treat everyone equally, the government should provide healthcare for everyone. There should also be a safeguard against healthcare providers taking advantage of any new program. If financially sound families can afford private health insurance, they should definitely invest in it. But, there should be no conflict in providing healthcare for those privately insured over those with government coverage.
The author Peter Singer does make a good case for rationing health care, and I do agree with his ideas. First off, Singer gives an scenario where we would have to imagine having advanced kidney cancer and we would have the option of taking Sutent (a drug that slows down cancer), but the catch would be that it would cost 54,000 dollars for only 6 more months. He then goes onto say of course if we had the money to pay for the treatment we would more than likely do it and there would be no problem. But if we could not afford to pay for the treatment then we would have to rely on our insurance to pay for the cost, and in doing so affect everyone else around us. The question that comes to mind is whether or not it is ethical for us to allow someone to get treatment that only prolongs there life for a limited amount of time, versus telling someone they can not have a treatment because of the expense. I agree with Singer in that rationing should be considered, but only to a point. Two factors should go into deciding whether or not someone should be given an expensive treatment, and those are their quality of life during their treatment and the amount of money. For instance, if someone has incureable brain cancer and the treatment for the person is 100,000 dollars, for only a few months with low quality of life then this should not be allowed. Versus have someone who is a quadriplegic like mentioned in the article, if their treatment is 100,000 dollars but their quality of life is improved and they are given the ability to live a better functioning life then I agree they should get the treatment. Again it all depends on the cost, and the quality of life the person will receive after the treatment. In the end, I agree with Singer’s perspective on rationing of health care.
Oddly, it is comforting to me that there is a math solution to determine the insurance company’s decision on what will be covered and what will not; although it is not a perfect solution, it is a good starting place. For example, If you know how much a person will pay for a specified reduction in risk, you multiply the amount that people are willing to pay by how much the risk has been reduced, the theoretically you have value people place on their lives. Peter Singer makes it perfectly clear that “there’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way”, in his article about rationing healthcare. After reading through his article several times and really considering the information including the specific people written about in his article I have to agree, healthcare needs to be rationed, (in fact is already is through private insurance companies). Singer gave the example of someone with a terminally ill kidney disease and the possibility to extend live up to six more months, for over $50,000; more then the average yearly income of most families. Is this a reasonable value to set on ones life, or is this just too much money. It is my opinion that spending that much money just to possibly extending the life of someone with a terminally ill disease is irresponsible. That amount of money could be used to save the life of someone or for a treatment that can improve the quality of life for some that is not terminally ill, or perhaps assist in finding a cure for a terminally ill disease. Not only do we need to be responsible in making these very difficult decisions, but we need to understand how complicated these times are for those that are fighting terminally ill diseases. Our healthcare system is in desperate need of a makeover. I don’t know all the answers. However, I agree that healthcare rationing is necessary.
In the article titled “Why We Must Ration Healthcare”, I feel the author Peter Singer makes a very good case and also points out different scenarios in which the rationing of healthcare is apparent but yet overlooked by many. What I mean by this is that whether or not the government wants to admit that rationing is being used within our own healthcare system the proof is there, it is just being disguised. Singer states that the government implicitly places a dollar value on human life by deciding how much to spend on healthcare programs, determining copayment amounts or how much to spend on someone who is uninsured but needs emergency treatment. What’s shameful is that some Medicare and Medicaid patients often can’t afford to pay the copayments for their prescriptions which can cost as much as $40,000 a year, while the pharmaceutical companies are charging way more money in the united stated than they charge for the exact same drugs in Britain. Why would something like this even be allowed to go on in the United States it’s all just a less visible form of rationing. Like the old saying only the strong survive, whoever has the money will live which allows them to pay for the expensive life saving treatments, while the weak person with no money will die. (strong meaning rich in this sense). The unfortunate story about the woman who came into the emergency room shows how the system of rationing that we do use in the United States doesn’t work for everyone. The mother died due to a brain vessel that burst in her brain all because she chose to buy food instead of fill her prescription for her much needed blood pressure medicine. Another way Singer justifies his case is by including the study that was done by Joseph Doyle, a professor of economics. He studied the records of many severely injured automobile accident patients who had no choice but to go to the hospital for care. It was concluded that those without insurance received 20 percent less care and had a death rate at 37 percent higher than those who had health insurance. Somehow we forget to mention all the people that do die in Americas emergency rooms every year due to lack of health insurance. Doyle’s studies indicate that the people that died were mainly in their 30’s and they clearly had another 30 to 40 more years of life to live. Had they of received the same care and treatments that were used on the insured patients, they would of survived and it would of only cost around 220,000 for each life that was saved. If the government and insurance companies want the most bang for the buck, this would have been a perfect opportunity to use that concept. Another example is the study that indicated that in the age group of 55-64; there are more than 13,000 extra deaths a year which are most likely contributed to the lack of insurance. Point being that without money or insurance you can’t get very far and healthcare is already being rationed in many ways whether it is recognizable or not. Like with the organization called NICE, where they set a limit of 30,000 to 49,000 with the intention of saving one’s life for a year or more. Well, the problem with this type of rationing is that it doesn’t help everyone. A perfect example is with the case of Jack Rosser the limit that NICE set for the value of one’s life was not enough for poor Jack he needed 54,000. But to Jack and his family his life was worth more than the limits set by NICE, even if it would extend his life for only six months, it would of given him a chance to see his one year old daughter Emma, start primary school. I feel Singer did an excellent job pointing out the fact that there is really no way around rationing. Rationing is a part of life it happens in every aspect of life. So instead of arguing whether or not the healthcare reform bill has rationing in it, that is not the problem, it clearly has rationing in it but it needs to be readdressed and rationed in another more sensible and money saving manner.
After reading the article Why We Must Ration Health Care by Peter Singer. Does the author make a good case for rationing? He does make a good case for rationing health care. He covered all his bases, from people with cancer, to teenagers and 85 year olds, to the disabilities of quadriplegics. He does raise a huge question, of “How much are you willing to pay to save your life?” But, I question the fact if you have a drug, such as Sutent that slows the spread of cancer, and it could give you that extra 6 month of life. Does this drug also, give you the quality of life for those 6 months? Are you suffering with great deal of pain and are you bed ridden? Then I would have to say no it isn’t. The cost of $54,000 is not even a year’s salary for most people and I don’t think that is fare to even have to make that kind of choice. For those who are more fortunate, that’s there choice. But for a mother, who chose to put food on her table for her kids, then for the medicine that will help, and in return left her children mother-less it again, is not fair. Health care needs to be more affordable for everyone. Wouldn’t it be better to provide a health insurance that would give a family peace for taking there child to the doctor for a common cold, and get the right kind of antibiotic vs. not going at all, and getting terribly sick and being put in the hospital for phenomena or something much more costly than simple doctors appointment and prescription. Peter Singer does bring a lot of facts and statics to the table from not only from the United States but from countries all over the world. He also states, “If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades”. I think this is a true statement, even though I have never been addressed with a life or death situation that would threaten my life or my loved ones and that could possibly change my feeling, but if it does come down to the quality of life I would still have to stand up for what I think is right.
After reading the article Why We Must Ration Health Care, Peter Singer presents a good case of why health care must be rationed in his opinion. He maintains that the only way to afford the ability to provide health care coverage to everyone is by rationing health care. Singer presents his position by utilizing several points of contention which demonstrated both the negative and positive aspects of health care rationing. Singer confirms that health care is a scarce resource and that all scarce resources are rationed in one way or another. (Singer, 2007) He presented his position by first pointing out that in the United States; health care is being rationed right now in both the private and public sectors. Health care which is privately financed is being rationed by price. The fact is that you get what you or your employer can afford or insure you for. Your health care is being rationed even though you are part of the private sector which finances its own health care coverage. Depending on your private insurance they dictate which procedure you are allowed to use or depending on your finances you may purchase either a generic or brand drug. Your health care coverage in essence is being rationed already even though you are part of the private sector. In the public sector, public organizations such as Medicare, Medicaid, and hospital emergency rooms, health care is already being rationed by long waits, high patient co-payment requirements, low payments to the doctors which in turn discourages some physicians form serving public patients, and the limits being made on the payments to the hospital. Singer also states his position by providing information on the Commonwealth Fund study which surveyed adults with chronic illness in Britain, Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the United Sates. This study pointed out that more Americans do without health care because of the cost compared to a significant lower percentage of people in the above mentioned countries. Singer also documented another study which was led by David Himmelstein. This study found that more than 60 percent of all bankruptcies are specifically related to illnesses due to the excessive amount of their medical bills including those who have health insurance in the United States. The rate of bankruptcy in Canada due to illness is significantly lower. The use of these two studies demonstrates exactly what the dilemma is today. The government’s inability to provide health coverage to all its citizens and the cost of medical expenses due to illnesses forces many American’s into bankruptcy. In Singer’s opinion the purpose of rationing health care is to receive a better value for the billions of dollars which we are spending by setting limits on which treatments should be paid for from public funds. His premise is that America cannot be a stable economic force of the world if one out of every six dollars is being spent on health care and other nations are spending far less and achieving health outcomes as good or as better in meeting the health care needs of their citizens. This is the point Singer stresses when compared to other advance nations. How can America as a country not be able to afford to provide medical coverage for all its citizens? Singer illustrates this point by telling us a story about a woman who went to the emergency room in critical condition because of a blood vessel that had burst in her brain. This was a result of being uninsured and having to choose to buy food for her children instead of spending money on her blood pressure medication. We know that this is very prevalent in America where many families are uninsured because of other necessities which need to be paid for.
He also points out that Americans without health insurance who go to the emergency room are receiving a lower quality of care when there. He presents his case in point by a studied done by Joseph Doyle, a professor of economics at the Sloan School of Management at MIT. (Singer, 2007) This study revealed that people who had no health insurance received 20 percent less care and had a death rate 37 percent higher than those with health insurance. This study demonstrated that the lack of insurance seems to be what caused the greater number of deaths. Singer contends that to achieve this, it is not going to be easy. He suggests using QALY which is similar to the organization in Britain named NICE. QALY is a formula which utilizes the basis of the quality adjusted life year or QALY. He states his point on how QALY can be used to help ration health care by illustrating QALY in relation to a quadriplegics choice of length of life with a disability or without. Again Singer provides explicit examples of the point he is trying to contend. QALY can be used to compare the cost effectiveness of a wide variety of medical procedures which are paid for with public money. The use of QALY would dictate the amount and type of care everyone received or was entitled to because government would be paying for health care coverage. QALY measures the benefits of health care treatment in relation to life expectancy and quality of life. The argument opposed to using QALY uses the rational that we are now basically putting a value on human life. The dilemma is deciding who the person is that decides the ethical question of what is the price of life. Rationing health care is assumed to be an immoral thought process because a monetary value is applied to saving lives. Singer presents a specific example how government run health care is achieved in regards to the use of Sutent for patients with advance kidney cancer and the ethical question who is approved for such treatment based on expense of the drug and is it worth the cost to only prolong a person’s life for six months. His example of Sutent demonstrates how Britain goes about approving such a treatment and drug since the government is funding the health care. Singer does a good job of presenting his position by playing devils advocate and presenting both sides of the issue to rationing health care. Singer ends his piece very well by surveying other countries and soliciting their opinion on the quality of their health care coverage which is run by their government such as Britain and Canada. Residents of both countries were surprisingly very happy with their ration health care coverage compared to the surveyed Americans and their health care coverage. Rationing is already taking place within the health care system in the United States just not in the direct and offensive question as to what the price of life is worth or who decides if treatment should be approved bases on the ability of the insurer to pay for a drug that only adds six months to someone’s life. Singer presents substantial evidence by utilizing examples to support his position on why health care should be rationed. He has given us much to think about in regards to our health care coverage.
Singer, Peter. "Why We Must Ration Health Care." The Times Magazine. The New York Times Company, 19 July 2009. Web. 7 Nov. 2009.
I believe the author does a good job on making his argument for rationing health care. Although, according to this article rationing has already been going on for years, the real dilemma that he talks about is the difference between how much are we willing to spend to save a human life vs. setting a dollar limit to save a life. The fact that there is are so many variables involved such as if you have no health insurance then you will fall into the group of people that will ultimately get 20% less health care in a medical situation vs. someone with health insurance who will get 37% more health care. I believe it really falls on the values people place on life, what's important to live and what they can ultimately live without. The ethical side of this is that until someone has that unfortunate illness befall a loved one and they experience who much that loved one's life means to them then other people who have never had to experience such dilemma will say that they don't want t foot the bill for others that could benefit from a life saving drug or treatment that will cause other people's premiums to go up if covered by insurance. Peter touches on that when he discusses that government puts a dollar limit and rations out how much should be spent on health care programs each year. The governments and health insurances bottom line, as Peter says, it to get as much bang for their buck without spending a whole lot on the front end. We all have a limit that we are willing to place even on ourselves as far as what we deem is worth saving even our own lives. I just wish there were an easier way to really make health care fair for everyone no matter what the circumstances.
The health care reform is meant to help people get health insurance. So now that they have insurance there is a limit to how much they can spend or they cant afford a procedure that someone with more money can. When I read the article it made me feel like because someone is poor their life is not worth spending money on to prolong it and if someone had money they can have the procedure that will prolong their life. The government is looking for ways to give everyone a chance to prolong their lives by making health insurance more affordable, so now that they have insurance they cant have the procedure what was the point of getting health insurance if they cant use it to save their lives. Singer makes a good point that, the debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Whose choice is it to make the decision that one or another person can get a certain procedure or not. The part about the advanced kidney cancer with the procedure only giving about 6 months of extra life and should not get the procedure because of the life expectancy is that not contradictory. So now, you can only get this procedure if you will live for up to a year after AND have the money to pay for it. Now its being limited again. I believe that everyone should have health insurance but when it comes to someone being terminally ill you should be able to do anything you and your insurance can cover. People in this state, know that they are not going to live much longer and from my experience many people are in more pain and more sick in the last few months. I do not want the risk that they will live for a year and be miserable the whole time would that be worth all the money that they paid to live just a little bit longer. Singer does a good job explaining that with the rationing it has to be done equally so that everyone can have a chance at high dollar surgeries that save lives.
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The author, Peter Singer, is trying to make a stance that it is impractical to use rationing as a means to determine what a human life is worth. Singer cites examples of the high costs of drugs in relationship to how long these drugs can expect to extend the life of a person. In Great Britain, where there is national health care, the author reminds us that their policy does not pay for drugs that are not a good value for the money. Americans openly state that they do not agree, but they also state they should be required to supplement through their insurance premiums for people that cannot afford the drugs. While the author does not directly say, he is suggesting that Americans truly want a rationing system, but only to a point that does not effect the individual. Singer tells us how President Obama uses his mother as an appeal to an emotion which is a situation, we cannot validate and politicians are infamous for creating to help gain support. What the author does discuss is the high cost of medicines, but not what can be done to reduce the cost and make it more affordable for the common person. I am in the opinion that in this case he is over looking the root cause of why there is high cost for medicine. The author did not discuss the question of who makes the decision on rationing and I was left to question if there was an answer. Singer provided some interesting correlations to other country’s health care system but did not rationalize the differences in culture and acceptance of what a life is worth. My overall opinion is that for the topic the author discussed, he did an adequate job of explaining the issues but asked more questions than provided answers. Without additional information to know if his facts are creditable, I cannot realistic say he made a good case for rationing. Singer did not provide a sufficient answer to help me understand the ramifications of rationing.
In the article “Why We Must Ration Health Care” I believe that the author does make a good point on the rationing of health care because even though it is a very bad thing to think about but in the case of prolonged life due to some drug or treatment that only prolongs your life for a certain amount of time I believe is not a good use of our scarce health care.
With the state of our economy being on the brink of a disaster Health care has become something close to extinction. The debate over which treatments and drugs should be used on someone that is near death should be put before an ethics committee and resolved to so that everyone wins. The prolongation of life for only 6 more months as heartless as it is for me to say is not and should not be an option for insurance companies. The risks taken by the people who allow for these treatments and medications is fatal to the rest of the population because it makes health care even less affordable for everyone else.
As the co-pays rise there will be less and less visits to the doctor leading to the spread of many sicknesses. Also there is the risk of the avoidance by doctors to see public patients because of their already low pay that they will eventually receive and the limits on payments. Either way with this risk we are all pretty much taking by doctors administering drugs that only prolong the evident ending we are all at risk of getting shitty health care and ending up spreading such epidemics as swine flu and other horrific plagues.
I understand that this is a hard decision for a parent to make because I don’t believe I could make it in the case of my daughter or son. My sympathy goes out to parents and families who have to go through this however, it must be understood that if the person who is reaching the end is only going to be given six more months to live with a miracle drug. I don’t think that a family should allow themselves to go through that pain of seeing hope once again hoping that the person who is dying will live longer. They should begin the grieving process and accept that that person is no longer with them as heartless as it may seem.
I think that even though this article was written from an economic perspective that it brings up several good points that need to be brought to the general publics’ attention. The evaluation of medical treatment for terminally ill patients should be brought in front some sort of ethics committee or a committee brought together to decide what happens in these specific cases. Something needs to be done about our current health care state and if this is a necessary precaution that needs to be taken to help us maintain a decent health care structure then so be it.
Being from Canada, this is my first time hearing about the idea of rationing health care and the author, Peter Singer, does a great job, I believe, in explaining it. Therefore, I believe that the author made a good case for rationing in the article, Why We Must Ration Health Care. He does this in three ways. He fills the article with cited statistics, facts, and examples, does not let his “emotional” side effect his point of view, and looks at both sides of the argument but always being able to defend his. After telling the sad stories of Bruce Hardy and Jack Rosser, the author wrote, “There’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way” showing readers that he is not heartless and can view this difficult decision from the opposing side but would like to look at it realistically and logically nor basing judgment on emotions but more on fact. I believe he did a great job of this showing that there is more to this when and/or if you can get passed the emotional side of the argument. After this brief moment, he goes on to share with readers the rationing that is going on behind closed doors. He claims( I wouldn’t doubt it), “ 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”. Americans who are covered by Medicare or Medicaid cannot afford these drugs and therefore it can also be seen as rationing; people who are able to pay, and those who are not. Making a woman decide over life-saving medicine and feeding her children is something that no one should have to deal with and manufacturers should be held accountable for this and should be brought to the publics attention so maybe something can be done so no more children have to live without their mother who could not afford the medicine. Singer makes a great argument about basically getting your moneys worth/ get a better value for your money. Singer says, “If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades”. It’s sad to say but true. Along with the Wisconsin automobile accident statistics from Joseph Doyle, a professor of economics, I can see Singer’s view. Who wouldn’t want to pay the same amount and get more out of it? Who wouldn’t want to save ten people that could live for another 30, 40 years than a person who will, with time, eventually pass away at the same cost. It is very tough to put a “value” on someone’s life, however, it is realistic in this situation as Singer sees it as well. Finally, he does a great job of looking at both sides and possible questions from the opposing side. In his example of the quadriplegic, this can be seen. During this part, he goes on to talk about the QAYL and possible question from the opposing side such as, “ Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics”. He later goes on and puts aside any further questions about his view and QAYL by saying, “The problem, however, does not lie with the concept of the quality-adjusted life-year, but with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability”. This is Peter Singer makes a good case for rationing.
believe that the author did a great job in explaining the good and bad things about rational health care. He considered both sides carefully, and he finally states that rational health care is better for the public. At first, the author talked about the case of Bruce Hardy and Jack Rosser, who had advanced kidney condition, could live 6 months more with Sutent, a drug that cost $54,000 dollars. The author brought up a question: “Is the few months worth that much?” If we are the people who could be benefit from that drug, we may say that the drug is definitely worth 6 months of living. However, if we are not, and our insurance premium will go up if someone else benefit from that drug. Would we still think that the drug is worth 6 month of living? I acknowledge that it is a tough decision because we are not only look at the value of money, but we also look at the ethical issues in each individual case. However, if we consider about ethical issue too much, there would be more people in the U.S. live without health insurance. The author also stated the idea that in the U.S. we ration health care in many ways, but it is more implicit compared to Canada and England. The author mentioned about a case that the mother had blood pressure who refused to fill out a prescription because she rather used that money to buy foods for her children. We rarely see rationing in our health care system because it is not obvious, but it is there. Health care is a scarce resource, and I truly believe that the only way that we can provide it fairly is through rationing. Even though it seems to be heartless in the case of Bruce Hardy and Jack Rosser, but we also need to consider about the quality of life. Even Bruce and Jack can live for 6 months, but their quality of life may be really bad. Instead paying a large amount of money to extend their lives, we should use the money to save the people who would be more benefit from that. There are many people in the United State do not have insurance because our government do not regulate the money being used in health care efficiently. I do believe that if everyone in the U.S. has health insurance and with rationing heath care more people will be benefit from it.
The article by Peter Singer was very interesting, the process for how it’s determined how health services are rationed, how rationing is done in Britain and Canada and the effects, the way Quality-adjusted-life-years (QALY) factor into the process or could factor into the process is considered unethical. Also, the big one for me was the fact that healthcare services are already being rationed in the United States through the private insurers and the government with programs like Medicare and Medicaid. Mr. Singer presents a strong case for healthcare rationing with strong facts and personal cases.
Britain’s government program NICE has a high approval rate and is a way for keeping the cost of medical treatment and services at an affordable rate. In doing this the pharmaceutical companies can not charge Britain’s outrages prices to get a very much needed prescription filled, which leads to decreased medical cost. Here in the U.S. there’s a lack of money because the U.S. is backwards or upside down when citizens can’t afford to purchase preventative meds such as antihypertensive, because they have to choose between putting food on the table and getting a prescription filled. There’s a high number of American citizens dieing from complications related to treatable disease because they couldn’t afford to pay for the prescriptions, this is totally unacceptable.
Mr. Singer also touched on the fact that here in the United States healthcare services are already being rationed through the private insurers, since they are the ones who decide who receives certain expensive treatments. This decision can be based on a number of factors including QALY or they simply put a value on your life and if that number is lower than the needed treatment then they pay, but if not the insurer will not pay and this practice was adopted many years ago. The government programs on the other hand are little more subtle in there rationing. With Medicare and Medicaid it’s usually seen with long waits, and high co-payments, therefore according to Singer “inability to pay is a form rationing”, again this has been going on for years.
In conclusion, I would have to say Mr. Singer makes a strong case for rationing, which is already happening in the U.S., we just don’t call it that. Therefore I think a hybrid is just what the healthcare reform bill could use. Granted nothing is perfect there are problems with Britain’s and Canada’s health systems, but ours is on the brink of collapse. We need reform now which may have to include rationing.
The author of the article makes an excellent case for rationing health care. He makes many good points and has the numbers of surveys to back it up. America’s health care system is in trouble. The costs of medical treatments have risen and are still on the rise. It is good to see that our leaders recognize the problem and are considering ways to deal with it.
The author puts into perspective other countries ways of dealing with healthcare. America should learn how these countries make their system work effectively. Having everyone covered under a national healthcare plan is a great idea. There will be no discrimination against absolutely anyone from billionaires to homeless people. Other countries are implementing national healthcare coverage with success so America should consider this option also.
There can never be a monetary value on any human life. In order to treat everyone equally, the government should provide healthcare for everyone. There should also be a safeguard against healthcare providers taking advantage of any new program. If financially sound families can afford private health insurance, they should definitely invest in it. But, there should be no conflict in providing healthcare for those privately insured over those with government coverage.
The author Peter Singer does make a good case for rationing health care, and I do agree with his ideas. First off, Singer gives an scenario where we would have to imagine having advanced kidney cancer and we would have the option of taking Sutent (a drug that slows down cancer), but the catch would be that it would cost 54,000 dollars for only 6 more months. He then goes onto say of course if we had the money to pay for the treatment we would more than likely do it and there would be no problem. But if we could not afford to pay for the treatment then we would have to rely on our insurance to pay for the cost, and in doing so affect everyone else around us. The question that comes to mind is whether or not it is ethical for us to allow someone to get treatment that only prolongs there life for a limited amount of time, versus telling someone they can not have a treatment because of the expense. I agree with Singer in that rationing should be considered, but only to a point. Two factors should go into deciding whether or not someone should be given an expensive treatment, and those are their quality of life during their treatment and the amount of money. For instance, if someone has incureable brain cancer and the treatment for the person is 100,000 dollars, for only a few months with low quality of life then this should not be allowed. Versus have someone who is a quadriplegic like mentioned in the article, if their treatment is 100,000 dollars but their quality of life is improved and they are given the ability to live a better functioning life then I agree they should get the treatment. Again it all depends on the cost, and the quality of life the person will receive after the treatment. In the end, I agree with Singer’s perspective on rationing of health care.
Oddly, it is comforting to me that there is a math solution to determine the insurance company’s decision on what will be covered and what will not; although it is not a perfect solution, it is a good starting place. For example, If you know how much a person will pay for a specified reduction in risk, you multiply the amount that people are willing to pay by how much the risk has been reduced, the theoretically you have value people place on their lives. Peter Singer makes it perfectly clear that “there’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way”, in his article about rationing healthcare. After reading through his article several times and really considering the information including the specific people written about in his article I have to agree, healthcare needs to be rationed, (in fact is already is through private insurance companies). Singer gave the example of someone with a terminally ill kidney disease and the possibility to extend live up to six more months, for over $50,000; more then the average yearly income of most families. Is this a reasonable value to set on ones life, or is this just too much money. It is my opinion that spending that much money just to possibly extending the life of someone with a terminally ill disease is irresponsible. That amount of money could be used to save the life of someone or for a treatment that can improve the quality of life for some that is not terminally ill, or perhaps assist in finding a cure for a terminally ill disease. Not only do we need to be responsible in making these very difficult decisions, but we need to understand how complicated these times are for those that are fighting terminally ill diseases. Our healthcare system is in desperate need of a makeover. I don’t know all the answers. However, I agree that healthcare rationing is necessary.
In the article titled “Why We Must Ration Healthcare”, I feel the author Peter Singer makes a very good case and also points out different scenarios in which the rationing of healthcare is apparent but yet overlooked by many. What I mean by this is that whether or not the government wants to admit that rationing is being used within our own healthcare system the proof is there, it is just being disguised. Singer states that the government implicitly places a dollar value on human life by deciding how much to spend on healthcare programs, determining copayment amounts or how much to spend on someone who is uninsured but needs emergency treatment.
What’s shameful is that some Medicare and Medicaid patients often can’t afford to pay the copayments for their prescriptions which can cost as much as $40,000 a year, while the pharmaceutical companies are charging way more money in the united stated than they charge for the exact same drugs in Britain. Why would something like this even be allowed to go on in the United States it’s all just a less visible form of rationing. Like the old saying only the strong survive, whoever has the money will live which allows them to pay for the expensive life saving treatments, while the weak person with no money will die. (strong meaning rich in this sense). The unfortunate story about the woman who came into the emergency room shows how the system of rationing that we do use in the United States doesn’t work for everyone. The mother died due to a brain vessel that burst in her brain all because she chose to buy food instead of fill her prescription for her much needed blood pressure medicine.
Another way Singer justifies his case is by including the study that was done by Joseph Doyle, a professor of economics. He studied the records of many severely injured automobile accident patients who had no choice but to go to the hospital for care. It was concluded that those without insurance received 20 percent less care and had a death rate at 37 percent higher than those who had health insurance. Somehow we forget to mention all the people that do die in Americas emergency rooms every year due to lack of health insurance. Doyle’s studies indicate that the people that died were mainly in their 30’s and they clearly had another 30 to 40 more years of life to live. Had they of received the same care and treatments that were used on the insured patients, they would of survived and it would of only cost around 220,000 for each life that was saved. If the government and insurance companies want the most bang for the buck, this would have been a perfect opportunity to use that concept. Another example is the study that indicated that in the age group of 55-64; there are more than 13,000 extra deaths a year which are most likely contributed to the lack of insurance.
Point being that without money or insurance you can’t get very far and healthcare is already being rationed in many ways whether it is recognizable or not. Like with the organization called NICE, where they set a limit of 30,000 to 49,000 with the intention of saving one’s life for a year or more. Well, the problem with this type of rationing is that it doesn’t help everyone. A perfect example is with the case of Jack Rosser the limit that NICE set for the value of one’s life was not enough for poor Jack he needed 54,000. But to Jack and his family his life was worth more than the limits set by NICE, even if it would extend his life for only six months, it would of given him a chance to see his one year old daughter Emma, start primary school. I feel Singer did an excellent job pointing out the fact that there is really no way around rationing. Rationing is a part of life it happens in every aspect of life. So instead of arguing whether or not the healthcare reform bill has rationing in it, that is not the problem, it clearly has rationing in it but it needs to be readdressed and rationed in another more sensible and money saving manner.
After reading the article Why We Must Ration Health Care by Peter Singer. Does the author make a good case for rationing? He does make a good case for rationing health care. He covered all his bases, from people with cancer, to teenagers and 85 year olds, to the disabilities of quadriplegics. He does raise a huge question, of “How much are you willing to pay to save your life?” But, I question the fact if you have a drug, such as Sutent that slows the spread of cancer, and it could give you that extra 6 month of life. Does this drug also, give you the quality of life for those 6 months? Are you suffering with great deal of pain and are you bed ridden? Then I would have to say no it isn’t. The cost of $54,000 is not even a year’s salary for most people and I don’t think that is fare to even have to make that kind of choice. For those who are more fortunate, that’s there choice. But for a mother, who chose to put food on her table for her kids, then for the medicine that will help, and in return left her children mother-less it again, is not fair. Health care needs to be more affordable for everyone. Wouldn’t it be better to provide a health insurance that would give a family peace for taking there child to the doctor for a common cold, and get the right kind of antibiotic vs. not going at all, and getting terribly sick and being put in the hospital for phenomena or something much more costly than simple doctors appointment and prescription. Peter Singer does bring a lot of facts and statics to the table from not only from the United States but from countries all over the world. He also states, “If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades”. I think this is a true statement, even though I have never been addressed with a life or death situation that would threaten my life or my loved ones and that could possibly change my feeling, but if it does come down to the quality of life I would still have to stand up for what I think is right.
After reading the article Why We Must Ration Health Care, Peter Singer presents a good case of why health care must be rationed in his opinion. He maintains that the only way to afford the ability to provide health care coverage to everyone is by rationing health care. Singer presents his position by utilizing several points of contention which demonstrated both the negative and positive aspects of health care rationing. Singer confirms that health care is a scarce resource and that all scarce resources are rationed in one way or another. (Singer, 2007)
He presented his position by first pointing out that in the United States; health care is being rationed right now in both the private and public sectors. Health care which is privately financed is being rationed by price. The fact is that you get what you or your employer can afford or insure you for. Your health care is being rationed even though you are part of the private sector which finances its own health care coverage. Depending on your private insurance they dictate which procedure you are allowed to use or depending on your finances you may purchase either a generic or brand drug. Your health care coverage in essence is being rationed already even though you are part of the private sector. In the public sector, public organizations such as Medicare, Medicaid, and hospital emergency rooms, health care is already being rationed by long waits, high patient co-payment requirements, low payments to the doctors which in turn discourages some physicians form serving public patients, and the limits being made on the payments to the hospital.
Singer also states his position by providing information on the Commonwealth Fund study which surveyed adults with chronic illness in Britain, Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the United Sates. This study pointed out that more Americans do without health care because of the cost compared to a significant lower percentage of people in the above mentioned countries. Singer also documented another study which was led by David Himmelstein. This study found that more than 60 percent of all bankruptcies are specifically related to illnesses due to the excessive amount of their medical bills including those who have health insurance in the United States. The rate of bankruptcy in Canada due to illness is significantly lower. The use of these two studies demonstrates exactly what the dilemma is today. The government’s inability to provide health coverage to all its citizens and the cost of medical expenses due to illnesses forces many American’s into bankruptcy.
In Singer’s opinion the purpose of rationing health care is to receive a better value for the billions of dollars which we are spending by setting limits on which treatments should be paid for from public funds. His premise is that America cannot be a stable economic force of the world if one out of every six dollars is being spent on health care and other nations are spending far less and achieving health outcomes as good or as better in meeting the health care needs of their citizens. This is the point Singer stresses when compared to other advance nations.
How can America as a country not be able to afford to provide medical coverage for all its citizens? Singer illustrates this point by telling us a story about a woman who went to the emergency room in critical condition because of a blood vessel that had burst in her brain. This was a result of being uninsured and having to choose to buy food for her children instead of spending money on her blood pressure medication. We know that this is very prevalent in America where many families are uninsured because of other necessities which need to be paid for.
He also points out that Americans without health insurance who go to the emergency room are receiving a lower quality of care when there. He presents his case in point by a studied done by Joseph Doyle, a professor of economics at the Sloan School of Management at MIT. (Singer, 2007) This study revealed that people who had no health insurance received 20 percent less care and had a death rate 37 percent higher than those with health insurance. This study demonstrated that the lack of insurance seems to be what caused the greater number of deaths.
Singer contends that to achieve this, it is not going to be easy. He suggests using QALY which is similar to the organization in Britain named NICE. QALY is a formula which utilizes the basis of the quality adjusted life year or QALY. He states his point on how QALY can be used to help ration health care by illustrating QALY in relation to a quadriplegics choice of length of life with a disability or without. Again Singer provides explicit examples of the point he is trying to contend. QALY can be used to compare the cost effectiveness of a wide variety of medical procedures which are paid for with public money. The use of QALY would dictate the amount and type of care everyone received or was entitled to because government would be paying for health care coverage. QALY measures the benefits of health care treatment in relation to life expectancy and quality of life. The argument opposed to using QALY uses the rational that we are now basically putting a value on human life. The dilemma is deciding who the person is that decides the ethical question of what is the price of life. Rationing health care is assumed to be an immoral thought process because a monetary value is applied to saving lives.
Singer presents a specific example how government run health care is achieved in regards to the use of Sutent for patients with advance kidney cancer and the ethical question who is approved for such treatment based on expense of the drug and is it worth the cost to only prolong a person’s life for six months. His example of Sutent demonstrates how Britain goes about approving such a treatment and drug since the government is funding the health care.
Singer does a good job of presenting his position by playing devils advocate and presenting both sides of the issue to rationing health care. Singer ends his piece very well by surveying other countries and soliciting their opinion on the quality of their health care coverage which is run by their government such as Britain and Canada. Residents of both countries were surprisingly very happy with their ration health care coverage compared to the surveyed Americans and their health care coverage.
Rationing is already taking place within the health care system in the United States just not in the direct and offensive question as to what the price of life is worth or who decides if treatment should be approved bases on the ability of the insurer to pay for a drug that only adds six months to someone’s life. Singer presents substantial evidence by utilizing examples to support his position on why health care should be rationed. He has given us much to think about in regards to our health care coverage.
Singer, Peter. "Why We Must Ration Health Care." The Times Magazine. The New York Times Company, 19 July 2009. Web. 7 Nov. 2009.
I believe the author does a good job on making his argument for rationing health care. Although, according to this article rationing has already been going on for years, the real dilemma that he talks about is the difference between how much are we willing to spend to save a human life vs. setting a dollar limit to save a life. The fact that there is are so many variables involved such as if you have no health insurance then you will fall into the group of people that will ultimately get 20% less health care in a medical situation vs. someone with health insurance who will get 37% more health care. I believe it really falls on the values people place on life, what's important to live and what they can ultimately live without. The ethical side of this is that until someone has that unfortunate illness befall a loved one and they experience who much that loved one's life means to them then other people who have never had to experience such dilemma will say that they don't want t foot the bill for others that could benefit from a life saving drug or treatment that will cause other people's premiums to go up if covered by insurance. Peter touches on that when he discusses that government puts a dollar limit and rations out how much should be spent on health care programs each year. The governments and health insurances bottom line, as Peter says, it to get as much bang for their buck without spending a whole lot on the front end. We all have a limit that we are willing to place even on ourselves as far as what we deem is worth saving even our own lives. I just wish there were an easier way to really make health care fair for everyone no matter what the circumstances.
The health care reform is meant to help people get health insurance. So now that they have insurance there is a limit to how much they can spend or they cant afford a procedure that someone with more money can. When I read the article it made me feel like because someone is poor their life is not worth spending money on to prolong it and if someone had money they can have the procedure that will prolong their life. The government is looking for ways to give everyone a chance to prolong their lives by making health insurance more affordable, so now that they have insurance they cant have the procedure what was the point of getting health insurance if they cant use it to save their lives. Singer makes a good point that, the debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Whose choice is it to make the decision that one or another person can get a certain procedure or not. The part about the advanced kidney cancer with the procedure only giving about 6 months of extra life and should not get the procedure because of the life expectancy is that not contradictory. So now, you can only get this procedure if you will live for up to a year after AND have the money to pay for it. Now its being limited again. I believe that everyone should have health insurance but when it comes to someone being terminally ill you should be able to do anything you and your insurance can cover. People in this state, know that they are not going to live much longer and from my experience many people are in more pain and more sick in the last few months. I do not want the risk that they will live for a year and be miserable the whole time would that be worth all the money that they paid to live just a little bit longer. Singer does a good job explaining that with the rationing it has to be done equally so that everyone can have a chance at high dollar surgeries that save lives.
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