From an interview with Princeton economics and public affairs professor, Uwe Reinhardt, who's also an expert in health care policy. Dr. Reinhardt talks about the value we put on human life and how much we're willing to pay to prolong our life and the lives of others.
Q: ...This is something you've written about -- this question about American culture, what we value, what we believe in. We seem to be a country that values independence, people making decisions for themselves. But if we're talking about health care, the question is whether we're all on our own to figure this out for ourselves or do we all share in a system where what happens to you affects me.
UR: Well, ... that is the problem. There are two problems in connection with that. Not everyone is actually able to think through some of these complicated issues. Again, we're a people who had trouble with mortgages! These are complex issues that involve clinical issues -- biological and ethical decisions -- so that's just one thing. Can every patient even digest the technical information? But then the other part of it is that some people are rich and some are not. If you're on your own financially, you may very well decide that, gee, I'd really like to have this drug but I can't afford it. Then the question comes back to the problem whether the government should force your neighbor to buy that for you through taxes and government programs like Medicare or Medicaid or subsidies. You just can't run away. I testified before Congress and one congressman threw in my face that I had said human life is not in fact priceless -- the price of human life is not infinite. Otherwise we would have, for example, equipped our troops better when we went into Iraq! He was very, very upset about it and asked, "How dare you tell me what my life is worth?" And I said, "I'm not telling you what your life is worth. I'm raising the question to what extent do your neighbors have to chip in by force of government to buy you an extra life-year?" That is a legitimate question to debate. Somehow to call that "fascism" is wrong. After all, we do leave a lot of people uninsured in the country now.
Q: I realize each country has its own system. But have European countries resolved some of these ethical and philosophical issues that we still seem to be grappling with in this country?
UR: Yes, they have. They make these coverage decisions, particularly England, in a very explicit way with NICE, that then recommends to the government whether or not to cover a procedure. Germany has a similar institution which is now, with a new government, under review. Nevertheless, they make those decisions as well. Australia does it and Canada does it. Of course, we look down on these countries because they make those decisions. But at some point, given the huge deficits we face... and don't ever forget, over half of all American health spending is already tax-financed now, over half! ... so at some point we do need to ask, "Is that actually the best way to spend money if you want health?" There is a lot of research that says education is far more important in determining the health status of a population than health care. You might get more mileage in terms of better health by education people better, particularly in how to manage their health -- not to become obese, not to take cholesterol too lightly. That may yield you more good health than putting it into heroic medical care. We need to have, at some point, a rational, civilized discussion that doesn't descend into what we saw last year.
The full interview is available at The Scribe.
