Utilitarian bioethicist Peter Singer turned his hand to solving America’s health care crisis in last week’s New York Times Magazine. He suggests that the US needs to learn from Britain, and from his native Australia, where universal government-funded health cover is backed up by private insurance. But his pet theory is the QALY, or the quality-adjusted life year. This is a concept used by health economists to take into account the quality and length of life conferred by medical treatment.

Singer gives a simple example. If we agree that we would be just as happy living 10 years as a quadriplegic as living 5 years without a disability, then we are saying (hypothetically) that “life with quadriplegia [is] as half as good as non-disabled life”. This helps to put dollar values on medical treatment.

The very idea of putting a dollar value on life is abhorrent to anyone who believes in the sanctity of life, Singer acknowledges. But without calculations like this, how can the US ever control health costs? Singer cites a rabbinical saying, “if you put one human life on one side of a scale, and you put the rest of the world on the other side, the scale is balanced equally”. But, he points out acidly, “If the Department of Transportation... followed rabbinical teachings it would exhaust its entire budget on road safety.”

“The QALY is not a perfect measure of the good obtained by health care, but its defenders can support it in the same way that Winston Churchill defended democracy as a form of government: it is the worst method of allocating health care, except for all the others. If it isn’t possible to provide everyone with all beneficial treatments, what better way do we have of deciding what treatments people should get than by comparing the QALYs gained with the expense of the treatments?”

Singer is best-known for his advocacy of animal welfare, but his fundamental principles are anything but sentimental. He consistently maintains that the “sanctity of life” is nonsense on stilts, that life can be valued by balancing pleasures against pains, and that personal attachments are irrelevant in making decisions about life and death. When he applies these to America’s broken health care system, the logical result is a recommendation to ration health care: “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. Then we can ask, What is the best way to do it?” ~ New York Times Magazine, July 15