Peter Singer offers some thoughts on health care and rationing in the New York Times. It's refreshing to hear a leftist acknowledge the existence of scarcity and costs, instead of asserting wild, paradoxical delusions that a monopsonist could somehow not choose what goods and services to purchase, which is what I often hear from the left, maybe because leftists love to ascribe agency to a group of people and label it a collective will. In the article, today's most prominent utilitarian delivers some fascinating utilitarian calculus:
As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds. These are, of course, generic teenagers and generic 85-year-olds. It’s easy to say, “What if the teenager is a violent criminal and the 85-year-old is still working productively?” But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.That he keeps adding what factors should be considered for life and death in different instances for different people almost brings him to a moment of clarity to reject cardinal utilitarianism and acknowledge the value of respecting individual rights. It seems to me that when people label utilitarianism, they imply that there is such a thing as cardinal utility. I believe that utility is ordinal, not cardinal, so I'm an individualist utilitarian.