U.S. Rep. Paul Ryan, caricatured in political ads last year and again this month as pushing Granny off the cliff of Medicare, is now the running mate of the maker of RomneyCare, who is running against the maker of ObamaCare. With the consequent renewed debate over proposed reforms of Medicare and other aspects of government-provided healthcare, this quotation is important:

In protecting safety, health, and the environment, government has increasingly relied on cost-benefit analysis. In undertaking cost-benefit analysis, the government has monetized risks of death through the idea of the value of a statistical life (VSL), currently assessed at about $6.1 million. But the government should rely instead on the value of a statistical life-year (VSLY), in a way that would likely result in lower benefits calculations for elderly people, and higher benefits calculations for children. The hard question involves not whether to undertake this shift, but how to monetize life-years, and here willingness to pay (WTP) is generally the place not to end but to begin.

The above passage is the entire abstract of a 2004 paper in the Columbia Law Review entitled “Lives, Life-Years, and Willingness to Pay,” by Cass R. Sunstein, departing this month as Administrator of the Office of Information and Regulatory Affairs—that is, Obama’s regulatory czar. (Citation: 104 Colum. L. Rev. 205 2004.) In essence, Sunstein’s theory holds that the life of a 20-year-old, who is expected to live 60 more years, is worth the lives of ten 74-year-olds, who are expected to live six more years each.

Sunstein applies his theory not only to regulatory matters such as pollution standards, but also to resource-allocation issues. He writes,

If a choice must be made, a doctor might reasonably decide, for example, that she will perform a difficult operation on someone who is thirty rather than someone who is eighty. And if the public health community has to allocate scarce resources, an inquiry into QALYs seems like a sensible place to start. [pp. 245-246]

‘QALYs’ are ‘quality-adjusted life-years’, one of Sunstein’s variations on his basic ‘life-years’ theme.

Now that government, through President Obama’s ‘Affordable Care Act’, is going to be an even greater controller of healthcare resources for all ages, Sunstein’s theory is particularly significant.

Here is a key argument from Sunstein’s paper:

Under the life-years approach, older people are treated worse for only one reason: They are older. This is not an injustice. Every old person was young once, and every young person will be old too (if given the chance). In fact an important form of reciprocity is built into the life-years approach. If regulatory policy is based on life-years, every person will, in a sense, be both benefited and burdened, and in exactly the same way. Indeed, every person will be both a beneficiary and a victim of the relevant discrimination. People—the same people—will be benefited when they are younger and burdened when they are older. They have no cause to complain of an approach from which they gained at an earlier stage. [p. 220]

What kind of mentality claims that young people ‘benefit’ from turning old people into ‘victims’? By Sunstein’s reasoning, it should be okay for 50-year-olds to rape 20-year-olds—as long as the 20-year-olds don’t die, because it would be a shame if a 20-year-old did not live long enough to enjoy the ‘benefit’ of raping 20-year-olds.

When pressed in Congressional testimony last year, Sunstein expressed doubt over the theory he had expressed with such conviction in 2004. Others doubted the sincerity of Sunstein’s doubting. It would be interesting to know Obama’s opinion of Sunstein’s theory, since Obama appointed Sunstein to the most powerful position from which to put such a theory into practice. What Obama did say earlier this month in announcing Sunstein’s departure from the Obama Adaministration was this:

Cass has shepherded our review of existing rules to get rid of those that cost too much or no longer make sense, an effort that is already on track to save billions of dollars.  With these reforms and his tenacious promotion of cost-benefit analysis, his efforts will benefit Americans for years to come.

But far more important than the current states of Sunstein’s and Obama’s minds is that the practical implementation of Sunstein’s theory—or a theory equally monstrous—is the inevitable result of Medicare, Medicaid, RomneyCare, ObamaCare, and all other forms of socialized medicine.

Socialized medicine assumes that we must not have a system of benefits based on ‘ability to pay’, that the healthcare resources in a society are to be controlled by society as a whole, and that society should decide how to allocate those resources and for whose benefit.

For example, according to whitehouse.gov, the federal government is building more health centers to “offer comprehensive, high quality, primary and preventive health care services to all Americans regardless of ability to pay.” Similarly, in 2010, President Obama said approvingly that “previous generations, those who came before us, made the decision that our seniors [how ironic given Sunstein’s proposal] and our poor, through Medicaid, should not be forced to go without health care just because they couldn’t afford it.”

In other words, the poor should not go without health care just because they have not earned it.

There is no way to legislate away the fact that there is some specific limit to the ‘ability to pay’. There is a finite amount of wealth at any given time. There are only so many doctors and medical machines and supplies. There is never enough of these scarce resources to meet every need. Everyone—even a billionaire—ultimately dies of some ailment, of some lack of health care to cure that ailment, whether that lack is a lack of a doctor’s time, or the lack of a drug, or lack of medical research done to discover a cure. If society tries to nullify the constraint imposed by each individual’s ‘ability to pay’, then it must impose a new constraint: society’s ability to pay.

How then are the scarce medical resources—which suddenly become far scarcer once society takes ownership—to be allocated among individuals by society? Will the resources be allocated equally, or by age, or by ‘intelligence’, or genetics, or political leaning, or influence?

Once ‘ability to pay’ is rejected, Sunstein’s final solution is merely one among many monstrous options.

In light of the above, ‘the Affordable Care Act’ is a far more damning name than ‘ObamaCare’.

There is a synonym for ‘ability to pay’ and for ‘earnings’: money. In a free, capitalist society, individuals use the money they earned to pay for goods and services offered by other individuals to mutual advantage, by mutual consent. Every individual, old or young, has the moral right to spend his own money on his own health care or the health care of his old or young loved ones.

Under capitalism, there is no confiscation of individual wealth and subsequent allocation of life and death by some maniacal, government-mandated cost-benefit analysis.

“When money ceases to be the tool by which men deal with one another, then men become the tools of men,” wrote Ayn Rand in Atlas Shrugged, anticipating Sunstein’s proposal to use the elderly as tools of the young. “Blood, whips and guns—or dollars. Take your choice—there is no other—and your time is running out.”

An earlier version of this article was published on Ron Pisaturo’s Blog.

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Ron Pisaturo

Ron Pisaturo is a writer and philosopher. He has written a screenplay, The Merchant of Mars.

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