Pricing Life: Why It's Time for Health Care Rationing

Basic Bioethics

by Peter A. Ubel

A rational look at health care rationing, from ethical, economic, psychological, and clinical perspectives. Although managed health care is a hot topic, too few discussions focus on health care rationing--who lives and who dies, death versus dollars. In this book physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to think about how best to ration health care. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He discusses the moral questions raised by this position, and by health care rationing in general. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general internal medicine. Straddling the fields of ethics, economics, research psychology, and clinical medicine, he moves the debate forward from whether to ration to how to ration. The discussion is enlivened by actual case studies.

Genres: Nonfiction

208 pages, Paperback

First published November 12, 1999

About the author

I am a physician and behavioral scientist at Duke University. My research and writing explores the quirks in human nature that influence our lives — the mixture of rational and irrational forces that affect our health, our happiness and the way our society functions. (What fun would it be to tackle just the easy problems?) My goal is to show you, in an entertaining way, why the key to living better, healthier lives, and improving the societies we live in, is to understand human nature.

I’m also a Professor of Business, Public Policy and Medicine at Duke University. (Officially, I’m the – prepare to be impressed – Madge and Dennis T. McLawhorn University Professor of Business at Fuqua.) My research explores controversial issues about the role of values and preferences in health care decision making, from decisions at the bedside to policy decisions. I use the tools of decision psychology and behavioral economics to explore topics like doctor-patient communication, medical decision-making, and healthcare cost containment.

I grew up in Minnesota where I attended an all boys, Roman Catholic, military high school – a definite triple whammy for a horny teenager. Then when I submitted my high school photograph to my undergraduate college, Carleton, and it got posted in the annual book of new students, my classmates decided I was a fascist , leaving me at a decidedly unCatholic, non-military, co-ed college, already shunned. Sigh…

In my spare time, I enjoy classical piano (fanatical about Beethoven and Chopin), chili peppers (both growing and eating them), and sports (when I’m not nursing my most orthopedic injury).

When my now “adult” kids are both in town, we love to spend dinner time playing bridge, the greatest card game ever invented. (Spologies to poker fans)

Reviews

[Kelly · Rating 3 out of 5]

This book discusses the phenomenon of healthcare rationing, including how and why it's become such a dirty word and why it's actually unavoidable. Most of Ubel's economic arguments are sound, and I agree with most of his conclusions. But I'm not confident that they're framed in such a way that someone who doesn't understand economics would be swayed by them. I feel like the book leans a little bit too heavily on economic phenomena without explaining them, and I think it will be a bit opaque to lay readers. It's also a little dry (though considerably less-so than the average econ book or paper. Recommended for those interested in the economics of healthcare, but you may want to make sure you have a bit of background in at least the economics (the book doesn't really require medical knowledge) first.

[Ross Mckinney · Rating 4 out of 5]

I'm teaching from this book in the Fall semester, so recommended. Its basic theme is excellent - we're almost certainly going to need to ration healthcare, but how do do so ethically? The discussion of the rationale behind "bedside rationing" was convincing and interesting, the writing clear and humorous. Continuing insights despite being written in the late 1990s. Shortcoming? Too much time on the details of Qalys and cost-effectiveness analysis.

[Bryan Kibbe · Rating 3 out of 5]

This book is about how healthcare resources (e.g. diagnostic tests, treatment therapies, etc.) should be rationed. Though written in 2001, the subject matter of the book has only become more relevant with time as the healthcare system becomes increasingly strained.

The first part of this book has a more technical focus on cost effectiveness analysis that felt a bit fragmented. However, the 2nd and 3rd parts of the book had more engaging ethical arguments that were better integrated.