Nonsense about Presidents, IQ, and War

Peter Singer outdoes his usual tendentious self in this review of Steven Pinker’s The Better Angels of Our Nature: Why Violence Has Declined. In the course of the review, Singer writes:

Pinker argues that enhanced powers of reasoning give us the ability to detach ourselves from our immediate experience and from our personal or parochial perspective, and frame our ideas in more abstract, universal terms. This in turn leads to better moral commitments, including avoiding violence. It is just this kind of reasoning ability that has improved during the 20th century. He therefore suggests that the 20th century has seen a “moral Flynn effect, in which an accelerating escalator of reason carried us away from impulses that lead to violence” and that this lies behind the long peace, the new peace, and the rights revolution. Among the wide range of evidence he produces in support of that argument is the tidbit that since 1946, there has been a negative correlation between an American president’s I.Q. and the number of battle deaths in wars involving the United States.

Singer does not give the source of the IQ estimates on which Pinker relies, but the supposed correlation points to a discredited piece of historiometry by Dean Keith Simonton, “Presidential IQ, Openness, Intellectual Brilliance, and Leadership: Estimates and Correlations for 42 U.S. Chief Executives” (Political Psychology, Vol. 27, No. 4, 2006). Simonton jumps through various hoops to assess the IQs of  every president from Washington to Bush II — to one decimal place. That is a feat on a par with reconstructing the final thoughts of Abel, ere Cain slew him.

Before I explain the discrediting of Simonton’s obviously discreditable “research,” there is some fun to be had with the Pinker-Singer story of presidential IQ (Simonton-style) for battle deaths. First, of course, there is the convenient cutoff point of 1946. Why 1946? Well, it enables Pinker-Singer to avoid the inconvenient fact that the Civil War, World War I, and World War II happened while the presidency was held by three men who (in Simonton’s estimation) had high IQs: Lincoln, Wilson, and FDR.

The next several graphs depict best-fit relationships between Simonton’s estimates of presidential IQ and the U.S. battle deaths that occurred during each president’s term of office.* The presidents, in order of their appearance in the titles of the graphs are Harry S Truman (HST), George W. Bush (GWB), Franklin Delano Roosevelt (FDR), (Thomas) Woodrow Wilson (WW), Abraham Lincoln (AL), and George Washington (GW). The number of battle deaths is rounded to the nearest thousand, so that the prevailing value is 0, even in the case of the Spanish-American War (385 U.S. combat deaths) and George H.W. Bush’s Gulf War (147 U.S. combat deaths).

This is probably the relationship referred to by Singer, though Pinker may show a linear fit, rather than the tighter polynomial fit used here:

It looks bad for the low “IQ” presidents — if you believe Simonton’s estimates of IQ, which you shouldn’t, and if you believe that battle deaths are a bad thing per se, which they aren’t. I will come back to those points. For now, just suspend your well-justified disbelief.

If the relationship for the HST-GWB era were statistically meaningful, it would not change much with the introduction of additional statistics about “IQ” and battle deaths, but it does:

If you buy the brand of snake oil being peddled by Pinker-Singer, you must believe that the “dumbest” and “smartest” presidents are unlikely to get the U.S. into wars that result in a lot of battle deaths, whereas some (but, mysteriously, not all) of the “medium-smart” presidents (Lincoln, Wilson, FDR) are likely to do so.

In any event, if you believe in Pinker-Singer’s snake oil, you must accept the consistent “humpback” relationship that is depicted in the preceding four graphs, rather than the highly selective, one-shot negative relationship of the HST-GWB graph.

More seriously, the relationship in the HST-GWB graph is an evident ploy to discredit certain presidents (especially GWB, I suspect), which is why it covers only the period since WWII. Why not just say that you think GWB is a chimp-like, war-mongering, moron and be done with it? Pseudo-statistics of the kind offered up by Pinker-Singer is nothing more than a talking point for those already convinced that Bush=Hitler.

But as long as this silly game is in progress, let us continue it, with a new rule. Let us advance from one to two explanatory variables. The second explanatory variable that strongly suggests itself is political party. And because it is not good practice to omit relevant statistics (a favorite gambit of liars), I estimated an equation based on “IQ” and battle deaths for the 27 men who served as president from the first Republican presidency (Lincoln’s) through the presidency of GWB.  The equation looks like this:

U.S. battle deaths (000) “owned” by a president =

-80.6 + 0.841 x “IQ” – 31.3 x party (where 0 = Dem, 1 = GOP)

In other words, battle deaths rise at the rate of 841 per IQ point (so much for Pinker-Singer). But there will be fewer deaths with a Republican in the White House (so much for Pinker-Singer’s implied swipe at GWB).

All of this is nonsense, of course, for two reasons: Simonton’s estimates of IQ are hogwash, and the number of U.S. battle deaths is a meaningless number, taken by itself.

With regard to hogwash, Simonton’s estimates of presidents’ IQs put every one of them — including the “dumbest,” U.S. Grant — in the top 2.3 percent of the population. And the mean of Simonton’s estimates puts the average president in the top 0.1 percent (one-tenth of one percent) of the population. That is literally incredible. Good evidence of the unreliability of Simonton’s estimates is found in an entry by Thomas C. Reeves at George Mason University’s History New Network. Reeves is the author of A Question of Character: A Life of John F. Kennedy, the negative reviews of which are evidently the work of JFK idolators who refuse to be disillusioned by facts. Anyway, here is Reeves:

I’m a biographer of two of the top nine presidents on Simonton’s list and am highly familiar with the histories of the other seven. In my judgment, this study has little if any value. Let’s take JFK and Chester A. Arthur as examples.

Kennedy was actually given an IQ test before entering Choate. His score was 119…. There is no evidence to support the claim that his score should have been more than 40 points higher [i.e., the IQ of 160 attributed to Kennedy by Simonton]. As I described in detail in A Question Of Character [link added], Kennedy’s academic achievements were modest and respectable, his published writing and speeches were largely done by others (no study of Kennedy is worthwhile that downplays the role of Ted Sorensen)….

Chester Alan Arthur was largely unknown before my Gentleman Boss was published in 1975. The discovery of many valuable primary sources gave us a clear look at the president for the first time. Among the most interesting facts that emerged involved his service during the Civil War, his direct involvement in the spoils system, and the bizarre way in which he was elevated to the GOP presidential ticket in 1880. His concealed and fatal illness while in the White House also came to light.

While Arthur was a college graduate, and was widely considered to be a gentleman, there is no evidence whatsoever to suggest that his IQ was extraordinary. That a psychologist can rank his intelligence 2.3 points ahead of Lincoln’s suggests access to a treasure of primary sources from and about Arthur that does not exist.

This historian thinks it impossible to assign IQ numbers to historical figures. If there is sufficient evidence (as there usually is in the case of American presidents), we can call people from the past extremely intelligent. Adams, Wilson, TR, Jefferson, and Lincoln were clearly well above average intellectually. But let us not pretend that we can rank them by tenths of a percentage point or declare that a man in one era stands well above another from a different time and place.

My educated guess is that this recent study was designed in part to denigrate the intelligence of the current occupant of the White House….

That is an excellent guess.

The meaninglessness of battle deaths as a measure of anything — but battle deaths — should be evident. But in case it is not evident, here goes:

  • Wars are sometimes necessary, sometimes not. (I give my views about the wisdom of America’s various wars at this post.) Necessary or not, presidents usually act in accordance with popular and elite opinion about the desirability of a particular war. Imagine, for example, the reaction if FDR had not gone to Congress on December 8, 1941, to ask for a declaration of war against Japan, or if GWB had not sought the approval of Congress for action in Afghanistan.
  • Presidents may have a lot to do with the decision to enter a war, but they have little to do with the external forces that help to shape that decision. GHWB, for example, had nothing to do with Saddam’s decision to invade Kuwait and thereby threaten vital U.S. interests in the Middle East. GWB, to take another example, was not a party to the choices of earlier presidents (GHWB and Clinton) that enabled Saddam to stay in power and encouraged Osama bin Laden to believe that America could be brought to its knees by a catastrophic attack.
  • The number of battle deaths in a war depends on many things outside the control of a particular president; for example, the size and capabilities of enemy forces, the size and capabilities of U.S. forces (which have a lot to do with the decisions of earlier administrations and Congresses), and the scope and scale of a war (again, largely dependent on the enemy).
  • Battle deaths represent personal tragedies, but — in and of themselves — are not a measure of a president’s wisdom or acumen. Whether the deaths were in vain is a separate issue that depends on the aforementioned considerations. To use battle deaths as a single, negative measure of a president’s ability is rank cynicism — the rankness of which is revealed in Pinker’s decision to ignore Lincoln and FDR and their “good” but deadly wars.

To put the last point another way, if the number of battle death deaths is a bad thing, Lincoln and FDR should be rotting in hell for the wars that brought an end to slavery and Hitler.

* The numbers of U.S. battle deaths, by war, are available at, “America’s Wars: U.S. Casualties and Veterans.” The deaths are “assigned” to presidents as follows (numbers in parentheses indicate thousands of deaths):

All of the deaths (2) in the War of 1812 occurred on Madison’s watch.

All of the deaths (2) in the Mexican-American War occurred on Polk’s watch.

I count only Union battle deaths (140) during the Civil War; all are “Lincoln’s.” Let the Confederate dead be on the head of Jefferson Davis. This is a gift, of sorts, to Pinker-Singer because if Confederate dead were counted as Lincoln, with his high “IQ,” it would make Pinker-Singer’s hypothesis even more ludicrous than it is.

WW is the sole “owner” of WWI battle deaths (53).

Some of the U.S. battle deaths in WWII (292) occurred while HST was president, but Truman was merely presiding over the final months of a war that was almost won when FDR died. Truman’s main role was to hasten the end of the war in the Pacific by electing to drop the A-bombs on Hiroshima and Nagasaki. So FDR gets “credit” for all WWII battle deaths.

The Korean War did not end until after Eisenhower succeeded Truman, but it was “Truman’s war,” so he gets “credit” for all Korean War battle deaths (34). This is another “gift” to Pinker-Singer because Ike’s “IQ” is higher than Truman’s.

Vietnam was “LBJ’s war,” but I’m sure that Singer would not want Nixon to go without “credit” for the battle deaths that occurred during his administration. Moreover, LBJ had effectively lost the Vietnam war through his gradualism, but Nixon chose nevertheless to prolong the agony. So I have shared the “credit” for Vietnam War battle deaths between LBJ (deaths in 1965-68: 29) and RMN (deaths in 1969-73: 17). To do that, I apportioned total Vietnam War battle deaths, as given by, according to the total number of U.S. deaths in each year of the war, 1965-1973.

The wars in Afghanistan and Iraq are “GWB’s wars,” even though Obama has continued them. So I have “credited” GWB with all the battle deaths in those wars, as of May 27, 2011 (5).

The relative paucity of U.S. combat  deaths in other post-WWII actions (e.g., Lebanon, Somalia, Persian Gulf) is attested to by “Post-Vietnam Combat Casualties,” at

Related posts about war and peace:
Libertarian Nay-Saying on Foreign and Defense Policy
Libertarian Nay-Saying on Foreign and Defense Policy, Revisited
Libertarians and the Common Defense
Libertarianism and Pre-emptive War: Part I
An Aside about Libertarianism and the War
Right On! For Libertarian Hawks Only
Why Sovereignty?
Understanding Libertarian Hawks
More about Libertarian Hawks and Doves
Defense, Anarcho-Capitalist Style
War Can Be the Answer
Getting It Almost Right about Iraq
Philosophical Obtuseness
But Wouldn’t Warlords Take Over?
Sorting Out the Libertarian Hawks and Doves
Now, Let’s Talk About Something Else
Libertarianism and Preemptive War: Part II
Give Me Liberty or Give Me Non-Aggression?
My View of Warlordism, Seconded
The Fatal Naïveté of Anarcho-Libertarianism
Final (?) Words about Preemption and the Constitution
More Final (?) Words about Preemption and the Constitution
QandO Saved Me the Trouble
Thomas Woods and War
“Proportionate Response” in Perspective
Parsing Peace
Not Enough Boots
Defense as the Ultimate Social Service
I Have an Idea
September 11: Five Years On
How to View Defense Spending
Reaching the Limit?
The Best Defense . . .
More Stupidity from Cato
A Critique of Extreme Libertarianism
Anarchistic Balderdash
Not Enough Boots: The Why of It
Blood for Oil

It *Is* the Oil
The End of Slavery in the United States
Liberalism and Sovereignty
Cato’s Usual Casuistry on Matters of War and Peace
The Media, the Left, and War
A Point of Agreement
The Decision to Drop the Bomb
The “Predator War” and Self-Defense
The National Psyche and Foreign Wars
Delusions of Preparedness
A Moralist’s Moral Blindness
A Grand Strategy for the United States
The Folly of Pacifism
Why We Should (and Should Not) Fight
Rating America’s Wars
Transnationalism and National Defense
The Next 9/11?
The Folly of Pacifism, Again
September 20, 2001: Hillary Clinton Signals the End of “Unity”

Previous posts about Peter Singer:
Peter Singer’s Fallacy
Peter Singer’s Agenda
Singer Said It
Rationing and Health Care
Peter Presumes to Preach

Crimes against Humanity

A post by Francis Beckwith (“Thomson’s Defense of Abortion at Forty“), which takes a new look at Judith Jarvis Thomson’s “A Defense of Abortion (Philosophy & Public Affairs, 1971),” prompts me to recall my writings and warnings about abortion and other eugenic practices.

I begin with an excerpt of my first anti-abortion post, from August 2004, “I’ve Changed My Mind“:

As a libertarian — who believes that a legitimate function of the state is to protect humans from force — I can no longer condone the legality of abortion. For one thing, legal abortion is a step on the path to legal euthanasia….

Once life begins it is sophistry to say that abortion doesn’t amount to the taking of an innocent life. It is also sophistry to argue that abortion is “acceptable” until such-and-such a stage of fetal development. There is no clear dividing line between the onset of life and the onset of human-ness. They are indivisible.

The state shouldn’t be in the business of authorizing the deaths of innocent humans. The state should be in the business of protecting the lives of innocent humans — from conception to grave.

I have much more to say about eugenics. Please read on. Continue reading

Peter Presumes to Preach

Thanks (?) to one of the Bleeding Heart Libertarians (Jason Brennan, in “Class Experiment on Helping the Poor“), I was introduced to an essay by Peter Singer, “Famine, Affluence, and Morality.” Singer was writing in 1972, when there were thought to be nine million destitute refugees in Bangladesh as a result of the Bhola cyclone of 1970 and atrocities committed by the Pakistani Army during the Bangladesh Liberation War of 1971.

I hope that Brennan, who teaches philosophy at Brown University, is using Singer’s essay to illustrate fallacious reasoning about moral obligations. For that is the lesson to be drawn from Singer’s presumptuous sermon on moral duty and its fulfillment.

I begin the lesson by arranging pertinent excerpts of Singer’s essay to give the main points of his argument:

[1.] I begin with the assumption that suffering and death from lack of food, shelter, and medical care are bad….

[2.] My next point is this: if it is in our power to prevent something bad from happening, without thereby sacrificing anything of comparable moral importance, we ought, morally, to do it….

[3.] The uncontroversial appearance of the principle just stated is deceptive. If it were acted upon, even in its qualified form, our lives, our society, and our world would be fundamentally changed. For the principle takes, firstly, no account of proximity or distance. It makes no moral difference whether the person I can help is a neighbor’s child ten yards from me or a Bengali whose name I shall never know, ten thousand miles away. Secondly, the principle makes no distinction between cases in which I am the only person who could possibly do anything and cases in which I am just one among millions in the same position….

[a.] The fact that a person is physically near to us, so that we have personal contact with him, may make it more likely that we shall assist him, but this does not show that we ought to help him rather than another who happens to be further away. If we accept any principle of impartiality, universalizability, equality, or whatever, we cannot discriminate against someone merely because he is far away from us (or we are far away from him)….

[b.] There may be a greater need to defend the second implication of my principle – that the fact that there are millions of other people in the same position, in respect to the [persons in need], as I am, does not make the situation significantly different from a situation in which I am the only person who can prevent something very bad from occurring. Again, of course, I admit that there is a psychological difference between the cases; one feels less guilty about doing nothing if one can point to others, similarly placed, who have also done nothing. Yet this can make no real difference to our moral obligations….

[4.] The outcome of this argument is that our traditional moral categories are upset. The traditional distinction between duty and charity cannot be drawn, or at least, not in the place we normally draw it….

[5.] It follows from some forms of utilitarian theory that we all ought, morally, to be working full time to increase the balance of happiness over misery…. Given the present conditions in many parts of the world, … it does follow from my argument that we ought, morally, to be working full time to relieve great suffering of the sort that occurs as a result of famine or other disasters…. [W]e ought to be preventing as much suffering as we can without sacrificing something else of comparable moral importance.

Singer continues:

I now want to consider a number of points, more practical than philosophical, which are relevant to the application of the moral conclusion we have reached….

This argument [against private giving] seems to assume that the more people there are who give to privately organized famine relief funds, the less likely it is that the government will take over full responsibility for such aid. This assumption is unsupported, and does not strike me as at all plausible. The opposite view – that if no one gives voluntarily, a government will assume that its citizens are uninterested in famine relief and would not wish to be forced into giving aid – seems more plausible….

I do not … dispute the contention that governments of affluent nations should be giving many times the amount of genuine, no-strings-attached aid that they are giving now….

[Another] point raised by the conclusion reached earlier relates to the question of just how much we all ought to be giving away…. [E]arlier I put forward both a strong and a moderate version of the principle of preventing bad occurrences. The strong version, which required us to prevent bad things from happening unless in doing so we would be sacrificing something of comparable moral significance, does seem to require reducing ourselves to the level of marginal utility [the level at which, by giving more, I would cause as much suffering to myself or my dependents as I would relieve by my gift]. I should also say that the strong version seems to me to be the correct one. I proposed the more moderate version – that we should prevent bad occurrences unless, to do so, we had to sacrifice something morally significant – only in order to show that, even on this surely undeniable principle, a great change in our way of life is required. On the more moderate principle, it may not follow that we ought to reduce ourselves to the level of marginal utility, for one might hold that to reduce oneself and one’s family to this level is to cause something significantly bad to happen…. Even if we accepted the principle only in its moderate form, however, it should be clear that we would have to give away enough to ensure that the consumer society, dependent as it is on people spending on trivia rather than giving to famine relief, would slow down and perhaps disappear entirely. There are several reasons why this would be desirable in itself. The value and necessity of economic growth are now being questioned not only by conservationists, but by economists as well. There is no doubt, too, that the consumer society has had a distorting effect on the goals and purposes of its members. Yet looking at the matter purely from the point of view of overseas aid, there must be a limit to the extent to which we should deliberately slow down our economy; for it might be the case that if we gave away, say, 40 percent of our Gross National Product, we would slow down the economy so much that in absolute terms we would be giving less than if we gave 25 percent of the much larger GNP that we would have if we limited our contribution to this smaller percentage.

Singer’s dicta make it evident that Singer not only is a strong utilitarian but also considers himself the keeper of the collective conscience of mankind. He knows how to measure the pain and pleasure of individuals, how to sum those quantities, and how to redistribute the world’s goods so as to arrive at a sustainable level of net pleasure.

The sustainable level, in Singer’s benighted view, is not the maximum that human beings could produce through their ingenuity, which is never a limited resource. No, the maximum, in Singer’s view, is much less than that because he is also a puritan who “knows” that there is entirely too much “consumerism,” and that its devotees ought to be made to scale it back to the “right” level — as defined by Singer.

In sum, nothing counts unless Singer says it counts. That rules out many values which compete or interfere with Singer’s view of what the world should be like. Those values include liberty, bonds of love and affection, the striving to better oneself and to leave something behind for one’s descendants, the cooperative spirit without which material progress and mutual acts of kinds and charity cannot flourish, and much more.

Singer’s world is a world in which governments apply a formula whereby persons having an “excess” of worldly goods — above some arbitrarily determined minimum — are required to forfeit that “excess” to those who have less than the minimum.

With this understanding of Singer’s mindset, the “logic” of his argument becomes apparent. I restate it more plainly below. Each restatement is accompanied by a libertarian alternative, in bold, italicized type.

1. I begin by appealing to the image of 9 million suffering human beings, as a way of lulling the unwary reader into believing that I am a caring human being, when in fact I have an authoritarian penchant for imposing my views on others.

Every bad thing that happens to an individual is a bad thing for that individual. Whether it is a thing that calls for action by another individual is for that other individual (or a group of them acting in concert) to decide on the basis of love, empathy, conscience, specific obligation, or rational calculation about the potential consequences of the bad thing and of helping or not helping the person to whom it has happened.

2. If it is in our power to prevent something bad from happening, without thereby sacrificing anything of comparable moral importance, we ought to do it. However, it is morally wrong for anyone to have more in the way of material possessions than anyone else. The limit of sacrifice is therefore defined by whatever one has to give up in order to reduce himself and his dependents and descendants to the standard of living that would result through massive income redistribution.

There is no universal social-welfare function. Therefore, it is up to the potential alms-giver to give or not, based on his knowledge and preferences. No third party is in a moral position to make that choice or to prescribe the criteria for making it. Governments have the power to force a choice other than the one that the potential alms-giver would make, but power is not morality.

3a. It is wrong to favor persons nearer to oneself over persons who are farther away. I am able to say that because I believe that such things as family, religion, ethnicity, club, church, community, and nation have no moral relevance. It matters not that individuals may form bonds of mutual respect and affection that lead them to commit acts of kindness and charity toward one another, and to treat each other with restraint. Such things are beyond the ken of the cold rationalist that I am.

It is foolish to say that persons with whom one shares no connection are as important as persons to whom one is connected. It is equally foolish to ignore the positive value of social connections. The personal choice about helping others (or not) may properly take into account the effects of that choice on those connections, without which there would be for more anti-social acts and state interventions.

3b. One’s moral obligation to give aid is unaffected by failure of others to do so.

Moral obligations arise from individual circumstances and mutual understandings, not from philosophical abstractions. But if one is inclined to help others in need, it is reasonable to ask whether a certain amount of money will materially aid those others. If not, withholding the amount may be the wisest course because it will be available for use in a case where it can have a material affect. Giving for the sake of giving can be irrational if one is truly committed to helping others.

4. Charity is duty; therefore, it is not charity.

Charity is a voluntary act that one commits without a sense of obligation; one helps one’s family, friends, neighbors, etc., out of love, affection, empathy, or other social bond. The fact that charity may strengthen a social bond and heighten the benefits flowing from it is an incidental fact, not a consideration. Duty, on the other hand, arises from specific obligations, formal or informal. These include the obligations of parent to child, teacher to pupil, business partner to business partner, and the like. Charity can be mistaken for duty only in the mind of a philosopher for whom love, affection, and individuality are alien concepts.

5. There is a universal social welfare function, and everyone ought to be striving, at all times, to maximize it. Moreover, only I know how to maximize universal social welfare. Anyone who contravenes my edicts is acting anti-socially and ought to be brought into line by the state (as long as it acts according to my dictates, of course).

If there is a universal social welfare function, then reducing the level of consumption in an affluent society just for the sake of reducing it (as Singer would) makes no sense; the outcome would be a reduction of social welfare. Of course, it may be that Singer would be so gratified by the reduction of others’ welfare that his own would rise by enough to offset that reduction. The preceding (facetious) observation points to the emptiness of the concept of a social welfare function, which implies that A’s unhappiness at having money stolen by B (or taxed away for B’s benefit) is canceled by B’s happiness at acquiring the money that he has acquired from A (by theft or taxation).

Finally, at the risk of seeming cold-hearted, I must ask the following question: Given the scarcity of resources (at a given time), is it not better to put those resources to work where they will do the most good? I disagree with Singer’s arguments for abortion and euthanasia (including “death panels“) because, among other things, such practices put us on a slippery-slope toward eugenics. But I can do disagree with Singer and still say that, given a choice, I will (and do) give to those who have a chance of a better life (especially if I love them) before giving to those whose lives seem hopeless.

My first duty (as Singer would say) is to those whom I love. And by helping to secure a future for them, I am also increasing the possibility that one or more of them will invent, develop, or apply technologies that help to prevent the kinds of suffering for which Singer merely prescribes palliatives.

Other posts about Peter Singer:
Peter Singer’s Fallacy
Peter Singer’s Agenda
Singer Said It
Rationing and Health Care

Other related posts:
Greed, Cosmic Justice, and Social Welfare
Positive Rights and Cosmic Justice
Utilitarianism, “Liberalism,” and Omniscience
Utilitarianism vs. Liberty
The Mind of a Paternalist
Accountants of the Soul
Rawls Meets Bentham
Enough of “Social Welfare”
The Left
Social Justice
The Left’s Agenda

Rationing and Health Care

Peter Singer — utilitarian extraordinaire , spokesman for involuntary euthanasia, and advocate of infanticide — recently shared with millions of rapt readers his opinions about why and how health care must be rationed: “Why We Must Ration Health Care,” The New York Times Magazine, July 15, 2009. Given Singer’s penchant for playing God, the “we” of his title could be an imperial one, but — in this instance — it is an authoritarian one.

Singer is among the many “public intellectuals” (some of them Nobelists) who believe in an omniscient, infallible government, provided — of course — that it does things unto the rest of us the way that they (the “intellectuals”) would have them done. And, like most of those “intellectuals,” Singer is dead wrong in his assertions about how to “solve” the “health care problem,” because his underlying premises and “logic” are dead wrong.

I begin with Singer’s central thesis:

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for.

Those two sentences are replete with inaccuracy and error:

  • There is no such thing as “health care”; the term is a catch-all for a wide variety of goods and services, ranging from the self-administration of generic aspirin to complex, delicate neurological surgery.
  • In any event, “health care” is not a “resource,” its various forms are economic goods (i.e., products and services), the production of which requires the use of resources (e.g., the time of trained nurses and doctors, the raw materials and production facilities used in drug manufacture).
  • Economic goods are not rationed by price; price facilitates voluntary transactions between willing buyers and sellers in free markets. Rationing is what happens when a powerful authority (usually a government) steps in to dictate the organization markets, the specifications of goods, and — more extremely — who may but what goods and at what prices (though dictated prices are essentially meaningless because they do not perform the signaling function that they do in free markets).
  • Much “health care” in the United States is privately financed, to the extent that most Americans buy and self-administer products like aspirin, antihistamines, cough medicine, band-aids, etc., and some (though relatively few) Americans buy medical products and services without the benefit of insurance. But much “health care” is not privately financed, because — as Singer soon notes — there is a substantial taxpayer subsidy for employer-sponsored insurance programs. There are various other taxpayer subsidies and government restraints  (e.g., Medicare, Medicaid, government-funded research of diseases and medicines, FDA approval of most kinds of medications and personal-care products).

The slipperiest of Singer’s facile statements is his characterization of what happens in free markets as “rationing,” thus lending back-handed legitimacy to true rationing, which is brute-force interference by government in what is really a personal responsibility: caring for one’s health. For it has somehow come to be common currency that “health care” is a “right,” something that government ought to do for us, instead of something that we ought to do for ourselves. (After all, we do live in an age of “positive rights,” which come at a high cost to everyone, including those who seek them.)

Most Americans are, however, enmeshed in a Catch-22 situation. They have less money to provide for themselves because it has been taken from them by government, to provide for others. But Singer deems the provision inadequate:

In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

Singer’s “solution” is to make things worse:

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it.

How will outright rationing entice doctors and hospitals to provide services that they are now unwilling to provide? If doctors leave the medical profession, and new doctors enter at reduced rates, what would Singer do? Begin drafting students into medical schools? What about hospitals that refuse to conform? Would they be nationalized, along with their nurses, orderlies, etc.?

What a pretty picture: Soviet-style medicine here in the U.S. of A. Yet that it precisely where outright rationing will lead if the politburo in Washington sees a shrinking supply of doctors, hospitals, and other medical providers — as it will. Most politicians do not know how to do less. When they create a mess, their natural inclination is to do more of what they did to cause the mess in the first place.

Singer, naturally, appeals to the authority of just such a politician:

President Obama has said plainly that America’s health care system is broken. It is, he has said, by far the most significant driver of America’s long-term debt and deficits. It is hard to see how the nation as a whole can remain competitive if in 26 years we are spending nearly a third of what we earn on health care, while other industrialized nations are spending far less but achieving health outcomes as good as, or better than, ours.

Well, if BO says it, it must be true, n’est-ce pas? The “system” is broken because government established Medicare and Medicaid, back in the days of LBJ’s “Great Society.”  Those two programs have “only” four fatal flaws:

  • They take money from taxpayers, who therefore are less able to provide for themselves.
  • They grant beneficiaries “free” or low-cost access to medical services, thus bloating the demand for those services and causing their prices to rise. (The subsidy of employer-sponsored health insurances has the same effect.)
  • They involve promises of access to medical services that cannot be redeemed by the paltry Medicare tax rate — thus the prospect of balooning deficits, leading to (a) higher interest rates and/or (b) higher taxes on (you guessed it) “the rich.”
  • “The rich,” who finance economic growth, will flee these shore (or their money will), and the deficits will grow larger as tax revenues fall.

Another natural inclination of politicians is to deplore the messes caused by other politicians, and then to do something to make the messes worse. In this instance, BO itches to trump LBJ.

But, of course, this time will be different — it will be done right:

Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. 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?

So, instead of insurance companies — which at least compete with each other to offer subscribers affordable and attractive lineups of providers and drug formularies — our choices will be dictated by all-wise bureaucrats. Lovely!

Singer defends the bureaucrats, as long as they do it his way, of course. He begins with NICE:

…Britain’s National Institute for Health and Clinical Excellence…. generally known as NICE, is a government-financed but independently run organization set up to provide national guidance on promoting good health and treating illness…. NICE had set a general limit of £30,000, or about $49,000, on the cost of extending life for a year….

There’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way….

Governments implicitly place a dollar value on a human life when they decide how much is to be spent on health care programs and how much on other public goods that are not directed toward saving lives. The task of health care bureaucrats is then to get the best value for the resources they have been allocated….

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….

Health care does more than save lives: it also reduces pain and suffering. How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.

This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care. The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money. If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S.

Here we have utilitarianism rampant on a field of fascism. Given that (in Singer’s mind) “we” must nationalize medicine (i.e., ration “health care”), “we” must do it right. To do it right, “we” must weigh human life on a scale of Singer’s devising, and not on the scale of our individual preferences. For Singer knows all! And government knows all, as long as it operates according Singer’s calculus of deservingness.

And why must “we” ration health care? Singer invokes a familiar statistic:

In the U.S., some 45 million do not [have health insurance], and nor are they entitled to any health care at all, unless they can get themselves to an emergency room.

Who are those legendary 45 (or 47) million persons? Are they entirely bereft of medical attention? Here are some answers to those questions, from June and Dave O’Neil’s “Who are the Uninsured? An Analysis of America’s Uninsured Population, Their Characteristics and Their Health“:

Each year the Census Bureau reports its estimate of the total number of adults and children in the U.S. who lacked health insurance coverage during the previous calendar year. The number of Americans reported as uninsured in 2006 was 47 million, which was close to 16 percent of the U.S. population… This number has come to have a large impact on the debate over healthcare reform in the United States. However, there is a great deal of confusion about the significance of the uninsured numbers.

Many people believe that the number of uninsured signifies that almost 50 million Americans are without healthcare simply because they cannot afford a health insurance policy and as a consequence, suffer from poor health, and premature death. However this line of reasoning is based on a distorted characterization of the facts….

More careful analysis of the statistics on the uninsured shows that many uninsured individuals and families appear to have enough disposable income to purchase health insurance, yet choose not to do so, and instead self-insure. We call this group the “voluntarily uninsured” and find that they account for 43 percent of the uninsured population. The remaining group—the “involuntarily uninsured”—makes up only 57 percent of the Census count of the uninsured. A second important point is that while the uninsured receive fewer medical services than those with private insurance, they nonetheless receive significant amounts of healthcare from a variety of sources—government programs, private charitable groups, care donated by physicians and hospitals, and care paid for by out-of-pocket expenditures. Third, although the involuntarily uninsured by some estimates appear to have a significantly shorter life expectancy than those who are privately insured or voluntarily uninsured, it is difficult to establish cause and effect. We find that differences in mortality according to insurance status are to a large extent explained by factors other than health insurance coverage—such as education, socioeconomic status, and health-related habits like smoking…..

The results [of a regression analysis] vividly show the importance of controlling for characteristics that are strongly related to health status and health outcomes and are also strongly related to insurance status. The unadjusted gross difference in mortality risk between those with private insurance and the involuntarily uninsured was -0.113 or 11 percentage points. After adding to the model all characteristics, including the variable indicating fair/poor health status (M3), we find that the differential in the mortality risk between those with private insurance and those who are involuntarily uninsured is reduced to -0.029, a 2.9 percentage point difference.

The unadjusted differential between the privately insured and the voluntarily uninsured … was small—only 3.3 percentage points—because the characteristics of the two groups are fairly similar. That differential becomes even smaller after controlling for measurable differences in characteristics. Thus … the mortality rate of the voluntarily uninsured is only 1.7 percentage points below that of the privately insured….

In summary, we find as have others, that lack of health insurance is not likely to be the major factor causing higher mortality rates among the uninsured. The uninsured—particularly the involuntarily uninsured—have multiple
disadvantages that in themselves are associated with poor health.

(See also The Henry J. Kaiser Family Foundation’s The Uninsured: A Primer, Supplemental Data Tables, October 2008.)

In summary, the so-called crisis in “health care” is a figment of fevered imaginations. To the extent that medical care and medications are more costly than they “should” be, it is because of government interference: restrictions on the entry of doctors and other providers (thanks to the lobbying efforts of the AMA — the doctors’ “union” — and similar organizations; long and often deadly FDA approval procedures for new drugs; subsidies for employer-provided health insurance; and the establishment of Medicare and Medicaid.

The obvious solution to the “crisis” — obvious to anyone who isn’t wedded to the religion of big government — is to get government out of medicine. But that won’t happen because the “crisis” is yet another excuse for politicians and pundits (like Singer, and worse) to dictate the terms and conditions of our lives. Unfortunately, too many voters are susceptible to the siren call of government action. Such voters are more than ready to elect politicians who promise to “do something” about trumped-up crises — be they crises of “health care,” “global warming,”

What will happen with the current “crisis”? The result will be something less destructive than BO’s preferred result, which would effectively nationalize medicine in the United States by making all providers and drug companies beholden to a single payer (i.e., government) and leveling the quality of medical care to a mediocre standard through mandatory participation in the nationalized scheme. But the result, whatever it is, will be destructive:

  • Costs will rise.
  • Many providers will quit providing, and fewer new providers will replace them, unless they are enticed by tax-funded subsidies.
  • Drug companies will develop fewer new drugs, unless they are co-opted by tax-funded subsidies.
  • “The rich” will be forced to bear a disproportionate share of the cost of making things worse. And so, “the rich” will have less wherewithal with which to stimulate economic growth, and less inclinations to do so (in the United States, at least).

Politicians being politicians, the resulting mess will have only one obvious solution: outright nationalization of medicine in the U.S. (The politburo, of course, will enjoy a separate and distinctly superior brand of taxpayer-funded medical care.)

And then we will have become thoroughly European.