Bioethicist Peter Singer argues for limits on health care benefits that are publicly paid for in health care reform: "If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades."

He shows not only how our current method of health care has "rationed" care for many but he refers to ways in which we (American society/consumers/businesses) already limit what we spend to save a life, based on "risk assessment," such as in not requiring seat belts on school busses to save lives. In discussing possible ways to limit public cost, Singer explains a bit about the quality-adjusted-life-year (QALY) concept that economists in health care have used for 30 years to discuss cost-effectiveness of various medical procedures. He suggests a combination of free public health insurance (with limits based on QALY yet assuring a good standard of health care for all) and private optional insurance (for those wishing to pay much more to be able to choose any possible health care option).