During the August recess, while the Community Organizer in Chief is leading the charge against communities organizing against his health care agenda, I thought I would take another look at the details, which the devil is notorious for being in. To me, the clearest long term effect is that the health care reform will end up in health care rationing. Not as an unintended side effect, but as the long term goal.
But no, you say, scare-monger! Trying to frighten people from the vision of The One! Well, maybe people should be scared. It’s astounding to me that this plan has gotten this far. True, the plan would have been passed months ago if Obama had been savvy enough to drop it already written onto the laps of Congress in early February. The country was in the throes of an Obamagasm and the President figured it would last enough to get this done in the summer. It’s easy to see how he miscalculated. All the major media organizations are still lounging in the bed, nude, and bathing in the afterglow. But much of the country either never got their promised release, or did, and afterwards felt sticky and thirsty, with a pounding headache coming on.
It’s a simple economic truth that in the broadest sense everything is “rationed.” That’s what money does; it determines a value for anything that there isn’t an infinite supply of, which is practically everything. Health care in the United States costs money, so if you have a lot of money, you can get as much as you want, or like most people who don’t have a lot of money, you have a third party payer pick up the tab. In Canada and Europe, healthcare still costs money; only the someone who is picking up the tab is the government. In the US, the third party payers (insurance companies) compete against each other for member’s and employer contracts. In systems where the government is the only purchaser of healthcare, there isn’t competition, or making a profit off of providing healthcare like there is in this country, only a staggering cost and annoying patients. Wait times often do the rationing, with patients waiting many months for care in limited facilities with limited medical providers. That’s one of the key differences between a private and government health care system. Building more facilities and hiring more staff helps to make money in a private system, so there is a powerful incentive to expand, but for the government, it’s merely a drain on resources.
The country had a bit of luck though in that President Obama’s first choice for Health and Human Services Secretary, Tom Daschle, was derailed by tax issues. Daschle, who had spent the years since losing his senate seat mucking about Washington as a lobbyist-who-never-registered-as-a-lobbyist also had time to write a book on health care, Critical: What We Can Do About the Health Care Crisis. The book lays out a plan very similar to what’s contained in HR 3200. Daschle was quite open in how he wanted health care to be rationed; he proposed a Federal Health Board to determine both clinical effectiveness and cost effectiveness, in other words, a board to determine approved courses of treatment in the same way that the Orwellian named NICE, the National Institute for Health and Clinical Excellence, does in the UK.
NICE determines cost effectiveness based on a formula that says that a treatment is cost effective if it doesn’t exceed $34,000 per Quality Adjusted Life Year. That means if an anti-cancer drug costs a cool 34K, but it will only increase your life span for 6 months, then sorry, go home and die. This insures that only the older, cheaper, treatments will be used with any regularity. That’s why the United States, with millions uninsured, has better long term survival rates on most common cancers, like breast, prostate, and colon cancer than the state supplied healthcare of Europe.
Daschle isn’t the only one in the President’s orbit who wants to ration health care. Dr. Ezekiel Emanuel, brother of Chief of Staff Rahm Emanuel, is a White House advisor on health care issues and has written extensively on various aspects rationing health. His take on rationing healthcare is based on his Complete Lives System. As Dr. Emanuel explains his proposal:
When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.
There is even a chart showing prime ages for using expensive medical treatment, and ages when…eh not so much eh?
The gist of this proposal is that if you are between 15 and 40, you are considered a good bet to get high quality, expensive medical treatment, because these are the ages when you have the most value to society. Under 15, not so much education or training has been spent on you, so there is no big investment. Over 40, you are beginning the end of your highest value to society and now you are starting to cause nothing but problems, what with your middle aged health ailments. Oy! As you can see from the chart if you are 60 or older, than it’s pretty much Soylent Green time. Just go to the center, take your poison, watch an IMAX movie and “go home.”
Rationing is so ubiquitous among the supporters of government healthcare that there doesn’t seem to be any shyness in discussing it. Apparently you can advocate health care rationing, just not use the word “ration” and that’s good enough. For example, Senator Edward Kennedy wrote recently for Newsweek about The Cause of My Life:
We also need to move from a system that rewards doctors for the sheer volume of tests and treatments they prescribe to one that rewards quality and positive outcomes. For example, in Medicare today, 18 percent of patients discharged from a hospital are readmitted within 30 days—at a cost of more than $15 billion in 2005. Most of these readmissions are unnecessary, but we don’t reward hospitals and doctors for preventing them. By changing that, we’ll save billions of dollars while improving the quality of care for patients.
The problem with re-admissions of course, is that you can’t know they are un-necessary until after the patients are re-admitted. How are you going to know which re-admissions are “unnecessary” until after they are re-admitted? How is the government going to reward hospitals and doctors for not admitting patients to the hospital?
And of course, this goes all the way to the top, to the Rationer in Chief. During the ABC Health Care Town Hall, President Obama made an astounding statement regarding that very subject, in response to a question from a woman who is a caregiver to her 105 year old mother, the woman told of her attempt to find a doctor to implant a pacemaker. She finally found a doctor who found her mother to be worth saving, and the surgery was done. Her question, would the government plan consider “a certain joy of living?” In determining who would get expensive medical care.
But what we can do is make sure that at least some of the waste that exists in the system that’s not making anybody’s mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what? Maybe this isn’t going to help. Maybe you’re better off not having the surgery, but taking the painkiller.
I don’t know why the President seems to think that doctors don’t already have to make those decisions, based on the health and ability of the patient to handle surgery. Now of course, there will be a new wrinkle added, the government’s desire to pay for healthcare for the unproductive.
Rationing isn’t a joke or an over the top accusation. It’s happening right now in other countries, and astoundingly there seems to be plenty of people who want to import the worst of socialized medicine to this country. My wife’s grandmother is British, and at 92 has been denied the gall bladder surgery that she needs by the NICE regulations. In this country, a 92 year old may or may not get surgery, based on the physician’s judgment that the patient is able to handle the surgery, not on government regulations and rules.
A British friend of my wife’s family, in his late 50’s was diagnosed a few months ago as needing bypass surgery and a shunt. He has a home in Florida as well as in the UK, and wanted to fly back to the States for surgery, since he was told that he couldn’t be scheduled for surgery for months. However the National Health Service has forbidden him to fly. In this country, go see a doctor and be told that you need open heart surgery and chances are you’ll find yourself admitted to a hospital the same day. So he is trapped in the UK, hoping he lives long enough for the scheduled surgery (hopefully by the end of August).
So this is how the government plans to “control costs.” True, the United States spends more per capita on health care than any other nation, but that’s because, goddamn it, we want health care, and we’re buying it. In other countries, healthcare is a line item in the national budget. You can’t buy more of it if you want or need more. You get what you’re allowed to have. Why anyone would want to copy that kind of system is beyond me, but what I do understand is why the government wants it. That’s in the nature of governments to constantly try to expand it’s power over us, and it has plenty of collaborators.