Health care's a right until we all get tired of paying for youBy Patrick McIlheran of the Milwaukee Journal Sentinel
Dec. 31, 2010
Surpassingly strange -- if not alarming -- how, when the administration added back Medicare’s end-of-life counseling coverage that Congress removed from Obamacare, it did it sneakily: One of the few congressmen in the loop e-mailed supporters to keep quiet, lest the public find out and the death-panel furor erupt again.
As the Wall Street Journal pointed out [separately copied below], the availability of end-of-life counseling was never the meat of the death-panel problem in the first place. The problem lies not in government offering to cover counseling about getting it over with for those who want it. The will-they-cover-it controversy, Journal editorialists write, illustrates “a larger truth about a world of finite resources and infinite entitlement wants.
Health care does not have to be a political matter. If rationing must be hashed out politically under highly centralized national system, then why are we moving exactly in the direction of a highly centralized national system?
For equity, of course, reply the advocates of Obamacare (as well as those who wanted to go much further). If we want absolutely everyone covered and covered fairly -- by which they mean that one's health circumstances have little or no bearing on how much of one's income must go to doctors -- then we must be centralized, national and political.
But again -- why? Universality is good and so is fairness, but not at any cost. Consider another phrase that’s widely uttered and that sounds nice, that health care should be a right. Ross Kaminsky in the American Spectator pointed out where this high-minded phrase leads.
To trouble. For one thing, it’s a “positive” right -- a right that must be supplied not by everyone else not harming you but by some specific others supplying you with something.
Because, as Kaminsky points out, everyone’s now acknowledged that this costs more than the country can afford. Medicare cost boss Donald Berwick has openly said there must be rationing. Yet if health care is a right, “shouldn't Grandma Smith be entitled to as much of the Jones' and Jacksons' money as necessary to keep her alive for as long as she wants to and can have a pulse in her heart, a breath in her lungs?
The problem lies in the guarantee -- in thinking in terms of rights and of universality and equity. This doesn’t mean we must embrace some every-geezer-for-himself savagery; it suggests that some more rational approach that centers on the autonomy of the patient -- such as, for instance, the concepts behind Rep. Paul Ryan’s “roadmap” -- be central.
None of this precludes social generosity outside the realm of politics -- indeed, it calls for exactly the kind of charitable spirit implicit in every hospital name that includes the word “memorial.” Not that the government doesn’t have a role, but when we talk about health care chiefly in terms of rights asserted and claims made on strangers via the political process -- as Obamacare does -- then inevitably those strangers will balk at the cost, and they will do so through the mechanisms of the administrative state.
Through panels, if you will. Or even if you won’t.
= = = = = the Wall Street Journal article mentioned above = = = = =
The Wall Street Journal
- DECEMBER 29, 2010
Death Panels Revisited
The left won't admit that Sarah Palin had a point about rationed care.At a stroke, Medicare chief Donald Berwick has revived the "death panel" debate from two summers ago. Allow us to referee, because this topic has been badly distorted by the political process—and in a rational world, it wouldn't be a political question at all.
On Sunday, Robert Pear reported in the New York Times that Medicare will now pay for voluntary end-of-life counseling as part of seniors' annual physicals. A similar provision was originally included in ObamaCare, but Democrats stripped it out amid the death panel furor. Now Medicare will enact the same policy through regulation.
We hadn't heard about this development until Mr. Pear's story, but evidently Medicare tried to prevent the change from becoming public knowledge. The provision is buried in thousands of Federal Register pages setting Medicare's hospital and physician price controls for 2011 and concludes that such consultations count as a form of preventative care.
The office of Oregon Democrat Earl Blumenauer, the author of the original rider who then lobbied Medicare to cover the service, sent an email to supporters cheering this "victory" but asked that they not tell anyone for fear of perpetuating "the 'death panel' myth." The email added that "Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch."
The regulatory process isn't supposed to be a black-ops exercise, but expect many more such nontransparent improvisations under the vast powers ObamaCare handed the executive branch. In July, the White House bypassed the Senate to recess appoint Dr. Berwick, who has since testified before Congress for all of two hours, and now he promulgates by fiat a reimbursement policy that Congress explicitly rejected, all while scheming with his political patrons to duck any public scrutiny.
But if Dr. Berwick's methods are troubling, the substance is more than defensible. Certain quarters on the political right are following the media's imagination and blasting Dr. Berwick's decision as the tangible institution of death panels. But the rule-making is not coercive and gives seniors more autonomy, not less.
The affront is that Medicare needs to sneak around in order to offer a type of care that is routine in private insurance. If the medical experts in Congress haven't decided that some treatment or service is worthy of the fee schedule, then the program won't pay for it even if it is in the best interests of patients.
In this case, fully a fifth of the U.S. population will be over age 65 inside of two decades, and whatever the other marvels of modern medicine, the mortality rate remains 100%. Advance care planning lays out the options and allows patients, in consultation with their providers and family members, to ensure that their future treatment is consistent with their wishes and moral values should they become too sick to decide for themselves.
The real death panel myth is that the term ever had anything to do with something so potentially beneficial. We wrote at the time that Sarah Palin's coinage was sensationalistic, but it was meant to illustrate a larger truth about a world of finite resources and infinite entitlement wants.
Under highly centralized national health care, the government inevitably makes cost-minded judgments about what types of care are "best" for society at large, and the standardized treatments it prescribes inevitably steal life-saving options from individual patients. This is precisely why many liberals like former White House budget director Peter Orszag support government-run health care to control costs: Technocrats in government can then decide who gets Avastin for cancer, say, and who doesn't.
Democrats and the press corps accused Mrs. Palin of misrepresentation to avoid reckoning with this inexorable rationing reality that President Obama has himself implicitly acknowledged. In a 2009 interview with ObamaCare advocate David Leonhardt of the New York Times, he called for "a very difficult democratic conversation" about the costs that are incurred in the last six months of life. The President even mused about whether his own grandmother's hip replacement following a terminal cancer diagnosis represented "a sustainable model."
The real problem is the political claim that Medicare and other entitlements are imposing on the culture of U.S. health care. Everyone, on the left and right, now behaves as if every medical issue is a political matter that the government or some technocratic panel can and should decide. No wonder "the 'death panel' myth" has such currency among Americans who won't be doing the deciding.