Monday, July 20, 2009

The "R Word"--Rationing--Spills Into the Health Care Debate

Barack Obama is hitting rough water--maybe shattering rocks--in his quest for health care "reform." Sample headline in The Washington Post: "Poll Shows Obama Slipping on Key Issues/Approval Rating on Health Care Falls Below 50 Percent." That was today's front page, above the fold. Ouch! And then along comes a Rasmussen Poll today, showing Obama and Mitt Romney in a dead heat for 2012, 45-45.

What's going on, of course, is that voters are starting to realize what's happening to them. They are starting to see that the Obama administration made a priority of bailing out Wall Street, and that bail-out-for-billionaires plan took precedence over help for Main Street. Oh, and a "stimulus" package that was mostly a sop to local governments. So now, after all that bad blood--and red ink--has been spilled, Obama is pushing lefty ideas for health care to a scared public and a wary Congress.

Meanwhile, the real intellectual roots of health care "reform" are starting to show--and they don't look good. Peter Singer, the eugenics-minded "bioethicist" at Princeton, probably didn't help the liberal cause when he wrote a piece for The New York Times Magazine entitled, "Why We Must Ration Health Care." Singer is a smart fellow, but his writings on so many topics are so extreme that his "endorsement" of rationed health care is a kiss of death. And so you have to wonder: Why did Singer go public? Perhaps he likes being in the opposition, being a critic, and so he is doing his sly bit to make sure that nothing he might like ever gets done.

The thoughtful blogger Bob Wachter, adds his own liberal take on the rationing controversy, in a post for The Health Care Blog entitled, "A Brief History of the R Word." He agrees with Singer and Uwe Reinhardt that some sort of rationing is inevitable, as a pure function of economics--somebody, somehow, has to allocate resources.

But that puts a pretty huge premium on the "who" doesn't it? That is, do we trust the neo-Platonic Guardians to make these decisions for us? A majority of Americans voted Democratic in the 2006 and 2008 federal elections, so that gives the Dems some claim to leadership. But not even a minority of Americans had ever of John Holdren, whom Obama named as his White House science adviser earlier this year--and whom the US Senate confirmed, obviously because few Senators bothered to read what he had written. But anyone interested in the fate of future US scientific policy--and medicine, after all, is partially a subset of science--should take great interest in what Holdren has written. And here's one detailed look.

It's safe to say that 90 percent or more of Americans would strongly disagree with Holdren's writings on forced abortions, mass sterilizations, and mandatory family-size management. Admittedly, he advocated those policies in the 70s, but he didn't retract them until those words until critics discovered them in the last few weeks. So it's reasonable to ask, and perhaps even accurate to surmise, that Holdren's recantation is less than sincere. (Note to Republicans in the Senate, who had a chance to vote on Holdren's appointment, and to at least raise concerns, even if they couldn't block him: Take the advise and consent function more seriously--use interns, if you have to, to pore through all the writings of these people; no doubt Holdren is not the only extremist that Obama has nominated.)

Thus the big question: Do we want Holdren anywhere near our health policy? And in addition, do we want the people who hired Holdren, and who think of him as a colleague, anywhere near our health policy?

Yes, some kind of system is needed: Hopefully it will be a system that encourages Serious Medicine. But if we are unlucky, then we will get a rationed system in which innovation is stifled, and so not only is health worsened, but the path to lower costs is blocked by short-term stinginess.

As an aside, blogger Wachter makes a good point: Why are so hung up on the "17 percent of GDP for health care" meme? What should the percentage be? Should we spend less on health care so we can spend on... Let's have a national conversation on how best the country should spend the other 83 percent of the economy. Much of it is private property, of course, and it should stay that way, but even conservatives and libertarians want good health care. If someone figures out what we really need, there could be lots of innovative ways to finance such an expansion. In addition, Wachter makes casual reference to ways that countries with Socialized Medicine, as opposed to Serious Medicine, deal with their hard medical cases:

As Singer notes, every society that rations provides a safety valve for the wealthy disaffected. In the UK, you can buy private insurance that allows you to jump the queue for your hip replacement. Canada’s safety valve is called the Cleveland Clinic. We don’t talk about the percent of our GNP we are spending on Starbucks lattes, or on iPods, or on vacations. People pay for these things out of pocket, and receive no tax advantages when doing so. Given the American ethos of self-determination and consumerism, any rationing plan will need to allow people who can afford care that isn’t covered by standard insurance to buy it with their own money (with absolutely no tax advantage). Two-tiered medicine, sure, but I see little problem with this as long as we are using the money in the communal pool to provide a reasonable set of benefits to the entire population.

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