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The Conservative Curmudgeon
August 18, 2009
What Will Rationed Health Care Mean
for Elderly and Disabled Persons?
by Allan C. Brownfeld
ALEXANDRIA, VA — The health care program now being considered by the Congress has many problems. The Congressional Budget Office (CBO) judges that the House version would cut the number of uninsured from 46 million in 2007 to l7 million in 20l9. But the cost would be $l trillion over the decade. Of that, $239 billion would be added to the budget deficit. In 20l9, the projection’s last year, the cumulative shortfall would be $65 billion.
Economist Paul Samuelson, author of The Great Inflation and its Aftermath, notes that, “Assuming that the deficit rises 4 percent a year, the cumulative shortfall in the second decade would total about $800 billion. The president... offers the illusion of reform while perpetuating the status quo of four decades.”
Senator Kent Conrad (D-ND), chairman of the Senate Budget Committee, posed the following question to Douglas Elmendorf, head of the CBO: “From what you have seen from the product of the committees that have reported, do you see a successful effort being mounted to bend the long-term cost curve?” Mr. Elmendorf replied: “No, Mr. Chairman. In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health-care costs... The cost curve is being raised.”
The plan under consideration would do the opposite of what President Obama has suggested. It would increase spending rather than restrain it. The notion of rushing through a program of this magnitude without careful debate and analysis — the President's initial hope — has now been widely rejected.
Aside from the question of cost is the more important moral question of whether the proposed government program would involve the rationing of health care, and how elderly and disabled persons might fare under such a regime.
The recent heated town hall meetings — with vigorous opponents often appearing more interested in disrupting the meetings than in raising important questions — have produced an equally disquieting reaction from House Speaker Nancy Pelosi and Majority Leader Steny Hoyer (D-MD). In an article in USA Today, Hoyer referred to protests against the healthcare plan as “un-American.” Some charges — such as that by former Alaska Governor Sarah Palin that the proposed legislation involves the creation of “death panels” to determine who will live and who will die — tend to overstate their case.
Still, there are legitimate questions to be asked about the question of rationing health care and about the fear of euthanasia as a possible option to cut costs. This fear is not irrational. Writing in The New York Times Magazine, Professor Peter Singer of Princeton University entitles his article, “Why We Must Ration Health Care.” He points out that President Obama has urged his supporters to avoid using the term “rationing” for fear of evoking a hostile response. Professor Singer has no such reticence.
He writes: “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.... The task of health care bureaucrats is... 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 the equivalent of saving l4 85-year-olds.”
Referring to the notion of a quality-adjusted-life-year (QALY), Singer describes “a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics.”
A Washington Post reporter recently asked Rabbi Daniel Zemel of Washington, D.C., what he thought about federal agencies putting a dollar value on human life. The rabbi cited a Jewish teaching explaining that if one human life were placed on one side of a scale, and the rest of the world were placed on the other side, the scale would be balanced equally. This, perhaps, is precisely what those who resist health care rationing think.In an April 28 interview in The New York Times, the President spoke of having the government guide “a very difficult democratic conversation” about “those toward the end of their lives who are accounting for potentially 80 percent of the total of the health care bill out here.”
Presidential health care adviser Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel and chairman of the Department of Bioethics at the Clinical Center at the National Institutes of Health, has argued that independent government boards should decide policy on end-of-life care. He also has defended rationing care more strictly for older people because “allocation (of medical care) by age is not invidious discrimination.”
House Republicans have warned against draft section l233 of the House Democratic health care bill as an area of deep concern. It provides “advance care planning consultation” for “end-of-life services” for seniors every five years. House Minority Leader John Boehner of Ohio and Rep. Thaddeus McCotter (R-MI) warn that the provision “may start us down a treacherous path toward government-encouraged euthanasia.” There is now talk of removing this provision, but the intent of its authors seems clear.
Ezekiel Emanuel goes so far as to say that it will be necessary to change the way doctors think about their patients. Doctors, he said, take the Hippocratic oath (“First do no harm”) too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June l8, 2008). Emanuel says medical care should be reserved for the non-disabled, not given to those “who are... prevented from being or becoming participating citizens” (Hastings Center Report, November-December l996).
Government cost controls should not have a role in the decision to deny care at the end of life — or at other times. Clearly, it is not irrational to be concerned about the plight of elderly and disabled persons under a rationed health-care system that many seem to be promoting. The more we know about these plans, the less likely Americans will be to embrace them.
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The Conservative Curmudgeon is copyright © 2009 by Allan C. Brownfeld and the Fitzgerald Griffin Foundation. All rights reserved. Editors may use this column if this copyright information is included.Allan C. Brownfeld is the author of five books, the latest of which is The Revolution Lobby (Council for Inter-American Security). He has been a staff aide to a U.S. Vice President, Members of Congress, and the U.S. Senate Internal Subcommittee.
He is associate editor of The Lincoln Reveiw and a contributing editor to such publications as Human Events, The St. Croix Review, and The Washington Report on Middle East Affairs.
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