Archive for Friday, April 24, 2009

Health care plan will involve rationing

April 24, 2009


— Unified theory of Obamaism, final installment: In the service of his ultimate mission — the leveling of social inequalities — President Obama offers a tripartite social democratic agenda: nationalized health care, federalized education (ultimately guaranteed through college) and a cash-cow carbon tax (or its equivalent) to subsidize the other two.

Problem is, the math doesn’t add up. Not even a carbon tax would pay for Obama’s vastly expanded welfare state. Nor will Midwest Democrats stand for a tax that would devastate their already crumbling region.

What is obviously required is entitlement reform, meaning Social Security and Medicare/Medicaid. That’s where the real money is — trillions saved that could not only fund hugely expensive health and education programs but also restore budgetary balance.

Except that Obama has offered no real entitlement reform. His universal health care proposal would increase costs by perhaps $1 trillion. Medicare/Medicaid reform is supposed to decrease costs.

Obama’s own budget projections show staggering budget deficits going out to 2019. If he knows his social agenda is going to drown us in debt, what’s he up to?

He has an idea. But he dare not speak of it yet. He has only hinted. When asked in his March 24 news conference about the huge debt he’s incurring, Obama spoke vaguely of “additional adjustments” that will be unfolding in future budgets.

Rarely have two more anodyne words carried such import. “Additional adjustments” equals major cuts in Social Security and Medicare/Medicaid.

Social Security is relatively easy. A bipartisan commission (like the 1983 Alan Greenspan commission) recommends some combination of means testing for richer people, increasing the retirement age, and a technical change in the inflation measure (indexing benefits to prices instead of wages). The proposal is brought to Congress for a no-amendment up-or-down vote. Done.

The hard part is Medicare and Medicaid. In an aging population, how do you keep them from blowing up the budget? There is only one answer: rationing.

Why do you think the stimulus package pours $1.1 billion into medical “comparative effectiveness research”? It is the perfect setup for rationing. Once you establish what is “best practice” for expensive operations, medical tests and aggressive therapies, you’ve laid the premise for funding some and denying others.

It is estimated that a third to a half of one’s lifetime health costs are consumed in the last six months of life. Accordingly, Britain’s National Health Service can deny treatments it deems not cost-effective — and if you’re old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.

Rationing is not quite as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by a myriad of similar criteria.

The more acute thinkers on the left can see rationing coming, provoking Slate blogger Mickey Kaus to warn of the political danger. “Isn’t it an epic mistake to try to sell Democratic health care reform on this basis? Possible sales pitch: ‘Our plan will deny you unnecessary treatments!’ ... Is that really why the middle class will sign on to a revolutionary multitrillion-dollar shift in spending — so the government can decide their life or health ‘is not worth the price’?”

My own preference is for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment. But if you believe that health care is a public good to be guaranteed by the state, then a single-payer system is the next best alternative. Unfortunately, it is fiscally unsustainable without rationing.

Social Security used to be the third rail of American politics. Not anymore. Health care rationing is taking its place — which is why Obama, the consummate politician, knows to offer the candy (universality) today before serving the spinach (rationing) tomorrow.

Taken as a whole, Obama’s social democratic agenda is breathtaking. And the rollout has thus far been brilliant. It follows Kaus’ advice to “give pandering a chance” and adheres to the Democratic tradition of being the party that gives things away, while leaving the green-eyeshade stinginess to those heartless Republicans.

It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.


average 8 years, 7 months ago

Yes. There will be a serious amount of rationing of care (unless you pony up for more).

There is right now.

Who the hell is Krauthammer's insurer? Or is he rich enough to pay out of pocket for anything and everything. For the rest of us, there are waiting lists, utilization reviews, bureaucratic hassles, and massive amounts of second guessing (including lawsuits if the doctor did either too much, or not enough) by the HMOs already.

Opponents of single-payer rarely bother to defend what we have. They put a Kafkaesque single-payer up against a strawman Marcus Welby system that doesn't exist (and doesn't exist anywhere on the planet). Put single-payer, warts and all, up against today's system (the child of Kafka, Nixon, Machiavelli, and the Marquis de Sade) and suddenly, single-payer (or, really, damned near anything else) looks pretty good.

notajayhawk 8 years, 7 months ago

logrithmic (Anonymous) says…

"Why does the Journal World elect to give column inches to this neocon?"

Can't answer that. I'm constantly amazed they print mindless comments from uninformed dogmatic potheads like you.

average (Anonymous) says…

Yes. There will be a serious amount of rationing of care (unless you pony up for more).

There is right now.

"For the rest of us, there are waiting lists, utilization reviews, bureaucratic hassles, and massive amounts of second guessing (including lawsuits if the doctor did either too much, or not enough) by the HMOs already."

As a care provider who works in a system that for all intent and purposes IS a taxpayer-funded 'single'-insurer system, I can tell you that you've just described government funded healthcare to a T.

Except you left out that government-funded systems (like Medicaid) aren't regulated like insurance companies are, and there's no legal requirement for them to keep reserves or even to pay claims. And the fact that they can (and do) just stop paying for claims when the amount of money the legislature budgeted for the year runs out.

madameX 8 years, 7 months ago

Wouldn't you rather the patient make decisions about the kind and quality of the care he receives than some government doctor that never sees him but is faced with the task of denying claims to save costs?

As opposed to with private health insurance, where there's a claims adjuster who never sees the patient faced with denying claims to save costs? How is the current scenario any better? At least with the former more people have a shot a getting care.

Besides, if a person only has catastrophic insurance because that's all he or she can afford, the likelihood is not that he or she is out there making independent decisions about what kind of treatment to have for non-catastrophic health problems, the likelihood is that he or she is simply skipping all treatments that are not covered by their insurance.

Practicality 8 years, 7 months ago

Hey loggie,

Where is the personal responsibility for the personal liberty you are always yammering about? You seem to want one but not the other.

Sigmund 8 years, 7 months ago

The solution is easy. Simply deny health care to the rich (who are generally older and close to retirement having saved over a lifetime of work). When they then die a few years earlier confiscate their wealth from their children. Repeat till no wealth is left and the entire country resembles Cuba. Obama will look cute in military fatigues with jaunty beret and we all can call him "El General." This is a case where the cure is far worse than the disease.

just_another_bozo_on_this_bus 8 years, 7 months ago

Hysterically funny, siggy, but can you tell us why that hasn't happened in Canada, Great Britain, Germany, Japan, or the many other countries that have instituted comprehensive healthcare systems available to all, (while spending half as much?)

notajayhawk 8 years, 7 months ago

logrithmic (Anonymous) says…

"The sad part about this is that no matter how many times this moron is confronted with reality, his/her dogma is all he/she can see. And he/she tries to mold reality around his/her dogma."

Thank you for the explanation, loggie. Now we know why you clamor for socialized medicine.

boohoozo (Anonymous) says…


First off, herr klowne, 'instituted' is somewhat misleading. How many of those countries had a healthcare system resembling ours and converted to a nationalized system?

Second, at least for the Canadian system, it's falling apart. It's going broke (so, to keep it running, they may end up following Sigmund's advice) and it's killing people with long wait times.

As far as 'half as much,' there are numerous factors that go into the disparity in healthcare costs, most of which won't change (at least they won't come down - some of them will go up) no matter who pays for the services.

But please, continue with your usual drivel, it's always amusing to watch you sputter and drool.

just_another_bozo_on_this_bus 8 years, 7 months ago

So nice of you to join in with such an "intelligent" and "civil" rejoinder, nota. Why is that, judging from the vitriol that characterizes nearly every one of your posts, you only post while either drunk or hungover?

JohnBrown 8 years, 7 months ago

Health care will always be rationed by some means unless we increase the number of clinics, doctors, nurses, medicines and beds and make their access free. More people want health care then then can be provided. What changes is how people get in line.

We could lower the cost of drugs by 40% by banning drug advertising since the drug companies spend 40% of their budget on advertising. Except for OTC drugs, all drug advertising should be directed at physicians, not ultimate consumers. Simultaneously, we could extend the lifespan of drug patents to 22 years so those companies might spend more of their budget on actual research.

Then, of course, there is the whole societal lifestyle option.

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