David Broder, the dean of the punditry class, has written a cogent and clear column in the Washington Post about the power President Obama wishes to convey to an unelected bioethics board as part of his effort to remake the entire American health care system. Commentary on the commentary over at Secondhand Smoke.
Monday, July 27, 2009, 5:55 PM
July 27th, 2009 | 10:16 pm
Wesley, I was just wondering: do you see any difference between (1) a board that is at least accountable to Congress and (2) insurance companies who are beholden to shareholders? Are you more concerned about controlling costs or making sure utilitarian calculations are not made? Cause the later is the case right now in both situations where decisions are made as to what procedures are covered (and what percentage of the bill will be paid), and we’ve already seen that the market alone cannot control health care costs.
July 28th, 2009 | 1:26 am
Hi Charlie. Indeed I do. The private insurance company is still required to follow the law and pay for ordinary and proper medical treatments. It can’t say, well you’re 80 and so we won’t give you a hip replacement.
But a government authority could change the what constitutes proper care in medicine and, at least theoretically, could tell public and private plans not to pay for hip replacement for octogenarians.
If we want to control costs, we should start with over utilization, not create invidious categories of medical discrimination against people who are expensive to care for.
That is why I think we need price competition, a national health insurance market, a vigorous tort system to keep the insurance companies honest (a different matter than med. mal.) health savings accounts, vouchers, tax credits, more competition, and government involvement for catastrophic cases.
Reform is needed. But not Obama reform.
Thanks
July 28th, 2009 | 6:27 am
I’m not necessarily arguing for Obama reform, but I think the idea that we can somehow avoid rationing health care resources is a denial of the finitude of human beings. We have finite resources and virtually infinite needs. Any acknowledgment that health care should not become an idol means that rationing care is a tragic part of the human condition.
Insurance companies are doing it today based on profit. They deny persons with pre-existing conditions needed coverage. They have premiums and co-pays which make having coverage cost-prohibitive for millions of Americans.
This seems at least as problematic as the uncomfortable issues you rightly raise with a government board negotiating reimbursement rates and what procedures will be covered…but this is happening with Medicare and Medicaid anyway. It doesn’t seem to be the fact that its happening that bothers you…but maybe you (and I, for that matter) don’t want Alta Charo doing it, perhaps?
July 28th, 2009 | 11:37 am
Stating that everyone can’t get everything they want, isn’t the same as a formal rationing plan that targets certain patients based on characteristics. That is discrimination of the invidious kind. At least, that’s how I see it.
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