House Majority Leader Steny Hoyer has defended the appointment of socialized medicine and health care rationing fan, Dr. Donald Berwick, to head Medicare/Medicaid.  As to Berwick’s advocacy of rationing, Hoyer punted, saying in essence, that care is already rationed.  But it’s not.  From the story:

Hoyer went to say he was not familiar with “the full quote” from Berwick and would not comment on his views, but he repeated the Democrats’ claim that health care rationing is commonplace in America through health insurers that deny care based on cost.  “Clearly health care is rationed right now,” said Hoyer. “That was the whole issue in this debate: to make health care affordable and accessible for all Americans. Why is it not accessible to all Americans? Because it’s not affordable to all Americans, [and] to that extent it’s rationed by cost.”

That’s not rationing.  Because some people can’t afford cars, doesn’t mean that automobile ownership is rationed.  It means some people can’t afford a car and therefore have to find alternative means of transportation.  Rationing occurs when a government legally imposes limits on access to a service or product—as it did with gasoline during World War II.

Health care, rationing—in the sense for which Berwick swoons—is a form of invidious discrimination, that is, some people are denied efficacious treatment under the force of law that is available to other people,  based on membership in predetermined categories, e.g. age, disability, seriousness of illness, etc.  For example, if a rationing board decreed no hip replacements to people age 70 and over, that would be a form of medical discrimination based on age.  If a person in a permanent unconscious condition is denied a feeding tube, available to other patients, that would be discrimination based on disability.

Another form of rationing restricts efficacious treatment based on quality of life.  This is the kind imposed on Oregon Medicaid, where more than 700 interventions are listed, but only 625 (say) are covered based on available money.  In that kind of system, those with political clout end up covered, and those without find themselves on the low end of the stick—as happened in Oregon with late stage AIDS (covered) and some forms of late stage cancers, (not covered).  Recall, that Oregon Medicaid refused life-extending chemotherapy to Barbara Wagner and Randy Stroup, offering to instead pay for their assisted suicides

We need health insurance reform—just not Obamacare.  But alleviating the very real problem of opening access to insurance does not justify legalizing medical discrimination against the most weak and vulnerable among us.

Articles by Wesley J. Smith

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