I wrote a quick piece in the wake of Obamacare’s passage for To The Source, in which I predicted dire developments. From my article:
For now, Obamacare preserves a private financing system—no public option. Nonetheless, it still represents a government takeover of healthcare. By eliminating risk assessment–and seizing control of benefit determinations—government bureaucrats will now choose winners and losers. Because we are all now ensconced in the same closed system, we each now have a direct financial stake in the health care received by every other one of us.
Government control is, by definition, intensely political. Politically powerful “in crowds” are rarely denied what they want, while “out crowds” may be excluded altogether. The same will be true in health care.
I write of events along these lines that have and are happening in Europe. I then warn:
Medically vulnerable patients should now be very afraid because the sheer heft of government–and the even greater weight of culture–are going to shift against them. Again, Europe provides the model. Some countries—Sweden, the UK, for example—are seriously considering or already beginning to limit health care to people with unhealthy lifestyles, smokers, the obese, and to those who are deemed to have a low quality of life, the elderly and those with cognitive impairments.
That same impetus will emerge and strengthen here as time passes. Because what happens medically to each of our neighbors will directly impact us, “suspect” classes–those who are expensive to “maintain”—will emerge and come to be perceived with a less compassionate and inclusive eye by the healthy and able bodied.
Indeed, public expectations about how to best care for seriously ill and disabled people will change, and a subtle idea will grow that they no longer really belong. This could lead to the “duty to die”—already under active debate in bioethics literature.
I discuss the potential impact on assisted suicide, and conclude:
The nuts and bolts of this dehumanizing system will be created primarily outside the spotlight of representative democracy in the tens of thousands of pages of rules that will now be promulgated by federal bureaucrats to effectuate Obamacare—including the extent of abortion coverage required in insurance plans and which life-extending or sustaining treatments will be refused coverage. Those with the most input in this process will be so-called “stakeholders,” that is non profit groups that advocate for affected people. And that–along with the courts–is to where the brunt of the battle over the sanctity of life in health care will now shift.
There is much work to do in a short period. No time to dawdle. What we can’t repeal, we must direct toward a life-affirming embrace of the intrinsic sanctity and equal dignity of all human life.
March 24th, 2010 | 11:58 pm
I agree.
The problem is one noticed by Pellegrino years ago:
The profit motive is irreconcilable with the patient’s best interests because when the covenant between physician and patient turns into a business contract, “the end result is a physician who is an employee whose loyalties are divided between organization and patient, and whose self-interests are pitted against the patient to curb costs or make profits”
Medical professionalism: Can it, should it survive? J Amer Board Fam Prac. 2000;13:148.
The dirty little secret is that the Obama plan lets the health care industry make a profit, and now they will have federal cover to deny you care.
the problem is not the bill as much as the pro death ideology and ethics that inspired the bill…did you know the AAFP health care reform panel “partnered” with a soros /open society group to promote health care “reform” on their lines?
Although the leader was up there with Obama for a photo op, I never heard that we supported the bill…I guess I wasn’t the only doc who protested…
March 25th, 2010 | 12:31 am
“Because we are all now ensconced in the same closed system, we each now have a direct financial stake in the health care received by every other one of us.”
Yep. This is the key point.
March 25th, 2010 | 1:58 am
[...] here to read the rest: Obamacare: “At What Cost?” » Secondhand Smoke | A First Things Blog By admin | category: cost | tags: article, cost, predicted-dire, quick-piece, source, [...]
March 25th, 2010 | 3:54 am
[...] This post was mentioned on Twitter by Vince Humphreys and Matthew Tyree, Tym Machine. Tym Machine said: RT @CO2HOG: SHS: Obamacare: “At What Cost?” http://bit.ly/cLOTV1 #tcot [...]
March 25th, 2010 | 7:00 am
Health care hysteria!!
How are winners and losers “chosen” now?
In 2002 the Institute of Medicine estimated that each year 18,000 Americans die prematurely because of lack of health insurance. A more recent study from Harvard in 2009 put the number dying each year at 45,000. How likely do you think it is that most of these “losers” were poor?
Do the current resource providers (including Medicare and Medicaid) pay every bill? Even now, do they pay $20,000 for a treatment that has a 30% chance of extending life 2 months?
When weighing the lives of at least 18,000 against the POSSIBILITY of reduced extraordinary measures for terminal cancer patients you feel the scale should tip toward the few.
I humbly suggest that we all work toward quality health care for while while ALSO protecting the few.
I spoke with a visiting Canadian businessman last night (he invests in health care businesses) and he was interested in how US citizens outside of DC felt about health care. He heard from both sides. He felt that although the Canadian system had problems, e.g., wait times for elective procedures, overall it was superior in that it covers everyone for 1/2 of what we spend in the US.
March 25th, 2010 | 8:16 am
[...] Obamacare: “At What Cost?” » Secondhand Smoke | A First Things Blog Should You Get Low Cost Life Insurance?Cheaper housing may cost more in long runInternet Marketing CostRecessionomics: Paris Hilton's Sunglasses Cost As Much As 500 …This amazing photo of Earth cost only $750 to takeRealClearPolitics – Immigrants Demand Reform, NowFancy Wall Street Journal iPad Edition Will Cost $17.99 A MonthGates assures no more F-35 cost, schedule woes « Res CommunisUS, Pakistan see new spirit of trust | EMOIZ.COMFlood of appeals likely after Neb. CSI conviction (AP … View the Contact Powered by Type [...]
March 25th, 2010 | 10:46 am
Hysteria driven fully by hyperactive emotions, not compelling data. At least global warming has data.
[Gratuitous insult to a certain type of Christian believer deleted]
David: The sarcasm was irrelevant and rude. If you can’t control yourself, don’t comment. Thank you.
March 25th, 2010 | 11:02 am
I oppose Obama care for many reasons. It will help bankrupt the nation, as if it isn’t already. But my state of Nevada is in a depression. We have 13-14 percent unemployment, a depressed housing market, miles of warehouse and office space empty. So I’m changing my mind and making an exception and rooting for progressivism to totally win out (except sanctity of life issues) in CA (only) so CA businesses will move up here and help heal our state-well, at least the Reno Sparks area. I hope our governor and Lt. Governor will fund progressive causes in CA for our good. Here’s a partial list of the progressive agenda that I’m hoping wins out in CA.
Universal health care for everyone in CA whether they are there legally or not, a 40 percent tax on Cadillac insurance programs, more just compensation (large increases) for all public employee pay, benefits and pensions, raise the minimum wage, pass card check, right for all public unions to strike, require prevailing wage for all government contracts, free university tuition, all day kindergarten, more social service spending, dramatic cuts in medical reimbursement rates, overthrow of conscience clauses, corporate income tax hikes, a carbon tax, raises in sales tax, income tax, higher taxes on Indian Casinos, overturn Prop 13 to raise property taxes, 10 percent wealth tax, more rent control, less water to valley farms and more fresh water to the delta to protect the delta smelt, a return of all CA rivers to the wild, drain Hetch Hetchy, permanent ban on Auburn Dam and any new dams, close Tahoe (on the CA side) and Yosemite to the public, more high salaries for CCRM, more government holidays, a ban on gasoline engines or diesel engines in 5 years, Kyoto emissions standards, more car pool lanes, bans on nuclear power, limits on hydroelectric power, more stringent no growth measures, tougher green laws, mandatory energy efficiency for every CA home and building including mandatory energy retrofitting of every building, paint all roofs white, bans on corporate salaries over $500k, ban on Walmart and “large box” stores, legalizing of marijuanna and narcotics, a ban on chemical pesticides, ban on and confiscation of guns, more public and private smoking bans, bans or fines on transfat, salt and unhealthy ingredients in restaurants, close slaughterhouses, close research labs doing animal reserach, more hate crime legislation, speech codes and etc.
I”m sure this is only the tip of the progressive icebergy, but I’m for all of these progressive measures in CA because Reno, Nevada needs CA businesses to move here and heal our economy. Three cheers for progressives taking over and bankrupting CA!
March 25th, 2010 | 2:47 pm
Speaking of hysterical arguments, Jeffery, if one compelling reason to pass the health care bill now is to save (your numbers) 18,000 lives per year, then why wait four years to fully implement the plan? By your count that’s a sacrifice of some 72,000 lives. Some emergency.
Or maybe the those numbers are like a lot of others in this debate, vaporous.
March 25th, 2010 | 2:50 pm
Speaking of hysterical arguments, Jeffery, if one compelling reason to pass the health care bill now is to save (your numbers) 18,000 lives per year, then why wait four years to fully implement the plan? By your count that’s a sacrifice of some 72,000 lives (or is it 180,000?). Some emergency.
Or maybe the those numbers are like a lot of others in this debate, vaporous.
March 25th, 2010 | 3:22 pm
^ Sorry for the double post! Thought I had deleted the first
March 25th, 2010 | 4:12 pm
But my dear Wesley, the citizens of Sweden and UK don’t want the chaotic thing we call the US Healthcare System. No one wants to do it our way. Not Israel, not Taiwan, not China. Even India where a private-public combination has worked very well – witness the very successful National AIDS Control Organization – charitable hospitals such as Narayana Hrudayala, Sankara Nethralaya, Arvind Eye Hospital, Sri Ramakrishna Seva Pratishtan (the unsung heroes of Calcutta), are all creating low cost insurance plans. This time in India I had an eye exam and when I told my doctor what it would cost in the US he was horrified. So I told him that should an eye doctor charge less, insurance companies would elbow him out of the network. My way or the highway
March 25th, 2010 | 6:33 pm
Dave C,
I agree! In fact it would have been better if enacted in the 90s or at least during the Bush years.
March 25th, 2010 | 8:52 pm
Wesley,
What follows below is the content of a letter I submitted to my local weekly a short time back. It wasn’t accepted for publication, but it came to mind when I read this piece. I thought it might be worth posting here. Thanks for providing additional insight into what I was attempting to get at in my letter.
1. Prominent supporters of the current health care reform proposals (Barack Obama, Ezekiel Emmanuel, Paul Krugman, Barney Frank) have stated their ultimate goal is a government run single payer health care system. Single payer means that the purchase of supplementary health insurance is ruled out by definition. Do voters wish to have the government deny them the option of purchasing supplementary insurance with their discretionary income?
2. The limit available for health care expenditure in a single payer system is the total of the insurance premiums charged and the federal tax revenue that can be made available. This limit will be less than it could be if health care expenditures were determined, partly or entirely, by individuals deciding how best to spend their income in the private market place. Although the distribution of expenditure across individuals and families, and among kinds of health care, will be different in a private market controlled system, it is important to realize that aggregate expenditure would not be as tightly constrained as in a purely public system.
3. As with expenditure on any other good or service holding down the total spent on health care would not be a matter of pressing public concern if medical expenditure were the result of individual decisions in a private medical care market. Holding down the total amount and percent of national income spent on health care is a matter of public concern only because of the impact of medical expenditure on the federal budget.
4. The combination of an aging population, improving medical technology, and the pricing system that will characterize a single payer system, will generate a demand for health care in excess of the maximum funds that can be raised by taxation and premiums. Thus, allocation decisions must be made. How they are made has serious moral and political implications. In a nation as large as the U.S. these decisions inevitably will be in the hands of a small regulatory bureaucracy. It will be virtually impossible to subject this bureaucracy to effective decentralized democratic control. The allocation principles developed to direct the single payer system will be determined by the moral and political views of this small bureaucratic elite. The moral thinking of this elite is an important consideration for us as we ponder the wisdom of moving toward a single payer system.
5. The ethical theory that guides much expert thinking is based on a utilitarian cost benefit analytical framework. The ethical opinions of men such as Peter Singer and Ezekiel Emmanuel appear to dominate elite bioethical circles. Do we want their views to shape the centralized funds allocation process necessary under a single payer system? Would we prefer a decentralized multiple payer private-public system with multiple choices that is more subject to effective democratic control, and in which total expenditure will not be as inherently tightly constrained as it will be if limited by the federal budget? Is it possible to identify specific problems in our health care system, and make specific changes to improve access and efficiency while also providing maximum respect for the moral standing of the persons the system is intended to serve?
March 26th, 2010 | 10:05 am
Frank,
Actually at present your treatment plan is drafted not by government bureaurcrats (who are as a rule well qualified and trained) but by spreadsheet wielding private sector clerks. In the US whatever the private sector can do the government does cheaper and better with less fuss. And single payer systems cost less the world over.
Wesley J. Smith Reply:
March 26th, 2010 at 10:13 am
Actually, Thurgood–and thanks for dropping by–the contrary is true. Right now if a private HMO or insurance company seeks to withhold efficacious treatment, they will have to face the wrath of regulators and lawyers, as well as market forces (too little there based on government restrictions of competition). If the govt. sets the standards, there is no recourse. The regulators will side with the govt. The lawyers won’t be able to sue because there will be no financial incentive, and the “appeal” will be utterly bureaucratic, as in the VA appeals. It will be the difference between having a fighting chance and being a drone.
March 26th, 2010 | 11:19 am
Jeffery,
As expected…. dodge the question, change the subject, blame Bush… A nice little waltz step you’ve perfected there.
But let’s get back to my question. If (as you say) so many Americans (18,000 — 45,000) are dying each year because they don’t have health insurance (never mind the absurdity of the notion that a lack of insurance is a cause of death — if I don’t have auto insurance will I get in an accident), why aren’t you and your cohorts in the streets right now demanding immediate implementation “to save lives”?
Links
Blogs
Find Us
Contact