Rationing health care?
Dr. Death is calling your number
One worry about universal health coverage is that there will be less state-paid care to go around, leaving seniors who currently rely on Medicare to compete with others for a slice of publicly funded medical pie. This would lead to rationing, the worriers say, and the inevitable demotion of seniors, the disabled, and, of course, the unborn to the bottom of the list.
Dr. Ezekiel Emanuel, the brother of Obama’s Chief of Staff Rahm Emanuel and a senior health care adviser to the administration, was attacked for publicly endorsing a sort of utility-based discrimination between would-be health care recipients.
According to Emanuel – dubbed “Dr. Death” by opponents – we must have a system, at least for emergencies such as epidemics, which determines the order in which citizens are treated. And perhaps in the course of everyday care, doctors and insurers might advise against performing expensive and risky organ transplants to elderly or terminally ill patients, rather than covering just any treatment for anyone who wants it.
But according to last week’s Lexington Blog in The Economist, rationing care within any kind of “human potential hierarchy” is asking for trouble. While such a move might be “philosophically defensible,” Lexington writes, “it is political poison.”
What’s particularly interesting about Lexington’s quip is how it captures the philosophy / practice gap we’re so familiar with and places it firmly at the crux of our most pressing policy debate.
Most Americans can appreciate both the sense in which a ‘buy all the treatment you want’ system oozes inefficiencies and the fact that, in a system as expensive and risky as ours, care is already rationed—not by government bureaucrats, but by purchasing power. But as Lexington points out, Americans are rather hesitant to face the music when it comes to life and death; we’d rather leave it to the market – toxic as it may become – than make what are often heart-wrenching medical decisions a matter of public policy.
If we must die, so be it. But please, can we just not talk about it?
Indeed, the provision that caused the whole “death panel” debacle was about exactly that – talking about death. This provision, actually supported by several Republicans, but nevertheless recently stricken from the proposed House bill after pressure from ‘deathers,’ called for end-of-life medical counseling to be available to seniors and their families, and encouraged living wills (the very opposite of death panels). There are good reasons to be concerned about government intrusion in end-of-life decisions, but it is difficult to see how the state’s support of a voluntary conversation about these decisions amounts to intrusion.
Is death destined to forever be a forbidden topic in political discourse? It’s been broached before (remember Terri Shiavo?) but rarely does a public conversation about the hereafter result in mutual understanding or measurable progress. To what extent, really, are our differences on health care for the dying really superficial stand-ins for our common fear death itself, and our resulting tendency to avoid discussing it?
-Colin
Related posts:
- Singer on health care rationing
- Health care and small government
- Dealing with death
- Should health care cover spiritual medicine?
- Was health care reform illegal?
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[...] New York Times has a nice update to an issue I discussed months ago – end of life decisions in health care and the angst that accompanies them. Official guidelines [...]