We Must Ration Health Care, says the New York Times

But not Congress'.

Back when the White House was but a gleam in Mr. Obama's eye, we pointed out that the real issue in giving health care to everyone is limiting how much money a sick person can ask the taxpayers to spend on his or her health.  As with any limited resource, there are only two ways to limit medical spending: price and rationing.

Limiting Demand

Rationing is complex - you need a bureaucracy to decide who can have which treatments.  A young person with many years of life remaining might get an expensive treatment that an older person would be denied.

This is very complicated, very political, and people who're denied treatment scream to high heaven.  For example, a British mother is campaigning against the National Health Service decision to deny her 22 year old son a liver transplant.  Times Online reports:

Reinbach, from Dagenham, Essex, does not qualify for an organ because official guidelines state that heavy drinkers must prove that they can be abstinent outside hospital before they are considered. His condition is so severe that he cannot be discharged to prove he can remain sober.

He's stuck in the rules - he's too sick to leave the hospital long enough to prove he can stay sober.  Without proof of sobriety, he can't have a liver.  Without a liver, he'll most likely die.

This sort of dilemma is typical of medical rationing schemes.  "More than 400 people died on the waiting list last year;" the bureaucracy stays within its budget by letting people wait until they die.

Rationing is complex and highly political, but limiting by price is simple - if you can't afford a treatment, you can't have it.  This gives vendors an incentive to figure out ways to cut prices so more people will buy from them.

For good or for ill, our society has decided against limiting consumption by price.  Heating assistance helps poor people generate extra greenhouse gases by burning more heating oil than they can pay for.  Food stamps let poor people eat more than they could otherwise afford; the resulting overweight is visible in every crowd.

Similarly, our society is deciding that we shouldn't limit medical care by price.  We're deciding that it's wrong to deny medical care to people just because they can't afford it.

The Right To Medical Services

In so doing, we're defining medical care as an "inalienable human right" that ranks right up with the rights mentioned in the Declaration of Independence.  Unfortunately, the only way health care can be effectively made a right is by denying other people's rights.  To give health care to someone who won't or can't pay for it, we have to deny doctors the right to be paid for their work or we have to deny taxpayers the right to enjoy the money they've earned.

The longer the health care debate goes on, the more we're hearing about huge tax increases to fund it.  It should be clear by now that defining health care as a right denies other people the right to keep their own money.

Even Mr. Obama admitted that his health care visions would cost big money and Massachusetts is finding that they can't pay for their universal care system.  Tax increases to fund universal health care aren't exactly news.

The Right To Wait In Line

What is news is that the liberals who've been championing universal access to medical services have admitted that health care will have to be rationed.  Instead of denying people medical care because they can't afford it, we'll deny people medical care because society can't afford it.

In "Why We Must Ration Health Care," the New York Times argues:

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn't going to be good. But suppose it's not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man - and everyone else like him - with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone's life? If there is any point at which you say, "No, an extra six months isn't worth that much," then you think that health care should be rationed.

The Times didn't point out that rationing requires a brand-new government department with the authority to place a value on every human life and decide who gets treatment and who's left to die.  Pundits rail against "heartless" insurance bureaucrats who deny medical treatment, but the Times is suggesting that government bureaucrats do exactly the same thing.

There's no way around it: when people don't pay for their own health care, somebody else has to decide who gets what.  Do we want such decisions made by private companies whom we can sue when they mess up or by government officials whom we can't sue no matter what they do?

In a Wall Street Journal op-ed published at the end of last year with the headline "Obama Will Ration Your Health Care," Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described how in Britain the national health service does not pay for drugs that are regarded as not offering good value for money, and added, "Americans will not put up with such limits, nor will our elected representatives." And the Democratic chair of the Senate Finance Committee, Senator Max Baucus, told CNSNews in April, "There is no rationing of health care at all" in the proposed reform. [emphasis added]

No Rationing for the Plutocracy

Sen. Baucus is telling the truth in a misleading way.  The proposed "reform" of our medical system has no rationing - for him.

As a Senator, he benefits from an extremely generous health care system which has been set up for the ruling political classes and other federal employees.  Their system is even more expensive than the UAW's health care system which bankrupted General Motors, once the most profitable business in the country.  In "Their Own Medicine," the Wall Street Journal explains:

In the health debate, liberals sing Hari Krishnas to the "public option" -- a new federal insurance program like Medicare -- but if it's good enough for the middle class, then surely it's good enough for the political class too? As it happens, more than a few Democrats disagree.

On Tuesday, the Senate health committee voted 12-11 in favor of a two-page amendment courtesy of Republican Tom Coburn that would require all Members and their staffs to enroll in any new government-run health plan. Yet all Democrats -- with the exceptions of acting chairman Chris Dodd, Barbara Mikulski and Ted Kennedy via proxy -- voted nay.

In other words, Sherrod Brown and Sheldon Whitehouse won't themselves join a plan that "will offer benefits that are as good as those available through private insurance plans -- or better," as the Ohio and Rhode Island liberals put it in a recent op-ed. And even a self-described socialist like Vermont's Bernie Sanders, who supports a government-only system, wouldn't sign himself up.

Why would any sensible politician risk his life to crummy care from the "public option" when he's receiving generous Congressional coverage?  Politicians know that the public option will limit spending by squeezing doctors and by not paying for treatments that bureaucrats think are are too expensive.

Our lives simply aren't worth as much taxpayer money to our elected officials as their own lives are.  The public option will provide crummy care so these people plan to stay out of it; Sen. Dodd doubtless plans to strip this requirement out of the law once it's too late for citizens to object to their hypocrisy.

The Wall Street Journal pointed out that Sen. Gregg (R-NH) was the only senator honest enough to say that the public option "will be so bad that I don't think anyone should be forced to join."

You Write The Law, You Live With The Law

What sort of health-care system will we end up with once Congress is done?  Will it be an improvement over the mess we have now?  Or will it be something even worse, costing more and providing less care?

There's only one way to get a positive outcome: We voters should force Congress to live with the laws they impose on us.  Congress doesn't care about Social Security because they have their own separate, fully-funded pension system. Congress isn't worried about being sued for sexual harassment because they exempted themselves from laws against it.  We've long since realized that powerful Democrats needn't pay income taxes.

The only way to fix Social Security is to force Congress - that is, the actual Congressmen and their families - to depend on it.  The only way to get some sense into our tax code would be to harshly enforce its rules against those who write it.  The only way to get a decent public health care system would be if Congressmen had to stand in the same line and obey the same regulations that they'd like to impose on all of us.

As long as our political masters have their own system, they'll ration out the crumbs and expect us to re-elect them in gratitude.  Even the New York Times realizes that they're planning to make us stand in line for treatment until enough of us die to keep within their budget as in the British system.  It would be nice if the rest of the people would catch on before this monstrosity is passed into law.

Will Offensicht is a staff writer for Scragged.com and an internationally published author by a different name.  Read other Scragged.com articles by Will Offensicht or other articles on Economics.
Reader Comments
The NYT agrees that Congress' health care plan is too expensive....

Health Insurance No One Needs
Congress's health insurance -- that is, the heavily subsidized preferred provider plan that most members have -- is too wasteful to be a good model for America.

July 22, 2009 8:44 AM
Except when I was in the Air Force, the taxpayer has never paid a penny for my healthcare.
Unfortunately, Medicare will have to be an option when I retire.
August 3, 2009 6:14 PM
From my experience, the NY Times is wrong in writing that insurance companies will pay for any and everything and all of your co-insurers will have to help pay for your procedure. Insurance Companies will not and what your plan covers is in your health insurance plan booklet. And, from my experience, if the insurance company thinks your procedure was unnecessary and over and beyond reasonable care, you will be refused. Doctors and hospitals always check with you insurance plan to find out what will be paid by insurance, and you are told this - up front.
August 5, 2009 1:04 PM
The NY Times reports that the White House has admitted that there will have to be rationing at least in a "few cases":

Sarah's Ghoulish Carousel
Despite putting out a proclamation in 2008 to plan ahead for health care decisions, Sarah Palin has managed to hijack the health care debate from President Obama with one catchy phrase.


She took a forum, Facebook, more commonly used by kids hooking up and cyberstalking, and with one catchy phrase, several footnotes and a zesty disregard for facts, managed to hijack the health care debate from Mr. Obama.

Sarahcuda knows, from her brush with Barry on the campaign trail, that he is vulnerable on matters that demand a visceral and muscular response rather than a logical and book-learned one. Mr. Obama was charming and informed at his town hall in Montana on Friday, but he's going to need some sustained passion, a clear plan and a narrative as gripping as Palin's I-see-dead-people scenario.

She has successfully caricatured the White House health care effort, making it sound like the plot of the 1976 sci-fi movie "Logan's Run," about a post-apocalyptic society with limited resources where you can live only until age 30, when you must take part in an extermination ceremony called "Carousel" or flee the city.

Painting the Giacometti-esque Emanuel as a creepy Dr. Death, Palin attacked him on her Facebook page a week ago, complaining that his "Orwellian thinking" could lead to a "death panel" with bureaucrats deciding whether to pull the plug on less hardy Americans.

But, much to Sarah's delight, he [Dr. Emanuel, a White House health care adviser] also conceded to The Washington Times that his "thinking has evolved" on the "very vexing" issue of deciding who gets treatment and who doesn't.

"When I began working in the health policy area about 20 years ago ... I thought we would definitely have to ration care, that there was a need to make a decision and deny people care," he told the paper, adding that he now feels that if we get rid of expensive "unnecessary care" that "we would have absolutely no reason to even consider rationing except in a few cases."

A few cases? Sounds like another Facebook entry for Sarah.
August 16, 2009 7:01 AM
The only thing you can't have in Obama's world is your freedom.

March 30, 2010 11:40 PM
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