Inside Obama Healthcare

Someone recommended reading bioethicist Peter Singer’s article, “Why We Must Ration Health Care,” in the July 19, 2009 Sunday New York Times Magazine. His point, in a nutshell, was that, although we are being assured “There is no rationing of health care at all” in currently proposed health care reform, it’s something we ought to be considering. From Singer’s perspective, health care is already rationed, as a matter of economic fact. Rich people can afford more and better health care than poor people.

“Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money,” Singer writes.

In practical terms, it means that under a public health care system, people with poor prognoses would receive few medical resources outside of palliative care. Those with diminished “quality of life” conditions – the quadriplegic, for example – would also receive limited health care resources. Since “it isn’t possible to provide everyone with all beneficial treatments,” there has to be a rational way of deciding what treatments people should get. Singer argues that government is better suited to make those decisions than the market.

This seems to be the reasoning behind health care legislation (H.R.3200, America's Affordable Health Choices Act of 2009, as introduced in the House) currently in Congress. According to various frantic emails making the rounds, the bill has a number of components that might have been written by Singer himself:

Sec 123: A federal government committee – the Health Benefits Advisory Committee – will determine appropriate treatment “standards”;
Sec 141: Establishes an independent agency in the executive branch of the Government, a Health Choices Administration, headed by a Health Choices Commissioner, with the duty of determining health benefits plan standards;
Sec. 1173A: Will “enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card.”;
Sec. 1173A: Also enables “electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice,” apparently giving the federal government direct access to bank accounts and the ability to make electronic transfers of funds.

So it continues, through nearly 1000 pages of text. The government will determine doctors’ salaries and no one can sue the government for price fixing. Private health care will be phased out; public health care will become mandatory.

Special needs people will receive restricted care. There are provisions for mandatory “end of life” resources…and “end of life” orders, whatever that means.

If passed, the government will create additional bureaucracies to regulate everything from the rental and purchase of power driven wheelchairs to cancer treatments. Hospital expansion, so-called “preventable readmissions,” Community Based Home Medical Services, Marriage & Family therapy, mental health services all fall under the government’s purview.

All of which is utterly reasonable…in a totalitarian state.

Stephanie Block is the editor of the New Mexico-based Los Pequenos newspaper and a founder of the Catholic Media Coalition.