The End-of-Life Rigmarole

Sometimes I almost believe that the right-wing critics of Obama healthcare "reform" are moles working for Obama. Take the end-of-life controversy. There is nothing in the House bill that would require Medicare recipients to have end-of-life counseling, much less submit to some kind of euthanasia process. All I can find is a requirement that Medicare pay for end-of-life counseling if requested. Not that I like this; I don't want government anywhere near medical care or end-of-life decisionmaking. But nothing is imposed on the elderly. (By the way NBC reported tonight that this provision has been dropped from the House bill.)

Correction: It's the Senate Finance Committee that has removed the provision from its bill.

Here's why I almost believe the right-wing critics are moles: By raising the phony "death panel" claim, Palin, Gingrich, Limbaugh, Beck and the others have taken everyone's eye on the ball. Defenders of Obama's scheme had an easy time demolishing the inventions of the right-wing simpletons, enabling Obama defenders to evade the real problem with"reform," which continues to fly under the radar.

The problem is not that the bill calls for death panels--it doesn't. The problem is that the expansion of medical coverage by government decree and taxpayer subsidy, along with a determination to keep prices from rising, logically requires rationing of medical services. How else can you expand demand without raising costs? Through government efficiency? Get real. (Price controls would lead to shortages and then rationing.)

With rationing the government would decide how medical resources would be distributed. Bureaucrats would have to make choices, and they'd have to have standards by which to make those choices. Is it outlandish to suggest that they would want to divert scarce resources from people who are near the end of life and with little chance of recovery to those who are not? This wouldn't be euthanasia; but it might well be a refusal to pay for some medical procedures for older people. It might even include a prohibition on paying for services privately. (The alternative to rationing is bankruptcy, to which Medicare has already put us on the path.)

Obama has already said he wants Medicare to pay for the value not volume of services. Value to whom?

Instead of conjuring up phantom death panels and compulsory counseling, the right wing should have been demanding that the defenders of "reform" explain how they can avoid rationing if they are serious about pumping up demand without pumping up prices. They should have been using their access to the media to point out that rationing in an inevitable implication of a government limit on total healthcare spending.

Maybe some advocates of "reform" really haven't thought about this. Maybe they believe that somehow costs can be controlled without rationing and bureaucratic triage. (This can't be said about others, such as Peter Singer.) But their premises logically commit them to rationing whether they know it or not and whether they like it or not.

By the way, do not accept the glib comeback that the market rations too, only by price. As I point out here, the market does not ration. The market is not a conscious, decision-making entity. It's a process in which people exchange money for goods and services, and vice versa. That is not rationing. Economists talk about markets rationing, but that is only a metaphor. Our choice is between rationing by bureaucrats (including insurance clerks empowered by government tax policy) and individual self-determination through free exchange.