Getting Philosophical Over Healthcare

Distressing to watch Obama's Presidency rapidly unravel over healthcare, and to see the Democrats' resolve dissolve in confusion.  The fault lies not in their policies but in their philosophies.  Wonkish reworking of the public option into co-ops will no longer disguise the philosophical morass that Obama got into in how he went about selling the bill. 

He started out selling us on the philosophy of Something For Nothing: we could expand coverage without raising taxes!  This ran afoul of the CBO's Trillion Dollar estimate of the cost of covering 5% more of the population, a mere third of the 47 million uninsured.  (Why so few?  The rest are either illegals, are in transition between jobs or are young and healthy who opt out.) 

He then tried the approach of Nothing Will Change: we could keep our current doctor, and health insurance if we wanted!  This ran afoul of simple reading of the bill, where it was clear any stumble (eg change jobs, require new coverage) would force you into the public option - even if you wanted your old insurance, you were precluded from continuing with it!

Now he is trapped in a philosophical debate over Who Controls My Life: 

if we need (say) a hip replacement, do we and our doctor get to decide or does the government?  Do we as Americans, the land of the free and the home of the brave, now allow faceless bureaucrats to control our very bodies? 

Make no mistake, the deterioration of support for his health reform is directly running in the shoals of personal freedom. This is now the battleground: will the government be able to decide what care is given, or will it remain a private matter between doctor and patient? 

The facile answer is always, we ration care now! What is different whether an insurance company or the government does it?  But this is sophistry, since an insurance company is not 'rationing'.  If the plan covers it, they have to pay.  This issue is usually raised in an indirect way, about insurance companies dropping people whose circumstances change, or raising premiums, or not being affordable in the first place.  We all have anecdotes of insurance companies acting badly, and this is exacerbated by employer-based health insurance, where the big companies are in cahoots with the insurance providers to limit costs, and only a small handful of plans get offered without much choice.  All valid issues that can be resolved with reform within the philosophical paradigm of personal freedom.  The bipartisan Wyden Plan is one such reform, and may be gaining support.  In contrast, if we have problems with the Public Option, we can never change it. Ever. Again.

How did Obama get from Something For Nothing to Taking Away Personal Liberty?  He got out maneuvered by of all people Sarah Palin, whose Death Panel facebook page captured the essence of the philosophical problem: to control costs, the government system will have to ration care, and as she put it:

And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

The Obama side when ballistic.  I doubt the rebuttals to her comment ever read her original piece. She was not talking of the 'end of life' counseling provision that many pundits said she was; she was talking about a philosophy of government healthcare to have to ration to control costs.  This is why so many got the story wrong.  How sad for example to see the Old Grey Lady drop an editorial on the front page (as if it were news) claiming no one had ever proposed death panels.  Their statement that "[t]here is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure" brought the philosophical challenge of who-decides-about-my-care front and center in the debate.  They began to backtrack on this storyline just a few days later.  They probably would never have run it in the first place if they had only read their own paper on the subject!  Just a few months earlier the New York Times had run a conversation with Obama which started with the story of his grandmother, who was terminally ill with cancer when she had an expensive hip replacement procedure so that she would not be bed-ridden for the last three to nine months of her life:

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

LEONHARDT: So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

Ah, there's the rub!  What is that 'independent group' and what powers does it have? In their own coverage of the Obama interview Peter Baker of the Times wrote this on May 1:

Some conservatives have cited Mr. Obama’s story to make the case that his plan to expand access to health care and reduce costs ultimately will result in rationing, of the kind that might have denied his grandmother the surgery unless she paid the bill on her own.

To me, Obama is laying out the intellectual case for health care rationing while acknowledging the potential human costs of such a policy,” wrote Matthew Continetti on the Web site of the Weekly Standard magazine. “He’s saying that,in order to contain costs, under a universal health care program his grandmother might have been denied that hip replacement, or forced to pay for it herself. This is the natural consequence of a universal policy, which would bankrupt the country without some form of rationing care.”

Amazingly such a panel has already been established - in the Stimulus Bill!  It granted $1.1B for a Council to make the hard decisions about rationing care.  In the terrible interview where Obama said to a questioner that maybe her grannie would have been better off taking the painkiller, he went on to say: 

[W]e want to use science, we want doctors and — and medical experts to be making decisions that all too often right now are driven by skewed policies, by out-dated means of reimbursement, or by insurance companies.

Hmmm, "medical experts".  Left out of the answer was the patient and her family.  Normally he is fairly careful in his answers, but he has dug himself a deep hole and will have a difficult time getting out of it.  It is clear he philosophically is NOT on the side of personal freedom but of a panel of experts.  We have seen where this leads: to the Orwellian-named panel of death in the British National Health System called NICE, which sets appallingly uncompassionate guidelines to refuse care and treatment to the needy in order to ration care that the national system finds it cannot afford to cover.  

(Doubt this?  Read this horror story. Think I am picking on the Brits?  Check out this coming fiasco in Canada.  Think it cannot happen here?  It appears to be already be happening over at the VA system, which just updated a pamphlet for vets dealing with end-of-life decisions. )

Maybe the very framework that started this reform movement - to somehow contain the increasing costs of healthcare - is itself the wrong place to start.  Like the Jesuit's Premise, it inevitably leads to panels of medical experts rationing care to contain costs.  While health spending as a percent of GDP has risen, consumer spending on essentials (food, housing, transport and healthcare) has been essentially flat for 60 years,  Maybe as costs of transport and food have dropped, we have decided to spend more on our health.  This is not a bad thing at all, given a paradigm of personal freedom.  

As discussed in a prior post, it is NOT total healthcare that has been spiraling out of control, but government healthcare, specifically medicare, which has grown on a per-patient spending level much faster than private healthcare.  It is difficult to find ANY area in which we would trust a government subsidized entitlement to contain costs better than a private market-based system.  When you add the risk of loss of personal freedom over our very bodies, it makes the direction of ObamaCare antithetical to American values. Time for a restart and a look at market-based solutions.