Writing in the pages of the Wall Street Journal (8/4/09) Laura Landro raises the question of how to make ever more complex health decisions when faced with multiple options, each with no clear advantage. According to Ms. Landro this decision making process involves coaching, consultation with a physician and the education of the patients.
As I see it, this recommendation makes eminent sense. Weighty healthcare matters should involve research, conversation and an assessment of risks and benefits. But as I was reading this article, it occurred to me that with Obamacare, or the bill being considered in the Congress, the personal deliberation and consultation would not be possible.
Although the president is quite right in his desire to eliminate waste in healthcare expenditures, he seemingly overlooks the personal decision making that undergirds the existing system and creates a remarkable level of assurance for the American people.
With Obamacare a council or a bureaucrat relying on a computer program will determine the appropriate level of care. If an eighty year old, for example, needs a hip replacement, the bureaucrat is likely to argue that a tin joint as opposed to a titanium joint is appropriate since the person only has a few years left based on actuarial expectations. Or if an eighty year old has cancer an advisory council might suggest that aggressive and expensive radiation treatment doesn’t make sense since that person doesn’t have long to live whatever the treatment.
This is ostensibly a rationing and triage system that determines who is treated and what kind of treatment is appropriate. The word “appropriate” is what is critical. Rather than the best care, the word appropriate is widely employed by members of the administration.
It is instructive that in countries that have a single payer system in which the government makes healthcare decisions, the death rate for those suffering from cancer and heart disease is higher than the United States. This isn’t coincidental. If one is obliged to wait for months to see a physician or is denied care because it is deemed too expensive for someone near the end of life, death through inattention is the likely result.
It is equally instructive that Canadian residents with resources don’t wait on the public queue for care, they travel to the United States and visit physicians here. Of course that may not be possible if the Obama bill becomes law. But it is odd that this administration is intent on altering the healthcare system most people in the world regard as foremost. Yes, it is expensive, but it is understandable that an affluent society would spend large sums on healthcare.
The arcane assessment of healthcare finances misses a point that Ms. Landro’s article makes. Flushing out unnecessary expenditures comes at the price of restricting personal freedom to choose. That is the argument the Obama team seems to ignore and frankly, it is the argument Republicans seem incapable of making.
For a nation that has put a value on liberty, the idea that the government will determine the nature of healthcare is unacceptable on any level, if only the public appreciated the fact this is the intent of the legislation. Perhaps in this recess period before Congress is back in session, this bill will be fully parsed. Without major changes, healthcare will change and despite President Obama’s assurance that this is the change the public has been waiting for, it will be the change most Americans abhor.
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