The American Spectator

The Right Prescription

All advocates of socialized medicine, including the President and his congressional accomplices, believe that government-imposed rationing is necessary to control health care costs. Having little faith in the judgment of individual patients and even less in the workings of the market, they are convinced that only the state is capable of efficiently allocating our medical resources. Very few of these people, however, have the courage of their convictions. With a few notable exceptions, they vehemently deny that they are for rationing. Indeed, as a matter of general strategy, they have done their best to exclude the "R" word from the reform debate. President Obama has gone so far as to explicitly to admonish his political allies "to avoid terms like 'rationing'" while promoting the Democrat health care agenda.

But, make no mistake about it, rationing will be an integral component of Obamacare. Last Sunday the President's budget chief admitted, "I'm not prepared to rule it out," when pressed for a straight answer on the issue. And another of Obama's advisors famously frets about the insistence of American physicians on doing "everything for the patient regardless of cost." Thus, stopping such costly interventions will be a primary mission of the "Federal Coordinating Council for Effectiveness Research," a new hive of health care apparatchiks created by the infamous "porkulus" bill. This new bureaucracy is intended to operate like its European counterparts, meaning that it will assign a monetary value to your life and deny your care if you contract a malady whose cost-of-treatment exceeds that amount.

If you are under the impression that it is impossible to calculate the value of a human life, you are obviously not a progressive policy expert or health care bureaucrat. This calculation, so elusive for philosophers and sages throughout the millennia, is child's play for such people. They have, in fact, already devised a formula for pricing out your life. It is called the "quality-adjusted-life-year" (QALY), and it assigns a numerical value to a year of life. A year of perfect health, for example, is given a value of 1.0 while a year of sub-optimum health is rated between 0 and 1. If you are confined to a wheelchair, a year of your life might be valued at half that of your ambulatory neighbor. If you are blind or deaf, you also score low. All that remains is to assign a specific dollar value to the QALY and, voilà, your life has a price tag.

Imagine, for a moment, what the harvest would have been had this soulless valuation system been applied throughout the West for the past three or four centuries. QALY would have rated John Milton, blind at the time he wrote Paradise Lost, at considerably less than 1. And the hearing-impaired Beethoven would have been lucky to score 0.5 on the QALY scale. For a more modern example, think of Stephen Hawking. Hawking is arguably the most gifted scientist since Isaac Newton, but QALY would value his life at very nearly zero. There would, however, have been winners in the life-rating lottery. The life of Ted Bundy, a good-looking, articulate young man in perfect physical health, would have been valued at a perfect 1.

And, lest you imagine that QALY is mere academic concept unlikely to be applied in the real world, it is already being used in countries burdened with socialized medicine. In Great Britain, for example, the National Institute for Health and Clinical Excellence (NICE) uses "cost per QALY" to determine if patients should receive expensive treatment or drugs. It was with this formula that NICE calculated the precise amount six months of an average Brit's life is worth. As the Wall Street Journal reports, "NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months." In other words, patients whose country has guaranteed them "free" health care are in some cases refused treatment because the incremental cost per additional QALY is too high.

Nonetheless, despite the obvious moral dubiousness of QALY, some progressive policy experts openly advocate its use in the United States. Princeton Bioethics Professor Peter Singer recommended this approach just last week in the New York Times Magazine: "If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S." Singer is untroubled that some severely ill patients will go without treatment simply because it is expensive: "A QALY approach may then lead us to give priority to helping others who are not so badly off and whose conditions are less expensive to treat." That the "badly off" patient may have been taxed all his life to support "universal" health care evidently has no meaning for the Professor.

Dr. Robert Wachter, Associate Chairman of the Department of Medicine at UC San Francisco, is likewise unconcerned about such "badly off" patients. Wachter writes at his blog that Singer's position would amount to mere common sense "in a society of grown-ups." In an apparent attempt to personify every "arrogant doctor" cliché known to man, Wachter pompously lectures his readers to the effect that government-imposed rationing is inevitable while heaping scorn on the Great Unwashed for daring to entertain alternative viewpoints: "Will the society that brings you Rush Limbaugh and Glenn Beck (or, I'm beginning to think, some of our Democratic representatives) deal with it in an effective, mature way? I truly doubt it."

Wachter, like many progressives, has a gift for unintentional irony. The real obstacle to an "effective" public discourse about rationing has nothing to do with talk radio hosts, television personalities, Blue Dog Democrats, or the immaturity of American society in general. It is, rather, the moral cowardice of the President and his allies in Congress that prevents a serious debate about rationing. If Barack Obama, Max Baucus, Nancy Pelosi, and the rest of their fellow travelers were honest, they would admit that they agree with Singer and Wachter. They would look us in the eye and tell us that the only way to control health care costs is for Washington to impose a Draconian rationing scheme that effectively puts a price on each of our heads.

Such a confession would certainly spark a vigorous national conversation. And this discussion would no doubt last until November of 2010, when the voters would give the Democrats the bum's rush they so richly deserve.

topics:
Health Care, Rationing