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At What Cost?

Original Article

Obamacare is now the law of the land. Because health care and wellness are such essential parts of our lives and our culture, America will never be the same.

For now, Obamacare preserves a private financing system—no public option. Nonetheless, it still represents a government takeover of healthcare. By eliminating risk assessment–and seizing control of benefit determinations—government bureaucrats will now choose winners and losers. Because we are all now ensconced in the same closed system, we each now have a direct financial stake in the health care received by every other one of us.

Government control is, by definition, intensely political. Politically powerful “in crowds” are rarely denied what they want, while “out crowds” may be excluded altogether. The same will be true in health care.

Canada is a vivid example, where terminal cancer patients are routinely refused life-extending chemotherapy by cost containment boards, while support is growing to fully fund IVF (recently allowed in Quebec) and abortions must be publicly paid.

The UK presents another disturbing look into our potential future. In the UK, the National Institute for Health and Clinical Excellence (NICE) imposes an explicitly utilitarian quality of life rationing, with the aged, for example, refused treatments available to younger people. Obamacare was written to establish a similar centralized federal oversight system.

Medically vulnerable patients should now be very afraid because the sheer heft of government–and the even greater weight of culture–are going to shift against them. Again, Europe provides the model. Some countries—Sweden, the UK, for example—are seriously considering or already beginning to limit health care to people with unhealthy lifestyles, smokers, the obese, and to those who are deemed to have a low quality of life, the elderly and those with cognitive impairments.

That same impetus will emerge and strengthen here as time passes. Because what happens medically to each of our neighbors will directly impact us, “suspect” classes–those who are expensive to “maintain”—will emerge and come to be perceived with a less compassionate and inclusive eye by the healthy and able bodied.

Indeed, public expectations about how to best care for seriously ill and disabled people will change, and a subtle idea will grow that they no longer really belong. This could lead to the “duty to die”—already under active debate in bioethics literature.

That trend has already started. In Oregon, Medicaid patients already have been denied life-extending chemotherapy based on cost, and offered assisted suicide as a substitute–not coincidentally–the far less expensive alternative.

Over the years, I think Obamacare will similarly fuel assisted suicide advocacy. After all, what “treatment” is less expensive than killing? Currently, the specter of HMOs subtly pushing the death option has helped keep the euthanasia monster at bay. But now, our societal costs will be reduced if expensive people kill themselves months or years before they would have otherwise died from serious illnesses, disabilities, or age-related morbidity. The old saying, “follow the money,” takes on a whole new meaning.

The nuts and bolts of this dehumanizing system will be created primarily outside the spotlight of representative democracy in the tens of thousands of pages of rules that will now be promulgated by federal bureaucrats to effectuate Obamacare—including the extent of abortion coverage required in insurance plans and which life-extending or sustaining treatments will be refused coverage. Those with the most input in this process will be so-called “stakeholders,” that is non profit groups that advocate for affected people. And that–along with the courts–is to where the brunt of the battle over the sanctity of life in health care will now shift.