07.31.2009 0

Health Care Rationing: Its No Myth!

  • On: 08/21/2009 09:31:33
  • In: Health Care
  • By Victor Morawski

    I awoke one morning last week, as I often do, with my clock radio playing The Wall Street Journal Report. A representative of the AARP was being interviewed. When asked whether his organization had concerns about rationing of health care to senior citizens, he assured the reporter that rationing is just a myth being perpetrated by the opponents of health care reform.

    This, of course, does not fit other analyses I have read on the issue. Nor, I might add, does it fit the truth. Reading the bill carefully (something one or two members of Congress might consider doing) makes it clear to me that, if a public option is out there, health care rationing is no myth. And senior citizens better beware.

    Rationing decisions, like those made within Britain’s National Health Service, are made within a system that both guides and ethically justifies them. So, let’s take a quick look at two such rationing systems. The first is currently in use in Great Britain and was recently defended by Obama Health Care Team member Dr. Peter Singer. The second was proposed by Dr. Ezekiel Emanuel, Obama’s top health care advisors.

    What will become unmistakably clear is just how heavily these two systems are weighted against the interests of the elderly.

    1. The QALY System
    Peter Singer, in his New York Times Magazine article “Why We Must Ration Health Care” (July 19, 2009) has boldly claimed: “The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?”

    Now, one might think that the chief good promoted by health care is the saving of lives—a good that we could easily measure in terms of the number of lives saved. If this were so, then presumably saving the life of an 85-year-old would count as much as saving the life of a teenager, both reflecting an instance of a life saved.

    But this way of looking at things is “too crude” for both Singer and the British NHS [National Health Service] because it doesn’t reflect our basic intuition that the death of a teenager is a greater tragedy than the death of an 85-year-old. What government should really aim for, Singer and his ilk contend, is not saving lives, but life-years.

    If we save the life of a teenager who could normally be expected to live another 70 years then we have saved 70 life-years. On the other hand, if we save the life of an 85-year-old, who could normally be expected to live only another five years, then we have saved only five life-years. “That suggests,” says Singer, “that saving one teenager is equivalent to saving fourteen 85-year-olds.” A perspective, which obviously gives the elderly little chance when it comes to the allocation of health care Singer and Obama advocate.

    2. The Complete Lives System
    As chilling as Singers’s views are, those of top Obama health care advisor, Ezekial Emanuel, may be even more devastating. In a Lancet article entitled “Principles for allocation of scarce medical interventions” Emanuel proposes what he and his colleagues call “the complete lives system.”

    The only problem is: it empowers those in government to decide who lives and who dies by determining who is really living – or, could yet live — what they determine is a “complete life.” And by “complete,” they mean both the quality of life and the length of years.

    Emanuel and his co-authors concede that their system “prioritizes younger people who have not yet lived a complete life and will be unlikely to do so without aid.” And they make no apology for this. While some things might constitute ageism—treating the elderly “differently because of stereotypes or falsehoods”…“treating them differently because they have already had more life years” would not.

    So, there you have it. And so, really, does AARP – though they will likely never admit it. Both Barack Obama’s top health care advisor, Ezekiel Emanuel (who also happens to be the brother of Obama’s Chief of Staff) and one of his foremost Health Care Team members, Peter Singer, have come our foursquare for rationing health care. Perhaps the only silver lining for the elderly is that if the bill passes in its present form, you won’t have to worry about it – for long.

    Victor Morawski is a professor at Coppin State University and a Syndicated Writer for ALG’s Liberty Features.


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