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Will health care be rationed?

By Scott Tibbs, September 22, 2009

One of the most hotly debated facets of health care "reform" is end-of-life care. Sarah Palin stirred up a firestorm earlier this summer with a Facebook post where she talked about "death panels" set up be President Obama. (See Palin's follow-up posts here and here.) The problem is that end-of-life care is the proverbial elephant in the room that some are pretending not to notice. It is very expensive to take care of the dying, and that expense has led to legitimate concerns that if the government is paying for health care that there will be rationing of health care.

President Barack Obama reinforced those concerns with a strange answer after a woman told the story of her mother, who sought a pacemaker after one doctor declined to perform the surgery because of her age. A portion of President Obama's answer is below. (The full version is here.)

We're not gonna solve every difficult problem in terms of end of life care. A lot of that is going to have to be we as a culture and as a society starting to make better decisions within our own families and for ourselves. But what we can do is make sure that at least some of the waste that exists in the system that is not making anybody's mom better that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what, maybe this isn't gonna help. Maybe you're better off not having the surgery, but taking the painkiller.

This does not exactly soothe concerns that government will not be leaning toward rationing care. As Newt Gingrich points out, "with more than 25% of all Medicare costs generated in the last two months of life, government already has the motive to ration care to the elderly." Gingrich asks if we can trust that government will not ration care if we give them the power to do so. The answer to that question is an emphatic "no."

For all of the outrage over Palin's statement about "death panels", one thing that has been well documented is that other nations with government-run health care systems have rationed health care for the elderly and disabled. In fact, the BBC reports that "the British Medical Association wants the government to accept responsibility for rationing decisions and to consult the public over which treatments should be restricted on the NHS. This would require a national policy - at the moment health authorities make the decisions on drug rationing on an individual basis." The BBC reported that a survey of doctors found 20% "said they knew patients who had suffered harm as a result of rationing" and that over 5% knew of people who died because they were denied treatment.

There's little doubt that some of the rhetoric about health care reform - from both sides - has been a bit overheated. Dismissing all concerns about rationing out of hand and lumping those concerns in with the "kook fringe" doesn't enhance the argument, especially when you consider the track record of other government health plans, the incentive to cut costs and the stated concerns of many health care proponents - including President Obama himself - about the cost of our nation's health care system. Those concerns need to be addressed honestly and there needs to be a serious discussion of whether we can simply offer some sort of assistance to those in need instead of creating a new bureaucracy.

Can the health care system be improved? Yes. Some conservatives have discussed removing barriers to consumer choice in what insurance companies they may choose, as well as things like expanding medical savings accounts. Does it need to be improved with a huge power grab by the federal government? Is federal control going to give the best possible solution in a nation of over 300 million that stretches across the continent and has a large diversity within the population? I can't imagine that it would.