30 November 2011

Obamacare Elderly Rationing--It's Not Brain Surgery

Recently, while at a social gathering with people from various walks of life, the topic of Obamacare came up.  One of the interlocutors was a liberally oriented health care worker at Walter Reed Army hospital.  She seemed anxious to quell concerns about government run health care by pretending to listen to objections to Obamacare and then ambushing her policy foes with the shining case of the Hawaiian State Health Care Mandate.

The Hawaiian paradigm is an interesting example, except that private insurers can still compete and the state government offers generous but not necessarily strictly mandated policy coverage.  Arguments against Obamacare often get stuck on the question of the constitutionality of the federal government mandating citizens engaging in commerce.  Obamacare is said to be modeled on Romneycare in Massachusetts but the health mandate can properly be a state power.

Another objection to Obamacare is a decline in quality care because of rationing.  Former Governor Sarah Palin (R-AK) called the perilous cost benefit analysis for the elderly as “Death Panels” which earned her a great deal of derision from the liberal intelligentsia.  The Walter Reed therapist attacked the characterization of “Death Panels” but noted that spiraling costs had to be contained for the last 18 months of life.

It was a pleasure to chat with a well informed ideological opponent about health care, so I enquired if medical research had dictated the change in mammography guidelines for women under 50.  She stammered and said that she had not read anything in medical journals but that was not her area of practice.  I recalled that an HHS preventative care government panel recommended against mammographies for women between 40 and 49 because it lead to false alarms and unnecessary biopsies. I noted that  HHS also downplayed the importance of self exams for women and recommended women get breast exams every other year. These changes seemed suspect since breast cancer is the 2nd highest cancer killer among women, thus I asked someone in the health field how the science changed. I suggested that the government panel of doctors and scientists might be anticipating rationing regime. Of course, the change in government guidelines gives the go ahead for private insurers to stop coverage for unnecessary treatment. She scoffed that I dared think that health policies might be driven by politics and quickly ended the healthy dialogue.

Now a brain surgeon who called into the Mark Levin Show revealed that Obamacare has language that if someone are over 70 years old and on government supported health care and required neurosurgery, they would only qualify for “comfort care” and not neurosurgery. Hospitals would not have difficult cases decided by ethics panels but actually administrators with their eye on the bottom line. Basically, this translates to rationing by death panels.

This issue of dictating comfort care for bleeding on the brain for those over 70 strikes close to home. A loved one had two episodes in a week of bleeding on the brain where he had to be rushed to a hospital. But between access to outstanding teaching hospitals and presumably Medicare supplement, he is living a vibrant and engaged life. It would be tragic to have a government bean counter arbitrarily overrule good medical practice in saving lives to just sling out comfort care.

Granted, costs for the last years of life can be costly and a government which is spending our grandchildren’s inheritance needs to find better ways of containing costs.  Nearly two decades ago, P.J. O’Rourke quipped “If you think that health care is too expensive now, wait until you see what it costs when it’s free.”   I would hate for the cost to be arbitrary rationing which dictates comfort care for those deemed superannuated. The next thing you know, government guidelines will prescribe a Life Carousel for renewal ala Logan’s Run.

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