Health care rationing is bound to come
Critics of Obamacare have charged that the government-regulated program will lead to the rationing of health care, especially for senior citizens, which is vehemently denied by its supporters. It is not necessary to examine in detail the 2000-plus-page legislation to resolve the matter. Rather, some reflection on the nature of the new government service, and the experience of other countries with similar systems, is sufficient.
According to the viewpoint of the bill’s supporters, the costs of health care are out of control, while people are being denied insurance coverage, because private corporations are making huge profits. Meanwhile, government programs, such as Medicare and Medicaid, lack sufficient funding and are ripped off by health care providers charging exorbitant fees for their goods and services. As Nancy Pelosi, Speaker of the House of Representatives, so tersely put it during the congressional debate, the present system is “unsustainable.” Whether that represents insight or rationalization on her part is the question.
The Affordable Care Act has established a vast new government entitlement program, which, like all such programs, is subject primarily to two difficulties: cost overruns and rationing. Carrying a conservative price tag of approximately one trillion dollars for the next decade, Obamacare dwarfs existing health care programs, which are already facing severe pressures. Medicare recipients grow in number each year not only due to a regular cycle of retirements but a long trend toward early retirements. Impartial reviews predict that the program will be insolvent by 2017, requiring drastic changes in eligibility or severe cutbacks.
Supporters of Obamacare say its huge outlays could be financed by cuts to Medicare, primarily by reducing payments to providers. Last week, I contended that glowing promises of “improvements” to Medicare would be made possible by cutting back, perhaps completely, on Medicare Advantage, which enables seniors to deal with a private insurance company rather than the federal bureaucracy. Considering that private comprehensive health insurance plans cost as much as five times more than Medicare, that is a serious threat to all but the wealthiest citizens.
Among the improvements promised are “support” for community health centers (how is not specified) and an increase in the number of primary care medical personnel. That’s putting a pretty face on increased resort to so-called Original Medicare with its bureaucratized routines at the expense of the much-disparaged Medicare Advantage.
Additionally, by imposing expensive requirements on private companies, such as covering persons with pre-existing conditions or including children up to the age of 26, Obama Care will force these companies out of business and their clients into government programs, virtually guaranteeing that costs will rise in both new and existing government programs.
As to rationing, Canada and the United Kingdom have socialized medicine in which arbitrary limits on health care are imposed as a matter of course. Not only are citizens of those countries denied coverage for illnesses considered untreatable or remedies deemed unnecessary, they are forbidden to seek care outside the government system because that would give them an “unfair” advantage. Of course, many of them travel to the United States where private health care is readily available, at least for now.
Rep. Pelosi was at least partly right when she said that our current situation is “unsustainable,” though not for the reasons she gave. Government now dominates the health care field with Medicare, Medicaid and a recently expanded program (SCHIP) that covers the gap between the poor and the middle class. Add to this the state programs. There is no market discipline in health care as we all seek care based only on its desirability rather than its affordability. In other words, as long as someone else is paying for it, we don’t worry about it.
All government-run programs here and abroad are running out of money, causing budget crunches and political anguish. Barring a retreat from such expansive plans, rationing is inevitable. As Burke Balch of the National Right to Life Committee so succinctly put it, “Overpromising plus underfunding forces rationing.” Following the state of Massachusetts, the federal government will unavoidably have a system where everyone will have equally poor care. President Obama has called it “bending the cost curve.”
Critics of Obamacare were severely attacked for using allegedly overheated rhetoric such as “death panels.” But given the fact that an 18-member Independent Payment Advisory Board will be established to set “quality and efficiency” standards that doctors will be forced to follow after 2015, that rhetoric does not appear to be so overheated after all. The critics’ current “overheated” term is repeal.
ABOUT THE WRITER
Richard Reeb taught political science, philosophy and journalism at Barstow College from 1970 to 2003. He is the author of “ Taking Journalism Seriously: ‘Objectivity’ as a Partisan Cause” (University Press of America, 1999). He can be contacted at rhreeb@verizon.net.
