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It’s coming. Health care reform, Round II.
Republicans pledged to do it as part of their manifesto during the midterm election campaigns. And House Speaker John Boehner, less than a day after the elections, vowed that the GOP would “do everything we can to try to repeal this bill and replace it with common sense reforms to bring down the cost of health care.”
But why was this such a high priority? The lack of cost controls? Unfunded state mandates? Questions surrounding federal funding of abortions? Well, yes, but the go-to critique of health care reform can be summed up in one word:
Rationing.
Recently, as part of a response to the FDA revoking its approval for a late-stage breast cancer drug, several key Republicans criticized this kind of rationing, but set their sights on a much bigger target:
“Unfortunately, this is only just the beginning,” they continued. “The new health reform law — the so-called Patient Protection and Affordable Care Act — creates 159 new boards, commissions and agencies that will destroy the doctor-patient relationship and replace it with federal bureaucrats deciding who gets care and what treatments they can receive,” The Hill’s Jason Millman reported.
And the GOP will have backing in this effort from a pro-life Christian base crying out against ‘euthanasia’ and ‘death panels’ in the new health care law.
But this attitude refuses to admit two undeniable truths about human existence:
We have virtually unlimited health care needs. (All of us will die some day.)
We have limited health care resources. (There is a finite amount of ‘stuff’ out there.)
We will never not be rationing health care. Any other conclusion misunderstands the human condition.
Consider Indiana Medicaid and six-month old Seth Petreikis as a case in point. Without a very rare ‘thymus transplant’ Seth would die within a few months, but his family couldn’t afford the $500,000 price tag. At first, Indiana Medicaid called the treatment ‘experimental’ and denied their claim. But perhaps because of media and other social pressure, and also because the treatment (though not yet formally approved by the FDA) could hardly be called experimental given its 73% success rate, the procedure was eventually approved . Obviously the family was overjoyed:
“I got the call and when I heard her say it was approved, I just fell down on the floor crying,” said his mother Becky Petreikis, a Dyer resident. She called her husband, Tim, who was driving home from his job in Chicago, and shared the news with their 3-year-old daughter, Julia. “The phone’s been ringing off the hook,” she said.
Great, right? The cold, unfeeling government defeated in favor of the vulnerable and desperate child.
Well, not so fast. From an ethical point of view it’s more complicated.
Medicaid works from fixed budgets and the hundreds of thousands of dollars needed to perform this transplant are resources that now cannot be used to serve other Medicaid patients. Indiana has a budget crisis caused in large part by medical costs. Their need to cut Medicaid is so great that they are even telling parents of disabled children that Medicaid funding is no longer an option–and perhaps they should leave their children at a homeless shelter if they cannot care for them at home. Indeed, states all over the country are scrambling to cut Medicaid costs–Arizona also recently made headlines by refusing to fund life-saving transplants. Physicians’ flight from Medicaid patients, already problematic because of poor reimbursement rates, will only get worse with the new health care plan.
Attempting to escape health care rationing has exactly the same chance of happening as we have of escaping the finite nature of our resources and, indeed, of our very being.
None.
Sadly, the effort that many Christians are leading against rationing misunderstands what it means to be pro-life in a fallen world riddled with tragedy. We should never, ever claim that any human being is of ‘less worth’ than another, nor should we ever directly aim at the death of an innocent human person. But neither should we engage in self-deception about the kind of world in which we live. Instead of pretending that this tragic, fallen state of affairs does not exist, Christians should be among the best at bravely attempting to face its reality. We should be able to recognize the false idol present in the consumerist mantra that we can have as much as we want of whatever we want. And we should soundly reject it.
We live in a fallen world–one riddled with tragedy. But in the interests of justice we must have the courage to make the difficult and even heart-breaking choices such a world requires.
Charles C. Camosy is Assistant Professor of Christian Ethics at Fordham University in the Bronx, New York and is author of Too Expensive to Treat? with Wm. B. Eerdmans Press.
Categories: Uncategorized
Good points.
This is the first thing the Nazis did. They rationalized not providing medicine to certain very sick people. Then they did the same with the retarded. Then went the criminally insane. Then wen the disturbed. The elderly followed. Certain “lesser” children followed them. Read a little bit about the T4 program.
Humans are not rational or logical beings. Once we instate a principle–that it is ok to deny a benefit for some–it is not uncommon for a recursive and iterative process to take place, extending the rationale beyond its original intentions. This is especially the case when a country is broke.
Be careful–we all get sick, we all get old, and we all die. Anyone of us could be the person denied life.
I cannot even pretend to any expertise in medical ethics,
What I can question, however, is whether some of the ‘super-expensive procedures’ really need to be so expensive.
What if we had price controls on drugs with no substitutes (like other industrial nations).? Then a cancer drug or an anti-rejection drug would not cost $1,000 a day. The cost of a transplant could be cut by up to
$200,000 right away.
What if a patient who needed 60 days in the hospital could be housed in an empty bed in the VA system? (which the government has already paid for) That would cut the cost of a transplant by another $200,000.
Even with these strictures, transplants would not be cheap.
But the residual funding from government and/or charitable grants would not be so incredibly difficult.
In so many aspects of medicine, we tend to assume that the price is actually the cost.
Instead, the price is often an ugly stab in the dark, based on a testing of what insurers are willing to pay. The real cost may be much, much lower.
Bob Hertz
Director, The Health Care Crusade
Let’s be careful about lumping millions of people together like this. I’m Roman Catholic, but I sit on the advisory board for this wonderful group of evangelical Christians:
http://www.newevangelicalpartnership.org/
“What would be your proven solution absent government intervention?”
If you listen to evangelicals, Christians don’t need medical care, they just need to pray more (and send donations for the healthcare plans of their leaders) and all their problems will go away. Pat Robertson would say that if you get sick it’s God’s message that you aren’t being a good Christian.
We do not have a scarcity of resources in health care.
There are plenty of doctors, more than enough hospitals, plenty of drugs and devices, too many MRI machines and it seems that half of the glass building in my town are Orthopedic Centers.
We are just being gouged when it comes time to purchase services from these resources, because other than directly, and rather nicely, supporting those who provide actual services, we also have to pay to a bewildering array of middlemen who contribute very little to actual medical care delivery, and everything is market up by orders of magnitude.
People have no idea what prices are and costs are never even mentioned. Prices are set in complete secrecy based on negotiations that have nothing to do with the product being sold and the only translation available for consumers is changes in price of insurance for buying those services in bulk, which seem to rise almost independent of estimated cost increases.
I guess for a very long time, those profiting from medical care delivery figured that people would pay inordinate amounts of money for “life saving” services. They had a perfect racket.
As long as the economy was growing and as long as people were making increasingly more money and as long as the purveyors of medical care did not go completely overboard, it all worked just fine, for most people.
The problem occurred once the bulk of Americans started getting poorer and the economy took a few turns for the worst, while the “healthcare industry”, oblivious to its surroundings, insisted on its historical entitlement to extract ever increasing fortunes from the populace.
While resources are still plentiful, it turns out that we don’t have the money to buy them. So what is it that you want to “ration”? Money to feed the “industry” beast?
And a powerful beast it is, seeing how people are willing to convince themselves that letting a few poverty stricken people die just so that the “industry” keeps its corporate profits growing, is actually the moral and ethical thing to do.
@tim- Yet you ignore the other side of the issue. Even a cursory reading of the New Testament illustrates the importance Christ placed upon caring for the needy, including the sick. What would be your proven solution absent government intervention? If one is truly a Christian, one should honestly answer that question. I dont think it suffices to assume that they will just somehow get care. Our history suggests that is no the case.
Steve
Can’t see where your arguments are connected.
“Rationing is done where supply is limited in order to keep prices artificially low.”
Like WWII where it was done actually because there was scarcity of resources needed elsewhere and price had nothing to do about it – just ensuring supply and fairness of distribution – cause we’re all in this together. During water shortages is rationing designed to keep prices low?
“Traditional economists argue that high prices act to reduce waste of the scarce resource.”
Like healthcare? Show me where this is happening in U.S. healthcare? High prices keep access limited so wealthy people, or those politically subsidized, can have unlimited supply and waste at will. High prices also attract producers/suppliers to provide as much supply as those able to pay can purchase.
Don’t try to include any economic traditional reasoning to healthcare, for the most part it doesn’t work.
Per Tim, sums it up fairly well for me!
Just like the Tucson incident, per the Democraps/liberal dialogue of late, don’t talk politics on our terms, you are stoking the fires of hate and injustice!
In other words, just do as we say, not as we do.
This is the kind of mentality you want health care decisions based on? Again, anyone saying yes, you deserve the representation you seek and embrace. And that is not just aimed at Democraps, but equally to Repugnocants as well!
Any political legislation to manage health care needs non political input. Comeon, who provided that to the Democrats in ’09? Any takers to that question?
I love it. A theological argument for government programs.
Jesus’ injunction to “love your neighbor as yourself” gets mutated, in the hands of the Left, into “happily send more money to government officials you’ll never know so they can give part of it to people you’ll never know (and waste the rest), using rules you’ll never completely understand and can’t influence anyway…and if you resist all this, by argument or vote, you are not a Christian, you are evil and greedy.”
Uh, no.
Wow,
Religion, politics and health care all together in one furry ball. I am glad this isn’t a cocktail party! Maybe the debate should exclude one from the other.
If I might just weigh in on one point, I really don’t think we need to add “rationing” to Death and Taxes as being the only things certain in life.
Rationing is done where supply is limited in order to keep prices artificially low. Traditional economists argue that high prices act to reduce waste of the scarce resource. Examples of real rationing include; rationing of ventilators in NY State during a flu pandemic, dialysis machines between 1962-67, and iron lungs for polio in the 1940s. All examples of limited supply.
Absent a lack of supply, you are using the wrong terms to describe economic underfunding of access in many of these examples.
My thoughts are with BobbyG and his family.
The Ratings Guy
We’ll always have rationing of the “other guy” as long as we are not all included in the same health care payment/benefit plan. That’s why there is so much opposition to healthcare reform because we want someone else rationed, not us.
This is a very good article and discussion. Patients do need to be held personally responsible for their deleterious behavior. Third-party diversion of funds does need to be stopped. Physicians are responsible for providing quality care. We have far more needs/wants than we do resources. We already ration health care. We do it by social class. The rich get it, the poor don’t. How we ration needs to change to a more egalitarian method.
What reality are you living in, Ms G-A? Your argument is foolish, turning it solely on the role of ending profit to free up “resources” to then provide all these services to make care ration-free. Nothing is infinite, and that is why arguments like yours are just annoying in the end.
Considerate yet empty or unrealistic promises are not better than lies and deceit. Let’s sell the realistic message about the health care debacle that is US health care as of 2010: it is the combination of responsible patient actions, invested and involved providers and other health care supports, accountable insurance and medical/pharmaceutical companies, involved but not intrusive state and federal political boundaries, level headed families/sig others, balanced media reporting, and most important, appropriate expectations about the boundaries of life, that can make a difference for some better for US citizens!
You want to spend a million dollars to save one life, something or someone else will have to be expendable to meet that cost. If you have your own dollar printing press, then start printing out them bills, dear. Just hope you have the gold reserve as collateral for your paper!!!
but since private individuals have not stepped up and come through for dozens of millions of the most vulnerable in the United States, it seems like government is the only place to turn to protect them.
Who are these dozens of millions? There are dozens of millions that take help they don’t need. The number of people that truly need help is actually pretty small, unfortunetly for political reasons we have programs that help the politicians not those in need.
I’m surious do you accept there is a difference between opposing rationing and opposing government rationing? Can you link to any examples of christians opposing rationing versus the logical oppostition to government rationing?
I’m with Margalit on her above points.
“How can you say we will never not be rationing health care…especially as we fall all over ourselves to cut Medicaid and try to cover the dozens of millions that private insurance excludes?”
Charlie, I am not saying “never”. I am saying that before we start rationing health care, we should stop throwing health care money down the “for-profit” drain. It is not fair to cut $1.4M dollar in transplants that may very well lead to the death of 100 people, citing “finite resources”, while allowing hospitals, insurers and others to walk away with “profits”.
The way I see it, every penny going into the health care pot should be used for health care proper.
My late daughter was denied waiting-list consideration for a liver transplant in 1996 which might well have saved her life and “cured” her. She had hepatoma (primary liver cancer) caused by her congenital hepatitis-B. Arguing for it was her relatively young age (28 at the time), no comorbidities, and her gym-rat fitness level, and the fact that removing what remained of her original liver would exise the Hbv along with it, replacing it with a “clean” one. Arguing against it (the successful argument, as it were) was her post-hepatoma surgery newly ascendent serum alpha-feto-protein (AFP) level, indicative of hep cells loose in her lymphatic system, with mets surely to follow (they did).
Bascially, “this kid is gonna die anyway; we’re not gonna waste a perfectly good liver on her.”
It wasn’t directly about money (California otherwise gave her a relentless Five Star effort from day one through her death 26 months later, notwithstanding her indigent Medi-Cal status).
It was all very frank and realistic. We understood.
But we have a virtually unlimited number of health care procedures which can attempt to fix things that are wrong with the human body…especially as we age and as we get closer to death. We obviously have limited health care resources…and they become even more radically limited when we think of other goods against which they must be weighed (education, defense, food, energy, etc.). How can you say we will never not be rationing health care…especially as we fall all over ourselves to cut Medicaid and try to cover the dozens of millions that private insurance excludes?
Hi Charlie,
I was not pressed for time, but I guess I missed the subtlety of virtually unlimited as opposed to plain unlimited. Keeping several organs functioning for a significant amount of time (not indefinitely), does not translate (in my book) to keeping the owner of those organs alive for an equal amount of time, and in any case this exercise does not fall under the health care rubric (more like assault, as Dr. Berwick points out). Therefore, it is the following sentence that I take issue with: “We will never not be rationing health care.”
As to Christianity, the article is geared towards a particular religion, but instead of getting into these types of arguments, I’d rather concede the point and assume going forward that the content applies to people in general.
Margalit, my post never mentions either (1) limiting the argument to Christians or (2) that Christians are better able to grasp reality. I also claimed that we have “virtually” infinite needs (we can now keep many patients alive almost indefinitely, just to name one of many examples that makes my point), not infinite.
Were you pressed for time such that you couldn’t read as carefully as you might otherwise have?
Well said Margalit Well said!
“Christians should have a better grasp of its reality than most curently do”
How is this requirement limited to Christians? Or perhaps Christianity supposedly endows one with better ability to grasp reality?
The superfluous Christianity reference notwithstanding, I am not convinced that we must ration health care. Yes, resources are finite, but needs are finite too precisely because we all die one day, i.e. have finite need for resources.
When tallying resources in one column and needs in the other, it seems to me that the “needs” column includes things that should not be there, such as corporate profits, shareholder dividends, excessive real estate, personal incomes that defy common sense, useless and unneeded services piled up on unsuspecting people either for fear of possible litigation, or just to make an extra buck, purposely built-in inefficiencies and plain fraud.
Get rid of all these and compare resources to needs one more time. If we still come up short on resources, we can discuss rationing. Anything short of this would be immoral and probably not very Christian either.
Health Care the Christain Great Crusade! The mission to ration care to only its elitists members? Becoming Christains now have perks? Should we Believe that They Know all things? We should follow them like other believers of faith,who participated in the massacres of the Great Crusades? No! I Think Not! However,Is it really about faith anymore? Have christians just bought into power, influence, and greed? I think they just may have a world domination Complex!
You can ask yourself, What would Jesus Do? Certainly not what these people proclaim should be done!
I would say that they are a misguided group like the pharisees and the saducees of ancient times.
I don’t care of what is thought of me and I not being critical of the faith. However,I’m being critical of Human Judgement.
DeterminedMD, I’m raising this as a religious issue only in the sense that Christians should have a better grasp of its reality than most curently do.
Erik, I’m not sure it follows from the argument I make above, but I do my ethics research within a Roman Catholic tradition which demands that the community (insofar as it is able) provide for the basic health care needs of its members. Ideally, I think this should be private individuals supporting things like free clinics; but since private individuals have not stepped up and come through for dozens of millions of the most vulnerable in the United States, it seems like government is the only place to turn to protect them.
Charles, well put.
I remember Obama’s plea about Healthcare reform- he mentioned it’s about who we are.
While the bill may do nothing to reduce costs directly, question of societal responsibility writs large.
I doubt this will ever get debated on religious ground, but it would have been nice. Once debate hits question of priorities, truth gets exposed.
There is one new thing in human being that I believe didn’t exist at time of religion founders- ability to screen out inconvenient facts and ideas that contradict one’s cherished or practiced ideals or show them in poor light. Your article will be mentally screened out too as will be my post.
Ms. Giffords was covered by government provided health insurance. None of the other wounded were left to lie/die on the sidewalk until their insurance coverage was determined (thankfully). If any was uninsured, who will cover their medical bills? If I am going to have any part of paying for an uninsured person’s care, I want it to be up front in the form of taxes and not hidden in the form of inflated insurance premiums or higher hospital/medical costs. We all need coverage!
This commentary makes sense to me, per the rationing issue. It is nothing less than amazing and incredulous how everyone is so ready to spend other people’s money, but when you have to turn to your wallet, the rules and expectations change, eh?!
God forbid should the shooter yesterday was not able to access mental health services if he had tried to use them, we will hear how someone else dropped the ball and the “system failed us (society) yet again”. And yet how convenient the services most susceptable to being nickeled and dimed to minimal support prior to this legislative intrusion has been mental health care!
And wait, you think this legislation will prioritize mental health care needs? Think again! Historically, those with mental health disorders are the first to be sacrificed in societies, case in point was Nazi Germany, look it up if you don’t believe me.
I just don’t get why the author made this a religious issue.
Hypocrisy does not have boundaries, be it gender, race, class, religion, or income!!!
We ration now by price, and marketing. That does not seem very Christ-like.
Steve
A very cogent argument for ethically/morally guided rationing in our world of limited resources. It probably won’t “convert” anyone, but it does lend articulate support to those of us in Ethics Committees that help patients and providers deal with these dilemmas on a regular basis.
A tag line could be, “The poor will always be with us, … and also will be the poor-in-health, so lets deal with it humanely without political rhetoric.”
Dr. Camosy,
With your current argument in mind: Should Christians support universal health care?
None of this is exactly news. To wit:
“Moral absolutism has powerfully emotive appeal. Easy as it may be to reject in the abstract, moral absolutism remains difficult to reject in practice. Indeed, the persistent power of absolutist beliefs in the face of unending escalation of health care costs is the most striking moral phenomenon of health law policy in the past quarter-century.”
“Nonetheless, moral absolutism is wholly untenable as a societal system of resource allocation. Most knowledgeable observers believe we could today easily spend 100% of our GNP on health care without running out of services that would provide some positive health benefit to some patient. Surely, the most committed moralist must concede that, if these observers are empirically correct, some health care must be denied even though it has a beneficial effect. Otherwise, the extreme a moral vision would require that we fund health care even if that means starving ourselves to death. And once the moralist makes this concession, she acknowledges that at some point trade-offs must be made and that thus the moral principle is not in fact absolute. The moral question then becomes aware, rather than whether, trade-offs are appropriate.” [“Allocating Health Care Morally,” Einer Elhauge, 1994, p. 1459]
Also, the observations of my mentor Dr. Brent James during the opening session of our 1995 company-wide CQI training:
‘Dr. James opens with a cautionary admonishment; basically that fastidious devotion to CQI, while undeniably necessary and intrinsically worthy, will not of itself resolve the larger socioeconomic issues surrounding health care. “Delivering optimal, healing/curative treatment today only serves to ironically assure that you will likely face an older, sicker and much more expensive-to-treat patient in the future, and we will inevitably continue to face serious ethical social choices that go far beyond the clinical”.’
http://bgladd.blogspot.com/2009/05/us-health-care-policy-morass.html