Op Ed: The government inevitably rations care

Op Ed: The government inevitably rations care

Posted: Wednesday, January 26, 2011 8:01 pm
By: Merrill Matthews, Special to The Press

Ohio, Wisconsin, Iowa, Kansas, Wyoming and Maine joined Florida and 19 other states in challenging President Obama’s health care law. This means that more than half the country – 26 states – has made it clear they want nothing to do with the overhaul.

And for good reason. These states recognize that ObamaCare will lead to widespread rationing and hurt American patients.

Consider Arizona’s recent decision to refuse seven kinds of transplant surgery under Medicaid, the state’s health insurance program for the poor.

While this transition could have been more incremental – some patients thought they were getting transplants, but were then rejected – the state’s decision wasn’t haphazard. It was based on evidence, which has been questioned by some, that these transplants had little chance of long-term success. Since the state’s decision, two patients have died and more may follow.

Liberals think they smell more than a little H-Y-P-O-C-R-I-S-Y. In what they perceive as a “gotcha moment,” they are asserting that it’s Arizona Republicans who have created “death panels,” not President Obama’s health care law.

But Arizona lawmakers’ efforts aren’t hypocritical; they demonstrate what critics of ObamaCare have been saying all along: When the government gets involved in health care, it will ration care.

It makes no difference whether Republicans or Democrats are in charge. ALL government-run health care is eventually rationed.

It may be rationed by setting a “global budget,” where the government determines how much it will spend on health care each year. That’s what countries like Canada and Great Britain do, which is the primary reason they spend so much less than us. Of course, there is nothing efficient or praiseworthy about setting an arbitrary spending level. It’s a very blunt hammer for controlling spending.

Health care can also be rationed through price controls. Imposing artificially low prices means that patients won’t have access to some medicines or doctors, which refuse to accept the price the government offers. Medicare, and especially Medicaid, exercise price controls regularly. 

And the government can to its various agencies like the Food and Drug Administration (FDA) to ration treatments by refusing to approve certain medicines. Take Avastin, the cutting-edge cancer drug, regularly prescribed for cancer of the colon, breasts, kidneys, lungs and brain. While not a cure, it’s highly effective at staving off cancer’s progression by cutting off blood flow to tumors. 

In December, though, the FDA revoked Avastin’s approval for treating breast cancer, despite strong clinical trials and impassioned pleas from women across the country. Though FDA officials deny it, many patients believe the decision was influenced by Avastin’s high price – about $8,000 per month. 

Once this decision becomes official, insurance providers – including Medicare and Medicaid – will almost surely drop their coverage of Avastin, leaving dying women to face the no-win choice of either paying out of pocket or facing cancer with one less treatment option.

All government-run or government-financed health care is rationed because politicians, with limited budgets, must make political trade-offs. More money for health care means less money for education or welfare or police services. 

The problem with the current unconfirmed head of Medicare and Medicaid, Dr. Donald Berwick, and so many other like-minded liberals is they have long operated as if all health care – whether government or privately funded – somehow comes under the government’s purview. And it will if ObamaCare is left to stand.

While reasonable people can disagree on whether Arizona made the right cuts, legislators were trying to balance the costs versus benefits. The FDA also makes the claim that it is balancing costs and benefits in its decisions. Maybe, but look for even more Avastin-type decisions in the future as the government realizes it can’t pay for all the health care it has promised.

Of course, some claim that private sector employers and health insurers also ration care. That’s true to an extent; insurers and employers don’t always cover things patients want or need, but that’s determined by contract, not government fiat. 

And employers – and often individuals who buy their own policies – can, and frequently do, switch plans or change insurers if they are dissatisfied. When the government is in charge, there may be few if any other options.

Everyone’s heart should go out to those poor patients and their families who found themselves caught on the wrong side of Arizona’s decision. When the government rations care someone always loses.

Conservatives and Republicans have opposed ObamaCare because it gives the government vast new control over the delivery and financing of health care, regardless of who is in charge. And when you do that you will get rationing, and you will, eventually, have “death panels” telling patients what they can and can’t have.

Editor’s note: Merrill Matthews is a resident scholar with the Institute for Policy Innovation in Dallas, Texas.

wcp 1/25/11


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