re: #833 Last Turnip

Obama: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80% of the total health care bill out here.

Leonhardt: So how do you—how do we deal with it?

Obama: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

So Obama says that there will be a “conversation” that is “guided” by experts, that “the country making those decisions” and then he says the experts guidance will not be “determinative.” Troubling here is that he first says that the decision (about life or death) will be made by “the country” and then he vaguely implies that the decision is “yours”. But is this the royal “you — the country” or “you-the idividual”.

No wonder people are wondering what he actually means, since he says it three ways: (1) The country decides, (2) the experts guide the country, (3) the experts guide you and you decide (where we cannot be sure who “you” is, is it “me” or is it “the country”.

It is horrible… and a perfect illustration of the social engineers’ outlook. To someone like Obama, citizens’ lives are interchangeable pegs whose aggregate benefit is the only relevant concern. He will make sure he optimizes the distribution of health-care resources so that they be spread as evenly as possible across as big a pool as possible, but only your young/productive years will be prioritized. Once you start actually needing intensive health-care in your later years, Obama’s team of ethicists, scientists, and actuaries, will cut (or drastically restrict) the lifeline because, you know, those resources you are wasting while chronically ill or elderly, could be more productively employed toward extending someone else’s youth. See, it’s about the greater happiness for the greatest number of people—utilitarianism reduced to its basics. And the optimization of this abstract function is, of course, to be implemented by the aforementioned “experts.” As if having a philosophy degree authorizes an “ethicist” to dictate to someone else how much care they deserve.

How this rationing by utilitarian calculus will be implemented is not through “death panels” though, but through comparative effectiveness research, which Dr. Emanuel and Dr. Blumenthal (two of the top architects of the bill) have pushed hard for the introduction of.

Some rationing is inevitable under the present conditions of medical technology: e.g. we cannot clone organs yet so people who need organ transplants must wait for a donor, whose organs, unless s/he has specified a recipient for them, will be assigned by a medical committee that takes into account the potential recipient’s age and health. This makes perfect sense when rationing scarce resources provided by nature, to which no one in particular is entitled. But when we’re talking about standard human-provided care, it’s a different story. How about it — if I want to save throughout my life so I can afford to take care of myself while old? That’s what private insurance does. It doesn’t ask “do you deserve care at your age and specific medical condition” but rather “can you afford it?” People who do, have a right to be provided vital care at any stage in life.