A Brief History…

The chart above is a suggestion for allocation of medical resources by age. It make clear, as does this article, that rationing is at the bottom of Obama’s plans for health reform, at least those that involve cost savings. Ezekial Emmanuel, physician and brother of the White House Chief of Staff, puts it clearly in several journal articles on medical ethics.

True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care: “Medical school education and post graduate education emphasize thoroughness,” he writes. “This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others.”

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient’s needs. He describes it as an intractable problem: “Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs.” (JAMA, May 16, 2007).

I agree that there is overuse, often the result of moral hazard secondary due to price distortions by insurance, including Medicare. What these people in this administration do not understand is that there is another way. Why not allow an accurate price for those interventions that are “optional?” John Wennberg has shown that variation is most pronounced in the utilization of those services about which there is the most uncertainty as to value. The incidence of hospital admission for acute MI or fractured hip varies little across the country. If we had an honest market mechanism in health care, that variation would be less of a problem, even as it declined. The statists in the administration are determined that they can control utilization of every medical intervention better than a simple marketplace based on price could do. The Soviet Union tried that for 70 years and collapsed.

Tags: health care, medicine, politics

This entry was posted on Thursday, August 27th, 2009 at 9:39 am and is filed under health reform. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.