The Corner

Rationing ‘Marginally Beneficial Care’

Above the screaming about Trump and beneath Hillary’s Benghazi lies, hidden from public view, medical technocrats are busy planning medical-resource redistribution and technocratic health-care rationing.

The future they plan is visible in an AMA Journal of Ethics article. (If you want to see what will be going wrong in the near future, I always say read the professional journals.)

The article discusses whether a doctor should refuse a hypothetical patient’s request for a mammogram — depicted as “marginally beneficial care” — because she is younger than the practice guidelines say should receive baseline tests.

The authors conclude that such refusals should not be the responsibility of the doctor, but made from on high by public policy makers. From “Grow a Spine, Have a Heart” (my emphasis):

The lack of consistency and accountability in US insurance policy, and the lack of reliable and fair redistribution of resources on a societal level, ought not to be compensated for by individual physicians’ actions to limit care at the bedside.

We believe instead that, collectively, physicians have a social responsibility to share their knowledge and experience at the policy level for the benefit of society at large and move our society toward fair and equitable systems.

This is best achieved through a fair process in open democratic deliberations.

At the bedside, the physician should be focused on the individual patient’s welfare and be willing to say “no” based on her best interests alone. The art of medicine lies in balancing respect for patient autonomy against beneficence and nonmaleficence.

I bring this to the attention of readers not because I disagree with the conclusion the writers reach in their hypothetical case, but because it clearly shows the Obamacarians’ overarching policy agendas:

1. Redistribution of health care resources. The medical technocrats believe that some of us receive too much care and others not enough. The answer is to take from the haves.

2. Health-care rationing. Equality of outcomes requires coercion.

3. “Society” should say no. The authors don’t believe the woman seeking the mammogram should necessarily receive it. They just don’t think the doctor should be the one saying no. The approach they would favor would be for policy makers should create guidelines that allow or refuse service.

4. Mandatory cost/benefit centralized-rationing guidelines: This is the purpose of the not-yet-in-effect Obamacare best practice rules — to allow refusals of care that could benefit individual patients — but which in the aggregate may not benefit macro patient populations.

In such a system some patients will have, say cancer, undiagnosed, toward the end that the overall system saves money on tests and that patients not undergo the expense and rigor caused by “false positives.”

Such a system also benefits special interest groups with political clout. Thus in the UK, 42 year-old women are entitled to expensive IVF services without charge if they can’t get pregnant — not a disease, but a natural age-related phenomenon — while some terminal cancer patients are denied life-extending treatment.

5. Democratic deliberations schmemocratic deliberations: The gesture to democratic deliberations is a false flag operation.

Cost-benefit rationing will be imposed through the bureaucracy, relying on technocratic “best practice” studies. Special interest lobbying can influence the bureaucratic process, but the people generally are pretty powerless in that system.

As we speak, efforts are underway to allow doctors and bioethics committees to refuse wanted and efficacious life-extending treatment based on the patient’s quality of life, known as “medical futility.”

But cutting off the ICU will not save sufficient resources to achieve the redistribution desired. That will require limiting what is known in bioethics as “marginally beneficial care.” That restricting agenda is already on the drawing board.

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