Human Exceptionalism

Obamacare: “All About Rationing”

Harvard Professor and former Reagan economic adviser Martin Feldstein writes today in the Wall Street Journal that Obamacare is “all about rationing. From the column:

The president has emphasized the importance of limiting services to “health care that works.” To identify such care, he provided more than $1 billion in the fiscal stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. That could morph over time into a cost-control mechanism of the sort proposed by former Sen. Tom Daschle, Mr. Obama’s original choice for White House health czar. Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost.

In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending. If a treatment costs more per QALY, the health service will not pay for it. The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as “too expensive.”

Exactly. Over time the cost control boards would ration not only “what, ” but also “who,” based on invidious categories such as age, disability, and quality of life judgmentalism.

Feldstein also pushes taxing Cadillac health insurance policies to prevent over consumption.  He mentions a 20% copay is excessive.  I am not sure about that. A lot of us have HMOs with very low copays, and they are hardly Cadillac.  Still, if “too much” private consumption of health care is bad–isn’t it stimulative?–there is no question that government-imposed rationing is worse.  Moreover, why shouldn’t consumers be allowed to have high deductible coverages to reduce insurance expenses?  We do for auto insurance.

These are the things we need the time to ponder and debate.  A lot is at stake.  The last thing we need is a mad rush  to force Obamacare down our collective throats.

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