Green Room

Barack The Rationer

posted at 3:30 pm on April 29, 2009 by

Ah, yes.  L.I. called it.  If we learned nothing else from Joe The Plumber, we learned that The One is prone to the potentially catastrophic unforced error (a la Ricardo Arona v. Rampage Jackson).   Our Orator-In-Chief let this little nugget slip towards the end of a NYT Magazine interview, regarding end-of-life care.

Q: And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: 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 percent of the total health care bill out here.

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

THE PRESIDENT: 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.

Let’s set aside, for one second, the galling ghoulishness of a President who does not hesitate to use his deceased grandmother as an empathy beard.  Allow me to cut through the sales pitch and translate:  We’re gonna ration.  Dude, if end-of-life and chronic care is 80% of the bill, and you’re looking to cut costs, isn’t that the first place you’d look to cut?  I don’t see any other possible justification for a “difficult democratic conversation”, and I don’t think Obama’s vision of “guidance” is similar to mine.  His kind of “guidance” is currently on display with TARP, GM, and Chrysler.  Congressional Democrats aren’t looking to cram socialized healthcare through budget reconciliation just to give themselves “not-determinative guidance”.  This is where the personal approval polls meet the job approval polls.  This is the first shot in the 2010 midterms.  I knew all along that L.I. was right, I just didn’t expect The One to screw up so soon.

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No palliative care or hospice care for you because it’ll just prolong your life and you’re going to die anyway. /sarc

deidre on April 29, 2009 at 4:06 PM

So, when Obama was discussing young people in Asia….

Oh, now I understand.

coldwarrior on April 29, 2009 at 4:15 PM

Abort on the front, let them die on the out. The essence of government healthcare. Eugenics.

Soylent Green, real life.

tarpon on April 29, 2009 at 5:25 PM

I hope the Baby Boomers that are all patting themselves on their backs for helping to ‘heal the planet’ and the ‘racial divide’ by electing this man think long and hard about this as they head into the twilight of their lives.

I know that all the commercials geared towards them are busy saying how they’ll never have to grow up….perhaps that’s true. But, growing up and growing old are two separate things.

JadeNYU on April 29, 2009 at 5:34 PM

Soylent Green, real life.

tarpon on April 29, 2009 at 5:25 PM

I was thinking Logan’s Run.

Disturb the Universe on April 29, 2009 at 5:36 PM

“…the galling ghoulishness of a President…”

Bingo!

Donald Douglas on April 29, 2009 at 5:58 PM

It’s the final, brutal reduction of the Marxist dialectic: we’ll have an endless supply of everything for free, but we’ll ration life. The rationing will kick in even faster than the socialists realize, because two very important groups of people will begin rapid migrations on the eve of National Socialist Health Care: doctors will leave the country… and if you think immigration is a problem now, wait until the dispossessed of South America get the word that Uncle Sam is giving out “free” health care now.

The doctor migration is a more serious problem than most people suspect. I know a few doctors, and all of them had plans to leave the country, or retire early, if HillaryCare had been implemented in 1994. They’ve all told me they’ll jump even faster if Obama’s crew implements it. We won’t lose every doctor, to be sure, but we’ll lose a lot of them… and we have a shortage of health care providers as it is.

The first ones to go will be the most experienced, who are old enough to prefer retirement to life as a postal clerk with a stethoscope, and the most successful, who have the greatest range of options to relocate out of Obama’s grasp. There’s no reason top surgeons can’t move their practices to tax- and regulation-friendly foreign locations, and ask their well-heeled patients to figure the cost of a plane ticket into their treatment plan. One doctor of my acquaintance told me in ’94 that he and his partners were thinking about buying a cruise ship and turning it into an offshore hospital. I never forgot the conversation, because I thought it sounded like an interesting idea for a novel, but I didn’t get around to writing it.

Another ugly aspect of nationalized health care is malpractice insurance, and the trial lawyers’ lobby. Those people make a lot of money from suing doctors, and they have a huge amount of influence within the Democrat Party. You don’t think they’re going to quietly close down their practices because the government will protect its new medical employees from lawsuits, do you? On the contrary, you can bet National Socialist Health Care will include plenty of feeding opportunities for well-connected trial lawyers to make money, draining even more resources from an already-stressed system… and giving doctors another reason to start checking out real estate in New Zealand.

Much of the quality of American life has been made possible by advances in medical technology, keeping pace with the rapid increase in life expectancy. Those rapid advances will come to a very abrupt end on the day health care is nationalized, and America was the engine driving biotechnology. A government floundering to provide minimal “free” services to its huge population, and already mortgaged to the hilt with towering deficits, is not going to have a lot of spare dough to fund medical research… which will pull that wave of technological advance out from under the aging population, just as the Baby Boomer tidal wave starts hitting their golden years.

ObamaCare will be all about convincing the population to be satisfied with less, based on the political calculation that the living will always be able to outvote the dead and dying.

Doctor Zero on April 29, 2009 at 7:54 PM

No soup for you. From the health nazi.

Dhuka on April 29, 2009 at 9:35 PM

Dr. Zero

I had a doctor tell me that after Clinton’s plan, he urged his sons not to go into medicine, and that now he happy they did not.

Dhuka on April 29, 2009 at 9:37 PM

Health care reform of any sort, market-based or otherwise, will need to address this issue. Only three choices exist here: 1) stop people from getting end of life care to save costs to the private-insurance/nationalized system, 2) let people have all the care they want, driving up costs for the private-insurance/nationalized system, 3) make people pay for their own / their loved ones’ health care out of pocket, allowing the wealthy to ration their own care if they so choose and leaving the poor with no alternative than unpalliated death.

#3 is the only choice consonant with justice, but nobody, Republican or Democrat, will touch it with a 10-foot pole. My advice: get used to paying for other peoples’ expensive treatments.

hicsuget on April 29, 2009 at 10:01 PM

Steven Hawking, age 67, is presently hospitalized with pneumonia, probably brought on by the ALS he has had since he was 21, as his paralysis spreads even further, if that is imaginable.

Here’s a nice medical ethics test:

Two questions, both to be answered under set standards as illustrated below.

Question 1: Under a National Health Care framework, as deduced from Obama’s comments…if Hawking were a young man today, and the ALS showed up in a health screening, what would be the determining factor of his receiving treatment?

Question 2: Under a National Health Care framework, as deduced from Obama’s comments…if Hawking were to show up at a hospital at age 67, having severe end-stage ALS and pneumonia, what would be the determining factor for his receiving treatment?

In the first set of answers, one has to remember that Hawking is a mathematical and cosmology genius, and has contributed an unfathomable wealth of information, theory and thought to the study of our universe, to mankind.

In the second set of answers, one must consider Hawking is just a normal everyday working stiff, makes rims for basketball backboards. No education beyond high school.

OK…begin.

coldwarrior on April 29, 2009 at 10:19 PM

Steven Hawking, age 67, is presently hospitalized with pneumonia, probably brought on by the ALS he has had since he was 21, as his paralysis spreads even further, if that is imaginable.

Here’s a nice medical ethics test:

Two questions, both to be answered under set standards as illustrated below.

Question 1: Under a National Health Care framework, as deduced from Obama’s comments…if Hawking were a young man today, and the ALS showed up in a health screening, what would be the determining factor of his receiving treatment?

Question 2: Under a National Health Care framework, as deduced from Obama’s comments…if Hawking were to show up at a hospital at age 67, having severe end-stage ALS and pneumonia, what would be the determining factor for his receiving treatment?

In the first set of answers, one has to remember that Hawking is a mathematical and cosmology genius, and has contributed an unfathomable wealth of information, theory and thought to the study of our universe, to mankind.

In the second set of answers, one must consider Hawking is just a normal everyday working stiff, makes rims for basketball backboards. No education beyond high school.

OK…begin.

coldwarrior on April 29, 2009 at 10:19 PM

You forgot to mention the most important piece of data that would determine Mr. Hawking’s fate under ObamaCare: Is he a member of the Party in good standing? You can rest assured that Obama and the rest of the Party elite will never join you in that 90-day waiting queue for an MRI, or sit anxiously by the phone, waiting to hear if they’ve been approved for treatment of a severe end-stage condition.

No matter how many frail elderly people with lifetime conditions are neatly triaged out of this world to ration scarce medical resources, physicians and equipment will be made speedily available for the ruling class. We might have to cut a few brilliant cosmologists loose, but there will always be infinite resources available to deal with Ted Kennedy’s brain tumor, or any unfortunate maladies the Obama daughters should happen to develop.

Doctor Zero on April 29, 2009 at 10:46 PM

Doctor Zero on April 29, 2009 at 10:46 PM

In essence, if I follow you correctly, the Party of Obama is thus no different from the CPSU or the Korean Workers Party or the NSDAP? All people are equal, some are just more equal than others. Privilege is accorded to the loyal.

I used this little test, with a different subject, a few years back, when discussing national health care and rationing, in an informal seminar setting long before Obama hit the stage, more addressing Hillary Care than anything else.

What shocked me were the responses…college students…that of course a genius was worth more than a worker, by more than half. But a clear majority. I had thought it was just a stereotype at the time, that libs were actually that callous, calculating.

As time progressed and our discussions continued, it became evident that the more liberal students held that view, save the genius, let the dumb guy die…while those more conservative students had more difficulty trying to answer the questions.

Some of the more conservative students even volunteering, in a rhetorical setting, of course, that if necessary they’d have donated money to a fund-raising effort for the working stiff, and a few offered that if it came to it they’d consider an organ donation, if they were a match and it was required to save the patient.

Some of the more liberal students mocked that sort of thing. Many just said the government could figure it out if it had to come to that.

Here is where I thought this was troubling…liberals are supposed to be concerned about everyone, or at least about the weak, the unwashed masses, the downtrodden, the oppressed. Yet in simple set of questions, if one extrapolates the responses…and this is no scientific poll by any means…the more liberal students really didn’t care at all about that. It was government’s job to make that distinction. Or, far worse, if you were a nobody, then you died.

The more conservative students were actually more troubled trying to answer the questions, more intense in their thoughts and responses drawing up solutions.

I originally drew this up and tossed this to a friend who is still teaching…

I have found that it gives a good psychological profile of the person responding. Might be worthy of an employment screening. I’d consider it as a part of an interview for any high value or sensitive job position.

Ethics can be evaluated.

coldwarrior on April 29, 2009 at 11:12 PM

coldwarrior on April 29, 2009 at 11:12 PM

I don’t find the responses you got from the college students all that shocking, although they are sobering. Perhaps the most damning indictment against nationalized health care (or any other industry) is that it inevitably follows a remorseless chain of reasoning that arrives at the value of human lives being judged and discarded by political appointees. It can never end any other way. No centrally planned system ever grows. They can only manage a static, and usually dwindling, supply of resources.

If I had a roomful of college students to work with, I would pose your two scenarios to them, and then ask them to analyze the same situations under a free market health care system. It wouldn’t be surprising to see many of the students immediately assert that the primary factor in whether or not Mr. Hawking received treatment would be his ability to pay for it. Personally, I would find the morality of that superior to basing his life on rationing and political considerations, since at least his survival would be based on the fruits of his own labors… but that’s not the full answer, because the power of freedom distorts the icy zero-sum rules that define a command economy. Free people have a way of beating the no-win scenario by changing the rules.

My answer to both questions, under a free market system, is that the determining factor in Mr. Hawking’s survival would be our refusal to let anyone die without a fight – whether they’re cosmologists or cosmeticians. Only capitalism gives us the wealth to declare that all life is beyond price. Only rich countries can take proper care of their environment, only free countries have the energy to hold their ruling class accountable to their laws, and only a free market can create the medical resources to prevent emergency rooms from turning into games of Russian roulette.

None of this would come about automatically or easily – freedom requires both risk and sacrifice. I think you’ll find that liberals casually toss off these cold-blooded, totalitarian ideas because the core principle of liberalism is caring about everyone in the abstract, but no one in particular. The faith in almighty government requires the belief that government will be ruled by all-wise Lightworkers who will make all the tough decisions for you. All you have to do is pledge allegiance to the Party, and recite its slogans, and your moral responsibility is absolved. Some rich guys will die in hospitals, because highly sophisticated officials with degrees from all the right schools will decide who gets those scarce drugs and surgical procedures. It’s a faith that lasts until someone you love dies because the system could not provide for them, but the Party will have people on staff to convince the faithful that nothing could have been done for them anyway. Statists are very good at persuading their subjects that they live in the best of all possible worlds.

What the disciples of liberalism cede to their masters is will. Their masters are all too happy to claim a monopoly on it. As to the similarities between Obama’s Democrats and other collectivists around the world… nothing will make those similarities more painfully apparent than the disparity between the treatment available to the elite and their subjects, many of whom will actually agree that the elite deserve better treatment, just as they think normal people should ride in golf carts but Al Gore should have a private jet. The lists of those who receive preferential treatment in tightly restricted ruling class hospitals will be as hard to come by as the list of people who were riding on Air Force One when it buzzed Manhattan.

Doctor Zero on April 29, 2009 at 11:53 PM

To get a sense of the value Obama places on life for its own sake, we needn’t look any further than the stance he took in IL on BAIPA. His rationing talk, quoted above, in entirely consistent with that. “Ghoulish” is the word.

Jillatpnp on April 30, 2009 at 3:59 AM

DOCTOR ZERO FOR PRESIDENT

Jim Treacher on April 30, 2009 at 4:02 AM

And just wait, under reconciliation Congress will only debate this for 20 hours before enacting it. And half of that will be for its proponents. Opponents of life-rationing will have a total of TEN HOURS to present this horror to the public.

My parents are still living at 88 and 86, so this is a big deal to me. My father is alive because he was able to have a quadruple bypass at age 85 and an abdominal aneurysm repaired at age 87. Under Obamacare he would be dead now.

rockmom on April 30, 2009 at 10:16 AM

And hey, maybe if we had not aborted 45 million babies since 1973 we would have enough people paying Medicare taxes to not have to kill off the old people.

rockmom on April 30, 2009 at 10:17 AM

Health care reform of any sort, market-based or otherwise, will need to address this issue. Only three choices exist here: 1) stop people from getting end of life care to save costs to the private-insurance/nationalized system, 2) let people have all the care they want, driving up costs for the private-insurance/nationalized system, 3) make people pay for their own / their loved ones’ health care out of pocket, allowing the wealthy to ration their own care if they so choose and leaving the poor with no alternative than unpalliated death.

#3 is the only choice consonant with justice, but nobody, Republican or Democrat, will touch it with a 10-foot pole. My advice: get used to paying for other peoples’ expensive treatments.

hicsuget on April 29, 2009 at 10:01 PM

Not so. There are many efforts underway now to control costs associated with caring for aging-related illnesses and conditions without simply leaving the patient untreated to die. My father-in-law is in one such pilot program in Massachusetts and it has dramatically improved his Parkinson’s symptoms, so that he no longer needs an expensive home health aide to come to his house and help care for him, and he only needs one medication daily instead of a battery of 13 drugs. However, this program is run by Blue Cross/Blue Shield. Medicare won’t pay for it, but it will pay for the home health aide and the 13 drugs.

There isn’t any innovation or cost control in Medicare or Medicaid now, and there won’t be if we go to a single-payer government run system either. THAT is the problem. Private insurers have an economic incentive to innovate and develop new programs and procedures that save money while not killing the patient.

In a government run system, the only options for cost control will be capping providers’ payments and rationing treatment.

rockmom on April 30, 2009 at 10:27 AM

I just emailed this piece to my liberal Obama-adoring sister-in-law and her husband. Both of them have aging parents, and she works for Blue Cross/Blue Shield. I hope they are very happy with their super-cool President when she loses her job and their parents are left to die.

rockmom on April 30, 2009 at 10:39 AM

And, of course, our elected federal government politicians (including retirees and extended families) will be willing to subject themselves to this “not-determinative guidance”, right?

Right??????

ladyingray on April 30, 2009 at 5:40 PM