As I noted in my statement last week, nationalized health care inevitably leads to rationing. There is simply no way to cover everyone and hold down the costs at the same time. The rationing system proposed by one of President Obama’s key health care advisors is particularly disturbing. I’m speaking of the “Complete Lives System” advocated by Dr. Ezekiel Emanuel, the brother of the president’s chief of staff. President Obama has not yet stated any opposition to the “Complete Lives System,” a system which, if enacted, would refuse to allocate medical resources to the elderly, the infirm, and the disabled who have less economic potential. [1] Why the silence from the president on this aspect of his nationalization of health care? Does he agree with the “Complete Lives System”? If not, then why is Dr. Emanuel his policy advisor? What is he advising the president on? I just learned that Dr. Emanuel is now distancing himself from his own work and claiming that his “thinking has evolved” on the question of rationing care to benefit the strong and deny the weak. [2] How convenient that he disavowed his own work only after the nature of his scholarship was revealed to the public at large.

The president is busy assuring us that we can keep our private insurance plans, but common sense (and basic economics) tells us otherwise. The public option in the Democratic health care plan will crowd out private insurers, and that’s what it’s intended to do. A single payer health care plan has been President Obama’s agenda all along, though he is now claiming otherwise. Don’t take my word for it. Here’s what he said back in 2003:

“I happen to be a proponent of a single payer universal health care plan…. A single payer health care plan – universal health care plan – that’s what I would like to see.” [3]

A single-payer health care plan might be what Obama would like to see, but is it what the rest of us would like to see? What does a single payer health care plan look like? We need look no further than other countries who have adopted such a plan. The picture isn’t pretty. [4] The only way they can control costs is to ration care. As I noted in my earlier statement quoting Thomas Sowell, government run health care won’t reduce the price of medical care; it will simply refuse to pay the price. The expensive innovative procedures that people from all over the world come to the United States for will not be available under a government plan that seeks to cover everyone by capping costs.

Our senior citizens are right to be wary of this health care bill. Medical care at the end of life accounts for 80 percent of all health care. When care is rationed, that is naturally where the cuts will be felt first. The “end-of-life” consultations authorized in Section 1233 of HR 3200 were an obvious and heavy handed attempt at pressuring people to reduce the financial burden on the system by minimizing their own care. Worst still, it actually provided a financial incentive to doctors to initiate these consultations. People are right to point out that such a provision doesn’t sound “purely voluntary.”

In an article I noted yesterday, Charles Lane wrote:

“Ideally, the delicate decisions about how to manage life’s end would be made in a setting that is neutral in both appearance and fact. Yes, it’s good to have a doctor’s perspective. But Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party — the government — recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don’t have to be a right-wing wacko to question that approach.” [5]

I agree. Last year, I issued a proclamation for “Healthcare Decisions Day.” [6] The proclamation sought to increase the public’s knowledge about creating living wills and establishing powers of attorney. There was no incentive to choose one option over another. There was certainly no financial incentive for physicians to push anything. In fact, the proclamation explicitly called on medical professionals and lawyers “to volunteer their time and efforts” to provide information to the public.

Comparing the “Healthcare Decisions Day” proclamation to Section 1233 of HR 3200 is ridiculous. The two are like apples and oranges. The attempt to link the two shows how desperate the proponents of nationalized health care are to shift the debate away from the disturbing details of their bill.

There is one aspect of this bill which I have not addressed yet, but it’s a very obvious one. It’s the simple fact that we can’t afford it. But don’t take my word for it. Take the word of Doug Elmendorf, the director of the nonpartisan Congressional Budget Office. He told the Senate Budget Committee last month:

“In the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs.” [7]

Dr. Elmendorf went on to note that this health care legislation would increase spending at an unsustainable rate.

Our nation is already $11.5 trillion in debt. Where will the money come from? Taxes, of course. And will a burdensome new tax help our economy recover? Of course not. The best way to encourage more health care coverage is to foster a strong economy where people can afford to purchase their own coverage if they choose to do so. The current administration’s economic policies have done nothing to help in this regard.

Health care is without a doubt a complex and contentious issue, but health care reform should be a market oriented solution. There are many ways we can reform the system and lower costs without nationalizing it.

The economist Arthur Laffer has taken the lead in pushing for a patient-center health care reform policy. He noted in a Wall Street Journal article earlier this month:

“A patient-centered health-care reform begins with individual ownership of insurance policies and leverages Health Savings Accounts, a low-premium, high-deductible alternative to traditional insurance that includes a tax-advantaged savings account. It allows people to purchase insurance policies across state lines and reduces the number of mandated benefits insurers are required to cover. It reallocates the majority of Medicaid spending into a simple voucher for low-income individuals to purchase their own insurance. And it reduces the cost of medical procedures by reforming tort liability laws.” [8]

Those are real reforms that we can live with and afford. Once again, I warn my fellow Americans that if we go down the path of nationalized health care, there will be no turning back. We must stop and think or we may find ourselves losing even more of our freedoms.

- Sarah Palin

[1] See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions
[2] See http://washingtontimes.com/news/2009/aug/14/white-house-adviser-backs-off-rationing/
[3]See http://www.youtube.com/watch?v=-hsqzSKuC44
[4] See http://article.nationalreview.com/?q=N2M0ODk0OTNkZjkwNGM4OGMyYTEwYWY3ODUzMzFiOTc=
[5] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html
[6] See http://www.gov.state.ak.us/archive.php?id=1094&type=6
[7] See http://blogs.abcnews.com/thenote/2009/07/cbo-sees-no-federal-cost-savings-in-dem-health-plans.html
[8] See http://online.wsj.com/article/SB10001424052970204619004574324361508092006.html

The President made light of these concerns. He said:

“Let me just be specific about some things that I’ve been hearing lately that we just need to dispose of here. The rumor that’s been circulating a lot lately is this idea that somehow the House of Representatives voted for death panels that will basically pull the plug on grandma because we’ve decided that we don’t, it’s too expensive to let her live anymore….It turns out that I guess this arose out of a provision in one of the House bills that allowed Medicare to reimburse people for consultations about end-of-life care, setting up living wills, the availability of hospice, etc. So the intention of the members of Congress was to give people more information so that they could handle issues of end-of-life care when they’re ready on their own terms. It wasn’t forcing anybody to do anything.” [1]

The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual … or upon admission to a skilled nursing facility, a long-term care facility… or a hospice program.” [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4]

Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” [5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones…. If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]

As Lane also points out:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic. [7]

Even columnist Eugene Robinson, a self-described “true believer” who “will almost certainly support” “whatever reform package finally emerges”, agrees that “If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending.” [8]

So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:

Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives…. It is egregious to consider that any senior citizen … should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. [9]

Of course, it’s not just this one provision that presents a problem. My original comments concerned statements made by Dr. Ezekiel Emanuel, a health policy advisor to President Obama and the brother of the President’s chief of staff. Dr. Emanuel has written that some medical services should not be guaranteed to those “who are irreversibly prevented from being or becoming participating citizens….An obvious example is not guaranteeing health services to patients with dementia.” [10] Dr. Emanuel has also advocated basing medical decisions on a system which “produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” [11]

President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisors are clear enough. It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.

[1] See http://blogs.abcnews.com/politicalpunch/2009/08/president-obama-addresses-sarah-palin-death-panels-wild-representations.html.
[2] See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[3] See HR 3200 sec. 1233 (hhh)(1); Sec. 1233 (hhh)(3)(B)(1), above.
[4] See HR 3200 sec. 1233 (hhh)(1)(E), above.
[5] See http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf
[6] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/07/AR2009080703043.html].
[7] Id.
[8] See http://www.washingtonpost.com/wp-dyn/content/article/2009/08/10/AR2009081002455.html].
[9] See http://www.nysenate.gov/press-release/letter-congressman-henry-waxman-re-section-1233-hr-3200.
[10] See http://www.ncpa.org/pdfs/Where_Civic_Republicanism_and_Deliberative_Democracy_Meet.pdf
[11] See http://www.scribd.com/doc/18280675/Principles-for-Allocation-of-Scarce-Medical-Interventions.