NCPA - National Center for Policy Analysis


August 14, 2009

Elderly Americans are turning out in droves to fight ObamaCare, and President Obama is arguing back that they have nothing to worry about.  While claims about euthanasia and "death panels" are over the top, senior fears have exposed a fundamental truth about what Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted, says the Wall Street Journal.

Far from being a scare tactic, this is a logical conclusion based on experience and common-sense.  Once health care is a "free good" that government pays for, demand will soar and government costs will soar too.  When the public finally reaches its taxing limit, something will have to give on the care and spending side.  In a word, care will be rationed by politics, says the Journal.

Virtually every European government with "universal" health care restricts access in one way or another to control costs, says the Journal:

  • The British system is most restrictive, using a black-box actuarial formula known as "quality-adjusted life years," or QALYs, that determines who can receive what care.
  • If a treatment isn't deemed to be cost-effective for specific populations, particularly the elderly, the National Health Service simply doesn't pay for it; the NHS generally won't pay more than $22,000 for treatments to extend a life six months.
  • "Money for the NHS isn't limitless," as one NHS official recently put it in response to American criticism, "so we need to make sure the money we have goes on things which offer more than the care we'll have to forgo to pay for them."
  • Even France -- which has a mix of public and private medicine -- has fixed reimbursement rates since the 1970s and strictly controls the use of specialists and the introduction of new medical technologies such as CT scans and MRIs.

Yes, the United States "rations" by ability to pay (though in the end no one is denied actual care).  This is true of every good or service in a free economy and a world of finite resources but infinite wants.  Yet no one would say we "ration" houses or gasoline because those goods are allocated by prices.  The problem is that governments ration through brute force -- either explicitly restricting the use of medicine or lowering payments below market rates.  Both methods lead to waiting lines, lower quality, or less innovation -- and usually all three, says the Journal.

Seniors have figured out that their own health and lives are at stake in this debate over ObamaCare.  They know that when medical discretion clashes with limited government budgets, medicine loses, says the Journal.

Source: Editorial, "Obama's Senior Moment; Why the elderly are right to worry when the government rations medical care," Wall Street Journal, August 14, 2009.

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