The American Conservative is one of the few conservative sites/magazines that I read regularly, despite its association with Pat Buchanan. Generally speaking it’s sober, rational writing from a conservative viewpoint, but every once in a while something like this number by James P. Pinkerton gets through:
Indeed, in the case of Brill-ish reformers, coming at the healthcare issue from the left, it’s almost impossible to separate their message from another message on the left that is, in fact, scary. And what idea is that? It’s the idea that we are spending too much on the sick and the elderly, that we should move toward a “rationalized” system that would measure “Quality Adjusted Life Years” (QALY)—as a prelude, we might note, to some polite form of euthanasia.
We should realize that these aren’t Palinesque fantasies; we should remember that Dr. Ezekiel Emanuel, one of the White House architects of the Affordable Care Act, outlined his views on QALY–and also DALY, for Disability Adjusted Life Years–in a 2009 article in The Lancet. And thus it’s easy to see how Sarah Palin’s son Trig, born with Down’s Syndrome, would fare under such a system. Moreover, the rest of us are on notice as well: As Emanuel’s chart on page 428 of the article shows, the very young and the very old will have to prove themselves–that is, prove themselves worthy of our care.
Scaremongering over Ezekiel Emanuel’s paper on the ethics of organ and vaccine scarcity is nothing new. And yes, they ARE Palinesque fantasies. No sensible person could argue that scarce resources such as organs ought not to go to people who will get the most out of them. The patient who’s too old to get a heart transplant because he’s, well, old, is a staple of medical dramas, and every time we have the same reaction. We aren’t happy that the nice old man won’t get a new heart, we think it’s unfortunate, but we don’t think it’s wrong.
Ultimately the issue isn’t that one day some person might use a set of objective criteria to evaluate whether or not you should receive some form of health care. That already happens with some regularity. It’s called triage, and it sucks, but it’s necessary in a situation where you have limited caregivers and many people needing life-saving care. The issue is scarcity. If we allow health care to become increasingly scarce (and thus increasingly expensive), one of two things will happen; a) we will adopt a set of guidelines, driven by metrics like QALY, that allocate care on an impartial, objective basis out of a sense of fairness, or b) only the well-off will be able to routinely afford health care.
Neither of those options have much appeal, so let’s do the smart thing instead and acknowledge the reality of the situation. As demand for health care increases, so will its cost. We are going to have to pay more for health care. That fact will not change regardless of whether or not the federal government is involved in providing health insurance to individual citizens. We know what happens when we don’t have social safety net programs like Medicare and Medicaid; emergency rooms get clogged with the uninsured, causing those of us who can afford insurance to foot the bill (in the least efficient manner possible) for those who can’t, and in the worst case scenario people die of treatable ailments simply because they’re poor.
Pinkerton’s right in that the government should be spending heavily on medical research for the betterment of all, but that needn’t come at the cost of the safety net. We can and should do both.