David B. Rivkin, Jr. and Elizabeth Price Foley construct a shoddy and intellectually empty argument against Obama care in today's WSJ ("'Death Panels' come back to life," December 30, 2010). Were I to respond in a LTE, I would write that such writing does not belong in a publication aspiring to higher quality. Since that publication is the WSJ, that would be satire.
The authors begin with a moral claim, as they analyze the FDA's banning of Avastin to patients with advanced-stage breast cancer:
Ponder the FDA's justification—there wasn't "sufficient" benefit in relation to Avastin's risks. Sufficient according to whom? For your wife, mother or daughter with terminal breast cancer, how much is an additional month of good-quality life worth? And what costs should be weighed? Like all drugs, Avastin has side effects including bleeding and high blood pressure. But isn't the real cost to these women a swifter, less dignified death?
In other words, considerations of quality of life are individual, and the government has not moral claim to determine these questions for us. We should be left alone to decide for ourselves what benefits us and what counts as dignified. They continue: "The FDA made a crude cost calculation; as everyone in Washington knows, it wouldn't have banned Avastin if the drug cost only $1,000 a year, instead of $90,000." Against such absolute claims of what counts as liberty, something as "crude" as an economic argument pales. They further emphasize this perspective in the following:
Think it can't happen here? Think again. The 2009 stimulus bill spent $1.1 billion to research "comparative effectiveness." That's the same approach used by Britain's National Health Service to ration care, weighing cost against factors such as the ever-elusive concept of quality of life.
Here, though, their thinking shows its weakness. Against absolutist claims of liberty, as they make about who should decide how best to conduct and live one's life, everything pales. It is an unfair comparison, since they have already dug out the highest ground for the claims of autonomy. By their reasoning, any governmental attempt to limit one's pursuit of happiness impinges on this kind of liberty: drug interdiction, traffic laws, food regulation, taxes. Obamacare, and its efforts to use scientific research to determine effectiveness of medical procedures, fails because any and all comparisons fail. This is ingenuous logic.
After a brief foray into finding support for the reality of 'death panels,' the authors find the crux of their claim:
There's an enormous difference between government-imposed rationing and treatment decisions in the private sector. When insurance companies deny coverage—for example, on grounds that treatment is "experimental" or not "medically necessary"—they do so based on contract language agreed to in advance by subscribers. If you don't like what a particular insurer offers, you're free to shop around.
This is an ignorant argument. People can hardly "shop around" for insurers to cover illnesses they might develop later in life, since they have no idea what those illness might be. And if they already have one, insurers will be able to deny them coverage (should Obamacare be repealed or found wanting Constitutionally) or hike up the premiums as to make them uninsurable. Further, the authors are now changing the focus of their disagreement, from the FDA's power to license a drug to the new health care bill's ability to determine what procedures will be covered, through the Independent Payment Advisory Board.
They should their ignorance with their claim that "Moreover, you and your doctor have extensive rights to appeal the insurer's denial, and wealthy patients can pay for the care out of their own pockets." That last would still be true; wealthy people covered by Medicare will still have the option of going outside the system to pay for care. But these author's do not acknowledge that. Instead, they point out:
When it comes to that right, courts have held that laws cannot impose an "undue burden" on access to life-preserving treatment. And there's no greater burden than blocking access to such medical treatments on the grounds that the average person, according to a government agency's reckoning, won't benefit sufficiently.
If the government wants to reduce health-care spending, it can impose higher beneficiary cost-sharing, means-testing or other limits on eligibility that would be perfectly constitutional. But it can't restrict every American's access to proven treatments. With regard to medical care, the government must weigh delicate considerations of cost, quality of life and other factors individually—not collectively—in order to preserve citizens' rights and dignity.
Accept courts do allow laws all the time that restrict our ability to pursue treatment, especially if that treatment has not already received social approval. And the authors do not bothered that insurance companies routinely make just these restrictions; laws may not intervene between me and my dignified pursuit of life, but financial considerations may. How is that moral? It is legalistic, a reversal of the tone they take at the beginning of their op-ed.
The authors seem genuinely upset that government is developing a process whereby decisions about one's health will be made that might restrict the kinds of care one receives. They should be, as should we all be. But the point of the health care bill is to bring more people into the system, a moral goal, and to strengthen the fiscal health of the system, a financial goal. Right now, the system works for those with money or those who are not sick. Criticizing the new health plan should mean suggesting ways for individuals and doctors to have more say in how a patient is treated, in a way that does not explode the cost curve of the entire system. Relying on insurance can work, as can developing a single-payer system, in each case provided there is enough money in the system but not too much money to create hazard.
No comments:
Post a Comment