Health Cares

An insightful post on my sister's blog about the health care debate grabbed my attention today. We've been so inundated with rumors, rancor, news, and views on this issue lately that it's no wonder many want to take refuge in a quiet cave somewhere, and come out only when the brouhaha is over. I'm one of them. But we must force ourselves to pay attention to this and learn all we can about it, as "health insurance reform," "public health care," or whatever you want to call it may be the most revolutionary and personally invasive government program ever to issue from Washington.

I'm not thoroughly versed in all the details of all the bills now circulating on Capitol Hill, nor have I read even a few hundred of the thousands of pages they take up. That puts me on about the same level as most of our Senators and Congressmen--a sobering thought in itself, since they bear the heavy responsibility of determining, very soon, whether this monumental package will become national law, and in what form. They will be doing so under enormous pressure from the White House, lobbies, interest groups, and even the news media--who all want "something done NOW"--without benefit of detailed knowledge or careful study of the legislation's provisions, or of its probable and possible effects. The very size and density of the legislation, and the desperate haste with which the Obama Administration is demanding final action on it, raise suspicion that there is much in its provisions that they do not want you (or your representatives) to know or think about.

A recent Associated Press article explores some of the more questionable claims made by both sides about the new health care legislation. It's said that "the bill would require Medicare to pay for advance directive consultations with health care professionals [about end-of-life issues], but it would not require anyone to use the benefit. . . Patients and their families would consult with health professionals, not government agents . . ." The problem is that when the government foots the bill, it can call the shots even for private parties. How long will it be before officials require health care professionals to certify that they have discussed end-of-life issues with their elderly or seriously ill patients, or require patients to have such consultations as a condition of public payment, in order to serve what the officials deem to be the best policy? The article also explains that health care revisions would not necessarily lead to government-funded abortions, but also notes proposals that each region of the country have at least one plan that does, and that "a health care overhaul could create a government-run insurance program, or insurance "exchanges," that would not involve Medicaid [but] whose abortion guidelines are not yet clear." Again, regardless of whether public coverage of abortions is mandated at the outset, the proposed reforms put in place the means (government-operated plans and certification of private plans) through which government-dictated policies can be forced on the private sector, at any time officials deem it desirable.

Perhaps even more ominous, the article acknowledges that "Denying coverage for certain procedures might increase under proposals to have a government-appointed agency identify medicines and procedures best suited for various conditions. . . . Obama says the goal is to identify the most effective and efficient medical practices, and to steer patients and providers to them." It's unfortunate enough when a private insurer denies coverage of a vital medical procedure to individual patients. But we are now confronted with the specter of enabling government boards to deny such coverage to entire classes of sufferers, on grounds that the procedures are too expensive or that the need for them is unproven. Just consider what the London Telegraph reports is happening in Great Britain's nationalized health care system at this moment:

Patients forced to live in agony after NHS refuses to pay for painkilling injections
By Laura Donnelly, Health Correspondent
Published: 7:45AM BST 02 Aug 2009

The Government's drug rationing watchdog says "therapeutic" injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known. Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy. Specialists fear tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain or pay as much as £500 each for private treatment.

The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million. But the British Pain Society, which represents specialists in the field, has written to NICE calling for the guidelines to be withdrawn after its members warned that they would lead to many patients having to undergo unnecessary and high-risk spinal surgery.

* * * *

Iris Watkins, 80 from Appleton, in Cheshire said her life had been "transformed" by the use of therapeutic injections every two years. The pensioner began to suffer back pain in her 70s. Four years ago, despite physiotherapy treatment and the use of medication, she had reached a stage where she could barely walk. "It was horrendous, I was spending hours lying on the sofa, or in bed, I couldn't spend a whole evening out. I was referred to a specialist, who decided to give me a set of injections. The difference was tremendous"; within days, she was able to return to her old life, gardening, caring for her husband Herbert, and enjoying social occasions. "I just felt fabulous – almost immediately, there was not a twinge. I only had an injection every two years, but it really has transformed my life; if I couldn't have them I would be in despair".

Such a development is perfectly predictable and normal for a government agency managing a health care system--they simply aren't going to cover things that agency officials don't feel are "cost-effective," and they aren't going to allow choices that they don't believe, in the professional judgment, are the "best" ones. And don't expect this state of affairs to be foreclosed by the maintenance of a "public option" plan in competition with private plans. Government by its nature and very purpose is about control, not competition, and will exert itself politically or by certification or other private-plan approval mechanisms, if not directly. In any case, it's become quite clear that the intent of health care reform's most active supporters--including the President--is to supplant, not supplement, private health insurance.

I'm concerned enough about what shape health care reform might take upon its emergence from Congress. I'm even more anxious about what it could easily become after a few years, when our attention has turned to other crises. Once government insinuates itself so deeply into the most personal aspects of so many people's lives, the tentacles of coercion are likely to become irremovable and inescapable.