By Wesley J. Smith

Editor's note. This first appeared on Wesley's blog at http://www.firstthings.com/blogs/secondhandsmoke/2010/11/09/obamacare-another-rationing-fears-irrational-we-need-rationing-editorial/

First it was the New York Times. Now, it's western cousin the Los Angeles Times, has written an editorial that calls rationing fears about Obamacare "irrational"–as it implicitly calls for rationing. First, the editorial decries the opposition and supposed political exploitation around the establishment of guidelines for cancer screening procedures. It isn't guidelines that people fear. It is enforceable guidelines that will restrict their ability to obtain these tests, even though they sometimes save lives.

The Times then gets more specifically into rationing. From "Irrational About Health Care Rationing:" [www.latimes.com/news/opinion/editorials/la-ed-health-20101108,0,7435506.story]

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These episodes illustrate what may be the biggest challenge facing policymakers as they try to restrain the healthcare costs that are consuming so much of the country's resources. Americans have a hard time accepting limits on their access to care, even if the treatment or drug is shown to be ineffective. They're much more willing to put up with rationing by income, which the current system imposes by allowing wealthier people to buy more and better care, than accept even the whiff of rationing by the government.

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We are not a country that promotes equality of outcomes, but equality of opportunity. Beyond that, the fact that some people are unable to pay for insurance isn't any more rationing than my being unable to afford a house the size of Al Gore's homes. What people fear is the government barring them from receiving efficacious treatments or procedures based on cost/benefit/quality of life invidiously discriminatory categories. Not the same thing at all. To be sure, we need to make health insurance accessible to those who want it. But as we do that, we should not let the government tell our doctors how they are to treat and care for us.

And then comes the disingenuous part:

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A similar theme has run through the criticism of the new federal healthcare law, which takes a few small steps toward promoting science-based medicine and more effective treatments. Republicans seem particularly eager to eliminate spending on research that compares the effectiveness of treatment regimens, evidently preferring to leave doctors in the dark than to lay a foundation for the government to stop funding some types of care. It's fair to debate how best to achieve healthcare reform. But it's hard to see how healthcare costs can be brought under control if attempts to make the system more efficient and effective get waylaid by irrational fears about rationing.

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Baloney. Nobody wants less data. Nobody wants doctors remaining in the dark. If the guidelines aren't enforceable, no problemo. Doctors and patients can consider the evidence when deciding the kind of screenings and preventive care that are best under the circumstances.

Ah, but unless they are enforceable, there is no guarantee the guidelines will save money. But if they enforceable, it is rationing. Therein lies the rub. So, once again, Obamacarians tell us we are nuts to worry about rationing, as they clearly seek to prepare the ground for the government to do just that.

It is important to note when considering this post that none of this kind of advocacy is being promulgated in a vacuum.

For example, we anti-rationers have noticed that the New England Journal of Medicine has proposed a NICE style rationing regimen based on Quality Adjusted Life Years.[http://www.firstthings.com/blogs/secondhandsmoke/2010/10/14/new-england-journal-of-medicine-pushes-nice-style-qaly-health-care-rationing.] They know that some of President Obama's main advisers (example, Tom Daschle) and bureaucrats (example, temporary Medicare head Donald Berwick) are outright rationing enthusiasts.

The American people see the code writing on the wall. They know what it portends. Their fears about rationing are anything but "irrational."