NRL News
Page 28
November/December 2009
Volume 36
Issue 11-12

Rationing Issues at Stake in Health Care Restructuring

As NRL News goes to press, the Senate is debating and amending Majority Leader Harry Reid’s health care restructuring bill, with the final components of the “Patient Protection and Affordable Care Act” not yet certain. Between press time and the date most subscribers are reading this, there will have been significant developments that cannot be anticipated.

It is important that you constantly update yourself about the status of the health care bill and its impact on the rationing issues at stake. To do so please frequently access the blog of the Powell Center for Medical Ethics. This is found at http://powellcenterformedicalethics.blogspot.com.

As detailed at www.nrlc.org/HealthCareRationing/ReidSubstitute.html, among the key rationing issues in the Senate bill at press time are:

Limiting Senior Citizens’ Right to Use Their Own Money to Save Their Own Lives

The Senate bill (Section 3209) duplicates the House bill provision (Section 1175) that would effectively allow federal bureaucrats at the Centers for Medicaid and Medicare Services to bar senior citizens from adding their own money, if they choose, to the government contribution in order to get private fee-for-service Medicare Advantage plans less likely to ration lifesaving treatment.

Limiting Exchange Users’ Right to Use Their Own Money to Save Their Own Lives

In the Senate bill, Section 1003 effectively allows state bureaucrats to limit the right of Americans who are NOT on Medicare to use their own money to save their own lives. With minor modifications, Section 1003 adopts the House bill provision (Section 104) allowing an exchange to exclude “particular health insurance issuers ... based on a pattern or practice of excessive or unjustified premium increases.”

Under a scheme of premium price controls, health insurance companies will ration lifesaving medical treatment as they are squeezed more and more tightly each year by the declining “real” (that is, adjusted for health care inflation) value of the premiums they take in. These day-to-day rationing decisions will have the most direct and visible impact on the lives—and deaths—of people with a poor “quality of life.”

“Shared Decisionmaking”

Section 3506 provides funding to develop “patient decision aids” that are supposed to help “patients, caregivers or authorized representatives ... to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences.” It is likely that these would follow the pattern of the notorious Veterans Administration’s “Your Life, Your Choices,” withdrawn by the Bush Administration but reinstated by the Obama Administration.

That document includes such efforts to “nudge” patients to reject lifesaving treatment—and thereby save the government money—as a set of “Key Things to Think About,” underneath the photo of a man with an agonized look on his face: “If you had severe dementia and then became ill with a reversible illness, such as pneumonia, would you want treatment even though the treatment would not help your memory problems? What if the treatment included going to the hospital?”