'Why Not ObamaCare?'
Millions of people like ObamaCare. The idea of universal coverage appeals to many Americans, as does the ability to cover adult children on a parent's policy. Addressing the subject of pre-existing conditions and portability of health insurance are also considered to be major benefits by respondents in many polls.
The left has done a good job of selling the high points of the "Patient Protection & Affordable Care Act" (ACA) to a frustrated population, leading many voters to ask Republican candidates, "Why not ObamaCare?" We conservatives had better provide those folks with an understandable answer to that question, or we will live with the slow-motion horror of collectivist medicine for decades to come.
To explain the ACA, it isn't necessary to plumb the bureaucratic depths of the legislation. The bill itself is 2,700 pages, and the implementing regulations thus far written already exceed 13,000 pages, yet they cover only roughly 20% of the bill. By the time they are complete, the tax code will seem a mere pamphlet in comparison.
A compelling argument against the ACA can be made by discussing just three things: the professional backgrounds of the people who designed the scheme, the principles that underlie it, and finally, the nearly identical "sister systems" already in use around the world. Few Americans realize that the architects of the ACA have already implemented their ideas in other countries, providing us with an invaluable glimpse into our own future.
The architects of ObamaCare are all world-renowned experts on the rationing of care in a collectivist model. Dr. Donald Berwick, who was recess-appointed by President Obama to be the head of the Centers for Medicare & Medicaid (until he resigned rather than face Senate confirmation hearings), is a lifelong advocate of the single-payer collectivist model and a senior policy advisor to "The Commonwealth Fund," a left-wing American think-tank dedicated for the last 90-odd years to transitioning the American system to a nationalized model.
Berwick is one of the original architects of the rationing board for the British National Health Service, known as the National Institute for Clinical Excellence, or by the Orwellian acronym NICE. One of Berwick's Commonwealth Fund acolytes, a former Harkness Fellow at the think-tank, is Kalipso Chalkidou, the current head of the international division of NICE. She travels the world teaching other nations how to implement the NICE model of cost-containment via the withholding of treatments and procedures.
Also playing on this field is Ezekiel Emanuel, the brother of former Obama Chief of Staff Rahm Emanuel. A bioethicist with the National Institute of Health, Emanuel is the designer of the "Complete Lives System," a formula for making decisions as to who will receive life-saving treatment and who will not.
The collectivist model of medicine requires doctors and hospitals to input a patient's individual data into templates like the Complete Lives System, to determine the appropriate course of treatment. Using a method called "Comparative Effectiveness Research (CER) (which quantifies the "best practices" for given medical circumstances), the template informs the doctor which treatments are available, and which are not "cost-effective" for that patient. Not surprisingly, the old and infirm, the very young, and the disabled score much lower than the rest of the population, and these groups are afforded fewer options for care. Comparative Effectiveness Research forms the basis for NICE and is the animating principle underlying the ACA.
President Obama appointed Ezekiel Emanuel to the "Federal Coordinating Council on Comparative Effectiveness Research" and gave the Council a billion-dollar funding endowment from his stimulus bill in 2009. The Council has received ongoing funding in excess of half a billion dollars annually ever since. Clearly, the Obama administration is serious about CER.
Whenever Congress passes a law, the nuts and bolts of its function must be codified through the writing of implementing regulations. The "devil is in the details," as the saying goes, and it is these implementing regulations that will put the teeth in the ACA's bite.
The ACA uses the phrase "... as the Secretary shall determine" a bit less than 3,000 times. It seems that whenever the bill-drafters found a provision to be thorny or difficult to design, they simply punted those decisions to the secretary of health and human services, Kathleen Sebelius.
It is this distressing incoherence that delegates immense power to unelected, unaccountable bureaucrats. They are allowed to make momentous decisions through the writing of the implementing regulations, regarding the access, delivery, and availability of health care in America. This is what Nancy Pelosi likely referred to when she said that "we have to pass the bill so we can find out what is in it." The actual day-to-day functioning of the system has not yet been worked out, and the people making those decisions within our government -- the bureaucracy -- are the farthest removed from public scrutiny and oversight.
The ACA and systems like it seek to provide the greatest quantity of treatments for the largest number of people for the least amount of cost. While that may appear to be a laudable goal at first blush, it is important to understand what that phrase looks like in practice before embracing it. Whenever resources are limited, a balance must be struck between what can be done and what must be done. Our present system of private insurance attempts a similar task, but from a far different mindset.
While watchful of costs, private insurers are also aware of the individual legal sovereignty of each patient and that patient's ability at law to punish the insurer for failure to cover costly but necessary treatments. Also nudging the insurer towards fairness is the need to protect its own reputation in the marketplace in order to gain new clients. No one wants to buy insurance from a company known to abandon its insured.
The collectivist's concern, however, is not for the individual patient, or for that patient's particular circumstances. A collectivist system requires its administrators to focus on the health of the system as a whole when determining what treatments are approved, what tests are permissible, and which patient will "score" highly enough to merit a life-saving medical intervention.
This is the situation millions of British, Dutch, and other European citizens face daily under ObamaCare's sister-systems. The British call it "tick-box" medicine, and it is deadly. In Great Britain, tens of thousands of elderly and disabled each year are prematurely ushered to life's exit through the misuse of a palliative care protocol intended to be instituted only in the final hours of a patient's life. Instead, physicians and hospitals are placing difficult-to-treat cases on the pathway, legally withholding food and water and medical treatment, thereby hastening death. The pathway is routinely used to cut costs and clear beds for incoming patients.
In the Netherlands (under a similar system), as many as 40% of all deaths annually occur as a result of either assisted suicide or some form of euthanasia. Active euthanasia was legalized there in 2006, and the Dutch have proudly advertised that the rate of euthanasia has barely increased in the years since. However, the touted statistics have been gamed to exclude the use of "passive" euthanasia, also known as "Continuous Deep Sedation" (CDS), which has skyrocketed, accounting for as many as 49,500 deaths annually.
Dutch doctors are also placing patients into CDS under a protocol known as "intensified alleviation of symptoms," ostensibly to relieve their pain. The patient is then kept in this diminished state until his organs fail and death occurs, hastened by the effects of the sedation itself. Moreover, according to a report in the British medical journal The Lancet, 42% of the time, this scenario plays out without permission or notification of families or even the patient. These deaths are also not counted as either active or passive euthanasia, serving to further shroud the growing prevalence of state-sponsored killing.
It is telling that a collectivist model of medicine requires otherwise rational, intelligent, and highly educated men and women to devise ways of convincing themselves that they are not actively snuffing out the lives of fellow human beings.
The most compelling argument against ObamaCare has nothing to do with care or cost. It concerns power, and whether we, as citizens, choose to retain that power for ourselves or vest it in bureaucrats with whom we have no meaningful influence. ObamaCare is unconstitutional, although not for the reasons argued before the Supreme Court. Rather, ultimately, the ACA by necessity will abrogate the most fundamental right our maker reserved to us: our right to remain alive.
The author writes from Omaha, NE and welcomes visitors to his website, www.readmorejoe.com.