Commentators on the right have had a field day with the discovery of past comments by President Obama’s health care advisors Ezekiel Emanuel (Rahm Emanuel’s brother) and Cass Sunstein about the need for health care rationing. Sunstein and Emanuel once made no bones about it; they are convinced that decisions will have to be made about who will receive expensive health care treatment, and who will not, if the cost of taxpayer-provided health care is to be kept within reason. Both men once argued openly that “quality of life” criteria should be applied when making these decisions, favoring the young over the old, the fit over the disabled. Sunstein and Emanuel made these comments before they were part of the Obama administration, but I have not read anything about them backing away from what they once said.
President Obama is another matter — at least in public. He denies he wants to “ration” health care, especially for seniors. You can see why. No politician wants to stand before an audience and argue the need for a board of medical authorities to determine which members of society will be suitable for expensive health care procedures. Especially if the audience is made up of senior citizens. They vote. The problem is that decisions of this sort are part and parcel of a single-payer health care system, which Obama admitted not too long ago is his endgame. (I have yet to hear him say that he has changed his mind about that goal.) It is impossible for the government to pay for every expensive medical procedure that medical technology comes up for every member of society who is in need of it, or thinks he is in need of it. It can’t be done.
That last statement is not debatable, even if it makes us uncomfortable to talk about it. It would be like arguing against gravity. Good intentions and genuine compassion for our fellow men and women are not enough. We have to come up with the money to pay for our noble societal undertakings. We have done that in regard to a basic education for every child in our society; also to ensure that no American starves or freezes to death. But it is not feasible to argue that the taxpayers can provide every available medical procedure, especially those that will be devised in the future, for everyone. Rationing is inevitable. The only question is how it will be carried out.
It strikes me that this is a time for the best of our Catholic moral theologians to step forward. Lay Catholics need sound guidelines as the debate over this issue takes place. If not, the discussion will be left to the liberal secular humanists. And we need more than high-minded rhetoric about the “respect that we owe to every man and woman” and the “inherent worth of every human life” from Church authorities. Even if well intentioned, pious aspirations do not deal with the dilemma. Permit me to elaborate.
The expression “hard cases make bad law” makes a sound point: We cannot set public policy based on a fear that something highly unlikely and undesirable might occur. We would not, for example, argue against maintaining jails simply because there have been cases when innocent people have been unjustly imprisoned. But that does not mean it is unwise to test our moral principles by considering them in a variety of situations, as long as they are not blatantly far-fetched and contrived. I insist that the following scenario is neither.
We all know how expensive kidney dialysis is. There are those who are pondering whether it will be possible for the taxpayer to pay for Medicare to provide dialysis treatments, year after year, for the millions of baby boomers who will need the treatment in the upcoming years. Without dialysis those senior citizens will die. With it, they can live for many years, at the cost of hundreds of thousands of dollars per year. Can we expect middle-aged taxpayers, trying to raise their families, to pay the bills for those treatments? Some say there are ways to handle the costs. Others say it is a burden that will be crushing for society. So far the number of people needing dialysis has not crippled Medicare, Medicaid and the private health insurance system. Time will tell.
Here is my question: What if science comes up with a treatment a step beyond kidney dialysis, a way of pumping blood and keeping the heart and lungs functioning that will permit people to routinely live to, say, the age of 110 or more? The people attached to these new machines for a few hours a day will still be old, still infirm, but able to eat and read, watch television and socialize with friends and families in a medical facility, a nursing home of some sort, and enjoy what they consider a “meaningful life.” Let us say it can be done at the cost of, oh, approximately $1,000,000 per year.
What do we do at that point? One could quibble with the numbers in my scenario; or argue that no such medical treatment is on the horizon. But I can’t see how it is possible to take issue with the proposition that medical technology will one day devise a treatment too expensive for the taxpayers to provide for every one of our elderly who would like to receive it. You do not have to be a math whiz to do the numbers: You can’t have one half of your population paying a million dollars per person for the other half. You will have to ration.
This problem will arise even if we do not turn to a single-payer system, by the way. Medicare and supplemental employer-provided insurance will also run into a brick wall when faced with a medical procedure such as the one in the above scenario. They too will have to ration; to say no to some of their insured.
If not, what? Can we forbid scientists and doctors to devise such a procedure, on the grounds that only the very wealthy will be able to take advantage of it? That will require some interesting new legislative philosophy. Or could we permit the wealthy to use their own money for the procedure, even if no one else is able to afford it? We do that in regard to expensive cosmetic surgery and luxurious retirement home facilities. But denying the common folk face lifts and lavish nursing home quarters is not the same as denying them lifesaving medical treatment.
Another consideration: Would a prohibitively expensive life-extending treatment for the elderly be considered an “extraordinary means” of preserving life by the Church, and therefore a treatment that would be morally permissible to deny to some elderly? On what basis? That it is expensive? Anyone want to argue that position? Coming up with a morally sound rationale for rationing looks easier to me.
I don’t feel comfortable making excuses for the Obama healthcare czars. My hunch is that they are opposed to Catholic teachings on the medical issues of the day, everything from abortion to stem cell research to euthanasia. But they are raising a valid point. Catholic theologians loyal to the Magisterium need to do more than condemn them. It would make more sense for our side to get involved with them in a discussion of this issue. It is one which we are going to face sometime soon, like it or not.
Do I have an answer to the problem? No, but that does not make the question any less valid. All that I am saying is that I would prefer to have someone from the Vatican defining the standards for rationing than the kind of people Barack Obama, or a future Barack Obama, will appoint to a healthcare commission.