Catholics and Health Care Rationing

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.

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  • I would say that a treatment that artificially prolongs life does not treat any disease, it only delays death, and therefore could legitimately be denied in a system funded with public money.

    I think that one thing the Church has to offer this debate is a realistic attitude toward death. The Medievals used to say, “Keep your death always before you,” meaning that one should be aware that death is possible at any time and one should always be prepared. The Church offers freedom from fear of death and the understanding that life is short regardless; why are people making choices to extend life by five years or ten when they are only postponing the inevitable? We should be looking forward to Heaven with the knowledge that God is the author of our life and death, and our technology can only do so much.

    So this is an opportunity for evangelization. People who believe in Jesus live in freedom from fear; they live wholesome lives of peace, joy, and charity. This is the “quality of life” that the medical system seeks to give us; we can’t get it from medicine, not really, but we can get it from God.

  • Joe DeVet

    A very valid question. I agree–it’s time (or maybe past time) we faced it straight up.

    I have a slight disagreement with one passage in the article. It’s true in a way that broad statements like “we must respect the dignity of every human being” is not enough from our leadership. The article implies in stating this that we need more specific suggested solutions from our leadership. However, we’ve already seen a number of “solutions,” ones which will cause more harm than good regardless of the beguiling rhetoric in which the bishops couch their proposals.

    Until they acquire some realistic recognition of economic realities involved in health care, which is among other things an economic good, it’s best that they limit their exhortations to broad generalities.

  • momof11

    I think this brings back the question of just what does it mean for something to be a “right”? We all have a right to life. It is given by God and no one should be able to take it away. But is health care a God given right? To what extent?

    What constitutes ordinary care? Accoring to the Church What are “extraordinary means” of prolonging a life? It is a legitimate and moral choice for a patient to refuse extraordinary means of treatment if they would entail to big of a burden either physically, emotionally, or financially.

    CCC 2278:”Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcomes can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause deth;one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.”

    But it is the patient who makes that decision, not the government…but then it is the money of the patient and/or family that the patient considers. However, when the government or insurance is footing the bill they will necessarily have something to say about it. So I suppose that the rich will be able to have the more expensive treatments if they are willing to spend their money for them.

    As I read further in the Catechism I see CCC 2289: “If morality requires respect for the life of the body, it does not make it an absolute value. It rejects the neo-pagan notion that tends to promote the “cult of the body”, to sacrifice everything for its sake, to idolize physical perfection and success at sports. By its selective preference of the strong over the weak, such a conception can lead to the perversion of human relationships.”

    If we think about it, we will realize that this whole health care/rationing mess will not be solved in the political realm anymore than will other life issues, because at the root of the whole thing are our attitudes as a society towards the dignity of the human person, the acceptance of suffering, the inevitability of death and what is the meaning of our life. If we are ready to die (I don’t mean having given up on life) we will not demand ever increasing treatments to prolong our life beyond its natural length. We will weigh the options.

    These are not easy issues to get our minds and heart around…

  • DWC

    I adimit this whole issue scares the be-jeepies out of me — mostly from an economic viewpoint, then a moral viewpoint. But that aside, per this issue, which is valid — I can surmise that supplemental insurance could come more into vogue to address possible gaps that exist/will exist in coverage.

  • Warren Jewell

    Actually, the srongesrt economic and moral case can be made rthat governement has been a health/medical-care problem for the last severasl deacdes, and getting governemnt nearly out of the picture, except to be a cash-ready safety-net for the truly impecunious, is a big part of the solution.

    It will lead to more health insurance coverage being but catastrophic-care in nature. More common and routine procedures will come right out of the patients’ pockets. But, then, any patient will be in position to shop around for the best quality at what he can afford, not what some bureaucrat says his neighbors can afford.

    This is part and parcel with each person being his own patient first. ‘Health-care’ really is more important than ‘medical-care’, and the patient has to take fullest repsonsibility for caring for his health. That is, he must realize medical-care is but others’ parts in his health. His health-care is primarily his business every day and in every way he can protect or damage his own health. If he so lives as to never need medical care until his last days, he is far ahead in not only health, but security for his loved ones in his healthy place among them. He will not have as many sick days away from work. He will be able to be active in ways that fit him for longer time and in more enjoyable aspect.

    BUT – but – we’re all ‘entitled’, now, aren’t we? So many feel ‘entitled’ right out of the personal responsibilty to take care of their own health. Part of having no choice but surrender part of that entitlement puts our economy in position of having to ration medical-care, regardless of health-care. ‘We can’t have everything’ – ‘There is no such thing as a free lunch’ – ‘The money doesn’t grow on trees’: we all know these, but do we act wisely to live within the restrictions and constraints that these reflect? I think that this last federal election proved we have too many entrenched ‘entitled’ citizens. Such as self-responsibility required to really reform medical-care may be but a dream, now.