On the other hand...

Maybe President Obama doesn't have plans to euthanize the elderly and disabled.

Last week Iowa Senator Chuck Grassely seemed to agree with Sarah Palin's "death panel" accusation, saying:

"There is some fear because in the House bill, there is counseling for end-of-life... And from that standpoint, you have every right to fear. You shouldn't have counseling at the end of life. You ought to have counseling 20 years before you're going to die. You ought to plan these things out. And I don't have any problem with things like living wills. But they ought to be done within the family. We should not have a government program that determines if you're going to pull the plug on grandma"

Due to the outrage caused by Palin's asinine comment, Congress is no longer considering end-of-life counseling as part of the health care bill. But now that the faux controversy is over, Grassely can re-acquaint himself with reality:

"Grassley says he opposes that counseling as written in the House version of the bill, but a spokesman said the senator does not think the House provision would in fact give the government such authority in deciding when and how people die. The House bill allows patients to decide for themselves if they would like such counseling."

If someone proposed an bill covering end-of-life counseling in a different context (were we not debating health care reform), it would be overwhelmingly popular. Too bad.

Usually when people make comments as dumb as Grassely's, I'm left asking myself whether they are stupid, crazy or disingenuous. Fortunately, Grassely answered the question for us.

Prices also ration goods and services

Princeton bioethicist Peter Singer has an interesting piece in the NT Times Magazine about rationing health care. On the general point of "rationing", Singer says:

"There’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way. But if the stories of Bruce Hardy and Jack Rosser lead us to think badly of the British system of rationing health care, we should remind ourselves that the U.S. system also results in people going without life-saving treatment — it just does so less visibly. Pharmaceutical manufacturers often charge much more for drugs in the United States than they charge for the same drugs in Britain, where they know that a higher price would put the drug outside the cost-effectiveness limits set by NICE. American patients, even if they are covered by Medicare or Medicaid, often cannot afford the copayments for drugs. That’s rationing too, by ability to pay."

While it seems painfully obvious, the point needs repeating: prices are used to ration goods. So the American healthcare system, which is largely based on individual ability to pay, rations healthcare in this way. Yes, most medical costs are payed by insurers, but insurance is expensive for individuals to buy and employer provided benefits are more generous for higher-payed workers.

No American should oppose any public health plan on the basis that it will ration care. Rather, we should judge policies based on how efficiently and ethically that care is rationed.