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President Obama's vision of post-reform health care

David Leonhardt conducts a wide-ranging interview with President Obama including this segment concerning what health care in America will look like in the “post-reform” era:

THE PRESIDENT: Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —

Yes, where it’s $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

Notice the arguments: It costs $20,000 for an additional week of life. These old people take up 80% of our health care costs.

So exactly what is his solution? Euthanasia? Age-based rationing of health care? Expect to hear rationalizations like we shouldn’t spend $20,000 on an old person. We can better use that money to vaccinate children. This emotional appeal is a false dichotomy. This is not an either/or situation. There are numerous elective medical procedures in the intervening medical spectrum that can be sacrificed so that neither children nor the elderly have to be killed.

We need a frank discussion and education on what is proportionate and what is disproportionate care. As Catholics, we do not advocate that every bit of technology must be used until the last dying breath. What we do say is that there is a moral obligation to use ordinary and proportionate care. When, from the perspective of the patient or the patient’s surrogate, the treatment is providing too little benefit for the level of burden the treatment imposes, the treatment can be deemed disproportionate. When a treatment is disproportionate, it can be refused or even discontinued if it has already been started. Note that it is the treatment that is being judged, not the life of the patient. In no way is the patient being judged unworthy of treatment. Rather the treatment is being judged unworthy of the patient.

Notice that the tone of President Obama’s remarks suggest that it is the elderly and the chronically ill are unworthy of our health care dollars. If he can make such a determination about the elderly and the chronically ill, whom else will he deem unworthy of care? The mentally disabled? Those with genetic anomalies? Those with the wrong political ideology?

We must not be so smug or arrogant to believe our culture is above the atrocities of past generations. We have willingly sacrificed the lives of 50 million children because we determined they had not right to live. We are willing to clone human life and then kill it for the sake of “progress”. In all humility, we should tremble at the level of evil our culture sanctions. As Archbishop Burke said in his address at the National Catholic Prayer Breakfast, there would be reason to despair if it was up to us alone. But it is not up to us alone. God is merciful. If we are faithful to Him, he will uphold us.

Even though I walk though the valley of the shadow of death,
I fear no evil;
For you are with me;
your rod and your staff, they comfort me.
(Psalm 23)


Barb, sfo said…
No surprise there.

There was a quote on "The Catholics Next Door" (Sirius radio) that the government, in the case of a TRUE swine flu epidemic and an actual crisis in terms of medication supply, would only medicate people between the ages of 15 and 40. Under 15--society hasn't invested enough in them yet. That was the actual "excuse." Wish I had a reference for that, but I've been unable to locate the source. But in that economy, only 1 out of 5 in my household would get medicine.
Michelle said…
Perhaps he should recognize that such decisions are above his pay grade.

Of course, that's why he puts together a group of people. If you dilute the responsibility, anything is ok.

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