Health Care Reform: Avoiding a Darwinian Nightmare

Republican-friendly media, like Fox News, the National Review and this outfit, are declaring a victory, today, for the Republicans — in particular, for the ex-governor of Alaska, Sarah Palin — as the news circulates that the so-called "death panel" provision has been dropped from the House health care reform legislation.

After the left's pundits pummeled her recent resignation and declared her public future at an end, Ms. Palin vaulted back into the spotlight by raising the "death panel" alarm in the current health care reform debate. At issue, it turns out, is a statement made some years back by Dr. Ezekiel Emanuel, brother to President Obama's chief of staff, Rahm Emanuel, and an adviser to the Obama Administration's health care reform team. Dr. Emanuel, apparently, contemplated at one time a plan to ration health care.

I'd like to comment on the issue. But before I do, let me be clear: I am in no way in favor of any plan that would ration health care. I am in no way an advocate for any plan that would fund or encourage euthanasia, forcibly deny health care to anyone for any reason, or even suggest to anyone that they voluntarily forfeit health care, no matter what the reason. When most of the country was criticizing the Catholic church and her parents for "interfering" in Terry Schiavo's adulterous husband's court fight to starve his comatose wife, I was one of the shockingly small number of Americans who publicly railed against the idea.

I don't recall Fox News or National Review or the Republican party rising up en masse in righteous indignation over that one. I heard very little about "judicial activism" in that case. (Nary a word from Ms. Palin or any of her friends. But I do remember a lone politician who stood up and took up the case of Ms. Schiavo's parents — the Rev. Jesse Jackson, who just happens to be black and a Democrat.)

And if I thought for one second that the Obama Administration actually intended rationing in its provision for funding voluntary access to "end-of-life" counseling, I'd be jumping up and down, screaming foul. But if we can get past the specter of "death panels" long enough to look at the realities of the Obama provision and the health care crisis we actually face, it might be possible to see things in a more calm and rational frame.

First, the bill currently before Congress had no such provision (see my previous post). There was no "death panel" awaiting Ms. Palin's son Trig or her aging mother.

Ms. Palin's angst is, at it's most pardonable, about her fears of what government involvement in health care might lead to if health care costs continue to skyrocket and the number of uninsured Americans continues to climb. All the more reason for Ms. Palin and friends to become partners in the discussion and help Mr. Obama find a rational solution to the issue of health care cost and availability, as we'll see.

Second, the Republican media machine now has managed, through innuendo alone, to create general distrust about health care reform. Ms. Palin's illogical leap and unfortunate choice of words provided just the right sort of sound byte right-wing commentators needed to muddy the waters of what Mr. Obama had hoped would be a clean, bi-partisan effort to reform health care.

(How is it that the Republicans, who have railed for so many decades against the bias and lack of objectivity of the "liberal media," are now so enamored of right-wing media celebrities who make no pretense to objectivity, gleefully sneer at anything remotely left-leaning, and cheer on those who disrupt public forums?)

I'd like to suggest that if we set Dr. Emanuel's rationing proposal and Ms. Palin's reaction to it against the proper backdrop, we might find that the two have ground for some agreement and, perish the thought, cooperation in the fight against something we should all want to avoid.

The pundits spend a great deal of time comparing the Obama proposal to health care systems now in existence in Canada, Great Britain, France and Switzerland. What they don't describe very well is what we'll get if we don't reform the health care system. For that, we need only look at the former Soviet Union. Just prior to its demise, health care in Russia was in an abysmal state. I remember reading an article about Russian Olympians at the time, who spent much of their earnings from the Soviet athletic training system stockpiling medical supplies, because in the Soviet Union's failing economy, the kind of health care most of us take for granted everyday was near nonexistent. While the Russian populace went without, what was left of Russia's system was reserved (in a survival-of-the-fittest fashion) for the famous (Olympians and educated technocrats) and the privileged (government officials).

Oh, I know, the Republicans will pipe right up and say, "Well, Mike, that's because, in the Soviet Union, the government ran the health care system." Sorry, that won't fly. Guess who's exporting quality health care all over Latin America? Not us. Sorry, it's Cuba. Its government-run health care system (patterned on the Soviet model) has quietly provided the doctors who are (dare, I say it?) revolutionizing public health care for the likes of Mr. Chavez and others left-wing wannabe despots in Latin America. My point? It's not that we should have government run health care. Rather, it's that we now have a private system whose only resemblance to the Soviet system is that its hell bent on bankrupting most of us and becoming the privilege of an elite. It matters much less who runs it than whether or not we can afford it. In a telling irony, Mr. Chavez has improved health care in Venezuela by exploiting the familiar free-market tenets of supply and demand. Cuba is only too happy to export doctors in trade for oil and cash. The market in action. Let me repeat: It's all about affordability.

Unfortunately, the market isn't handling the task so well, here, so the government has stepped in. The Republicans defeated Mr. Clinton's program 12 year ago, and then for eight years under President Bush, we saw health care costs rise at four times the rate of wages. We watched the roll of the uninsured grow every bit as fast during the good times as the rolls of the unemployed have increased during our current recession. Now we have another shot at cleaning up the mess.

The Democrats, at least, are trying. And, by all accounts, most physician's groups and professional health care organizations are onboard. Only the Republicans seem to prefer things the way they are. But that makes sense, doesn't it? The G.O.P. has for a long time been the party of the monied elite: Those who can afford to self-insure. Those who own the insurance companies. Those who believe the poor are poor by choice. It's no skin off their noses if 45 million Americans are uninsured. Glenn Beck and Rush Limbaugh don't bear the cost of treatment for these folks at emergency rooms, because Beck and Limbaugh and their friends can afford the lawyers and accountants it takes to weasel out of the taxes that pay for it. Wall Street doesn't foot the health care bill for the poor folks who live on the side streets that branch off from Main Street. Main Street foots the bill.

Set against that backdrop, Dr. Emanuel's "rationed care" proposal, formulated years ago (and which he now disowns) still has no appeal. But it is understandable when we consider that if we continue on our present course, it would be the lesser-evil alternative to de facto rationing based on far less attractive criteria: Those who control the guns and money get quality health care. Everyone else gets what's left ... or nothing at all. Deja vu, Soviet Union. If we're going to be fearful about something, let's be fearful about that prospect, shall we?

Unfortunately, the Republican right seems bent on derailing Mr. Obama's attempt to avoid this truly Darwinian nightmare by postulating an entirely fictitious Orwellian nightmare, in which the government controls and predetermines our health care options.

We must be clear: The same thing happened with Mr. Clinton's plan: The right appealed to exactly the same fears, and there was no reform. Since then, your premiums and mine have climbed far faster than our incomes. And the rising cost of health care for the uninsured is paid for by the same taxpayers who see their premiums going up. (Actually, that's not really true, is it? It'll be paid for — maybe — by our children and their children, because its all borrowed money. Medicare, a key plot point in the health reform drama, is one of the largest contributors to our national debt).

Can we really afford to see health care reform go down the drain again? Do we really want to pass this problem on (again) to the next generation?

No one, not even Dr. Emanuel, wants to ration health care. That's why health care reform is on the docket. If it falls off the docket again because people fear what might happen instead of facing up to what will happen if we don't do something, then we'll inevitably get what Ms. Palin and Dr. Emanuel both fear most.

Now that the objectionable provision is no longer part of the bill, there's no good reason why Mr. Emanuel and Ms. Palin and their friends can't get on with a rational, productive debate about what might be the best way to do what we all ought to fervently believe needs doing.

That assumes, of course, that Ms. Palin and friends are actually interested in health care reform. The evidence, so far, indicates that assumption is unwarranted. Hope I'm wrong about that.