Secreted in the House version of the stimulus bill the President is trying to rush through Congress is the germ of a major overhaul of the American health care system. One provision causing increasing concern is the future role of the National Coordinator of Health Information Technology, who will be in charge of collecting and monitoring the health care being provided to every American.
Think of it, a centralized, federal database tracking your every visit to a health care provider - where you went, who you saw, what was diagnosed and what care was provided. Chilling. The immediate concern is privacy - traditionally these matters are between a doctor and patient, but now the federal bureaucracy will interpose itself into that relationship. The bill contains some boilerplate, assuring everyone that the records will be held in strictest confidence, but given the weakness of database security these days, that can be considered more a hope than a guarantee.
The purpose of the database is to help increase health care "quality, safety and efficiency." The first two goals are commendable, but what does efficiency mean?
The word is omnipresent in that section of the bill, but not defined. For guidance one can consult tax-impaired former HHS nominee Tom Daschle's 2008 book "Critical: What We Can Do About the Health-Care Crisis," which seems to have inspired that section of the legislation.
In it he discusses various approaches to reducing the costs of health care, including restricting the types of expensive treatments available to seniors and people with severe maladies. According to Daschle, Americans consume too much expensive health care. Thus one way to drive down costs is to limit the availability of or access to certain costly services. To many this sounds like denying care. But therein lie the efficiencies, making sure that providing health care is tied to a return on investment for society. If it costs too much to treat you, and you are nearing the end of your life anyway, you may have to do with less, or with nothing. You just aren't worth the cost.
Daschle's book recommends, and the bill appears to institutionalize, a body free of political influence to make the hard choices regarding how these efficiencies will be realized - what care will be limited, and who will be denied what services. Naturally politicians would prefer to stay clear of these critical decisions, but do the American people really want questions this important to be free of oversight?
One would think that the hard questions are the ones most in need of transparency and accountability, and not be buried in bureaucratic secrecy. It brings to mind Hannah Arendt's observation about the banality of evil. What nondescript GS-11 will be cutting care from Aunt Sophie after her sudden relapse before he or she heads to the food court for some stir fry?
There is no telling what metrics will be used to define the efficiencies, but it is clear who will bear the brunt of these decisions. Those suffering the infirmities of age, surely, and also the physically and mentally disabled, whose health costs are great and whose ability to work productively in the future are low. And how will premature babies fare under the utilitarian gaze of Washington's health efficiency experts? Will our severely wounded warriors be forced to forgo treatments and therapies based on their inability to be as productive as they once might have been? And will the love between a parent and child have a column on the health bureaucrats' spreadsheets?
Consider the following statement: "It must be made clear to anyone suffering from an incurable disease that the useless dissipation of costly medications drawn from the public store cannot be justified."
This notion is fully in the spirit of the partisans of efficiency but came from a program instituted in Hitler's Germany called Aktion T-4. Under this program, elderly people with incurable diseases, young children who were critically disabled, and others who were deemed non-productive, were euthanized. This was the Nazi version of efficiency, a pitiless expulsion of the "unproductive" members of society in the most expeditious way possible.
The program was publicly denounced in 1941 by Clemens Galen, the Catholic Bishop of Muenster, who said in a sermon, "Here we are dealing with human beings, with our neighbors, brothers and sisters, the poor and invalids ... unproductive - perhaps! But have they, therefore, lost the right to live?"
The efficiency-based approach to health care reform is a betrayal of the compact between those who are most capable of work and those who are least capable of defending themselves. And we have come a long way from what was supposed to be a "targeted, timely and temporary" stimulus bill.