The re-election of President Obama to a second term and the Senate remaining in Democratic hands confirms that Obamacare will be fully implemented. One of the major fears Americans have with regards to the impending regulations of the Affordable Care Act is the formation of death panels. Even though no such panels exist so far, the fact remains there will be significant rationing of health care resources at all levels.
One method is through the implementation of the “complete lives system.” This model was described in an article in The Lancet, co-authored by Dr. Ezekiel Emanuel, brother of Rahm Emanuel and former special adviser for health policy to the director of the White House Office of Management and Budget. Like Goldilocks in her visit to the bears, an American seeking treatment in the future will have to fall into the “just right” category in order to receive care.
The “complete lives system” is based on age and how productive the person will be to benefit the state. The chance of a patient receiving treatment or a procedure increases if that patient is between the ages of 15 and 50. The only patients receiving treatment will be the ones fitting into the proper age group, the ones who are “just right.”
This gives preference to teenagers and young adults over infants. The whole idea behind this is that infants have not received education and parental care like their teenage counterparts. These factors are actually looked upon as investments by the state — investments that will be wasted unless the older patients can “complete” their lives.
If a small child is diagnosed with a disease requiring expensive treatment, he or she may be denied care because there is no guarantee the treatment will ensure a “complete life.” Dr. Emanuel supports this argument by referring to a survey in which people agreed it is terrible when an infant dies, but it is worse when we lose an adolescent. Still, a poor teenager will be given the same care as a wealthy teenager even though there may be an imbalance in the investment in education and parental care between the two. This is where social justice will weigh in.
Likewise, an active Vietnam veteran may be denied a needed procedure because his “complete life” is almost over and any treatment will be deemed a poor investment by the government. Whether or not this will hold true for members of Congress and other elected officials remains to be seen.
Making decisions for physicians will be the Independent Payment Advisory Board (IPAB), a group of people appointed by the president to determine what services will be made available to Medicare patients. As ominous as that sounds, the board’s duty is somewhat restricted in the Affordable Care Act — restricted in the monetary sense.
The board’s real goal is to guarantee there will be no increase in Medicare spending. With the increasing number of baby boomers expected on the Medicare rolls in the coming years, this is going to be a formidable task.
The Affordable Care Act also guarantees there will be no formal rationing of health care. The only way spending can be curbed without rationing is to limit how much money will be authorized for the care. If the money is not available, the care cannot be provided.
What happens when there are too many patients who qualify for the same treatment and there is not enough funding to go around? Dr. Emanuel has an answer for that as well — a lottery.
As one would expect, the tentacles of the IPAB will reach out beyond Medicare patients. The board has power to control spending and quality of care in the private sector as well. The opportunity will surely arise for the board to make life-and-death decisions for infants and children.
Under the guise of cutting Medicare spending and improving quality care, the government has made a dangerous move toward a socialistic form of health care, a form devoid of personal choice. Medicine is out of the hands of patients and their physicians and at the mercy of a board focused on stripping health care to the bone.
America is becoming a Brave New World composed of young adults with a life expectancy at the mercy of God and God alone. The tax burden will be too big. The health care benefits will be too small. In order to receive any kind of treatment at all, the patient will have to be “just right.”
Dr. Constance Uribe is a general surgeon and author of “The Health Care Provider’s Guide to Facing the Malpractice Deposition” (CRC Press, 1999).