Here's one of the clearest discussions of rationing of health care, the impossibilities, the need, the politics that I've read in a while.
....We want our doctors to go all-out for our loved ones and ourselves. But as voters and consumers, we send a different message. We pick politicians who promise to cut taxes, and we demand low-cost insurance. We're telling government and the health-care industry to hold the line on health-care costs, even if it means sacrificing clinical benefits. And we put doctors in the middle of this contradiction.
In recent weeks, private insurers have revealed plans for double-digit rate hikes. Our medical bills are already close to a fifth of our national income, on track to reach one-third within 25 years. Soaring Medicare and Medicaid costs are the main reason for nightmarish federal deficit projections over the long term. Yet as Republicans and Democrats battle over the federal budget to the point of threatening a government shutdown, serious health-care spending cuts remain unspeakable.
House Budget Committee Chairman Rep. Paul Ryan, R-Wis., recently proposed to cut Medicare and Medicaid by shifting their costs to poor and middle-class Americans who can't afford them. It's an unconscionable approach, but it at least acknowledges the urgency of gaining control over federal health-care spending. Neither President Obama nor congressional Democrats have put forth plausible proposals for doing so.
Andrew Sullivan has a proposal to lower health-care costs that actually makes some sense. “If everyone aged 40 or over simply made sure we appointed someone to be our power-of-attorney and instructed that person not to prolong our lives by extraordinary measures if we lost consciousness in a long, fatal illness or simply old age,” he writes, “then we’d immediately make a dent in some way on future healthcare costs. A remarkable proportion of healthcare costs go to the very last days or hours of our lives.”
His idea is voluntary. But I’d make a different suggestion. What if, to be eligible for Medicare, you had to give someone power of attorney and sign a living will? You could tell your attorney, and write in your will, that you want every possible measure employed to keep you alive. You could say cost is no object, and neither is pain or quality of life. You could make whatever choice, and offer whatever instructions, you want. You just have to do it. You have to make the decision.
The Palinites wouldn't be able to get past the "to be eligible part," of course. But, in fact, the suggestion reiterates what's always been true: living wills allow you to choose whatever you want.