FACING THE CHALLENGE OF HEALTH CARE RATIONING
With Congress preparing for floor votes on health care restructuring this Fall, we must guard against the grave danger of rationing life-saving medical treatment, food, and fluids.
Since its inception, the pro-life movement has been just as committed to protecting older people and people with disabilities from euthanasia as to protecting unborn children from abortion. We have long recognized that denial of treatment, food and fluids necessary to sustain life against the will of the patient is a form of involuntary euthanasia, and thus have fought to protect the vulnerable from rationing of health care, whether by health care providers such as hospital ethics committees or by the government.
All versions of the health care restructuring bill provide for premium subsidies to help the uninsured obtain health insurance. The problem is that the proposals under serious consideration to date fail to ensure a sustainable method of financing these subsidies (See NRLC’s webinar at http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar/ and also www.nrlc.org/HealthCareRationing.describeplan.html). Indeed, a substantial part of the subsidies, under current proposals, would be paid for by “robbing Peter to pay Paul” – reducing Medicare funding for older people in order to cover the uninsured. The dangerous consequence is that in a few years, having over-promised and under-funded, the government will be faced with the choice of adding other means of revenue or else (and far more likely) in some way imposing rationing.
The companion piece describes how “comparative effectiveness” research included in the legislation could be used to accomplish such rationing.
When the Kennedy bill was considered in the Senate Health, Education, Labor and Pensions Committee, several important anti-rationing amendments sponsored by pro-life Senator Mike Enzi (R-WY) were adopted. However, a critically important amendment to prevent “comparative effectiveness” from being used for rationing was defeated (see http://www.nrlc.org/press_releases_new/Release062209.html). Moreover, a provision in the Kennedy bill reported from the committee gives Secretary of Health and Human Services Kathleen Sebelius unconstrained authority to issue regulations governing doctors, hospitals and other health care providers who want to be paid by qualified insurance plans with the vague objective “to improve health care quality”– authority that could be used to require them to deny so-called “ineffective” treatment to their patients.
Through the good offices, in particular, of the staffs of pro-life Senators Enzi and Chuck Grassley (R-IA), NRLC has been able to negotiate language to be included the comparative effectiveness portion of the bill planned to be brought before the Senate Finance Committee in September that would forbid use of comparative effectiveness data to deny treatment discriminatorily based on disability, age, or terminal illness. Since no such language is included in the Kennedy bill or House legislation, however, there is no guarantee that this protective provision will be included in any bill finally passed by Congress. Moreover, if the bipartisan group of six Senators does not agree on a compromise bill by September 15, Democratic Senate leaders have warned they may bring the Kennedy bill to the Senate floor under a procedural maneuver, called “reconciliation,” that would permit many portions of it to pass with only 51 votes – meaning that Senate Republicans and centrist Democrats could be cut out of the process and the negotiated anti-rationing language might not be part of the bill brought to the floor.
The House legislation, as reported from the Energy and Commerce Committee, contains provisions to promote advance directives like “living wills,” including:
1) Medicare reimbursement for consultations about “advance care planning” between health care providers and their patients when they enter Medicare, every five years thereafter, and if they become seriously ill;
2) requiring private and public health care plans to give potential enrollees the option to establish advance directives; and
3) a public education campaign, toll-free telephone hotline, and clearinghouse to promote advance directives and other advance care planning.
Advocates of such measures frequently cite the cost savings if, as they expect, this promotion results in more directives rejecting life-saving treatment. “We refer to the end-of-life discussion as the multimillion-dollar conversation because it is associated with shifting costs away from expensive . . . care like being on a ventilator in an ICU, to less costly comfort care…,” says Holly Prigerson of Boston's Dana-Farber Cancer Institute. National Right to Life strongly encourages the execution of a pro-life advance directive, the Will to Live (See http://www.nrlc.org/MedEthics/WilltoLiveProject.html). However, the pro-life fear is that efforts to push patients and prospective patients to prepare advance directives may in practice become a means of persuading or pressuring them to agree to less treatment as a means of saving money. Moreover, governmental promotion of advance care planning must not include the “option” of assisted suicide. Especially in the Senate, NRLC is working to address these concerns through negotiations and, if necessary, by preparing amendments to be offered in the Senate Finance Committee and on the Senate floor.
It is critically important that pro-life citizens make their voices heard while Senators and Representatives are at home during August, and after they return to Washington in September. The contemplated restructuring of America’s health care system will affect the life – and death – of every American.
--Article Published in July/August 2009 NRL News
“Facing the Challenge of Health Care Rationing” by Burke J. Balch, J.D., director, Robert Powell Center for Medical Ethics