July 25, 2009 10:07PM

Government Health Care Trade‐​Offs: Death or Treatment?

Uwe Reinhardt has made the argument that health care rationing is health care rationing.  It's inevitable, so there's no big deal about the government exerting more control.  I argued earlier that this ignores the question 0f who is doing the rationing, us or the government?  Since resources are finite but desires are infinite, we all engage in "rationing" in most every aspect of our lives.  But we do so based on our needs, wants, wishes, and dreams, not those of politicians or bureaucrats.

Who makes the decision especially matters when the issue is life and death.  There was a recent report on RedState.com that a Democratic congressional aide was overheard suggesting that expanded Hospice care would help solve the cost problem for health care: 

And, for the crowning glory, the aide feels that “probably the best part of the bill is the increase in Hospice care which will solve the prolonging of life issue.” 

One has to be careful dealing with second-hand reports of overheard conversations.  Nevertheless, RedState's Erick Erickson pointed to Oregon's health program, which seems to trend the same way.  As Fox News detailed:

Some terminally ill patients in Oregon who turned to their state for health care were denied treatment and offered doctor-assisted suicide instead, a proposal some experts have called a "chilling" corruption of medical ethics.

Since the spread of his prostate cancer, 53-year-old Randy Stroup of Dexter, Ore., has been in a fight for his life. Uninsured and unable to pay for expensive chemotherapy, he applied to Oregon's state-run health plan for help.

Lane Individual Practice Association (LIPA), which administers the Oregon Health Plan in Lane County, responded to Stroup's request with a letter saying the state would not cover Stroup's pricey treatment, but would pay for the cost of physician-assisted suicide.

"It dropped my chin to the floor," Stroup told FOX News. "[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?"

The letter, which has been sent to other terminal patients throughout Oregon, follows guidelines established by the state legislature.

Oregon doesn't cover life-prolonging treatment unless there is better than a 5 percent chance it will help the patients live for five more years — but it covers doctor-assisted suicide, defining it as a means of providing comfort, no different from hospice care or pain medication.

"It's chilling when you think about it," said Dr. William Toffler, a professor of family medicine at Oregon Health & Science University. "It absolutely conveys to the patient that continued living isn't worthwhile."

Where government picks up the tab, it obviously has to decide what services it is willing to cover.  In the case of Oregon, the juxtaposition of refusing to pay for medical treatment while underwriting euthanasia should cause significant discomfort at the least.  Of course, drawing the line will never be easy.  But surely we don't want government to decide where to draw the line for the rest of us who are not — presently, at least — dependent on Uncle Sam for their health care.

Which brings us back to the problem of rationing.  We should not be able to count on someone else paying so we can receive every last medical treatment and procedure that is available, irrespective of how miniscule the likelihood of success.  But we should be able to spend our money, either directly, on treatment, or indirectly, on a generous insurance policy, if that's what we desire.  Government's responsibility is to help ensure access for those unable to help themselves, not make medical decisions for the rest of us, no matter how "rational" they might seem to someone else.