Thursday, April 30, 2009

Obama on health care

From this interview with The New York Times:
I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
This is rather frustrating to read. Obama is well aware that the health care sector, like all industries, faces the problem of limited resources. Money is finite and you can't provide to everyone all the services that they need or want. After recognizing this and admitting his likely anger if treatment were to be denied to his grandmother he proceeds to say that a "very difficult democratic conversation" will have to take place, which in practical terms means the politicians will decide.

His invocation of the need for "some independent group" meanwhile to provide guidance strikes me as a bit of a deus ex machina. This is totally mythical. Who will comprise this group? Will it be self-appointed people from the private sector? Unlikely. More realistically any group with such guiding powers will be appointed by the government, with their positions by definition political. Any semblance of independence therefore falls apart, unless given lifetime appointments such as on the Supreme Court, in which case you have an unelected, unaccountable group given the power to almost literally decide who lives and who dies.

Obama clearly grasps the problem, but he is nowhere close to coming up with anything approaching a solution.

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