Paging Dr. Mises

Essay focuses on the philosophy for rationing health care supported by the Obama administration. Obama's plans for us should make every Americans' skin crawl.

Dr. Emanuel has embraced a technique for simplifying some of the tough calls: age discrimination. He wrote in The Lancet in 2008: “Unlike allocation by sex or race, allocation by age is not invidious discrimination.” We all were young once, the argument goes, so denying the elderly and weak in order to care for the young and fit is just. It does not take the fine nose of a Robert Parker to detect a whiff of Social Darwinism in ideas of this vintage. It is morally shallow, but unsurprising: Age discrimination is not a side effect of politically managed health care; it is a critical and fundamental feature of Britain’s National Health Service and other government-run health systems admired by Obama and his advisers. Under their arithmetic, the rewards of a procedure must be divided by the remaining life expectancy of the patient, leaving the elderly with what McCaughey calls a “denominator problem.” As she points out, this has led to such perverse outcomes as elderly patients’ being denied eyesight-saving therapies to treat their macular degeneration until after they’ve lost the use of one eye. The benefits of saving a patient’s only remaining eye are weighted more heavily than the benefits of saving one of two functional eyes.

Dr. Emanuel’s [and by extension, President Obama's] view of health care is narrowly ideological, regarding it as a zero-sum game in which every act of consumption by one party is an act of denial to another. These views are commonly denounced as Marxist, but that does a disservice to the intellectual sophistication of the better Marxian critics. In Dr. Emanuel’s crude view, medicine is two kids fighting over a candy bar.
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Given its inherently arbitrary character, centralized health-care planning will necessitate a certain amount of cruelty. If your mother and your child both were grievously sick, you might have to make a heart-wrenching resource-allocation decision between the two. Or you might not. Instead of deciding how to slice your medical-spending pie, you might decide to bake a bigger pie, forgoing other spending instead. But Drs. Emanuel and Blumenthal seek to foreclose that option and, in fact, to aggravate the problem: A political program of reduced health-care spending means more scarcity, and more hard decisions. And those decisions, in Obama’s vision, will be made by the government, not by consumers of health care.
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What is most worrisome about Dr. Emanuel’s [and by extension, President Obama's] oddball attack on the Hippocratic Oath is his stated desire to replace one set of incentives — the Hippocratic mandate to do everything possible for an individual patient — with a different set of incentives: distributing medical resources in a manner consistent with the preferences of Dr. Ezekiel Emanuel. Physicians are not as a class known for their humility, but the arrogance implicit in his critique is remarkable, as is the naïveté. The government cannot even rationally or effectively price a gallon of milk (or a tranche of troubled mortgage-backed securities), but Dr. Emanuel and his trusted associates are going to manage every course of cancer therapy in the United States of America. Because they’re smart guys. Because they have computers.

This is truly scary stuff.