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Obama Suggests Health Care Reform Will Mean Rationing for Some, But
Admits He Would Pay Out-of-Pocket for His Own Family
Friday, June 26, 2009
By Christopher Neefus

(Photo courtesy of ABC News)
(CNSNews.com) - During ABC’s health-care forum Wednesday from the
White House, “Prescription for America,” President Obama cited his
deceased grandmother’s hip replacement surgery as an example of
rationing care.

During the 90-minute question-and-answer session, which hosts Diane
Sawyer and Charlie Gibson said was attended by 164 people “on the
front lines of health care in America,” epilepsy specialist Dr. Orrin
Devinsky asked the president one of a few challenging questions.

Devinsky asked: “If a national health plan was approved and your
family participated, and, President Obama, if your wife or your
daughter became seriously ill, and things were not going well, and the
plan physicians told you they were doing everything that reasonably
could be done, and you sought out opinions from some medical leaders
and major centers, and they said there's another option that you
should -- should pursue, but it was not covered in the plan, would you
potentially sacrifice the health of your family for the greater good
of insuring millions? Or would you do everything you possibly could as
a father and husband to get the best health care and outcome for your
family?”

Obama didn’t answer directly, saying that “(I)f it's my family member,
my wife, if it's my children, if it's my grandmother, I always want
them to get the very best care.”

But the president questioned whether his now-deceased grandmother
should have received her hip replacement while suffering a terminal
illness.

Recounting the dilemma, Obama said, “(T)he question was, does she get
hip replacement surgery even though she was fragile enough that they
weren’t sure how long she would last (or) whether she could get
through the surgery.”

“I think families all across America are going through decisions like
that all the time,” Obama said.

This was not the first time the president had used his grandmother to
illustrate his point on health care. In an April 2008 interview with
The New York Times Magazine, Obama suggested much of the cost of
health care in America comes from the elderly and those with chronic
illness.

“That’s where you get into some very difficult moral issues,” Obama
said – specifically considering whether “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.”

But in the April interview, Obama also admitted that his own
grandmother would have gotten the procedure either way.

“I would have paid out-of-pocket for that hip replacement just because
she’s my grandmother,” he said.

The president told the magazine that the chronically ill and elderly
represent 80 percent of American healthcare costs, and said, “(T)here
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.”

“And that’s part of why you have to have some independent group that
can give you guidance,” he added.

Michael Tanner, a senior policy fellow at the libertarian Cato
Institute, told CNSNews.com the question illustrates the fundamental
contradiction in the health-care debate.

“Everybody wants to live forever, and everybody wants their loved ones
to live forever, and nobody wants to pay for it,” he said.

Tanner suggested Devinsky’s question gets to the root of the matter --
whether government should make decisions like the ones Obama made
about his own grandmother.

“I think it does show that these are personal questions and therefore
something that should be left to the individual and not be rationed by
third parties,” Tanner said.

Asked whether there would be any restriction on the kinds of rules a
government plan might impose, Tanner said, “No, no, there’s no limit
at all.”

“(A)nd, in fact, what we would probably see,” Tanner speculated, “is
the use of these clinical effectiveness, or the ‘cost-effectiveness
research’ studies to begin to say, ‘Well, we’ll stop reimbursing for
x, y, and z because it’s not cost-effective.’”

Funding for the National Institutes for Health to conduct comparative-
effectiveness research in healthcare was included in the economic
stimulus bill, the American Recovery and Reinvestment Act, signed by
the president in February.

But Judy Feder, a senior fellow in health-care issues at the liberal
Center for American Progress, said it is wrong to connect comparative-
effectiveness research with cost-effectiveness.

“What comparative effectiveness research does is tell us what works
and what doesn’t,” she told CNSNews.com. “It’s not about limiting
care. It’s about essentially providing doctors and patients evidence
on what care works.”

Feder also said that, currently, new technologies and treatments are
rushed into wide use.

“(They) are being applied well beyond where there’s evidence that they
do good,” she said.

“(W)hat researches will enable us (to do) is to know whom it helps and
whom it doesn’t. That’s good research; that’s what you want to know.”

Similarly, Obama told Levinsky, “(T)here is a whole bunch of care
that’s being provided that every study, every bit of evidence that we
have indicates may not be making us healthier.”

But Tanner says government research could ultimately become
politicized, citing an attempt by the state of Oregon to create an
exhaustive list of treatments the state’s Medicaid program would pay
for “in order to be able to spend the money further than it was
going,” he said.

“And within weeks of the final list being published, it had been
completely rewritten by the state legislature,” Tanner added.

Feder says the two are not comparable, and that those worried about
health-care rationing should “Get a grip.”

She told CNSNews.com, “This is all about getting doctors and patients
real information, objective information about what works so that we
can get decisions.”

At the forum, Obama admitted “(W)e’re not going to solve every
difficult problem in terms of end-of-life care.”

“But what we can do is make sure that at least some of the waste that
exists in the system that’s not making anybody’s mom better (is
eliminated),” he told the audience. “(A)t least we can let doctors
know and your mom know that, you know what? Maybe this isn’t going to
work.”
http://www.cnsnews.com/Public/Content/article.aspx?RsrcID=50149