Testing Obamacare’s Meddle

To cut costs, government must meddle not just with how we live, but how we die.

By Jonah Goldberg
http://www.nationalreview.com/
August 14, 2009, 0:00 a.m.

If I went to a Democratic town hall, I’d probably boo, too. Hence, according to various Democrats and supporters of Obamacare, I’m paranoid and just a bit unpatriotic.

Well, let me dilate on my paranoid treachery for a moment.

Under the plan discussed at President Obama’s infomercial-esqe town halls, America would cut costs and expand coverage while avoiding rationing. Apparently, it’s paranoid to think that’s too good to be true.

Imagine you’re in charge of bringing pie to a company picnic. You’re planning to provide dessert for 100 people. Then, your boss says you need to hand out pie to 150. Fine, you say, I’ll make more pies. But — oh no! — you can’t, because you’ve also been told costs must go down. Okay, then you can cut slices of the existing pies smaller so everyone can have a piece. Wait! You can’t do that either, because you’re not allowed to ration (i.e., give less to more).

According to Obama, the health-care pie will be sliced into more pieces, of equal or greater size than available now, for less money — all because government is so much better than the private sector at managing large projects.

Such contradictions run through the talking points for Obamacare. Consider life expectancy. In his big speech before the American Medical Association in June, Obama insisted that “the quality of our care is often lower, and we aren’t any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do.”

It’s true, a few countries beat us in terms of life expectancy. But life expectancy is only partly about health care. Other factors matter. Swaziland’s life expectancy is 31.88 years. That doesn’t mean the average Swazi dies just a couple of weeks before his 32nd birthday. It means lots of people die young and a few people die old and the average comes out to around 32.

According to the CIA World Factbook’s 2009 estimate, American life expectancy is 78.11 years. In the U.K. — with its nationalized system — it’s a whopping 79.01. Taiwan’s is 77.96 and so is Albania’s. Do we really think the best explanation for all this is how they pay for medical care? Or perhaps things like diet and culture are more important? Is Japan’s health-care system what explains Japanese longevity, or is it that fish and seaweed are staples of the Japanese diet?

Even greater disparities exist within America. Asian-American women, according to a 2006 study by Harvard’s School of Public Health, have a life expectancy of 87 years, while for African-American men it’s 69. The healthiest white people in America are the low-income folks of the Northern Plains states. Again, is our health-care system the biggest factor?

But here’s the kicker: The more life expectancy improves, the more we will spend on health care. Despite his professed outrage over charges of “death panels” and whatnot, Obama admits this. In an interview with the New York Times last spring, he acknowledged that oldsters are a “huge driver of cost.” 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,” Obama explained. Which is why he advocated an advisory panel of experts to offer “guidance” on end-of-life care and costs. But don’t you dare call it a “death panel.”

Now, I don’t think Soylent Green-style solutions are coming down the pike. (Government cheese is people!) But every nationalized health-care system to one degree or another rations care based on the quality of life and number of “life years” a procedure will yield. That’s perfectly reasonable. If you put me in charge of everyone’s health care, I would do that, too. That’s a really good argument for not giving me — or anyone else — that power.

When it comes to civil liberties, liberals are often distrustful of government power. But, for reasons that baffle me, they are quite comfortable with Uncle Sam getting into the business of deciding, or providing “guidance” on, which lives are more valuable than others. A government charged with extending life expectancy must meddle not just with our health care, but with what we eat, how we drive, how we live. A government determined to cut costs must meddle not just with how we live, but how we die.

That sounds scary and un-American to me. And if that makes me paranoid and unpatriotic, then I am what I am.

— Jonah Goldberg is editor-at-large of National Review Online and the author of Liberal Fascism: The Secret History of the American Left from Mussolini to the Politics of Meaning.

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