In the May 10 New York Times Sunday magazine, President Obama reflected on his elderly grandmother’s hip replacement. This episode, portrayed in a touching manner, turns out terribly enlightening about the hard questions all Americans face under his regime.
Obama’s grandmother had already been diagnosed with cancer, and the fall which broke her hip might have been caused by a mild stroke. Soon after the hip replacement, she went into serious decline, and passed away just two days short of seeing her grandson elected president.
“I don’t know how much that hip replacement cost,” said Mr. Obama. “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.”
“Society,” of course, cannot make decisions. Only people can make decisions. So when the powerful want to absolve themselves of the consequences of their decisions, they blame “society.”
If Mr. Obama were more forthright, he would have said: “I would spend as much of my own money as necessary to pay for my grandmother’s hip replacement. But because I intend to control all health care spending in this country, I (or people I appoint) will decide whether everybody else’s grandmothers will get hip replacements. The answer is ‘no.’”
Well, those are the breaks when you accept that other people should pay for your health care. Unfortunately, that’s the way most Americans think. Consider the results of a recent survey by Frank Luntz, a Republican pollster and campaign strategist.
A full 58 percent of people agreed with the statement that “decisions about my healthcare should be between me and my doctor and no one else,” and 53 percent agreed that “I should have the right to choose the healthcare that’s right for me.” However, only 9 percent agreed that “my healthcare belongs to me,” and only 12 percent agreed that “the right to spend my own money for my own healthcare must be protected/preserved.” That simply does not compute.
If you are not willing to take control of your own health-care spending, you cannot expect the person who does control it not to interfere with your relationship with your doctor or the treatments you can use. Back in World War II, the government allowed employers to give health benefits as non-taxable compensation. Even today, a worker who would prefer to buy his own health-insurance policy, instead of accepting his employer’s, would have to use after-tax dollars.
The Wall Street Journal calls this the “original sin” of American health care and “sin” is an appropriate term for such discrimination. Most libertarian and conservative health reformers focus on the fact that health costs are out of control and quality uneven because the patients don’t control payment. Of course they are right. However, the status quo also infringes on our moral choices.
If the government changed the tax-code to free every American to buy health insurance of his or her choice, instead of one chosen by an employer or the government, Barack Obama would not hold the power to decide whether anyone else’s grandmother lives or dies due to the availability of medical options.
Health insurers would differentiate their policies according to beneficiaries’ values. Some people, happy in a managed-care setting, would pay high premiums but low co-pays and deductibles to insurers like Kaiser Permanente for integrated treatment. Others would pay doctors directly, and buy low-premium policies covering only catastrophically expensive diagnoses or accidents.
More critically, pro-life citizens would not have to worry about whether this president will revoke the previous president’s “freedom-of-conscience” permission for health-care providers to decline to participate in abortions. Instead, they would buy health-insurance policies that assured them that their “network” included only pro-life doctors and allied health professionals.
People who wanted the option of hip replacements until they draw their last breath would pay the higher premiums for policies promising such replacements. Others would spend less to buy policies with carefully defined conditions under which they would not expect heroic surgery, just painkillers to help them along.
Such decisions are not easy, but neither are most moral challenges. The most immoral decision of all is to surrender our own choices in health care to the power of the state.
John R. Graham is Director of Health Care Studies at the California-based Pacific Research Institute.