Secreted in the House version of the stimulus bill is the germ of a major overhaul of the American health care system. One provision concerns the future role of the National Coordinator of Health Information Technology, who will be in charge of monitoring the health care being provided to every American.
Think of it, a centralized, federal database tracking your every visit to a health care provider — where you went, who you saw, what was diagnosed and what care was provided. Chilling. The immediate concern is privacy — traditionally between a doctor and patient, but now the federal bureaucracy will interpose itself into that relationship.
The purpose of the database is to help increase health care “quality, safety and efficiency.” The first two goals are commendable, but what does ‘efficiency’ mean?
The word is omnipresent, but not defined. For guidance one can consult Tom Daschle’s 2008 book “Critical: What We Can Do About the Health-Care Crisis,” which seems to have inspired the legislation. In it he discusses various approaches to reducing the costs of health care, including restricting the types of expensive treatments available to seniors and people with severe maladies.
According to Daschle, Americans consume too much expensive health care. Thus, one way to drive down costs is to limit the access to certain costly services. To many this sounds like denying care. But therein lie the efficiencies. If it costs too much to treat you, and you are nearing the end of your life anyway, you may have to do with less, or with nothing. You just aren’t worth the cost.
Daschle’s book recommends, and the bill appears to institutionalize, a body free of political influence to make the hard choices regarding how these efficiencies will be realized — what care will be limit-ed, and who will be denied what services. Naturally politicians would prefer to stay clear of these critical decisions, but do the American people really want questions this important to be free of oversight? One would think that the hard questions are the ones most in need of accountability, instead of being buried in bureaucratic secrecy.
There is no telling what metrics will be used to define the efficiencies, but it is clear who will bear the brunt of these decisions. Those suffering the infirmities of age, surely, and also the physically and mentally disabled, whose health costs are great and whose ability to work productively in the future are low. And how will premature babies fare under the utilitarian gaze of Washington’s health efficiency experts? Will our severely wounded warriors be forced to forgo treat-ments based on their inability to be as productive as they once were?
Consider the following statement: “It must be made clear to anyone suffering from an incurable disease that the useless dissipation of costly medications drawn from the public store cannot be justified.”
This notion is fully in the spirit of the partisans of efficiency but came from a program instituted in Hitler’s Germany called Aktion T-4. Under this program, elderly people with incurable diseases, critically disabled young children, and others who were deemed non-productive, were euthanized. This was the Nazi version of efficiency, a pitiless expulsion of the “unpro-ductive” members of society in the most expeditious way possible.
The program was publicly denounced in 1941 by Clemens Galen, the Catholic Bishop of Muenster, who said in a sermon, “Here we are dealing with human beings, with our neighbors, brothers and sisters, the poor and invalids … unproductive — perhaps! But have they therefore, lost the right to live?”
The efficiency-based approach to health care reform is a betrayal of the compact between those who are most capable of work and those who are least capable of defending themselves. And we have come a long way from what was supposed to be a “targeted, timely and temporary” stimulus bill.