Liberty and ObamaCare

This article was featured in The Bulletin (Philadelphia-area newspaper) on 8/10/09, and The Bucks County Courier Times on 9/6/09. You can see The Bulletin version here, or check out the print column each week.

President Obama may see resistance to his healthcare proposal from a group he was not expecting: Obese Americans. A new study in the journal Health Affairs found that obesity-related health spending costs $147 billion annually, and that obese Americans spend an average of $1,400 more per year on health expenses than those in a healthy weight range. The research ties closely with an earlier study in the Health Affairs Policy Journal showing that obesity creates a 36% increase in inpatient and outpatient spending, and a 77% increase in medication use. The findings led RTI health economist Eric Finkelstein to say, “Unless you address obesity, you’re never going to address rising health-care costs.”

So why should obese Americans worry about President Obama’s universal healthcare proposal? Shouldn’t they be happy that their increased costs will be paid for by the government? Not exactly.

ObamaCare rests on the idea of cost control through government intervention and regulation. By limiting extraneous tests or procedures and identifying cost-ballooning health risk factors, President Obama’s plan hopes to guide the healthcare market to greater efficiency, allowing the government to offer inexpensive care.

This theory of cost control through regulation is where the administration claims it will save money in the long run, or “bend the curve” of health spending.  Recently, Lawrence H. Summers, President Obama’s chief economic adviser, said it more poignantly:

“Whether it’s tonsillectomies or hysterectomies…there’s no benefit in terms of the health of the population…some experts…estimate that we could take as much as $700 billion a year out of our health care system.” What Mr. Summers is referring to is rationing and regulation: In order to control costs for the whole, government will control or limit care for individuals.

The foundation of ObamaCare is the idea of collectivism, that what is best for the whole (the collective) is what is just for the individual. So, if you choose to have a “needless” tonsillectomy for your child, and the procedure raises the overall cost of care for the nation, you’ve done something wrong. Your choice has hurt the collective, so your choice must be limited. Under ObamaCare, such indiscretion will be forced out of the system.

Fundamentally, collectivism shifts responsibility and choice away from you and onto the government. Currently, it is your choice what procedures and medicine are available to you and your family. Under ObamaCare, if a procedure falls outside of the government’s cost-efficient estimates, it will be disallowed. If a prescription is deemed “cost-ineffective,” it will be deemed unnecessary.

If you think rationing is unrealistic hyperbole, you need only to look to our Canadian and British counterparts. In Canada, 44% percent of the drugs approved by Canadian health authorities are not allowed by the healthcare system due to their high cost. In Britain, the National Institute for Health and Clinical Excellence (NICE) recently ruled against the use of Lapatinib (a drug that prolongs the life of those with certain forms of breast and stomach cancer), Stutent (a drug to help terminally ill kidney-cancer patients), and Aricept (an Alzheimer’s drug that delays dementia) because they were not seen as “cost effective.” Despite outrage from doctors in the U.K. over the importance of the drugs, Peter Littlejohns, NICE’s clinical and public health director, stated that “there is a limited pot of money” which might be better spent elsewhere.

So how does obesity factor in? Studies show that the vast majority of Obese Americans are overweight by choice (the remainder have genetic or thyroid conditions), and therefore raise costs drastically for the collective because of their personal lifestyle. Under ObamaCare, a preventable choice that damages the whole is simply unacceptable. Indeed, Democrats have already proposed a massive tax on sugary drinks and trans-fatty foods; it is easy to imagine caloric control limits or compulsory weight reduction programs for the obese.

And why stop there? The New England Journal of Medicine recently reported that “healthcare costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers.” Shouldn’t everyone that participates in ObamaCare be required to quit smoking? And what about alcohol consumption, high carbohydrate diets, or high stress jobs? Each has been linked to increased medical costs. In a collectivist system, such choices must be limited.

Addressing the prospects of universal care in the United States, Scott W. Atlas, a senior fellow at the Hoover Institution and a professor at Stanford University’s Medical Center put it best: “There is no mystery here—it has been proved the world over that when government dictates prices on services, those services become unavailable. And when bureaucrats dictate medical care, it is the patient who suffers most. Directly or indirectly, choice becomes limited, and health care becomes rationed.”

What the government provides, it also controls. What the government controls it also rations. Perhaps now more than ever, Thomas Jefferson’s words ring true: “Government big enough to supply everything you need is big enough to take everything you have… The course of history shows that as a government grows, liberty decreases.” On healthcare, we would be wise to heed this warning.

-Matt Benchener from TruPolitics.net