"How can we learn to say no?" asks David Leonhardt, "Economic Scene" columnist for the New York Times. Put your tongue on your palate, aspirate and round your lips? Nah, that's not what he means. His column is on health-care policy:
The federal government is now starting to build the institutions that will try to reduce the soaring growth of health care costs. There will be a group to compare the effectiveness of different treatments, a so-called Medicare innovation center and a Medicare oversight board that can set payment rates.
But all these groups will face the same basic problem. Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care.
These new institutions are necessary, Leonhardt explains, because the "try-anything-and-everything instinct," which is "ingrained in our culture," is expensive: "From an economic perspective, health reform will fail if we can't sometimes push back against the try-anything instinct."
Leonhardt argues that sometimes costs can be cut without reducing the quality of care:
When patients are given information about potential benefits and risks, they seem to choose less invasive care, on average, than doctors do, according to early studies. Some people, of course, decide that aggressive care is right for them. . . . They are willing to accept the risks and side effects that come with treatment. Many people, however, go the other way once they understand the trade-offs.
They decide the risk of incontinence and impotence isn't worth the marginal chance of preventing prostate cancer. Or they choose cardiac drugs and lifestyle changes over stenting. Or they opt to skip the prenatal test to determine if their baby has Down syndrome. Or, in the toughest situation of all, they decide to leave an intensive care unit and enter a hospice.
Still, patients' voluntarily forgoing treatments whose costs outweigh the benefits may not be enough. Having taken on, over the objections of the public, the responsibility for everyone's medical care, the federal government may not be able to keep its promise: "Eventually, we may well have to decide against paying for expensive treatments with only modest benefits."
Oops, sorry about that, Gramps!
It seems as though this is a pretty strong argument against ObamaCare. But we need to encapsulate it in a pithy phrase. What would you call governmental institutions that empower bureaucrats to decide when to deny medical treatment--panels, as it were, that have the authority to determine when a patient's death is necessary for the health of the fisc?
Coming up with a suitable term is a high-powered intellectual challenge. Our thinking cap is on, and we'll get back to you as soon as something dawns on us.