The Blog

Kennedy: Let's Ration Health Care

4:35 PM, Jul 19, 2009 • By WILLIAM KRISTOL
Widget tooltip
Single Page Print Larger Text Smaller Text Alerts

Newsweek Managing Editor Daniel Klaidman explains that his magazine decided to ask Sen. Ted Kennedy to author a cover piece on health care, because "his absence during this historic debate had been so palpable, yet here was a way for this respected voice on health care to weigh in and be part of the national conversation at a critical moment."

Well, Sen. Kennedy has weighed in, and he may have helped doom Obamacare.

For Kennedy and his co-author, Bob Shrum, have let the rationing cat out of the bag. And that's a problem for President Obama and the Democrats. Make no mistake: Beyond all the other crippling problems with the Democrats' health care proposal--its cost at a time of massive deficits, the tax increases it requires at a time of recession, its preference for government over the private sector and for central planning over free competition--the deepest vulnerability of Obamacare is that it (intentionally) puts us on a course towards government rationing of health care.

Here's the key paragraph from Kennedy and Shrum:

We also need to move from a system that rewards doctors for the sheer volume of tests and treatments they prescribe to one that rewards quality and positive outcomes. For example, in Medicare today, 18 percent of patients discharged from a hospital are readmitted within 30 days--at a cost of more than $15 billion in 2005. Most of these readmissions are unnecessary, but we don't reward hospitals and doctors for preventing them. By changing that, we'll save billions of dollars while improving the quality of care for patients.

Now first of all, if there are problems with Medicare, the laws and regulations governing Medicare--a government program--can be changed, without a government take-over of the rest of the system. Second, given that first diagnoses are often wrong or that hospital treatments lead to unanticipated complications, it's not so clear on the face of it that an 18 percent readmission rate within 30 days for elderly patients is unreasonable. And third, even if the whole $15 billion worth of hospital readmissions were unnecessary (which can't be case), $15 billion per year is less than 1 percent of our health care spending.

But the most important implication of the Kennedy-Shrum claim--"Most of these readmissions are unnecessary, but we don't reward hospitals and doctors for preventing them. By changing that, we'll save billions of dollars."--is this: The government is going to decide--ahead of time, obviously, since deciding after the fact wouldn't save any money; and based on certain general criteria, since the government isn't going to review each individual case--what kinds of hospital readmissions for the elderly are "unnecessary" and what kinds aren't. And it's going to set up a system "to reward hospitals and doctors for preventing" the unnecessary ones. That is, the government will reward hospitals and doctors for denying care they now provide, care the government will now deem "unnecessary."

Indeed, this understates the case. For in reality the government isn't going simply to reward "good" and penalize "bad" admissions. It's going to prevent insurance companies from paying for "unnecessary" admissions and procedures, if those companies want to participate in the government system. In other words, government bureaucrats are going to deem entire categories of treatment inefficient for all or certain categories of patients, and put those treatments out of bounds for doctors and hospitals.

There are problems aplenty with our current health insurance and health care system. But do the American people want this kind of reform, one that has at its center an expansion of government control and one that leads, according to its own logic, to government rationing and denial of health care?