It’s the rationing, stupid.

There isn’t enough money in Washington, even when we get to Quantitative Easing No. 254, to pay for unlimited medical services and care for everyone.  There must be rationing.

The question is how will the rationing be accomplished.

Paul Krugman just admitted that “death panels” will be an important part of this process.  The government will appoint experts who will decide which procedures and medicines are acceptable for which types of patients:

So, what I said is that the eventual resolution of the deficit problem both will and should rely on “death panels and sales taxes”. What I meant is that
(a) health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they’re willing to pay for — not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care…

Krugman now is where Sarah Palin predicted we would end up, when she issued this statement in August 2009:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

I noted at the time that Palin was making a reference to an article published by Dr. Ezekial Emanuel (brother of Rahm), “Principles for Allocation of Scarce Medical Interventions,” published on January 31, 2009.  I went on to point out:

The incoming fire has been withering, as usual. Palin is accused of becoming the “Zombie Queen,” certifiably insane, “clinically wrong,” and espousing a “gruesome mix of camp and high farce.”

Krugman is not wrong, if one believes that government is the answer.  If government giveth, government needs to decide what to taketh.

While Krugman was referring to Medicare and Medicaid, those are the models for where we are heading for all health care once the private insurance market is pared back.

The question we need to face, which we have not, is how will rationing take place.  Will it be on a dispersed, individualized basis as takes place now in the private sector, or will a panel of experts make the decision without regard to any individual.

I prefer the individualized method, where people can raise funds, seek alternate providers, provide for themselves, or do any of a myriad of things to get necessary care.  Once the government decides, it’s over, there is no recourse.

I suggested in August 2009:

To exclude the issue of allocating resources away from the elderly and infirm from the debate over “cost cutting,” however, ignores the ethical elephant in the room. Let’s have the debate, and understand specifically how resources would be reallocated, before any vote on a health care restructuring bill.

The politicians never had the debate over rationing as Democrats rammed through Obamacare, but the “American people did have that debate.  And Americans rejected refudiated death panels.

Update:  In honor of the Oxford University Press naming “refudiate” the word of the year, the text and post title have been changed accordingly (original post title “Americans Were Against Death Panels ….).  The Oxford blog announcement notes that “normalcy” was a word invented by Warren Harding which was criticized at the time as a mangling of the language but now is, er, normal.

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