Pork and the usurpation of freedom, Or, all QALYs are equal, but some are more equal than others

As usual, Thomas Sowell cuts to the chase: “Why does it take more than 1,000 pages of legislation to insure people who lack medical insurance?”

Take your time.


Let’s grant for the moment something that I do not in fact think is true: that it is (pick your level of shrillness) 1) a problem 2) a disgrace and an outrage that millions of people in the United States do not have health insurance.

As I say, I do not think it is a very big problem, much less a “disgrace” — Why? One reason is that our compassionate society provides medical care whether or not you have health insurance. But let’s grant the premise for the nonce.

Why take a 1000 pages to fix it? As Sowell points out, those who have bothered to read the bills have discovered two things 1) they contain “all sorts of things . . . that have nothing whatever to do with insuring the uninsured.” And 2) they contain an abundance of things designed to take “medical decisions out of the hands of doctors and their patients, and [transfer] those decisions to Washington bureaucrats.”

Pork, on the one hand, and the usurpation of individual freedom, on the other hand. That’s really what Obama care is all about.

Partly, it’s an application of “the Chicago Way” to the nation as a whole: take care of your constituents and supporters. An AP headline today: “Firms with Obama ties profit from health push”: you don’t say?

Even more worrisome, though, is the second part. The further expansion of government bureaucracy. Let me once again quote what Ronald Reagan had to say about the use of “health care reform” to further socialism: “One of the traditional methods of imposing statism or socialism on a people,” Reagan observed, “has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project.”


My only quibble is with the word “disguise.” Tom Sowell is right that “deception” is at the heart of the Democrats’ health care proposals. They say they are trying to “fix” health care. Really they are attempting to extend government control over a bigger part of the economy and your life. But the effort to further socialism by means of a government takeover of health care is not something disguised as a humanitarian project. It is a humanitarian project in its purest left-wing form: a humanitarian project imposed on the unwilling “for their own good” — a “good,” naturally, that is defined by a government bureaucracy.

One of the most rebarbative features of this new effort to bring government-control to a life near you is its combination of the antiseptic rhetoric of utilitarian social science with old-fashioned central planning. Consider Dr. Ezekiel Emanuel, the brother President Obama’s Chief of Staff Rahm Emanuel, who is a top White House advisor on health care reform. Dr. Emanuel has famously argued that doctors “take the Hippocratic Oath too seriously.” Dr. Emanuel wants to concentrate medical services not on those who need it most — the elderly, seriously impaired children, etc. — but on those who are likely to contribute to “the continuation of the polity,” “ensure healthy future generations,” etc. “Services provided to individuals who are irreversibly prevented from being or becoming participating citizens,” he argues,


are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.

Got a loopy grandparent or a kid who is playing with half-a-deck? What can they contribute to “the continuation of the polity” or “healthy future generations”? (Catch that whiff of Ziclon B? I did too.)

Cass Sunstein, the University of Chicago lawyer who also advises President Obama, combines the antiseptic language with the nihilistic utilitarian conclusions even more blatantly. “At least since 1976,” he wrote in one coma-inducing policy paper,

“analysts [analysts!] have suggested the possibility of focussing regulatory policy on either life-years or quality-adjusted life-years (QALYs). Through the latter measure, the issue is not merely the number of life-years saved by regulation; attention is also paid to qualitative improvements in health. An aggregate measure of QALYs would catalogue all of the health-related benefits of regulation. And for many years, some agencies have experimented with the idea that cost-benefit analysis should consider either QALYs or life-years, not merely the number of lives saved.”

QALYs, eh? And what does the above-quoted gibberish portend? Elementary, my dear Watson:


“A program that saves younger people is better, along every dimension, than an otherwise identical program that saves older people . . .”

All animals are equal, Comrade, but some are more equal than others. I hope you feel better that folks like Cass Sunstein and Dr. Ezekiel Emanuel get to say which is which.

Glenn Reynolds made the observation, amusing and scary in equal measure, that what we’re dealing with here bears an awful similarity to the troubled “cash for clunkers” program: “First Grandma’s Caprice, then Grandma.”


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