On August 18, 2009 Mr. Martin Feldstein published an article in the Wall Street Journal under the title: “ObamaCare Is All About Rationing.” In it, he says this: “In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year … about $49,685 of additional health-care spending. If a treatment costs more … the health service will not pay for it. The existence of such a program in the United States would … deny lifesaving care …”
So this is how those who talk about rationing healthcare services define the word ration. Well then, in the interest of saving time and mental energy, let us not squabble as to whether or not the definition matches the word and accept that nomenclature. This done, let us look at what Mr. Feldstein is saying and what he is not saying. By not proposing that the expenditure on “expensive treatments” be raised to a higher value, Martin Feldstein is saying that there should be no limit.
First of all, let us observe that having no legally mandated limit is the case in Canada and all the public plans that I know of. Second, let us be honest and admit that if having a limit is a sign of deficiency in a system, then the most deficient of all is the American system because it is in it that the adjuster for a private insurance company determines whether or not they will pay for a treatment, and if they do, how much and for how long they will pay.
And this raises an important question which is the following: Was Mr. Feldstein aware of this part of the argument? The answer is: Of course he was aware; he is an intelligent man. And this is why he hastened to add the following to the statement I quoted above: […The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as "too expensive.”]
Anticipating an attack on his argument, Feldstein tried to reinforce it preemptively with the speculation that future researchers will go sour and stop researching because their discoveries might go over the limit and be rejected. And of course, there is no suggestion here that having made the discovery, those researchers would try to make it more affordable. In addition, there is something odd about the idea that researchers can determine the cost of a treatment before they even discover it and thus be forced to refrain from researching it.
And there is still more to it than meets the eye because what Martin Feldstein has actually done is clarify what the choice comes down to in his opinion, and what his preferred choice really is. However, before we delve into this, we must all stop beating around the bush and admit that everything we do in life, especially when it comes to allocating scarce resources, we do it according to a list of priorities we draw up whereby we make the choice every step of the way as to what is more important under the current circumstances and proceed with it.
Consequently, Feldstein says that the choice now comes down to either spending the available money to give nearly 50 million Americans an adequate coverage or spending it to aim at giving those who now have a luxurious coverage an even more luxurious one -- so luxurious in fact that it has not yet been discovered but remains a glimmer in the eyes of some researcher. And guess what Feldstein’s choice is: Very sad to say, he has chosen the second proposal.
The figure I have is that the American health bill amounts to approximately 2 trillion dollars. This means the bill for covering 50 million Americans would come to about 300 billion dollars. Martin Feldstein says throw these people to the dogs and spend the 300 billion dollars on research that will end up coating the existing gold plated coverage which some people have with an even thicker layer of gold. Is he serious?
I hope the man is only playing the devil’s advocate because I know he is a much better person than that.