The more a health care system is centralized, the less options there are for those who are shortchanged by it. It is why Americans who can't afford to pay for surgery can look to charities, surgeons willing to do procedures pro-bono, and various fundraising mechanisms. By contrast Canadians have to travel to the United States or look into one of a number of illegal clinics. In a free market health care system, the main barrier is financial, and that can be overcome far more easily than in the socialized system where lack of resources and centralized planning combines to close off all legal options.
That is why ObamaCare would not serve to expand American's access to health care, but rather close it down. The big lie of socialism is freedom from scarcity, but there is no escape from resource shortages. Instead socialism insures greater resource shortages than a free market economy, because it is woefully inefficient, inflexible and unrewarding. And those resource shortages are then passed on to the average citizen in ways far more unjust and restrictive than in any free market system.
While socialism insists on promising an infinite amount of pies in the sky, in the real world there is still only one pie. Where the free market uses trading strategies between consumers and businesses to maximize access to the pie, socialism locks the pie up in Al Gore's strongbox and creates a bureaucracy to parcel out access to it. By the time the pie has gone stale and everyone has figured out there's no more pie left, the system either breaks down or becomes nakedly totalitarian.
The question therefore is who will lose out under socialized medicine. Since socialized medicine is premised not on profitability, resource shortages become a much more pressing problem. That means that a socialized system must either limit access to everyone, or selectively limit access to certain groups of people. Or both.
The downside of limiting access to everyone across the board is that it insures that everyone will be unhappy. And it also cheats out government bureaucrats of the one thing they love most, playing god, and deciding who lives and who dies. Unlike private health care systems, socialized medicine exists for the society as a whole. As a socialized tool, it is subject to the mandate of social improvement. This opens the door to letting ethicists, read eugenicists, recommend how to best utilize existing health care resources. Which is a fancy way of saying, deciding who lives and who dies.
The elderly and the disabled who benefit most from a private health care system because it allows them to use their resources to obtain medical care, are the first on the butcher's block under socialized medicine. So are children with Down's Syndrome whose parents in a free market system can obtain health care for them, and all the other sort of people who don't pass muster as having a bright future of productive citizenship ahead of them. Or in the Third Reich's distinctive phrasing, "Life Unworthy of Life."
Dr. Ezekiel Emanuel, the brother of Rahm Emanuel and Health Policy Adviser at the Office of Management, provides a preview of how such a system will get started...
Such an approach accepts a two-tiered health system-some citizens will receive only basic services while others will receive both basic and some discretionary health services... Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.
Obviously. How could anyone disagree with rationing health care by allocating it based on creating people with reasoning skills who can fully and actively participate in the future of the Reich? Dr. Ezekiel Emanuel probably didn't even have to work too hard to translate his reasoning from the original German.
Or as Dr. Hermann Pfannmüller, who would later stand trial at Nuremberg for his Starvation Hospitals for those he deemed unfit, put it,
"The idea is unbearable to me that the best, the flower of our youth must lose its life at the front in order that feebleminded and irresponsible asocial elements can have a secure existence in the asylum."
The idea is essentially the same. Why should the weak, the sick and the degenerates receive treatment at the expense of the healthy?
Here's a quick pop quiz. See if you can guess whether the next paragraph comes from Dr. Pfannmüller or Dr. Ezekiel Emanuel?
The complete lives system also considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognoses.
Dr. Ezekiel Emanuel writing in the Lancet this time. It could just as easily have been Dr. Pfannmüller of the Starvation Hospitals who put it much more colorfully;
These creatures (the children) naturally represent for me as a National Socialist only a burden for the healthy body of our Volk. We do not kill with poison, injections, etc.; then the foreign press and certain gentlemen in Switzerland would only have new inflammatory material.. No, our method is much simpler and more natural, as you see. With these words, he pulled, with the help of a … nurse, a child from its little bed. While he then exhibited the child like a dead rabbit, he asserted with a knowing expression and a cynical grin: For this one it will take two to three more days. The picture of this fat, grinning man, in his fleshy hand the whimpering skeleton, surrounded by other starving children, is still vivid in my mind.
But here's another resource allocation quote to try your wits on. Is it Dr. Ezekiel Emanuel or Dr. Pfannmüller?
social value allocation prioritises specific individuals to enable them to promote other important values, or rewards them for having promoted these values. In view of the multiplicity of reasonable values in society and in view of what is at stake, social value allocation must not legislate socially conventional, mainstream values.
Dr. Ezekiel Emanuel naturally. The tipoff is his concern that a system of socialized health care eugenics not unduly favor people who represent mainstream values. Else where will the Obamas of tomorrow come from?
But here's another little preview of the moral calculus behind ObamaCare
Allocators must also avoid directing interventions earmarked for health needs to those not relevant to the health problem at hand, which covertly exacerbates
scarcity. 8,49 For instance, funeral directors might be essential to preserving health in an influenza pandemic, but not during a shortage of intensive-care beds.
For instance, former organ donors seem to deserve reciprocity since they make a
serious sacrifice and since there is no surplus of organ donors. By contrast, laboratory staff who serve as vaccine production workers do not incur serious risk
nor are they irreplaceable, so reciprocity seems less appropriate for them.
Ah, but somehow I suspect funeral directors will actually be quite vital under ObamaCare. Or perhaps they'll simply dispense with the carbon footprint of energy inefficient funerals and just shove them into the ovens. If they can find any ovens that are "green" enough.
It is of course safe to say that Dr. Ezekiel Emanuel will be considered most "essential" to preserving health under this system.
But here's another quote for the pop quiz.
Making a well-off person slightly better off rather than slightly improving a worse-off person’s life would be unjust; likewise, why give an extra year to a person who has lived for many when it could be given to someone who would otherwise die having had few?
Another deep thought from Dr. Ezekiel Emanuel at the Lancet on who should live and who should die. The Lancet you will remember served as a source for the vastly inflated Iraq civilian deaths that proved to be blatantly false. But that was okay since the Lancet only lied because they cared so much about human life. It is really wonderful how much liberals care about human life. And about apportioning that life to those humans they feel are worthy of life.
But here's one last quote challenge;
The complete lives system assumes that, although life-years are equally valuable to all, justice requires the fair distribution of them... Finally, the complete lives system is least vulnerable to corruption. Age can be established quickly and accurately from identity documents. Prognosis allocation encourages physicians to improve patients’ health, unlike the perverse incentives to sicken patients or misrepresent health that the sickest-first allocation creates.
And if the doctors can't... well it's no great loss anyway. And the good people like Dr. Ezekiel Emanuel who will be pulling down six figure salaries to provide "ethical guidance" will be doing gangbusters business ethically guiding the new ObamaCare Eugenics (TM).
The premise that health care should be doled out to those capable of developing reasoning skills and active participation in the political system, can be easily used to allocate medical treatment based on progressive political views... which in the liberal lexicon is identical with "reasoning skills" and "active political participation".
Furthermore if health care is allocated based on the overall social goal of political participation by the next generation, affirmative action and diversity will inevitably factor into the decision. By linking civic participation with health care allocation, Dr. Ezekiel Emanuel has made an argument for rationing health care in order to promote progressive politics and racial diversity. This of course would bring ObamaCare full circle to merge with Nazi eugenics in a horrid prescription of death.