Another Obama Advisor Favors Health Care Rationing

Barack Obama has nominated Henry J. Aaron to head the Social Security Advisory Board, a panel that advises the president and Congress about the old age system. The choice is most dangerous, since Aaron has a decades-long record as an advocate of denying American patients health care along the lines of the British national health system.

Aaron, a Brookings Institution scholar, has devoted his entire career to creating an intellectual and economic basis for health care rationing. In 2000, Aaron wrote, “The problem is that in the real world of limited medical resources, denial of beneficial care is inescapable.” Aaron wrote in a 2009 paper it is necessary for the government “to develop protocols that enable providers to identify in advance patients in whom expected benefits of treatment are lower than costs [and] to design incentives that encourage providers to act on those protocols.” That is, government must provide “incentives” to assure doctors deny treatment to those whom the ruling class deems unworthy of life.

Far from a passing interest, it would be fair to say advocacy for health care rationing has been the defining goal of Aaron’s career. In 1984 Aaron and William B. Schwartz wrote The Painful Prescription: Rationing Hospital Care. Six years later, the team wrote Rationing Health Care: The Choice Before Us. In 2005, Aaron teamed with Schwartz and Melissa Cox to write Can We Say No? The Challenge of Rationing Health Care for Brookings. A blurb for the book explains:

Can We Say No? argues that sensible health care rationing not only can save money, but can improve public health and general welfare as well…The choices the British have made point up the nature of the options Americans will face if they wish to prevent health care budgets from driving taxes higher and private spending from crowding out increases in other forms of worker compensation and consumption. The authors explain why serious consideration of health care rationing in the United States is advisable, even inescapable.

In the chapter he contributed to the book Setting Domestic Priorities: What Can Government Do?, Aaron wrote explicitly, “The simplest way to slow the growth of health care spending is to cap resources available to health care providers.” He noted hopefully, “Confronted with severe limits on equipment and staffing that necessitates denial of beneficial care to patients in Britain, one physician stated that there are always some reasons not to treat particular patients.” (Emphasis added.) The British physician admitted he “states the reason for not going forward in medical terms…but that formulation in many instances is in no small part conditioned by the fact that there really aren’t enough resources to treat everybody.”

Aaron then delineated his own plan, which:

would start with the establishment by the federal government of a ceiling on U.S. health care spending. A national budget would be parceled out among regions or states and then to substate units. The budgets would be allocated among hospitals and other providers by quasi-political entities. No one has described in detail how such expenditure caps would be calculated, what organization would determine allocations among and within the states, and how the limits wold be enforced.

Aaron may have hinted at how this will be enforced in a May article for the New England Journal of Medicine. Aaron argues the Independent Payment Advisory Board (IPAB) was the greatest act of Congressional “statesmanship” since the establishment of the Federal Reserve. IPAB, a little-remarked component of the health care bill, is charged with finding “savings” for the government, although its proponents insist this will fall short of rationing. The 15 unelected members of the IPAB have the power to make policy that can only be overturned by a three-fifths majority vote of Congress.

Aaron’s top-down vision of central planning should give pause for numerous reasons. The enforcement mechanism of the federal government is currently in the hands of Barack Obama, who denies or seeks to deny federal funds to Red State America. Giving the State control over such fundamental goods as health care encourages sycophancy, corruption, and the formation of a medical spoils system. The approach similarly calls to mind the way Science Czar John P. Holdren envisioned a “comprehensive planetary regime” that would determine “the optimum population for the world and for each region and for arbitrating various countries’ shares within their regional limits.” Obama’s decision to surround himself with such men shows his unyielding belief in government regulation and an ever-more-rigid regimentation of society — and apparently one that places an exceptionally low value on human life.