In one sense, at least, Health and Human Services Secretary Kathleen Sebelius deserved better last month when she refused to intervene in the case of a 10-year-old Pennsylvania girl given only weeks to live without a lung transplant. When politicians and others pleaded with her to override regulations prohibiting the use of adult lungs in children, Sebelius replied during a House hearing that “I would suggest, sir, that, again, this is an incredibly agonizing situation where someone lives and someone dies.”
As tactless and patronizing as her words were, Sebelius was right. Just ask the people who didn't receive transplants after an emotional media blitz and a court order allowed little Sarah Murnaghan to get her adult lung – and a second one after the first operation failed.
If you still can.
The uncomfortable reality exposed by Murnaghan's plight was this: Where medicine and other valuable but finite commodities are concerned, there will inevitably be a mechanism for determining how those resources are distributed. Fair or not, Sebelius' seeming deference to medically questionable regulations and seeming indifference to a dying girl's suffering revived the specter of the alleged “death panels” that will ration resources under Obamacare.
And make no mistake: Medicine will inevitably be rationed under Obamacare, just as it is today by medical necessity, economics and choice.
Yes, choice. As the Associated Press points out, many young Americans will simply choose to pay an annual $100 penalty instead of the thousands of dollars that might be needed to pay for insurance. For them, it makes perfect sense: Young people are generally healthy and lack large amounts of disposable income, and Obamacare allows people who develop medical problems into the system whether they previously paid for coverage or not.
But for Obamacare, the potential loss of millions of healthy participants and the dollars they represent could make the system even more insolvent than it was always destined to be, thereby increasing either the national debt or the need for rationing.
And if care is going to be rationed – and it is – I trust the market and the private sector far more than I trust Obama, Sebelius and their IRS enforcement agents. That is not to suggest that the poor should not receive care, as they do today. But is the illusory quest for equality really worth the prospect of even more bureaucrats controlling the lives of even more Americans?
Even the Obama administration senses the trap it has built for itself, delaying until 2015 implementation of a key provision that requires most employers to provide “affordable” coverage. City and county officials say most employees already receive coverage compatible with the new regulations, but it's unclear whether low-income workers across the country will really be able a to spend as much as 9.5 percent of their pay on health insurance.
What is clear, however, is this: Local taxpayers will be subsidizing Obamacare very soon. Fort Wayne and Allen County governments, for example, will have to pay a fee of about $62 for every employee or dependent covered by health insurance – a $200,000 expense for county government alone. Commissioner Nelson Peters said the county will invite the city to participate in the county's in-house health clinic in an effort to save money.
And in the meantime, the public and private sectors struggle to cope with Obamacare regulations that change almost as fast as the Indiana weather.
“It's such a moving target,” said Darren Vogt, president of the County Council, which must adopt a budget in just a few months despite not knowing exactly what to expect.
And now the Democrats have conveniently moved parts of it back beyond next year's crucial congressional elections – and Republicans, who never supported Obamacare in the first place, question the administration's authority to delay its own law and seem eager to see it enforced.
Where the insanity ends, no one can say. But whatever happens, some will indeed live and some will die. The question is: Who will decide, and why?