Annals of Government Medicine

The Supreme Court is hearing arguments on Obamacare today, which makes the timing ideal to consider this news story from the cradle of socialized medicine, the United Kingdom. The article is titled “Elderly dying due to ‘despicable age discrimination in NHS.’”

Thousands of elderly people are dying unnecessarily early because “despicable” age discrimination in the NHS is denying them treatment for cancer, a charity has warned.

A lack of treatment or insufficient treatment is contributing to 14,000 deaths a year in people over the age of 75, Macmillan Cancer Support has found, in what it called an “unacceptable act of discrimination”.

Deaths from cancer are reducing in most age groups but at a slower rate in those aged 74 to 84 and are increasing in people aged 85 and over, the report said. The report, The Age Old Excuse: the under treatment of older cancer patients, said treatment options are too often recommended on the basis of age rather than how fit the patient is.

This point is especially salient, given the current debate over health care in the U.S.:

According to research published in the journal Cancer Epidemiology, there would be 14,000 fewer deaths from cancer in those aged over 75 per year if if mortality rates from cancer matched those in America.

Obamacare would institute a rationing system in the U.S. similar to the National Health Service in Great Britain. Committees (commonly referred to as death panels) would decide what treatment options would be available for different types of patients. The idea is to save money by not “wasting” it on the treatment of people who are old anyway. This is what President Obama acknowledged when he said, in answer to a question from an audience, that under his system grandma will have to “just take a pill” rather than be provided expensive treatment:

We see the result of this sort of rationing in the U.K., where thousands of elderly people die needlessly every year.

This is not to say, of course, that our existing system has solved the problem of exploding end-of-life health care costs. It hasn’t. Currently, the federal government borrows money and uses that borrowed money to pay for more or less all the medical care elderly people want. Everyone admits that this approach is unsustainable. There are three options: 1) continue on the present path until the federal government’s finances collapse, bringing down Medicare and many other things; 2) repeal the Medicare program; and 3) reform the Medicare program, most likely by making it a fixed rather than open-ended benefit.

My own preference is to phase out Medicare. The Constitution gives the federal government no general responsibility with respect to the medical care of its citizens, elderly or otherwise. Health care for veterans and federal employees can be justified under the “necessary and proper” clause as ancillary to enumerated powers of the federal government. Beyond that, I cannot see how the Constitution authorizes either Medicare or Obamacare. In an ideal world, health care for elderly citizens would be paid for by a combination of 1) savings, 2) insurance, 3) charity hospitals and 4) such welfare programs as state and local governments might see fit to enact. It would be up to each elderly person and his or her family to decide how much they are willing and able to spend on health care, along with whatever insurance they may have paid for. This is, in my view, the only proper and dignified way for free citizens, not subjects of an all-powerful state, to make such decisions.

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