Sunday, April 17, 2011

Death Vouchers

“Do you realize that your leadership is asking you to cast a vote today to abolish Medicare as we know it?”
Nancy Pelosi, April 15, 2011

The convoluted logic went like this. We were going to take something away in our existing health care system, we were going to have to reduce what was covered, some procedure choices would be pushed out of reach, some spending on inefficient older bodies and minds would need to be trimmed, some people would need to be judged in a faceless bureaucratic court of cost, and health care rationing would be introduced. The empanelled bureaucrats charged with weighing your life’s worthiness of repair would make up a cold hearted “death panel.”

The kind and loving face of the right had once again worked overtime injecting fear into the debate of President Obama’s health care reform. Yet whether one agrees with the result or not, there were not, are not, and will not be death panels in the loosest sense. The aim was to cover more people with insurance. Death panels were a leap of hyperbole about rationing.

An interesting component of rationing is the use of coupons or vouchers to give everyone the same slice of little. Vouchers are a device that invokes getting a tangible just due reward that one can spend as one sees fit. Misunderstood is that vouchers are also the device to get government money into private business hands with the least amount of government and voter controls. And like a coupon, vouchers are not necessarily intended to cover all costs, just the basics in part with you throwing in the difference. Now if coming up with the difference is a problem, and it will be, for many elderly Americans then the result is…surprise…rationing health care.

Senior fixed budgets will be subjected ever greater pressures to choose among the necessities of food, shelter, and health care in a process that is simultaneously going to be inadequate, confusing, and subject to market whims. On the political front it will be easier to reign in spending by trimming coupons a bit here and there depending on who is in power. The ability to indirectly cut Medicare as we knew it by hacking at it one remove away at the voucher level brings to mind reducing what will be covered, pushing some procedure choices out of reach, forcing decisions on spending on inefficient older bodies and minds onto the voucher recipients, leaving some people to be judged in a faceless bureaucratic market of cost, and thus introducing full blown health care rationing for older citizens. One might even call this weighing your life’s worthiness of repair the determinate factor in how one might elect to spend their inadequate cold hearted “death voucher.”

Medicare as we know it may face spending structural issues but the essential factor in the midst of all the economic debt fear of the future being spread by the right who want their profits now is ultimately about choice. We need only climb onto a tank and waive a corporate tax file to present our petition.

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