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Forced equality destroys the quality of medicine

By Richard E. Ralston
web posted June 2, 2014

For hundreds of years, governments have promised existential equality for all of their citizens. Not one government has ever delivered on that promise.

There are many reasons for this failure, but the most essential one is that the push for equality in results is a means of distracting from the fact that these governments have ignored the equality that is within their rightful power:  equality before the law.

But defending the political rights and freedoms of citizens is uninteresting, because it is inconsistent with and provides no scope for the growth of political power. The promises of equal income, equal housing and equal lunches are the lies of big government--as is the big lie of equal health care.

The destruction of the quality of medical care has been going on for many years. For instance, acquisitions of medical equipment by hospitals and physicians are restricted by government "certificates of need"--even when a hospital or physician has the resources to pay for the goods and the ability to use them effectively. That is typical of how government keeps down the cost of medical care: much of it is forbidden.

The Food and Drug Administration requires hundreds of millions of dollars and many years of review before approving promising new drugs as safe and effective.

In this process, terminally ill patients often die without access to those drugs, which may undergo even more years of review by "comparative effectiveness" commissions. They have the power to deny the use of a drug when it is effective in many cases but not in others in the same way. The drug is then denied to everyone, including those for whom it could be life-saving.

How will that process work for the advancement of personalized medicine, which, through genetic research, can customize a drug to help an individual patient, or use a patient's own stem cells to treat him? It can't--but the government priority is equality, not quality.

In exactly the same way, Obamacare's Independent Payment Advisory Board (IPAB), if it deems a drug, surgical procedure or other treatment too costly, will forbid it for everybody--even those who can pay for it themselves or have the insurance to do so. All decisions are final without any review by Congress or the courts. That is the price of medical equality.

That price is now going up.

Donald Berwick, President Obama's first appointment to head Medicare and Medicaid, stated, "Excellent medical care is, by definition, redistributional."

Equal care has become the purpose of government care. Cries of alarm that inequality of income is the most important issue of our times are becoming ever shriller. Your medical care, like your income, may be redistributed elsewhere  (or nowhere).

Quality care will become scarce, and costs of care and insurance will escalate, as providers are overwhelmed or driven out of their professions.

Of course, the very wealthy may still be able to retain some quality care. The politically connected will receive waivers through the political spoils systems they finance. Our elected officials have always reserved highly unequal benefits for themselves, their staffs, their clients and favored elites. They will definitely receive more than the "equal" medical care dispensed to the rest of us, who will share only equal misery. We will have nothing but what the system provides. Nothing else will be permitted.

History has shown that if we are vigilant, politicians--at their very best-- might sometimes leave us alone. But the only equality that government intrusion can actually deliver is the equality of death. ESR

Richard E. Ralston is the executive director of Americans for Free Choice in Medicine, Newport Beach, California. Copyright © 2014 Americans for Free Choice in Medicine. All rights reserved.






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