Former Colorado Governor Richard Lamm got a bad reputation by stating in a speech some years ago, “We [meaning when we get old] have a duty to die and get out of the way.” When I interviewed Lamm for the “duty to die” discussion in Culture of Death, he told me that he had not meant precisely what he said, rather that the immortality project is a mistake (I agree), adding as quoted on page 152:
The human way is to make way for the next generation by living our lives to the full, and when the time goes, letting go gracefully. That by no means translating into bumping off the infirm.
Maybe not, but then again, maybe so. Lamm was an enthusiast for health care rationing back then, and he is even more passionately for it now as Obamacare looms. From his article in the Huffington Post (where all radical bioethical ideas go to gestate):
Let me present a more positive case for rationing. I suggest that a society will not start to maximize its health case access and quality until it fully confronts the issues involved in rationing. It is my passionate belief that we can all have better health care through rationing.
That’s nonsensical on its face. We “all” won’t receive better care. The people being rationed out—the frail elderly, profoundly disabled, and other expenseive patients for whom to care—not only won’t be getting “better health care,” they won’t be getting any health care at all, except of the palliative variety.
Lamm tries to put a respectable patina on this ugly fact:
All nations ration — some by price, some by queuing, and some by setting priorities. I believe a nation does not maximize its health care until it starts to ask the hard question: How can we prioritize our expenditures to buy the most health care for the most people? We should not apologize for rationing; we should promote it and advance it. We cannot explore the “opportunity costs” of limited dollars unless we admit that we cannot pay for everything for everyone and spend our limited money where it will do the most good. In a world of public policy, we cannot say “yes” unless we say “no.” It is an inevitable dialogue, and we ought to make a virtue out of necessity.
No one is saying that everything should be covered. For example, cosmetic surgery isn’t covered by health insurance, nor should it be (as opposed to reconstructive surgery). But that isn’t rationing: It is making people pay for their own purely voluntary procedures engaged in for non medical reasons—e.g., to look prettier or younger. That isn’t the same thing as a formal rationing system based on age or quality of life that will prevent undervalued categories of people from receiving necessary care based on invidiously discrmininatory attitudes reflected in rationing public policies.
So, I guess that Lamm does, in a certain way, want to “bump off the infirm” after all. Or perhaps he just doesn’t see the crucial difference between “graciously” refusing life-extending treatment and being prevented from obtaining it by faceless bureaucrats when it is wanted.
One more point relevant to the Obamacare debate: Lamm’s view is wildly supported within the greater bioethics movement. Indeed, the blog for the American Journal of Bioethics—which reliably reflects the attitudes and views of the mainstream bioethics movement—supports Lamm’s piece enthusiastically and wants “rationing” to cease being thought of as “a dirty word.”
Remember: These are the people who would be appointed to the cost/benefit rationing panels if Obamacare is passed. Add it all up and it menas that Obamacare is rationed care: Be afraid. Be very afraid.
