Flash Forward: The Year in Bioethics 2010

Each year, the CBC asks me to predict what will happen in the coming year in bioethics.  I have done so.  From my piece:

“Flash Forward” is a new and interesting television drama presented on the ABC Television Network. The premise is brilliant – due to reasons still unknown, everyone in the world (except the bad guys) blackout for two minutes seventeen seconds. Planes crash, people collapse on the streets, swimmers drown, it is an utter catastrophe that results in the deaths of 20 million people. Being unconscious, blackout victims experience a “flash forward” – a vision of precisely what they would be doing for two minutes and seventeen seconds at the same specific time in April 2010. Some have happy futuristic visions of new loves, some unhappy of broken marriages and deaths, some terrifying such as being murdered, one hilarious – an FBI supervisor is chagrined to admit he spent his entire flash forward on the toilet. Still others have nothing but blackness, indicating that they may be dead next April. The show raises several fascinating questions; whether free will exists, can “the future” be changed , indeed, can it really be predicted.

My main focus is Obamacare.  Here is how I see it coming to pass:

I predict a health care reform bill will be signed into law in 2010. That’s the easy part. The question becomes, what will it look like? That is hard to say since many of the important details will be determined by the tens of thousands of regulations promulgated to carry out the law in over the next few years. Still, the outlines are growing clear in my crystal ball. Here is my personal Obamacare flash forward:

The Public Option. One of the biggest controversies surrounding Obamacare is whether there will be a government health care plan to compete with private insurance companies. I predict that the pure PO will not become law in 2010. Instead, there will be a hybrid alternative enacted permitting non-profit companies – and only non profit companies – to join a government authorized purchasing collective. Whether they will actually threaten the private insurance sector – which I believe is the intent – will not become clear until after the law goes into effect in 2013.

Heath Care Rationing. Obamacare doesn’t call explicitly for health care rationing, but creates its foundation with the establishment of cost/benefit/best practices boards that will be given tremendous sway over the standards of medical care and extent of coverage for both private and public plans. There is almost zero chance these boards will not be part of any law that passes. That means health care rationing will remain a looming specter and a cause for continuing societal debate for years to come.

Abortion. Companies participating in the public exchanges will be required to provide some abortion coverage, but there will not be direct public funding of most abortions. However, the law will permit regulators to require indirect public funding, for example, allowing abortion coverage to be purchased with government vouchers or tax credits.

End of Life Counseling. The provision allowing doctors to be compensated for providing end of life counseling will pass. But the law will require that it be voluntary and not directed to any particular decisions or outcomes.

Illegal Aliens. The law will not explicitly provide for coverage for people who are not legally in the country. But it will not require purchasers of government underwritten health insurance to provide proof of legal status, meaning that undocumented aliens will find ways to purchase health insurance under Obamacare.

I also discuss what I think will happen with assisted suicide, health care rationing/futile care theory, and embryonic stem cell research.  Tune in to see the future.  Or, I could be wrong.  I have been both in years past. I am also interested in your predictions.  Let’s have a little fun with this.