Rationing Revealed at the Heart of Obamacare

If you like police officers having quotas for speeding tickets, you will love the Obama administration's new health care regulations. Doctors are going to be paid for giving "end-of-life counseling," one version of what was labeled as "death panels" during the health care debate this last spring. Combining this with Obamacare giving doctors a financial incentive for withholding medical care as well as financial penalties if they give out too much care, it is easy to see where things are going and what types of doctors will prosper.

Public opposition forced Democrats in both the House and Senate to drop such counseling from the original health care bill. Even with the massive Democrat majorities in both houses, the bill passed by only the slimmest of margins, and there was no way they were going to pass it if that provision had remained in the legislation. But the new regulation goes well beyond the original "end-of-life counseling" proposed in Congress. The original law proposed counseling take place every five years, but the new Obama administration regulations will make counseling part of people's yearly physical examinations and will cover how to prevent aggressive life-sustaining treatments when people become ill.

The Obama administration knows quite well this new regulation is unpopular. That is why they chose to reveal the new regulation after the elections, and virtually no one pays attention to the news on Christmas day. So much for President Obama's campaign promises of transparency. Democrats seem to think that all these changes will be forgotten by the time the 2012 elections roll around.

Democrats haven't wanted to publicly defend end-of-life counseling. As evidence just look at an e-mail sent out by Rep. Earl Blumenauer, D-Ore., who wrote the original end-of-life provision in the House health care bill. This e-mail was sent in early November to a select group who had worked with him on the health care legislation: “We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded. Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch and may be calling on you if we need a rapid, targeted response. The longer this goes unnoticed, the better our chances of keeping it.” Obviously, the Obama administration wished no public debate about this new regulation and has managed to avoid any discussion of it until Christmas day, just a few days before the regulation goes into effect on Jan. 1.

After he was elected president, the Obama administration briefly admitted how it was going to reduce health care costs, but they quickly switched gears. Back in April 2009 on "Meet the Press," Larry Summers, Obama's chief economic adviser, explained why universal health care wasn't going to increase the deficit because people are just getting too much unnecessary care. Summers claimed: "whether it's tonsillectomies or hysterectomies . . . procedures are done three times as frequently [in some parts of the country than others] and there's no benefit in terms of the health of the population. And by doing the right kind of cost-effectiveness, by making the right kinds of investments and protection, some experts that we -- estimate that we could take as much as $700 billion a year out of our health care system."

That $700 billion accounted for about 30 percent of health care expenditures in 2008, and that is just surgery. Summers softened the blow by saying that right now the government wouldn't have to cut expenditures by more than a third of that $700 billion. But it gives people an idea of what type of rationing this administration wants.

Tonsillectomies have primarily been done because of acute or chronic throat pain. Where different people are willing to draw the line between pain and surgery is a choice that we have traditionally left up to patients, but unless you know something about the patient's preferences it is hard to claim that a surgery was a "mistake."

Obviously Obamacare will directly limit people's health care options. Government bureaucrats will evaluate treatment options, not on the basis of whether they are effective, but based on whether the government thinks that they are worth it. Bureaucrats will weigh how much a person's pain and suffering should be valued. Even Democrats, such as Paul Krugman, who had viciously attacked Sarah Palin for warning about government rationing of health care, are now admitting publicly that is exactly what Obamacare will do. It is hard to see how Obama and the Democrats have learned anything from the "shellacking" they received in November.

John R. Lott Jr. is a FOXNews.com contributor. He is an economist and author of "More Guns, Less Crime" (University of Chicago Press, 2010), the third edition of which was published in May.