President Obama: Potential for Getting Healthy? You Win!!

Let’s be clear: President Obama’s push for healthcare reform will significantly change the way people with serious medical conditions, especially among the elderly, those with disabilities, and the terminally ill, will be treated.

Well, not treated, actually.

There’s no doubt that the President’s message, hammered relentlessly at every turn, is made in starkly economic terms – that medical care is very expensive, costs need to be controlled, and resources have to be allocated in new ways.

That’s half the pitch.

Here’s the other half: Because of this problem, it’s important to see which groups of people disproportionately consume the lion’s share of medical care dollars.

We already know: People with disabilities, people with serious chronic illnesses, the terminally ill, and the elderly.

The president hasn’t gotten around to making his economic case about people with disabilities yet, but he has in terms of the elderly and the terminally ill. My take is that among the targeted groups, it’s the disability community that will raise stiff opposition. The elderly and the terminally ill are more vulnerable, and are less likely to protest.

Let me put the president’s strategy more bluntly:

"Medical care is expensive. Some people get a lot of care, others very little. Many people who get a lot of expensive care are the elderly, those with disabilities, and those who are probably not going to ever be as healthy as they used to be. We don’t have the money to pay for every expensive procedure for everyone, so we need to decide who gets the care that’ll give us most bang for the buck."

The President doesn’t say it this way, instead he uses a euphemism it’s hard not to like: Health. We must give medical care to make people healthier.

Note what’s not said: If you have no prospect of getting healthy, then the government needs to step in and decide whether or not you are worth getting the treatment.

President Obama drive this point home in his interview to the New York Times in April (all italics are mine):

And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control. And right now we’re footing the bill for a lot of things that don’t make people healthier.

The president drummed the “Health” theme again in his ABC News Health Care Forum at the White House last week:

But here's the problem that we have in our current health care system, is that there is a whole bunch of care that's being provided that every study, every bit of evidence that we have indicates may not be making us healthier.

And later:

And in terms of how doctors are reimbursed, it's going to be the same system that we have now, except we can start making some changes so that, for example, we're rewarding quality of outcomes rather than the number of procedures that are done. And this is true not just for doctors, it's also true for hospitals. One of the things that we could say to hospitals is, reduce your readmission rate, which is also often a sign that health outcomes have not been so good.

Now, we've put forward some specific ways of paying for the health reform that we talked about. About two-thirds of the cost would be covered by re-allocating dollars that are already in the health care system, taxpayers are already paying for it, but it's not going to stuff that's making you healthier.

Prediction: If the President has his way, expensive medical care will be redirected to the winners in this money game, those who have the potential to be healthier.

If you have a disability, if you’re elderly and in poor health, or if you have a severe chronic or terminal condition, you lose.