Wheel of Death

Dutch television has come out with a macabre new game show called "A Matter of Life and Death." The studio audience votes whether a patient should receive life-saving medical treatment. In a recent episode the audience had to choose between two cancer patients who both wanted an expensive new drug. Whose life was worth trying to save? The television series is financed in part by the Dutch Ministry of Health, and the goal is to get people used to the idea of medical rationing. Doctors make these life-and-death decisions all the time, viewers are told. The underlying message is that the government must select who will be treated . . . and who will be shunted aside to die. And this is the health-care system President Clinton wants to import to America. The Clinton plan is modeled loosely on social insurance systems like Holland's. It would inject the government directly into a host of sticky ethical questions. Take the question of medical rationing. Through modern medical technology, we have developed sophisticated treatments that are effective but expensive. For example, since 1970, the annual number of heart bypass operations has risen from 14,000 to more than 400,000. Looked at in dollar amounts, that represents a huge increase in costs. But it also represents a huge increase in benefits. The Clinton plan promises to cap costs while maintaining the same high level of benefits. If you believe that, I have a bridge I'd like to sell you. The truth is that capping costs will inevitably mean reducing services: Hospitals will have to stop using all that expensive medical technology. In plain English, they will have to stop treating so many people. Things like heart bypass surgery will have to be rationed. Patients who are elderly, handicapped, or chronically ill will be pushed to the end of the line. Just as they are in many European countries. In Britain, if you are over 55 you cannot get kidney dialysis. In Sweden, if a newborn's birthweight falls below a certain limit, doctors don't even try to save the baby. Under national health plans, the government decides whose life is worth saving. The family has no choice. Another sticky ethical question, of course, is abortion. The administration's plan would require coverage for abortion. Hillary Clinton has portrayed the plan as moderate, saying it would not make "people on the extremes of this issue happy." But she was wrong. Extremists who favor abortion are very happy. The president of the National Abortion Rights Action League praised the Clinton plan; so did the president of Planned Parenthood. The fact is that under Clinton's health plan, you and I would be forced to pay for an act we find morally abhorrent. Today, through our representatives in Congress, we can vote against federal funding of abortion-as we did a while ago. But under the Clinton plan we would have no choice. If the president's plan passes, perhaps we'll even see an American version of the Dutch game show, designed to help us accept the idea that the government should decide who lives and who dies. We might call it "Wheel of Death."

12/30/93