This post continues my Ten Principles of Affordable Healthcare Reform.

Health care changes should be made in small increments, easily understood by the People.

Any changes that are made should be made in small increments and they should be cost effective and easily accepted by the public. It is clear at this juncture that we cannot afford the breadth and the scope of “reform” that is being currently proposed; to do so would constitute nothing less than fiscal nymphomania leading to financial suicide. We would not be pushing grandma over the cliff; we would be pushing ourselves along with her.

If I have learned anything in the last 35 years addressing these questions, it is that any change must be gradual and universally acceptable by the constituency most affected by it. What I cited above is an example. Such small steps that would be universally accepted would include the elimination of geographic boundaries with respect to the provision of healthcare insurance claims and ratings. The elimination of the “preexisting” clause is yet an example of another small step that could be accomplished. The issue of insurance portability from job to job, and state to state is another that could be readily accepted. Biting off more than one can politically chew not only leads to constituency indigestion, but can, in a further political sense lead to choking to death, particularly in severe economic times when the populace has little if any trust in their elected representation. The problem is it would be We the People doing the choking, and not those who we elected.

Rationing is a logical outcome in any system with limited resources and high demand.

We must accept that rationing is a logical outcome of any system with limited resources and high demand. To grandstand this issue is not only an insult to your intelligence, it is out and out balderdash, pure rubbish!

Any scarce resource that must be used over an extended period by a large number of people logically must be rationed. The terms, definitions and nature of the rationing of public money should be determined by those charged by that same public to ascertain, adapt and legislate outcomes that are in the best overall interests of those they serve and whose money they distribute. These decisions should not be in the hands of political appointees, hand picked by the Administration as is the case in the current Law (Independent Payment Advisory Board or IPAB). To whom would we appeal? Will the bureaucrat on the other end of the line really care? What further cuts will this arbitrary board make in the future as our abilities to fuel this monster diminish over time?

At this time, The PPACA aka Obamacare, which is now the law, calls for all healthcare expenditures to be monitored by the IPAB, including those of commercial carriers. That said, let’s turn to Medicare and talk about rationing and Death Committees.

Right now, Medicare turns down 6.85% of all its claims, more than double that of Cigna and Humana (but interestingly, almost the same as Aetna). Is this not rationing? In the last years of life, how many of you have a Do Not Resuscitate or DNR in your Living Will? How many of you want to pass peacefully, and not squander what you have saved to pass on to your grandchildren and children? So, if you think it not prudent to spend your own money, where is the prudence in spending the public’s money? We need to understand that death is a part of life and accept that, and like anything else, it is something for which we must plan. When I hear the gibberish about Death Committees all I want to do is just say Put a sock in it!

Clearly, difficult choices will have to be made in the future. Our choice right now is whether healthcare should be rationed by free people making their own economic decisions and calculations or by a bureaucracy run by a non-elected, not Congressionally approved IPAB with no Congressional oversight who can run amuck any time they choose. If I am making my own decisions, as any free individual should, then I am likely to utilize only what I value above price, using funds I have earned, or in the case of charity, have given voluntarily. This self-imposed rationing is done freely and of my own will with my own property and my own discretion and not at the political whims of others for whatever reasons they choose. Simply stated, I believe that the individual at the end stages of life and his/her family, and not the government must do the rationing, for it is in the last two years of life that Medicare spends 27.4% of all its outlays for the elderly. I also believe that sometimes the physician must just say “No!” What a street-smart colleague of mine has said is that we must no longer be presented with a smorgasbord of care. The price is too high and the value of becoming overstuffed is no longer fiscally healthy or sustainable.

Mitchell Brooks  is an orthopedic surgeon and the host of Health of the Nation on Talk Radio 570 KLIF in Dallas, Texas.  He blogs at Health of the Nation.

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