It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance.
—President Barack Obama in a New York Times interview on how costly medical decisions should be made.


The people behind the long table do not know what they've become. The drug of power has been sugared over in their mouths with a flavoring of righteousness. Someone has to make these decisions, they tell their friends at dinner parties. It's all very difficult for us. But you can see it in their eyes: It isn't really difficult at all. It feels good to them to be the ones who decide.

"Well, we have your doctor's recommendation," says the chairwoman in a friendly tone. She peers over the top of her glasses as she pages through your file.

You have to clear your throat before you can answer. "He says the operation is my only chance."

"But not really very much of a chance, is it?" she says sympathetically. Over time, she's become expert at sounding sympathetic.

"Seventy percent!" you object.

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Martin Kozlowski
"Seventy percent chance of survival for five years—five years at the outside—and even that only amounts to about 18 months in QALYs: quality-adjusted life years."

"But without this procedure, I'll be dead before Christmas."

You try to keep the anger out of your voice. The last thing you want to do is offend them. But the politicians promised you—they promised everyone—there would never be panels like this. They made fun of anyone who said there would. "What do they think we're going to do? Pull the plug on grandma?" they chuckled. The media ran news stories calling all rumors of such things "false" or "misleading." But of course by then the media had become apologists for the state rather than watchdogs for the people.

In fact, the logic of this moment was inevitable. Once government got its fingers on the health-care system, it was only a matter of time before it took it over completely. Now there's one limited pool of dollars while the costs are endless.

"You have the luxury of thinking only of yourself, but we have to think about everyone," says the professor of ethics. He's a celebrity and waxes eloquent every Tuesday and Thursday on Bill Maher Tonight. "This isn't the free market, after all. We can't just leave fairness to chance. We have to use reason. Is it better for society as a whole that we allocate limited resources for your operation when we might use the same dollars to bring many more high quality years to someone, say, younger?"

"I'm only 62."

He smiles politely.

"Look, it's not just about me," you argue desperately. "My daughter's engaged to get married next year. She'll be heartbroken if I'm not there for it."

"Maybe you should have thought of that before you put on so much weight," says the medical officer. "I mean, you people have been told time and again . . ."

But the chairwoman is uncomfortable with his censorious tone and cuts him off, saying more gently, "Perhaps your daughter could move the wedding up a little."

The member in charge of "stakeholder" exceptions shakes her head sadly as she studies your file. "If only you could have checked off one of the boxes. It would be awful if you were penalized just because of a clerical oversight."

It begins to occur to you that this is how you are going to die: by the fiat of fatuous ideologues—that is to say, by the considered judgment of a government committee. They are going to snuff you out and never lose a minute's sleep over it, because it's only fair, after all.

That logic is implacable too. Free people can treat each other justly, but they can't make life fair. To get rid of the unfairness among individuals, you have to exercise power over them. The more fairness you want, the more power you need. Thus, all dreams of fairness become dreams of tyranny in the end.

You know you should keep your mouth shut. Be humble—they like that. But you speak before you can stop yourself.

"What you're doing here is evil," you cry out. "You're trying to take the place of God!"

"Sir, this is a government building!" says the chairwoman, shocked. "There's no God here."

- WSJ, Andrew Klavan, contributing editor to City Journal. His latest novel is "Empire of Lies" (Harcourt, 2008).

On Friday, March 30, 2011, Medicare indicated that it plans to cover the cost of Provenge, a prostate cancer drug that costs $93,000 per patient. In clinical trials, the drug extended the lives of patients receiving it by 4 months.

When we said nearly half of U.S. doctors might close their practices or retire early rather than live under the Democrats' health overhaul, we were heavily criticized. The critics, though, were wrong.

Four in nine doctors responding to an IBD/TIPP poll sent out in August 2009 said they "would consider leaving their practice or taking an early retirement" if Congress passed what has become known as ObamaCare. That means as many as 360,000 physicians have plans to be doing something other than treating the growing number of patients in this country.

The doctors also told us — 67% to 22%, with 11% not responding — that they expected fewer students to apply for medical school in the future if the plan became law.

Given these views, it's no surprise that 71% were doubtful that the government would be able to cover the 47 million uninsured Americans with better care at lower costs, which ObamaCare supporters have promised.

Other findings from our poll of 1,376 doctors included: six in 10 agreeing that the Democrats' plan would strip drug companies of the incentives they need to make lifesaving pharmaceuticals, and 65% believing that a government overhaul would lead to lower-quality care for seniors.
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Now a Merritt Hawkins survey of 2,379 doctors for the Physicians Foundation completed in August has vindicated our poll. It found that 40% of doctors said they would "retire, seek a nonclinical job in health care, or seek a job or business unrelated to health care" over the next three years as the overhaul is phased in.

Of those who said they planned to retire, 28% are 55 or younger and nearly half (49%) are 60 or younger.

A larger portion (74%) said they plan to make "one or more significant changes in their practices in the next one to three years, a time when many provisions of health reform will be phased in."

In addition to retirement, and finding nonclinical jobs elsewhere, those changes include working part time, closing practices to new patients, employment at a hospital, cutting back on the number of patients and switching to a cash or concierge practice.

Obama doesn't like them much either.