The Deciding Factor in Government Health Care Decisions

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In light of the Charlie Gard story out of the United Kingdom, Stephen Green reminded Instapundit readers about this 2016 story:

Obese people will be routinely refused operations across the NHS, health service bosses have warned, after one authority said it would limit procedures on an unprecedented scale.

Hospital leaders in North Yorkshire said that patients with a body mass index (BMI) of 30 or above – as well as smokers – will be barred from most surgery for up to a year amid increasingly desperate measures to plug a funding black hole. The restrictions will apply to standard hip and knee operations.

Green’s point in reviving this article is simple:  “Single payer, single decider.”  When government is responsible for paying all health bills, government will be the one deciding what’s worth spending money on.  The government has decided that certain eating preferences and habits are unhealthy and justify restrictions on what treatments government will fund.  The matter of Charlie Gard, in which the parents procured funding elsewhere but were still prohibited from attempting treatments for their newborn son, showed that the money is really just the most immediate manifestation of power.

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On the other hand, consider the latest Rhode Island news about the state’s incremental advance toward government health care by mandating that all “insurance” must cover politically favored conditions:

The law also could expand access to fertility-preservation services for another group of Rhode Islanders who have historically had trouble getting coverage: transgender people. …

Hormone-replacement therapy for people diagnosed with gender dysphoria can result in temporary or permanent sterility, and many transgender people now use fertility-preservation technologies, according to a 2016 article in the American Medical Association Journal of Ethics.

“We have a number of patients who have donated or saved their sperm,” Dr. Michelle Forcier, a pediatrician who provides hormone-replacement therapy for transgender children and adolescents at Lifespan’s Gender and Sexual Health Services Center. “We’ve had a smaller number of patients who have had their eggs frozen. And the big issue for all these is cost. Insurance does not cover it.”

When the government runs all health care, who will win in the battle for funds — the heavy man who needs a knee replaced in order to maintain his ability to walk or the man who wishes to freeze his sperm so he can use it later to father children when he’s had operations to make his body more like that of a woman?

My point, here, isn’t to make a prediction or even, really, to pick a side, but to emphasize that the answer will be political.  If the people running government dislike fat people, they’ll insist that the consequences of a predisposition to overeat should not fall on taxpayers, even if taxpayers are being billed for the fertility consequences of other people’s predisposition to want to be the other sex.  If portliness comes back into fashion, then our governing elites will think it cruel to allow its consequences to continue and transfer health dollars accordingly.

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