"The Need to Conserve Limited Medical Resources"
A federal district judge has ruled that New York State’s Medicaid program may deny a certain indigent person a certain operation because the state has a legitimate interest in “conserving limited medical resources.”
As I have said ad nauseum: the notion that an economy can provide all the health care that everyone needs or wants is a ludicrous fairy tale. Health care, whether writ large or small, is a scarce good that must be rationed. The only question is whether the rationing will be done by patients and physicians (and, yes, the “big bad insurance companies”) or by politicians and bureaucrats (and, apparently, federal judges). But rationing will occur; elementary economics demands it.
Would this particular indigent person have received this particular operation if there had been no Medicaid in the first place? Probably not, without some system of charitable and pro bono care. But the point is that the advocates of socialized medicine in America ought to have the ethical framework to include some truth-in-labeling for their proposals. “Universal health care” is simply not universal. It never can be.
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What’s that? You want to know who the indigent person was and what operation was denied?
Fine with me:
Plaintiff was born a male but has “identified as a woman” since the age of 16. She has been “living as a woman” since the age of 20. In or about 1978, plaintiff was diagnosed with [Gender Identity Disorder] and began hormone therapy in order for her body to conform more closely to the gender with which she identified.
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[B]eginning in approximately 1980 Medicaid paid for the hormone treatment but terminated coverage in or around September 2004.
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In January 2007, plaintiff was examined by a medical doctor who is Professor and Chairman of Plastic and Reconstructive Surgery at the Philadelphia College of Osteopathic Medicine who has opined that hormones, orchiectomy and vaginoplasty are medically necessary to treat plaintiff’s GID. This opinion is endorsed by plaintiff’s current psychologist as well as by a prior treating psychiatrist.New York [in 1997] adopted a regulation disallowing reimbursement for services for gender reassignment treatments and services[.]
So much for a “right to universal health care” for the poor. In, remember, one of the most liberal (and spendthrift) states in the nation.
More:
The state agency’s assessment of public comment on the proposed regulation explained succinctly the reasons for denying reimbursement of gender reassignment surgeries and associated treatments. It cited “serious complications” from the surgeries and danger from life-long administration of estrogen. This provided a more than sufficient rational basis which was related to legitimate government interests — the health of its citizens and the conservation of limited medical resources.
Great “universal” health care — if you can get it.
Also recall that Congressional Democrats — led by Barney Frank — gladly threw transgendered people under the bus just last year during the debate over the Employment Non-Discrimination Act.
So when the rationing of so-called “universal heath care” comes, whom do you think will be targeted for rationing first: middle-class heterosexual octogenarians with kidney stones and colon cancer, or middle-aged inner-city indigents with gender identity disorder? What will our “humane” and “enlightened” policies be? Rulings such as this?
The case is Casillas v. Daines, No. 07-Civ-4082 (S.D.N.Y, Aug. 5. 2008) (PDF – 20 pages). (Via Hunter of Justice.)
Filed under: Gay Rights and Issues, Law, New York City & State, Socialized Medicine
Where modern liberalism went wrong was when it mistakenly began to conflate equality under the law with equality of outcome. Where self-described "libertarians" (not yourself) too often go wrong is in thinking that equality under the law is no longer worth fighting for when we lose a battle to prevent a program aimed at equality of outcome. If anarchism is either undesirable or impossible (and I think it is, even though I respect the anarchist position), then the baseline requirement of government must be equality under the law – absolute neutrality. This is, of course, one of Hayek's central points – and a point too often lost on those who try to use Hayek as proof that liberalism (of any stripe) equates to fascism.
I am very much beginning to think that the proper libertarian approach ought to be to fight for equality under the law under any and all programs, no matter how expensive. When we get the inevitable response that "resources are limited and we can't take care of everyone," we can simply say, "exactly."
"Also recall that Congressional Democrats — led by Barney Frank — gladly threw transgendered people under the bus just last year during the debate over the Employment Non-Discrimination Act."
Mr. Frank counted votes and determined that the bill would not pass with transgendered "rights" in it, so he decided to be practical and ax that section of the bill. Mr. Frank personally supports including the transgendered in the bill, but he did not want to push a bill forward he knew would fail.
I oppose this legislation as a libertarian, but I think you are being unfair to Mr. Frank.
[Kip replies: How is what you wrote different from "threw transgendered people under the bus"?]