Questions About Rationing Health Care Cross Party Lines

Yesterday, Medicare and Medicaid chief Donald Berwick got roasted by Republicans at his first hearing before the House Ways and Means Committee.

Berwick, in case you forgot, was appointed to his job during a Congressional recess and without a confirmation hearing. The administration's decision to go that route, stemmed in part, from controversial comments he made in 2009 about rationing health care.

This morning, however, Indiana Gov. (and rumored Republican presidential hopeful) Mitch Daniels made some strikingly similar comments at a briefing with health reporters. Now, will the GOP be as harsh on Daniels — who's been out in front as a critic of the new federal health care law — as they've been on Berwick? We'll see.

But first, let's compare the two men's statements, shall we? See if you can tell who said what.

Quote A:

The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.

Quote B:

We cannot afford — no one could, to do absolutely everything that modern technology makes possible for absolutely everyone to absolutely the very last day and the very last resort. There will be limitations....

If you guessed Berwick was responsible for the first quote and Gov. Daniels for the second, you would be correct.

For what it's worth, Berwick said in the Ways and Means hearing Thursday that he "abhors rationing." And Daniels, for his part, said the central question remains whether government will impose restrictions or people will "make choices for themselves through some mechanism."

How Daniels sees that happening is a little fuzzy.

On the one hand, he said, take the case of a family with a desperately ill relative. "We can try this thing that has almost no chance of working and it's going to cost an incredible amount of money, and by the way it's not going to cost you anything," he said. "What do you want to do? Any person of course is going to say, 'Try it, it's Dad.' "

So Daniels suggests that perhaps patients should be paying more of their own health costs. "Eventually we'll have to deal with it," he said. "And I don't think there's a more humane way than the re-involvement of the patient himself, herself, the loved ones, to a greater extent," he said.

OK. So what about the idea of paying doctors to counsel Medicare patients on end-of-life alternatives, so perhaps Dad wouldn't end up in that expensive situation in the first place, some reporters asked.

Daniels demurred. "I'm very suspicious when government is the agent of this," he said. "And that's not the right way to do it," he said.

Clearly this is a debate that's just getting started.

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