Obama: No Pacemaker For You!

Via Megan McArdle, I see that President Obama told a woman whose now-105-year-old mother got a pacemaker five years ago that, under Obamacare, we might just give old ladies a pill:

Megan observes, “I don’t know that this is going to hurt the image of healthcare reform.  But it probably isn’t going to help.”  That was my reaction, too, until I realized that the exchange took place in the ABC News town hall special on June 25 and this was the first I’d heard of it.

Of course, the fact that Michael Jackson died the same day might have something to do with that.

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.


  1. Jeff B says:

    Seems reasonable to me. A government-funded health care system, or any private insurance system, is required to make cost/benefit analyses like this. If it seems like a pacemaker costs $50k and might only extend life for a year on average, it’s a bad idea.

    You, of course, are welcome to piss away your money on irrational treatments. It’s a free country, after all. But you can’t expect other people to pay for it.

  2. JKB says:

    Well, there certainly seems to be a lot of material the administration is providing that isn’t being used. The posted video is one but how about HHS Secretary Sebelius on the Daily Show replying to John Stewart’s question that as a rich person who will be taxed can he stop poor people from smoking and eating ice cream. Her response, “I hope so.” Question starts at 4.05 in the video. Not to mention her insistence that the US healthcare is far worse than other countries. Did you know US citizens are sicker than those in other countries, although, she does skip the part where Britain lets their sick people die.

  3. floyd says:

    “It’s a free country, but you can’t expect other people to pay for it”

    Exactly what conservatives have been saying!

  4. floyd says:

    Isn’t it strange that a person who uses the system is “expecting others to pay for it”.
    Yet free health coverage for the poor is not?

    If the one is legitimate… why not the other??

  5. Jeff B says:

    Because having a healthy society where everybody can expect basic treatment for illness and injury will make us a much stronger nation, with a better economy, less social strife, etc. It’s the same reason we don’t let old ladies starve in the gutter any more.

  6. just me says:

    I can just see the commercials on this one.

  7. floyd says:

    Jeff B;
    The question did not go to the legitimacy of the care, it went to the legitimacy of the statement…
    “”It’s a free country, but you can’t expect other people to pay for it”

    So you say its OK to give coverage, but not actual care? Sounds like a cruel joke!

    So the question remains … Why should we expect “other people” to pay for coverage and then use the above quoted statement to deny care when needed?

    BTW, on a tangent subject…Offering basic care is quite different to limiting care to a basic level. Medicare supplemental insurance generally refuses to pay when Medicare refuses the “basic” treatment.

    Let’s not be fooled, the government plan amounts to lowest common denominator.

  8. odograph says:

    I think this might be a tactical error on Megan’s and James’ part. They have to believe that the government should buy 100 year olds pacemakers in order to believe that Obama’s position is wrong.

    Do they really believe that? All 100 year olds? With or without consideration of other health conditions?

    How big do Megan and James want the health budget to be?

  9. hcantrall says:

    I think the thing that bothers a lot of people are the questions that aren’t answered. At what age am I not worth having around anymore? Or which illness, will be the one not worth treating. That scares the shit out of me, I’m “only” 38 years old but a whole slew of things could happen to make me “not worth” curing or treating? Usually that’s a personal decision but it’ll be taken away from us and made by other people. I don’t like it at all. My health insurance is working now, for me and my family. I am afraid of what it’s going to become. If other people get to decide if we’re worth treating, will assisted suicide be an option for us too?

  10. Dave Schuler says:

    The woman was 99 when she needed the pacemaker; she’s 105 now. We don’t have enough information to determine whether it was cost effective or not. It may have been the case that the cost of the level of care she would have needed and received without the pacemaker would have exceeded the cost of installing the pacemaker. I’ve seen statistics which suggest that would have been the case but I just don’t know.

  11. Jeff B says:

    hcantrall you act as if you are the first person to have considered this question, which is of course absurd. All countries with national health care systems have a commission which evaluates the cost/benefit ratio of treatments, and decides which can be paid for out of the public purse and which can’t. It will only take you a few seconds’ contemplation to see that setting a broken bone for a 25-year-old worker who would otherwise be disabled is cost effective, whereas a liver transplant for a 95-year-old who might gain on average six more months to live would not be.

    If you’d like a nice survey of the subject see this article from the previous New York Times Sunday Magazine


  12. Dave Schuler says:

    As I read the guidelines it could have been cost-effective and her physician might well have been acting unethically if he or she refused to perform the procedure. We just don’t know enough about her history or condition.

    It’s quite possible that President Obama was wrong on the cost, on the medicine, and on the law. Or he might have been right. But isn’t that the problem with the entire discussion?

  13. DL says:

    It’s not so much who gets what when, it’s who decides who gets what when. If you want healthcare you’d better belong to the correct party in the future. If you think otherwise, look closer at the soviet state for the ultimate model of efficiency.

    The Dutch have a good system of involutary euthanasia by the medical community also.
    The culture of death reigns as religion declines.

  14. PD Shaw says:

    Odograph: The lady’s treatment IS Obama’s to make because he wants to make it. I will not make it. I don’t believe James or Megan want to make it. I won’t pretend three levels of bureaucrats and administrative law judges will do anything but exhaust process and budget.

  15. odograph says:

    I think PD you are onto the vibe. It isn’t really logical, but it is the vibe.

    So tell me about poor 38 or 99 year olds. Should they never get pacemakers?

    If maybe they should, in some circumstances, do you suppose you need “three levels of bureaucrats and administrative law judges?”

    What’s the alternative?

  16. floyd says:

    Does anybody doubt that the guy pictured two articles earlier [Carter] would get a pace maker from Obama”care” should the need arise??

  17. hcantrall says:


    I don’t believe that anything I said implied that I think I’m the first person to consider this. I SIMPLY stated that those are MY concerns! Either I didn’t state it clearly enough or you need to learn how to comprehend. Others seemed to understand what I said..

  18. First: The alternative of spending your own resources for keeping yourself alive will no longer be an option. Partly because your assets are presumed to be property of the government and not yours to dispose of; and, partly because there will no longer be a private option available – at least in the United States.

    But more importantly: While 100 years old may seem to be a reductio ad absurdum. What about 88? My mother had a new pacemaker at 88 this year no problem – NOW – but in the future? The average life expectancy is currently 77. So what happens at 78? I had a coworker who had 4 heart attacks by age 50 and calls himself disabled, what about him at 52? He is now what the Progressives used to call a useless eater already.

    Obama speaks of less subjectivity and more objectivity when subjectivity is what we really personally need. Do you really want someone else to decide you have outlived your useful life? Be very careful what you ask for, those are the rules you will live and die under.

  19. Debbie says:

    I know that every time I receive a paycheck, I pay someone named “Medicare”. I’m 50 and I’ve been paying this since I was 15. You bet I’ve paid for Medicare and I’m betting this elderly person also paid it over her lifetime. When you the elderly receive their social security check, again Medicare is deducted. This woman could be 80 mentally and physically because she’s taken care of herself and her heart issue could have originated from something genetic. Why NOT give a pacemaker and save her a pill a couple of times a day for 5 years. There’s a domino effect with medication – reactions. My mother had a pacemaker at age 73. She’s 82 now. It’s definitely worthwhile. I can’t believe these thoughtful and caring people who want everyone to have healthcare (they are such good people) but they don’t want our mothers and fathers to have it because it’s going to cost them a few bucks.

  20. Greg says:

    So are we going to stop treating breast cancer and other forms of illness because they have low survival rates? I just attended a funeral of a mom who was 34 yrs old. She had 3 & 5 yr old daughters. She battled breast cancer for two years and lost the battle a short time ago. So with Obama-care, will some government bureaucrat do a cost / benefit analysis and decide who is treated and who is not? Won’t that be nice? Having the likes of a DMV or postal worker making life and death decisions. I agree with the earlier comment. “That scares the heck out of me.”