Obamacare and WIC: When others pay the bills

Michelle Obama recently wrote an opinion piece in the New York Times discussing her pet project of childhood obesity. Discussing the Special Supplemental Nutrition Program for WomenInfants, and Children, known as WIC, she criticized the House of Representatives for considering a bill that would allow white potatoes to be included in the list of foods that could be purchased with WIC funds.

One can debate the nutritional benefits of potatoes. Potatoes are complex carbohydrates and provide nutritional benefit if eaten boiled, rather than as French fries or potato chips. And in moderation. Apples or oranges eaten in excess also deliver a load of sugar and calories. This is about more than whether or not we should eat potatoes.

The larger point is, what is the role of the government in deciding what we are allowed to eat? The WIC program has “food packages,” defined menus of products that can be purchased using WIC dollars. That’s all fine and good, steering WIC recipients toward healthier foods. But what happens when the “approved” food item is unavailable in the store or is not tolerated due to taste or other dietary issues?

Such a situation was recently described, where a mother purchasing baby food discovered that the store was out of her usual and “WIC approved” item. Her child would not eat the only other WIC approved baby food on the shelves, leaving her to purchase an “unapproved” baby food as her only choice. The cashier did not allow her to purchase the “unapproved” jar of baby food without WIC permission, unless she paid for the items herself.

Beyond food, what happens when government agencies decide what type of health care is approved? Obamacare insurance plans have essential benefits that must be provided. What about unessential benefits? Who decides what is unessential? Stories abound over insurance companies denying coverage for cancer care or other serious conditions. Or limiting provider networks much like WIC limits food choices. Health care can also be limited through wait lists, as we continue to learn through the unfolding VA scandal.

Think these are isolated situations or simply examples of private insurance company greed? Obamacare already has a built-in rationing provision called the Independent Payment Advisory Board (IPAB) that will determine which tests, procedures, or medicines are covered under Medicare. Much like which brands of baby food can be purchased through WIC, the IPAB will decide what Medicare will and will not pay for. This already occurs in other countries, such as the United Kingdom, where the government decides which treatments it will pay for.

Rationing health care can and should be discussed and debated. Given that health care is a resource with a finite supply and infinite demand, some type of rationing is necessary. But who decides? Should this be the choice of individuals or the government?

As we are learning with WIC, the VA, or Obamacare, when we let others pay our bills, we also let those others decide what they will pay for. The expression, “He who pays the piper calls the tune” is fitting. The Healthcare.gov website initially referenced “free health care” but deleted that reference as nothing is really free. There are many hidden costs within Obamacare such as copays, coinsurance and deductibles. But another hidden cost is limited choice.

Benjamin Franklin told us, “They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.” The temporary safety of allowing someone else to pay for our health care or food bills comes with a price, namely the liberty to choose and make your own decisions. That may mean Mrs. Obama telling WIC recipients that they can’t eat potatoes or the VA telling veterans that their line for medical care is long and may even lead to a dead end.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor.  This article originally appeared in WND.

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