With “controlling costs” a primary goal of Obamacare, and half of all medical costs coming in the last six months of life, “rationed care” takes on a new meaning for us all.

London’s Telegraph reported Sunday that the National Institute of Health and Clinical Excellence, known by its Orwellian acronym NICE, intends to slash by 95 percent the number of steroid injections, such as cortisone, given to people who suffer severe and chronic back pain.

“Specialists fear,” said the Telegraph, “tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain or pay as much as 500 pounds each for private treatment.”

Now, twin this story with the weekend Washington Post story about Obamacare’s “proposal to pay physicians who counsel elderly or terminally ill patients about what medical treatment they would prefer near the end of life and how to prepare instructions such as living wills,” and there is little doubt as to what is coming.

The Post portrayed the controversy as stoked by “right-leaning radio” using explosive language like “guiding you in how to die” and government plans to “kill Granny.” Yet, is not the logical purpose of paying doctors for house calls to the terminally ill, whose medical costs are killing Medicare, to suggest a pleasant and early exit from a pain-filled and costly life?

Let us suppose the NICE plan in Britain is adopted. And an 80-year-woman, living alone, with excruciating persistent back pain, is visited by a physician-counselor. What is he likely to advise? What conclusion would Grandma be led to by a doctor who sweetly explains what treatment she may still receive, what is being cut off, and what her other options might be?

What other options are there?

Examples of how to “die with dignity” are at hand.

Three weeks ago, Sir Edward Downes, the world-renowned British orchestra leader, who was going blind and deaf, and his wife of 54 years, who had terminal cancer, ended their lives at a Zurich clinic run by the assisted suicide group Dignitas. They drank a small amount of liquid and died hand in hand, their adult children by their side.

This is the way of de-Christianized Europe. For years, doctors have assisted the terminally ill in ending their lives. Indeed, it has been reported that indigent, sick and elderly patients who could not make the decision for themselves had it made for them.

In America, we have a Death with Dignity Act in Oregon and such suicide counselors as the Hemlock Society, which itself took the cup in 2003. Now we have Compassion & Choices, which counsels the elderly sick on a swift and painless end. Before he took to ending the lives of patients who were not terminal, but sick and depressed, Dr. Kevorkian had his admirers. Not infrequently, one reads of nursing homes where the infirm and elderly have been put to death.

Beneath this controversy lie conflicting concepts about life.

To traditional Christians, God is the author of life and innocent life, be it of the unborn or terminally ill, may not be taken. Heroic means to keep the dying alive are not necessary, but to advance a natural death by assisting a suicide or euthanasia is a violation of the God’s commandment, Thou shalt not kill.

To secularists and atheists who believe life begins and ends here, however, the woman alone decides whether her unborn child lives, and the terminally ill and elderly, and those closest to them, have the final say as to when their lives shall end. As it would be cruel to let one’s cat or dog spend its last months or weeks in terrible pain, they argue, why would one allow one’s parents to endure such agony?

In the early 20th century, with the influence of Social Darwinism, the utilitarian concept that not all life is worth living or preserving prevailed. In Virginia and other states, sterilization laws were upheld by the Chief Justice Oliver Wendell Holmes, who said famously, “Three generations of imbeciles are enough.”

In Weimar Germany, two professors published “The Permission to Destroy Life Unworthy of Life,” which advocated assisted suicide for the terminally ill and “empty shells of human beings.” Hitler’s Third Reich, marrying Social Darwinism to Aryan racial supremacy, carried the concepts to their logical if horrible conclusion.

Revulsion to Nazism led to revival of the Christian ideal of the sanctity of all human life and the moral obligation of all to defend it. But the utilitarian idea — of the quality of life trumping the faith-based idea of the sanctity of life — has made a strong comeback.

And the logic remains inexorable. If government intends to “bend the curve” of rising health care costs, and half of those costs are incurred in the last six months of life, and physician-counselors will be sent to the seriously ill to advise them of what costs will no longer be covered, and what their options are — what do you think is going to be Option A?

buchanan.org/blog/time-to-go-grampa-1623