[ Friday, August 14, 2009 ]


Healthcare Reform: "Death panels." Much has been made of this. Sarah Palin referred to them in calling Obamacare "evil:"

“The Democrats promise that a government health care system will reduce the cost
of health care, but as the economist Thomas Sowell has pointed out, government
health care will not reduce the cost; it will simply refuse to pay the cost. And
who will suffer the most when they ration care? The sick, the elderly, and the
disabled, of course. The America I know and love is not one in which my parents
or my baby with Down Syndrome will have to stand in front of Obama’s ‘death
panel’ so his bureaucrats can decide, based on a subjective judgment of their
‘level of productivity in society,’ whether they are worthy of health care. Such
a system is downright evil.”

Now, to be fair, the bill in question provides compensation to doctors for having consultations with patients to discuss their options in respect to end-of-life care decisions. The doctors will be guided by a government panel of experts, presumably housed somewhere in the "Federal Coordinating Council for Effectiveness Research." Here's how President Obama sees it happening:

"LEONHARDT: And it's going to be hard for people who don't have the option
of paying for it.
THE PRESIDENT: So that's where I think you just get into
some very difficult moral issues. But that's also a huge driver of cost, right?I
mean, the chronically ill and those toward the end of their lives are accounting
for potentially 80 percent of the total health care bill out here.
So how do you - how do we deal with it?
THE PRESIDENT: Well, I think that
there is going to have to be a conversation that is guided by doctors,
scientists, ethicists. And then there is going to have to be a very difficult
democratic conversation that takes place. It is very difficult to imagine the
country making those decisions just through the normal political channels. And
that's part of why you have to have some independent group that can give you
guidance. It's not determinative, but I think has to be able to give you some
guidance. And that's part of what I suspect you'll see emerging out of the
various health care conversations that are taking place on the Hill right now."

Now, that's not exactly a panel of government bureaucrats deciding, "No Procrit for you!" because you're old or disabled. But it definitely is a government panel advising physicians on how to advise patients regarding end-of-life issues, which the physicians are incentivized (i.e., paid) to provide. My dictionary includes as a definition of "death" the "end of life." So there's a government panel advising physicians on advising patients about death. Is "death panel" a grossly exaggerated phrase? Add to that the fact that this is in a bill that's supposed to "bend the healthcare cost curve" down; is it unreasonable to think that the "panel" and the consultations would encourage a reduction in that "driver of costs"? Especially when you consider the various sources of input to the Obama Administration.

Consider this as well: The Senate Finance Committee dropped the provision from its package. "We are working very hard to avoid unintended consequences by methodically working through the complexities of all of these issues and policy options," Iowa Sen. Chuck Grassley, the ranking Republican on the Senate Finance Committee, said in a statement. "We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly."

So apparently even the Senate drafters of the legislation noted how the language could be construed that way. Personally, I agree with Althouse: I think it's a bit of hyperbole (a "polemical" is a good descriptor). But that doesn't stop the journalism community from deeming it an outright lie. From an email from the Columbia Journalism Review: "The health care debate is too important to be muddied up with lies, but, well, there they are. In the first of a series we're calling Straight Talk, CJR's Trudy Lieberman traces the history of a particularly nasty fabrication—that reform legislation includes a "death panel" that will decide who should get treatment—back to its dubious source."

Like I said, it's not a lie. There will be panels that will advise doctors on end-of-life (i.e., death) issues, and that panel will focus on cost-benefit analyses. That panel will advise doctors, who will be paid to advise their patients regarding end-of-life (i.e., death) issues. At least it's not a lie like "I have not said that I was a single-payer supporter."

Now, I think it's true that the vast majority of our healthcare spending is focused on the last few months or years of life, and a lot of that money returns relatively little in value. I certainly think people should consider the cost of the care they want versus the benefit it will provide. But who should make that decision, the person paying or the person receiving the care?

Therein lies the underlying problem: OPM. Yes, I've said it before, but the problem with our healthcare system always comes back to "other people's money." If the person receiving the care is also the person paying the money for the care, then the decision is made by the person impacted, and whatever the decision, it's the right one.

Jeff [2:07 PM]

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