Saturday, August 15, 2009

Death Panel -The Grain of Truth behind the Bruha

The debate over health care, at least as reported in the news, is way out of control. Both sides are distorting facts, misusing statistics, taking things out of context, and inappropriately exaggerating. None of this helps clarify our understanding of the real situation and the issues at stake.

One of the most recent uproars has been the claim that the current bill under discussion includes forced euthanasia. I haven't read the entire bill--it's hard to take the time to read over a 1000 pages of a moving target--but what I have read about it does not support the claim that people will be murdered by order of a government "death panel."

However, like all overstatements aimed at creating fear and repugnance (see Miscounting the Uninsured for an example of this tactic by those in favor of ObamaCare), there is a grain of truth behind the exaggeration.

As Robert Trasinski writes in yesterday's TIA Daily (subscription required):

Jack Wakeland sent me an e-mail yesterday which captured how these "end-of-life" decisions—let's put it bluntly: decisions about dying—are currently, and properly, treated.

"When a patient is terminally ill, it is entirely proper and legitimate for doctors to push for frank discussions between the patient and his family about whether or not the medical profession can really do anything for him other than alleviate pain. It is entirely proper and legitimate for the patient to consider the financial burden he is imposing on his family if they are supporting him, or the financial loss to his family if he intends to bequeath to them what remains of his estate after his death. This kind of end-of-life cost/benefit analysis is a deeply personal issue. It is so intensely personal that one's own family members—including one's own wife or husband—may not legitimately involve themselves in the decision unless they're asked by the one who is to die."

Yet Obama is proposing to turn the subject over to a whole bunch of strangers, to an "independent group" "guided by doctors, scientists, ethicists."

And, that "independent group" is to be organized and directed by government mandates.

Such a plan is similar to the existing National Institute for Health and Clinical Excellence in Great Britain--also known as NICE. Charged with making decisions about which procedures and medicines the government-run National Health Service will fund, this division of the NHS evaluates medical treatments using the criteria of the Quality Adjusted Life Year (QALY.) No one is "forcefully euthanized" but certain procedures and treatments are deemed insufficiently "cost effective" --which means: not worth the expenditure for society--and thus are not funded. If that treatment is something like dialysis for chronic renal failure, or certain types of expensive cancer chemotherapy, the decision not to treat is a death sentence. (See WSJ editorial "Of NICE and Men" for a few examples.)

As described in the above quote, such decisions must be made. The question is by whom and how those decisions are made: by individuals about their own lives and resource priorities, or by a government panel using the standard of what is good for society. This is not forced euthanasia, but --and here is the "grain of truth"--if a government panel is making such life and death decisions for its citizens, is that not a type of "death panel"? Even so, such emotionally charged, misleading terms do not further reasoned debate and only serve to distract from (and worse, undermine) the underlying real and valid criticisms of government mandated and government-funded health care.

There's plenty to be concerned about without such obfuscation. Health care means life and death--and we need to treat this matter rationally with the care and seriousness it deserves.



Anonymous said...

First things first. The Republican talking heads have talked the public into believing they lack the brain power to read such a lengthy tome. I'm shocked that you would buy into it. The 1,000 pages is misleading. The margins are something like 2 inches. I counted 150 words per page, versus about 250 for your average college term paper. So, now we're down to about 600 real pages. Of those, a good bit is devoted definitions and other legal nonsense that you don't really need to read in its entirety to understand the bill. Also, it's organized in such a manner that you don't really need to read every section. The section pertinent to the current discussion is Section 1233. You should read it.

Second, NICE sounds like triage. If we don't like the idea of rationing care based on medical and cost effectiveness, perhaps we should have an uproar about how emergency room patients are separated into those we can help and those we can't, and how those who we can help are separated into those we need to help NOW and those who can wait.

I think it's a given that we can't afford to keep everyone alive forever. Insurance companies currently make those decisions for profit, and like any government system we may have in place in the future, they point out that they are not denying CARE (they don't provide care, anyway), they are just denying payment for it; they aren't stopping anyone from ponying up for their own care.

All this is true. And, if insurance companies behaved in a socially redeeming way we probably wouldn't be having this discussion. How it got to the norm that insurance companies can just drop you for filing a claim, i.e. getting sick, is beyond me. The value proposition used to be we pay premiums and when we get sick you pay for care. Now it seems to be we pay premiums and when we get sick, you pay, unless it's an expensive disease, in which case we terminate your coverage.

Finally, as I understand it the quote you presented is disinformation. The bill provides the money for individuals and families to get legal and medical counseling, so they can have an end of life plan in place before it's necessary, and often too late. Further, it provides that money every five years, so individuals can update their plans. Until the opponents of a public option present an actual case of a person for whom end of life decisions have been made by Medicare, I have to count all the hysteria as just baseless political tactics.

Here is link to the bill: just click on section 1233.


Beth said...

For some reason my comments feed has not been alerting me to your comments. I apologize for not reading them earlier. I am just now finding several as I look through my comments in order to locate an article reference I placed earlier.

I have tried reading some of the actual bill and will look into section 1233 per your recommendations. You make some interesting points about the length of the bill---but even at 600+ pages, it takes time to read, understand, and fully grasp the broader consequences of such a massive piece of legislation.

I do not think your comparison of rationing to triage is appropriate. Medical care is a known expense of life, even if the specifics can not be accurately predicted. We should be planning for this via real insurance (i.e. coverage for large and unpredictable events vs. routine predictable, expenditures) Triage is the procedure of applying preset-priorities for resource allocation to be implemented in an emergency situation.

There is something drastically wrong if we are responding to normal life occurrences (such as a need for health insurance and medical care) as if they are unexpected emergencies.

Anonymous said...

I understand your point regarding triage. However, as a society we have an actuarial knowledge of our needs in emergencies. Triage is a purely medical process. What I was attempting to illustrate is that we have to make choices, the choices "insurance" companies make every day regarding what they will pay for and what they will not. IN their case the choices are made on the basis profit; in the case of government health care those same choices will be made on the basis of what we as a society can afford. And, again, it's not a matter of denying the procedure, it's a matter of denying the funding; those with their own money will still be free to spend it on whatever procedures they like.

Beth said...


Just a matter of funding? I don't see it that way.

It seems you are saying: I can choose to purchase whatever medical care I can afford, except that the government gets to decide how much of my earnings I am allowed to keep for my personal choices, and how much I am required to contribute to a program in which they get to decide what to do with my earnings--which has a significant effect on what I actually can afford to purchase.

I have a real problem with the idea that society gets to choose my life priorities for me--even if I am honest, hard-working, responsible, and not violating anyone else's person or property.

As long as we disagree on this fundamental principle, we will disagree on the proper limits of government power. As you argued in a previous post, you have to start with moral principles and then build political and economic systems which are consistent with those principles.

Most people do not want to reexamine their fundamental moral beliefs, so I end up addressing the impracticability of government interventionism and central planning. However, I see no conflict between the moral and the practical. The moral requirements of life must be practical (by definition!) and something which is not truly practical (workable) can not be a moral requirement.

I have no pretense of convincing you of my beliefs. I do hope to create a better understanding.

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