Death Panels and Who Will Die

Amy Sullivan has a remarkably deceptive piece on her blog in which she attempts to debunk this as a “myth:”

I’m very, very concerned about the elderly. I don’t know if this is also correct, but I understand that a federal health board will sit in judgment of medical procedures and protocols to impose guidelines on all providers — when to withhold certain types of care — like, what is the point you get to when we say, I’m sorry that this cannot happen.

Except for quibbling over the word “all,” the “myth” is of course true.

To control costs, any sensible health care reform needs to create a Federal Health Reserve which uses science (as opposed to politics) to determine what we spend our limited resources on. Should a patient be reimbursed for $50 worth of drugs if it keeps her alive another year? What if the cost is $500? $5000? $50,000? $500,000? $5,000,000?

The Federal Health Reserve would be the Life Panel. It would be the Death Panel.

In a real way, experts will control who lives and who dies.

This will mean that some people will be driven to euthanasia because the government will not pay for life-sustaining treatment. There is simple to demonstrate. Some life-sustaining treatments will not be given because technocrats who the patient never sees have determined that it is an inefficient use of funds. Euthanasia is already legal in several places. Therefore, some patients, given the choice between dying painfully from neglect and dying peacefully through euthanasia, will choose euthanasia.

The only alternative to a Death Panel is the Congress. That is, we can listen to those who trust politicians and have politicos decide whether $40,000 on chemotherapy is better spent than $40,000 on a new treatment. Of course, Congress will be driven by polls as opposed to medicine or science. The only alternative to a Death Panel is even worse than a Death Panel.

Now, this is only a nightmare if Obama gets his socialist Public Option through as part of reform. If the Public Option is created, it will never be allowed to fail. Its inefficiencies will take down the rest of the health insurance industry with it.

Create the Federal Health Reserve. Stop the Public Option.

24 thoughts on “Death Panels and Who Will Die”

  1. Doesn’t all this presuppose:

    1. A person’s only health care option will be through some form of monolithic conglomerate or agency whose reimbursement decisions will determine whether he may live or die. (Insurance, government, ….?)

    2. Everyone will be tied into said, common system.

    Or perhaps I misread you (the terminology is fairly new, perhaps idiosyncratic) and you are talking about price-setting within the marketplace so that X procedure may cost only $X and Y procedure only $Y.

  2. Curtis,

    Great questions.

    Certainly it depends on how influential ObamaCare turns out to be. If we have a Public Option with a tax on insurance private companies, we should expect an ever-greater number of people to enroll in the Public Option

    In spite of his earlier statements, I don’t believe Obama will try for a single-payer health plan. This, this will only hit the poor and middle class.

  3. If we have a Public Option with a tax on insurance private companies, we should expect an ever-greater number of people to enroll in the Public Option

    One thing I find curious in the current passionate debates/protests:

    a.) Those who argue on the one hand that individuals and their doctors should be able to make all health decisions for themselves (and thus fear government-run health care) but

    b) on the other hand are terrified of the public’s mass decision to switch to a Public Option.

    Isn’t that curious? I once made the argument that the extremist libertarian positions were a house divided against itself, since they argue so passionately for the right to self-determination (liberty) but fundamentally believe people do not have a right to choose community, or social, or socialist solutions.

    “NO, you may not all rush to a Public Option! We are deciding for your own benefit to protect you from choosing a Public Option!”

  4. [Incidentally, I understand the concerns that a failure to ensure the viability of market competition would eliminate private insurance thus limiting choice-making ability. But why is a public’s choosing to go the route of Public Option for themselves an evil?]

  5. You have to understand that this health-care bill is more than just setting up a government health-care system. Its really an attempt to pass lots of leftest type programs through the back door. It does everything from force medical schools to accept more non-whites, to funding “community organizations” who have the job of “educating people about government health-care,” to creating lots of worthless jobs for people with “diversity studies” degrees. I read the first 500 pages of the bill (with Law school books to assist me) and these details stuck out at me. Notice I wrote the section and interpreted them:

    Pg 16: SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE. lines 3-26 of the HC Bill – OUTLAWS PRIVATE INSURANCE by forbidding enrollment after HR 3022 is passed into law.

    Pg 21-22: SEC. 113. INSURANCE RATING RULES of the HC Bill MANDATES the Government will audit books of ALL EMPLOYERS that self insure!!

    Pg 30: SEC. 123. HEALTH BENEFITS ADVISORY COMMITTEE of HC bill – THERE WILL BE A GOVERNMENT COMMITTEE that decides what treatments/benefits you get.

    Pg 42: SEC. 142. DUTIES AND AUTHORITY OF COMMISSIONER of HC Bill – The Health Choices Commissioner will choose your HC Benefits for you. You have no choice!

    PG 50-51: SEC. 152. PROHIBITING DISCRIMINATION IN HEALTH CARE in HC bill – HC will be provided to ALL non US citizens, ILLEGAL or otherwise.

    Pg 58: SEC. 163. ADMINISTRATIVE SIMPLIFICATION HC Bill – Government will have real-time access to individual’s finances and a National ID Healthcard will be issued!

    Pg 59: SEC. 163. ADMINISTRATIVE SIMPLIFICATIONHC Bill lines 21-24 Government will have DIRECT access to your BANK ACCOUNTS for electronic funds transfer. This means the government can go in and take your money right out of your bank account.

    PG 65: SEC. 164. REINSURANCE PROGRAM FOR RETIREES is a payoff subsidized plan for retirees and their families in Unions and community orgs (ACORN).

    Pg 72: SEC. 201. ESTABLISHMENT OF HEALTH INSURANCE EXCHANGE; OUTLINE OF DUTIES; DEFINITIONS Lines 8-14 Government is creating an HC Exchange to bring private HC plans under Government control.

    PG 91: SEC. 204. CONTRACTS FOR THE OFFERING OF EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS Lines 4-7 HC Bill – Government mandates linguistic appropriate services. Example – Translation for illegal aliens!

    Pg 95: SEC. 205. OUTREACH AND ENROLLMENT OF EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS IN EXCHANGE-PARTICIPATING HEALTH BENEFITS PLAN HC Bill Lines 8-18 The Government will use groups i.e., ACORN & Americorps to sign up individuals for Government HC plan.

    pg 124: SEC. 223. PAYMENT RATES FOR ITEMS AND SERVICES lines 24-25 HC No company can sue the GOVERNMENT on price fixing! No “judicial review” against Government Monopoly!!

    Pg 146: SEC. 312. EMPLOYER RESPONSIBILITY TO CONTRIBUTE TOWARDS EMPLOYEE AND DEPENDENT COVERAGE Lines 22-25 Employers MUST pay for HC for part time employees AND their families.

    Pg 149: SEC. 313. EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE Lines 16-24 ANY Employer with payroll of $400k and above who does not provide public option pays 8% tax on all payroll.

    PG 272: SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!

    PG 425: SEC. 1233. ADVANCE CARE PLANNING CONSULTATION Lines 4-12 Government mandates Advance Care Planning Consult. Think Senior Citizens end of life

    Pg 469: SEC. 1302. MEDICAL HOME PILOT PROGRAM Community Based Home Medical Services=Non profit organizations. Hello, ACORN Medical Services here!!?

    Page 472: SEC. 1302. MEDICAL HOME PILOT PROGRAM Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. 1 monthly payment 2 a community-based org. Like ACORN?

  6. Seerov answers at least part of my question. (I will ignore for now the racist overtones.) Is the fear then not of a Public Option so much as the fact of how that that Public Option is legislated, in its current incarnation, would add more “stumbling blocks” to private insurance and current practices? In other words: on the one hand setting up a Public Option while the other hand purposely tries to make the currently less-than-wonderful private options more horrible?

  7. Seerov,

    Fact is, current practices already have a Death Panel, situated at the head of the board room table of every health insurance company in America — with subsidiary Death Panels in most corporations (since corporations get to decide which health insurance company their employees may choose or else, in the case of small business, get to choose not to offer health insurance.)

    (Just trying to nudge this post back on that focus….)

  8. Curtis raises a number of good points. I will try to address them in turn.

    I once made the argument that the extremist libertarian positions were a house divided against itself, since they argue so passionately for the right to self-determination (liberty) but fundamentally believe people do not have a right to choose community, or social, or socialist solutions.

    The liberterian answer is that your choice to live as you want does not extent to using police powre to subsidize that choice. Hence, you are free to have whatever health care, drugs, and prostitues you wish, but you can’t expect any of them to be subsidized.

    A better answer is that the benefit of market competition comes from creative destruction. Inefficient allocators of resources are removed from the marketplace, either through disollution, reconstitution, or retreat. Thus, IBM (which seems monolithic) removed itself from competition in desktops and laptops, because it was unable to allocate resources efficiently in these markets.

    However, “public options” (that are, state-owned industries [1]) cannot be removed by market forces. They can only be removed through political forces.

    Fact is, current practices already have a Death Panel, situated at the head of the board room table of every health insurance company in America — with subsidiary Death Panels in most corporations (since corporations get to decide which health insurance company their employees may choose or else, in the case of small business, get to choose not to offer health insurance.)

    While there is allocation in market-based competition, there is rationing in rational, government-based competition. [2] Much fear of ObamaCare comes from the concern that people will no longer be able to buy their way out of the decision of a “Death Panel.”

    Seerov,

    You may be interested in Lexington’s even-handed analysis of the law.

    [1] http://www.tdaxp.com/archive/2009/08/08/obama-the-socialist.html
    [2] http://chicagoboyz.net/archives/8601.html
    [3] http://chicagoboyz.net/archives/8652.html

  9. “Create the Federal Health Reserve.”

    Dan, are you the sold proprietor of this idea?

    I see no one else talking about it. That does not mean it is bad or wrong, if so. It does mean that it is not a realistic option, if so. An idea that no one knows about, or that only TDAXP readers know about, can’t be enacted into law.

  10. “Dan, are you the sold proprietor of this idea?”

    Hmm…no. Obviously, if it hypothetically cost one hundred billion to treat the life threatening condition of a single individual, then I would think it not irrational to not dish out that kind of money, but at the same time you can’t rationalize the fact that this of constitute as a “death panel” de facto.

    With that said, pointing out the potential for a death panel isn’t irrational, but what is irrational is the circumstances of which are being asserted in which denial of payment would be applied (Obama’s going to kill my down syndrome baby, Stephen Hawking would never make it in the UK, etc.).

    Keep in mind that Dan isn’t arguing against allowing someone to pay out of pocket, and keep in mind that, at the end to the day, there probably isn’t going to be a situation in which a private insurer is going to dish out more for a claim than the public option given the inherent nature of private insurance.

  11. there probably isn’t going to be a situation in which a private insurer is going to dish out more for a claim than the public option given the inherent nature of private insurance.

    Very interesting observation, especially when considering Death Panels.

    But then what is the nature of the insurance industry, in the first place? Aren’t insurance companies a system in which everyone pays in but not everyone benefits equally — all determined in large part by what that insurance company is willing to pay/cover and how they set the “merit” of the consumer, thus the amount paid in, based on age, previous conditions, gender, etc?

  12. “I will ignore for now the racist overtones.” (CGW)

    How can you ignore the racialist (I use the tern racialist since I don’t truly understand what a ‘racist’ is) overtones when racialism is part and parcel of what this bill is all about?

  13. Oh sorry Seerov, I wasn’t clear.

    I was ignoring those tones in your comment.

    Now back to the main debate! (Which I suppose is still about what is, is not, a Death Panel and whether they exist in nature, or at least various levels of our society or merely will suddenly bloom with either ObamaCare or Federal Health Reserve, etc.)

  14. Curtis,

    Thanks for your “grande bombaste” :-1) Shannon’s post left be unsatisfied, too, as whether you are not rationed care, or you cannot pay for the care you could otherwise allocate, you’re still sick/dead/whatever.

    Still, transition to a government-based system of life-and-death from a market-based on is a big shift. It’s as big of a shift as that from capitalism to socialism with Chinese characteristics [1].

    The Public Option is a horrible idea, because it allows a subsidized competitors enter the marketplace, be immune from market discipline, and warp everyone’s actions without anyone being able to quantify its effects. (In this it is similar to GM, or AIG, or other very large socialist firms.)

    As to Death Panels — as Obama said, we need to stop subsidizing people a couple weeks from dying getting hip transplants. Spending more and more of our economy on transforming the morbid into the healthy may make sense. Spending more and more of our economy to get an extra 30 days of morbidity probably doesn’t.

    [1] http://www.tdaxp.com/archive/2009/08/08/obama-the-socialist.html

  15. “we need to stop subsidizing people a couple weeks from dying getting hip transplants. … Spending more and more of our economy to get an extra 30 days of morbidity probably doesn’t.”

    We.

    Our.

    That is the problem. Once it is the government doing all this, it is the taxpayers money at stake, and virtually every personal choice any person makes that could potentially have health implications becomes “our” business. It is impossible to have one-size-fits-all for 300 million people without making most of them unhappy.

    The government should be going 180 degrees the other way, getting out of these choices, widely spreading decision-making power, allowing as many options as profit-seeking and ingenuity can provide.

    Once it is top down, every time someone’s grandmother dies 30 days sooner because the government cut off the money, because it is “our” money and “we” should not have to pay for it, there will anger. Everyone will want cost-savings for themselves as taxpayers and limitless spending on their own families. Politicians will try to satisfy both demands and costs will go through the roof. I see no possible way this does not end badly.

  16. Lexington,

    I agree.

    Medicare’s the time bomb.

    We have a basic choice, I guess, of simply ending the program (in which case those who were expecting it get treated badly), or move away from subsidizing morbidity (that is, turning the last 30 days into the last 60 days).

  17. “Once it is top down, every time someone’s grandmother dies 30 days sooner because the government cut off the money, because it is “our” money and “we” should not have to pay for it, there will anger. Everyone will want cost-savings for themselves as taxpayers and limitless spending on their own families. Politicians will try to satisfy both demands and costs will go through the roof. I see no possible way this does not end badly.”

    In a sense isn’t Social Security in the same box? People will demand personal responsibility of others (why didn’t they save enough for retirement?) while demanding an exemption/bailout for their family.

    This has been an extremely good discussion to follow and learn from. I sympathize with what LG is pointing out about “We” and “our” but I also can see Dan’s point of the dilemma faced by leaders now and in the future regarding such harsh choices. CGW brings in the excellent observation that what some view as allocation in the private system is viewed by the recipients of that decision as rationing. Dress it up however we want, people are being hurt now and will likely continue to be hurt in the future by such decision-making. Do you do it with a mixture of moral and economic factors involved, a purely quantifiable system or try to just save money by promising one thing and doing another, a policy insurance companies specialize in that we call rescission?

    The political opportunism of both sides will not allow for such decisions to be made for actual reform (think of how Democrats took advantage of Bush’s effort on Social Security and how Republicans now do the same for what Obama is planning for Medicare reforms) until we are literally bankrupt.

  18. Curtis GW,

    One reason we’re seeing so much opposition to the bill is over all the non-health care (overly leftest ideological ideas) contained in the bill.

    Another fear relates to one of your comments, but goes back to race anyway. After reading the first 500 pages it appears that the government option will make it more difficult for people to hold on to private insurance. So when Obama says “you can keep the one you have” people see through this, as the information in the bill says otherwise.

    This scares people as they think about a health care program being presented by a man who has a history of actions that make white people worse off. These people also see the President placing radical (anti-white) leftists in key positions and allowing black radicals to intimate white people at polling places.

    Lately on the news some leftists in the pro-Left media have been suggesting that the protesters have subconscious “racist” reasons for opposing the bill. Afterwords, we see the clueless Right stand up and say “race has nothing do with this” (as Limbaugh calls Leftists Nazis).

    The fact is, this debate is ALL about race! The bill basically takes resources from old whites and gives them to young non-whites (mostly Hispanics).

    American politics is now ALL ABOUT RACE! This is the reality of a multi-ethnic state. Once in a while someone will cynically stand up and say ” we need to talk about race” but the fact is, America is structurally configured to not talk about race in a meaningful way.

    —–OK, now go back to your fascinating discussion——

  19. Eddie,

    In a sense isn’t Social Security in the same box? People will demand personal responsibility of others (why didn’t they save enough for retirement?) while demanding an exemption/bailout for their family.

    Good point. The difference comes from SS is an even contribution, while Medicare spending ramps us during sickness and before death. It is still a touchy subject, but you have the potential for a different dynamic: why does my grandma have longer wait lines for years so that yours can be alive another week?

    Dress it up however we want, people are being hurt now and will likely continue to be hurt in the future by such decision-making.

    Excellent point. A great summary.

    The political opportunism of both sides will not allow for such decisions to be made for actual reform (think of how Democrats took advantage of Bush’s effort on Social Security and how Republicans now do the same for what Obama is planning for Medicare reforms) until we are literally bankrupt.

    It requires an elder statemen approach, like a Dole-Daschle plan, which only during a crisis. Hopefully this comes before default.

    Seerov,

    Another fear relates to one of your comments, but goes back to race anyway. After reading the first 500 pages it appears that the government option will make it more difficult for people to hold on to private insurance. So when Obama says “you can keep the one you have” people see through this, as the information in the bill says otherwise.

    Indeed. The New York Times referred to this as an “aspiration” which “may not be literally true or enforceable” [1].

    The fact is, this debate is ALL about race! The bill basically takes resources from old whites and gives them to young non-whites (mostly Hispanics)

    I think you are overly racializing Obama’s upbrining. The attacks against him from the left for not being an ‘African-American’ were insightful — his formative experience was not spent in the south or a rural area in the North, but in non-black areas of the country and oversees. He may be many things, including a sort of socialist [2], but he is not much of a race warrior.

    [1] http://www.nytimes.com/2009/08/10/health/policy/10facts.html
    [2] http://www.tdaxp.com/archive/2009/08/08/obama-the-socialist.html

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