Wednesday, August 19, 2009

Is the talk of "death panels" so crazy?

A million articles, blog posts, etc., have made the same point: the suggestion that the health-care reform passed in the United States will involve anything that could be described as "death panels" is crazy and unfounded -- so don't even bring it up.

Well, as my mom argued in this diavlog, there are problems with saying that "death panels" should be out of bounds in civilized debate just because they're not in the text of the pending bills. First of all, we're not seeing the law in its final form. And even if we were, you can't assume that the text of a law gives you a complete picture of how it's going to be applied. It could be interpreted in surprising ways, especially since it's so long and unwieldy.

Also, does it matter if the legislation might represent a baby step toward future reform in the same direction? You might say: no, that's just a slippery-slope argument. But supporters of health-care reform often tell each other that moderate reform in the near future would be good in part because it could make a single-payer system more likely in the long term. (I myself find this argument somewhat convincing and encouraging.) If supporters of health-care reform are allowed to argue that reform would put us on a good slippery slope to something more expansive, shouldn't critics be allowed to argue that a component of reform (for instance, voluntary end-of-life counseling) could put us on a bad slippery slope to something more sinister (involuntary end-of-life rationing)?

It also seems fair to look beyond the text of the currently pending bills -- which, let's face it, few people participating in this debate have the time to read -- and look at the underlying goals of the key actors. So let's look at what President Obama said in April (which Just One Minute recently drew attention to -- via Kaus):

THE PRESIDENT: Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —

[David Leonhardt:] Yes, where it’s $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, ... when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

[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.

[Leonhardt:] 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.
The blog Just One Minute (in the same post linked above) sums it up:
So as of April 2009 Obama himself expected the final legislation to include some sort of group (but NOT a "death panel"!) that would produce voluntary guidelines for end of life care with an eye towards saving money.
But is the word "death" just too inflammatory to use? I wish it weren't. Death is a fact of life. We're all going to experience it some day. Society should think seriously about how to deal with it. So I don't think it would be a positive development to ban the word "death" from the debate.

Ah, but any end-of-life consultation would be voluntary, right? Well, what did Obama mean when he said, "[T]here is going to have to be a very difficult democratic conversation that takes place"? If the only issue were voluntarily providing people with information about hospice care and the like -- well, that doesn't sound controversial at all! Why would that require a "very difficult democratic conversation"? Why would Obama say it raises "very difficult moral issues"?

But surely any end-of-life panels would have to remain voluntary, because no one would be in favor of cutting off life-sustaining resources for "grandma," right? (Why is the concern always about "grandma"? Is this another example of women's lives being valued more than men's?)

Well, actually, there are smart, left-leaning commentators who have already endorsed rationing even if it means doing just that. For instance, William Saletan has said:
[J]ust as some people have enough money, others have had enough time. If you make it to 100 and can fund your own surgery, that's terrific. But Medicare should focus its resources on people who haven't been as lucky as you. Living to 99 is no tragedy.
Similarly, Peter Singer wrote a long New York Times piece about "Why We Must Ration Health Care," in which he argued that we should allocate medical resources based on a nuanced cost-benefit analysis that takes into account "quality-adjusted life-years." Specifically, Singer thinks we should put a greater value on younger people (since they statistically have more years left to live) and on those with higher-quality lives.

Of course, I'm not saying that Congress is going to enact Saletan's or Singer's views on these issues. But their views aren't so far beyond the pale that they shouldn't be part of the health-care debate.

To be blunt, those writers would presumably be in favor of something you could call "death panels." Many would strongly disagree with them. Isn't that part of the "very difficult" debate Obama recently said we're going to need to have? So, let's have the debate, and let's stop trying to forbid the use of the term "death panel."


Jason (the commenter) said...

You're right.

All the people I've heard who've been shocked by the use of the term "death panels" have confounded it with "end of life counseling," seemingly on purpose. It's usually a set-up for a straw man argument.

Quoting Obama, is also pertinent. Our President has a habit of saying just the right sort of thing to inflame his opponents, and he's done a horrible job at selling this bill.

LemmusLemmus said...

Well, what she actually wrote:

'The America I know and love is not one 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.'

I think you've very eloquently missed that point.

Dust Bunny Queen said...
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Dust Bunny Queen said...

It isn't JUST the end of life counseling that comprise "death panels".

The issue is that a group of faceless and unaccountable bureaucrats will be deciding for the entire country who gets medical care and who doesn't based on the cost benefit analysis of your life.

Does private insurance not cover every instance of health care? Of course NOT. Not everyone is insurable either. That is just a fact of life. However, you can shop around for another policy to see if you can get a better deal. You can CHOOSE to pay more for coverage. When it is Government controlled health care we have no other options. No other recourse is available to you.

The horror in this bill is the government deciding who is worthy and who isn't. It isn't a far reach to say that the Government might decide worthiness and who gets to live and die based on political or even ethnic criteria. It has happened before in other fascist states and these liberals are nothing less than fascists.

John Althouse Cohen said...

LemmusLemmus: I agree that Sarah Palin's specific example was unfounded. I never mentioned Sarah Palin in the post, because I'm not trying to defend her; I'm just arguing against the extreme reaction against the whole idea that "death panels" are germane to the debate.

hombre said...

Her comment, although hyperbolic, was well-founded.

Health care rationing overseen by committee is inherent to government "single payer"health care. It is absurd to claim otherwise.

Lawyer Mom said...

Thanks for posting the excerpts from that NYT interview (or article?) because I completely missed it. And so did the media, best I can tell, when Palin twittered about death panels. She certainly hit a nerve.

In my view, Obama's statements in this interview make the euthenasia argument wholly relevant and show that Palin was not so far afield.

Call them death panels, or "playing God" panels, or whatever you like. The fact is, scarce resources + increasing demand = rationing.

Jason (the commenter) said...

I think we actually need to talk about death panels. If the government can't deal with this issue, it has no business thinking about nationalized health care.

Josh said...

I thought people would be able to buy extra coverage? That's wrong?

John Althouse Cohen said...

Josh: I would assume they can buy extra coverage. That would be a good example of a constructive response to charges of "death panels." Remember, I'm not saying there will be death panels involved and therefore health-care reform shouldn't be passed. I want to see health-care reform passed. I just think a lot of liberals are being disingenuous by trying to laugh off the very idea of "death panels" and not even trying to engage in a substantive argument with people who disagree with them.

Jason (the commenter) said...

JAC : I just think a lot of liberals are being disingenuous by trying to laugh off the very idea of "death panels" and not even trying to engage in a substantive argument with people who disagree with them.

They can't talk about death panels, they can't talk about rationing, they can't talk about cutting the total amount of money spent of health care. They can't even talk to their own constituents. They have no business writing any bills on health care.

I think all the euphemisms they've been employing over the years have somehow become real to them. They can't see through the bullshit to the core issues.

But we can probably say the same think about Republicans.

Unknown said...
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