Thursday, August 13, 2009

More on "death panels"

It's another one of those issues that just ain't gonna go away, and the Democratic left doesn't seem to understand why. So I'm going to try to explain it again.

First, let me set this up:

Yes, I oppose ObamaCare.

No, I do not believe that President Obama or any of the Democrats in Congress, or the Democratic punditry, or the average Democrat on the street, wants a system in which "death panels" decide who gets medical care and who gets a nice strong morphine cocktail and a dirt nap.

In point of fact, the "end of life" stuff in the bill was co-sponsored by at least one Republican (former Representative, now Senator, Johnny Isakson of Georgia), and he's been clear that he didn't intend for it to imply "death panels." Rather, he just wanted to make sure that people in "end of life" situations would be covered by ObamaCare when it came to paying for discussions with their doctors about things like living wills, Do Not Resuscitate orders, hospice care, etc.

I have no doubt that the Democrats (or at least 99.9% of them) who support ObamaCare also believe that that's exactly what the whole provision was about.

I say "was" because the Senate Finance Committee just excised it from the bill. That's not going to end the discussion, though.

So anyway, it's not surprising that Democrats and other supporters of the health care "reform" bill would find the whole "death panels" explosion surprising and dismaying. However wrong-headed ObamaCare may be -- and it's plenty wrong-headed -- what it isn't is an intentional secret conspiracy to save Uncle Sugar the cost of a year of Depends® by having a nurses' aide smother grandma with a pillow, mkay?


That doesn't mean that the whole "death panels" thing is paranoid and unreasonable, either. Here's why:

First, as I've mentioned before, Terri Schiavo. Let me take a step back from my stated opinion on the matter (that her death was murder most foul) and appeal to those on both sides of the argument.

Maybe Terri Schiavo was in a permanent vegetative state, maybe she was just mentally disabled but still "living" in a meaningful sense of the word. Maybe her physical death was merely a formality, her consciousness having long since left the building, or maybe she was a helpless, but at least nominally aware, victim of a miscarriage of justice.

Either way, it is matter of record that she had no formal advance directive on file anywhere that could be found, that her husband's claims of an informal directive were questionable (having been stated only after he'd won an insurance lawsuit in which he told the jury the award would be used to provide for Terri's perpetual care), and that it was a government "death panel" -- in this case, a court -- which decreed that her feeding tube would be removed and that her body would be allowed to die of starvation.

Can those of you who believe that she was in fact in a vegetative state and, for all intents and purposes dead, understand why those who believe otherwise might impute meaning to an "end of life" provision in a government health care bill that wasn't intended by the provision's authors?

Secondly, the UK. Their "single-payer" health system is, at this very moment, in the throes of a public discussion on denial of care to the elderly and to those whose health problems are "their own fault" (obesity, smoking-related illness, etc.).

To put this as simply as possible: To the extent that government is "in charge" of health care, private sector options are going to be less accessible, even if they're not outlawed completely. Patients are going to have to take what the government gives them, and the government will regulate what they are able to get.

Throw your hands up and scream when I use the word "rationing" if you want, but there are only so many doctors, so many hospital beds, etc., the available amount of those things will never be infinite, and therefore the people allocating the time of those doctors, the occupancy of those beds, the distribution of limited quantities of expensive drugs, etc. are going to have to make choices.

Pretend you're one of those allocators, and you face the following situation:

Two patients in front of you, more coming behind them. One bed, one surgeon, one operating theatre available.

One patient is 19 years old and has just been shot by a burglar whom he encountered in his home. It's touch and go, but his chances of survival are good, if he's on the table ASAP.

The other patient is 91 years old, is in the final stages of pancreatic cancer which will kill her within weeks or months, and just fell and broke her hip.

You are the decider. Which patient goes into the OR and under the knife, which one goes to the nearest hospice and gets a morphine drip?

You're a one-man death panel. Someone is going to die. You have to decide who. And yes, I'd save the 19-year-old's life too.

In a government healthcare system, the "decider" in that situation is going to be a government "death panel" by definition. And assuming -- as any reasonable person must assume -- that there will be financial limitations, limitations on the number of available doctors, beds, meds, etc. in general, not just in rare situations as described above, it's not a stretch to imagine that there will be ... guidelines ... for those panels to follow.

It's easier to tell 10,354 projected patients who are 85 years old or older and need hip replacements "no" as a matter of policy than to let the inevitable "terminal elderly patient with broken hip versus otherwise healthy young patient with treatable gunshot wound" incidents pile up one at a time and handle them a la carte and on the fly. Bureaucracies love guidelines, standards, etc. Such things let them avoid making difficult decisions themselves and help them cover their asses for the decisions they do make.

No, "death panels" are not a secret evil conspiracy intentionally inserted into this bill. But they are an inevitability in implementation of any bill of the kind.

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