Monday, August 17, 2009

Are Rumors of the Death Panels Greatly Exaggerated?

Much of the health care debate over the last two weeks has revolved around Governor Sarah Palin's statement from her facebook page about her parents or her baby with Down Syndrome having to stand before a government "death panel" which would determine whether or not they would receive medical care.

The media coverage has almost universally centered around reassuring people that no such thing exists and that Palin has simply got her facts wrong. I'm no fan of Palin and I think it is definitely fair to say that her "death panel" remark is at the very least some over the top rhetoric. It's also accurate to say that the House bill does not set up any type of governmental body called a death panel. Still, I'm not convinced that this is a simple open and shut case of Palin lying while President Obama, Congressional Democrats, and the Media champion full and honest disclosure.

In order to appear as if they have the indisputable facts on their side, many in the media have identified a provision in the House bill that would allow Medicare to pay for end of life counseling with a doctor as the item that sparked the death panel remark. They are correct that discussions with a doctor about end of life issues are certainly important medical services; and, as such, they ought to be covered by medical insurance. But what if it isn't this particular provision that upsets people who do worry about the creation of some type of death panel?

Last Friday, the New York Times had an article purporting to reveal the real source of the death panel rumor, which was heralded by some bloggers as providing the definitive refutation to what they saw as Palin's baseless accusation. The article detailed how this rumor is really nothing new and that it represents an attempt to derail the current health care reform by the same people that destroyed President Clinton's effort at reform in the nineties. After what was a thoughtful and persuasive article, the authors concluded on this note:

Still, one proponent of the euthanasia theory, Mr. Neumayr, said he saw no reason to stop making the claim.

“I think a government-run plan that is administered by politicians and bureaucrats who support euthanasia is inevitably going to reflect that view,” he said, “and I don’t think that’s a crazy leap.”

This, for me, speaks to the longevity of the death panel rumor. Not that people who oppose Obama's policies in general are entitled to their own facts, but that an administration whose worldview does not consistently value life (Obama's position on FOCA is well documented) may be in a position to make decisions which could harm individuals in the name of what they see as the greater good.

But there really is no need to take my word for it. We should see what the President himself has said. Slate blogger Mickey Kaus, a liberal, says that Obama, "came a lot closer to talking about "death panels" back in April than I'd thought." He then quotes from an interview between the President and David Leonhardt of the New York Times:

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.

Yikes. ... I'm sure the "not determinative" part was very important to Obama. Still! He's talking about a panel of independent experts making end-of-life recommendations in order to save costs that have an effect at an individual level. And he thought it would be in the bill that emerges. ... It's also pretty clear that something like the "IMAC" panel is what he has in mind. Whether or not the IMAC would actually do this--Harold Pollack says end-of-life issues are well down the curve-bender's list, for example--Obama thought it would do it. . .

This reaction reveals two critical points with regard to the current debate. First, the notion of a death panel cannot be totally remote when someone supportive of Obama can see the possibility. Second, the death panel fear does not spring from the inclusion of end of life counseling in Medicare. This provision is little more than a straw man, knocked down in the service of discrediting Palin.

While I'm certainly not claiming that the Obama administration is ready to literally pull the plug on anybody, nor that such an outcome is even their intent. However, having said that, I don't believe the fear of such an outcome is totally misguided. The government already has tremendous power over life and death. It doesn't seem at all crazy to worry that health care reform would extend that power even further.


Dad29 said...

They are correct that discussions with a doctor about end of life issues are certainly important medical services; and, as such, they ought to be covered by medical insurance.

"..ought to be covered"? Why?

Jeremy R. Shown said...

Let me be more precise.

If we are going to have an insurance scheme that covers routine medical care, then it ought to allow a patient the chance to talk to their doctor about end of life care.

I would consider this part of routine medical care and something that people ought to discuss with their doctor.

Since no one other than Dick Armey is suggesting we get rid of Medicare, it sounds like we are going to have a scheme for covering routine medical expenses for some time to come.