Monday, August 17, 2009

Keep Worrying about Death Panels

The following was written before the administration hinted it would stop insisting on a "public option" in the health care bill. I am now in South Dakota. Given that the idea of greatly expanded government provision of medical care is obviously not going away, I think the following still has interest, even if the hints are correct.

Last week Sarah Palin caused all kinds of upset when she said on Facebook:

"And who will suffer the most when they ration care?" She asked. "The sick, the elderly, and the disabled, of course. The America I know and love is not one in 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. Such a system is downright evil."

This is hot-button rhetoric, but it did more to spark useful discussion than any one thing anyone else has said in this whole shallow, manipulated, spin-doctored debate. I think that the discussion soon became side-tracked, however.

It ended up with whoever is in charge of the mysterious "Senate bill" supposedly saying that payments for "end of life counseling" are out of the bill. End of discussion of that issue.

No, not end of discussion. Palin's comment was not about end of life counseling, it was about the broader issue of rationing. Now, to avoid sounding dense: Yes, I do see the connection between this counseling and rationing. If health insurance encourages these sessions (and why is "insurance" paying money for something that does not reduce risk to the insured?) more oldsters will think of alternatives to imposing heavy costs on loved ones (and taxpayers) with an endless series of surgeries with little promise of great benefits. Maybe you should just take a pain pill, or buy a nicer wheel chair. The saved money will then be spent on those who can get more out of it. The result would be a redistribution of death, to the old and ugly from the young and cool. That is one of the things that rationing does.

But it is not the only thing, nor is this the only reason to worry that this system would involve, or soon evolve into, rationing. Another reason is the well established mindset of those who push government health care.

You non-academics may not know this, but there is a sort of academic cottage industry called "medical ethics." The people in it often give seminars in which the sole question discussed is something like "which form of socialized medicine is the right one?" Yes, they are overwhelmingly for it, and they work without ceasing to impose their paper utopias on the rest of us. They are intensely dedicated, and absolutely convinced that their views are enlightened and sophisticated, and that those of us who disagree are a bunch of moral troglodytes.

A commonplace idea among them is that, once we have government health care, we should not indiscriminately give medical care to anyone who "needs" it. What is the point of government control, if we fail to organize the system more rationally than that? A term of art that is often used here is that of the QALY, or quality adjusted life year. This means that if we are thinking of investing money on a medical procedure for you, you lose points the older you are and the fewer years of life you will get out of the procedure, and you also lose points if the quality of the additional years is impaired somehow -- because you will be in pain, or are already missing a couple of limbs, or are retarded.

If the "experts" who have been pushing government health care for sixty years have their way, Sarah will basically be right. Both grandma and Trig will be in trouble.
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