On the death panels

Under government-run health care, would the elderly find themselves facing a government process (run by a panel, perhaps) that would decide whether they would receive life-saving care? Of course they would.

We don’t need to know anything about the specifics of the health care bill. It is inevitable that government-run health care (as the “public option” would bring about) would ration care, and it is perfectly reasonable to expect that it would do so primarily by cutting costs among the elderly (as that is where the greatest expenses are).

But we needn’t rely on common sense; we can look at the record of other nations with government-run health care. In the UK, there is a board (a “panel”, even), going by the Orwellian name of “NICE”, that is responsible for rationing care. Cost is very much a factor in its decisions.

But we needn’t rely on the record of other nations; we can look at the pronouncements of health care nationalization’s principal proponent, President Obama. In a town hall meeting, the president said that those who suffer from heart arrhythmias might be denied a pacemaker, and be prescribed a painkiller instead.

Not clear enough? Last April, the president was blunt in an interview with the New York Times. A Bloomberg story has this:

President Barack Obama said his grandmother’s hip-replacement surgery during the final weeks of her life made him wonder whether expensive procedures for the terminally ill reflect a “sustainable model” for health care.

But there’s more:

THE PRESIDENT: 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.

[Q:] 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.

(Via JustOneMinute, via Kausfiles, via Instapundit.)

So an “independent group” will be giving “guidance” about cutting costs in care for the “chronically ill and those toward the end of their lives.” That sounds pretty clear.

The term “death panel” may be melodramatic, but it seems fairly apt. The biggest problem with the term is probably the fact that the panel won’t only be making life-and-death decisions; it will also be looking to control costs by limiting quality-of-life care.

So what’s in the actual bill? A lot has been made of the bill’s end-of-life counseling sessions. True, the sessions are not mandatory (contrary to some early reports), but neither are they truly voluntary. As Charles Lane wrote in the Washington Post:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.

What’s more, Section 1233 dictates, at some length, the content of the consultation. The doctor “shall” discuss “advanced care planning, including key questions and considerations, important steps, and suggested people to talk to”; “an explanation of . . . living wills and durable powers of attorney, and their uses” (even though these are legal, not medical, instruments); and “a list of national and State-specific resources to assist consumers and their families.” The doctor “shall” explain that Medicare pays for hospice care (hint, hint).

(Via Volokh.)

So the counseling sessions are a bit sinister, but they don’t constitute panels empowered to ration care to the elderly and chronically ill. Where are those? They’re hidden:

A key House chairman and moderate House Democrats on Tuesday agreed to a White House-backed proposal that would give an outside panel the power to make cuts to government-financed health care programs. White House budget director Peter Orszag declared the plan “probably the most important piece that can be added” to the House’s health care reform legislation.

This panel, the Independent Medicare Advisory Council, would be empowered to propose changes to Medicare. If its recommendations meet with the president’s approval, they would go into effect unless rejected by a joint resolution of Congress. Note that joint resolutions, unlike concurrent resolutions, are subject to a presidential veto. A veto would be inevitable since the president would have already approved the changes, so it would take a two-thirds majority of Congress to reject the panel’s recommendations, and that would never happen. (This is an unconstitutional delegation of legislative power, but that’s unlikely to matter nowadays.)

Thus, this provision essentially gives the president and the IMAC (which the president would appoint) the power to make changes to Medicare. So there’s no need to put the president’s care-rationing group into the bill, and there’s significant political downside to doing so. Instead, he can use the IMAC to slip it in afterward.

Bottom line, there’s very good reason to be afraid.

UPDATE: Even the New York Times is starting to see it now.

UPDATE: Come to think of it, it’s more likely that the IMAC would simply be the rationing board.

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