There has been much discussion of the possibility of “Death Panels” being imposed by the Health Care Reform plans being considered by the House and Senate. While such “Death Panels” are not explicitly referred to in the bills, anyone who has read my previous pieces understands that the complex bureaucracy being created by the new bills could easily create “cost-effective” protocols for coverage, and/or benefits, and/or treatment that would limit access to expensive treatments that are deemed to yield little benefit especially for the elderly or severely impaired. In fact, Dr. Ezekiel Emanuel is known to favor such schemes and has rationalized them using a communitarian ethic to replace the outdated Hippocratic Oath (see “President Obama’s Rationer-in-Chief” which is in the links) . It is well-known that Dr. Emanuel’s opinion helps inform the President’s vision, and that opinion did indeed, seem to be reflected in Mr. Obama’s response to Ms. Sturm regarding her mother’s pacemaker in the now-famous Town Hall meeting held June 24 at the White House. I have written a separate piece on this titled “The President’s Real Waterloo – a Pacemaker” which is located elsewhere in this blog.
But to summarize, Mr. Obama first indicated the woman could not get a pacemaker because it wouldn’t be sufficiently better than alternative, less expensive “painkillers,” and then changed his mind when he heard the woman had had to be hospitalized for arrhythmia a number of times at great expense. Mr. Obama indicated that “if we’ve got experts who are looking at this and they are advising doctors across the board that the pacemaker may ultimately save money, then we potentially could have done that…” that is, give her the pacemaker. These “experts” who are “advising doctors” how to “save money” sounded pretty much like a “cost effective treatment panel” which, if it interprets data the literal way Mr. Obama appeared to do that night, might easily turn into a “Death Panel.”
Often, in Socialized Medicine bureaucracies, the tool which provides the rationale that may be used to deny the elderly and severely impaired access to treatment is the so-called “Quality Adjusted Life Year” or QALY. In fact, this concept may already be manifesting itself in the Medicare system. Essentially, economists attempt to place value on one additional year of life adjusted for your quality of life after treatment, prorate that value according to how long a given treatment is expected to prolong life, and then compare that to the cost of the treatment. As an example – let’s say you reside in the UK and your QALY for a given procedure at your age is about $20,000 and it is expected to prolong your life for about 3 1/2 years. That means if the procedure costs less than 3.5 x $20,000 = $70,000, then you might get it (provided there is no alternative treatment that yields a similar benefit at a lower cost – i.e. ‘comparative effectiveness’ – the subject of a future post). However, if the procedure costs more than $70,000, then it cannot be justified and, under the British system, you will simply not receive this treatment even if there are no other suitable alternative treatments available. To those of us who are used to receiving health care according to the U. S. model, this denial of access to treatment to certain categories of individuals by a bureaucracy is exactly what we mean by a “death panel” – that is, the bureaucratically mandated “end-of- therapeutic care” which results in the “end of life.” And the worst thing about it is that it is not some villainous insurance company to whom the patient owes no allegiance and against whom the patient might have recourse, but rather the Government itself, rendering ultimate judgment.
Of course, we have heard the President repeatedly scoff at the idea of “Death Panels,” or that he is going to “pull the plug on Granny.” These scenarios, he claims, are based totally on “misinformation” spread by “fearmongers” who are, perhaps, evil individuals in the insurance industry. Actually, our fears are based on Mr. President’s own words regarding the woman’s pacemaker, and he is the one spreading the “misinformation” that critics are referring to a literal “death panel” convened for each patient rather than an actuarial scheme devised by his “experts” to save money. But let’s just accept his premise for now. Fine, Mr. President, if the bills are “not envisioned” to deny access to health care to the elderly and impaired based on a cost-effectiveness rationale, then you, and your colleagues in the Congress, should have no objection to an amendment that, essentially, just clarifies that this very kind of cost-effective rationale, which denies access to care in the health care systems of other countries, will not be allowed in our system.
I believe the natural place for such an amendment occurs relatively early in the House bill, H R 3200 -in Section 122 which describes the requirements for “An Essential Benefits Package.” This section, beginning on page 26 of the bill defines the essential benefits package as
“health benefits coverage … to ensure the provision of quality health care and financial security, that —
[paragraph—(a)(3)] does not impose any annual or lifetime limit on the coverage of covered health care items and services;”
This requirement is aimed at current private insurance coverage which, in many cases, includes such annual or lifetime maximum expenditures. I think it follows naturally that this paragraph would also forbid the maximum payout schemes typically employed by Government Bureaucracies under Socialized Medicine systems to limit treatment of the elderly. My proposed amendment reads:
“[Paragraph—(a)(3)] does not impose any annual or lifetime limit on the coverage of covered health care items and services. No health benefits coverage based on, or restricted by, the concept of “Quality Adjusted Life Years” or similar actuarial valuation of additional expected life years which, effectively, imposes a limit on coverage for certain individuals, shall be deemed to meet the requirements of this section;”
If there are no cost-effective “Death Panels,” envisioned, then this amendment should go sailing through. It is merely a clarification of the word “limit” in the original text. I think it could even be argued that a close reading of “limit” in the original paragraph, makes this clarifying amendment unnecessary. Nevertheless, in my opinion, such an amendment would have no chance whatsoever of passing. Why? Because it would definitively close the door on an essential element of cost savings envisioned down the road by Dr. Emanuel and Mr. Obama. Cost savings achieved by limiting access to therapeutic treatment by the big users of health care resources – the old and severely ill – through regulations and guidelines yet to be devised and implemented.
I have heard folks in the media implying that the phrase “I want my Country back,” is a manifestation of racism on the part of protestors. However, to me it means something else. When I was growing up, we believed that how we treated the weakest among us indicated how strong we were as a Nation. That is the Country “I want back.” Now we are divided one against the other and the weakest seem to have little voice. I think this is a frightening new Country – like Speaker Pelosi, I too am frightened – but I am most frightened by her vision of a Government that can impose its will on the citizens regardless of their wishes.
I propose we perform an experiment. Take my draft “harmless” amendment – reword it – make it your own – make it even blander and more harmless. Send it to your Congress Person as I have already sent it to mine, and challenge them to propose it merely as a clarification that there are no silly “Death Panels” hiding in the woodwork. If some Congress Person does this and the amendment passes, that would be a great victory. If no one takes up the challenge or the amendment gets defeated, all I ask it that you join me in remaining extremely skeptical about the Administration’s ultimate intentions regarding health cost control, and the quality of Public Health that may result.