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About those “death panels”


I was reading an article at Conservatives4Palin that points out (correctly) that when the former Alaskan governor made her infamous “death panels” post on Facebook she wasn’t referring to end of life counseling.

This is what Sarah Palin said:

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? 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.

Health care by definition involves life and death decisions. Human rights and human dignity must be at the center of any health care discussion.

I know this will surprise those people who are convinced (or pretend to be convinced) that because I refuse to demonize Ms. Palin that I am infatuated with her but I disagree with the former Vice Presidential candidate.

Before I explain my disagreement I want to clarify what Sarah Palin actually said. Contrary to the assertions of Ezra Klein and others, Palin never claimed that Obamacare would euthanize anyone. She claimed that Obamacare would result in rationed health care and that bureaucrats would decide whether or not to pay for treatment based on subjective criteria like the patient’s “level of productivity in society.”

While there is a nugget or two of truth in what Palin said we’re hardly talking about exterminating “useless mouths.” What we’re talking about is the kind of cost-benefit analysis that people already have to make every day.

Despite what some people think none of us has a “right to life.” On a long enough timeline the mortality rate is 100%. As Clint Eastwood said, “We all got it coming.”

As we saw during the Terri Schiavo case, the general consensus in this country is that at some point it is acceptable to terminate life-support. The real question in cases like that is who (other than the patient) can make those decisions and when they should be made.

But “death panels” cases aren’t about whether or not to pull the plug on someone, they are about the limits, if any, on the payment for health care services.

Forget the specifics of Obamacare for the moment and assume we adopted some version of single-payer like all the other industrialized nations have done. Call it Medicare For All. As the cost goes up and the prognosis grows more grim, is there some point at which we should say “enough is enough?”

Let’s say we have a patient in his eighties who is diagnosed with cancer. Treatment will cost approximately $1 million, the chances of success are less than 10% and he has already exceeded his life expectancy so even if the cancer doesn’t kill him he isn’t gonna celebrate many more birthdays anyway.

Should we pay for his treatment? What if he had diabetes and tuberculosis too? What if he’s already in a persistent vegetative state? Is there any point at which we should draw the line?

The fact is those decisions are already being made, but the decision-makers are health insurance company bean-counters and profit-minded executives.

I think that if we are going to control health care costs one thing we need to do is set limits on how much health care we will pay for. The factors considered in setting those limits should include cost but also a number of other factors, including prognosis and quality of life.

But those limits need to be determined in an open manner by people answerable to the public. There needs to be an open process and a way to appeal the decisions that are made.

What do you think?



33 Responses

  1. When I was looking for an appropriate graphic for this post I found this:

  2. End of life treatment is only one part of the total treatment one get throughout life. It starts with babies and ends with old people. Any comprehensive health plan should, and current plan does, supports the whole spectrum. There huge expenses today is other areas except end stage patients. For example, chronic diseases.

    “Death Panels” is an attempt to cause anger by forgetting that limits exist no matter what system you use, the current one or the 2014 one Obama has compromised on. Furthermore, the current cost of health care in the US will either destroy the country or will have be lowered substantially. In a future logical health care system, patients will be dealt with differently. This will include end stage patients. The cost of health care at the end stage will be lower as well.

    There is much more to say about this topic.

    • It’s like with organ transplants – there are only so many donor organs available so we have to prioritize who gets them.

      In many cases it would be better to focus on making someone’s last days as pleasant as possible instead of putting them through surgery and chemo in an effort to squeeze out a few more weeks or months of life.

      • Reality and human nature means that when you put the government in charge, some people are going to be more equal than others. The Ted Kennedy’s of the world will get the state of the art cancer treatments. The rest of us will get cost effectiveness measures.

        • Yup. A truly egalitarian society has never existed. Even in the Soviet Union, where “equality” was brutally enforced, the well-connected had the best of everything. The “rules” of equal sharing were for the little guy without political friends in high places.

          The Workers Paradise is as big a pipe dream as the Utopian Free Market. Capitalists need to be channeled and restrained by the govt, and the govt itself also needs to be restrained by the liberties of the People. The best system is a somewhat uneasy balance of various oppositional powers, which is what we had in this country for a long time, and are losing fast.

          • some people are going to be more equal than others.

            Some people are already more equal than others. Back when abortion was illegal in most places the wives and daughters of the wealthy could take vacation trips to where it was legal.

  3. I just read an article in Bicycling about a series of distracted drivers who killed or nearly killed cyclists in Santa Rosa. One anecdote that stood out was of one patient whose prognosis was dim, for little more than remaining in a vegetative state. A former elite athlete, his parents chose to bring him home, where he has made some progress. But in doing so, they had to terminate insurance reimbursements. The insurance co. had made the call that his care would not exceed being parked in a bed until he died – no therapeutic interventions.

    Happens all the time.

  4. I agree with you, myiq, that a real discussion about how much care we can reasonably pay for needs to be had. And I agree that UHC is the most efficient way to pool resources.

    The problem is that Obama and the Democrats lied. They lied, and lied, and lied some more. Because THAT discussion, how to ration care, is touchy, and liable to stir up passions. So they refused to have an honest argument. They sugar-coated everything with “premiums down 3000%, and if you like your plan, you can keep your plan!!”

    Which was bullshit. And almost everyone knew it was bullshit. And when you have your govt bald-faced LYING to you repeatedly, over truths that are self-evident, then is is not difficult at all for people to become veeeery suspicious and distrustful of putting life and death decisions into the hands of those same assholes who keep blowing sunshine up your ass with no shame whatsoever.

    No, it is not all right-wing paranoia. Some of the verbiage gets extreme, but it is rooted in a distrust of our govt that is entirely logical under the circumstances.

    Whether one is talking about healthcare, taxes, or any other subject, our root problem in this country is a crisis of trust. And if, like myself, you believe that there are some things the govt really needs to do, that creates a big problem.

    See, the kids need groceries, but YOU are a chronic drunk driver and are known to take my paycheck down to the corner and get high with it when I send you for groceries. So if I stubbornly refuse to hand over either my paycheck or the car keys, it does no good to scream at me that I am a heartless bitch who doesn’t care if the kids starve. It’s not true, and it doesn’t address the problem. But that is pretty much the reaction of the left to all those citizens who are balking. Good luck with that.

    Because in a crisis of trust, conservatives win by default. Shrinking the size and power of the entity you do not trust sounds like a very good idea, indeed. It’s not that most folks think the insurance companies are fabulous guys. It’s that they trust the govt even less. Which is pretty freaking sad.

    • WMCB, you get my first HONK of the year!
      HONK!!!!!!!

      I have said it before, one thing that makes the Tea Party so powerful is that they have great truth on their side, and that is that the past 10 years have shown that “you can’t trust Washington.”

  5. I’ve been crazy busy lately, so haven’t been around much, so forgive if this is a repost:
    & the hits just keep on comin’. When will they realize he always WAS and IS a corporatist?!

    Liberals scoff at Daley’s new job

    Adam Green, one of the most prominent progressive voices, was quick to criticize President Obama’s decision on Thursday to make William Daley his next chief of staff.

    “This was a real mistake by the White House,” Green, the co-founder of the Progressive Change Campaign Committee, said in a statement. “Bill Daley consistently urges the Democratic Party to pursue a corporate agenda that alienates both Independent and Democratic voters. If President Obama listens to that kind of political advice from Bill Daley, Democrats will suffer a disastrous 2012.”

    Green says a big concern for progressives is Daley’s opposition to the Consumer Financial Protection Bureau being overseen by Elizabeth Warren, in addition to his opposition to the “public option” during the health care debate.

    In a statement, MoveOn.org Executive Director Justin Ruben said Daley has “close ties to the Big Banks and Big Business” and that the announcement is “troubling and sends the wrong message to the American people.” He added: “Americans are looking to the White House for economic plans that will create jobs and reign in Wall Street’s excesses, and it’s up to Daley to prove that he’s not carrying water in the White House for the big banks that took our economy over the cliff. As the President continues to reshuffle his staff, particularly his economic team, it is now more important than ever that he focuses on rebuilding a middle class and developing policies that create more jobs on Main Street, not on Wall Street.”

    http://www.politico.com/politico44/perm/0111/thanks_but_no_thanks_8d73d4c0-7bb8-42ce-9576-09a92ad709b0.html

  6. Secondly, I’ve been watching reruns of Palin’s Alaska on TLC to see what all the fuss is about, and call me crazy, but I really like it! Not only is she “really likable” as Oprah said, but it definitely features the beauties and uniqueness of Alaska. I’ve watched dog sleds, bears, fishing, neighborhood pie places etc. Piper is as adorable as ever, and Sarah is authentic, seems to be a very good mother, and is at home in the wild. Before people freak out–I am not talking about her policies, but the demonization will not work, because she is a real person who lives a real life.

    • I can’t understand why so many people are unable to separate politics and personalities.

      I find Sarah Palin likable, intelligent and genuine, but I disagree with her politics.

      My BIL is a religious conservative, but he’s a helluva nice guy and smart too. Am I supposed to hate him and pretend he’s stupid?

    • I’ve enjoyed it, too, especially the dog sledding episode which featured my daughter’s half-brother. His name is Mike and he gave Sarah a tour about the camp.

      • very cool. Isn’t it weird when someone you know appears on TV? I remember when I was pregnant with my first son, I was watching Phil Donahue and I heard a familiar voice. I looked at the TV and there was Mark, a guy I had done theater with in HS. In fact he was my first stage kiss. He was doing a McDonald’s commercial.

  7. Sarah Palin is a hypocrite on health care. Her children and husband are native Americans in Alaska. They have access to health care. My sister in law has passed away but she had good health care because she was an Alaskan native.

    Sara says a lot of things but because of her husband’s heritage she reaps the benefits of both worlds!

    The health care issue in Alaska is part of the land deal that was made.

    “The health, housing, and other benefits that are conferred on the Alaska
    Natives as partial payment for the past takings of land are of importance
    not only to the Native community but to the economy of the state itself.”
    Roy M. Huhndorf

  8. the government needs to stay out of the end of life issue. Doctors already talk to patients about this subject, if and when they are ready for the discussion. Paying doctors to have that talk is counter productive. The advice is about the humanity of the people involved and if we make it just another way for doctors to profit, soon we will require they have “the talk”.
    Sorry but I think the government has to stay the hell out of this area. It’s working okay and doesn’t need to be fixed.
    In 2004 I was living with a man who came down with lung cancer. It was stage 4 when they found it. He died with in 3 weeks of the diagnosis. About four days before he died a social worker came to the room and he answered a questionnaire about what treatment he wanted under what circumstances. He wanted EVERYTHING done. I became medical power of atty. In the long run it was me who had to make the choice to put him on the hospice unit where he died 8 hours later. None of that would have been made better by a doctor having a talk with him. In fact I think it would have been really upsetting to him.
    Right now the whole system is working just fine. Every case is a unique circumstance, and people do not need to feel they are being railroaded in to certain choices because it is better for the tax payers.

  9. Re Silent Kate: Did you know that sanitation workers in New York City –who were too busy to pick up either snow or garbage this last week get FREE healthcare including dental and vision benefits? And if they retire with a union pension, that FREE healthcare is for life! Just asking.

    I’m glad that the original poster got to Ms. Palin’s point. She was looking at “quality panels” under the English National Health System where judgements are made about the relative cost of treatments versus the remaining years of “quality life”. Yes it’s bean counting, and it’s done by government employees, not “greedy corporate vice presidents”. At the end of the day, if treatment is denied you, you’re still just as dead–whether it was GS-15 or an Insurance Co. Vice President who said “no”.

  10. Myiq, this is a great post and perhaps there do have to be reasonable limits. But I must point out that there are death panels — in Texas, signed into law by then-Governor GW Bush, with support from the Right to Life group.

    The law is called the Texas Advance Directives Act (aka Texas Futile Care Act) and is under the Texas Health and Safety Code, Title 2, Subtitle H, Section 166:

    http://www.statutes.legis.state.tx.us/docs/Hs/htm/HS.166.htm

    Most of the statute concerns a patient setting up directives on whether he/she wants to be kept alive with an “irreversible condition” (treatable but not curable) or a “terminal condition” (death within six months). All well and good.

    But subsection 166.046 provides that if an attending physician does not want to follow the directive (for ex. keep patient who wants to stay alive on machines after their insurance has run out), the decision is reviewed by an ethics committee. If they side with the doctor (thus becoming “death panels”), the patent has 10 days (usually) to find another facility willing to keep them alive (subpart e, but see also 166.0045(c)).

    Here is more info:
    http://en.wikipedia.org/wiki/Advance_Directives_Act

    Click to access %28CM%29TXFutileCare.pdf

    http://www.washingtonpost.com/wp-dyn/content/article/2007/04/10/AR2007041001620.html

    Info on the case of six month old Sun Hudson who died when this law and a court permitted the hospital to remove his breathing tube against his mother’s wishes:
    http://www.chron.com/disp/story.mpl/metropolitan/3087387.html

    I must note that the hospital would not let reporters in to see the baby as the mother wanted, citing privacy (whose?) concerns.

    Governor Palin is friends with Gov. Perry. I have long wondered whether Gov. Perry discussed death panels with her but pretended they were in the current US health care bill (projection?), rather than where they really are: in Texas, placed there by right-to-life Republicans.

    djmm

    • There really is “futile care” and no clinician should be forced to continue treatment which does not cure nor provide comfort.

      The situation is rather like someone wanting antibiotics for a viral cold (but on a more significant scale).

      “Futile care” is what Terri Schiavo did not want.

      I’d worry more about hospice care being cut. That almost happened in Washington state recently for Medicaid patients but the governor, bless her, refused to consider cutting that benefit.

      • I agree that treatment should not be continued if it does not cure or provide comfort, NYLuna — but the “or provide comfort” part is not in the bill. But it is a very complicated issue and I appreciate myiq raising the issue and your response.

        In Texas, until they got hit with really bad publicity, they were even taking people off machines keeping the patients alive when they were conscious and wanted to live — because the doctor and ethics committee said it was a reasonable decision given that the patient would likely die in six months. Fortunately in one case I read about, the family was able to fight long enough to find another hospital to take the patient — an older man who was conscious, rational, talking and sitting up in bed, but on machines with with a heart condition that would kill him sooner or later. Need I say that his insurance had run out?

        The six month old baby was afflicted by a birth defect that likely would have killed him, yes. But he was six months old and his mother said he was awake and responsive. The hospital said no, but they would not allow reporters in to see the baby. So if he lived another six months, albeit with a breathing tube, that would have doubled his life, with a mother who loved him. Worth it? I am not sure but the mother was. But the court said no, the tube was removed and the baby died.

        Would they have pulled the plug if it had been Dick Cheney’s grandchild?

        The allowed 10 days is often not long enough to find another hospital. 30-60 days would be more reasonable. But attempts to amend the bill have been unsuccessful.

        I particularly dislike “terminal condition” being defined “according to reasonable medical judgment will produce death within six months, even with available life-sustaining treatment.” A lot can happen in six months; three to six weeks would make more sense. One friend of mine was told cancer would kill him in three months. But a new treatment became available and he is alive and well 20 years later. Another friend got 5 years of healthy life from unconventional cancer treatment when one of the best cancer centers said he would be dead in three months. Worth it? It was to him and his wife.

        Gov. Palin has been painted in some places (not here) as crazy for being concerned about such panels because they do not exist. They are not in the current US health care law just passed but they do exist in the state where Gov. Palin’s good pal Rick Perry is governor. I wonder what she would think.

        djmm

  11. Over the Christmas break, I asked my father this question. He’s a retired physician. He talked some about the spiraling costs of MRIs and other high tech medical diagnostic procedures…lamented the fact that more physicians are being trained as technologists than care providers. As to end of life counseling and decisions, he said the patient and family first, then doctors, government, insurers and lawyers last.

  12. My mother passed away 1.5 years ago after a good year battling a failing body. She just turned 78 when she passed. I tried to be her medical advocate during the last year because she just blindly did what doctors told her to do. That profession brutally and aggressively put her through every conceivable test on the planet even though they knew exactly what was wrong with her and that she was not long to live.

    For a reason that differed from what the doctors heard I asked about quality of life and just how many decisions were they making so they could practice on their new testing equipment and keep their staff busy. Treatment dramatically changed after that and finally a week before she died they suggested we bring in hospice while they explained the true prognosis of her illness. I know that not all hospitals encourage their medical staff to behave like this, but I’ll never forget or think kindly over the invasive gold digging the medical profession did on my mother. When anyone mentions death panels, I think of that team of doctors. “First do no harm” — pure bs

  13. If you ask most people what they want done under extreme circumstances with a life threatening illness, most will make the right decision. I am not inclined to let anyone make that kind of decision who is not immediate family. There are the extreme cases like the Schiavos, but many times, it is the physician who goes all out when a demented nursing home patient is brought to the hospital and ends up escalating the cost of dying. It is surprising how little time the physician will spend discussing outcomes of critically ill patients with the family. He/she, the physician is too busy. Things are better now in regards to allowing people to die. I don’t want the insurance companies to get any more control over medical decisoin making than they have right now.

  14. On Ted Williams and NBC. David Sirota gets something right.

    In a country whose social class mobility has now dropped below many fellow (and often “socialist”) industrialized nations, Williams is being implicitly promoted by our media as a representative example of how the American Dream still exists. I say “implicitly” because other than NBC explicitly insisting Williams’ story is “proof that life in this country can change overnight,” most of the media is not making such absurd claims. However, the very fact that this has become such a huge national story logically implies that all the media promoting it believes it represents something bigger or national. Indeed, why else would the national media cover the story of one homeless person as a national story, if not to suggest it represents something of national importance?

    This, then, is a microcosm of a media that has become far more a manufacturer of false, establishment-serving storylines than a documenter of genuine everyday reality. The idea that the American Dream still exists and that everyone can “make it” like Ted Williams is, by all objective economic measures, demonstrably false. But that idea is nonetheless incessantly promoted by politicians, corporate leaders and their media servants because it convinces large swaths of the put-upon general public to refrain from asking fundamental questions about inequality, poverty and the punitive structure of our economy — i.e. questions that corporate-backed politicians, pundits and media institutions do not want asked.

    • The idea that people can “make it” in this country is predicated on their working hard and starting their own business.
      I don’t think that has anything to do with this story. I think that in tough times people like a Cinderella story. They want to see someone survive against all odds, win the lottery, reunite with Mom.

  15. Contrary to that cartoon, not having a mammogram before 50 might be the evidenced-based thing to do. It depends on the individual’s risk. From Susan Love, MD,’s website:

    mammography is not as good a tool in younger women.

    The studies also are pretty clear that whether you have a mammogram every year or every two years after 50 the results are about the same. In fact, most European countries do mammography every two years, with similar results to those in the U.S.

    Furthermore, the use of breast self-exam to “find cancers at a curable stage” has never been supported by randomized controlled data.

    Recommendations on mammography screening must also take into account our new understanding of the biology of breast cancer. We used to think that all cancers were the same, that they all grew at the same pace, and that there was a window when all breast cancers could be caught before they spread. We now know that there are at least five different kinds of breast cancer based on their molecular biology. Some breast tumors are so slow growing and are so unlikely to spread that they will never do any harm. Others grow and spread very quickly. The idea that they all can be “caught early” is wishful thinking. In fact screening is best at finding the “good ones” that might even disappear if left alone. Remember the reduced the mortality from mammography is 30% not 100%!

    http://www.dslrf.org/breastcancer/content.asp?L2=1&L3=4&SID=130&CID=1931&PID=4&CATID=0

  16. I think you may have missed the point. Your whole argument seems to presuppose that health care is single payer and that the ‘government’ through whatever mechanism has the right (because of its monopoly of provision) to ‘ration’ in the interests of efficiency of resource allocation. This is the case in the UK, Canada etc and is the inevitable result of public provision. What is at the ’emotional’ root of the objection is the elimination of the ‘possibility’ of personal choice to extend life if the individual so chooses and can afford it. In most systems you cannot simply pay more in the public system to divert its resources your way. This is why Canada and the UK continuously introduce or flirt with two-tier systems (parallel public/private approaches) to cater to this real-life issue.

    Perhaps in the US, what underlies the ‘resistance’ is an atavistic attachment to individual ‘freedom of choice and action’ and a belief that ‘encroachments’ on any freedom of choice is a wedge to reduce personal choice. I can understand and sympathize; that very freedom has indeed contributed to a hugely vibrant and economically successful society probably over and above the US’s natural endowments. However, if you want to either buy (private insurance) or receive (from the public purse) a service such as health care then you must accept the terms and conditions (rationing by profit or by some logic). Which brings us back to a two-tier system with private provision as a choice. This is no different from the provision of public and private education.

    Which of course brings up the issue of operating efficiency and the ‘demonstrable’ weaknesses of monopoly systems to be run on behalf of the providers not the customers…

    All that said, Canada and the UK (systems I have and do live under) deal with the rationing issue in a very compassionate way at the sharp end of actual health provision. Both systems have their problems, notably wait times for help. But in both systems my personal experience has been that emergencies and the truly ill are dealt with as expeditiously as in the US (which system I have also lived under).

  17. While I abhor the term “death panels”, it’s interesting that no one, especially Sarah Palin and her fellow Tea Partiers, are talking about what’s going on in Arizona – rationing that is costing people their lives. (How do you hyperlink on this site??)

    http://www.examiner.com/democrat-in-national/arizona-governor-jan-brewer-s-republican-death-panel-claims-second-life

    Arizona Republicans, led by Governor Jan Brewer, are sentencing innocent citizens to death. A second patient is dead after being denied a transplant because of budget cuts. The unidentified patient, who was waiting for a new liver, died Dec. 28.

    On Oct. 1, the state stopped paying for certain organ transplants for patients covered by Medicaid. About 95 to 100 people were taken off the waiting list, and effectively sentenced to death by Arizona bureaucrats, the Republican controlled state legislature and Republican Governor Jan Brewer (a real death panel).

    Wednesday University Medical Center spokeswoman JoMarie Gellerman reported the unidentified person died Dec. 28 due to hepatitis after earlier being removed from the center’s list for a liver transplant.

    Gellerman says hospital officials believe the patient’s death was “most likely” a result of Arizona’s controversial scaled-back coverage for transplants.

    • Thank you for pointing that out, cmugirl. I commented above about the Texas death (ethics) panels: Arizona is another Red state with “death” panels. What is the response from many? Yawn. Think what the response would be if it were happening in a blue state.

      djmm

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