A Glimpse at the Coming Death Panels in the U.S.A.
Newsweek, September 21, 2009
We all knew that the Affordable Health Care Act, popularly known as Obamacare, would lead to lead to rationing. Shortly after Barack Obama became President, he and Nancy Pelosi began promoting such reforms–to redistribute a shrinking pie more equitably. Instead of doctors and patients, or even insurance companies, deciding who would receive medical care, when they would receive it, and how much they would receive, there will now be 160 panels of bureaucrats whose primary mission is to reduce health care costs to the government.
As 2014 approaches, what Sarah Palin called “death panels” are starting to take shape. In this recorded interview with Mark Levin, Jeff, a neurosurgeon, describes what it will mean for his profession.
“If someone over 70 years old has a bleed on the brain in the middle of the night, I have to wait for a panel in Washington to tell me whether I can operate…. I’ve been 9 years in medical school and 10 years in training and now I’ve got people who don’t know a thing about what I am doing telling me when I can or cannot operate.” Without special permission to operate, the new prescription for a bleed on the brain for people over 70 years of age will be “comfort care.” Such decisions will not be determined by a doctor’s evaluation of whether a surgery would provide the patient with many more years of a high quality life; they will be a death sentence.
As with the incremental raising of taxes, rational and impersonal governments incrementally reduce services. If they feel the need to reduce the health budget further, they will change the definition of a “long-enough life” from 70 years of age to 65 years of age. We have seen this in the incremental raising of the full retirement age for social security from 65 years to 70 years. Governments do this because they are made up of human beings who want to increase their income each year, just as people employed by businesses do. The only way bureaucrats have to improve their own welfare, is to do so at the expense of those they are supposed to serve. This is not the case in productive businesses, because they can produce and sell more products and increase the welfare of employees without forcing other people to sacrifice. It is the difference between redistributing a limited pie, or making a bigger pie. Rationing happened in Germany, in Russia, and the United States. It is less a matter of ideology, than the nature of bureaucratic social organization.
This is an example of when the economic and political spheres dominate the cultural sphere, rather than when society is integral.The concept of “Affordable Health Care” did not mean more affordable for American citizens, but more affordable for the government. The solution? Less health care. In Rome, from 150-400 a.d., great population decline accompanied the consolidation of the economy under feudal lords. The children of Rome’s vibrant middle classes became serfs, whose only way out was “to marry the handsome prince.” Obamacare is a part of a similar transformation going on in the United States today, only the feudal lords will not be property owners as much as industrial lords and bankers, who will eventually lay off all the unnecessary federal workers, as the banks have begun to do in Europe with their appointment of Greek and Italian presidents.
If the healthcare decision were left to a king, he would subjectively decide who lives and dies based on how valuable the patient was to him. If the decision were made by a doctor, he would obey the Hippocratic Oath and do what he could for the patient to live, whatever the cost. If the power is in the hands of a rational bureaucracy, rationing is the normal outcome. If the government were to follow the principle of subsidiarity (the greatest responsibility to the lowest possible level), then the decision could be left to communities of people who had face-to-face relationships with the person–they would know him by name, not as a “unit.” Of course, being human themselves, the death panels will make exceptions for themselves, for those they personally know, or those they feel are valuable to society. The system is ripe for cronyism.
This is an example of the nature of a bureaucracy depersonalizing human beings, turning them into a statistical unit. I described this process in greater detail in my book Life, Liberty, and the Pursuit of Happiness, Version 4.0 in the chapter “The Principle of Subsidiarity.” This principle, an essential feature of good governance, is being blatantly violated by the fraudulent rhetoric of those who promise health care they know they will never deliver, but it creates more federal jobs for cronies at the expense of citizens.
It would be good to reassert the label of “citizen,” which implies political sovereignty, rather than referring to people as objects for the manipulation of others: “units,” “consumers,” or even “voters.” All such terms dehumanize people by making them items for statistical analysis, the way any bureaucracy–whether in a government or an insurance company–will operate.
A Glimpse at the Coming Death Panels in the USA, is frightening title that stands in contrast to the Newsweek headline, the Case for Killing Granny – curbing excessive end-of-life care is good for America. Obviously, there is more to the story than what meets the eye. Anyone seeking a simple answer to the problem of affordable health care and government policy on universal health care is going to be disappointed. There are no simple and really easy answers to this issue. Unfortunately, the rhetoric has gotten out of hand with expressions like death panels, I was a teenage death panelist and the case for killing elderly grandmothers. It is an immature and sensationalized kind of speech that distracts from the importance and gravity of the issue. Rationing is in part a dilemma or a trade off between equal or nearly equal choices. Let’s understand that rationing ought to be accompanied with steady reasoning and prudent thought. In the universal health care debate, the idea of rationed care, is tainted by horror stories of poor medical judgments made by indifferent bureaucrats or cost cutting insurance executives. The end-of-life story is far more complicated. Life carries risks. Many people will face serious illnesses and exhaust all their resources both family and financial types then turn to the government as their last hope for another chance in life. We are better off to remember that fate is a ruthless card dealer where many lives … millions of lives … are dealt a weak hand in life. More often than not, fate is the result of a series of poor personal decisions that results sadly in misfortune, illness and tragedy. Mortality is a universal fate. Universal health care is not a panacea for all medical misfortunes and regrets.
The reality of the lack of managed health care in our modern society is a symptom of other kinds of misplaced values and short sighted thinking. Our world is slipping on a tragic downward slope towards political and economic despotism. Nations have fallen for masterful ponzi schemes. The evidence of this decline is the trend towards the over concentration of wealth and power into the hands of a privileged political class. In this process the subsidiary principle that is rooted in communal ethics, personal responsibility and face to face relationships is being undermined, rendered ineffective and cast aside. A new revival of the subsidiary (4PF ) principle that is essential to good governance is needed.
Some form of rationing is required anytime there are a number of people depending on a provider. If a family has ten children, they have to ration care to their children, but they do so on the basis of individual needs and a personal connection, so the rationing transcends a cold rational equality and creates a greater true justice that considers the needs and possibilities of each person. Even doctors that have many patients have to ration their time spent with each one. But they do so based on their professional experience about how they can do the most good, not the heartless equality of a bureaucratic panel without professional expertise.
The real test of Obamacare will be whether it allows responsible people to pay for their own medical services, and for doctors to provide these services independently of Obamacare. Canada prohibits its doctors from acting in an open market outside the system. This has caused some Canadian doctors and patients to go to the U.S.; and South Korea, Mexico, and India are attracting American doctors and patients because they can provide care quickly and at a lower cost. If Obamacare prohibits US doctors from offering their own market rates to private citizens that want the best services, not just rationed services, then we will see more flight to these other countries, and a domestic black market for medical services. There will also be a decline in US Medical school enrollments and an increase in the countries expanding medical services.
One thing the rationing of Obamacare implicitly implies is that there should be limits on the amount of care people on government welfare can expect. Traditionally it was the Democrats who supported providing government dependents with the same services as people who could afford their own medical care. This is an open acknowledgement that the Democrats a willing to cut services to their own voters.
A broad new look has to be taken on the role of government regarding personal health care in the information age. The internet has made large amounts of medical information on personal health available to the public. With this information, people must assume more personal responsibility for life style choices and their long term health. Government cannot remedy all the medical misfortunes that are the result of high risk life style choices. i.e. chemical substance abuse like drugs and alcohol, excessive eating, etc. This is not to say that government does not have a significant role in a government option for low cost and effective health maintenance policies and programs. Health care monopolies should be vigorously avoided. However, there is still a government role in maintaining a national center for disease control ( CDC ). With greater education of the public on matters of personal responsibility, the role of government shifts and moves toward a subsidiary and libertarian point of view. The subsidiary principle that emphasizes communal problem solving and familial decision making can emerge and gain wide spread acceptance. Citizens have the implicit freedom to assume more responsibility for their personal lives in a social environment of greater knowledge and lower government intervention. Doctors would be allowed to market their services to consumers at fair market prices. Medical tourism is one of many options. Charity health maintenance services could be encouraged and supported by non-profit communal organizations like churches. Private health care insurance and HMO’s would still continue. Government and bureaucrat intervention in the complex end-of-life story should be kept to a minimum. It should return to the ( 4PF empowered ) subsidiary level.
Agreed: “If the healthcare decision were left to a king, he would subjectively decide who lives and dies based on how valuable the patient was to him. If the decision were made by a doctor, he would obey the Hippocratic Oath and do what he could for the patient to live, whatever the cost. If the power is in the hands of a rational bureaucracy, rationing is the normal outcome. If the government were to follow the principle of subsidiarity (the greatest responsibility to the lowest possible level), then the decision could be left to communities of people who had face-to-face relationships with the person–they would know him by name, not as a “unit.”
Lessen the power and re-set the criteria.
Good analysis.
Gordon’s articles are always thoughtful and incredibly intelligent. But I have hesitated to comment, because I cannot BELIEVE that Obamacare will/would have the consequences which Gordon describes (“death panels…”).
I have no facts to refute Gordon. He may be right. I just hope that he is not.
I have had dozens, perhaps hundreds, of experiences with European “socialized medicine” – in the Netherlands, in France and in many other European countries. I spent my first 25 years there, and my wife, children and I return there all the time.
I have experienced Dutch, French, Swedish, German, Swiss and other European health care – as more effective and cheaper than American health care. People in those countries don’t spend nearly 20% of their GDP on health care, and yet they are healthier and live longer than we do.
My mother is now 99. While we, her adult children, would love to have her live near us in the US, we found it prudent to re-locate her in a Dutch retirement home, where her care, her health and her well-being are much more secure than they would be in the US, and at a fraction of the cost.
What the Americans have passed has very little resemblance to the European health care Tom refers to. While European plans have some degree of rationing, they are more rational and more personal. They are more rational because they a planned by reason, not by a combination of lobby groups getting together to ensure they each get their cut with a government guarantee. They are more personal because they are at the state level. Obamacare at the Federal level is better compared having a healthcare plan for the entire EU, where the Dutch pay for the Greeks–like the Euro. Finally, since you have many European states with different plans, they can all learn from one another. In the US, we implemented a monopoly that will prevent innovation.