Wednesday, August 19, 2009


Jonah Goldberg, on the use of the term "Death Panels":
...But I guess I'm more in the McCarthy & Steyn camp. As a matter of the finer points of policy discussion, I think the death-panel label is awfully blunt and inexact.

I think M&S are right that it distilled some important issues down to an important truth: if Obama, Pelosi, Waxman et al get their way, the relationship between the citizen and the state is profoundly, and perhaps permanently, altered and down that path lurks death panels. Oh, they won't be called death panels, but that function will lurk like the ghost in the machine of the federal bureaucracy. Back when the health-care debate was abstract and liberals were sure they would win the day, they were far more comfortable talking about this sort of thing. Barack Obama talked about rationing care for people like his grandmother and seeking guidance from a super-smart panel of experts in this regard. Just a month ago, the New York Times magazine saw nothing wrong with running this unabashed love-letter to a health-care system, in effect, ruled by death panels (See my post on this last Friday, or Tom Maguire's Sunday item for more). Now, suddenly, to even suggest such a possibility is McCarthyism — now called Palinism — according to Richard Cohen.

What drives me crazy about liberal complaints about conservative tactics these days is how selective they are. Obama, Barney Frank, Jacob Hacker, and others have said that they want these reforms — specifically the public option — to lead to single payer. But when conservatives take them at their word, suddenly it's outrageous misinformation and "fishy" stuff. When the wind is at their backs, liberals look way off to the horizon, like Obama at a podium, dreaming of a future of European-style statism. But when conservatives use this to their advantage, suddenly it is outrageous to even consider the possibility of a road to hell being paved with good intentions. Suddenly liberals bleat that it is scare-mongering to look beyond what they are proposing in this exact moment, outrageous to ask "Where will this lead?" I agree entirely with Andy that conservatives are under no obligation to unilaterally agree to liberal terms or definitions but rather, as he puts it, "Our function is to call the opposition on such hair-splitting nonsense, not to make the fog harder to pierce."

And this raises what I think is part of the problem. As Mark says, this is a massive political fight — one that conservatives are winning, by the way — and there's a natural tension between wanting to argue the finer points of policy and win the battle over the politics. I don't begrudge NR's attempt to get this balance right by erring on the side of describing the policy correctly and in good faith. But, also in good faith, I don't see it quite the same way, and I don't think Palin's contributions are part of the problem with the health-care debate.

I'm inclined to agree with Goldberg. In fact, as a physician, I think that the descriptive "Death Panels" terminology effectively summarizes what is an entirely logical progression of Obama's health policies. This progression is derived directly from Obama's own words and those of his health-reform minions/czars.

Here is the logical progression:

(A) In order to reign in health care costs, some system of health care rationing must be put in place, or as Obama says, your government will undertake a "very difficult democratic conversation" about how "the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care" costs. Or,for the exact quote:
"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."

(B) So, what criteria for rationing health care (particularly at the end of life) is likely to be used? ------------->

(C) To answer (B) we only need to consider what criteria for health care rationing has already been put forth by one of Obama's key advisors on the issue, a bioethicist and "expert" on cost-efficient health care, Dr. Ezekiel Emanuel (brother of White House Chief of Staff Rahm Emanuel who wrote an article in a major medical journal in January, 2009 titled: "Principles for allocation of scarce medical interventions") :
Emanuel writes about rationing health care for older Americans that "allocation (of medical care) by age is not invidious discrimination." (The Lancet, January 2009) He calls this form of rationing — which is fundamental to Obamacare goals — "the complete lives system." You see, at 65 or older, you've had more life years than a 25-year-old. As such, the latter can be more deserving of cost-efficient health care than older folks

(D)Therefore, based on a system proposed by none other than the key advisor to Obama on this issue:
The basic premise seems to be that since someone or some entity must allocate scare medical resources there should be a "morally" acceptable method for such allocation. The authors, which include Dr. Ezekiel J Emanuel, brother of President Obama's Chief of Staff, and "Special Advisor for Health Policy" to the president presents a detailed proposal of how this allocation should be done. (Using the passive voice here serves the purpose or not having to say that the government will do the allocation.)

The authors begin with a critical review of the currently in existence allocation systems and finding flaws in each proceed to devise their own "hybrid" supposedly salvaging the good and casting out the less desirable elements of the various systems.

Expectedly, this "morally acceptable" allocation process would allocate less to the elderly and those with incurable illnesses. Perhaps unexpectedly, their process would place, for example, a fifteen year person allocation-wise above an infant because they say more social expenditures have been made on the adolescent and society need to get its money's worth.

The underlying theme is that individuals exist for the good of the collective ( state, society, pick one) and in health care decisions the greater good of society, now apparently denominated in "life years", trump the individual every time.

The authors describe their system:

This system incorporates five principles ... youngest-first, prognosis, save the most lives, lottery, and instrumental value. As such, it prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: “individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate.”Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system.

They explain further in regard to the old folks issue.

Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Treating 65-year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.

The blog summarizes the system in this way.

Infants get minimal treatment, because the State has not invested anything yet in their education. Old people get minimal treatment because their working lives are over.

So if you discriminate because someone is old that is ageism and invidious but if you treat differently because they have lived longer ( i.e. have had more life years) it is not. Talk about contrived nonsense.

Here is another quote that I find chilling.

The complete lives system assumes that, although life-years are equally valuable to all, justice requires the fair distribution of them.” (my bolding)

If you like social justice that sentence should really please you. Not only should most things be distributed fairly but now apparently how many "life-years" you get.

If you like distributive justice you will find a lot to like here. If you are old enough for Medicare or economically unfortunate enough to rely on Medicaid, you might be a little worried that the President's Advisor on health matters thinks this way.

(E) Now, there are many options for what you might call a panel that is set up to determine the "fair distribution" and "socially just" allocation of costly life-prolonging medical treatments, but "DEATH PANEL" captures the essence of what these arbitrary committess would do; and, in addition, it is a perfectly clear, concise, and to-the-point term.

What would you call them? Only the reality-challenged political left, with their loving, compassionate and bizarre notions of "social justice" would consider them... NICE.

UPDATE: Why stop at Death Panels? Why, indeed? When you can have Fat Panels, Exercise Panels, and Diet Panels to fairly distribute the socially just opinions of the leftist elites about how you should live your life.

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