Tuesday, August 18, 2009

The "death panel" issue

From Contentions at Commentary Magazine:

...my main criticism of Sarah Palin's "death panel" remarks is that they reduce in scope the disapproval of the proposed health-care bill to a concern that, while not wholly unfounded as you pointed out, sounds exaggerated and rhetorically ill-pitched. Rightfully fearing a backlash from senior voters, Democrats yielded to the opposition regarding provisions for end-of-life counseling and removed them from the bill—and some consider this a victory for Palin.

But her outrage seems to have been misallocated, as now more must be mustered for countering the rest of the bill, which remains chock-full of problematic stipulations, some much more deleterious to both the health-insurance industry and the interests of health-care consumers than what Sarah Palin chose to focus on....


Obama's statements that you quoted are suggestive of the extreme utilitarian mindset that permeates the bill. To be sure, its architects do intend to ration care to the elderly and the chronically ill, but how such rationing would be implemented is not through any "death panels" but rather through the perverse actuarial calculus known as comparative effectiveness research. This is a formula that divides the cost of a treatment by the number of "quality-adjusted life years" that the patient is likely to enjoy—a cost-benefit quotient to guide bureaucratic boards on allocating medical resources. In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than do younger patients: until recently, older patients with macular degeneration, which causes blindness, were told that they had to go totally blind in one eye before they could get an expensive new drug to save the other eye.

As Betsy McCaughey notes at the Wall Street Journal: "The House bill shifts resources from specialty medicine to primary care based on the misconception that Americans overuse specialist care and drive up costs in the process (pp. 660-686). In fact, heart-disease patients treated by generalists instead of specialists are often misdiagnosed and treated incorrectly. They are readmitted to the hospital more frequently, and die sooner."

This is just another corollary of the utilitarian ethics motivating the bill, concerned with allocating communal resources for the greatest benefit to the greatest number. In such context, it's hardly a misconception that Americans overuse specialty care. Indeed, however grave a disease may be, if it ails only an unlucky few, the medical resources tied to treating it could instead help a greater number of people stricken by more common ailments. If such considerations dictate the allocation of scarce resources on a large scale, the result will be generic health care for all and specialized treatments—those needed the most—for few or none.

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