Objectively Pro-Death Panel
I’m sure someone has already made this point, but if you take the idea of a “death panel” seriously, it doesn’t really seem like that terrible of an idea. As I’m sure most of you know, you can apply the Pareto principle (more commonly known as the 80/20 rule) to the distribution of health care costs – the vast majority of health care costs are generated by a distinct minority of consumers (it doesn’t actually have to be 80/20, though in this case, I think it is). And of course, the elderly are the overwhelming majority in that distinct minority. After all, they cost the most.
According to the Kaiser Family Foundation, for those 65 and older, average health care spending clocked in at $8,776. By contrast, average spending for Americans aged 45-64 is $4,863, and average spending for the next youngest group of Americans (25-44) is $2,305. What’s more, most of this spending is concentrated in the last year of life; according to a report released in 2001, the last year of life accounted for a little more than a quarter of all Medicare spending.
If we take the death panel claim seriously, then what President Obama is proposing is a board, of some sort, which would evaluate potential end-of-life treatments and reject those that didn’t meet a predetermined level of cost-effectiveness. Ethical considerations aside, if done correctly, these death panels could be a really effective way of bringing down total Medicare costs (which, as I’m sure you all know, are completely unsustainable over the long-term). It may not make us feel particularly good to deny great-grandma a pacemaker, but if we’re looking to cut waste, why not?
Ethical considerations aside?!?! That’s one hell of a caveat.
Anyway, this is begging to be stuck on the front page.Report
I don’t believe in death panels. I do believe in rationing treatment, but based on effectiveness as treatment. Yes, some discussion has to be centered around end of life care, but it’s more about the effectiveness of treatment then determining when to “let go of Grandma”.
The real point is that private insurers already do this. For some reason, in polite company they’re allowed to do it where government is not, because Free Market Magic Competition Innovation the Marketplace Libertarian Fairy Dust.Report
Interesting post. It suggests that the heartless results that conservatives typically are willing to tolerate should be effected by the state. The sheer pragmatism would be appealing if the means weren’t so monstrous. Given the nature of the post, you may be obliged to waive Godwin’s rule.Report
oh for the love of vishnu. Since there have been modern medicine there have always been people who choose what kind of treatments are available to patients. They are called Doctors and Scientists. They research stuff and say what works. then doctors offer treatments based on their best knowledge. Insurance companies do this, any forking payer of bills will do this.
Of course we should have comparative effectiveness research. Not just because it will cut costs but so we-patients- will have better info to make choices. The repub’s got their panties in a bundle so the money to find out what treatments work and don’t got cut.
Doctors and patients already make these kind of decisions regarding how much a treatment will help and how it will affect quality of life. What we need is info.
What kind of ethical considerations are there involved in determining what treatments work and what don’t? What is the problem with not paying for stuff that doesn’t work? Why shouldn’t we have Doctors and Scientists going through all the research and letting us know what works? Patients need to know that.
feh it’s late and i’m cranky.Report
Like I said in the comments for E.D.’s post, Medicare spending is rising at the same rate as total healthcare spending. If old folks were the biggest problem, then why isn’t Medicare spending growth outpacing the rest of the industry?Report
I’m fairly certain it’d be next to impossible to get statistics on this given the piecemeal nature of Medicare, but it would be really useful to see a forward-looking cost/year figure instead of a backward-looking one. I mean, if someone on Medicare dies of complications related to breast cancer when the prognosis was that more likely or not there would be complete remission, that shouldn’t count as wasted end-of-life spending. When someone undergoes a procedure that’s not statistically proven to increase the chance of even extending their life let alone recovery and is associated with increased suffering, that’s a problem.
The trickiest situation here is something like pancreatic cancer that can strike very young people and is often incurable. What’s the value of extending life by 1 to 3 months for a 30-year-old? How much should we invest in that outcome? Of course, even thinking about this stuff is what gets Ezekial Emanuel compared to Nazis every day. It’s the 2009 equivalent of pointing out that we aren’t really all that sure that there’s WMD in Iraq.
The big irony here is that almost no one’s insurer doesn’t take these same cost/benefit figures into consideration when choosing whether to deny coverage for any particular therapy. The same drugs that conservatives hold up as examples of a broken NHS are more often than not not covered by private American insurers, and, even if they are, the copay alone is too much for many of the rest.Report
The “if done correctly” does a LOT of work in that sentence.
I’ve posted my full response here: http://www.poligazette.com/2009/08/19/if-done-correctly/Report
Jamelle – it’s fine and good to have these decisions made, but only by the people effected by them. Letting the state make these decisions raises too many long-term concerns.
If people were given health care vouchers instead of simply receiving the services, they would have a much better sense of cost, of how they wanted to pursue treatment – especially at the end of the line. The further we remove people from their own decisions about health care, the higher the cost.
And at some point everyone agrees that the costs of Medicare will be unsustainable. I guess I’m just saying – yes, let’s help people pay for their health care, but let’s allow them to ration it as best they can on their own. Even now, in the system we have, we are too disconnected from our own health care choices.Report
Nat Hentoff makes this particular distinction here:
http://jewishworldreview.com/cols/hentoff081909.php3
But the Obama administration claims these fateful consultations are “purely voluntary.” In response, Lane — who learned a lot about reading between the lines while the Washington Post’s Supreme Court reporter — advises us:
“To me, ‘purely voluntary’ means ‘not unless the patient requests one.'”
But Obamas’ doctors will initiate these chats. “Patients,” notes Lane, “may refuse without penalty, but many will bow to white-coated authority.”
Now, I am a *HUGE* fan of end-of-life consultation when it is initiated by the patient and the patient’s family. I am down with whatever conclusion they reach after having meditated/prayed/argued about it. BUT!!! And here is the distinction I am making!!! *IT MUST BE INITIATED BY THE FAMILY*.
The whole euthanasia discussion strikes me as barbaric. Not because I am against the idea of “death with dignity” (I’m a fan!) but because I don’t want THE GOVERNMENT to be put in charge of definitions of “dignity”. As I believe I’ve said before. I would fully support euthanasia being illegal… but knowing that a family could ask a doctor to shut the door and any discussion that took place when that door was shut would be private (indeed, the family has a *RIGHT* to privacy). The family could discuss what they needed to discuss, say what they needed to say, scream what they needed to scream, and then stuff could move on. When this is done by individuals, it is not monsterous.
When, however, there are laws in place discussing the circumstances under which it becomes okay to ask one’s gran gran to kick off, it becomes something horrid. When there becomes a spreadsheet that needs to have various squares filled in, it’s awful.
End of life consultations made wonderful, perhaps even beautiful, unofficial policy. As official policy, one ought to bust out the references to various political leaders from the first half of the 20th century.Report
Jay, the way I see death panels, it is about the government limiting how it spends taxpayer money. Patients in private practice could ask for their lives to be extended any way they wish, but as long as we are talking about patients whose healthcare is funded by the government, the government should restrict that to basic care (which it would be unreasonable to say that people dont need it) and stay away from advanced care (in which reasonable people can disagree about whether it is necessary).
For example, if a kidney transplant is going to extend the life of patient A by 20 years, but patient B by 1 year, if the government is to be involved in healthcare at all, it should pay for patient A, but not patient B.
But whether the extra year is worth it should be up to the individual right? Well, if a person feels like it is worth it (as he may reasonably feel) there is always the private sector. If the patient feels that it isn’t, then it isnt a problem for anybody. The private sector is always available for people to go to whatever reasonable (or even unreasonable) lengths in order to extend their own lives or those of their loved ones.
But I dont think libertarians should be arguing that the government should basically throw tax payer money at people on request.Report
I think death panels are a great idea. Let’s spare the living the burden of their old people’s last throes, etc etc. I, for one, will deny the doctors and hospitals my money for my death. Let my kids enjoy it… Too bad most people disagree with me. And too bad that they have the free-market system on their side of the debate.
Nobody thinks that the free market is some form of magic–as Freddie’s straw man suggests (above). It’s just that the free market is the system most people want to preserve.
That’s why the “death panels” themselves, or “rationing,” etc etc is not the problem. Of course there are “death panels” and “rationing” already happening under the present system. But that’s just because health care is a service like any other in capitalism and it’s “rationed” by cost…like everything else in the private market.
So, advocating the “death panels” is the same as advocating “socialized medicine.” After all, shoes are “rationed” by cost as well. We don’t want a “a board, of some sort, which would evaluate [people’s shoe requests] and reject those that didn’t meet a predetermined level of cost-effectiveness. ”
It’s a trivial example, I know. But the point is that people do not want socialism…ethical considerations aside and it looks like Obama is not admitting that his proposals amount to socialism.Report
Jamelle, I’m with you on the pragmatism. Unless we wake up from our current financial delusions (and by extension, environmental), we’re all going to hell a lot faster than we think anyway.
IF we had a mandatory public option, this could be a really significant issue just based on popular distrust of government – but it isn’t so, Obama is folding on even the offering of a public plan.
That said, I agree with E.D. that people should be aware of the costs incurred by these expensive end-of-life treatments, and the costs should be appropriately allocated to whomever wants to pay for ‘exotic’ alternatives above and beyond what is fiscally and medically reasonable. I don’t think it is unethical to deny someone treatment (I already have trouble with the idea of a ‘right’ to live beyond what nature intended) because the costs cannot be borne – it already happens to the poor and uninsured, which, to me, is a far greater issue than denying alternative treatments to the non-productive elderly.
That said, it’s already bad how old people are treated these days. It only underscores how divided and selfish Americans are as a people, old people included.Report
“non-productive elderly”Report
It’s worth adding that I am not actually in favor of “death panels,” and that this is really just me thinking through something a little bit.Report