08/20/2009 (12:55 pm)
One of my readers directed my attention to this article from American Thinker, which makes the case that Congressional Democrats have already created the mechanisms through which the government will make, then enforce, care decisions according to cost-benefit algebra. Death panels are not in Obama’s plan because they already exist.
Of course, “death panel” is not precise; it’s just gruesome jargon. This portion of the health care debate rages over how, when, and by whom decisions should be made to cease treatment of the elderly or terminally ill because the cost of further care is greater than somebody wants to pay. In a sane system, care ends when the patient chooses not to pay. Under national health care, care ends when a bureaucrat chooses not to pay. Defenders of Obama’s or the Democrats’ plans love to point out that today, care ends when the insurer chooses not to pay, but they are badly mistaken for several reasons. First, shortages are not nearly so severe, and prices not so prohibitively high, when the government is not manipulating the market, so fewer such decisions are necessary in a free market; second, even if the insurer says “No,” private care is available at the patient’s expense that would not be available under a government plan; and third, appeals (and, if necessary, lawsuits) are possible with an insurer that would not be possible under a government plan. Even with insurers in the mix (who are so prominent in our current system because of government meddling), the final decision is made by the patient and his or her family where it should be made, and not by an unconnected bureaucrat.
However, the Democrats have apparently side-stepped the debate (who’s surprised?) by inserting language into unrelated legislation, the Stimulus bill. Pay attention; you’re going to learn how vague laws and unread legislation can be used to implement tyranny. This is tricky.
Critics call attention to two regulatory boards created by the Health Care portions of the Stimulus bill: the National Coordinator of Health Information Technology (HIT), and the Federal Coordinating Council for Comparative Effectiveness Research (CER). The HIT coordinator is the administrator responsible for building a national patient record system, a measure that will certainly improve health coordination if the system is built correctly. The portion of the Stimulus bill that creates the HIT coordinator position spells out the process of creating, coordinating, and propagating this new, central database of health information to public and private health care providers around the nation. In my mind, this is a rare measure that might actually fall within a legitimate definition of the role of the national government, and if our nation’s fiscal health were not in crisis, I might even favor it — but wait ’till you hear what’s buried in it.
The HIT legislation states that it “…reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information….” Then the legislation sets up the means by which a nationwide information system will be created, with review, strategic planning, testing, and financing. Finally, it says it will phase itself in over several years by paying a financial bonus to doctors and hospitals who become “meaningful users” of the system. “The Secretary [of HHS] shall seek to improve the use of electronic health records and health care quality over time by requiring more stringent measures of meaningful use selected under this paragraph,” it adds, regarding the payment standards for doctors and hospitals separately.
Now, if I were paranoid, I might note that this is vague enough that literally anything might be slipped in, in the definition of a “meaningful user.” I might further note that the bill contains a mechanism by which the Secretary of HHS might add new restrictions at will, without oversight from any source, and without the public’s knowledge. Since it is entirely at the whim of the Secretary of HHS, he or she could say that a “meaningful user” is one who uses the system’s recommendation of the most cost-effective treatment — after inserting a cost-benefit calculus into the system. In this manner, a clever definition of “meaningful user” could incent doctors and hospitals to implement a value-assessment standard for care decisions, like the one Democrats have been favoring.
Why would I be so paranoid as to imagine such a thing?
Two reasons. The first is that former Senator and nominee for HHS secretary Tom Daschle wrote a book in 2008 entitled Critical: What We Can Do About the Health Care Crisis, in which he described measures almost identical to those in the Stimulus bill, and explained how he would use them. His intentions and the legislation by which he would achieve them were covered back in February by New York’s former Lieutenant Governor Betsy McCaughey in this article on Bloomberg. Since the bill she wrote about at the time was an interim version, I verified that the wording on which she reported actually remained in the final bill. It’s all there. With Daschle or somebody familiar with his intentions at HHS (like, say, the radically pro-abortion Kathleen Sebelius), we can expect doctors and hospitals to be required to use the new patient and treatment database as a means of restricting care by cost, or forfeit healthy incentive payments by the government.
The second reason is the other commission, Federal Coordinating Council for Comparative Effectiveness Research (CER). Remember when I said that given fiscal health, I might even favor the national patient information system? The Comparative Effectiveness Research body is another story; the government has no business performing this analysis at all.
“Comparative effectiveness” is jargon in the Progressive policy world for rationing on the basis of cost-benefit analysis, using language uncomfortably reminiscent of the Eugenics craze of the early 20th century. Naturally, the language speaks of “social justice,” but such justice is defined as certain citizens sacrificing their rights (not voluntarily) for the benefit of other citizens who produce more. You are blessed, citizen! You have been selected to sacrifice for the good of all! And it speaks of the “maturity” to enact such “difficult” measures, like this smug essay by a medical school prof at UCSF.
Take the comments by CER board member Ezekiel Emanuel (Rahm’s brother), taken from recent medical journals by Betsy McCaughey:
…Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.
Many doctors are horrified by this notion; they’ll tell you that a doctor’s job is to achieve social justice one patient at a time.
Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (JAMA, Feb. 27, 2008).
Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.
He explicitly defends discrimination against older patients: “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” (Lancet, Jan. 31).
By Emanuel’s logic, discrimination against blacks, women, gays, Jews or any other group would be justifiable, so long as that group is given the opportunity to pay it back against their oppressors at some other time. This is insane, but it’s the sort of rationalization that has been going on for years among Progressives, who wonder whether humankind is a cancer on the planet.
The CER panel is modeled after the board in the UK’s national health system called the National Institute for Health and Clinical Excellence, or NICE. NICE is, simply put, the UK’s health care rationing board. It decides what sort of care is appropriate on the basis of a cost-benefit calculus that says that Britain can only afford to spend up to $22,000 to extend a life for 6 months.
From the Wall Street Journal:
What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. For example:
In March, NICE ruled against the use of two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs — including Sutent, which costs about $50,000 — that would help terminally ill kidney-cancer patients. After last year’s ruling, Peter Littlejohns, NICE’s clinical and public health director, noted that “there is a limited pot of money,” that the drugs were of “marginal benefit at quite often an extreme cost,” and the money might be better spent elsewhere.
In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: “When treatments are very expensive, we have to use them where they give the most benefit to patients.”
And it is this board that the Stimulus bill recreates in the form of the CER. But it is delusional to think that Obama’s health care proposal contains death panels. We’re bearing false witness, says the most patently dishonest President in our history (yes, worse than Clinton.) With all due respect, Mr. President, you can shove that self-righteous posturing right up your ass.
McCaughey, in the Bloomberg article, states that the Stimulus bill language requires that Medicare care decisions include the findings of the CER. This is not entirely clear in the language, but then, that’s the point. The Secretary of HHS has latitude to define a “meaningful user” as anything he wishes, and to impose more stringent standards as time goes along. Without oversight. Or letting anybody know, aside from the hospitals who must comply if they are to be reimbursed for installing the patient records system.
No, there are no laws saying “We are going to withhold care from granny.” Who was naive enough to imagine that there would be, if such a thing were to come about? But Daschle explained how he would slip it in, empowering an unelected bureaucracy to make the hard decisions about health care rationing that elected politicians are politically unable to make. They are unaccountable for our good, don’t you see?
The demographic impact of the Baby Boom on medical care and Social Security has been apparent for some time now. It has been amplified by the loss of 50 million potential wage-earners to abortions. But now, it appears that Progressives have chosen to deny the Boomers any say in their own demise; simply because it is convenient, not to mention consistent with their misanthropic world view, the Obama administration is preparing to solve the demographic crisis by simply allowing the Boomers to die with only minimal care. He’ll never say so, of course. We’re bearing false witness if we mention it. Holocausts never arrive through the front door.