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August 17, 2010

Comments

On the contrary, it appears to me that hysteria over

*the term "death panels" and the fact it was coined by Sarah Palin*

is preventing a necessary debate over which approach would be most effective and fair.

MartyB

I appreciate Brendan's careful distinction, that the term "death panels" has been used to mean rationing or to mean that a government panel will decide which individual is orthy of some expensive treatment. As Brendan points out, the latter usage is false. Nobody has proposed or contemplated such a system.

However, the level of falsity is small IMHO. If you're a cancer victim who will die without unaffordable Provenge, it doesn't make much difference to you whether a government panel decides not to pay for this drug in general or specifically for you. Either way, you're just as dead.

Compare that to Obama's huge error in promising that you will be able to keep you current insurance. In reality, I believe, the working of the Plan will drive out or make unaffordable much or most of private health insurance.

Or, the lie that the Plan will reduce costs, based on unrealistic assumptions of how it will operate.

We see an example of this sort of lie from Obama's appointees who are Social Security Trustees. They put out a 2010 Trustees' Medicare Report based on such ridiculous assumptions that the SS Chief Actuary added this amazing note:

The actuary’s alternative memo explains that “the projections in the report do not represent the ‘best estimate’ of actual future Medicare expenditures.” Worse than that, they are not even in the ballpark of reasonability. The official 2010 Trustees’ Report tells us that total Medicare expenses will be total 6.37% of GDP by 2080. The CMS actuary’s alternative memorandum explains that 10.70% of GDP is a more reasonable estimate for that year – though one that is roughly 68% higher.

If a private company used such unreasonable assumptions in their Annual Report, that company's President would be guilty of a felony under Sarbanes–Oxley and could expect a stretch in prison. Fortunately for Mr. Obama, the law does not hold the US President to the same high standards it applies to a corporate President.

BTW I would add that the term Death Panel, inaccurate though it was, facilitated appropriate debate IMHO. Until Sarah Palin raised the public interest, the terms of the Health Reform act were pretty much unreleased and unknown. There was little or no debate until the other side got a rallying point.

I consider that we've made great progress, looking at the issue of rationing on a broad basis versus Ezekiel Emanuel-like decisions about which individuals or categories of individuals are deserving of life-extending care (which Sarah Palin dubbed "death panels"). There was a time, you may recall, when all such matters were lumped together dismissively as "the euthanasia myth."

There is, however, some middle ground between rationing applicable to everyone and decisions about whether individual patients are worthy of heroic efforts. That's when decisions about what kinds of treatments are available or reimbursable are made on the basis of definable categories of persons, for example, based on age of patients or on how advanced a disease may be or how imminent death is. See, e.g., the National Health Service's Liverpool Care Pathway, recommended by the Orwellian-named National Institute for Health and Clinical Excellence (NICE). The one thing we can be sure of is that if there are death panels, they won't be called death panels, they'll have anodyne names like NICE.

Before the passage of the bill, the Obama administration opened a Website where people could recount their horror stories of dealing with insurance companies -- recission, claims denied, refusal to pay for certain treatments, etc. These of course could not include the 35 million Americans who had no such stories because they had no insurance. Yet to hear Beck, Palin, and most of the Republicans, you'd think that rationing and insufficient coverage were unknown in the wonderful system we had, where decisions were never made by "bureaucrats."

After having a manditory second opinion meeting with an insurance company Dr, I have met with the Death Panel. Completly disregarding letters from treating physicians, Dr's records, MRI and X-Ray evidence of a destroyed L5 disc from an auto accident. The insurance company Dr proclaimed after a 15 minute examiniation that I was cured, needed nothing else in the way of medical intervention. The death panel is indeed with us, it's nothing new to those of us with a chronic injury or illness. It has been a tool of the insurance companies used to deny coverages and treatments long before the health care reforms so desperatly need in this country.

This is a red herring:

“in terms of the specific claims about Provenge, CMS hasn't denied coverage and experts say it's unlikely they will do so at the end of the year-long process. The entire claim is based on speculation.”

Isn’t the fact that there is even a process underway to determine whether to deny coverage of any drug proof that eventually someone will be denied coverage of some life-saving drug? That seems to be the concern, not whether this specific drug ends up being denied.

MartyB

I am not an expert on health-care rationing but have the following off-the-top-of-my-head thoughts on your comment:

“It's true that Obama's proposal is likely to increase rationing, but so would every other proposal to control the unsustainable trajectory of future health care spending.”

The problems I see with government sponsored vs. private Insurer rationing boil down to several issues:
a) Global Decisions and Diversification of Risk: Decisions will be made globally by the government at even further distance from individual situations, leading to potentially greater harm to more individuals –and a greater sense of capriciousness of the decisions. Also, if one private Insurer makes a “wrong” decision, it’s more likely the damage of the decision will be limited as other insurer's may make the "right" decision.
b) Appeals: Less chance of equitable exemptions or appeals. If a private insurer makes a “wrong” decision, the individual has greater opportunity to protest, ask for review, or appeal to a higher authority. If the highest authority makes the decision up-front, there less chance of review or appeal.
c) Accountability: A government panel has less accountability than a similar panel in the private market as negative publicity is much more effective against private company, as the bottom line is always a concern.

Some Republicans are calling for unlimited entitlements, while others say we haven't addressed controlling any of the costs of health care.

I guess that explains why they never made a health care reform proposal of their own...too conflicted.

Howard, it's a misperception--a false claim--a myth!--that Republicans didn't have a health care reform proposal. They did.

You're welcome.

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