Streetcar Line

Death Panels by Proxy

Yes, Obamacare tips scales toward death.

By 8.24.09

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Let's posit that Sarah Palin overstated the case when she warned about "death panels" in the House version of Obamacare. Obviously, there are no specific provisions in the legislation that create all-powerful boards whose members give a thumbs-up or thumbs-down on whether or not one person receives life-saving care while another one is left to die or even "assisted" in dying. But that doesn't mean that fears of government-prompted premature deaths are unwarranted. Call it "death by proxy," or DBP. Obamacare encourages DBP in multiple ways -- and it's not at all unfair to suggest that President Obama himself doesn't really mind that prospect.

First, consider the context. We have a president who has such extreme, sickening disregard for inconvenient life that he opposed the Born Alive Infant Protection Act in Illinois, thus refusing to require hospitals to care for babies who survive an attempted abortion. And regarding the other end of life, this is the same president who told the New York Times' David Leonhardt that because "the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here," therefore "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."

So this president wants a "conversation" that is "guided by" supposed experts who are apart from the "normal political channels" but that is nevertheless influenced by "a very difficult democratic conversation." Is it any wonder that some people interpreted this "independent group" as a "death panel"???

This same president surrounds himself with people who aren't -- shall we say -- particularly bashful about considering the possibility of rationing care so that young adults get priority ahead of their grandparents and their would-be children. Yes, the president's chief medical policy advisor, Dr. Ezekiel Emanuel, is personally opposed to euthanasia. But the Washington Post editorial board protests entirely too much when it absolves him -- without much proof -- of approving the rationing of care that disfavors the old and infirm. Frankly, the Washington Times editorial on August 16 blows the Post's editorial out of the water, because there is no way to explain away Dr. Emanuel's statement that "allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age." From the executive summary of his piece published just this past January, this could not be more clear: "We recommend an alternative system -- the complete lives system -- which prioritises younger people who have not yet lived a complete life…."

Then a president who won't save infants born alive but who does want the government to be involved (a "democratic conversation") in deciding end-of-life treatment -- and whose medical policy adviser would "prioritise" young people -- hires as his chief science adviser a man, John P. Holdren, who first gained notoriety pushing eugenics ideas such as coerced abortions, forced sterilizations through the water supply, and other notions so outrageous that the man should never be accepted in polite company again, much less have the ear of the President of the United States. Again, the Washington Times summed it up, with a hat tip being appropriate for Internet journalist "Zombie" via Michelle Malkin.

It is in that context that Section 1233 of the main House health care bill started catalyzing fears of "death panels." The section provides for end-of-life counseling, and it lays out in specific form exactly what should be included in that counseling. Significantly, the substance of that counseling is not negotiable: It "shall" -- not "may" but "shall" -- include all of the possibilities that so raised people's fears. As Betsy McCaughey noted at this site, the provision also effectively imposes sanctions against doctors whose results aren't up to… uh… snuff.

This is precisely where the "death by proxy" really comes in. If medical personnel are rated on how effective they are at getting patients to create living wills and the like, and if independent boards are deciding that patients will not be reimbursed for their payments for certain forms of care, then the effect is that death becomes the default option. DBP, indeed.

Anybody who doubts that such provisions inevitably lead to rationing care in a way that subtly favors death need only consider that this is exactly what already is happening at the state level, not just in "assisted suicide" states like Oregon but also in Georgia, as approved by a federal court. 

Even without the now-infamous Section 1233, rationing does occur, frequently, in government-run and government-mandated systems. And even without any health care bill, the camel's nose already is under the tent in the form of the Federal Coordinating Council for Comparative Effectiveness Research.

Despite what Mr. Obama keeps saying about how extreme right-wingers are "distorting" his plans with tales of death panels and the like, the truth is that these concerns come from all parts of the political spectrum, and that they are valid. The Washington Post's own Charles Lane, formerly editor of the liberal flagship the New Republic, wrote as much a few weeks ago. Lane is worth quoting extensively:

Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs? Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist.

Lane continues:

Section 1233 goes beyond facilitating doctor input to preferring it. Indeed, the measure would have an interested party -- the government -- recruit doctors to sell the elderly on living wills, hospice care and their associated providers, professions and organizations. You don't have to be a right-wing wacko to question that approach.

Noted civil libertarian Nat Hentoff, nobody's example of a right winger, goes even further than Lane did, pronouncing himself "scared" of Obamacare -- which he says could amount to a "chilling climax of the Obama presidency." The Hentoff column, linked here, is well worth reading in full. "No matter what Congress does when it returns from its recess," Hentoff accurately writes, "rationing is a basic part of Obama's eventual master health care plan." Without using the words, what Hentoff describes, and warns against, is exactly DBP.

And I dare say the president knows it.

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About the Author
Quin Hillyer is a senior editor of The American Spectator and a senior fellow at the Center for Individual Freedom. Follow him on Twitter @QuinHillyer.