Philip notes that the news reported by Robert Pear in the New York Times — that the Obama administration has issued a regulation affecting Medicare that will amount to the infamous “Death Panels” provision originally in the Democrats’ health care bill — is simply “the reality of what happens when government is involved in medical care — suddenly the state gains an interest in individual decisions.” Philip also explains that the regulation was devised by Donald Berwick, who has a “self-professed love of Britain’s health care system and fondness for rationing….”
For all the talk of Death Panels, the kind of end-of-life counseling and advance directives that were stripped from Obamacare and are now funded in this regulation are good and worthwhile ideas on their own, separate from the question of government involvement. They can help dying patients and their loved ones avoid unhelpful trauma at the end of their lives, and prevent unnecessary spending on procedures that won’t help ease patients’ pain or prolong their lives. Given that a huge percentage of Medicare spending goes toward treating people in their last months of life, Berwick is only smart to try to cut costs there without harming anyone.
The charge that Berwick’s regulation constitutes — or could lead to — Death Panels arises because, as Avik Roy explained in what I think was one of the best posts on health care of the past year, “if the government is funding health care, and simultaneously funding end-of-life counseling, the government has a conflict of interest.” In other words, someone has to make decisions about the trade-offs between humane, life-prolonging health care and its costs, but that person shouldn’t be paid by the government or advised by someone paid by the government if the government is footing the bills.
Berwick would probably shrug off such concerns by arguing that the conflict of interest wouldn’t matter, considering how Medicare is organized, and he might be right for the near future. But Roy demonstrates that conservatives’ concerns that such policies will ultimately lead to something resembling Death Panels are well-founded: that is already the case in the U.K.’s government-run health care system, as well as in the Veterans Administration’s (please read Roy’s post for detailed examples).
The most humane health care system in the world would be useless if it were unaffordable. Right now Medicare is unaffordable and unsustainable, so it’s only logical to try to cut costs where possible. For now, saving money in end-of-life care is humane, but it’s only likely that at some point it will lead toward Death Panels. That reality makes the case for replacing Obamacare with a more free-market, patient-centered plan stronger.
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