Monday, August 10, 2009

Sarah Palin Right About Obama "Death Panels"

An Inconvenient Truth About The "Death Panel":
... If the critics, who hold themselves in the highest of intellectual esteem, had bothered to do something other than react, they would have realized that the approach to health care to which Palin was referring was none other than that espoused by key Obama health care adviser Dr. Ezekial Emanuel (brother of Chief of Staff Rahm Emanuel).

The article in which Dr. Emanuel puts forth his approach is "Principles for Allocation of Scarce Medical Interventions," published on January 31, 2009...

While Emanuel does not use the term "death panel," Palin put that term in quotation marks to signify the concept of medical decisions based on the perceived societal worth of an individual, not literally a "death panel." And in so doing, Palin was true to Dr. Emanuel's concept of a system which
considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had a few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern the disproportionately large amounts of resources will be directed to young people with poor prognoses. When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable....

When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.
Put together the concepts of prognosis and age, and Dr. Emanuel's proposal reasonably could be construed as advocating the withholding of some level of medical treatment (probably not basic care, but likely expensive advanced care) to a baby born with Down Syndrome. You may not like this implication, but it is Dr. Emanuel's implication not Palin's.

***
Certainly, no Democrat is proposing a "death panel," or withholding care to the young or infirm. To say such a thing would be political suicide.

But one interesting concept which is central to the concepts being discussed is the creation of a panel of "experts" to make the politically unpopular decisions on allocating health care resources. In a letter to the Senate, Barack Obama expressed support for such a commission:
I am committed to working with the Congress to fully offset the cost of health care reform by reducing Medicare and Medicaid spending by another $200 to $300 billion over the next 10 years, and by enacting appropriate proposals to generate additional revenues. These savings will come not only by adopting new technologies and addressing the vastly different costs of care, but from going after the key drivers of skyrocketing health care costs, including unmanaged chronic diseases, duplicated tests, and unnecessary hospital readmissions.

To identify and achieve additional savings, I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under this approach, MedPAC's recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.
Will such a commission decide to curtail allocation of resources to those who are not deemed capable of "complete lives" based on prognosis and age, as proposed by Dr. Emanuel? There is no way to tell at this point since we do not have a final Democratic proposal, or know who would be appointed to such a commission.

To exclude the issue of allocating resources away from the elderly and infirm from the debate over "cost cutting," however, ignores the ethical elephant in the room. Let's have the debate, and understand specifically how resources would be reallocated, before any vote on a health care restructuring bill...
(emphasis added)


Previous Pro Ecclesia posts on this subject:
Health-Care Rationing Violates Catholic Teaching

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