Death Panels

It's hyperbole, but not as far-fetched as you might think. I first saw the term attributed to Sarah Palin. Although the White House and members of the mainstream media rushed to dismiss Palin's statement as "nuts," the threat of the government plan becoming a "death panel" for the weakest members of society may not be far off the mark. ABC News recently reported that the Oregon Health Plan refused to cover cancer drugs that cost $4000 per month for Barbara Wagner, a 64 year-old terminally ill patient with lung cancer. Instead they offered to give her a one-time prescription for lethal drugs to end her life, which would cost the state health provider only $50.

I can offer you this excerpt from Camille Paglia's essay on Salon.com (hardly a right-wing rag), posted today:

"I simply do not understand the drift of my party toward a soulless collectivism. This is in fact what Sarah Palin hit on in her shocking image of a "death panel" under Obamacare that would make irrevocable decisions about the disabled and elderly. When I first saw that phrase, headlined on the Drudge Report, I burst out laughing. It seemed so over the top! But on reflection, I realized that Palin's shrewdly timed metaphor spoke directly to the electorate's unease with the prospect of shadowy, unelected government figures controlling our lives. A death panel not only has the power of life and death but is itself a symptom of a Kafkaesque brave new world where authority has become remote, arbitrary and spectral. And as in the Spanish Inquisition, dissidence is heresy, persecuted and punished.

"Surely, the basic rule in comprehensive legislation should be: First, do no harm. The present proposals are full of noble aims, but the biggest danger always comes from unforeseen and unintended consequences.

"What was needed for reform was an in-depth analysis, buttressed by documentary evidence, of waste, fraud and profiteering in the healthcare, pharmaceutical and insurance industries. Instead what we've gotten is a series of facile, vulgar innuendos about how doctors conduct their practice, as if their primary motive is money. Quite frankly, the president gives little sense of direct knowledge of medical protocols; it's as if his views are a tissue of hearsay and scattershot worst-case scenarios."

This all comes from the proposed Health Benefits Advisory Committee, and relevant sections of the proposed bill: The "advance care planning consultation" provisions featured on pages 424 - 443 of HR 3200, "the American Affordable Health Choices Act."

A main feature of the legislation is a proposed "Health Benefits Advisory Committee" under the Executive Branch, which would be charged with determining "essential benefits" for all health-insurance plans and formulate standards for treatment that incorporate cost-cutting strategies. The federal health board would be comprised of a panel of medical experts, half of which would be nominated by the President. Under the current proposal, the HBAC would be independent of Congress, and its rules and recommendations guiding doctor treatments and insurance companies could only be overturned if Congress, the Executive Branch, and ordinary citizens through the judiciary act within 30 days. Even then, the actions of the Committee would have to be accepted or rejected in toto, with no exceptions.

But Palin pointed out the enormous danger for federal health boards becoming "death panels" through a policy of rationing, especially by following the policy proposed by Dr. Ezekiel Emanuel, an issue first raised by Rep. Michele Bachmann (R-Minn.)

Emanuel is a key advisor of Obama's health care reform as health-policy adviser at the White House's Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research. A member of the National Institutes of Health's Clinical Bioethics Council and brother to Obama's Chief of Staff Rahm Emanuel, he advocates "The Complete Lives System," which as he described in a Jan. 31, 2009 article, "prioritizes younger people who have not yet lived a complete life."

Emanuel's approach has five principles which he lays out in "Principles for Allocation of Scarce Medical Interventions" published on January 31, 2009: "youngest first, prognosis, save most lives, lottery, instrumental value."

"When the worst-off can benefit only slightly, while the better-off could benefit greatly, allocating to the better off is often justifiable," wrote Emanuel.

He continued that the CLS discrimination based on age is not "invidious discrimination" because "everyone who is 65 years now was once 25 years." But in the CLS, care would also be rationed away from young people with a "poor prognoses" because they lack "the potential to live a complete life." (Read here)

Emanuel has also stated that doctors take the Hippocratic Oath too seriously, and stated that "Savings [in the medical industry] will require changing how doctors think about their patients" in a 2008 article written for the Journal of the American Medical Association. In a separate 1996 article for the Hastings Center Report, Emanuel spoke about rationing care away from those "who are irreversibly prevented from being or becoming participating citizens" to the non-disabled, adding "An obvious example is not guaranteeing health services to patients with dementia."

Approximately 33 percent of medical spending occurs in the final year of a patient's life, and throughout the legislation (HR 3200), enormous pressures are put upon on physicians and medical professionals to incentivize them to cut costs.

Hyperbole? Yes... but, according to the legislation, not as far off the mark as you might think at first glance.