Tuesday, September 8, 2009

Death By Panel

I knew from the start that this whole discussion about so-called "death panels" -- or "end-of-life counseling" if you're on the other side of the divide -- was somehow out of focus. Now it suddently occurs to me that -- shazam! -- just like nearly every other political question, it boils down to economics, and some very simple economic principles can serve to clear up all the fog, noise, and strife.

Take, for example, the situation that usually obtains today -- at least for people who aren't institutionalized, i.e. who are not already wards of the state. This would include free choice (relatively speaking, within the bounds set by the AMA and its monolithic medical model) as to treatment and treatment providers... and that free choice would, of course, be constrained, for most people, by economic realities -- i.e., how much is covered by their insurance and how much they can afford to cover themselves. So it is true already -- though few dare admit it -- that not everyone can receive "the finest medical care" -- even (maybe especially) as the last roundup approaches. At some point, someone is going to pull the plug -- either literally or figuratively -- and this might very well be the person himself, in which case you could say that each patient is already his own "death panel". Now -- the difference between the care provided in the Mayo Clinic and that provided in DC General, while appreciable, does not constitute an onerous burden on the poor and underprivileged -- in fact, given that care for those on the bottom end of the economic totem pole is likely to be entirely covered by the government, one way or the other, the care they are getting -- way above their means -- is actually quite good, and befits "a civilized nation". So what is being proposed by Obama & Co. is a way to deal with the currently uninsured who are still not poor enough to simply check in (or out) on welfare... in other words, they have to pay for their treatment out of their own pocket. So he is not talking about the poorest of the poor; this is a point that is usually missed in the discussion. What he is talking about is the "missing middle"... above the DC General ER but waaaay below the Mayo Clinic. At least... that's what he claims he is talking about, but we all know how liberal social and taxation programs usually work -- they equalize outcomes by making everyone equally miserable. Rather than putting a chicken into every pot, they take the chickens out of pots and leave thin gruel in their place (and then run off to the Senate cafeteria for a chicken dinner). So what has people upset is, at least to some extent, not what the administration has actually said about the health care plan but the fact that, when's the last time any Democratic president has told the truth about a piece of social or economic legislation?

But having said all that, it remains true that, for most people, end-of-life decisions are their own to make -- call it the "pro-choice" position (at least up to the point of assisted suicide, which remains -- inexplicably -- a state-level legal issue, when everything else under the sun has been federalized). And so yes, it comes down to economics and the bottom line -- but it's the bottom line of the person involved, and no one else. If it gets to the point where I realize I can't afford to stay alive... well, it's unfortunate (no pun intended), but at least it's my own decision based on my own personal situation, constraints, priorities, etc. A guy in intensive care with $100K in the bank may decide to spend it all on a few more weeks of low-quality life, or he may decide to leave it to his kids (after the government takes its cut, of course) and pull the plug. Fair enough. This is what is called "death with dignity". Of course, it's only the advancing state of medicine that has made these decisions even possible, or relevant... and then only in the last few decades. Time was -- and I remember -- when "there's nothing more that can be done" was something the doctor said _before_ anyone spent a couple hundred thousand... in fact, there was nothing to spend a couple hundred thousand _on_; end-of-life treatments were no more costly than treatments at an earlier stage. In fact, beyond a certain point, they were cheaper, because there weren't any. These days we can keep people alive who have been brain dead for years; I mean, look at Robert Byrd.

Contrast this, if you will, with the picture provided by ObamaCare and "end-of-life counseling". The person is insured by the government, right up to and including "catastrophic" coverage... and there he lies, with life-extending machines arrayed around his bed, chugging, whirring, and beeping. To go on, or not to go on -- that is the question. But is it up to the patient -- or his family? Heck no -- this time it's the government that has to make the decision, which means a group of licensed, certified "professionals" -- including, I'm sure, at least one man or woman of the cloth -- who meet on a regular basis somewhere on the premises and weigh the pros and cons of keeping Joe Snuffy alive. Now, if Joe is from the vast army of "tax receivers", he's probably already stayed alive longer than he would have in our current, cut-throat, dog-eat-dog world. But what if he's from the middle... or even the upper middle? Remember, no one will have the choice not to be insured... which means that, in a sense, we will all be wards of the state, for life, when it comes to health issues. So there's no way he could have opted out, and stayed off the books, on his own, and making his own decisions. Plus -- since he is now subject to actuarial considerations when it comes to extending his life, he finds himself in a pool of all other eligibles (for treatment) -- including -- dare I say it? -- many who are less worthy as well as, let's admit, a few who are more worthy. In other words, he's in the very same boat with everyone else in his condition, or approximate condition. Now, to the liberal, this situation seems eminently fair -- why should those who are "lucky" enough to have resources get to live high off the hog, health care-wise, while the "underprivileged" (which really means "unprivileged", by the way -- a little corrective grammar, there) have to take the scraps and leavings? (Of course, the people running the show won't have a problem; they'll still be heading off to the Mayo Clinic on a regular basis.)

So the objections to the "death panels", or whatever, are, at heart, objections to the collectivization process more than to the reality of having to make end-of-life decisions. Those decisions are made every day, in a hundred different ways -- but they are made by the people themselves, and those who care about them. Contrast this with a faceless government panel -- and frankly, even if the outcome were no worse, who wants some guy in a mask pulling the plug? Who wants to be the victim of an actuarial table? Is this "death with dignity"? Of course not. This, I believe, is the real issue, and if it were defined this way we might be able to have a more productive discussion.

No comments: