At the risk of bringing an unwanted commentator or two out of the woodwork, I've decided that I've put off long enough writing about this: Back in September, Wesley J. Smith drew his readers' attention to this NYT op-ed by Steven Rattner entitled "We Need Death Panels." Don't talk to me; talk to Rattner. Of course, he immediately goes into the, "Heh, heh, folks, no, not really, heh" spiel. After a sudden rush of honesty to the keyboard in the form of the title, his first sentence begins,
Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name...
Not death panels exactly. By all means, Mr. Rattner, let's be exact. What exactly do you advocate?
Turns out he advocates, exactly, Britain's system. In the British system the NICE (I am not making up that acronym) uses QALY's--Quality of Life Years--to determine whether a given patient is worth a given treatment. More about QALYs here. Rattner says,
Take Britain, which provides universal coverage with spending at proportionately almost half of American levels. Its National Institute for Health and Clinical Excellence uses a complex quality-adjusted life year system to put an explicit value (up to about $48,000 per year) on a treatment’s ability to extend life.
And now for more on Britain's wonderful cost-containment system:
GPs have been asked to select one in every 100 of their patients to go on a list of those likely to die over the next 12 months.
The patients will be singled out for ‘end-of-life care’, potentially saving the NHS more than £1billion a year.
The ‘toolkit’ giving doctors and health and social workers new guidance on how to select candidates was launched by Liberal Democrat Care Minister Norman Lamb at a conference on end-of-life care.
It states that ‘approximately 1 per cent of people on a GP’s list [of all patients] will die each year – this equates to an average of 20 deaths a year. Around 70 per cent to 80 per cent of all deaths are likely to benefit from planned end-of-life care.’
It said: ‘Have your local practices identified the 1 per cent of their practice population who may be likely to die in the next year?’
Doctors are told to pick out such patients during routine consultations that show ‘indicators of frailty and deterioration’ and are told that ‘older people are a priority to consider’.
They are also told to use feedback from district nurses or hospital consultants, while patients in care homes should be ‘actively considered for your register’, the advice states.
Information for GPs on what happens to such patients said they would be ‘less likely to be subject to treatments of limited clinical value’.
Mr. Rattner's heart should be rejoiced. The only sad thing from the perspective of people like Rattner is that America is insufficiently enlightened (yet) to tell its GPs to put frail patients on a death list. Go on, Mr. Rattner, you might as well just say it and keep on saying it: "We Need Death Panels."