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Yes, actually, the leftists do want death panels

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.

Just what we want--a committee deciding on our quality of life years. Rattner thinks the IPAB set up by Obamacare should be made more like the NICE, as if the IPAB weren't already bad enough.

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."

Comments (27)

From the article:

But in the pantheon of toxic issues...none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.

Nice strawman.

Death panels are inevitable in a centrally planned society. Someone has to decide who's worth treating after all! Individuals are not capable of such decisions (or so the central planner says).

The problem, as I see it, is that we have slowly but surely succumbed to the notion that the government belongs squarely between a patient, their insurance company and their doctor. Think about that for a minute... Doctors used to make house calls and get paid in chickens. Now, the government decides (via Medicare, Medicaid and now Obamacare) who they may treat, what services they can offer and how much they can charge for them. We Americans, like frogs in slowly heated water, sit idly by and allow the government to creep further and further into our lives. If we fail to take drastic action (like perhaps voting for a third party en-masse) we will be stuck with government creep until the system collapses!

Around 70 per cent to 80 per cent of all deaths are likely to benefit from planned end-of-life care.’

"End of life care" being, of course, the purely palliative care to make you more comfortable while they carefully don't treat your condition, so that your end of life comes faster. So, what they mean by "benefit" is that (a) the system benefits to the tune of $1 billion, and the patient "benefits" by not being treated except for pain.

And this is the compassionate liberal state we are supposed to emulate?

Somebody needs to tell Mr. Rattner that America doesn't WANT half the health care for half the cost. Health care isn't a human right the way fair treatment before the law is a human right: you cannot mandate that someone else take care of you just because you need care, or you take away HIS human rights. When you nationalize health care and make its delivery a "right", you end up making health a zero-sum game, so rationing becomes imaginable. But the whole of the free-market economic system is built on the reality that goods and service activities are NOT a zero-sum game, that overall increases for satisfying life's needs is a normal effect of allowing the God-given creative spirit be applied to as many spheres of individual goods as possible, and health service is amenable to that formula just as much as most other services.

There is indeed something Orwellian about the use of "benefits" to refer only to bringing about death sooner. I notice that the UK story says that patients put on the likely-to-die-in-a-year list will be given the opportunity to refuse life-sustaining treatment. That's nice. Will they also be given the opportunity to choose to have it? As usual, these "benefits" go only one way.

The UK article also mentions the Liverpool Care Pathway, which has turned out to be a nightmare. Many patients have simply been medicated into insensibility and dehydrated to death, even if they were previously capable of eating and drinking by mouth. Guarantees one dead human being within two weeks, or your money back.

The Liverpool Care Pathway - for which a more honest name might be the Liverpool Death Pathway - has, apparently, 'eased the last hours' of some patients who were not in fact dying.

Quite apart from being singled out for 'end of life care', an old person in a British hospital can be in danger of dying by neglect from unconcerned nurses who fail to administer drugs as prescribed, or even to make sure that frail patients have a drink of water.

I find it kind of strange that those who seem to be opposed to any public funding of healthcare are concerned that the government will cap funding.

Countries with public healthcare systems typically don't cap your ability to purchase added insurance or spend more for added care. (Canada for some stupid reason does impose restrictions on private healthcare though).

Remember there's at least one example of regulations estimated to save 1 live per roughly $17 trillion (1995) dollars spent (see Table 1 on page 58). Yes that's trillion - more than the entire US annual GDP.

Infinite spending given finite resources just doesn't work - strange here that the left seems to have a stronger grasp on that than this post. There's always rationing, it's just a question of whether the public purse or your wallet is involved in any particular case.

I find it kind of strange that those who seem to be opposed to any public funding of healthcare are concerned that the government will cap funding.

Obiecare cuts 716 billion dollars from Medicare. It's really strange of people to think the government ought not to steal the money set aside to care for them in old age. And now they want to cut (I mean steal) 200 billion from Medicare Advantage. A lot of seniors might begin to suspect someone wants them to die quicker. They're probably just strange, though. You know how old folks get.

There's always rationing

Correction: there is always a limit on a finite resource. 'Rationing' implies controlling allocation of a good that is yours to control. Nobody gave the healthcare industry to the government to control and allocate. And nobody should, either.

I find it kind of strange that those who seem to be opposed to any public funding of healthcare are concerned that the government will cap funding.

Well, I can explain that to you. At least in the US, the people who are pushing to take healthcare decisions out of the hands of the individuals who want to get it (on the one hand) and those who want to provide it (on the other) and put it into the hands of nameless bureaucrats, are the very same people who in all other issues are driven by EQUALITY OF OUTCOME as the high ideal. They consider that Jane having a bigger house than Peggy to be a frank injustice. So we (rightly) can surmise that if the people who are pushing to control healthcare get their way - at least in this county - eventually they WILL forbid private dollars being spent on healthcare. One stepping stone toward that would be creating outrageously high dis-incentives (taxes, penalties, fees) to buying such care, instead of allowing any kind of free market forces control that market.

Countries with public healthcare systems typically don't cap your ability to purchase added insurance or spend more for added care.

It's so strange that lefties always bring this up, but when they blather on about how we "need death panels" and how "there's always rationing," and when they pressure people to agree to be dehydrated to death in their last days, they never say, "Now, let it be understood, Mrs. Jones, that if your Public Healthcare Top-Up Insurance is in force, you will *of course* be able to get your food and water at the nursing home, because your care will be paid for by your own Top-Up Insurance." In fact, it's such a strange thing: The death decisions are always standardized, and the talk is always of "our dollars." Somehow, it just *happens* that virtually nobody seems to have that ability to receive what should be basic care (nutrition and hydration) and not be done to death by the doctors, if only they have this extra top-up insurance.

Oh, and by the way: In the UK these decisions are carried out against the wishes of the families and patients, and no lawsuit for wrongful death is allowed.

In the United States, hospitals now have futile care panels who make decisions regardless of ability to pay. After a head injury, Zach Fernandez was almost dehydrated to death with breathtaking haste by a death panel decision at a Texas hospital, and there was no question even raised of inability to pay. That simply wasn't what it was all about.

The pretense that it's "just that if you want to live on we want you to pay for it" is a lie. No other word will do. That some people get to live on when their lives are regarded as futile and hence "waste resources," which are thought of as belonging to the Collective regardless of the actual economic set-up, is an offense in itself, and the more centralized the medical decisions, the fewer choices anyone has, period. *Maybe* the very richest in those countries can find some way around this, but I never hear about it if so. One way and another, the vast majority of people are forced into the system in which they have no choice. So we should cut the pretense.

I'm guessing that whoever came up with acronym "NICE" for the National Institute for Health and Clinical Excellence had never read C.S. Lewis's "That Hideous Strength."

Look on the bright side, Lydia. If they don't suffer the consequences of government run health care, they won't have any incentive to count their costs. We should not be trying to save seniors from having the coverage capped until there is a general consensus among them, as a voting bloc, that we need serious market-oriented reform.

NICE reminds me of Lewis' novel "That Hideous Strength". An organization with the same acronym that was controlled by demons and demon worshippers.

hmmm seems fitting.

Public healthcare gets the same health outcomes at half the cost compared to the USA. Even systems "more private" then the USA feature regulatory controls that would probably be distastful to the purist (price controls and purchasing mandates in Singapore).

Nice slogans. Also, way to go completely ignoring the point of the main article. In case you didn't get it and need it spelled out, here is the point of the main post: Leftists' idea of healthcare cost control involves deliberately cutting off the elderly and other vulnerable people from needed care, even quite basic care, so that they will die sooner. This is unacceptable. This is also made more prevalent by increasing centralization and governmental control of healthcare.

Besides all of which, Lydia, it's just not the case that those countries get "the same outcomes at half the cost." It's an absurd premise to begin with.

Yep. Many things to be said about that particular meme. The same outcomes, really? We could also mention all the people who come to this country to get away from the wait-lines in their own countries.

Wait lines, and of course to get away from rationing, as in the real kind, where services are withheld from people who are able to pay for them because it's not their turn in the queue (or because some panel has decided that their life just isn't worth living). And don't even get me started on the survival rates for deadly diseases, the availability of sophisticated surgeries and equipment (or even equipment considered pretty standard for a hospital in the US, like an MRI machine), etc., etc., etc.

Oh, and then there's the difference between "price" and "cost," which is always elided in arguments coming from the left. You can "set" a price at half what it is in the US, but a cost is immutable, and must be paid in other resources (such as time, the availability of medical professionals, the supply of equipment, etc., etc.) The government could dictatorially set the price of all food commodities at half what it is now and attempt some kind of "single payer" system for food, but that wouldn't reduce the cost of food by half, and it would be guaranteed to produce massive shortages and--of course--rationing, which would be justified precisely on the grounds that there was a sudden crash in supply. Government "single payer" systems create the very conditions that are used to scare people into believing they are necessary.

Government "single payer" systems create the very conditions that are used to scare people into believing they are necessary.

Truer words were ne'er spoken.


I would LOVE the government to stop pointing a loaded gun at me and demanding I hand money to old people who then immediately hand it to drug companies and rich doctors and hospitals owned by rich people.

What? You think it's horrible that I don't want a loaded gun pointed in my face and my money taken? That's so MEAN of me, isn't it?

I'm so very tired of delusional animals screaming at me at the top of their lungs.

You would hate nothing more than the government GETTING OUT OF old people's health care.

The previous comment does not contribute to the high quality of discussion at this site. The only reason I'm posting this response instead of junking the comment is that at the moment it feels slightly subjectively simpler to do this. But I'll rouse myself to the trouble of junking in the future rather than letting the quality of discourse be lowered in that fashion.

Amusingly, I believe I'm the only "delusional animal" (!!) at this site to have favored finding ways to phase out (gradually) Medicare and Social Security and even to have questioned (to the shock of some) their constitutionality. I believe it will be best for the elderly in the long run if this is done. But that is a policy discussion which I do not believe the previous commentator is capable of engaging in profitably.

Amusingly, I believe I'm the only "delusional animal" (!!) at this site to have favored finding ways to phase out (gradually) Medicare and Social Security and even to have questioned (to the shock of some) their constitutionality.

I'm just such a delusional animal. Nice to have company in the sanitarium. (I can almost hear Lydia's screams as she reads this).

Dang, and I thought I got there first. I think I have stated here - years ago - my opposition to social security, at least as it is now constituted. What it is right now is a pay-as-you-go welfare system that masquerades as a retirement system. It is not and never has been a retirement plan, not really.

Well, according to Austrian economics (as I understand it) government involvement in the free market distorts the functioning of the market and creates 'bubbles' or artificially high prices. Thus the government, both directly (through the creation of Medicare/Medicaid in 1965) and indirectly (through wage controls after WWII which resulted in employer supplied health insurance) began a process that has resulted in the current health care bubble.

Prior to such interventions, most patients had knowledge of what individual medical procedures actually cost. Going to the doctor was like going to an auto mechanic, the diagnosis was made and the price was laid out, then negotiated. Doctors, as I said above, would often be paid in chickens - or even wave fees altogether. The influx of health insurance introduced a disconnect in the market between supplier and consumer as to price. That, coupled with government set pricing via Medicare/Medicaid, has produced the situation we are in today.

It may be helpful here to expand on the auto repair analogy. What if the auto repair industry was regulated like the health care industry? What would the effects of mandatory "repair insurance", fixed pricing, and the government bureaucracy that goes along with taxpayer funded payments be on the auto repair industry?

As to the benefits of the British system: I have a coworker whose family lives in Ireland (which has cradle-to-grave public funded health care) and he says that the current reality over there is that anyone who can afford to has some form of supplemental private insurance because that is the only way to get timely health care. He says, for instance, (and he talks with family members weekly over there), that a pregnant woman with no supplemental insurance will not be able to see a doctor until her second trimester, but with supplemental insurance she can see her doctor within a couple weeks. Such are the consequences of centrally planned health care in the real world.

Amusingly, I believe I'm the only "delusional animal" (!!) at this site to have favored finding ways to phase out (gradually) Medicare and Social Security and even to have questioned (to the shock of some) their constitutionality.
No, you're not. I've been doing that possibly longer than you've been alive.

'Health care' is an elastic notion that can be stretched to include almost any condition which is construed as adverse to human happiness. When a central authority is set up as a 'health care provider' that promises free treatment at the point of delivery, there's no limit to the demand for medical intervention. That's one reason why the NHS is inevitably criticised for failing to control costs and meet its commitments.

There's a folk legend that when the National Heath Service was founded in 1948, millions of people, who previously had been managing without, suddenly availed themselves of free dentures and spectacles. By 1951 prescription charges for dental care and glasses had to be introduced.

The trouble with Obama is that he has forgotten that God exists and has removed any mention of getting people to pray for the sick in his health care system.

He could get the most powerful force in the Universe on his side, but , like an idiot, he refuses to take seriously the idea that you can solve any problems by prayer.

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