It is funny–in both the ha-ha and ironical senses–that those who often scream most loudly against the “death panel” meme often follow, sotto voce, ”But we need death panels.” The fact is that most of those in the technocratic classes want to medically discriminate against those who are seen as health care “takers” or perceived to have a lower quality of life.
They’re just not sure how to get from “here” to “there,” and retain popular support. (Hint: They can’t.)
Now in a Rolling Stone interview, Bill Gates joins the chorus. He says–like bioethicist Daniel Callahan–that we have to be careful about making technological improvements in medicine because we won’t want to make them available to all. From the interview:
G:…If you accelerate certain things but aren’t careful about whether you want to make those innovations available to everyone, then you’re intensifying the cost in such a way that you’ll overwhelm all the resources.
RS: Like million-dollar chemotherapy treatments.
G: Yeah, or organ transplants for people in their seventies from new artificial organs being grown. There is a lot of medical technology for which, unless you can make judgments about who should buy it, you will have to invade other government functions to find the money. Joint replacement is another example. There are four or five of these innovations down the pipe that are huge, huge things.
RS: Yeah, but when people start talking about these issues, we start hearing loaded phrases like “death panels” and suggestions that government bureaucrats are going to decide when it’s time to pull the plug on Grandma.
G: The idea that there aren’t trade-offs is an outrageous thing. Most countries know that there are trade-offs, but here, we manage to have the notion that there aren’t any. So that’s unfortunate, to not have people think, “Hey, there are finite resources here.”
But they do want to have the government (or bioethics committees delegated the task by government) decide “when to pull the plug on grandma.” Moreover, ”trade offs” is a code term in this context for death panels.
A few points I made about these matters at the World Affairs Council symposium on Obamacare earlier this week:
- Patients should be treated based on their individual circumstances, not as members of a “class” or group.
- Refusing wanted efficacious non-elective treatment is coercion–in essence, a duty to die.
- Death panels will destroy what shaky trust remains in our health care system, particularly, I think, among minority communities.
- Death panels undermine Hippocratic values and deprofessionalize medicine.
- Education is already promoting better, less expensive care decisions. Very few terminally ill people insist on ICU treatment at the end. Hospice participation now exceeds 40%.
- How can we justify refusing non-elective treatment based on invidious classifications when we keep expanding what we call “basic health care” to elective, life-style enhancing procedures and interventions? For example, in California today, gay and lesbian persons are legally entitled to expensive fertility treatments if they are covered by group health insurance–whether they are actually infertile or not. I only see this trend growing.
- If we have to cut back through regulatory changes, how about starting on elective interventions that don’t impact physical health? Medicare has paid countless millions on penile pumps and Viagra to allow 75-year-old men pretend they are 18 in the sack. I mean, c’mon!
Yes, we have to find ways to control medical costs. But not through death panels! Not through invidious discrimination depriving people of non-elective or necessary care, while payment for coverage of life-style enhancers continues to increase.
That approach is both morally wrong and politically unsustainable.