The Corner

Car Czar Argues for Death Czars

Steve Rattner, who honchoed the auto bailout for the Obama administration, has a full-throated defense of death panels — rationing — in the Times today, which is sort of refreshing, in its call-a-spade-a-spade way. Rattner says the greatest third rail in American politics is “overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.” He goes on to argue, more or less, that Medicare needs to follow Britain’s NHS in assigning a cash-money value to the last year of life:

Medicare needs to take a cue from Willie Sutton, who reportedly said he robbed banks because that’s where the money was. The big money in Medicare is not to be found in Mr. Ryan’s competition or Mr. Obama’s innovation, but in reducing the cost of treating people in the last year of life, which consumes more than a quarter of the program’s budget.

No one wants to lose an aging parent. And with price out of the equation, it’s natural for patients and their families to try every treatment, regardless of expense or efficacy. But that imposes an enormous societal cost that few other nations have been willing to bear. Many countries whose health care systems are regularly extolled — including Canada, Australia and New Zealand — have systems for rationing care.

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.

At the least, the Independent Payment Advisory Board should be allowed to offer changes in services and costs. We may shrink from such stomach-wrenching choices, but they are inescapable.

Death-panel hypotheticals are perfect “intuition pumps” for drawing out latent conservative impulses in people who probably wouldn’t describe themselves as conservatives. Many, even most Americans, will at some point have to make “stomach-wrenching choices” about end-of-life care for themselves or for loved ones. Thinking through all the possible scenarios is morally torturous, and that’s when decisions are being made between doctors and families alone. Now imagine the federal government comes in and sets the value of a marginal year of life at $48,000 — roughly the price, and afraction of the true unsubsidized cost, of a Chevrolet Volt.