Why the discussion about "Death Panels" matters

Mark Steyn's posting summarizes very well why having the government involved in telling the patient what treatment, test, surgery, drug, etc. one may or may not get is an important concept to oppose:


Give Me Liberty or Give Me Death Panels [Mark Steyn]

. . . but you can't have both. On the matter of McCarthy vs the Editors, I'm with Andy. I think Sarah Palin's "death panel" coinage clarified the stakes and resonated in a way that "rationing" and other lingo never quite did. She launched it, and she made it stick. So it was politically effective.

But I'm also with Mrs. Palin on the substance. NR's editorial defines "death panel" too narrowly. What matters is the concept of a government "panel." Right now, if I want a hip replacement, it's between me and my doctor; the government does not have a seat at the table. The minute it does, my hip's needs are subordinate to national hip policy, which in turn is subordinate to macro budgetary considerations.

For example:

Health trusts in Suffolk were among the first to announce that obese people would be denied hip and knee replacements on the NHS.

The ruling was part of an attempt to save money locally.

The operative word here is "ruling." You know, like judges. You're accepting that the state has jurisdiction over your hip, and your knee, and your prostate and everything else. And once you accept that proposition the fellows who get to make the "ruling" are, ultimately, a death panel. Usually, they call it something nicer — literally, like Britain's National Institute for Clinical Excellence (NICE).

And finally I don't think this is any time for NR to be joining the Frumsters and deploring the halfwit vulgarity of déclassé immoderates like Palin. This is a big-stakes battle: If we cross this bridge, there's no going back. Being "moderate" is not a good strategy. It risks delivering the nation to the usual reach-across-the-aisle compromise that will get Democrats far enough across the bridge that the Big Government ratchet effect will do the rest.

After my weekend column recounted the experience of a recent British visitor of mine, I received an e-mail from a gentleman in Glasgow who cannot get an x-ray for his back — because he has no sovereignty over his back. His back is merely part of the overall mass of Scottish backs, to which a government budget has been allocated, but alas one which does not run to x-rays.

Government "panels" making "rulings" over your body: Acceptance of that concept is what counts.


'Obamacare is Gitmo for all Americans' [Andy McCarthy]

That's what I argued in yesterday's column, which explored the anomaly that, while terrorists like KSM get the red-carpet treatment of federal courts with all the trimmings, American citizens are to be stuck with the diktat of Kathleen Sebelius because Obamacare cuts off their access to judicial review of key HHS decisions. Optoons review has some fun with the idea in a bit called "Obama Transfers Terrorists Out of 'Legal Black Hole' at Guantanamo Bay; Replaces Them with American Health Care Patients." Great stuff.


Does a 'Death Panel' Already Exist? [Andy McCarthy]

At the American Thinker, Joseph Ashby says yes:

H.R. 1 (more commonly known as the Recovery and Reinvestment Act, even more commonly known as the Stimulus Bill and aptly dubbed the Porkulus Bill) contains a whopping $1.1 billion to fund the Federal Coordinating Council for Comparative Effectiveness Research. The Council is the brain child of former Health and Human Services Secretary Nominee Tom Daschle. Before the Porkulus Bill passed, Betsy McCaughey, former Lieutenant governor of New York, wrote in detail about the Council's purpose.

Daschle's stated purpose (and therefore President Obama's purpose) for creating the Council is to empower an unelected bureaucracy to make the hard decisions about health care rationing that elected politicians are politically unable to make. The end result is to slow costly medical advancement and consumption. Daschle argues that Americans ought to be more like Europeans who passively accept "hopeless diagnoses."

What ought to frighten the daylights out of everyone is how Obamacare lays the groundwork for what Mark Steyn calls the "Big Government ratchet." As Ashby elaborates:

What may pass as a 1,000 page health care law will explode into perhaps many thousands of pages of regulatory codes. The deliberate vagueness will give regulators tremendous leverage to interpret its provisions. Thus Obama's Regulatory Czar Cass Sunstein will play a major role in defining the government's role in controlling medical care.

How does Sunstein approach end of life care? In 2003 he wrote a paper for the AEI-Brookings Joint Center for Regulatory Studies arguing that human life varies in value. Specifically he champions statistical methods that give preference to what the government rates as "quality-adjusted life years." Meaning, the government decides whether a person's life is worth living. If the government decides the life is not worth living, it is the individual's duty to die to free up welfare payments for the young and productive.

Not to rehash our discussion here about the proper definition of a death panel, but, again, I think saying the government will be "deciding whether a person's life is worth living" is about more than "cut[ting] off care for the critically ill as a cost-cutting measure" — the narrow definition of death panels used by the New York Times (as Ashby recounts). It's about foreclosing care to the treatable — based on some government formula — such that they wither and die before their time. For all these years, the Left has told us we must butt out of end-of-life decisions because they are so intensely personal; turns out they're only intensely personal if you're decision is to die — if you want to live, that's up to the bureaucrats.


Health-Care Rationing and Minorities — A Curious Silence [Peter Kirsanow]
If, under Obamacare, the federal government allocates health-care expenditures on a utilitarian basis — i.e., on a cost/benefit analysis driven in part by the life expectancy of the patient — then certain groups could be affected more than others. Obviously, the elderly who've shown up at town-hall meetings have concluded that they will suffer the biggest impact.

But studies also show that blacks, Hispanics, and Native Americans often have lower projected survival rates than whites and Asians for various diseases. Accordingly, it's possible that under Obamacare patients from the former three groups would be denied the more expensive (but only marginally more effective) treatments granted patients in the latter two groups.

This wouldn't be [intentional] disparate treatment; rather, there may be a disparate impact on blacks, Hispanics, and Native Americans based on survivability rates. Since, e.g., blacks (for numerous reasons, including finances, diet/lifestyle, seeking initial treatment much later than whites, etc.) are more likely to die within five years of certain cancer diagnoses than are whites, there may be a greater probability that the more expensive interventions will be withheld from blacks in the aggregate.

Typically, the Left is alert to any possibility, however remote, that a governmental policy or piece of legislation may have a disparate impact on protected classes ("Administration Fails to Act on Asteroid Threat: Minorities and Women Hardest Hit"). Yet thus far there's been absolutely no discussion of whether rationing may have a disparate impact on certain minority groups. Does anyone doubt that such discussion would be loud and vigorous if, say, Newt Gingrich were the primary sponsor of the health-care bill?


Krauthammer sez:

On the Obama administration backing off the public option:

It's a full retreat. Look, Obama had wanted the public option a lot because it is the road to a government-run system, which is what, in his heart, he wants.

And he wanted to have planted it [the public option] in his presidency so —[even though] it wouldn't become government-run until the very end, [even though] it wouldn't have had its major effect until perhaps after his presidency — ...he would have been known as the father of national health care. But he's not going to get it and he knows it.

And he knew it early, but he hung on because it would be a bargaining chip when he goes for the minimal plan, which would be health insurance reform, where he slaps a lot of restrictions on the insurance companies where there are no preconditions, et cetera. And in return, he would offer to drop the public option. That's why he wanted to hang on until the end.

The reason he had to drop it now is because of the town halls and the public rebellion. It's because of the reaction, the angry, agitated, educated reaction of people against the public option — understanding that it's a way to national health care — that it became a distraction and a liability.

And if you're going to drop it anyway, he had to drop it now. But it takes away his leverage with negotiations in the end with insurance companies…

Look, as long as it [the health-care debate] was in Congress and behind closed doors and in negotiations, he could have hung on until the end. It's when it became — when Congress adjourned and all of this exploded in the public and it became a national issue and a huge liability and a drag on his own popularity — that's when he understood it had to go.

And yet he hung on for a couple of weeks longer than he should have, until he understood he had to cut his losses, because it was destroying the rest of the plan.


In the Matter of Editors v. McCarthy & Steyn [Jonah Goldberg]

Since a bunch of readers want to know where I come down on the great debate of the day, let me start by saying that Rich Lowry is not only a handsome man, but a wise and powerful one. As are all of the editors and others who make my work so enjoyable around here (of course, the womenfolk are lovely, as opposed to handsome). But I guess I'm more in the McCarthy & Steyn camp. As a matter of the finer points of policy discussion, I think the death-panel label is awfully blunt and inexact.

But in the arena of a vital political contest, I think M&S are right that it distilled some important issues down to an important truth: if Obama, Pelosi, Waxman et al get their way, the relationship between the citizen and the state is profoundly, and perhaps permanently, altered and down that path lurks death panels. Oh, they won't be called death panels, but that function will lurk like the ghost in the machine of the federal bureaucracy.

Back when the health-care debate was abstract and liberals were sure they would win the day, they were far more comfortable talking about this sort of thing. Barack Obama talked about rationing care for people like his grandmother and seeking guidance from a super-smart panel of experts in this regard. Just a month ago, the New York Times magazine saw nothing wrong with running this unabashed love-letter to a health-care system, in effect, ruled by death panels (See my post on this last Friday, or Tom Maguire's Sunday item for more). Now, suddenly, to even suggest such a possibility is McCarthyism — now called Palinism — according to Richard Cohen.

What drives me crazy about liberal complaints about conservative tactics these days is how selective they are. Obama, Barney Frank, Jacob Hacker, and others have said that they want these reforms — specifically the public option — to lead to single payer. But when conservatives take them at their word, suddenly it's outrageous misinformation and "fishy" stuff.

When the wind is at their backs, liberals look way off to the horizon, like Obama at a podium, dreaming of a future of European-style statism. But when conservatives use this to their advantage, suddenly it is outrageous to even consider the possibility of a road to hell being paved with good intentions. Suddenly liberals bleat that it is scare-mongering to look beyond what they are proposing in this exact moment, outrageous to ask "Where will this lead?" I agree entirely with Andy that conservatives are under no obligation to unilaterally agree to liberal terms or definitions but rather, as he puts it, "Our function is to call the opposition on such hair-splitting nonsense, not to make the fog harder to pierce."

And this raises what I think is part of the problem. As Mark says, this is a massive political fight — one that conservatives are winning, by the way — and there's a natural tension between wanting to argue the finer points of policy and win the battle over the politics. I don't begrudge NR's attempt to get this balance right by erring on the side of describing the policy correctly and in good faith. But, also in good faith, I don't see it quite the same way, and I don't think Palin's contributions are part of the problem with the health-care debate.


100 or So Days Later... [Jonah Goldberg]

While working on a column yesterday, I went back and found what I wrote on the occasion of Obama's first 100 days, when for the editors of Newsweek (henceforth my shorthand for sycophantic Obama disciples) birds were chirping, the sun was shining, all was looking wonderful in the world. It was the greatest first 100 days ever. Looking at the news that conservatives now outnumber liberals in every state, tens of thousands are quitting AARP, James Carville is floating the idea of scrapping the healthcare bill entirely, Obama is (maybe) abandoning the public option — just as he has the death panels supervisory commissions on when to cease continuing life —- and all the rest, it seems that what I wrote was a bit prescient and also a bit understated:

...Obama has proved to be, if anything, more of a left-wing culture warrior than Bush was a right-wing one. All the while, Obama transmogrifies his principled opponents into straw-man ideologues while preening about his own humble pragmatism. For him, bipartisanship is defined as shutting up and getting in line.I’m not arguing that conservatives are poised to make some miraculous comeback. They’re not. But American politics didn’t come to an end with Obama’s election, and nothing in politics breeds corrective antibodies more quickly than overreaching arrogance. And by that measure, Obama’s first 100 days have been a huge down payment on the inevitable correction to come.

Update: From a reader:

Jonah,Don’t forget this part of your prediction—“For him, bipartisanship is defined as shutting up and getting in line.”

And here’s what our President has to say about freedom of speech and political dissent:"I don't want the folks who created the mess do a lot of talking. I want them to get out of the way so we can clean up the mess. I don't mind cleaning up after them, but don't do a lot of talking."