Concerning the "Death Panels" in H.R. 3200

Sarah Palin has written a detailed response to Obama's fervent denial that the mandatory end of life counseling in H.R.3200 is nothing like a "Death Panel".

Her article on Facebook is titled, Concerning the "Death Panels" and it contains exact references for her statements.

One of the things that shows me how hollow Pelosi's and Obama's promises are is the fact neither ever quotes page reference for the positions they are taking. It may be that neither of them has read the entire bill and are relying on the words of others, but I think their denials are intentionally evasive.

To me, the strongest indication of devious intent by the bills supporters has been the voting down of amendments that would specifically prohibit rationing of heath care or would deny free health care to illegal immigrants. Amendments that would have clarified the intent of this bill have been voted down on party lines.

Confusing language is not a "bug" in this bill, it is a feature. If the law is "silent" (meaning non-specific) the general practice is to continue prior practice or let judges decide. If we have a 1000 plus page bill that is confusing, there is a very good reason for it being written that way.

I have set myself the target of reading this bill and it's amendments so I can get a more comprehensive view of what is actually being proposed. Secondhand viewpoints, even from trusted writers, reflects their reality and is not necessarily true.

Feel free to take my views with a grain of salt as they are not true for you unless you have verified the facts yourself.

Comments

[Julian Gall]

The underlying problem with most health care systems is the cost. In Britain, where I live, new medicines and treatments are evaluated according to objective criteria by the National Institute of Clinical Excellence. A very expensive drug that has limited benefit for a small proportion of patients who might be given it, won't get approved. This means that the limited money available (from our taxes) is used for the treatments that bring the most benefit. I'm not sure how it could be otherwise.

I'm interested to know what health insurers in the US do. Is any new drug automatically available for the insured? I assume not or costs would increase uncontrollably. Presumably, each insurer makes their own decision.

It is interesting to see how the British National Health Service (NHS) is viewed with horror in some parts of the current debate in the US. Here, we are presented with a horrific view of the US system when anyone suggests changing the NHS!

The NHS has many faults and there may be far better systems in other countries. For example, it is wasteful and bureaucratic. However, it seems to me a fundamentally humane concept. Anyone who is ill gets treated based on their need. Nobody loses health cover because they lose their job or can't keep up insurance payments. Nobody has a problem getting treated for a pre-existing condition. Nobody, actually, is refused treatment because they are too old etc. If a woman gets pregnant, she gets the same access to a hospital birth as anyone else - it doesn't depend on payment of premiums by the woman or her employer. If someone is ill for years, they never need worry about treatment stopping. If a couple have a child that needs expensive treatment, this doesn't become the major financial factor in their life from then on.

In addition to all this, private health care flourishes in Britain and many companies pay for cover for their employees all or in part.

I would hope whatever is being proposed for the US builds on the best practices from around the world. I am generally not in favour of the state interfering in people's lives and I do wonder if a national health service can ever be made to operate efficiently. However, I haven't seen any alternatives that don't have major problems of their own.

On the specific subject of "Death Panels", what do US health insurers do when someone gets old. Do they pay for ever increasing treatment costs with smaller and smaller benefits? If a treatment might extend the patient's life by a couple of months, will they pay for it? Who makes the decision?

[mattbg]

I know very little about this situation, but didn't Obama pledge to make a simpler tax code? Simpler college applications? He is sending out simple messages, but how is a 1200 page document compatible with this?

It seems that moving toward "transparency" causes the useful information to become buried in large documents that very few people will read. One way or another, the information is inaccessible.

One thing is certain, though: you discuss issues a whole lot more, and in more depth, in the US than we do in Canada. The level of political debate in Canada is embarrassing.

[mattbg]

Julian, the problem with being humane via a large and self-determining bureaucracy is that it costs too much. I expect Britain will discover this in the short-term, with so many people being employed by the government, paid for by shrinking tax revenue -- much of which goes to the healthcare system, it being the largest employer in the UK.

As soon as you decide that you will save lives to the best of your ability no matter what, you are stuck struggling against the never-ending growth of available remedies and treatments. We won't stop innovation, so where does it end?

The problem for me is that a population will vote to no end to keep a free healthcare system going, even as a country plunges deeper and deeper into debt. In Canada where I live, for example, and where we have a public system in which it's illegal to offer private healthcare, 43 cents of every tax dollar go toward healthcare. The concept of public debt is becoming dangerously separated from the individual consciousness. Government debt is our own debt and not somebody else's problem, though the latter is becoming a popular way of thinking.

Another problem that most European countries will soon wake up to if they haven't already is that their social spending makes them beholden to continually increase the size of their population in order to pay for the promises of these programs, even if their natural birth rate is in decline. This means massive immigration and a fast deterioration of national identity and cohesiveness, and it must occur regardless of whether or not the economy can absorb the influx because the promises of the past must be paid for with current tax revenue.

[Julian Gall]

Matt is right. Cost is certainly the issue. However, the US system is, I believe, the most expensive in the world. The issue of cost is not exclusive to state-funded systems.

[GBGames]

Check http://www.whitehouse.gov/realitycheck/7

In the short video there, there is mention of an exact reference: Section 1233 of the bill.

I checked the section. End-of-life services is there. Unless people are interpreting that to mean euthanasia, which no one who knows what it is actually believes, it is a GOOD thing.

Every 5 years, a senior citizen gets to discuss his/her options with his/her doctor. It can be more often if the health of the patient is changed significantly. It describes how it will be paid for, and it says that standards will be in place to measure how effective any care applied is, whether palliative or otherwise. Presumably with measurements in place, the plan can be improved by getting rid of what doesn't work and doing more of what does. It makes sense in business, and it makes sense here.

So seniors and their families basically get to talk to their doctor about their options, the plan pays for the consultation, and the plan is measuring effectiveness.

Where is the euthanasia section? It doesn't exist, but "death panels" has a nice emotional charge to it. And unfortunately emotions are more important than facts, so the section was removed from the bill. Now terminally ill seniors have to pay out of pocket if they want to discuss palliative measures with their doctor? A nice basket for Palin.