|
|
|
|
Paul Krugman and "Death
Panels" Part Two of Three By Dave Andrusko I had just settled into my chair at work yesterday when my phone rang. The call was from a dear friend, someone who is familiar to veteran pro-lifers: civil libertarian Nat Hentoff.
Over the decades, Nat has written eloquently about abortion and particularly about the ghastly cases where nutrition and hydration were withheld from babies born with severe--and in some cases, not so severe--medical problems. He called to ask me if I had heard about what New York Times columnist Paul Krugman had said Sunday on ABC's "This Week with Christiane Amanpour." Krugman's been busy trying to put a happy face on what he said, but let's first, see what he said on the program's roundtable discussion. The topic was the recommendations of the Debt Reduction Commission. Amanpour says, "But what is going to happen? I mean, are you clear on where a compromise is going to be? It's got to be discussed before the end of the year, no?" Krugman responded, "No. Some years down the pike, we're going to get the real solution, which is going to be a combination of death panels and sales taxes. It's going to be that we're actually going to take Medicare under control, and we're going to have to get some additional revenue, probably from a VAT [Value Added Tax]. But it's not going to happen now." Following the show Krugman wrote on his blog (which Hentoff , a genuine liberal, pointed out is ironically titled, "The Conscience of a Liberal") that he was going to "clarify" what he characterized as "deliberately provocative." Krugman's explanation begins with "health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they're willing to pay for -- not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we're willing to spend for extreme care." That's a mouthful in only a few words. Let's begin with "not really death panels" and Medicare/Medicaid "decid[ing] what they're willing to pay for." The original use of the term "death panels" referred to a provision in the House bill (not included in the legislation that was ultimately enacted) that would have provided reimbursement under Medicare for health providers to discuss advance directives (such as the "living will") with their patients. Critics feared that doctors would be paid to push patients into rejecting life-saving medical treatment so as to save the government money. By and large, private insurers follow the same general approach when deciding to cover services. However, a good candidate for the title of "death panel" is the obscurely named "Independent Payment Advisory Board." This board will reach into every corner of the private (not just government) health care system to limit what Americans can spend to save their own lives. The board's mission is to force what we are allowed to spend below the rate of medical inflation though the use of "quality" and "efficiency" measures. What this amounts to is that doctors, hospitals, and other health care providers will be told by Washington bureaucrats just what diagnostic tests and medical care is considered to meet "quality" and "efficiency" standards not only for federally funded health care programs like Medicare, but also for health care paid for by private citizens and their nongovernmental health insurance. And these will be standards specifically designed to limit what ordinary Americans may spend on health care so that it cannot keep up with medical inflation. Treatment that a doctor and patient in consultation deem needed or advisable to save that patient's life or preserve or improve the patient's health but which the government [Medicare/Medicaid] decides is too costly will run afoul of the imposed standards – even if the patient or the patient's insurance is willing and able to pay for it. Second, what did Krugman mean by "medical effectiveness"? This is misleading because he does not mention that Medicare ALREADY pays for "medically necessary" treatments, which Medicare defines as ones that (1) are proper and needed for diagnosis, or treatment of your medical condition; (2) are provided for the diagnosis, direct care, and treatment of your medical condition; (3) meet the standards of good medical practice in the medical community of your local area; and (4) are not mainly for the convenience of you or your doctor. However, there are major dangers if you only want to pay for the most "medically effective" treatment or penalize doctors who do other things first based on that patient's individual profile. That quickly gets you into the whole arena of so-called "Quality Adjusted Life Year" and the dangerous uses of "comparative effectiveness." Both put elderly populations in a very dangerous predicament. There is a reason Krugman's comments raised a hornet's nest. They should have. Please send your comments on Today's News & Views and National Right to Life News Today to daveandrusko@gmail.com. If you like, join those who are following me on Twitter at http://twitter.com/daveha. |
