Washington is all atwitter about "death panels": President Barack Obama derides the idea that his healthcare reform calls for them; the Senate is stripping "end of life" counseling language from its bill — and last Friday the voice of the liberal establishment, The New York Times, ran a Page One story "rebutting" the rumor that Obamacare would create such boards to decide when to pull the plug on elderly patients.
But all those protests miss the fundamental truth of the "death panel" charge.
Even without a federal board voting on whom to kill, Obamacare will ration care extensively, leading to the same result. This follows inevitably from central features of the president's plan.
Specifically, his decisions to (1) pay for reform with vast cuts in the Medicare budget and (2) grant insurance coverage to 50 million new people, vastly boosting demand without increasing the supply of doctors, nurses, or other care providers.
Whether or not he admits it even to himself, Obama's talk of cutting "inefficiencies" and reducing costs translates to less care, of lower quality, for the elderly. Every existing national health system finds ways to deny state-of-the-art medications and necessary surgical procedures to countless patients, and Obamacare has the nascent mechanisms to do the same. With the limited options that Obama's vision would leave them, many will find that "end of life counseling" necessary and even welcome.
"Reform" would cut care to the elderly in several ways: Slash hundreds of billions from Medicare spending, largely by lowering reimbursement rates to doctors and hospitals for patient care.
If a hospital gets less money for each MRI, it will do fewer of them. If a surgeon gets paid less for a heart bypass on a Medicare patient, he'll perform them more rarely. These facts of the marketplace are not only inevitable consequences of Obama's cuts but are also its intended consequence. Without them, his savings will prove illusory. Expanding the patient load by extending full coverage to 50 million Americans (including such "Americans" as illegal immigrants) without boosting the supply of care will force rationing decisions on harried and overworked doctors and hospitals.
People with insurance use a lot more healthcare resources — so today's facilities and personnel will have to cope with the increased workload. Busy surgeons will have to decide who would benefit most from their treatment — de facto rationing. The elderly will, inevitably, be the losers. The Federal Health Board, established by this legislation, will be charged with collecting data on various forms of treatment for different conditions to assess which are the most effective and efficient. While the bills don't force providers to obey the board's "guidance," its recommendations will still wind up setting the standards and protocols for care system-wide.
We've already seen Medicare and Medicaid lead a similar race to the bottom with their formularies and other regulations. With Washington dictating what every policy must cover and regulating all rates, insurers, and providers will all have to follow the FHB's advice on limiting care to the elderly — a de facto rationing system. In assessing whether to allow certain treatments to a given patient, medical professionals will be encouraged to apply the Quality-Adjusted Remaining Years system. Under QARY, decision-makers seek to "amortize" the cost of treatment over the remaining "quality years of life" likely for that patient.
Imagine a hip replacement costing $100,000 and the 75-year-old who needs it, a diabetic with a heart condition, is deemed to have just three "quality" years left. That works out to $33,333 a year — too steep! Surgery disallowed! (Unless of course, the patient has political connections . . . )
Younger, healthier patients would still get the surgery, of course. The QARY system simply aims to deny healthcare to the oldest and most infirm, "scientifically" condemning them to infirmity, pain, and earlier death than would otherwise be their fate.
In short, Obamacare doesn't need to set up "death panels" to make retail decisions about ending the lives of individual patients. The whole "reform" scheme is one giant death panel in its own right.
© Dick Morris & Eileen McGann