Healthcare: Of course there will be death panels

Dr. Tracy C. Miller's picture

Recently the debate about “death panels” has been heating up as Republican Congressional leaders express their opposition to implementing the Independent Payment Advisory Board (IPAB) by refusing to appoint members to serve on it.

The IPAB, which was referred to as a death panel by Republicans during the 2010 Congressional elections, is a committee that was to be created as part of healthcare reform and consists of 15 full-time members appointed for staggered six-year terms.

The IPAB must provide a report to Congress about how to hold Medicare spending within legislated limits. Congress is given a strict timetable within which it must consider the board’s recommendations and either vote to accept them or come up with alternatives that achieve comparable savings.

Although the IPAB might not be the best way to do it, as long as the government pays for healthcare, someone must have the responsibility of making decisions about which healthcare will not be paid for even in cases where the care might prolong the person’s life.

Although intended to be a pejorative term, the term “death panel” accurately reflects decisions that have to be made about whom to save when resources are scarce. We simply do not have the resources to provide as much healthcare as people might desire for prolonging their lives or the lives of their loved ones.

If government pays for healthcare, as it does for Medicare and Medicaid beneficiaries, limited funds necessitate that sometimes people will be denied access to care. If the decision of who does and who does not get care is not made explicitly by an appointed committee, it will be made by default as scarcity necessitates that some must wait in line for healthcare.

It is not hard to find tragic stories of Medicaid or Medicare beneficiaries who died because they could not get the care they needed.

In some cases, this is due to the fact that reimbursement rates are so low that those with urgent health problems may have to wait too long to get an appointment. In others, an explicit decision may have been made to deny coverage to someone.

When government or an insurance company pays the bill, scarcity necessitates that people cannot get all the healthcare they might want or need.

It might be better for an appointed board to decide the rules that determine when care gets paid for and when it does not, than for people to be told they are entitled to whatever care they need, but then end up waiting for treatment until it no longer does them any good.

In our market economy, if a board such as the IPAB decides that a certain treatment will not be covered by Medicare, that does not mean that a patient who desperately needs the treatment cannot get it. If something is not covered by Medicare, those who are willing and able to do so may pay out of their own pockets so they or their loved ones can get the healthcare they need.

Republicans, or anyone else opposed to the idea of death panels, should be consistent. They should either support elimination of healthcare entitlements, particularly Medicare and Medicaid, or support changing them into defined contribution plans, where government contributes money toward health insurance premiums and lets insurance companies decide what is covered and what is not.

This way, those covered by Medicare and Medicaid would at least be able to have some choice about who makes those decisions and how they are made. As long as they are counting on a third party to pay for their healthcare, Americans should not expect to be able to get as much care as they want or need regardless of cost.

If government is going to continue to pay for healthcare entitlements, the question is not whether some people will be denied healthcare; it is about who makes the decision and how the decision is made.

Rather than pretending that it is possible for the government to spend whatever it takes to provide unlimited healthcare for all, the pertinent question is what are the rules and procedures for deciding and who are the ones assigned to interpret the rules about who gets care and who does not.

Those who supported the politicians who gave us Medicare, Medicaid, and healthcare reform should not be surprised that those in charge of those programs want the power to make those life and death decisions and might make them in a way that goes against the principles we believe in.

[Dr. Tracy C. Miller is an associate professor of economics at Grove City (Penn.) College and contributing scholar with The Center for Vision & Values (www.VisionAndValues.org). He holds a Ph.D. from University of Chicago.] © 2013 by The Center for Vision & Values at Grove City College.

Cyclist
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Healthcare and Illegals

I know, I know, Pelosi and the other "liberal elite" have said that illegals will not have access to Obamacare. However, I've seen the TV commercials in Southern California asking why is this discrimination against illegals allowed to exist.

Who inside the beltway will standup and say the US can't afford it?

http://www.youtube.com/watch?v=yXzW91TfwCs

Lets see how this plays out.

PTC Observer
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Cyclist - You

know how it's going to play out. As soon as the current "undocumented" get their right to vote.

Cyclist
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PTCO - And that will

.....probably happen before you know it.

I remember when Obama said we are a nation of laws.

PTC Observer
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Cyclist - Mr. Obama

is correct, we are a nation of laws and citizens that follow them because they must.

"There is no worse tyranny than to force a man to pay for what he does not want merely because you think it would be good for him."

― Robert A. Heinlein, The Moon is a Harsh Mistress

conditon55
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Should we bankrupt the country

THe health care industry play on the emotions of th epeople selling fear. Why ? they are additicted t othe drug of easy federal dollars. Dollars paid to reimburse for 'health care services rendered' But what about the value of those services ? What about the appropriateness of the services.

The health care industry is addicted to federal dollars. As such they cannot police themselves. So cost spiral out of control. Who pays? You pay and I pay in taxes.

$16 trillion dollars in debt, the health care propoganda spewa forth unabated.

But even GOP senators and representatives know the well has a bottoom and we ar damn near it. Some thing has to get and why not blam Obama ? Never mind George Bush had 8 years and did nothing.

There is nothing special about the health care industry as a system to milk the federal government money cow dry.

SO is it worth bankrupting the ocuntry to fund a few fat cats? Or does the coutnry belong to the poeople ?

When you read the rant about Obama is the spawn of the devil and the Obamacare is the ruin of the nation, ask where dpoes the opinion come from and what are they selling, and what is the viable alternation option ? Cause in all of the rants, I do not see it.

albion
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Palin's death panel nonsense...

... started in 2008 and not the 2010 mid-terms, has been thoroughly debunked. Asserting otherwise is simply admitting to the world that you are either under informed or overly politicizing an otherwise minor bureaucratic oversight panel. Get over it.

S. Lindsey
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Nothing to see here move along...move along...

"A top Democrat strategist and donor who served as President Obama’s lead auto-industry adviser recently conceded that the rationing of heath services under Obamacare is “inevitable.”

Steven Rattner advocated that such rationing should target elderly patients, while stating, “We need death panels.”

http://joemiller.us/2012/10/obama-adviser-admits-that-obamacares-death-panels-are-inevitable/#ixzz2VxiE1R7x"

Paul KRUGMAN: "The advisory path has the ability to make more or less binding judgments on saying this particular expensive treatment actually doesn’t do any good medically and so we’re not going to pay for it. That is actually going to save quite a lot of money. We don’t know how much yet. The CBO gives it very little credit. But most of the health care economists I talk to think it’s going to be a really major cost saving."

albion
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That's right more nothing

For those that prefer context over cherry-picking, here's the link to the Rattner op-ed: http://www.nytimes.com/2012/09/17/opinion/health-care-reform-beyond-obam...

Major cost savings... how dreadful!

kcchiefandy
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The context is, albion...

...that it's like 'Logan's Run' for those under the Gov't medical care - unless you win the lottery, there will be a decision by the Gov't as to when it's time to end your life (or in less harsh terms, "quality-adjusted life year system to put an explicit value on a treatment’s ability to extend life"). It sounds like lawyer-speak for 'death panel decision'.

Let's hope & pray it's not your, or my, parent or child who is subject to the 'quality-adjusted life year system'. If not, who cares; ain't my problem, right?

albion
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Except for the fact...

...that the Affordable Care Act is not government healthcare, and the entirely appropriate end of life counseling language was removed from the bill over the hype created by the death panel fear-mongering. Insurance companies, historically in charge of denial of service decisions, have been reined in to some degree by this legislation. However, they are still in the profit business and would rather collect premiums and deny claims then shell out. Perverse incentives.

S. Lindsey
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Not Government Healthcare????

Let's see...

Run by the Government...Check
Managed by the Government...Check
Created by the Government...Check
Enforced by the Government...Check

Walks like a duck...quacks like a duck...looks like a duck... Albion believes it's a water buffalo.

albion
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Absolutely SL

Legislated and regulated by the government. Yes. However the care part of the healthcare comes from civilian providers and you can keep your own insurance if you choose. If you don't have employer based insurance or can't afford it, you can opt for assistance. The choices exist.

With regard to IPAB's, the so-called death panel, the law says "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums ..., increase Medicare beneficiary cost sharing..., or otherwise restrict benefits or modify eligibility criteria."

By law, no care rationing, hence no life or death decisions allowed, by law. What other evidence is needed to dismiss this idiotic Palinism?

It's a simplistic reduction to call it government healthcare, but it suits your purposes, so I understand why you would choose to use this distortion.

S. Lindsey
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Yeah Rightttttt.....

Facts are in evidence albion... no matter how you attempt to disassociate from it...

kcchiefandy
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SL, I was going...

...to reply 'ok, how about Government DIRECTED health care', but just decided to leave it alone. Supporters of our Orwellian masters will never concede that this is a bad thing...

S. Lindsey
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kcc...I know..I know... ***sigh***

There will always be those willing to sell their Freedom for some perceived safety. In this case perceived safety of responsibility.

As long as people are willing to be slaves there will never be a shortage of Slave Masters.

albion
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Which freedom has been diminished?

Is it the 105 million Americans that no longer have lifetime dollar limits on their coverage, or the millions of children with pre-existing conditions that can no longer be denied coverage?

Oh not those, maybe it's the private insurers proviiding coverage for nearly 174 million Americans having to justify double-digit premium increases, and nearly 76 million Americans covered by insurers who are now required to spend at least 80% of premium dollars on health care? I got a rebate from my insurer for this last year. I wasn't less free as a result.

Could it be The 360,000 small businesses that received a tax credit in 2011 to help them pay for health insurance for an estimated 2 million workers? They must feel terrible about their loss of freedom.

Oh this must be it: 54 million Americans now can receive a free preventive service, such as cancer screenings, through their private insurance plan. They're not free to get undetected cancer.

Is it the 3.1 million young people having coverage on a parent’s plan through age 26? I suppose they should be left to be free to have no coverage when they can't find a job (that Congress hasn't created because they're too busy spending taxpayer $'s on futile repeal votes) after college and having huge student loan payments to make.

Perhaps it's the more than 50,000 Americans with pre-existing conditions that have gained coverage through the new Pre-Existing Condition Insurance Plan? No?

How about the 3.6 million people that received a 50% discount—worth an average of $604 each—on brand name prescription drugs after hitting the Medicare donut hole in 2011, or the more than 32.5 million seniors that received one or more free preventive services?

None of those? Really? Then it's got to be the average person with Medicare saving about $4,200 from 2011 to 2021 and those with high prescription costs saving up to $16,000. Yeah that must be it. They're not free to be victimized by for-profit insurers because they need life saving drugs!

Wow, this freedom thing is tricky!

kcchiefandy
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Impressive numbers, albion...

...and no one can argue that our medical system could use some overhauling. So, since you apparently have coverage, for health insurance companies to compensate for losses for mandated increased coverages, you're ok to have your rates increased to account for that, right? Or, since the insurance industry is bent on bilking clients and limiting/denying coverage, we should let the gov't do that (ref. previous comments)? It's really one or the other; free market or gov't control. In the current state of our union, it's the latter. You didn't like the rebate from your insurer last year? We can fix that; we'll legislate that they can't do that to you and grant you a tax break for what we think is the difference. Btw, who's paying for all these increased coverages you provided?

The simplistic, easy answer is to socialize medicine, or just increase the national debt to unsustainable levels. Having the most outstanding medical abilities in the world have truly become a burden.

albion
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My point is the freedom argument

It' s bogus. Freedom is not affected on way or the other.

My rates have always been affected by the uninsured. I'd rather it be on the books than off. The free market has failed with respect to healthcare.

I appreciated the fairness of the rebate I received. I didn't indicate otherwise, and I didn't provide any additional coverage. Not really sure what you're on about there.

Costs need to be adressed. Continually. Universal healthcare IS the answer. You want to call it socialized, OK, I'm down with that.

S. Lindsey
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...and again
albion wrote:

Freedom is not affected on way or the other.

So if the Government forces you to buy something OR assesses a penalty for not doing so you think your Freedom has not changed?

albion wrote:

Universal healthcare IS the answer. You want to call it socialized, OK, I'm down with that.

That you are OK with Socialism is something that was never in doubt..

albion
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Socialized healthcare...

... and socialism are not the same thing. There are many non-socialist nations with socialized healthcare.

We elect politicians in a representative government, they legislate, and then we are subject to the effects of the legislation and associated regulations. This IS our particular form of freedom. You just want to pout and moan when the legislation is not to your liking. You and I have not ceded any freedom. Our system is intact. Although the process is a bit broken.

A majority of Americans and elected officials agree with the discrete principles codified by the ACA. It's only when BS assertions of death panels are tossed about that polling shows opposition. Opposition to made up stuff doesn't count for anything.

So I take it you would rather pay for emergency room coverage of the uninsured through your higher premiums, as you have been doing, than to have them pay for their own coverage? Is that more like freedom for you?

S. Lindsey
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When you refuse to acknowledge facts...

...already in evidence then there can be no discussion. Socialized Healthcare IS Socialism... Plain and simple... It is one step away from Single Payer and Nationalized Healthcare.

So albion if those politicians "legislate" that Religious Freedom in this Country really means everyone has to be Mormon... would that be OK with you?

Somehow I doubt it... So just because they "legislate" does not make it right nor Constitutional.

No moaning and no pouting... just plain old facts.

Most of America does not want Government involved in our healthcare..

Somehow you believe because Government is involved prices will go down and we will all share in the bounty of Government largess. The real truth is you can't add 30-40 Million new people to a limited supply chain and expect it not to break. It cannot happen...

Remember the passage of this "act" was supposed to make healthcare less expensive...

But the reality is... Cost are going up.. way up and fast. Why?

albion
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A clear lack of understanding

Single payer universal healthcare is not socialism. Just because you assert that it is doesn't make it so. Your ridiculous Mormon counter point notwithstanding, Obamacare has proven to be constitutional. Most Americans don't agree with your "most Americans" arguement. Nice try. Do some homework. Nationalized implies government care providers. That's not what we have here.

Public health care in other industrialized countries tends to be more affordable than in the US. We spend so much because our health care system is more complex and thus more costly. Universal health care or single payer by its nature reduces administrative costs. It's a proven model.

California has already demonstrated the cost savings realized from Obamacare. Nathan Deal is hurting the people of Georgia and he will eventually have to face the facts that his opposition to cost savings won't stand up.

Actual costs are not going up. Insurers might be trying to jack up rates, but they're now being penalized for their vulture capitalism. Profiting off of sick people is morally objectionable, but you seem to be an advocate. Like many, you'll use it when it benefits you and won't see the irony.

S. Lindsey
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albion

You claim I do not understand but yet all you have done is give us talking points. You don't like the term Death Panels yet even one of the architect's of Obamacare Sen. Baccus said this is going to be a "Train Wreck" His words not mine...

"A senior Democratic senator who helped write President Obama's health care law stunned administration officials Wednesday, saying openly he thinks it's headed for a "train wreck."
"I just see a huge train wreck coming down," Senate Finance Committee Chairman Max Baucus, D-Mont., told Obama's health care chief during a routine budget hearing that suddenly turned tense."

http://www.foxnews.com/politics/2013/04/18/top-dem-sen-baucus-warns-trai...

The recent denial of a 11 year old child to get a double lung transplant by Sebelius of the Heath and Human Service (A PANEL)just because it wasn't beneficial and not likely to succeed.

So let's examine this... A PANEL specifically it's director said "Some will Live and some will DIE". She denied the appeal to have the operation regulations relaxed...so HHS decided the child would DIE..

Ergo.. A Panel decided a child was to die... Thus A Death Panel.

You can call a pig a Rose...but it's still a Pig no matter how much lipstick you put on it.

That is what I understand...

Definition of SOCIALISM by Merriam Webster...

1. any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods..

Now... If the Government by force of taxation or penalty forces you to buy a product and insurance IS a product AND the product is "UNIVERSAL" AND created by Government, directed by Government and controlled by Government... then does this not meet the definition of Socialism above?

...and if you don't think so then why not?

albion
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Straw man alert

BS. Tiresome and tone deaf.

Government does not "own" the healthcare industry. Nor do they "administrate" care. Apparently you can read and quote from the dictionary without understanding the meaning of the words. Hopeless! Please resume your downward spiral unabated.
[walks away shaking head]

S. Lindsey
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Don't go away mad... just go away

We really don't need your big Government styled Socialism...

Thanks for playing...

BTW-Who owns Obamacare?

Who created it?

Who oversees it?

Who enforces it?

You don't want to answer these questions because then you have to actually THINK and once you do that you realize just like with GM GOVERNMENT OWNS THEM...

Now what was that definition of Socialism?