I figured it was about time that I got back to the health care series and began answering some of the questions that are out there. You all presented a plethora of things that you wanted me to research and I have been attempting to read everything I can in order to find some answers. Tonight I am going to talk about one of the hot button issues that seemed to stoke the fires at the town hall meetings. It seems there was a lot of sentiment out there for the fear of government creating death panels that will decide life and death for our elderly. I know that there is strong belief on both sides of this debate. Those on the left compare anyone who even asks the question to the “birther” movement and therefore state I am simply crazy for even giving any time to look deeper into the allegation. But I say failing to do some research and find out what government is really up to is as naive and crazy as anything I have heard. After all, with this group of 535 criminals running the show, Death Panels isn’t that far fetched of an idea.
Allow me to first add a disclaimer. There is no definitive health care reform bill out there. HR 3200 seems to be the version they were working hardest on, but there were 3 different bills in play in the House. Then there is the Baucus bill in the Senate. So it is tough to give direct answers here. What may be true in one bill may be false in another. Let’s start under the assumption that if it is in any one of the bills, it is under consideration, as at least someone in Congress was supporting the idea.
The idea of the death panels seems to have been the biggest driver of debate and divide among American citizens. Some of those on the right swear they exist in the bill. Those on the left characterize those folks as nut jobs. I know that I have seen several comments right on this site stating that Sarah Palin is both crazy and dangerous because she has come out claiming that death panels are real. I say that had the federal government not shown us on so many different occasions that they are capable of the most heinous acts imaginable, there wouldn’t have been so many people willing ot quickly believe that something like death panels was possible. So let’s get to the bottom of this question.
The death panels, as discussed, are panels of folks in the government that would determine the fate of those in need of medical care in the United State’s Health Care System. Hypothetically, if a 72 year old needs a $100k procedure to extend his or her life, this panel would determine how much and what level of care the senior in question would be eligible to receive. The premise being that the cost of the procedures would be weighed against expected return on investment. Can the senior further contribute to society? Questions like that. So let’s first see what part of the bill makes those making the claim feel that death panels are being created, at least according to the rhetoric.
A provision in the House bill written by Representative Earl Blumenauer (Democrat, OR), would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.
That in no way says anything about death panels or panels at all. So let’s be clear that the “death panels” as were reported are absolutely not in the health care bills being presented before Congress. The Associated Press and the New York Times went to great lengths to publish highly circulated articles to show what was actually said in the legislation being debated in Congress. In almost all of my searches for the truth around the claim of “death panels”, I was unable to find much of anything that actually said anything about these so-called death panels in any of the 4 bills that have circulated through Congress. The idea that these health care bills do anything along the lines of creating a panel that would have any say over what procedures or steps a patient can consider in seeking treatment, is patently false. I found no supporting evidence.
I do understand the arguments out there that say rationing is an inevitable result of the health care system being put in place. In fact I agree that rationing has been the result in every other country that tried this, so it is only logical that we would see it here as well. But rationing wasn’t the claim. Death Panels were the claim. Palin very clearly stated the following on her facebook site: “The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.” This was absolutely wrong of Palin to say. The health care bill doesn’t say anything about death panels. So she was lying, right? Simply making it all up. Showing the world how much of a dumb pageant girl she really is.
Not so fast….
All of you remember HR 1, right? That was the economic spendulus bill that I have railed about on many occasions. It seems that while politicians have adeptly pointed out that the death panels are nowhere to be found in the health care legislation being debated today, they conveniently leave out the fact that the council for comparative effectiveness was in fact created in the economic spendulus bill! I offer you this section, copied and pasted directly from the final version of the bill that can be found at the thomas.gov site linked at the bottom of this article (Highlights are mine):
In addition, $400,000,000 shall be available for comparative effectiveness research to be allocated at the discretion of the Secretary of Health and Human Services (`Secretary’): Provided, That the funding appropriated in this paragraph shall be used to accelerate the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies, through efforts that: (1) conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions; and (2) encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data: Provided further, That the Secretary shall enter into a contract with the Institute of Medicine, for which no more than $1,500,000 shall be made available from funds provided in this paragraph, to produce and submit a report to the Congress and the Secretary by not later than June 30, 2009, that includes recommendations on the national priorities for comparative effectiveness research to be conducted or supported with the funds provided in this paragraph and that considers input from stakeholders: Provided further, That the Secretary shall consider any recommendations of the Federal Coordinating Council for Comparative Effectiveness Research established by section 804 of this Act and any recommendations included in the Institute of Medicine report pursuant to the preceding proviso in designating activities to receive funds provided in this paragraph and may make grants and contracts with appropriate entities, which may include agencies within the Department of Health and Human Services and other governmental agencies, as well as private sector entities, that have demonstrated experience and capacity to achieve the goals of comparative effectiveness research: Provided further, That the Secretary shall publish information on grants and contracts awarded with the funds provided under this heading within a reasonable time of the obligation of funds for such grants and contracts and shall disseminate research findings from such grants and contracts to clinicians, patients, and the general public, as appropriate: Provided further, That, to the extent feasible, the Secretary shall ensure that the recipients of the funds provided by this paragraph offer an opportunity for public comment on the research: Provided further, That research conducted with funds appropriated under this paragraph shall be consistent with Departmental policies relating to the inclusion of women and minorities in research
Now I know that “comparative effectiveness” seems like a pretty harmless council to create. Don’t think for a second that the name was chosen randomly or in order to effectively tell us what the panel will do. As is the norm, any government creation is usually given a name that tells you nothing about what that creation actually does. And this time is no different. So I had to ask myself what this council does. I start with the bolded brown highlights.
research assessing the comparative effectiveness of health care treatments and strategies, through efforts that: (1) conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions
Sounds harmless enough, right? I don’t think so. The word that I highlighted was the one that stood out to me. The group will determine the appropriateness of the medical procedures. That doesn’t equal a death panel. But I do start to have the hairs on my neck go up when I am told that the federal government is going to conduct a study to determine what procedures are appropriate. I stand by the belief that doctors determine appropriateness. Government determining appropriateness, in my opinion, opens us all up for government telling us we can’t have a procedure under their health care system because they don’t deem it the appropriate procedure. But I do agree, this in and of itself, does not back up Crazy Sarah’s death panel claim. It does make her claim seem a little less crazy, though.
So the next question I had to ask myself is what else can we find out about this comparative effectiveness creation. Who was behind it and what is their vision for what it will be? Interestingly, the council is the brainchild of one Tom Daschle. Oh, you all remember Tom. He was the administration’s first nominee for the Secretary of Health position. He didn’t pay $128,000 in taxes and had to withdraw his name. Too bad too. The Senate was expected to confirm him despite his criminal actions. I wrote about it HERE . At any rate Good ole Tom was the brain behind this being put in the stimulus bill. So what does Tom have to say about his vision of the panel?
Fortunately for us, Tom Daschle wrote a book in 2008 that distinctly outlined both what this council will be and the changes to the health care system in America that are needed. The book was titled Critical: What We Can Do About the Health-Care Crisis. According to Tom, the goal is is to slow down the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system. Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. (I have admittedly not read Dachle’s book. All of these comments from the book were, however, discussed on the Senate floor by Senator Burton of Indiana, so I am assuming them to be accurate, as they were not challenged on the Senate floor).
Now this is a little more disturbing. It seems that Daschle’s vision for the council that was created in HR1 was modeled after the UK panels that use a cost effectiveness formula, dividing cost by number of years of benefit. That bothers me. I also read on several sites that HR1 has language that supports this type of change. The most common claim was that HR1 changes Medicare from a system of approving based on “safe and effective” and changes it to a cost effectiveness standard set by the Federal Council. None of those claiming this offered a page of the bill to check (all except the one listed in the links below, and her page numbers were incorrect) and I didn’t have time to go back and re-read the entire 1000+ pages again looking for it. So consider that claim to be with a grain of salt as it is unverified.
So where does this leave us? It leaves us with a few things. First, politicians can rightly claim that the death panels are not in the health care bills. That is fact. Second, Daschle’s version of the UK rationing panels is in the Economic Spendulus bill. That is also fact, but it took looking at Daschle’s book to realize that… very clever of him. As a side note, it is not surprising that this was tucked in HR1. Daschle wrote, prior to the 2008 elections, that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.” He was completely comfortable slipping his nationalized health care ideas behind the backs of Americans. Any Senator who says something like that cannot be trusted. Period. And doesn’t this sound awfully similar to the Senate Majority Leader’s threat to use reconciliation to pass health care reform because it is too important to be stalled by something as silly as rules of Senate debate?
Third, I want you to refer to the shaded pink sections of the spendulus bill passage. I pointed them out for a different reason. I want you to note the ambiguity that is intentionally put into federal legislation. They want to tell you that it is 1000+ pages to dot every i and cross every t. Yet this one page from that bill is laden with ambiguity in terms of timelines, rationale, and requirements. This is done on purpose. If you think Congress can interpret something as simple as the Constitution of the United States in so many despicable ways, imagine what they can do with language like this. What exactly does within a reasonable time, as appropriate, and to the extent feasible actually mean? Remember that for every page in this 1000 page bill, another couple thousand pages will be written into government agency protocols, directives, and rules. And none of those hundreds of thousands of pages will be scrutinized by the public or appear on C-Span. Ambiguity here allows the government TONS of latitude to screw us everywhere.
As more Americans delve into the disturbing details of the nationalized health care plan that the current administration is rushing through Congress, our collective jaw is dropping, and we’re saying not just no, but hell no!
I guess the question I have is whether we simply made an assumption when we judged her on her statement about the death panels. We assumed that she meant the health care bills. And that made her a liar. But perhaps she expected everyone to be a little smarter and understand that “delving into the disturbing details” meant to do so in the same way we have done here, looking much further than the language of a single bill. It is obvious that when we do that, the claims of death panels may not be fully substantiated, but they certainly are not quite as put to rest as we might first assume. Perhaps Sarah isn’t quite as dumb as the left would like to make her seem. I know Ray will answer that my defending her in any way is part of some secret obsession with Palin (he has made that claim several times already). But that is not the case. I simply have the ability to eliminate my bias on the matter and judge based on what I find.
My final analysis is this: I am not ready to say that the death panels being screamed about are an accurate way to portray anything that the federal government is proposing. I am not sure that it would even be fair to call the existing and proven UK panels as “death panels.” There simply isn’t enough evidence to prove that the path the government is taking, no matter how convoluted, is leading to a group of government lackeys sitting around deciding who will live or die and telling grandma she is out of luck. The evidence just isn’t there, despite the fact that some of the players involved (Tom Daschle, Ezekiel Emanuel) are absolutely proponents of rationing care to the elderly. So I officially say that the idea of death panels is false. As a judge I would throw this case out for lack of evidence….
And then I would keep my eyes really open to see if anything more concrete pops up that points to rationing panels in the future. The evidence isn’t there. But I trust these 535 hyenas about as much as I trust Michael Vick to pet-sit my puppy.
Some Articles I used for research (admittedly my computer shut off during writing and I lost track of one or two, so if you want more information on anything I said, let me know and I will search for it again)