|In Praise of Death Panels: A Modest Proposal
||[Sep. 3rd, 2009|04:24 pm]
The American Caliban
The current conflict over health care policy in the U.S. is painful to watch. One of the bizarre and dishonest claims made by opponents of the President's plan is that it would result in "Death Panels." By this they mean that the aged or those with life-threatening diseases may be forced to endure a kind of star chamber in which officials will determine their fate, rather than the supposed current situation in which patients can choose their own path.
This isn't in the plan, of course. It's a dishonest propaganda claim intended to stir up fear.
However, the death panel is a fine idea and I support its introduction as soon as possible.
As things stand today, decisions on treatment alternatives result from a murky process. The health plan, the physicians, the patient, and other agents are all involved somehow. Sometimes patients don't get all the information they need to make an informed decision. Other times physicians aren't given authority to make their own decisions because they are employed by the health plan. And other times the health plan declines to authorize treatment. Finally, the health plan and other care providers employ cost control experts who also act as advisers, whose job it is to reduce expenditure. This last is called Utilization Review.
Who decides who lives or dies? Who decides how much pain is worth how much money? Who decides what is cured and what is only managed? The process produces different results each time, and we see its workings as through a glass, darkly. One patient may get the newest drug or surgery, another may get a less effective treatment, another get no treatment at all, and another may wait so long for the decision that Nature finishes the argument. I personally have seen an HMO slow down on paperwork in hopes that the patient may die before an expensive and possibly life-saving surgery is scheduled. The patient and family had no idea.
Now let's imagine a Death Panel. This would include a judge, a medical doctor or highly skilled nurse, a medical social worker, and at least one outsider such as a publicly selected juror or an elected official. They would review the documents and the patient's state of health, hear statements from the patient and family and involved physicians, and converse with the payer, whether it is government or private.
Then they could issue the decision: what treatment, if any; eligibility for organ donations; end-of-life counseling. All of it. The decision could be appealed to a higher court, or even to an executive authority. But it would be final.
This is in every way preferable to the current situation. Someone under 65 who becomes ill now is at the mercy of an opaque bureaucracy that does not have the patient's best interests at heart. Decisions are made by employees hired specifically to reduce costs. Physicians and other medical professionals are not given freedom to choose their own treatments, and patients are considered last of all. The only reason that the public isn't up in arms already is that the health care decision system, like the sausage factory, is behind a wall. Crack open that wall and it's screaming pigs and blood everywhere, and suddenly the sausage looks a lot more expensive.
So let's have death panels. It will be depressing, frightening, oppressive, and full of flaws. Many will die who shouldn't, and many will be given treatment that cannot help them. Those with influence will live longer. The poor and uneducated and confused will die sooner, and elderly patients without strong advocates will be quietly euthanized by tired bureaucrats.
In short, we'll have just what we have now. The difference will be openness: transcripts, filings, histories of decisions, debate, and accountability of officials will all be on record. We will know exactly what is happening as it occurs, sausage by sausage. Then we will see face to face.
Bring on the death panels! We deserve nothing less.