Tuesday, August 11, 2009

And now a few words about death panels

An interesting point in today's Washington Post about why the two sides of the health reform debate can't seem to do anything but shout at one another. One side, on the left, is answering charges about "death panels" and Candadian-style healthcare by referencing the bills' stated goals. As written, there is no death panel. There is no single-payer system expressly contemplated in any of the bills. But that response is unsatisfactory to those who are arguing about what they see as the inevitable consequences, intended or not, of the current health reform plans.

Read more
Or as Danielle Allen, a Princeton academic puts it:

"One can't answer them by saying: 'These policies won't ration; there will be no death panels.' If these reforms do either of these things, they will do so as a matter of unintended consequences. The appropriate answer, therefore, is to explain the institutional checks that will prevent the emergence of such unintended consequences."

Right. There actually are some institutional checks, but the administration doesn't want to talk about them for fear of angering a left that's already suspicious it's being "punked." The biggest check against a government takeover is the limit on who's eligible for the proposed "public option." The public option is unliley to be an option for anyone who already already has (or is elgible for) Medicare, Medicaid, or insurance through his job (assuming this insurance meets new federal standards). Only those who are currently uninsured or are buying their own coverage on the individual market -- AND who have no access to an existing government program or to coverage at work -- is likely to be eligible. If private insurers wanted to go after that market, there's been nothing to stop them -- and they haven't -- so it's hard to see how the government offering coverage to a group of people unattractive to business will bankrupt private insurance. Indeed, the new individual mandate to buy insurance will do more good for the insurance industry than the public option would do harm.

This does not mean the public option is a good idea. Only that to the extent it's a bad idea, it's not because it will necessarily lead to Canadian healthcare and/or "government rationing." Most serious advocates of single-payer don't believe that.

No, the public option is a bad idea because it will be very expensive and won't fix what's really wrong with healthcare: A lack of transparency in pricing and coverage; costs that are rising at an unsustainable rate; a severe gap in the supply of service providers to meet the demand of those who want and need services; and a canyon-wide difference between what people expect to get from their healthcare, and how much they expect to pay for it. Effective reform needs to address those issues, and the public option doesn't.

I wish the "death panel" debate could, similarly, be put in a more reasoned framework but the whole issue seems to be the work of Sarah Palin and her Facebook post. It is true that most healthcare dollars are spent on the elderly. It's also true that one of the stated goals of healthcare reform is to "bend the cost curve." And it's further true that at least one of the bills does envision paying doctors to counsel Medicare patients about end-of-life issues. I suppose if someone puts that together they might imagine death panels in some science fictiony way. But honestly, people. Physician counseling hardly represents death panels. It merely would reimburse physicians for having discussions with people that make sense to have.

No comments:

Post a Comment