On Friday, Aug. 14, The New York Times ran a front-page story "rebutting" the "rumor" that Obama's health care plan calls for the creation of "death panels" to decide when to pull the plug on sick patients. The rebuttal misses the fundamental truth of the death panel charge.
While there will be no federal board that will vote to kill patients, there will be extensive rationing that will, inevitably, lead to the same result. Taken together, Obama's decision to cut the Medicare budget and to expand insurance coverage to 50 million new patients without any new doctors or nurses, mean that rationing is unavoidable.
When Obama speaks of cutting "inefficiencies" and reducing costs, he means that he will reduce the amount and quality of health care available to the elderly. Denied state-of-the-art medications and necessary surgical procedures, patients will be faced with the grim likelihood of their immanent demise. In the face of this reality, end-of-life counseling will be both necessary and, given the choices, welcome.
Obama will cut care to the elderly in several ways:
1. He will cut 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 will also perform them more rarely. These facts of the marketplace are not only inevitable consequences of Obama's cuts, they are its intended consequence. Without them, his savings will prove illusory.
2. By expanding the patient load through extending full coverage to 50 million Americans (including such "Americans" as illegal immigrants), he will force rationing decisions of harried and overworked doctors and hospitals. There will simply not be enough facilities or personnel to cope with the increased workload. As a result, there will be a de facto rationing as busy surgeons decide who would benefit most from their treatment. The elderly will, inevitably, be the losers in these contests.
3. 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 conclusions of this board are not specifically imposed on HMOs and health care providers by the legislation, their recommendations will, inevitably, set the standard of care and the protocols that should and will be followed throughout the system. Otherwise, why collect the data at such great cost and effort? Individual public or private insurance companies, and their HMOs, will use these data to allow or deny care to the elderly, a de facto rationing system.
4. In assessing whether to allow certain treatments to sick patients, medical and administrative professionals will be encouraged to apply the QARY system (Quality-Adjusted Remaining Years). Under QARY, the cost of treatment will be amortized over the remaining quality years of life that are likely for each patient.
Does a hip replacement cost $100,000? A 75-year-old diabetic with a heart condition may only have three more quality adjusted years. At $33,333 per year, the price is too steep and the surgery would likely be disallowed. But a 50-year-old who is otherwise healthy, may have 25 years of quality life ahead of him, and, at $4,000 per year, the surgery makes sense.
These assessments diminish the importance of the remaining lives of the elderly and condemn them to infirmity, pain and an earlier death than would otherwise be their fate.
To the extent that any of these steps that curtail care for the elderly lead to an earlier demise, end-of-life counseling will be necessary. While no panel will specifically pronounce a sentence of death on an old person, doctors, hospitals, HMOs and the Federal Health Board will all be forced to participate in decisions to deny adequate care that will amount to the same thing.
