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Jewish World Review Jan. 21, 2011 / 16 Shevat, 5771 Who Needs Democracy? By Paul Greenberg http://www.JewishWorldReview.com | What a bother having to deal with Congress, public opinion, elections, the whole complicated web that the Founders in their antiquated vocabulary referred to as the consent of the governed. How much simpler to pass your own laws. Just call them executive orders or administrative rules, official regulations, whatever designation applies. Hesto, presto, a provision nixed after long hours of tedious debate and much public furor can be enacted by arbitrary decree. It's so much quicker that way, and nobody needs to know. At least till the public wakes up. In place of the messy, unpredictable democratic process, let an expert make the decisions. No fuss, no muss, no votes, not even a discussion. Just a decision. Problem solved. There, see how easy that was? Who needs all those old checks and balances, anyway? They just get in the way and upset people. Knowing what's going on so often does. See the case of the death panels--excuse me, consultations about end-of-life treatment--that were authorized by the new head of federal Medicare and Medicaid Services. At least till the public got wind of what was going on, and this administration had better and more democratic thoughts. And rescinded the controversial new regulation. By deciding which medical services will be subsidized, and which won't be, the country's health-care czar can pretty much determine the shape of American medicine. Subsidize a procedure, test, treatment or just consultation, and there's bound to be more of it. That's not some sophisticated medical principle, it's just simple economics. Hey, it's free--at least to the consumer--so why not take advantage of it? The provision for "end-of-life consultations" and "advance planning" was nixed in the rundown to the final passage of ObamaCare, that largely unexamined 2,000-page horse-choker of a bill. But the administration's man in health care wasn't about to let that stop him. He just issued a regulation -- ever so quietly, almost unnoticeably -- and the deed was done. Who needs democracy? The game being played here should be familiar to anyone who's ever been pressured by an insurance company to get somebody in the family into hospice care as soon as possible and so avoid more expensive treatment. (I've been there.) The impetus for such pressure isn't medical but economic. Or as a doctor friend e-mails me: "Many people do not understand that the intent of end-of-life planning is not so much whether someone should get care in an ICU, but rather to discourage expensive therapies which statistically either have only a limited degree of success or may prolong life for only several months or years, particularly among elderly patients. I emphasize the word statistically, since statistics can never reflect every individual case, and therefore treating patients based solely upon alleged statistical data is, I believe, medically immoral, inasmuch as the physician is supposed to be treating a patient and not a statistic. "Doctors have always discussed various therapeutic options and the patient's prognosis with their patients -- this is standard medical practice and does not require separate reimbursement. The obvious intent of this administrative decree is to have doctors dissuade patients from certain therapies in order to limit health costs. This may sound innocuous, but, when combined with Medicare's ultimate refusal to pay for these therapies, it starts to become clear that these consultations can easily morph into discouraging the patient from embarking on further expensive treatment -- a decision that may be based on bureaucratic, not medical, criteria." And if doctor-patient consultations about end-of-life (don't use the D-word) are to be paid for by Medicare like any other procedure, surely we'll want to include the appropriate medical specialist(s) in the consultation -- cardiologist, oncologist, nephrologist, psychiatrist, geriatrician, whatever applies. Plus a radiologist or maybe two. (Different doctors can read the same X-ray differently.) And what about your minister/priest/rabbi/imam/psychologist, depending on your religious or irreligious preference? And don't forget the morticians. Who more appropriate to consult with about end-of-life arrangements? They deal with the inevitable every day, and offer good rates for advance planning. It doesn't take much imagination to see how what is now the quiet little doctor-patient conversation about When the Time Comes could morph into Sarah Palin's death panels, or even a death industry, given enough of a government subsidy, Call it thanatopsy. Ridiculous? Unthinkable? Lots of things are, or at least were at one time. Long ago and in another culture, when Roe v. Wade was first handed down (Jan. 22, 1973), those wide-eyed alarmists over on the Religious Right warned that it could lead to a hundred thousand perfectly healthy babies being aborted every year. Ridiculous? Unthinkable? Turns out they were understating the case. By a factor of 10. The unthinkable can become the acceptable, even ordinary, with remarkable ease. It's extraordinary what we learn to accept as ordinary. And shouldn't advance directives about medical care, or declining it, involve legal as well as medical advice? Badmouthing lawyers is an American habit by now, and I've done more than my share of it, but while lawyers in general may be less than popular, one's own is indispensable -- a source of counsel, support, comfort and even friendship. The biggest hole in the administration's regulation, which was soon terminated itself, was that it left out the role of lawyers and law in advance planning. Not that the government should be in the business of subsidizing such legal consultations; responsible people will do it on their own. And have been doing it. Then why should government be subsidizing such consultations? It's hard to think of a reason except to hold down the medical costs that government pays through Medicare and Medicaid. So when the administration is caught pulling a sneak play like this, you have to wonder if it's practicing medicine or just cost-accounting. In a society acculturated to devaluing life, euthanasia for economic reasons shouldn't trouble any more than abortion for any reason at all. Or even destroying human embryos for research purposes. Just last March, this president, overturning precedent (the Dickey-Wicker Amendment) and his predecessor's long-considered and carefully nuanced policy, proudly announced that the federal government would now subsidize experiments that would destroy human embryos in order to further stem-cell research. The first federal grants for embyronic stem-cell research were announced just last month with little fanfare. Death goes on. If ever so quietly. What once might have shocked becomes routine. Hannah Ardent's phrase about the banality of evil remains relevant -- if anyone still remembers it. Far from rebutting moral objections to such a change of policy, Barack Obama seemed oblivious to them. If he spoke of them at all, it was as an inconvenience. An inconvenience. Morality. Ethics. Reverence for life. They were all dismissed as "inconvenient" obstacles to scientific progress. But why should we ordinary citizens concern ourselves with the ethics of life and death? Leave it to the experts. Science uber alles! The president's pronouncement could have been translated from the original German. For when it comes to embyronic stem-cell research, Barack Obama has achieved what some of us might once have thought impossible. He's made George W. Bush sound like a Socratic philosopher. Paul Greenberg Archives Every weekday JewishWorldReview.com publishes what many in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here. JWR contributor Paul Greenberg, editorial page editor of the Arkansas Democrat-Gazette, has won the Pulitzer Prize for editorial writing. Send your comments by clicking here. © 2010 Tribune Media Services, Inc.

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