Yes, he really said it. He is an honest man. These were the opening words of a New York Times Op-Ed article.
He got my attention!
Then he explained.
Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.
He is playing verbal games here. Rationing means that a committee must allocate scarce resources. A committee is a panel. In life-and-death situations, some people will die.
It’s called “pulling the plug.”
As surely as a battlefield physician uses triage to decide who gets treatment, so will death panels.
Let’s call a spade a spade. Let’s call them death panels. That’s what they are.
Geezers get money from the federal government: Medicare. Geezers therefore get on the inevitable list. The panel looks at the list and asks: “Who should live? Who shouldn’t?”
There are no free lunches. There is no free life extension.
But in the pantheon of toxic issues — the famous “third rails” of American politics — none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.
Resources are scarce. Those in charge of allocating them must decide who gets them. This is an economic law. It is inescapable.
The irresistible force is about to hit the immovable object.
Most notably, President Obama’s estimable Affordable Care Act regrettably includes severe restrictions on any reduction in Medicare services or increase in fees to beneficiaries. In 2009, Sarah Palin’s rant about death panels even forced elimination from the bill of a provision to offer end-of-life consultations.
Ah, yes: the evil Sarah Palin, who called a spade a spade.
But help is on the way! There will be lots of creative ideas. President Obama has promised this.
Meanwhile, Mr. Obama’s hopes for sustained cost containment are pinned on a to-be-determined mix of squeezing reimbursements, embracing a selection of the creative ideas that have spewed forth from health care policy wonks and scouring the globe for innovations.
To Mr. Obama’s credit, his plan has more teeth than Mr. Ryan’s; if his Independent Payment Advisory Board comes up with savings, Congress must accept either them or vote for an equivalent package. The problem is, the advisory board can’t propose reducing benefits (a k a rationing) or raising fees (another form of rationing), without which the spending target looms impossibly large.
That’s the view of the bipartisan Medicare trustees, whose 2012 report stated: “Actual future Medicare expenditures are likely to exceed the intermediate projections shown in this report, possibly by quite large amounts.”
What does this mean? This: Medicare will go broke. But before it does, a committee will decide whether to pull the plug on granny.
Let’s not forget that with the elderly population growing rapidly, even if cost increases for each beneficiary can be contained, Medicare would still claim a rising share of the American economy.
Medicare needs to take a cue from Willie Sutton, who reportedly said he robbed banks because that’s where the money was. The big money in Medicare is not to be found in Mr. Ryan’s competition or Mr. Obama’s innovation, but in reducing the cost of treating people in the last year of life, which consumes more than a quarter of the program’s budget.
No one wants to lose an aging parent. And with price out of the equation, it’s natural for patients and their families to try every treatment, regardless of expense or efficacy. But that imposes an enormous societal cost that few other nations have been willing to bear. Many countries whose health care systems are regularly extolled — including Canada, Australia and New Zealand — have systems for rationing care.
Death panels are inevitable. Resources are not free. The panels used to be called “families.” They are now called . . . what?
Politics will decide what they are called and how much power they will have. But government will make the call.
That’s because government is now paying the bills.
He who pays the piper calls the tune.
Will the tune be “Taps” for granny? Count on it.