"But they're cousins! Identical cousins all the waaaaay"

I see (via the Dish) that the National Review has seen fit to call out Sarah Palin for her "death panels" comment. So, credit where it's due. I would love to find the space in my heart to simply say "Strong work, National Review!" without having to add a "... but" to the end. But, there's this:
Anyone who thinks rationing by government is something to be feared has reason to worry about the health legislation being discussed in Washington. The president has many times said that cutting costs is the goal of health-care reform and mused aloud about denying services to the elderly as a method of doing so. It is in this context that the controversy erupted over the proposal, now withdrawn, to pay for end-of-life counseling sessions. It was only reasonable to suspect that this proposal was included to encourage people not to get treatments they otherwise would get. (It’s not as though it moved us toward universal coverage.) The proposal to form a board that could recommend against Medicare payments for various procedures, with Congress required to fast-track its advice, raises the same concerns.

Baleful trends among bioethicists should heighten those concerns. The view that medical care should be withheld from people based not merely on the likelihood of success or the cost but on judgments about the quality of their lives is no longer held only by a fringe. Practices that are at best close cousins to euthanasia have become widespread. And as anyone familiar with the work of Wesley Smith knows, inquiries into patients’ intent are not always fastidious.
First of all, true confession here. I don't know Wesley Smith from a hole in the wall. If this somehow makes my opinions uninformed and thusly moot, feel free to ignore everything else I have to say. However, um... I take some pretty gross exception to the above.

Let's start with the first quoted paragraph. I don't know what they would consider "reasonable," but their implication that doctors would discourage people from choosing end-of-life care they would otherwise want in order to cut costs is rank slander to members of my profession. I have never, in years of working with indigent patients at public hospitals in two major cities, ever once seen a medical provider cite cost as a factor for denying any patient end-of-life care. Doctors who discuss end-of-life care with patients are doing so in order to have the patients' wishes known in advance in order to comply with them as fully as possible. To insinuate otherwise is not, in my opinion, "reasonable."

Further, yes, perhaps those consultations will prevent patients from receiving services that they would otherwise "get." (And yes, perhaps money would be saved.) But are they services that they would otherwise want? A common refrain when discussing end-of-life care is "he/she would never have wanted to live hooked up to a machine." Giving people an honest description of what end-of-life care looks like may prevent them from ending up on the grossly-misnamed "life support," with various machines assuming the function of organs that will never recover. Preventing this for people who don't want it is a good, not an ill. And, again, there is no evidence that anyone has ever, or will ever, try to talk people out of the care they would choose because of cost.

Then there's that second paragraph. "Close cousins to euthanasia"? "Widespread"? What the holy hell does that mean? What is a "cousin" to euthanasia? What is this "widespread"? Somehow I think this is their way of describing Terri Schiavo-like circumstances, in which case I would question both what kind of relative that would be to euthanasia, and how "widespread" those cases are.

Still, lamentable crap aside, I do give the chaps at National Review credit for criticizing Sarah Palin. It's a close cousin to sanity.


  1. You have never ever seen an indigent patient denied any care for financial reasons? Then you really, really won't like Obamacare.

    Vancouver Sun

    "The Fraser Health Authority confirmed Thursday it intends to cut surgeries, seniors' programs, and services for the mentally ill to help deal with a budget shortfall of up to 160 million. [...] despite an increase in base funding of $96 million from the provincial government this year."

    I have plenty of examples from the UK's NHS and denying care based on financial considerations. It is what highly advanced Western governments do when they take control of healthcare.

    Dan, better practice up on your bedside "sorry, but we don't have the budget to treat you this year." This is just one example of those things that happen when government decides it can do things more "efficiently" than anyone else.

  2. Well, since I already have a "sorry, but your insurance company won't pay for treating you" speech that I use with great regularity, I'm sure I can come up with a new one to use if it proves necessary.

  3. Also, please read what I wrote more carefully. I have never seen cost cited as a reason for denying a patient end-of-life care, not any care. Nobody has ever "pulled the plug on grandma," and I question that ObamaCare (as you style it) will lead to it. I have, of course, seen financial considerations impact all the time. It's why I support health care reform, come to think of it.

  4. We won't need to worry about pulling the plug on Grandma; we are more likely to worry about getting Grandma plugged in at all, given the IMAC guidelines (well, the old gal is pushing 77, and she probably won't last another two years, decade and a half tops, so why exactly are we fixing her knee when a cane is so much more cost efficient?).

    I'm not really sure what you mean by "end-of-life" care. Is it pallative care at the end when death is knocking on the door? That doesn't sound very expensive.

    And, to the last point that insurance doesn't cover everything, at least the government acts as referee in contract disputes. Got a beef with your coverage? You can appeal to contract law if you have been wronged. But if the government is the insurer, who will be the impartial referee? You are asking government to play to the game and call the balls and strikes. That sounds a bit fishy to me.