Tuesday, August 18, 2009

Obama Advisor: There Very Well May Be a Death Panel

Economist Martin Feldstein is probably coming as close as an Obama advisor can to letting the country know that a death panel may be on its way. Feldstein was appointed by President Obama to the President's Economic Recovery Advisory Board.

In Wednesday's WSJ, Feldstein writes:
The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating "high cost, low-value treatments," by "implementing a set of performance measures that all providers would adopt," and by "directly targeting individual providers . . . (and other) high-end outliers."
Got that, "eliminate high cost, low value treatments"? Do you think that means a 20 year old youth with a broken leg who has many tax paying years ahead of him, or Grandma, where it is decided that it just isn't worth the cost to keep her alive through one more Christmas?

So how exactly will "they" decide what is "high cost, low value"?

Feldstein spills the beans on this also:

The president has emphasized the importance of limiting services to "health care that works." To identify such care, he provided more than $1 billion in the fiscal stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. That could morph over time into a cost-control mechanism of the sort proposed by former Sen. Tom Daschle, Mr. Obama's original choice for White House health czar. Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost.
Got that? That's a medical decider treatment panel, a death panel, if you will. This is exactly what nut job Peter Singer is advocating. It's all about QALY. It's about Singer designing equations to determine who lives and who dies. This is exactly what he wrote in New York Times Magazine, just weeks ago:

As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years,then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds.
After they kill off Grandmas, they are going after the quadriplegics. Here's Singer again:

How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.

This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care...If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S
So what are the chances of this type rationing that Singer is calling for actually occurring? Here's Obama advisor Feldstein, again:

Although administration officials are eager to deny it, rationing health care is central to President Barack Obama's health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive.


  1. It's right there in the House bill. It is not in the end of life counseling section. It is located in Title IV, in the provisions that established the "Comparative Effectiveness Research Commission" to determine what medicine and treatments are effective enough, and, therefore, which the government will allow patients to receive and will allow to be paid for by "private" insurance. This is what Feldstein is talking about. These determinations are to be based on the treatment or prescription being economically "effective," depending on whether the patient (or a category of patients) is deemed worth the expense because of age, potential productivity, health, and other factors. It mandates the creation of a commission like the UK's National Institute for Health and Clinical Excellence, or NICE, which assigns a value to a year of life based on age, existing conditions, etc. If a procedure or treatment exceeds that value, you don't get the medicine, treatment or procedure. Title IV of the House bill, HR 3200: TITLE IV—QUALITY 11 Subtitle A—Comparative Effectiveness Research SEC. 1401. COMPARATIVE EFFECTIVENESS RESEARCH. (a) IN GENERAL.—title XI of the Social Security Act is amended by adding at the end the following new part: ‘‘PART D—COMPARATIVE EFFECTIVENESS RESEARCH ‘‘COMPARATIVE EFFECTIVENESS RESEARCH ‘‘SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED....— You won't even get a personal visit to the "death panel." This commission will determine what treatment you may receive without ever looking at your individual case. Instead, you will be assigned to a cohort or a category, and the applicable limits -- rationing -- applied to your care

  2. Yes, there will be a death panel. It doesn't matter if they take some verbiage out of the bill that is too obviously explicit, it doesn't matter because the entire logic of the bill points toward a death panel

  3. Nice work.

    This has been obvious since teh stimulus draft came out in january for anyone with a tiny bit of a brain who cares.

    it is truly sad that just now people are catching on to the comparative effectiveness statutes that already exist, are set to come in hr 3200 and the plan for using that authority in the obama administration

    eyes wide shut, america

  4. "These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys."

    Surveys? Is a quadraplegic worth half of a paraplegic? Maybe we should vote on it? Perhaps if they sell this right, people will start volunteering to die. They just need to be convinced that their life has less value than somebody else's.

    I find it amazing that a person who is an economics advisor would throw around the word value as if it had some objective meaning that could be universally measured.

  5. Comparative Effectiveness is a way for health insurers to make money off their huge databases. Just as "No Child Left Behind" enriched educational testing companies, health insurers stand to rake in the green from mining their "clinical data."

    Mining retrospective data is very different from controlled clinical trials. This is another boon for health insurers.

  6. Peter Singer is an "animal rights" philosopher. A person who believes the rights of animals should have equal value as the rights of human beings wants to pretend he's an authority on judging the value of human lives against one another.

    Need I say more?