Death Panels? Of Course…

death panelRecently the debate about “death panels” has been heating up as Republican Congressional leaders express their opposition to implementing the Independent Payment Advisory Board (IPAB) by refusing to appoint members to serve on it. The IPAB, which was referred to as a death panel by Republicans during the 2010 Congressional elections, is a committee that was to be created as part of health care reform and consists of 15 full-time members appointed for staggered six-year terms. The IPAB must provide a report to Congress about how to hold Medicare spending within legislated limits. Congress is given a strict timetable within which it must consider the board’s recommendations and either vote to accept them or come up with alternatives that achieve comparable savings. Although the IPAB might not be the best way to do it, as long as the government pays for health care, someone must have the responsibility of making decisions about which health care will not be paid for even in cases where the care might prolong the person’s life.

Although intended to be a pejorative term, the term “death panel” accurately reflects decisions that have to be made about whom to save when resources are scarce. We simply do not have the resources to provide as much health care as people might desire for prolonging their lives or the lives of their loved ones. If government pays for health care, as it does for Medicare and Medicaid beneficiaries, limited funds necessitate that sometimes people will be denied access to care. If the decision of who does and who does not get care is not made explicitly by an appointed committee, it will be made by default as scarcity necessitates that some must wait in line for health care.

It is not hard to find tragic stories of Medicaid or Medicare beneficiaries who died because they could not get the care they needed. In some cases, this is due to the fact that reimbursement rates are so low that those with urgent health problems may have to wait too long to get an appointment. In others, an explicit decision may have been made to deny coverage to someone. When government or an insurance company pays the bill, scarcity necessitates that people cannot get all the health care they might want or need. It might be better for an appointed board to decide the rules that determine when care gets paid for and when it does not, than for people to be told they are entitled to whatever care they need, but then end up waiting for treatment until it no longer does them any good.

In our market economy, if a board such as the IPAB decides that a certain treatment will not be covered by Medicare, that does not mean that a patient who desperately needs the treatment cannot get it. If something is not covered by Medicare, those who are willing and able to do so may pay out of their own pockets so they or their loved ones can get the health care they need.

Republicans, or anyone else opposed to the idea of death panels, should be consistent. They should either support elimination of health care entitlements, particularly Medicare and Medicaid, or support changing them into defined contribution plans, where government contributes money toward health insurance premiums and lets insurance companies decide what is covered and what is not. This way, those covered by Medicare and Medicaid would at least be able to have some choice about who makes those decisions and how they are made. As long as they are counting on a third party to pay for their health care, Americans should not expect to be able to get as much care as they want or need regardless of cost.

If government is going to continue to pay for health care entitlements, the question is not whether some people will be denied health care; it is about who makes the decision and how the decision is made. Rather than pretending that it is possible for the government to spend whatever it takes to provide unlimited health care for all, the pertinent question is what are the rules and procedures for deciding and who are the ones assigned to interpret the rules about who gets care and who does not.  Those who supported the politicians who gave us Medicare, Medicaid, and health care reform should not be surprised that those in charge of those programs want the power to make those life and death decisions and might make them in a way that goes against the principles we believe in.


This article was originally published at the Center for Vision and Values.

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  • Victoria

    “We simply do not have the resources to provide as much health care as people might desire for prolonging their lives or the lives of their loved ones.” But by gum we have enough resources to pay health insurance companies to provide the splendid value they give us, which would be . . .um . . . providing profits to their shareholders by rationing care to the sick.

    “The Washington Post, May 23, 2013:
    Here’s a look at median CEO pay by industry last year, as calculated by executive pay research firm Equilar. For the fourth time in five years, health care CEOs got the most pay and utilities CEOs got the least.
    —Health care: $11.1 million”

    Medicare is not involved in the private health insurance companies, but if we eliminated the middle man we would have enough to ensure that everyone was covered.

  • Dr.K

    I agree with Dr. Miller. Since we are not a Socialist nation, why should we expect the government to take care of everything? When did we turn into an Entitlement culture? I, like most other taxpayers, do not mind helping out the truly less fortunate or those who cannot help themselves, but FORCING everyone to support one more bureaucratic, inefficient monster (read, OBAMACARE) is anti-American! If you want to voluntarily donate all of your income to the government because they can manage it better than you can, then by all means please do that. As for me, I plan on using the gifts God has given me and helping the less fortunate in a more efficient, value-respected way.

  • Poppiexno

    Liberals mock the term “Death Panels.” They imply a group making decisions on a case by case basis. But that’s not how it will work. Eighty year old needs a pacemaker? Sorry, not cost effective to give eighty year olds pacemakers. Eighty year olds are a net economic drain on society. So we will have euthanasia by default. And why not. We kill at the beginning of life. Unborns can be an economic and emotional burden; let’s get rid of them. The elderly can be an economic and emotional burden so let’s get rid of them too. Who’s next in our seach for perfection? Maybe we should give the obese six months to lose weight or….

  • John

    Scarcity may be part of reality, but the reason those of us so strongly opposed to death panels are actually consistent are twofold: 1) First, human life trumps profitability; 2) It is Mr. Obama’s government takeover of health care that will steal our choice and options and potentially make death panels a reality for everyone. If we want to stop death panels, we have to get rid of Obamacare.

  • tg

    don’t think the author made a clear direction of which way they want to go. do think they are mistaken about being able to opt for an alternate pay source. Affordable Care Act (so misnamed, aka Obamacare), has designed purpose of eliminating any viable alternative payor sources. if you can’t see that then you really don’t know what you are talking about. private payments, if not outlawed altogether (likely) will be to expensive for most who desire said pacemaker for example. that is why we pool our resources into insurance, because not everyone will need one but we are all covered and the few that do can then get it. somewhat invented by knights of Columbus incidentally. then profit motive got involved of course so that is imperfect also. but at least without full implementation of ACA there is some choice. and with recent revelations of numerous scandals in other agencies (IRS, EPA, ETC), do we really want to put that kind of power in the hands of political appointees!? real easy to disguise bias then, ie most conservatives live in rural areas where they are more susceptible to disease A, but most liverals/progressives live in cities where they are more susceptible to disease B, so board decides to make up stats to say that disease B is worth treating but disease A is not (only more complicated).