The idea of offering incentives for medical professionals to discuss “end-of-life issues” with elderly patients and their families has become the lightning rod of the health-care debate—less, by the way, because conservatives latched on to it with the “death panel” label but because liberals thought they had the Right dead to rights with the “death panel” accusation. Surely, they believed, the forces arrayed against ObamaCare had gone too far; surely the “death panel” charge would boomerang against the anti’s, and finally the health-care package would take wing. By taking such exception to the death-panel charge, supporters of ObamaCare did more to promote it than did its author, Sarah Palin, who issued her statement about it not by making a speech but by posting it on Facebook.
It seems that many opponents of ObamaCare are finding it necessary to separate themselves from the death-panel charge, on the grounds that it is demagogic and dishonest. National Review has done so in an editorial; so has David Frum; so have others. Now, clearly, the language of the proposed legislation does not mandate a committee of bureaucrats that sits and disposes of life-and-death matters. But there is some disingenuousness at work—and, yes, intellectual dishonesty—on the part of those who want such matters to be part of the bill.
Anyone who has been paying attention to the medical-ethics discussions of the past quarter century is very familiar with the reason for the focus on end-of-life matters: the expenses that the medical profession has been required, ethically, to incur in the preservation of life among those who are inevitably going to die has seemed to many to be money wasted on health care that could be better spent elsewhere. As the one-time governor of Colorado, Richard Lamm, notoriously said in 1984, “We have a duty to die”—by which he meant, to die more quickly so that it wouldn’t cost his state too much in Medicare. What Lamm said was shocking, but only because he said it so crudely. The view that the American way of dying has become needlessly prolonged is at the heart of the professional medical-ethics ideology, an instrumentalist ideology whose implicit purpose is to raise moral questions and congratulate itself for raising moral questions before dismissing them in favor of the notion that moral decision-making has no place in medical matters.
Given this record, and given the implicit notion that costs will be controlled by fiat under the new ObamaCare dispensation, it is well within reason to assume that rationed care for the elderly will be the place to look for savings; that determinations of which care and of what sort will be covered would eventually become the purview of a committee; and that the decisions that committee makes will play a role in the deaths of those who are refused coverage. To deny that the subject the president himself called a “very difficult democratic conversation” is the choice between life and death, and that under ObamaCare those decisions will not eventually be the sole purview of the patient and his family, is disingenuous. As the president said in an April interview with David Leonhardt of the New York Times:
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
LEONHARDT: So how do you — how do we deal with it?
THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think it has to be able to give you some guidance.
Given the president’s own admission back in April that the conversation is just so difficult in a democracy that it needs to be guided by experts is to travel part of the way down the road according to which experts not only guide a conversation but make the rules for the conversation as well. And that is why the matter is certainly worthy of a wide-ranging discussion, even when the discussion might turn into a very different kind of “very difficult democratic conversation”—one in which the conversation takes a course Obama and the supporters of ObamaCare do not wish it to take.