John, my main criticism of Sarah Palin’s “death panel” remarks is that they reduce in scope the disapproval of the proposed health-care bill to a concern that, while not wholly unfounded as you pointed out, sounds exaggerated and rhetorically ill-pitched. Rightfully fearing a backlash from senior voters, Democrats yielded to the opposition regarding provisions for end-of-life counseling and removed them from the bill—and some consider this a victory for Palin.

But her outrage seems to have been misallocated, as now more must be mustered for countering the rest of the bill, which remains chock-full of problematic stipulations, some much more deleterious to both the health-insurance industry and the interests of health-care consumers than what Sarah Palin chose to focus on. The natural resources of rhetoric can be depleted by the overuse of incendiary language, to which the public gradually grows insensitive.

While as a private citizen Sarah Palin is entitled to express her criticism of the bill however she sees fit, Michael Steele, as a leader of the opposition party, showed questionable judgment in backing remarks likely to court gratuitous controversy. Focusing on end-of-life consultations leaves the opposition vulnerable to the rejoinder that such services are already covered by existing private-insurance plans. It also derails the argument from one about socialized health care, whose most objective merits or lack thereof are grounded in economics, into one about controversial social issues such as the right to die. Involving euthanasia in this debate may agitate mixed loyalties among the socially liberal but fiscally conservative—a needless risk for the opposition.

Obama’s statements that you quoted are suggestive of the extreme utilitarian mindset that permeates the bill. To be sure, its architects do intend to ration care to the elderly and the chronically ill, but how such rationing would be implemented is not through any “death panels” but rather through the perverse actuarial calculus known as comparative effectiveness research. This is a formula that divides the cost of a treatment by the number of “quality-adjusted life years” that the patient is likely to enjoy—a cost-benefit quotient to guide bureaucratic boards on allocating medical resources. In Britain, the formula leads to denying treatments for older patients who have fewer years to benefit from care than do younger patients: until recently, older patients with macular degeneration, which causes blindness, were told that they had to go totally blind in one eye before they could get an expensive new drug to save the other eye.

As Betsy McCaughey notes at the Wall Street Journal: “The House bill shifts resources from specialty medicine to primary care based on the misconception that Americans overuse specialist care and drive up costs in the process (pp. 660-686). In fact, heart-disease patients treated by generalists instead of specialists are often misdiagnosed and treated incorrectly. They are readmitted to the hospital more frequently, and die sooner.”

This is just another corollary of the utilitarian ethics motivating the bill, concerned with allocating communal resources for the greatest benefit to the greatest number. In such context, it’s hardly a misconception that Americans overuse specialty care. Indeed, however grave a disease may be, if it ails only an unlucky few, the medical resources tied to treating it could instead help a greater number of people stricken by more common ailments. If such considerations dictate the allocation of scarce resources on a large scale, the result will be generic health care for all and specialized treatments—those needed the most—for few or none.

Winning the debate against socialized health care requires educating the public on what it entails for them, to which end plenty of facts, statistics, and case studies can be employed, often originating in countries that have adopted similar systems to the one America is contemplating. But the public is more boggled than enlightened by talk of “death panels.” Why resort to bombastic rhetorical devices when facts—cool, objective, dispassionate facts—are already on our side?

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This entry was posted on Tuesday, August 18th, 2009 at 2:31 PM and is filed under Contentions. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.