Jul 142017

by Thomas L. Knapp…….

In 2009, former Alaska governor and vice-presidential candidate Sarah Palin raised the kind of ruckus she’s known for with her comment on the then-notional Affordable Care Act, aka “ObamaCare.” In a Facebook note, she wrote:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide … whether they are worthy of health care.”

Palin’s aim was rather off (she was grousing about an ACA provision allowing Medicare to reimburse patients for voluntary “end of life care” consultations), but as the world watches the unfolding tragedy of 11-month-old Charlie Gard’s terminal illness in the United Kingdom, “death panels” are suddenly newsworthy again. Palin’s core worry was relevant then and it’s relevant now. It’s also non-controversial, or at least it should be.

Healthcare is a “scarce resource,” by which I mean that there is more desire for it than there are doctor hours and hospital beds and bottles of medication to fulfill all that desire. In any healthcare system, therefore, care is going to be rationed. If people want or need ten units of health care and there are only nine units available, someone is going to lose out.

Rationing can be handled in a number of ways: Pricing in an entirely free-market system, quick triage in an emergency situation with multiple victims presenting varying levels of injury,  alleged experts in systems ranging from the bureaucratic mess of an “insurance” system in the US to the “single-payer” systems in the United Kingdom and other countries. While I favor a free-market system, my intention here is not to argue that point, but rather to point out that “death panels” are inherent in the overall situation.

While it’s heartbreaking that young Charlie likely faces death from mitochondrial DNA depletion syndrome, and soon,  that would likely also be true in the US. Most insurance companies would balk at paying for the experimental treatment his parents seek, and their ability to raise funding for it through charity is not the usual course of things.

The instant problem here is not that a panel of alleged experts at London’s Great Ormond Street Hospital or at some other level of the UK’s National Health Service reached the painful decision to allocate the scarce resources at their disposal to someone or something other than prolonging Charlie’s life.

The problem is that, having taken that decision, those experts demanded that Charlie’s parents accept their authority in the matter, and successfully fought them in to court to prevent them from seeking treatment for him elsewhere.

While it so happens that Charlie is an infant whose parents are claiming the rightful authority to make that decision, the “death panel” precedent here could just as easily be applied to a terminally ill adult: “We can’t treat you any more, and we’re not going to let you seek treatment elsewhere either.”

That way lies the darkest evil and savagery. Free Charlie Gard.


Thomas L. Knapp (Twitter: @thomaslknapp) is director and senior news analyst at the William Lloyd Garrison Center for Libertarian Advocacy Journalism (thegarrisoncenter.org). He lives and works in north central Florida.

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 July 14, 2017  Posted by at 12:40 am Issue #227, Thomas L. Knapp  Add comments

  5 Responses to “Death Panels: Sarah Palin Was Right, Sort Of”

  1. This is a case of medical ethics. Ethics ain’t the same as morals. Ethics are more realistic than idealistic.
    With the experimental treatment, which cannot reverse his condition, only keep him alive, brain-dead Charlie Gard will be a live vegetable with NO sensory input or output. He will process food perhaps. Without the treatment, he will be allowed to follow his destiny and become a deceased baby boy and a fond loving memory.
    Keeping people alive at any cost, in any condition, is an ethical question, subject to the times.
    One way to answer ethical questions is to decide what you would want the doctors to do if it were you whose body could not function.

    • “With the experimental treatment, which cannot reverse his condition, only keep him alive, brain-dead Charlie Gard will be a live vegetable with NO sensory input or output.”

      Interesting. Your qualifications for that medical opinion?

  2. Having experienced both single-payer and private insurance systems, I can assure you that the biggest difference is the cost to the insured. In the US, we pay medical insurance over and over again: house insurance liability, car insurance bodily injury for yourself, your passengers, and others, workers’ comp, your personal medical insurance, VA benefits, politician’s medical, Tricare, Medicare, Medicaid, indigent care, specialty insurance like Divers Alert Network, and more, plus possible co-pay. Have a medical issue and they all argue that it is not in their scope of coverage. Much of the cost of medical here is in administration costs. Car insurance in Florida ran three times the cost of insurance on icey Canadian roads. Homeowner’s insurance was double, for a less vulnerable house. Tobacco and alcohol tax covered all the medical insurance above the border. Your doctor visit was typically free, and although the fee the doc was paid was much less than here, they still were very well off and did not have to deal with the complicated claims process that just adds to cost here. Their liability insurance was also much less.
    Generally speaking, I am in favor of total free enterprise and minimal government involvement in anything. But a health bill that forces the purchase of private provider insurance just makes it all more expensive. Whether you have personal medical or not, in this country you still pay for the insurance of very many others, although indirectly. And almost any expensive fee has to be pre-authorized or you could be stuck with the full claimed price. Like Obamacare, Trumpcare will mainly benefit the insurance providers and any medical problem could bankrupt you.

    • Actually, in this country we have very little resembling “health insurance” (hedged bet against catastrophic illness or injury). What we have is almost entirely, since the HMO act of the early 1970s, “prepaid health care,” with lots of exceptions and lots of administration.

      I’m guessing that single-payer is the future, and frankly it looks like that wouldn’t be as bad as what we have now. I do often wonder what an actual private/free enterprise system would look like, but the US hasn’t had anything resembling one since the late 19th century, when the AMA got the states to implement guild socialism in the form of a licensing monopoly.

  3. Many young people elect to pay the fine rather than buy the overpriced insurance. And your very poor don’t pay a dime and still get treated. Forced insurance will bankrupt either the insurance company or the worker. Thankfully I am on Humana and mostly healthy but with back issues and a recent fall accident I have been costly to them.

    Now do we want to talk about marked up prices and the games doctors must play to get what they need. Look at your drug prices if cash or insurance. It should be called fraud.

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