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Health Care Financing Reform and "Death Panels"

by Professor Will Huhn on August 17, 2009

in Wilson Huhn

     Presented below is a summary of our options regarding reform of how to pay for health care and a brief discussion of the false rumors about "death panels" supposedly contained in the pending legislation.  In tomorrow's entry I will describe the constitutional right to refuse lifesaving medical treatment which was established in the case of Cruzan v. Director (1990).

     Almost everyone agrees that the cost of health care and health insurance is out of control and that we have to reform the way we pay for health care.  People disagree about how we should change the current system, and there must be a wide-ranging and open debate about what we are going to do to solve this complex problem.  Accordingly, it was surprising to me upon returning from vacation to learn that the country has recently been consumed with the false assertion that pending federal legislation would establish "death panels" that would have the power to force euthanasia.  This was a ridiculous charge, and it has diverted the country from confronting the difficult problem we face – how to pay for medical care. 

    The federal law currently being considered before Congress never contained any reference to "death panels."  In this article Jim Rutenberg and Jackie Calmes of the New York Times traced the rumor to political rivals of the President and opponents of health care financing reform.  In fact, the House bill simply extended existing provisions in Medicare allowing doctors and hospitals to be reimbursed for advising patients about advanced directives – living wills and durable powers of attorney.  Those who concocted the rumor about "death panels" succeeded in terrifying a sizable segment of the population, and as a result the Senate has eliminated the provision allowing doctors to be paid for discussing living wills as described in this report by Christie Parsons and Andrew Zajac of the Los Angeles Times.  But this distraction has not brought us any closer to solving the crisis that we all face – as medical costs skyrocket, how can we provide or maintain affordable access to health care? 

     Over the next few months this country will have to decide how we can reduce the cost of medical care.  Options include expanding "medical savings accounts" allowing private individuals a tax incentive to pay for medical care out of their own pockets; requiring all employers to provide health insurance to employees; reducing or eliminating the tax deduction for health insurance provided by employers; providing government subsidies to individuals to assist them in purchasing health insurance; expanding Medicare and other government programs that currently pay for medical care for the elderly, the disabled, and children in families below a certain income level; expanding government programs like the Veterans Administration which provide medical services directly to individuals; and establishing government-supported cooperatives to purchase insurance or to negotiate directly with doctors and hospitals in setting rates of reimbursement for services.

     Living wills and durable powers of attorney are not "cost-saving" devices, but rather represent the best means for exercising a constitutional right – the right to refuse lifesaving medical treatment.  This right was first recognized in the case of Cruzan v. Director (1990).  I will discuss the Cruzan case in tommorrow's blog.

{ 4 comments }

larry d. August 17, 2009 at 2:49 pm

Of course they can save a tremendous amount of cost as well, professor.

I'm not sure many if any seriously argued there would be forced euthanasia–just rationing based on some creepy guidelines like age and capacities to contribute to society, as good old Zeke has outlined in his creepy writings.

Even Obama talked about 'tough moral decisions' when it comes to providing healthcare for old folks and the terminally ill. Not many Americans want the government making tough moral family decisions about life and death.

Alice August 17, 2009 at 8:51 pm

Yea for Larry…….help me out here……who is Zeke and his creepy writings?

Isn't it becoming clear to anyone that national health care is the end result that Obama is aiming for?

Professor Will Huhn August 19, 2009 at 9:07 am

Larry and Alice,
Even the AARP characterizes the talk about "death panels" or forced rationing as false – simply a scare tactic. Check out this article by Patricia Barry in the AARP Bulletin at http://bulletin.aarp.org/yourhealth/policy/articles/health_care_reform2.4.html. That article links to Ezra Klein's Washington Post interview with Republican Senator Johnny Isakson at http://voices.washingtonpost.com/ezra-klein/2009/08/is_the_government_going_to_eut.html. (Sorry, I haven't fighured out how to put links into the comments.) No-one, liberal or conservative, wants to withhold medical care from old people or anyone else.
If anything, reformers can be criticized for trying to accomplish too much – for being too ambitious in expanding access to health care. Rationing occurs now because people can't afford to pay for medical care. The problem is trying to figure out a way to make high quality health care affordable to everyone. Maybe it can't be done. But I don't think that we should assume that people on either side of this debate have evil intentions. Because of the complexity of the problem it isn't the intended consequences of these proposals we have to worry about – it's the unintended ones!

larry d. August 21, 2009 at 4:18 pm

AARP is losings scores of thousands of members because of their nonsensical stance on this issue, professor.

When people can't afford something, it is regrettable and when it's healthcare something should be done about it. That doesn't mean it's "rationing," however. That is as dishonest as the hyperbolic "death panel."

And of course rationing would be the consequence of any governmental attempts to control costs through a public option or single payer system. It's happened everywhere.

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