Death panels? Certainly. I sit on one, and am subject to another. But, today, it’s all OK.
How is that so? How are death panels OK? Well, let’s start by defining the term death panel. A death panel is an entity with final authority to make decisions over the course of treatment, including the ending of treatment and removal of life support.
So, we do not want those. Right?
Well, death panels have been around since the close of Eden. In earlier times, in more advanced societies, panels consisted of the patient and his or her close family. Together, they decided how their collective, limited resources would be allocated to healthcare. And, at some point, and in many cases, the decision to reduce or end treatment had to be made—such being the human condition.
These panels functioned without government control—and they functioned well. Life and death were, for the most part, a family matter.
Recently, though, the structure of the panels has changed due to the ever-increasing state. The panel I sit on—for my parents—is structured under a legal contract—the power of attorney. This agreement purportedly provides me and my sister control of our parents’ well-being, should the need arise. But, in reality, the state has created a myriad of laws and regulations governing healthcare, including the ending of such care. So state has, in essence, appropriated at least one seat on the panel.
The same power my parents have given to me and my sister is the very same power I have given to my wife and children—to lord over my last days, basing decisions on their limited resources and other concerns, within the constraints imposed by the state, of course. An enormous power and responsibility. Nevertheless, it works as best as can be expected given an intrusive state. We are OK—not in the best situation, but OK nonetheless.
As stated above, the hand of the state has intruded into a very personal, family matter. And with each intervention, life—and death—has gotten more difficult to address. But these infringements on liberty are nothing compared to what may await us all in the near future.
Death panels are not per se evil. They are required given the realities of limited resources. However, death panels become evil when the state gains control. Replace the concerns of the family with the bony finger of a government agency and we all need to fear.
So how does the state justify its growth in such intimate matters? And, more importantly, why do its citizens allow it?
The modern state survives on one great lie: the state claims that it holds the power to end the human condition resulting from limited resources. An example of how this plays out: A parent is concerned about burdening his or her child in old age. The state comes along and says it will bear that burden, and it will do so at no direct cost to the parent or child. But the bargain is Faustian. In exchange for bearing the burden, the state claims the authority to make final decisions regarding how long and to what extent the burden will be borne.
And, most importantly, the state does not say that, in the end, it bears the burden by burdening the child. This is true because the state produces nothing, it only thieves what it can. So to bear the burden of the parent, it taxes the efforts of the child.
As a result, the parent and child gain thing, but liberty is lost.
In the coming years, I expect to see government-controlled panels first allocate only government resources (thieved from the taxpayers, of course), so the individual and his or her family will still be able to supplement as desired. But the progression will be toward more government control, until the point is reached where the state no longer allows individuals to trump its decisions. And when that occurs, death panels will truly be the death panels we fear.
Death panels are a reality due to the never-ending reality of limited resources. But death panels are not the issue. The issue is the state.
This is always true: A thing per se is not necessarily evil, but that thing in conjunction with the state are always evil.
Jim Fedako (send him email) is a business analyst and homeschooling father of seven who lives in Lewis Center, OH.
The State is there at the contract level, too. But surely custom and the natural law that the State should keep out of a family’s business should obviate the need for contracts.
Of course, that was before the State began redefining “family.”
I see no end in sight.
Very good post, Jim. One supposes that this all depends on whether people want the freedom to make their own hard choices or if they want to toss that responsibility elsewhere. One would hope that while tossing the choice, as many do, they realize the state may one day decide in a fashion that is distressing to these very persons. Faith in a group of powerful people is generally very badly misplaced.
RE: “Death panels are not per se evil. They are required given the realities of limited resources. However, death panels become evil when the state gains control.”
REALLY???? Just because the government has involvement, or a controlling role, automatically renders it evil?? That seems to presume the government is always evil, or becomes evil when co-joined with a “death panel” function.
Certainly the govt’s involvement is asking for trouble…though, generally, more along the lines of the ignorance, stupidity and incompetence variety. Which is not “evil.”
Consider: In this country (USA) when government has actually gotten involved in a “death panel” issue the invariable pattern has been one of prolonging the provision of what many [most?] consider extraordinary medical treatment for utterly hopeless cases.
Benchmark Examples: Karen Quinlan’s case set a number of legal precedents and that took years to resolve via court cases thru the State Supreme Court. Terri Schiavo was in an irrecoverable brain-damaged vegetative state maintained for 15 years, ultimately involving numerous courts and even formal Congressional legislation (signed by President Bush) specific to her case to keep her alive. Though, ultimately nature was allowed to take its natural course in both cases.
SO, in the REAL WORLD we see that when government (at least US government) entities get involved in “death panels” the invariable pattern is one prolonging, via extraordinary medical technologies, human life. And this isn’t sometimes, this is pretty much all-the-time. Most people would consider the preservation of human life a good thing….
HOWEVER, IN the philosophical world of this Briggs-endorsed essay comes the presumption that what government ‘would do’ is so necessarily evil that mere membership in a panel renders that panel evil!
As its been put in a variety of ways, e.g. Luke 6:44 — “A tree is identified by its fruit” meaning one determines what something is by what it actually produces/does, not presumptively by its potential…the essay cherry-picks a presumption of the worst-case potential as the only one that will occur–and that is presumed & postulated despite so much evidence to the contrary!!
When the philosophy addresses matters disconnected with reality, there’s something fundamentally wrong with the philosophy. In this case and in this country, a real but tiny risk is presented as an inevitable outcome — that has no practical bearing in the-way-things-are-here-and-now.
FOR FUN, lets accept the premise, “Death panels are not per se evil. They are required given the realities of limited resources. However, death panels become evil when the state gains control.” By that, much of the US legal system, including Congress & President Bush, were–as members of a de facto “death panels,” such as in the case of Terri Schiavo, were evil.
But there’s an intrinsic underlying ambiguity there: Does that prove therefore that Congress & President Bush (and others) were evil, or, only that by virtue of their involvement in a “death panel” the “death panel” became “evil”? Did they become evil upon membership in the “death panel” or was the “death panel” transformed into an “evil” entity upon their membership while those government members remained pure?
Such is an example of the idiotically nonsensical thought exercise tangents philosophical thinking can lead one. Which is why few people take philosophers seriously….
Soon you will be reading stories like this about Obama care.
http://www.theguardian.com/commentisfree/2013/may/22/nhs-killing-disabled-people-like-daughter?CMP=twt_gu
Dear Mr. Briggs,
The Patient Protection and Affordable Care Act has in fact established a “Death Panel” with plenary power over what care will be afforded patients, and how much health care providers will be paid for “approved” drugs and treatments. It is called the ” Independent Payment Advisory Board”.
Will,
Thanks. But note that I’m not the author of the piece.
There are a number of very difficult issues involved in thinking through issues about ‘death panels’.
Family and loved ones with an up-to-date power of attorney for personal care can and should work in most cases.
Most cases does not mean all cases. I don’t think the main issue at the present time is ‘the evil state’ although it could become the main issue.
The main problem humans have is changes to medical technology, the resources required to deploy the technology, and uncertainty about the situation of particular patients.
Consider the case where a new treatment becomes available after the power of attorney for personal care has been signed, the family is following the instructions and become aware of the ‘new treatment’. What to do?
Those with the power of attorney now have to interpret the wishes, say of a parent, discussed when neither the parent or those with the power of attorney, were aware of the new treatment. Evidence for the efficacy of the treatment will be mixed, as it usually is, and will depend on the condition of the patient and perhaps his/her age.
One outcome is that those with the power of attorney say, “Her wishes have been very clear and she would say ‘no’ to the treatment.” Why? “Well, she told us that at the age of 96 when it is time for her to go let her go.”
Fair enough.
One can imagine a different choice made for a different, perhaps younger, patient.
But the issue is not that simple since there are medical personnel involved who may say that, “These treatments are not doing anything for the patient and you are asking us to torture them for no positive outcome. We took an oath to ‘First do no harm.’ So we want to stop the treatments.”
The family objects and the case goes to court. I don’t think the use of the word ‘evil’ to a government institution, in this case a court, helps. In fact I would argue it misses the point completely.
Personally, I don’t envy anyone involved. The family cares deeply about the patient, the medical personnel involved, have done what can be done and after what can be tried has been tried are convinced that further treatment is wrong, and a judge does his/her best with a situation that basically has come about because of advances in medical technology. In 1900 the patient would have died because there was nothing a doctor could do.
Use of the word ‘evil’ in the cases I know about is of no help. I can imagine situations where ‘evil’ might be appropriate but I would be very careful in my use of the word.
Two articles of interest:
http://umanitoba.ca/philosophy/ethics/media/At_the_end_of_life.pdf
http://www.ctvnews.ca/canada/rasouli-life-support-case-scc-rules-consent-needed-before-ending-treatment-1.1502434
There is another voice on the panel – the healthcare provider(s) – whose motivations are substantially budget-driven within the limits the State puts on them. I have witnessed hospital personnel urging a pulling of the plug on a patient whose expressed wish was for all medically possible measures be taken to sustain life. This “suggestion” was not followed because the State found the patient’s wishes superceded the hospital’s bottom line. How much longer this will continue is anybody’s guess, but the zeitgeist leans against it.
Will said, “The Patient Protection and Affordable Care Act has in fact established a “Death Panel†with plenary power over what care will be afforded patients,”
Since the Federal Government is taking over $700 billion out of Medicare in the next ten years when the baby boomers will flood onto Medicare requiring health care, it is pretty much guaranteed that Obama’s death panel will be very busy.
Does this mean less hip implants? Fewer knee implants? How about those millions of seniors suffering from COPD? Something will have to give.
Will,
That is not a death panel, per se. Unless, of course, you assume that acting men and women are helpless without government support. Similar to saying a death panel is a welfare agency that cuts of some type of (day) food support. It becomes a death panel when folks are no longer allowed to supplement on their own.
The term Death Panel has been used more to bring to light that, once health care in entirely in the hands of the State then we’ll see a greater rationing of care and it’s being determined by those other than the patient, the patient’s family and doctor. The slippery slope is towards complete socialized medicine where the choice for treatments (not necessarily life and death treatments) is out of the hands of the patient and entirely in the hands of the State.
Ken,
You must have missed reading about the greater part of the 20th century.
In particular, you conflate the state forcing others to act with the state acting itself. Big difference between the two.
“The family” does not necessarily have the welfare of individual members at heart. While mass euthanasia was planned in Hilter’s Germany, it took a letter from a father who wanted to be relieved of the burden of caring for his infant son to give officials a reason to test the program–which was wildly successful, ultimately killing an estimated 275,000 deemed ‘unworthy of living’. (See: http://www.telegraph.co.uk/education/3319981/Named-the-baby-boy-who-was-Nazis-first-euthanasia-victim.html). “The family” can be quite on board with a decision that leads to a quick death of a so-called loved one (such as the Liverpool Pathway) if there are perceived gains (such as more free time for shopping, or more funds to shop with).
Before Hitler, the role of doctors in Germany [with its rich history of socialized medicine] transformed from being carers and patient advocates to essentially being government cooperators.
Though we think we are new era, we have not moved beyond reach of the past. The road ahead has been trodden before, with miserable, terrible results.
Jim,
1-)Could you present some of the article of law you mention?
2-)You realize that private insurance were doing even worst before when they decided that they were cancelling policies at will. A practice that the ACA has ended.
3-) The death panel that was mentioned by Sarah Palhin was something included by a republican who asked that the consultation concerning a living will with a doctor should be reimbursed.
It is somewhat understandable how people on this blog get frustrated by the law since you guys show so little understanding of it.
You realize that private insurance were doing even worst before when they decided that they were cancelling policies at will. A practice that the ACA has ended.
Yeah. Much better they cancel them at gun point.
Theses policies were so substandard, they can only (now) be extended for another 2 years. Fancy that.
http://www.foxnews.com/politics/2014/03/05/administration-offers-2-year-obamacare-extension-for-canceled-health-plans/
http://www.foxnews.com/politics/2014/03/07/obamacare-signing-up-few-uninsured-americans-studies-show/
Katie,
Certainly, there is no utopia, and no free market utopia. But this is true: either government is involved or it is not, it cannot be halfway involved. I would rather it not be involved (see the 20th century).
Regarding euthanasia: What entity actually committed the act? Family or government? And which entity promoted the act? Family or government? And which entity deemed the act legal and provided the necessary justification and defense? Family or government?
Of course, there was a strong intellectual movement in the early part of the 20th century (starting in the US, nonetheless) that partnered with government to provide a veneer of justification (Eugenics Movement). So there is an excluded middle above (certain intellectuals, with similar ones active today), so to speak.
Families are not perfect, by any means. But government is nothing but members of other families — it’s made up of your neighbors, etc. So I would not assume altruism (not saying you did) with regard to government in such matters.
The purpose of the health care act is to slowly, but surely nationalize health care and make it the only option for the vast majority of Americans. The wealthy will never be bothered by it.
Like Social Security, the more people that are dependent on the Government, the more power the Government has, and the more likely people are to vote those into office who will increase that power. It’s a vicious cycle of “bread and circus’s” which typically ends in bankruptcy or insolvency.
Jim,
For your McKinsey survey:
You should read the actual survey, instead of the foxnews report. Foxnews seems to have some creative reading of it.
http://healthcare.mckinsey.com/individual-market-enrollment-updated-view
Reported enrollment has continued to increase, particularly among the previously uninsured
“Across the four surveys conducted since November, reported enrollment has continued to increase. Of the 2,096 QHP-eligible respondents in February’s survey, 48 percent said that they enrolled in a 2014 individual product, up from 37 percent in January, 31 percent in December, and 19 percent in November (Exhibit 1).”
1-) The problem with the website in October surely delayed the enrollment, though the ACA was always on faster rhythm than Romneycare in Mass.
2-) You also need to account for the massive advertising which recommended/suggested to not respect the law and to not enroll. Such advertisement surely got some attentive hear in republican lead State.
3-) Only an idiot would prolong a substandard policy (Sadly their are a vast number of them that are republican). In most cases the holder of such policy can find a better and cheaper policy on the market. While before insurance policy had lifetime cap (good luck getting insured once you had reached that cap), ridiculous deductible in the 10s of thousands of dollars, and they had the ability to kick you out,even though you had always paid your premium once you got sick.
sorry that was DAV
From the Fox link:
Based on what data?
And this is contradicted by the McKinsey survey which showed that it was increasing every month. Which strangely coincide with a relax of negative advertisement on the airwaves.
Based on what data?
“Gary Cohen, the Centers for Medicare and Medicaid Services official who oversaw the insurance marketplaces through their troubled rollout”
And he said this about two days ago.
What? You’ve never heard of cms.gov? Did they forget to tell you again?
So I guess then we should take what he has to say with a pinch or two of salt.
Yet the survey still show the number are increasing month after month.
So we should take seriously the word of the guy who said that the website would run smoothly!!!!!!
Is he still working or has he been fired for his incompetence?
Yet the survey still show the number are increasing month after month.
Well, I would guess he would be more intimate with the details than anyone at McKinsey & Co. Who should we believe? Not the government? Really?
So we should take seriously the word of the guy who said that the website would run smoothly!!!!!!
If you mean the Big O, we here have been asking the same for a long time.
1) It is interesting to see fox news give so much credit to the guy that some republican asked that he should get fired.
2) He was talking at a conference held by the insurer with whom he is trying to find a job with.
http://www.bloomberg.com/news/2014-03-06/u-s-health-insurance-regulator-gary-cohen-to-resign.html
The numbers are clear, every month there are more and more people that are enrolling for Obamacare.
http://acasignups.net/graph
BTW they are now at over 50% of what was first projected with one month to go.
You already have 10-13 million persons who are now insured because of the ACA
Let’s get this straight. You would have us believe every piece of government propaganda except for those which don’t support you?
Every government announcement carries some amount of puffery and rosy performance figures (of itself, that is). The interesting part being reported is that here the rosiest picture a government official can paint is “We don’t know.”
Think about that. It’s in their best interest to trumpet the number of uninsured becoming insured through Obamacare yet we hear that they aren’t collecting the data. If one was cynical, one would guess that they started to then realized it wasn’t quite in their best interest to continue to do so.
The McKinsey report says that around 1 in 4 of those obtaining insurance through Obamacare categorize themselves as previously uninsured. The whole point of ACA was to get insurance for the uninsured yet the uninsured are continuing to avoid it in droves. So, even using the rosiest picture supplied by Mckinsey & Co. (and you gotta wonder where they got the numbers if the government is collecting them), it’s an abysmal failure.
BTW they are now at over 50% of what was first projected with one month to go.
The deadline is March 31. That’s 3 weeks. And the projection was only 50% of the first projection when 100% of Americans were supposedly required by law to participate? That’s pretty sad. Seems they have set their sights really low. Impresses those who can’t think I suppose.
You already have 10-13 million persons who are now insured because of the ACA
And 4.7 Million who no longer are.
DAV,
Cohen said himself that the number of new insured is not a data they collect.
So he has not data to back up his claim.
What we do know is the number of people logging on the market place is getting higher every month and that the number of people buying insurance gets higher.
Then we have the McKinsey survey that confirms that the number of people buying insurance keeps getting higher.
That the numbers are lower than what was projected is a problem. But a problem that can be explained by the problem with the website that have been fixed since, and the massive mis-information campaign.
Still this rollout goes better than the Romneycare rollout in Mass and shows a faster pace than what was seen in Mass.
The ACA law actually only concerned about 45 million peoples. Not all American. Since more than 20 states opted out of the Medicaid expansion that number got reduced by about 15 millions.
The number of total insurance bought on the market was first projected at around 8 millions and it now stands at 4.5 millions with 1 month to go. They will reach the projected number but it should take a few weeks to do so.
“And 4.7 Million who no longer are”
Those policies were extended for up to two years, so no one lost their insurance.
Cohen said himself that the number of new insured is not a data they collect.
So he has not data to back up his claim.
Yes. It’s true that if you claim you aren’t collecting data then you have no data to back up your claim.
Those policies were extended for up to two years, so no one lost their insurance.
So delaying it another two years does what exactly?
The ACA law actually only concerned about 45 million peoples. Not all American. Since more than 20 states opted out of the Medicaid expansion that number got reduced by about 15 millions.The number of total insurance bought on the market was first projected at around 8 millions and it now stands at 4.5 millions with 1 month to go.
That 45M was the estimated number of uninsired in the country and now only applies to 1/3 that number and the projection was for only 1/2 of those?
And no, even if generously assuming the 13M you quoted was correct (which can’t be proven — as of yesterday they can’t even show how many have actually paid a premium to be covered) and using McKinsey, that would be 0.27 * 13M = 3.5M and not 4.5M. It’s not clear at all where McKinsey got their numbers. Are you manufacturing these numbers?
Also, you have to sign up to just to get the information needed to make a decision and even then, it’s very difficult to get how much it’s going to cost. I know, because I tried. So that generous 13M is most disingenuous. They don’t know how many are actually obtaining the insurance.
Face it. It’s a failure from the start and waste of money.
An update.
Lou Dobbs on the financial problems surrounding Obamacare.
http://video.foxnews.com/v/3310006025001/another-setback-for-obamacare/#sp=show-clips
http://www.foxnews.com/politics/2014/03/07/obamacare-in-peril-questionable-sign-ups-delays-mar-launch/
http://www.foxnews.com/opinion/2014/03/07/your-health-isnt-political-here-way-out-obamacare-mess/
Both of these people have been mentioned before and both had insurance that paid for these things (obviously substandard, eh?) — but no longer.
DAV,
“Yes. It’s true that if you claim you aren’t collecting data then you have no data to back up your claim.
Those policies were extended for up to two years, so no one lost their insurance.
So delaying it another two years does what exactly?”
Delaying it means that the two stories you linked to are total scam since these substandard insurance are still valid. They cannot blame Obamacare for insurance they had before it was active. It is easy to make claim, it is harder to have them sustain to scrutiny.
On Hannity a couple claim that they had lost their insurance, that their daughter had a pre-existing condition, and that they wouldn’t be able to find other insurance. This was false. Obamacare eliminated pre-existing condition and lifetime cap.
A few weeks ago Foxnews misinterpreted a CBO report claiming that Obamacare would cost 2.6 million jobs.
http://nation.foxnews.com/2014/02/04/cbo-obamacare-will-push-2-million-workers-out-labor-market
This of course was false. What the CBO really is that some people would now be able to work less hours and spend more time with their family which would liberate enough hour to create 2 millions + jobs.
Delaying it means that the two stories you linked to are total scam since these substandard insurance are still valid. They cannot blame Obamacare for insurance they had before it was active. It is easy to make claim, it is harder to have them sustain to scrutiny.
Scam? No. The 4.7M who lost their insurance at the end of last year can’t just regain it with a wave of the hand. It’s still lost. Once it’s gone it’s gone. The policies have ceased to exist and are no longer obtainable. How many more ways can there be to say it? Do you have any idea how insurance works? In two years, even more will lose theirs. The purpose of the two year extension is to delay the ugly truth and one can only wonder why.
It is easy to make claim, it is harder to have them sustain to scrutiny.
Indeed and yours don’t stand up.
See: https://www.wmbriggs.com/blog/?p=11670&cpage=1#comment-114572 for starters.
Only a fanboy would fail to see the pig behind the badly applied lipstick. Or see attaining a goal after moving the goal posts closer time and again as an achievement.
DAV,
The 4,7 millions number represent the number of letter sent by insurer announcing the cancellation of substandard individual plan starting January 1. But in mid-november Obama authorized the prolonging of these policies for one year, and lately for a second year. So these policy never actually got cancelled unless the recipient decided to cancel it.
These letters were also the origin for the claim that healthcare policy were rising by 100s of %. Insurer used these letters to offer new policies that were not in the same category. It’s like if my Honda dealer told me that Honda doesn’t make the Civic and that I have no choice but buy the Odyssey which cost 3 times more, and not mentioning that I could buy a Fit instead.
Here is a link that I think should be an eye opening for you:
http://www.foxnews.com/opinion/2013/11/05/insurance-cancelled-dont-blame-obama-or-aca-blame-america-insurance-companies/
A juicy quote:
“The government did not “force†insurance companies to cancel their own substandard policies.The insurance companies chose to do that rather than do what is right and bring the policies up to code”
The delaying of cancellation happened before the actual cancellation took effect. So these policy have never been actually been cancelled, though they are only available to people who already had them.
http://americablog.com/2013/11/obama-delay-health-insurance-cancellations-one-year.html