06 January 2011

More on presenting issues: death panels and other lies.

During the debate on the health care bills that eventually merged into "Obama-care" the Republicans, never a group troubled by truth, used as the presenting issues "death panels." The idea was that the government or the health care providers or someone would create committees that would evaluate the probable value of a treatment as opposed to palliative care and in some cases for cost / benefit reasons, care would be denied. This was of course portrayed as horrible.

Never mind that the actual bill did not contain this idea. Never mind that the one thing that was offered, time of death counseling is a common practice now. Never mind that DNR (Do Not resuscitate) orders are a standard and non-controversial part of geriatric medicine. Simply scream "rationing" and "death panels" and you have a presenting issue.

OK, it is a lie but so what?

Which leads me to this story In Arizona it appears we have a death panel -- the GOP government. And indeed people are dying. Those people are of course not rich republicans so the death panel is presumably working the way the GOP thinks they should.

If one looks past the presenting issues, something not encouraged by Republicans of late, one can often encounter reality. Here is the reality, every system has to deal with the fact that needs are infinite and resources are not. Somewhere, someone has to decide where to spend the available resources. The mess we call the American health care system distributes the decision making process across many actors. Benefits administrators, corporate employees charged with buying insurance policies within budgets make a lot of the decisions. Anonymous employees of the carriers make many of the decisions. At the end of the day what they do is rationing.

But the GOP lies about it (no surprise) and calls this mess, "choice." In the sense that every system delivering scarce resources represents someone's choices, I suppose we can accept the label. The question is who is making the choices? The answer at the end of the day is board's of directors who authorize budgets, insurance carrier employees charged with limiting costs, politicians setting budgets and only at the end of the very long line, sick people. In plain language that is rationing and the legislatures and board are death panels. So, we got them, without the optimal health care plan.


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