July 9, 2014

OUT: “Death Panels” Are A Lie Invented By Sarah Palin. IN: Death Panels Are Good For You!

In his Politico piece calling for a revival of Obamacare’s original end-of-life-counseling provisions, Harold Pollack blames “Palin, Bachmann and McCaughey” for having “dragged comparative effectiveness research (CER) into the broader partisan knife-fight over health reform.” But of course the main person who dragged comparative effectiveness into the knife-fight was Barack Obama, expounding on red pills vs. blue pills to David Leonhardt in the NYT months before Palin’s “death panel” gibe (and doing it again in subsequent speeches and statements). … Obama also put cost saving through “comparative effectiveness’ squarely in the context of end-of-life decisions when he questioned whether his terminally ill grandmother should have been given a hip operation. (While Pollack says end-of-life treatment is not one of the top targets for savings, Obama says it’s a “huge driver of costs.”) And Obama made it clear he favored a centralized effort to at least nudge doctors into dropping some treatments — and not such a democratic effort either . . .

Why did this discussion have to be part of the debate on extending coverage to the uninsured and security to the insured? A: It didn’t. But that was Obama’s choice, not Palin’s. “The critics have said, you’re doing too much, you can’t do all this at once, Congress can’t digest everything. I just reject that,” he told Leonhardt. In this case — given Obama’s failure to sell voters on his cost-cutting, tough-choice-making ACA — it’s hard to say the critics weren’t right.

I could go on (Pollack has convenient fantasies about how wonderful it is for people to die at home, and about hospice care, which in my experience with actual patients in excellent Southern California facilities means precisely that your docs have given up on you and are now farming you out to lower-cost care provided by drive-by contractors.