Health Care Death Panels?

Former Vice Presidential candidate, Sarah Palin, accused the Obama Administration’s plan for healthcare reform of setting the stage for the establishment of healthcare “Death Panels.” Certainly, Ms. Palin’s statement is pretty inflammatory, but her logic is pretty reasonable, if you one accepts the premises.

Researchers estimate that the 27% of all costs for Medicare occur in the last year of life (Source USA Today). So if one is looking to reduce the cost of healthcare, end-of-life care is certainly a place to start. Concretely, do you want your taxes to pay for an 85 year old’s quadruple bypass surgery? What is the likely return on your health care dollars? How long is such a person likely to live? Wouldn’t it be better to spend that money on improving health care for children. Ms. Palin’s point was that if a commission is created to discuss end-of-life treatment issues, there may come a time when such a panel will be making decisions which amount to decrees about whose life is worth saving and whose life isn’t. Whether you agree with such an assessment or not is immaterial, the fact is such a possibility is not out of the question. In the government, what it can do frequently morphs into what it “should do.”

Indeed these are difficult moral and financial questions. But ignoring them won’t make them go away.  I take Palin’s concerns seriously. A government that supports the killing of children just because they are unwanted, shouldn’t be trusted to determine which old person gets care and which one doesn’t.  However, I do agree with President Obama’s idea that publicly-funded health care should be evidence-based.  I don’t see why the government, (i.e. taxpayers) should be forced to pay for treatment that only has a 10% chance of success. The problem is what is the magic number? I don’t know. The fact is, standardized policy’s are ALWAYS unfair to someone due to human finitude. That is why I argue for a principle I call “sufficient justice” rather than complete or perfect justice.

I don’t have any easy “Christian” answers to the issue of health care that could be reasonably instituted in a pagan society like the U.S.  But I do argue that one of the reasons (and there are many) why we are in this health care mess is due to our denial of death. Christians have properly done much to oppose the culture of death our pagan societies’ have been endeavoring to create. However, we must also fight the idea that death is the end of it all. I contend that many people want to spend inordinate sums of money (both their own and others peoples) in a futile attempt to live a little longer because of their unChristian belief that death constitutes the end of existence. Christians need to remind the world that this life is not the end. That we live on after death to face the judgment of a righteous God. Death is not the ultimate evil, the second death is.

Secondly, we Christians must help people distinguish between health care decisions that prolong life and health care that simply prolongs death. Christians must work for the former but we are not morally obligated to extend the latter. A book entitled “Terminal Choices” does a superb job helping Christians use that distinction to differentiate between euthanasia and denial of our finitude.

In a sense, we have come full circle. Obama is correct that the health care crisis is a moral issue. Unfortunately, he forgets that the cause of the crisis is not in a lack of compassion in society, but due to a society whose members have failed to educate their moral decision-making skills and therefore are now confronted with a monumental economic issue.

Stephen Vantassel

Copyright 2009

  1. It is very late, but I hope the article below can be a meaningful part of the discussion. Peter

    October 22, 2009

    Honesty and Dishonesty in the Health Care Debate
    The debate on reforming health care in the United States seems to be winding toward a final decision. This debate has revealed new depths of irrationality, dishonesty and anger in political discourse. I recognize that the reform of our health care system is threatening to many, but there is no rational person who believes it can continue as it is without bankrupting business and individuals alike. The fact is that we in the United States have the most expensive health care system in the developed world, and this despite the fact that some forty million of our citizens presently have no coverage. Ours is also not the best health care system in the world as so many defenders of the status quo continue to suggest without the slightest bit of documentation. The United States ranks 23rd among the nations of the world in infant mortality, 21st in life expectancy for men and 20th in life expectancy for women. How could anyone view these facts and still seriously make the claim for the superiority of our system? American health care is quite probably the “best health care system in the world” for something like the top 20% of our population, but beyond that it is less and less competitive with other nations and for the bottom 20% of our population it is an outrageous embarrassment.

    The issues in this health care debate are not as clear as we wish, but a major reason for that is that it is in the vested interests of certain people to make sure that these issues stay unclear. Fear, scare tactics and even incredible misstatements of facts thrive in that kind of environment. Great numbers of people in our society have their mouths in the proverbial feeding trough of our current health care system, having dined well there for years. The lawyers are one such group. They resist tort reform because they make enormous money by suing doctors for malpractice and being awarded huge settlements by a jury of a victim’s peers. Drug makers are also reaping huge profits, even though far too often they have to use some of those profits to pay for the dramatically, devastating painful deaths that have accompanied certain drugs. The makers of medical devices are another group frequently shown to be guilty of deliberately hiding defects that have been disastrous. Of course, all of us wind up paying the costs of these legal settlements in the ever-expanding cost of our insurance. Doctors today are not nearly as negative to things like the public option as they once were. In fact, one recent poll suggested that 70% of America’s doctors favored the public option. I talked with a highly regarded doctor recently who favored, and thought we would eventually adopt, the single payer system. He cited the fact that doctors have worked with Medicare for years now and they know that the government interferes in patient health and in medical decisions far less than private insurance companies do. Doctors also know that Medicare, unlike the health care companies, will pay them promptly and fairly for the senior citizen section of their practice. Many doctors also resent the lack of freedom and the massive amount of paperwork that is primarily an insurance company effort to manage costs and thus to maximize profits. Paperwork connected with insurance forms has forced doctors to hire staff just to manage the paper flow, which in turn raises medical fees. For these reasons doctors are not as negative to a national health service as they once were.

    If the truth were fully disclosed we would discover that the insurance companies are making huge profits. There is no other reason for them to be spending billions of dollars to lobby against any reform. All of the proposed bills in Congress are designed to cut the cost of medical care, and that means cutting the profits of the insurance companies. Spokespersons for this industry are the people primarily responsible for the loaded rhetoric that has been dumped into the debate. It comes straight out of unscrupulous public relations firms. Whenever one hears in this debate emotionally loaded words like “government takeover,” “government death squads” (who, they suggest, will decide which elderly people will live and which will die), and “government bureaucrats” (who will stand “between you and your doctor”), all of us should know that this rhetoric is the result of paid lobbyists seeking to manipulate public opinion. What we have operating in the economy today is an insurance company takeover of American health care and they do not want to be challenged by what they call “a government takeover of American health care.” The insurance companies are today the ones who decide what services will be covered. They thus are already making the decisions as to who will live and who will not. Their rhetoric simply projects what they are already doing onto their favorite bogeyman, “the government.” At least a government program would be responsible to its constituency, the people of the United States, while the insurance companies must satisfy their constituency of profit-driven management and dividend-seeking stockholders. Few people recognize that 35% of the premiums people pay for health insurance goes to executive compensation, bonuses and dividends. There is enormous profit in health care. One wonders how moral it is for a few to profit from the illnesses of the many.

    Another rather ingenious attack on health care reform heard recently in Congress by the perpetual naysayers is that the provision requiring everyone to carry insurance amounts to a “new tax” imposed on young Americans. Behind this charge is the fact that among those who have no health insurance is a significant number of young Americans who refuse to get it for two reasons: one, it is very expensive and two, they feel no need for it, given their youthful and robust health. To me this is one more manifestation of the selfish greed that so deeply affects this nation. I was responsible for an urban hospital in Jersey City for 24 years while I served as the bishop of Newark. It was not only our desire to serve the poor, but also a government mandate, that we had to treat any patient in need who appeared in our emergency room whether they were insured or not. Under this law we in turn billed the government for “uncompensated care.” The government obviously passed on these costs to the taxpayers. So the fact is that all of us today are already paying for those who have no insurance, even though those in the young adult category are quite capable of paying for it. If all the young and healthy Americans were forced to come into the health care system at appropriate levels, we would discover that the cost of health care would go down for all. We require those who drive a car to have insurance. Is that a tax? I think not! It is an act of responsible citizenship. This fact also counters the fear, so often expressed in this debate, that this nation cannot cover the uninsured without adding hugely to the national deficit. It is amazing how opponents of health care can argue both sides of an issue whenever it serves their purpose, even if the two sides are radically contradictory. That is when you know that the real agenda is hidden.

    The biggest scare tactic of all has been the suggestion that under a new plan the health care of the elderly would be rationed by setting up “death panels” to determine which senior citizens to euthanize. Here again behind this fearful and dishonest rhetoric there are some facts that need to be made clear. An enormous percentage of our health care dollars is expended in the last year of a person’s life. Some of that is normal and to be expected, since death comes to most people after a sickness in old age. There is, however, a large elephant in the room in this debate that is never mentioned, which is the systemic over-treatment of the elderly. As Evan Thomas noted in a recent Newsweek article, researchers at Dartmouth have discovered and documented that the average cost of a Medicare patient in Miami is $16,351 while in Fargo, North Dakota, it is $5,738. This study also revealed that the average Medicare patient undergoing end-of-life treatment in Manhattan spends 21.9 days in the hospital while in Iowa, it is 6.1 days. There is no evidence to suggest that there is any difference in care or longevity related to the difference in cost. The primary difference was in the number of tests and procedures that doctors ordered. Medicine pays by the procedure. According to Mr. Thomas some studies estimate that Americans nearing death are over-treated by roughly 30%. Some of this I am certain is motivated by the fear of malpractice suits, some by the “fee for service” way we practice medicine and some by greed. In places like the Mayo Clinic, where doctors are paid a salary to care for patients, the costs go down and the effectiveness of care goes up.

    Another important issue, which has been demonized in this political season, is the effort to encourage end-of-life conversations between doctor and patients. This has never been a prelude to euthanasia as the hysterical Senator Charles Grassley of Iowa has irresponsibly suggested. It is designed to give a patient a major role in managing his or her disease. Where this has been done effectively, patient costs have dropped 35% while the quality of life has been improved. People with this counseling tend to die at home in the care and arms of their loved ones, not in an antiseptic environment surrounded by strangers.

    I applaud the ingenuity of our health care professionals, which has expanded both the length and the quality of life. I have had two diagnoses in my life that my grandfather would not have survived. There is a fine line, however, between expanding life and postponing death. I do not believe that life and existence are the same. Insurance should not pay for guilt, but for meaningful life. I want to wring every ounce of sweetness possible out of my length of days, but I also do not want to live one moment beyond the time when my life loses meaning and contact with those I love. I do not want anyone’s religious values to be imposed on me. I do not ever want life to be defined as extended time. There is a difference and someday I hope unscrupulous politicians and those with clearly vested interests will understand that as I do.

    – John Shelby Spong

  2. Hello again Peter, but I have trouble listening to a man who has difficulty taking the Bible seriously but still claims to be a Christian leader. I would suggest finding a Christian who takes the Scripture as the Word of God and who wishes to comment on the issue.
    Furthermore, you may want to subscribe to the Evangelical Review of Society and Politics as it will be having a forum on the topic next year.

  3. Hello Stephen, I think I’m done with this. American health care is not really my busines; I got involved when the anti-health care crowd in the US was misrepresenting Canadian medicare. I allowed myself (not unwillingly) to get drawn into the ‘discussion’.

    As for Spong and his writings, for me he is a God send. I have gained
    understanding and faith through reading his work. Previously I have been pitied or criticised for ‘lack of faith’ because I do not believe the unbelieveable, or given the brush-off when honestly searching for truth.

    I think I am a christian and it horrifies me to think that unless we take seriously the issues dealt with by Spong, Christianity cannot hope to survive.

    Sincerely, Peter

  4. Peter,

    If Christianity is true, it will survive because the God it worships cannot die. If Christianity is false, then no amount of compromise will save it.

    Not sure what you mean by faith (belief in Christian doctrine, trust in the unseen etc.) But everyone has faith. Atheists have faith, Muslims have faith. The question is what is the content of faith? Good feelings about God are useless. Christ wants us to worship him as He wants to be worshiped. That requires doctrine, which regrettably Spong wishes to reshape in the modern image. The apostle Jude had some harsh words for such behavior.

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