Steve Rattner, who honchoed the auto bailout for the Obama administration,
has a full-throated defense of death panels ? rationing ? in the Times today,
which is sort of refreshing, in its call-a-spade-a-spade way. Rattner says the
greatest third rail in American politics is ?overtly acknowledging that elderly
Americans are not entitled to every conceivable medical procedure or
pharmaceutical.? He goes on to argue, more or less, that Medicare needs to
follow Britain?s NHS in assigning a cash-money value to the last year of
life:
Medicare needs to take a cue from Willie Sutton, who reportedly said he
robbed banks because that?s where the money was. The big money in Medicare is
not to be found in Mr. Ryan?s competition or Mr. Obama?s innovation, but in
reducing the cost of treating people in the last year of life, which consumes
more than a quarter of the program?s budget.
No one wants to lose an aging parent. And with price out of the equation,
it?s natural for patients and their families to try every treatment, regardless
of expense or efficacy. But that imposes an enormous societal cost that few
other nations have been willing to bear. Many countries whose health care
systems are regularly extolled ? including Canada, Australia and New Zealand ?
have systems for rationing care.
Take Britain, which provides universal coverage with spending at
proportionately almost half of American levels. Its National Institute for
Health and Clinical Excellence uses a complex quality-adjusted life year system
to put an explicit value (up to about $48,000 per year) on a treatment?s
ability to extend life.
ability to extend life.
At the least, the Independent Payment Advisory Board should be allowed to
offer changes in services and costs. We may shrink from such stomach-wrenching
choices, but they are inescapable.
Death-panel hypotheticals are perfect ?intuition pumps? for drawing out
latent conservative impulses in people who probably wouldn?t describe themselves
as conservatives. Many, even most Americans, will at some point have to make
?stomach-wrenching choices? about end-of-life care for themselves or for loved
ones. Thinking through all the possible scenarios is morally torturous, and
that?s when decisions are being made between doctors and families alone. Now
imagine the federal government comes in and sets the value of a marginal year of
life at $48,000 ? roughly the price, and afraction of
the true unsubsidized cost, of a Chevrolet Volt MORE
the true unsubsidized cost, of a Chevrolet Volt MORE
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