As virtually everybody in America now knows, former Alaska governor Sarah Palin posted the following on her FaceBook page:
The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil.
Naturally, she was roundly reviled for these comments. One person quoted by the New York Times replied, "One problem: None of the bills emerging from various committees includes the kind of 'death panel' that Ms. Palin says would be rationing care."
I guess that's that, eh? Mrs. Palin should go back to shooting elk and stop irritating the New York Times.
Well, not so fast.
It's true the bills don't explicitly identify a "death panel," but there is plenty that would lead to exactly that outcome. Some of it is already law, in fact.
First, Congress already enacted, as part of the stimulus package, $20 billion for Health Information Technology, or HIT. This is designed to get every doctor and every patient wired up to a national database of health information. Every disease, diagnosis, prescription, and treatment will be submitted to this national database and made accessible to researchers, payers, and law enforcement. This is not speculation; it's the law.
Next, the stimulus package also appropriated money to create a "comparative effectiveness research" program. Its proponents claim this will only be "research" to determine what treatments work best for large populations, using the health information database to make their determinations.
This is based on Britain's "NICE" (National Institute for Clinical Effectiveness) program. NICE determines the dollar value of a "quality adjusted life year" (QALY) and allows payment for drugs and treatments that are lower than that number and disallows those that cost more. NICE has already disallowed cancer drugs and treatments such as hip replacements for elderly people and stopped allowing injections of steroids for people with severe back pain.
Of course, just doing research doesn't sound threatening. Research is good, isn't it? We all love research.
This is where the current bills come in. To hold down the costs of Obama's health care program, the administration has come up with a whole menu of activities-chronic disease management, pay-for-performance, wellness incentives, and so on.
I know, I know, the eyes glaze over at this kind of bureaucratic gobbledygook. Who really knows what any of it means? That's why Sarah Palin is so dangerous. Her controversial statement cut through all the fog and made people sit up and take notice.
In fact, these are the kind of programs that take benign "comparative effectiveness research" and put some teeth into it. Suddenly it isn't just research. Suddenly we are using that research to decide how much to pay doctors. That is the whole purpose of pay-for-performance (or P4P among policy wonks.)
Physicians will be paid more if they follow the guidelines established by the yet-to-be-named research group. (My suggestion for a name is Comparative Effectiveness Research Commission of the United States, or CERCUS.) The HIT will be able to alert the CERCUS as soon as any doctor tries to violate the P4P guidelines. Uh-oh! A warning will pop up on the doctor's computer: YOU ARE TRYING TO VIOLATE THE GUIDELINES! EXPLAIN YOUSELF!!
Your doctor may be able to fill out all the paperwork to get an exception, and appeal any denial, but it will be an uphill slog. More likely, the doctor will go with the flow and accept the higher level of payment for being obedient.
That's where Mrs. Palin comes in. She would like her son Trig to live. She will need to appeal the decision to . . . whom? Very likely a panel much like what she describes.
Only it won't be called a Death Panel. It may be called the LIFETIME Panel: "Listening to Irritating Families Explain Their Insistence on a Medical Examination."
Greg Scandlen is director of Consumers for Health Care Choices at The Heartland Institute.
