Friday, September 18, 2009

On Sarah Palin's Gloating, Or Why Rationing is Good.

On September 8, Sarah Palin had an op-ed in the Wall Street Journal (via lifenews) about health care rationing that included the following "death panel" gloat:

Given such statements, is it any wonder that many of the sick and elderly are concerned that the Democrats' proposals will ultimately lead to rationing of their health care by—dare I say it—death panels? Establishment voices dismissed that phrase, but it rang true for many Americans. Working through "normal political channels," they made themselves heard, and as a result Congress will likely reject a wrong-headed proposal to authorize end-of-life counseling in this cost-cutting context. But the fact remains that the Democrats' proposals would still empower unelected bureaucrats to make decisions affecting life or death health-care matters. Such government overreaching is what we've come to expect from this administration.

I tried to ignore her; I was working on an article on rationing at the time (that hasn't yet gone live.) But there are a few points regarding her letter that are worth debunking if only because she makes such outrageous claims.

Firstly, the "death panels" claim was loudly debunked by AARP, the largest seniors group in the country. The only reason it caused so much noise and concern was because the media found it - and Palin - too juicy to resist. In other words, Palin has confused fearful alarm caused by erroneous accusations with lack of understanding of a complicated proposal. She helped create the fear-mongering and disinformation that she is now claiming as public concern.

Secondly, health care decisions are currently made by doctors and their patients and then approved (or disapproved) by insurance companies. Insurance companies are driven by cost. Which is why we have 50 million Americans who are completely rationed out of health care coverage. Rationing exists in our current system because private entities have been left to operate without strict oversight, without a conscience for those it serves, and without the cost containment necessary to serve the entire population. An estimated 20,000 people die each year because our current system neglects their health needs.

Government, however much hated by libertarian conservatives, is really the only entity in our society that can protect all citizens from the tyranny of private corporations. And isn't that what conservatives count on government to do when we are threatened by war, terror or other violent evils? Health care should be considered no different. But conservatives aren't concerned for the poor, the disenfranchised, or the voiceless because they have "big government" to chastize and private corporations to suck up to.

Historically, democracy hasn't been good to minorities and the poor. If you rely on a voting populace to get over it's petty racisms and discriminations you have a long wait coming. Legislation seldom steps in to protect those unprotected by economic and prejudicial forces in society. So the courts are often left to step in for equal justice. Look at women's reproductive rights. Look at civil rights. Democracy has a shitty history of catching up with social injustice. Our current health care system is a great social injustice.

But I digress. The truth is that rationing exists in our current system. And rationing will exist in any future system. The current medical culture has refused to face issues of death with anything other than extreme medical procedures. Chalk it up to a profession founded to save life, to poor end of life care training, to a tradition of not accepting the limits of its own powers.

And patients, who are raised on the authority of the medical profession have followed suit, accepting that death must occur in hospitals, that all options have been exhausted.

Add to that our human denial of death, our reticence to discuss end of life issues and you have a paternalistic medical system bullying patients into extreme treatments in the midst of their fears and egged on by a money-hungry industry all too willing to make a buck on grandma's death bed.

(I won't even get into religious conviction that suffering is redemptive and that government (or the state), God, doctors, and patients all make a claim for jurisdiction over suffering. I just finished another article on suffering that has not yet been posted.

Rationing will never go away. Nor should it! We are overtested, overmedicated, overtreated - and still the 37th healthiest country on the planet despite our expenditure of 1 in 6 dollars on health care. Mammograms do little to increase the survival rate of breast cancer patients. The examples of gratuitous, ineffective medical care are endless.

If a new drug costs $40,000 a month and only guarantees a patient one month more than a placebo, why should we cough up the money to prolong that patient's suffering and death and not better counsel the patient on what is to come?

We're not necessarily wired to accept death, but when it comes, no amount of medical treatment will cure it. And we would be juvenile to not recognize the resources freed up by noting this fact.

As to the horrible, deadly government bureacracy Palin says will decide who lives and dies? I would rather it be the government, subject to regulation, privvy to the latest science, invested in the health of it's constituents, willing and able to protect the poor and minority, than some corporate entity that gives two licks for it's clients: their wallets and their monopolization. Oh, and maybe their fear.

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