Obamacare Full of Death Traps

The proposed federal health care overhaul, former Alaska governor Sarah Palin insists, will create “death panels,” with bureaucrats deciding who should live or die. Obamacare proponents scoff at the claim.

It’s very difficult to tell from the text of the bills who’s right. And that’s a big problem.

HR 3200, the bill furthest along in Congress, doesn’t mention death panels. It’s more subtle and complicated than that.

First, the bill mandates improvements in “best practices” in health care, to improve “quality” and make it “affordable” and “efficient.” What do these terms mean? It doesn’t say. So they will indeed be defined by bureaucrats issuing expansive federal regulations after the legislation is passed.

Second, the “comparative effectiveness” of treatment options must be identified and implemented under this bill to improve “quality and value.” What is “quality?” What is “value?” Can’t tell. These terms will be defined by bureaucrats, statisticians, and economists. If the UK’s model is followed, a high-cost procedure for an older person often will be prohibited.

That’s another troubling point. Right now, patients themselves decide what health care treatment they want. Their doctors advise them, of course, but the ultimate decision is theirs. HR 3200, however, moves toward decision-making “shared” with clinicians and payers.

Then we come to the direct “death panel” provision of HR 3200. This starts with mandatory counseling for Medicare recipients on “advance care directives” for end-of-life measures, such as living wills and durable health care powers of attorney. These have long been standard documents drafted by probate lawyers for their clients, expressing the prospective patients’ preferences for treatment, such as “Do Not Resuscitate.” They are not binding on physicians.

HR 3200 would change that, requiring that Medicare beneficiaries be urged to enter into “orders” regarding “life sustaining measures” to be taken in future life-threatening situations. These are defined as use of antibiotics, artificial feeding, and hydration, among other things. Unlike living wills, these “orders” would indeed bind physicians, although one must read the bill very closely to figure this out.

The scariest part is that these “orders” are to be written by the beneficiary long before any life-threatening condition develops. They “may” be updated later, but it’s not required. It may very well be impossible for an individual to make an informed decision in advance.

Let’s say an elderly widow is found stuporous in her apartment. She lives alone and hasn’t been eating much food or drinking enough water. This type of stupor mimics a near-death coma, but insertion of a feeding tube and a hydration IV often can fully revive such patients. If this widow has signed an “advance directive” forbidding the doctor to administer food and water artificially, she has condemned herself to a premature death. It’s not hard to think of other troubling possibilities.

Other than the “death panel” issue, the public debate about health care reform has centered mostly on whether there should be a single government payer system and whether federal funding will be available for abortions and illegal immigrants. But there is much more going on here: the issue of who should get care or not get care, who should live or die, and who should decide.

The American people deserve and should demand a full and fair public discussion on these matters.

Maureen Martin (mmartin@heartland.org), an attorney, is senior fellow for legal affairs at The Heartland Institute.