Sarah Palin was wrong when she said the provision for end of life
counseling in the health care reform bills pending in Congress is a
first step toward government "death panels" which will decide who gets
expensive medical care and who doesn't.
The death panels there are two of them already have been voted
into law as part of the stimulus bill Congress passed in February.
President Obama has appointed members to them, and funded them to the
tune of $20.6 billion.
The death panels are not, of course, called death panels. They are the
Federal Coordinating Council for Comparative Effectiveness Research
(hereinafter "Federal Council"), which will set policy, and the National
Coordinator for Health Information Technology (hereinafter
"Coordinator"), who will enforce it.
The Federal Council will perform essentially the same functions as the
National Institute for Health and Clinical Excellence (NICE), which
rations care in Britain's National Health Care system. One member is
Dr. Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel.
Dr. Emanuel has written that American physicians take the Hippocratic
Oath (do no harm) too seriously, and that priority in health care should
be given to those most useful to society, which he defined as those
between the ages of 15 and 40.
"Comparative Effectiveness Research" bases approval or rejection of the
treatment of patients on a formula that divides the cost per treatment
by the number of years the patient is expected to live after having
received the treatment. Language authorizing the Federal Council to set
a cost effectiveness standard for treatment can be found on pages 73 and
74 of the final text version of the stimulus bill, which you can read
The health care bill pending before the House would create a subordinate
Center for Comparative Effectiveness Research whose purpose, according
to Dr. David Janda, who alerted me to these provisions, is "to slow the
development of new medications and technologies in order to reduce
costs." This provision is in Section 1181 on page 502 of the bill,
which you can read here:
071409.pdf. Dr. Janda is an orthopedic surgeon in Michigan who is one
of the world's leading authorities on injury prevention and health care
Britain's NICE has a rule of thumb that it is inappropriate to spend
more than $22,000 to extend life by six months. Consequently, British
cancer patients do not have access to drugs readily available in the
United States. Dr. Karol Sikora, formerly head of The World Health
Organization's cancer section, estimated in 2000 that 25,000 Britons die
prematurely each year because of these restrictions.
The Coordinator will "guide medical decisions at the time and place of
care." Doctors and hospitals that are not "meaningful users" of the new
system will face penalties. Dr. Janda said Members of Congress told him
this means doctors could be fined or imprisoned if they provide more
care than the guidelines call for.
The eminence grise behind the death panels seems to be former Senate
Majority Leader Tom Daschle (D-SD), who was slated to be President
Obama's Secretary of Health and Human Services until his nomination was
derailed by the revelation he'd failed to pay some $100,000 of taxes
owed on a car and driver provided him by a private equity firm. He's
been a frequent visitor to the White House since Mr. Obama took up
In his 2008 book "Critical: What we can do about the health care
crisis," Mr. Daschle proposed a health care equivalent to the Federal
Reserve Board, which the Federal Council resembles. And he offered tips
on how to get his vision enacted into law.
President Clinton made two big mistakes when he tried to revamp the
health care system in 1993, Mr. Daschle wrote. He put too many details
about his plan in his bill, and allowed the public too much time to find
out what was in it. And he followed regular procedure, which required
60 votes for approval in the Senate.
Mr. Daschle recommended President Obama be vague about what he wants to
do, to put key provisions in budget bills, and to rush the measure
through during his "honeymoon" period. This may be why the president is
saying the time for debate is over, even though most of the provisions
of the bill wouldn't go into effect until 2013.