Not quite a death panel, but close

One of the big topics in the health care debate this weekend was Sarah Palin’s statement calling ObamaCare “evil” and suggesting it would create “death panels” that could deny care to elderly Americans. There seems to be a lot of confusion over this statement and whether the bill does create such a panel to oversee end-of-life decisions for seniors. Although I recall seeing an interview in which a doctor mentioned this type of provision that required such counseling and oversight of seniors, I wasn’t able to find any mention of it in what I presume to be the most updated version of the bill, here.

Perhaps part of the problem is that there are multiple versions of the bill that are circulating – the bill as it was introduced in the House and the three drafts passed by the Energy & Commerce, Education & Labor and Ways & Means committees.

Over the weekend, there has been widespread criticism of Palin’s remarks. While the panel she refers to is not explicitly created in the bill, her concerns are not as far fetched as some may suggest.

What the bill does explicitly create is a Center for Comparative Effectiveness Research in Section 1401. This group will research “the outcomes, effectiveness and appropriateness“ of procedures and will “take into account the potential for differences in the effectiveness of health care…[for] various subpopulations such as…different age groups (including…seniors) and individuals with different combordities.”

The group will then provide this research to health care professionals and “promote the timely incorporation of such findings into clinical practices.” In other words, if it finds that a certain treatment is not quite as ‘effective’ for one class of people, this group of bureaucrats will kindly *suggest* (i.e., decide – remember, this is the federal government) that that treatment should perhaps be limited or even potentially avoided altogether for that group of people.

What does ‘effective’ mean in this context? Are we speaking in medical terms or purely economic terms? A good way to understand this is to look to President Obama’s story of his grandmother’s hip replacement surgery. After his grandmother was diagnosed with cancer, she received a hip replacement surgery that made the President question whether our current health practices are sustainable.

“The chronically ill and those toward the end of their lives are accounting for potentially 80% of the total health care bill out here.” So, President Obama wonders whether it’s wise to give the elderly or the chronically ill medical help that costs us so much.

Back to comparative effectiveness. The problem with this topic is that even though Obama has told this story about his grandmother so many times, he never takes that final step. He never flat out suggests what his answer to this problem is. Instead, he points to how expensive and inefficient the current system is, leaving us to make the connection that perhaps if a panel like the comparative effectiveness research panel existed, such medical procedures and the corresponding high costs could be avoided.

So, while this isn’t exactly a death panel, it’s more like a rationing panel. But, the intentions are the same, and in that respect, Palin’s concerns are very relevant.

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Update: I realize the death panels and the approach Palin refers to stem from this article by Dr. Ezekial Emanuel. My point is that while there is no legislation that creates any such death panel explicitly, putting decisions in the hands of a comparative effectiveness panel that will make decisions for certain groups of people (based on sex, race, and age for example) is perhaps another way of getting to the same end.

*Originally published August 9, 2009 on The American Issues Project Blog, here.

Tags: comparative effectiveness, death panels, health care debate