She's Back

Sarah Palin is back in the news declaring that ObamaCare is evil:

"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," the former Republican vice presidential candidate wrote.

The AP reports this as a lie

The nonpartisan group FactCheck.org, a project of the Annenberg Public Policy Center at the University of Pennsylvania says the claim is false...

Obama addressed the controversy during a July 28 AARP-sponsored town hall.
"Nobody is going to be forcing you to make a set of decisions on end-of-life care based on some bureaucratic law in Washington," he said.

Fact Check actually goes farther in asserting the claim that this legislation "may place seniors in situations where they feel pressured to sign end of life directives they would not otherwise sign [which] may start us down a treacherous path toward government-encouraged euthanasia" is false:

We can’t argue with Boehner’s claim that counseling “may” cause more seniors to refuse treatment... but we see no evidence that it will. There’s certainly no requirement in the bill that seniors decline life support or extraordinary measures of medical treatment.

Furthermore, seniors have had control over the end-of-life issues the Republicans are concerned about for a long time...

As for the argument claiming that this is the first step on a slippery slope leading to government-encouraged euthanasia, that’s a stretch. The right to draw up an advance directive is federally guaranteed, but doctor-assisted suicide is legal in only three states. It would take a lot more than Medicare-funded counseling for voluntary euthanasia to become a standard government recommendation.

The original author of this part of the legislation responded... saying that "nothing could be further from the truth."

FactCheck's "non-partisan" reasoning is exceptionally weak. The facts that there is no requirement that seniors decline care and that seniors have ultimate control over their care speak in no way to the question of whether seniors may be pressured by counselors to make decisions they would not otherwise make. Even the intent of the original author, we all well know, is subsumed by the plain meaning of the authored words. Their evidence that this would not be a step on a slippery slope has even less to do with price of tea in china. In other words, Fact Check has a different basis for its conclusions than the available evidence.

In the long term, Boehner and Palin's claims are almost certainly true and Obama's FactCheck claim false. The key fiscal motivation for health care reform is spiraling medicare costs. End of life care is a major cost contributer: ~30% in the last year and 15% in the last 60 days. Bending the curve, then, requires meaningfully reigning in end-of-life care. Under the current rules, where seniors have, more or less, control over their care, this demands convincing them to refuse expensive treatment they would have otherwise opted for. Should persuasion fail to produce the required savings, some form of rationing can reasonably be expected.

I suspect that the most just means of rationing care -- end of life or other -- and the one -- I fear -- least likely to be adopted by the current administration, is to ensure that price signals are exposed to patients. If subsidized patients were required to pay a meaningful (as determined by individual financial situation) portion of the cost of their treatments, individuals could make personal choices in the context of their own values while, in aggregate, producing a result that best reflected the values of society.