By Edward Zelinsky
Certain opponents of President Obama’s effort to revise the U.S. medical system claimed that the President sought “death panels” to deny medical care. Among those decrying such “death panels” was Governor Palin.
President Obama quickly disclaimed any desire to create such panels. The President said he favored permitting Medicare to pay for purely voluntary physician counseling about end-of-life choices. Using the unfortunate metaphor which came to dominate this discussion, President Obama affirmed that he does not want to “pull the plug on Grandma because we’ve decided that it’s too expensive to let her live anymore.”
This debate was apparently resolved when Senator Charles Grassley of Iowa, ranking Republican on the Senate Finance Committee, declared that any federal health care legislation will omit provisions concerning end-of-life counseling. This outcome, now seemingly endorsed by Republicans and Democrats alike, suggests that the United States can provide unlimited medical resources to the elderly during their final illnesses.
Regrettably, this debate obscured larger and more difficult truths: We do not have unlimited resources. No society does. We cannot afford to spend indefinite amounts on the care of the terminally ill, particularly as the large Baby Boomer cohort queues up to meet the Grim Reaper. We consequently need death panels to control medical costs. We already have such panels although we don’t openly label them as such.
There are many reasons that the United States’ outlays for medical care outstrip those of other nations. Among these reasons are our enormous expenditures for medical treatment at the end of life. Roughly thirty percent of Medicare’s expenditures occur within the patient’s last year of life.
Some of this care is palliative and thus relatively inexpensive. Some of this care is for patients who die unexpectedly. However, the American medical system provides aggressive treatment at the end of life which other nations do not. There is no way for us to reduce the burden of medical costs without curbing these end-of-life outlays for aggressive care.
Much political rhetoric on reducing medical costs implies that such cost cutting can be painless. Various formulas (“administrative costs,” “bureaucracy,” “ineffective care”) make cost cutting sound anodyne. Democrats and Republicans, liberals and conservatives have all avoided the unpleasant realities: Medical care costs cannot be controlled without denying services to somebody. Zealous end-of-life treatment is expensive, a prime candidate for cost control.
Every major hospital and medical institution today has an ethics panel. Such panels often address end-of-life issues, advising physicians and other caregivers when to terminate treatment. These are “death panels,” authoritative bodies which often conclude that treatment of the terminally ill should be discontinued.
Flippant references to pulling-the-plug on grandma resonate with me personally since, twelve weeks ago, I became a first time grandfather. That makes me part of the class which President Obama and Governor Palin apparently want to guarantee unlimited access to Medicare resources at the end of life.
Speaking as a new grandfather, there is another perspective I urge on the President and his Republican opponents: my grandson’s. My grandson is a lucky child, born into a loving family that lives in a great nation. But on the negative side of the ledger, his generation inherits a national debt which threatens its economic future.
We must do many things to put our economic house in order for my grandson and his peers. Controlling medical costs is one of them. Sometime, hopefully far in the future, that may indeed require pulling the plug on his grandfather when it is no longer sensible to treat his final illness. Death is a part of life. In a world of finite resources, “death panels” are and should be part of our national effort to control medical costs.
Edward A. Zelinsky is the Morris and Annie Trachman Professor of Law at the Benjamin N. Cardozo School of Law of Yeshiva University. He is the author of The Origins of the Ownership Society: How The Defined Contribution Paradigm Changed America.