Would Roger Ebert Go Before Obama's Death Panels?

I read Roger Ebert's attack on Sarah Palin this morning (see, "'Death Panels.' A Most Excellent Term").

The essay's an amalgam of heart-tugging feel-sorry-for-me anecdote and wickedly selective faux-fisking of Palin's criticism of Team ObamaCare's health-rationing policy.

Ebert's basically dishonest in omitting any mention of Ezekiel Emanuel's published comments on comparative healthcare effectiveness. For a perfect rebuttal to Ebert, see Martin Feldstein's, "ObamaCare Is All About Rationing":

Although administration officials are eager to deny it, rationing health care is central to President Barack Obama's health plan. The Obama strategy is to reduce health costs by rationing the services that we and future generations of patients will receive.

The White House Council of Economic Advisers issued a report in June explaining the Obama administration's goal of reducing projected health spending by 30% over the next two decades. That reduction would be achieved by eliminating "high cost, low-value treatments," by "implementing a set of performance measures that all providers would adopt," and by "directly targeting individual providers . . . (and other) high-end outliers."

The president has emphasized the importance of limiting services to "health care that works." To identify such care, he provided more than $1 billion in the fiscal stimulus package to jump-start Comparative Effectiveness Research (CER) and to finance a federal CER advisory council to implement that idea. That could morph over time into a cost-control mechanism of the sort proposed by former Sen. Tom Daschle, Mr. Obama's original choice for White House health czar. Comparative effectiveness could become the vehicle for deciding whether each method of treatment provides enough of an improvement in health care to justify its cost.

In the British national health service, a government agency approves only those expensive treatments that add at least one Quality Adjusted Life Year (QALY) per £30,000 (about $49,685) of additional health-care spending. If a treatment costs more per QALY, the health service will not pay for it. The existence of such a program in the United States would not only deny lifesaving care but would also cast a pall over medical researchers who would fear that government experts might reject their discoveries as "too expensive."

One reason the Obama administration is prepared to use rationing to limit health care is to rein in the government's exploding health-care budget. Government now pays for nearly half of all health care in the U.S., primarily through the Medicare and Medicaid programs. The White House predicts that the aging of the population and the current trend in health-care spending per beneficiary would cause government outlays for Medicare and Medicaid to rise to 15% of GDP by 2040 from 6% now. Paying those bills without raising taxes would require cutting other existing social spending programs and shelving the administration's plans for new government transfers and spending programs.

An interesting hypothesis is whether Roger Ebert himself would be a prime candidate for ObamaCare's death panels.

After being diagnosed with thyroid cancer, Ebert underwent agressive medical treatment, including multiple surgeries and a four-week course of radiation therapy to his salivary glands. However, the cancer spread to his lower jaw and he had surgery to remove part of his mandible in 2006 at the age of 64. Unsuccessful follow-up surgeries, to repair surrounding tissue, resulted in "unplanned bleeding" complications. Doctors administered a tracheostomy to Ebert's windpipe to help ease breathing during recovery.

At today's essay, Ebert admits that "I am happy that heroic measures were made to save my life." He also notes that "I had good insurance coverage." But would he have received coverage as good under ObamaCare? Now 69 years-old, Ebert would probably be denied treatment under Ezekiel Emanuel's "Complete Lives System." As Emanuel argued in his paper, "Principles for Allocation of Scarce Medical Interventions":

Although not always recognised as such, youngest-first allocation directs resources to those who have had less of something supremely valuable—life-years ... These justifications explain much of the public preference for allocating scarce life-saving interventions to younger people ...

Allocation systems based on quality-adjusted life-years (QALY) have two parts ... One is an outcome measure that considers the quality of life-years. As an example, the quality-of-life measure used by the UK national Health Service rates moderate mobility impairment as 0·85 times perfect health.66 QALY allocation therefore equates 8·5 years in perfect health to 10 years with moderately impaired mobility. The other part of QALY allocation is a maximising assumption: that justice requires total QALYs to be maximised without consideration of their distribution. QALY allocation initially constituted the basis for Oregon’s Medicaid coverage initiative, and is currently used by the UK’s National Institute for Health and Clinical Excellence (NICE).

Also, Emanuel has argued:

Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years ...

But note something important: As Joseph Ashby pointed out last weekend, ObamaCare's death panels are not hypothetical - they already exist:

H.R. 1 (more commonly known as the Recovery and Reinvestment Act, even more commonly known as the Stimulus Bill and aptly dubbed the Porkulus Bill) contains a whopping $1.1 billion to fund the Federal Coordinating Council for Comparative Effectiveness Research. The Council is the brain child of former Health and Human Services Secretary Nominee Tom Daschle. Before the Porkulus Bill passed, Betsy McCaughey, former Lieutenant governor of New York, wrote in detail about the Council's purpose ....

Who is on the Council? One of its most prominent members is none other than Dr. Death himself Ezekiel Emanuel. Dr. Emanuel's views on care of the elderly should frighten anyone who is or ever plans on being old.

On average 25-year-olds require very few medical services. If they are to get the lion's share of the treatment, then those 65 and over can expect very little care. Dr. Emanuel's views on saving money on medical care are simple: don't provide any medical care. The loosely worded provisions in H.R 1 give him and his Council increasing power to push such recommendations.

Similarly hazy language will no doubt be used in the health care bill. What may pass as a 1,000 page health care law will explode into perhaps many thousands of pages of regulatory codes. The deliberate vagueness will give regulators tremendous leverage to interpret its provisions. Thus Obama's Regulatory Czar Cass Sunstein will play a major role in defining the government's role in controlling medical care.

Roger Ebert received agressive medical treatment for his cancer illness. My sense is that over the course of a few years of extensive and multi-faceted treatment, Ebert's insurance company incurred hundreds of thousands of dollars in cost outlays. It's clear that Ebert was not subject to a "Complete Lives System" in the determination of his eligiblity for care. Ebert lost his voice as a result of therapy and breathing treatment, and today he uses a computerized voice system to speak. In 2008 he underwent additional surgery to repair a fractured hip. Ebert has obviously received outstanding medical care, and in his continued writing he offers a passionate and valuable perspective for his policy positions.

His ability to do so - and in fact, the existential question of Ebert's contributions to the debate - would be seriously compromised under the ObamaCare medical regime, with its death panels seeking to ration medical care for people battling the same life challenges.

Hat Tip: Pundette & Pundette, "This Will Hurt, Especially If You're Old or Disabled."