The Magazine

The New Third Rail

Why 'death panels' are a political killer.

Sep 21, 2009, Vol. 15, No. 01 • By TOD LINDBERG
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If Hogwarts were a school for politicians, there would be a required class on "Defense Against the Dark Arts of Demagoguery." President Obama considers his health reform effort a target of this dark art--indeed, he seems to view it as the main reason reform has faltered on Capitol Hill.

Here is the defense he mounted in his big speech to Congress this week:

"Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Now, such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple."

Professor Snape would not be impressed. At issue, of course, are the two words "death panels," uttered widely in opposition to Obamacare, most famously by Sarah Palin, the prominent politician to whom the president alluded. The phrase may indeed be "cynical" shorthand for a new government role in deciding on appropriate care as one nears the end of one's life; certainly it is polemical. And it may even be "irresponsible"--in exactly the same way that Democratic political operatives for decades have irresponsibly tried to frighten the elderly into believing Republicans were going to take away their Social Security benefits. But "laughable" is precisely what it isn't. End-of-life care is beginning to look a lot like a new third rail of American politics. Republicans will be happy to let Democrats learn this lesson the hard way.

Now, it is true that none of the proposed reform legislation calls for convening panels of government bureaucrats to make life-and-death decisions about the elderly on a case-by-case basis, with the power to shut off their medical care. Unfortunately for Obama, that doesn't make "death panels" a "lie, plain and simple." Rather, it is an exaggeration. When Obama responds to an obvious exaggeration with the rejoinder that it is not literally true, he is missing the point. The question is what this exaggeration is getting at. And the answer is that it is getting at something very real, the primal anxiety people feel about the end of their own lives.

It is just folly to pretend that this anxiety is anything but genuine among those who are getting on in years or who have received a diagnosis that looks to be life-threatening in the absence of treatment, and perhaps even with. And it is disingenuous in the extreme to pretend that the current reform effort doesn't have potentially large-scale implications for treatment decisions for the old and sick. Obama would like to ignore both points while blaming Republicans for making the whole thing up, but it won't work.

Since, as we all know, health care is expensive and the demand for it is vast, there has to be some way of settling the scarcity question. The current system is an unlovely hybrid with major deficiencies, but it has a couple of core virtues: Quality of care is first among them, but another important one is that for those with insurance or Medicare or Medicaid, care decisions are (within limits) mostly between people and their doctors, who take their Hippocratic Oath seriously. Even the limits have the virtue of being mostly known or knowable. True, people get unpleasant surprises from time to time about what's covered and what isn't; the system senselessly ties insurance to employment, inhibiting mobility, especially when "preexisting conditions" come into the picture. And it's not like the cost of insurance coverage and copays is going down. But there is an intelligibility and reliability to the system as it exists for those who are in it.

At a minimum, Obamacare introduces a major element of uncertainty. Of course nobody really knows what Obamacare is, including Obama; the term is a catch-all for whatever (if anything) Congress comes up with that the president can sign. But that's just another way of saying that overall uncertainty is high and rising, including on the issue of "end-of-life" care. And it won't do to try to alleviate the concern here by pointing to specific provisions of possible pieces of legislation and saying, "See, it's not there." Everything is up for grabs, and people don't like it when everything is up for grabs.