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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Then we have the more specific reasons for people to be concerned about who will be deciding what for them as they become sick or grow old. It is hardly fanciful to suppose that in a system in which resources are limited, global treatment protocols are going to decide eligibility for care in a way they do not currently. Likewise, people who are eligible for a particular treatment are going to have to wait in line until it's their turn. If there is any currently existing national health care system, such as the left dreams about, that does not contain these features, it's strange that no one has pointed to it to prove that health care, unlike everything else, need not involve tradeoffs.

The point for single-payer advocates, including in their "public option" guise, is that equality is the highest virtue, and that means equal access to what is available. It's simply unjust, in their view, that some people can afford high-quality care while others get none: If the price of a universal system is that some lose privileges they have long enjoyed, that's the kind of a tradeoff they are prepared to make.

But old folks and sick people in the current system, or people thinking about either prospect, may not see it that way. The question they have is, "What's going to happen to me?" The baseline they have is the care the system around them currently provides. They are right to worry about changes to the system.

To the general problem of the need to find a basis for allocating finite health care resources, one must add certain specific anxiety-inducing details that have come out in the debate: First, the inclusion in some of the early legislative language of provisions funding end-of-life counseling sessions--the objective correlative of the "death panel" polemics.

Second, the quick ditching of the counseling proposal once the "death panel" rhetoric hit, fostering the impression that the proposal was indeed up to no good.

Third, Obama's own musing in a New York Times interview about whether the decision to provide a hip replacement to someone diagnosed with cancer (in this case, his grandmother) is "a sustainable model."

Fourth, his public reflections on the high health care costs associated on average with the last six months of a person's life.

Fifth, the statements of such supporters as Todd Gitlin, whose only criticism of a speech he found otherwise inspiring was: "You can say that he's still not willing to talk to Americans straight about the need to limit high-tech medicine for the very old and very frail. Presidents won't do that."

Sixth, the administration's insistent and probably misguided attempt to portray its health care reform as cost-cutting--reduced spending on the health care of whom, exactly?

At the end of Shakespeare's Tempest, Prospero, the greatest wizard prior to Albus Dumbledore, gives up his powers and prepares to "retire me to my Milan, where / Every third thought shall be my grave." People do brood about death, quite unbidden.

When they are made to brood about it, as in the case of the new focus on end-of-life care--previously known as medical care for the very sick and elderly--they are likely to resent the intrusion. And when the substance of the intrusion is a proposal that upsets the expectations they have formed on this most difficult of topics, many will be inclined to reject it. Obama's sinking job-approval numbers among seniors and the broad decline in support for the plan likely reflect these tendencies.

Obama will not dispel the anxiety by saying the rhetoric about "death panels" would be laughable were it not so irresponsible and cynical. You disrupt the expectations of the elderly only at great political peril, and there are more such Americans every day.

Contributing editor Tod Lindberg is a research fellow at Stanford's Hoover Institution and editor of Policy Review.