Always August: pt. 4 End of Life

Progressive accountants look at the way Americans spend money on health care and despair. "They spend _____% of health care dollars in the last 6 months of life! What's the point?" Thus arises the bedrock proposal that the health care system should be forced, either through market incentives or through regulatory fiat, to move away from providing (euphamism warning!) "end of life care." Sounds good, even compassionate, as long as you don't think about the implications. Sadly for pogressive health care reform's advocates, plenty of people have been thinking about these implications. You may have seen them on YouTube or CNN yelling at John Dingell, among others. Progressives are creepily insistent in cutting "end of life care." This is the Achilles Heel of their reform efforts, and yet they insist on baring it before the world and then act surprised when people start worrying about "death panels."

The problem with cutting "end of life" care is one that should be obvious, but has eluded all the smart folks pushing these reforms: we don't know when our lives will end. We certainly don't know when the six-month countdown starts that would render any further care superfuous and wasteful. How a government panel, or our betters in Congress, can know the unknowable is hard to imagine, but these are people who think they can manipulate the climate, so they are used to grandiose conceptions for their proposals.

What sets people off is this: we can all agree that "heroic" medical care should end when there is literally no hope, but that can be a brief window of time, and certainly not six months. I am not a doctor, but have been around enough dying relatives to know that people can take a turn for the worse very quickly. I suspect most American adults have had this experience. Doctors sure have. But until they reach that point, most people and their families would like to receive good medical care so long as there is even a bare probability that they will recover and survive, even for a short period of time. But creating a six month cut-off? No.

I have seen enough people die to know what death looks like. A person who is dying simply looks different from someone enduring a medical emergency from which they can recover. The spark leaves their eyes. Their skin takes on a pallow glow. They are clearly at death's door. Doctors know this, which is why they are often the ones (gently) prodding grieving relatives to let nature take its course. This is a profound moment, and one that forces people to confront questions of life and death, and the mysteries of our mortality. Nancy Pelosi showing up with a slide rule isn't going to cut it.

Progressives love to point to the poverbial 99 year-old receiving a pace maker. OK that might seem silly if she dies six months later. But what if she lives another 3 or 4 years, something not outside the realm of possibility nowadays? Are "compassionate" progressives really saying she should not have that chance? What if her family has money and wants to pay for the operation, regardless of the "death panel's" pronouncement? I say no problem, but the point of all of this is so a person with ready money doesn't have an unfair advantage over more downscale patients. Will it be illegal to pay for your own "extra" care because it wouldn't be equal? That's the rule in most government health care systems. Is it any wonder people are more than a little freaked out?

Progressives are right that there are no "death panels" mentioned in the various drafts of legislation. As usual they are technically correct, but also profoundly deceptive. There is no abortion mentioned in the Constitution, but progressives seem comfortable with the idea that such a constitutional right can be read into it. And, right now, there are plenty of hints out there that health care rationing is contemplated by its proponents. The legislation contains provisions setting up a basic protocol for such conversations between doctors and seniors. In Oregon, where there is a state health system and an assisted suicide law, there are already stories about seriously ill patients being denied treatment and offered the "choice" of assisted suicide. The same phenomenon is well known to occur in The Netherlands.

Just a few weeks ago, the NY Times Sunday Magazine ran a cover-story by Peter Singer giving the intellectual argument in favor of rationing. Singer is well known for his ethically and morally challenged arguments in favor of basic rights for animals and euthanasia for newborns under a month old. Yet we are assured that he is a leading philosopher with the imprimatur of a Princeton professorship and page-space in the nation's leading liberal-left media outlet. Pass universal health care now, and watch Singer's argments treated as even more mainstream than they already are.

Progressives may play at fiscal conservatism when they urge we cut cost by limiting "end of life" care. But the intellectual and political rationale for such restrictions are coming straight out of the proponents of the Culture of Death. These are certainly not the people you want to have in the room when you and your doctor are discussing how to cope with a serious, yet survivable, illness. In part, the protestors attending this summer's contentious Town Hall meetings are making clear that this is not the path they want the government to go down.