“Death Panels” have always been real

One of the great calumnies of the original debate over the ACA — and one still heard today — is that it would set up “death panels” that would make life-or-death decisions over the people they considered worthy or unworthy of spending health care money on. “Your child / grandmother / spouse is of [no] value, therefore they shall be allowed to live [die].” The idea of government bureaucrats passing such judgments was seen to be horrifying, and represented a profound source of paranoia about the ACA.

But as anyone who had ever argued on the phone with an insurance company over coverage already knew, “death panels” (bureaucrats making life-and-death decisions over whom to spend money on or not) have always been with us — in the form of the insurance companies and their internal “Hey, we need to cut our payout spending” committees and “specialists.” Even today, under the ACA, as the attached article demonstrates.

Part of this inevitable — money is a finite resource, and the demand on it is arguably infinite. But we find the making of such decisions, whether for purposes of increased profitability or for some vague tyrannical / political reason, to be revolting. Which lets people accuse the ACA (or single-payer, or whatever other Marxist-Socialist Conspiracy of the Week is getting play in Breitbart) of doing something awful (whether it is or not) which is already a feature of the existing system.

The question, of course, is: given a world of finite resources [1] that are going to be allocated and triaged in some fashion, driven by motivations or goals that may or may not be agreeable, with whom would you rather argue:

1. A private for-profit insurance company who has the last word on what the fine print of the policy really means, and shoals of lawyers to resist any effort to take you to court (or, more likely, forced arbitration with an arbitrating company that is paid by the insurance company itself) if you disagree.

2. A governmental agency [2] that might be just as bureaucratic but which, as a political concern, is subject to public pressure — an outraged Congressman, bad press, etc.?

Neither is ideal, but neither is a world of finite resources, and as the attached story indicates, the idea of a “free market” somehow saving us from all this turmoil and torment is a grave fallacy [3].

Something to consider as the health insurance debate progresses, and Trump and his GOP sometimes-supporters try to turn the clock back to the days when all of these decisions were made with an eye to how to maximize profitability for the insurance companies.

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[1] Unless you are independently wealthy, in which case there are never any “death panels.” But that’s not how most people feel comfortable thinking of the system.

[2] Again, it’s worth noting that this particular case represents option 1, even though it takes place under the ACA. But let’s assume we’ve moved into a completely nationalized health system.

[3] There’s a reason why the scenes of Bob Parr trapped in a job as insurance adjuster in the early part of The Incredibles resonates so much.

Insurance company sends letter to 9-month-old boy explaining he’s too expensive to keep alive

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