Part of the point in raising 'death panels' is the question - is this something we want government to be actively engaged in, deciding and determining in law what is or isn't covered?
Indeed, a major question. In the case of the health care reform, only the MINIMUM required coverage for a plan to qualify is determined by either legislation or regulation, not the maximum. The government will not, at least now, be saying "plans in the marketplace CANNOT cover _". So one can always choose a plan which DOES cover such things...at your own (possibly increased) cost.
That's perhaps largely true in what ultimately passed, but not entirely. For some perspective on the debate at the time, there was a lot of back and forth over single payer or advancing a government option alongside exchanges. Any health care plan will cover some things and not others, including government plans. The major concern is with a government only plan or one where government crowds out private insurance, the country would be moving further and further in the direction of government deciding for more and more people, what is and isn't covered - literally, by panel or committee. In August of 2009, when Sarah Palin made the 'death panel' comment, this was still being hotly debated. Baucus didn't release his bill from committee until mid-to-late-September 2009. The Senate "Patient Protection and Affordable Care Act" bill wasn't released until mid-to-late-November 2009. The final bill didn't become law until March 2010. http://finance.senate.gov/issue/?id=32b ... 5215c1ba65
Leading up to the act, part of the stimulus package created a kind of government health care information clearing house which would be used to advance the digitization of health care information, but also would be used to analyze health care practice and make recommendations going forward on efficacy. See here part of that vision from the Obama campaign, my emphasis added:
Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care.21 Barack Obama and Joe Biden will accelerate efforts to develop and disseminate best practices, and align reimbursement with provision of high quality health care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare and FEHB will be rewarded for achieving performance thresholds on physician-validated outcome measures.
This is government
directing the practice of medicine based on what it
determines to be best for the patient and paying doctors accordingly.
One of the keys to eliminating waste and missed opportunities is to increase our investment in comparative effectiveness reviews and research. This information is developed by reviewing existing literature, analyzing electronic health care data, and conducting simple, real world studies of new technologies. Barack Obama and Joe Biden will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have accurate and objective information to make the best decisions for their health and well-being.
This is government
directing the research to define
the practice of medicine, which will direct care based on disseminated best practices - with an eye toward cutting costs.
Over seventy-five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease, and high blood pressure.15 Many patients with chronic diseases benefit greatly from disease management programs, which help patients manage their condition and get the care they need.16 Barack Obama and Joe Biden will require that plans that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care and lower costs, as well.
This is government
which treatment plans will be permitted.
Although all Americans are affected by problems with our health care delivery system, an overwhelming body of evidence demonstrates that certain populations are significantly more likely to receive lower quality health care than others. Barack Obama and Joe Biden will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health, both of which play a major role in addressing disparities. They will also challenge the medical system to eliminate inequities in health care by requiring hospitals and health plans to collect, analyze and report health care quality for disparity populations and holding them accountable for any differences found; diversifying the workforce to ensure culturally effective care; implementing and funding evidence-based interventions, such as patient navigator programs; and supporting and expanding the capacity of safety-net institutions, which provide a disproportionate amount of care for underserved populations with inadequate funding and technical resources.
This is government
actively collecting data to hold the medical centers and insurers accountable for disparate outcomes in 'disparity populations' with a presumption of guilt on the part of these businesses - that they are the cause of any disparity and responsible for its remedy. Now, while its a laudable aim to seek to help to improve the quality of care, where does government authority begin to be in a position to demand the data to actively police medical facilities in this regard? Where does this police power end in health care and by what rationale is this only limited to health care if government has such authority?
Mind you, this is mild campaign literature touting all the good the plan the president envisions will do and is rather modest compared to what was being proposed at the time. What actually passed in this regard (efficacy data collection and research) happened largely well before the Act passed, as part of the stimulus package. And government employees are now hard at work building the digital health care infrastructure and identifying the necessary research which aligns with the policy objectives of the administration to develop these best practices or proven regimes of care which will be recommended or incentivized or required
These are the bureaucrats Palin and Sowell are referring to - those who will rise from the well funded infrastructure now being erected to better empower and enable government to examine, analyze, assess, encourage, direct, and require... And it is true when considering all forms of government health care today, even before the act passed, close to or more than 50% of care was government funded with certain, clear, bureaucratic restrictions on what is covered, how it is covered, etc., where in Medicare, for instance, average lifetime out of pocket costs for what is not covered are extraordinary, in the neighborhood of $200,000 per person. And that program was, time and again, referenced as a model for what's coming.
By mandating within the exchanges what must, by law, be covered, and at the same time letting no new private plans come into existence outside the exchanges, and introducing new regulatory regimes within the private insurance market, and mandating coverage, over time, Americans end up within plans in the exchange being the only option for insurance - by design. And regulating minimum coverage doesn't get you to cost savings. Quite obviously increasing benefits across the board increases costs while the legislation also limits what plans can charge - how much they can increase premiums from year to year by now 'soft' price controls, making the industry overall less profitable and more than ever, dependent upon government decisions for their profitability. So how do you ultimately get to these savings, if ever (because I don't believe we see savings)?
Control. By directing how, when, and for whom care is performed by heavy handed and overarching regulation. And the great bulk of the cost of care for most is at end of life, in making life and death decisions, to decide to prolong life or let nature take its course and at the individual level, great per capita cost is found in the chronically ill and disabled. The combination of the consolidation of such power to government in this area, combined with men and women then/now in government of seriously questionable morality, and the pressure to keep down costs... this is what inevitably leads to the deliberate rationing of care in law and regulation by government - to death panels.
I think people like Palin and Sowell and their arguments struck a chord with the American people and have served to wake people up to get more involved in the process of putting good, honest, trustworthy people in office to represent their interests and preserve the republic - to make the argument against increasing centralization and for greater subsidiarity and respect for our rights - in health care and health insurance and more broadly.
Pax et bonum