I Want to be a Death Panelist

I am considering dressing up as a death panel for Halloween. Well, I considered it briefly, until I decided that the costume wouldn’t work very well. It’s been on my mind a lot lately, as I monitored the crazy town hall scenes in August, the conservative propaganda from members of Congress, and finally the “you lie”-tinted speech that President Obama delivered last week.

And here’s why it’s been on my mind: it’s not a terrible idea. Look, I’m 100 percent behind Obama’s push for health care reform, although I would much prefer a MUCH stronger public option, maybe just a complete overhaul that nationalizes the entire system and turns us into a better-functioning version of Canada (I am aware this is impossible). What interests me is that people get so caught up in the idea of “rationing” health care, and that no one—be it doctors, policy makers, other experts, anyone—should be allowed to decide whether an 84-year-old with terminal kidney cancer is worth less money in health care costs than a 24-year-old with lymphoma or some chronic and expensive-to-treat disease. This is obvious to me, but say it out loud—“Spend more on the 24-year-old!”—and suddenly you’ve convened a death panel. Sorry, a Death Panel.

The actual use of that term, or whatever it was Palin meant by it, has been completely debunked a thousand times by now, but she managed to get it into the discussion. Her message, though, that all life is completely equal and no one should be denied a certain treatment because they have less value to society or something, is preposterous. If we remove the word “rationing,” we realize it happens all the time. On an acute level, it’s called triage. I cut my finger so badly a few weeks ago that it simply would not stop bleeding no matter what I did, so I went to the emergency room and sat there until 4:30 AM until a doctor came and put two stitches in it. I waited four hours because my finger wasn’t as important as any number of other things going on in that ER. That’s a small example of health care rationing. The resources available were used in a way that fit the situation. The terror!

On a much larger scale, the entire system is set up to ration health care. Your insurance costs differ depending on your age, risk factors, everything. Thus, certain people are deemed more worthy of receiving care than others. The way it works now, the only thing that factors in is how much it costs to treat those people (rather than, say, their value to society). So why not just take it a step further, make more use of tools like quality-adjusted life years (QALYs) and start spending money in logical, productive ways? I hereby volunteer to be President Obama’s first Death Panelist. And I don’t even need a Halloween costume to do it.