Over at TNR, in an article titled ‘Have You No Decency?‘ Harold Pollack engages in some gratuitous Palin-basing in his commentary on healthcare policy:
Palin and Bachmann remind no one of Hillary Clinton in their success in grasping complex policy issues, or in their desire to do so. It may be too much to expect them to trace the origin and veracity of these talking points.
…but politics ain’t beanbag, as they say, and I’m not in the Palin-defending business (or in the business of defending any other public figure).
I am in the trying to get people to be honest and consistent in their arguments business, and so – given that the thrust of his argument is that Palin and Bachmann are being dishonest when they say that one of the consequences of healthcare reform is that:
The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.
– he needs to show just a little honesty himself.
Instead he responds by making five points:
1) “I can’t find the words “death panel” in any administration position paper, the stimulus package, or the House and Senate draft health reform bills.”
2) “First, these issues are quite separate from the main issues being debated in health reform.”
3) “Second, health reform would address an equally fundamental dilemma of human dignity and human rights: millions of people’s lack of access to basic care.”
4) “Third, people genuinely worry that comparative effectiveness research (CER) is a stalking horse for rationing or for curtailing care for the sick, elderly, or disabled. This is a misplaced concern.”
5) “Fourth and finally, publicity-seeking politicians subtract a lot from these conversations. Palin, Bachmann, and others score cheap points by scaring people and by spreading falsehoods.”
To which I respond:
1) When the bill calls for Medicare to make ‘end of life counseling’ part of the healthcare process, we’re talking about some kind of change. And when administrative decisions are made about what will and won’t be covered – when government and law reaches deeper into personal medical decisions as it will have to in order to rationalize them – the point he’s making is somewhere between niggling and deceptive.
2) Yes and no; as I noted in my personal story about this, these are brutally difficult decisions that are wrenching at a personal level and massively expensive to us socially. As my cohort ages, they will get far more wrenching and far more expensive. By shifting the locus of decision from social norms and personal choice (and yes, personal means) toward an administrative handbook, we are changing the game. There’s no way around that.
3) Straw man. Careful you don’t catch fire carrying that around. It’s perfectly possible to propose a health care plan that doesn’t touch end of life care; it just won’t be as ‘curve bending’ as it would be otherwise.
4) Liar, liar, pants on fire. Here’s Pollack later in the same paragraph:
None of the identified high-priority items involved anything approximating the rationing of life-saving or life-extending care. End of life care ranked 28th in their chart of priority areas for CER research. This may be a mistake. Better approaches to palliative care often look very good when evaluated against the standard benchmarks of medical cost-effectiveness.
5) The answer to bad arguments is better debate. If Pollack weren’t so concerned with shutting his ideological opponents out of the argument (“I wish the Post would exercise greater quality control over what appears in its pages.”), he might plausibly be making a case for a higher level of debate. But to him – no debate is necessary.
Which makes him the most dishonest person in this argument.
Because on an issue this big, complex, and important, we need lots and lots of debate.
I honestly don’t know where I stand on Obama’s bills. I believe we need to make changes in our healthcare system. I even – shudder – think it’s legitimate to talk about how much of other people’s money we’ll use on treatments that are certain to be fruitless (I’ll go stand over in the corner with the UK National Health bureaucrats now).
But the idea that we’ll do something like this in 90 days to get it done before midterms is a f**king joke. And makes me as inherently suspicious as the used-car salesman who says that I can have this deal on the car, but only if I sign right now.
Let’s work on health care without buying any clunkers, if we possibly can.
UPDATE: Here’s the Charles Lane of the teabagging Washington Post on the issue:
On the far right, this is being portrayed as a plan to force everyone over 65 to sign his or her own death warrant. That’s rubbish. Federal law already bars Medicare from paying for services “the purpose of which is to cause, or assist in causing,” suicide, euthanasia or mercy killing. Nothing in Section 1233 would change that.
Still, I was not reassured to read in an Aug. 1 Post article that “Democratic strategists” are “hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors.”
If Section 1233 is innocuous, why would “strategists” want to tip-toe around the subject?
Perhaps because, at least as I read it, Section 1233 is not totally innocuous.
Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.
Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.
What’s more, Section 1233 dictates, at some length, the content of the consultation. The doctor “shall” discuss “advanced care planning, including key questions and considerations, important steps, and suggested people to talk to”; “an explanation of . . . living wills and durable powers of attorney, and their uses” (even though these are legal, not medical, instruments); and “a list of national and State-specific resources to assist consumers and their families.” The doctor “shall” explain that Medicare pays for hospice care (hint, hint).
Go read Section 1233 yourself…