Obamacare got a bad rap for “death panels” back in 2009, even though the bill didn’t actually feature such a provision.
With the coronavirus pandemic upon us, it seems a good time to re-examine the concept. There seems to be agreement among many if not most people that the young should be prioritized over the elderly, and also that some patients who live in a vegetative state for many years or decades can consume an immense amount of money and resources.
If there just aren’t enough ventilators and beds to go around, then simple triage would kick in, but might a death panel just be a more formal version of triage?
I don’t know what the answer is, but it’s not death panels. Or rather, they’re likely not a good thing, but perhaps you should define what a death panel is, who would be on it, how it works etc. Since it was never a real thing, there’s not a whole lot to talk about.
Death panels = a group of administrators who would hold decision power over which patients get to remain on life support and which get the plug pulled, perhaps also have power to issue directives like “during this pandemic, patients over age 80 will not be treated should there be a shortage of manpower or resources”
As a concept, isn’t a “death panel” just basically a formalized approach to triage, i.e. we have limited medical resources, how can we allocate them to maximum overall benefit? Part of that calculation, be it in the frenzy of a battlefield or in the sterile calm of a hospital conference room, is recognizing that some cases could have infinite resources thrown at them and the patient will die anyway. I almost admire the effective use of the phrase “death panel” as a political/propaganda weapon, though.
It seems like those decisions are best left up to the doctors and nurses working on the floor. Let the people working directly with the patients decide who is most in need of treatment and the admins can do admin-y things like finding some loose change somewhere to get more equipment so this problem happens less often.
The UK has a system called National Institute for Health and Care Excellence that pretty much does this. They determine how many quality adjusted life years you get per intervention, and they have a cutoff where if an intervention is too expensive they don’t cover it.
”Death panels” would be more ethical than insurance companies. Hell, just arbitrarily shooting 1 patient in 10 would be more ethical than what the health insurance industry does. At least you’d go in knowing the rules.
The Death Panel concept is that a group of people decide on a case by case basis who lives and who dies. Since it doesn’t specify who the people are, or how they decide, then obviously the panel will consist of people neither you nor I trust making decisions on a basis that neither you nor I agree with.
So whatever it is that must be done, calling it a Death Panel is not a good idea.
This. Republican opposition to Obamacare was based on the fact that the power of life and death over Americans was taken away from corporations and given to doctors.
We already have death panels and there is no way to run any system with limited resources without them in some sort. Even on a purely libertarian end the doctor looks at the patient and say it will cost $1mm to keep you alive, the guy looks at his bank account and asks his friends, family, anf greater network if they will cover the rest to keep him alive that group then decide if they want to pay the million to keep him alive and have just formed a death panel.
Right now each state is asking its self how much they are willing to pay to prevent people from dying some states are locking down to minimize the number of deaths while other have decided the stay open for business as long as possible. Each of those states have a death panel.
I’d feel better if we knew who these death panels are and how they were making their decisions and so I’d support a more formalized death panel structure.
Of course it is not a bad idea. It never was - whether you acknowledge it as triage, rationing…
This is the sort of thing that confounds me when folk act as tho the US would have to manufacture a sensible, compassionate, workable, affordable health care system out of whole cloth. Everyone else is able to do it. I guess the US is “exceptional” in the same way as the kids who ride the short bus are “special”… :rolleyes:
Ensure a certain standard of care for everyone, and allow anyone who can/wishes to pay for supplemental coverage. I can’t understand why so many people think that the for-profit insurance companies are going to efficiently come up with a decision that is in the individual’s best interest. Of course, underlying any rational system would be an acknowledgment that EVERY person does not get ALL of the care they desire at LITTLE cost.
Do we just use likelihood of recovery in the death panel? What if we have a choice between saving 79 year old Dr. Fauci (or pick someone else if you don’t like him) who is very important to have survive and go on to do better things versus random 37 year old unemployed alcoholic wife beater whose only contribution to society is keeping the liquor companies in business? Let’s assume that from a pure “quality of life” years, the 37 year old is the one to go with.
A few comments. The term “death panels” is a ridiculous juvenile invention of Republican extremists with intentionally scary connotations that is exactly equivalent to a young Ronald Reagan in the early 60s warning that a proposed new program to be called “Medicare” would, if enacted, bring about the end of freedom and the end of America as we know it.
I must confess that although I vaguely knew about it, it was only just now that I read the cited details. Frankly, as much as I respect the NHS and know how popular it is, I find these sorts of calculations to be callous and rather appalling. To the best of my knowledge, nothing even remotely like it exists under single-payer health care in Canada. Indeed one of the fundamental statements in the preamble to the Canada Health Act which governs all provincial health programs is that everyone must have equal access to all medically necessary health care that is normally provided by doctors and hospitals, and it must be provided at no cost to the patient. We’ve been pretty successful at achieving this, obviously with the inevitable gaps here and there because no system is perfect – for example, the relative difficulty of accessing health care in the far north.
My personal experience with this is the excellent care that my mother received well into her 90s, which included multiple hospital stays, some of them lengthy, a pacemaker, and medical supplies at home such as an oxygen generator, a second portable oxygen generator for mobility so she could still go shopping if she felt so inclined, and home care workers in the form of nurses, a dietician, and personal care worker – all paid for by the health care system. I had a frank discussion with the head of the cardiac department once about the prognosis, and he said the only real cure was major heart surgery, and because of her very advanced age, “no surgeon would do it”, so the situation had to managed medically. Note that this was not the result of some callous calculation that she wasn’t “worth it”, but quite the opposite – that she likely had some good years left, whereas attempting major heart surgery at her age would almost certainly have killed her. And indeed, although she grew weaker over time, she did have some good years left. She lived far beyond the average life expectancy and her last years were comfortable and even enjoyable, spent at home with family, largely due to the excellent health care support she received.
For those who may not remember, the original bill did feature funding for end-of-life and palliative care consultations, which is an important but often overlooked part of essential medical care. Many people don’t even know what a DNR order is. Republicans of course seized on this to declare that Democrats with pitchforks were going to kill your grandmother to reduce health care expenditures. And this was before the Trump era, where now Republican politics is a total self-parody.
I’m not sure what the point of this question is supposed to be. My major point above is that the “death panel” was a stupid exaggeration – an outright lie, to be clear – by Republican extremists against the ACA on behalf of private health insurers. So the question is moot as no such body should exist and no such choice should ever have to be made, as I also noted above.
Instead, the health care system should be funded, staffed, and equipped so that such a choice never has to be made. I will say this, though. In the event of a major catastrophe where the health care system is overwhelmed and such a choice does have to be made, I do NOT want bureaucrats involved, especially not self-serving insurance company bureaucrats. But I don’t want government bureaucrats armed with calculators and health care economics studies involved either. What I would want is to continue to follow the existing protocols: the job of the government’s single-payer system is to always pay the bill, period, no more, no less. Medical decisions in our (Canadian) health care system are always left to the doctors, and it should remain that way, even in catastrophic emergencies where heart-wrenching life-and-death decisions have to be made, as was the case in Italy when they ran out of ventilators.
The way my Mom was cared for in her final years makes me proud of my country.
The provision required in every Obamacare coverage policy that ended up being hysterically labelled “death panels” is that everyone is covered to have a consulation with their doctor to set up what is known as POLST (Provider Orders for Life-Sustaining Treatment) which allows every person to decide ahead of time what THEY prefer as a level of heroic treatment. I had mine after I threw a pulmonary embolism that could have killed me–I got a nice letter that asked me if I’d like to consult with a doctor and/or set up my end of life orders. Not being an idiot and knowing what I do about heroic measures and how incredibly ineffective they actually are, I set mine up (I have a nice little fridge magnet with my POLST registry number on it for handy reference) as DNR. If I code out I don’t want some poor bastard of a paramedic having to do compressions forever on my dead meat until a physician formally declares me to be dead. CPR done in the field is amazingly useless overall and even done under the most favorable conditions (in a hospital, by a trained professional, with a crash cart right there) it doesn’t work nearly as often as the doctor shows want you to think. So if I crash, I crash and no drama for me, thanks.
And that, my friends, is the entirety of what’s involved in Obamacare “death panels.” Super exciting and terribly shocking, isn’t it? picture wanking motion here
Field CPR is effective in only ~10% of cases, and there is a significant potential for neurological damage leading to a significant reduced quality of life from cardiac arrest. Numerous cardiologists and neurologist have opined that they would prefer that CPR be not performed upon them personally because of the potential of an unacceptable quality of life consequence (brain or cardiac damage that is irreparable). In NOLS/WMA Wilderness First Aid and Wilderness First Responder training CPR is covered but with the qualification that the likelihood of successful patient outcome is very slim in a backcountry scenario where rapid evacuation to a qualified medical facility is not available. Basically, we are told to attempt resuscitation as long as possible but don’t expect success.
CPR is still a valuable skill that everyone should have because it can sustain someone until EMS arrives and can take over with cardiac stimulation but without defibrillation and cardiac care it is like a tourniquet; just enough to maybe keep a patient from dying until intensive medical care is available.
