Asymmetrical Information - Megan McArdle

10.31.12

The Reality of Death Panels

Was Sarah Palin Right?

A couple of conservatives have asked why I wrote this passage:

Sarah Palin took a lot of chaff for her silly "Death panel" remark, but in the case of small diseases like this, that's what these sorts of cost-benefit decisions effectively become.  There are only 270 patients in Britain with this CF variant; the NHS knows all the names of the patients who will be sentenced to death if they withhold this treatment.   

If she was substantively right, then why criticize?

I'm no reflexive Palin-hater, but her Facebook post about "death panels" was simply wrong.  This is the relevant passage:

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.  

I think you can argue--in fact, I have argued--that the kind of rationing ObamaCare's designers envision will mean making uncomfortable decisions about who lives and who dies.  And even that those decisions will tend to undervalue the lives of people with Down's syndrom and other disabling conditions.  It's not all useless back surgery and unnecessary appendectomies and needlessly prolonging Grandma's death throes.  What will we do about very expensive care that can extend life, or quality of life, at very high cost?

But it is simply not the case that any individual person is going to be paraded in front of any sort of regulatory agency in order to get the individual thumbs up or thumbs down, a la Nero.  And that's what Palin was describing.  I don't think that you can reasonably read that passage as metaphorical.  

I don't think that her worries about rationing are wrong.  I even think it's reasonable to believe that IPAB will be a "death panel"; if it works as designed, it probably will deny potentially lifesaving, but extremely expensive, treatments.  

But Palin chose to dramatize the issue as a kind of regulatory human life review, where we have a government agency in charge of deciding which individuals are worth treating.  That is not what is in the law now, and moreover, I find it vanishingly unlikely that it will ever be in the law.  The very reason that Palin's warnings about "death panels" resonates is the reason that we will not have them: almost everyone finds the idea monstrous.  

So yes, it was silly, even if there's a grain of truth hidden in there, underneath the lurid pulp sci-fi details.