Is there a “death panel” in Obama’s health-care bill?

by James Hubbard, M.D., M.P.H.

Of course not, you say.  Ridiculous.  But could a report by ABCNews.com about 64-year-old Oregon woman Barbara Wagner suggests otherwise?  When she was dying of lung cancer, the state insurance refused to pay for her cancer treatment because the drug didn’t give her a “5 percent survival after five years.”

Sarah Palin recently stirred up some controversy when she wrote she thought the congressional universal-health overhaul would lead to a “death panel,” a central group of chosen ”experts” in charge of making life-or-death decisions for everyday people.  She thought those disabled or elderly would fare the worst.  While many claim her assertions are ridiculous, the conservative online publication American Thinker suggests Wagner’s story is an example of just such death panels.


ARE DEATH PANELS INEVITABLE?

Of course, no one touting the current health-care plan would ever think of using the term “death panel,” and I doubt any really are considering rationing treatments for unproductive members of society.  But the costs will have to come from somewhere and this business of the government making medicine more efficient is dubious to say the least.

So why not take a look at Oregon, which has been trying to find ways to cut health-care costs since the 1990s?  Oregon passed the physician-assisted-death law in 1997.  In addition, there have been reforms some might call rationing of care.  How’s it working out?  Are they saving money?

The ABC report indicates this woman was not alone in having her treatment for terminal cancer canceled.  Her drug in question cost $4,000 per month and, according to the report:

The median survival among patients who took erlotinib was 6.7 months compared to 4.7 months for those on placebo. At one year, 31 percent of the patients taking erlotinib were still alive compared to 22 percent of those taking the placebo.

The state insurance was happy to pay to make the patient comfortable, just not prolong the life. They apparently wrote her a not-tactful letter explaining they would be glad to pay for palliative care or doctor-assisted suicide treatment.


BUREAUCRATICALLY, IT MAKES SENSE

Well, if you look at the this situation objectively, without feeling, kind of in a bureaucratic-machine sort of way, it makes sense.  This drug would cost about $24,000 for six months when she could be put out of her misery for less than $1,000. The saved money can be used for a sick child. There’s only so much money to go around.  Also, the lady did choose to smoke.  Since she had lung cancer, we can assume the smoking caused it.  Was Oregon to pay for her bad habits?

What’s a couple of months of life worth, and who is to decide?

These are certainly questions we have to answer at some point.


WHAT DOES THIS REALLY MEAN FOR SENIORS?

Personally, I think every patient situation is different and the patient should be the one to make the decision.  This subject should not be taboo and people should be educated.  If you are capable, you should be in charge of your final days.  From the account of this story, this patient was quite coherent and the treatment not experimental.  Rather, it had proven effectiveness, however minimal.  Rules and far-away bureaucracies don’t care about that.  They can’t.  They have to meet budgets.

Many countries revere their seniors for their wisdom and see them as ones who have paved the way for the young.  I have heard of other countries where the terminal old folks go off in the woods to die so they won’t be a burden.

Even without “death panels,” are we paving the way so that, in 20 years, we start looking on our aging population’s health care with disdain and as a burden?

What do you think?


James Hubbard, M.D., M.P.H., is the publisher of
My Family Doctor, a magazine written by health-care providers for the general public.

Photo credit: Petr Kratochvil, Public Domain Pictures.net.

Correction: The ABC article was published in August 2008. This article has been revised to reflect that.


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As with all information on this site, this article cannot replace professional, personal medical advice. Read more here.


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5 Responses to “Is there a “death panel” in Obama’s health-care bill?”

  1. Zane Safrit Says:

    Interesting.

    So, you’re equating what is reported in a news show with what’s contained in the healthcare reform bill? You project a story about a single patient in Oregon into the text of the 1000 page healthcare reform bill?

    I noticed you don’t refer to the actual text of the bill.

    “Even without ‘death panels’”… those would be the ‘death panels’ that everyone’s heard about, but no one’s seen in the text of the healthcare reform bill. And more and more people, having read the bill, see as at best a distortion and at worst a manipulation of people’s fear of change. So, the issue of ‘death panels’ becomes the strawman issue created only to stir fear and anger at the unknown changes.

    As a doctor, I’m surprised you so easily ignore the data that conflicts with your diagnosis. That may speak more to the issues with our healthcare system than anything in the bill itself, even in its real text.

  2. James Hubbard, M.D., M.P.H. Says:

    No, I was not equating the two. I am talking about the general implications of health care reform. I seriously doubt the 1000 page bill will be passed as is.

    True I have not read the bill. I doubt you have either. So we both are speculating. At least the Oregon plan has a history we can look at.

    Decisions will have to be made to cut costs. Someone will decide where these costs will be cut and what is worth the cut. Who is going to be the someone? I would like personal decisions just to be made by just bureaucrats and computer decision-trees.

    Why not look at a state like Oregon and see what they have done and see what has worked and not worked, look at the sacrifices they have had to make. Is it worth the money?

    With politicians, it’s always have your cake and eat it too. We are told we can have cheaper and better health care with better coverage by being more efficient in administering it, and the government is going to do that for us.

    I don’t think the government is simply going to be satisfied by increasing the efficiency of health care by administrative costs and streamlining. The average population is going to continue to age and costs go up and medical costs will also go up. We have limited resources. At some point, the government will also.

    I say they are ignoring the tough decisions which will have to be made. At some point someone have to decide is how much we are willing to cut in care in order to cut costs (or how much we are willing to spend.) Who is going to be in charge of these decisions?

    I hope the patient has a lot of say-so in his/her individual care.

  3. Zane Safrit Says:

    Thanks for the reply. Mine was leaning towards the snarky. Your point is well-taken that demographics of our aging population point to the need to address the obvious. And the regular counseling, discussions, understanding of the options, with doctors like yourself as we and our parents continue to age give us the knowledge resources to allow us to make intelligent decisions and not a bureaucrat from any institution, private or public.

  4. ocbody.com doc Says:

    It is clear that any reform that is aiming to save money will have to ration care. It is commonly known that the last days of life are the most expensive, so a “Death panel” paradigm is just the natural extension of this thinking.

  5. michael Says:

    Part of HR 3590 mandates studies that determine the cost/benefit effectiveness of treatments. This inevitably will lead to situations such as you describe, when the cost of a treatment is very high compared with the limited extension of the life of a terminally-ill patient. It may be that, in this circumstance, the patient(or his family)could pay for the cost himself. HR 3590 as I downloaded it spans over 900 pages of dense and complex text. There are many demonstration programs designed to test a variety of approaches that hopefully will slow the growth of medical expenses and distribute them more equitably. Many question these – but cannot question the fact that the cost of medical treatment, rising substantially faster than our national income (which in effect leads to rationing) must be brought under control.

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