Monday, October 05, 2009

Some exchange with Hays on Health Care Reform

SH: The death panelists would be presidential appointees. They wouldn’t be elected. And they wouldn’t be subject to Congressional advice, consent, or oversight.

VR: You wouldn't happen to know where this is in the bill, or what Obama statement this comes from?

SH: Indeed, the whole point is to insulate them from the democratic process so that they can make unpopular choices that politicians are afraid to make.
VR: If they are Presidential appointees, and they did something like this, it would fall back on the President's head politically. If someone were victimized in such a way, they would run straight to FOX News and tell their story (assuming the rest of the media is too biased to listen). I certainly would.

The present system is prohibitive for people of modest income who don't have a large enough full-time enployer to provide coverage (I know, since almost all my work has been part time for the last 19 years--full time in total, but part time per employer), there are pre-existing condition exclusions, people get dropped by their insurance companies when the get sick, and there are lifetime caps on what insurance companies will pay for a person's care.

All Obama's public option can do is deny payment, not deny care. To actually deny care you have to have a single-payer system in which the health care and health payment are provided by the same governmental entity. Now, if the denial of payment is tantamount to the denial of care, then we already have death panels. There are treatments the companies won't pay for, and people die as a result. If denial of payment is distinguishable from denial of care, then nothing short of a full and complete single-payer system could possibly result in death panels.


bossmanham said...


The death panels already happen in European socialist nations. There are people who determine if it's "cost effective" for grandma to live. I don't trust our government to be any better at it.

Victor Reppert said...

Of course you need specific details on these charges.

But I think you missed my point. If you have one institution doing both payment and treatment, then the death panel can decide whether it's cost-effective to provide treatment and then the hospital denies the treatment. That is at least possible if you have a single payer system.

If you have St. Joseph's Hospital doing the treatment, they will say "OK, we'll treat Grandma if you can find enough money to pay us." You don't have it, so you look to your insurance provider to provide payment. If they say no, is that a death panel? If it is, then the current system has death panels. If that is not a death panel, then you can't have death panels without a single payer system.

The insurance company or the government can say that it's not cost effective to treat Grandma, and can withhold payment. Now it is true, as one of my commentators noted, the insurance company might withhold payment for financial reasons, perhaps the government might have some other, more esoteric motive for letting Grandma did. But I am yet to be persuaded that Grandma does any worse with a public option than she does without the public option. The way the public option is being proposed now, it wouldn't be available to just anybody who might prefer it. If she's on the public option it means she probably couldn't get covered otherwise.

Of course you can quote Obama to the effect that he would like to go single payer if he could. But single payer has a snowball's chance in hell in America so long as insurance companies have as much political influence as they have in the funding of political campaigns.

Victor Reppert said...

Our government will be "better" because Americans don't approve of death panels, and because Obama isn't saying that treatment should be turned over to the government. At most, payment should be, in some cases.

bossmanham said...

I think experience shows this isn't necessarily the case. People here in America usually do not have problems with lines or with being treated for life threatening diseases. Yes, some insurance companies throw around the "preexisting condition" card, but you don't have people being denied life-saving health care. I have shared with you one personal account I know of this happening in Germany, and I have also read many accounts of lines and refusal of health care in socialist nations because the governments just don't have enough money and have to prioritize. The people who can afford it come to America for their care. Private insurance companies, despite all their problems, don't have the money flow issues of the government. They also don't have the organizational issues that the government inevitably impose on the things they run, ie the DMV and the post office.

Victor Reppert said...

Again, you are talking about single-payer systems. Single-payer isn't on the table. It hasn't been proposed. And I just linked to a paper giving an account of HMOs encouraging assisted suicide in Oregon.

Victor Reppert said...

Again, if funding is refused because of a pre-existing condition, and death results, isn't that the same as having a death panel? What is the relevant difference?

Victor Reppert said...

The trick is comparing these systems as a whole. Odd thing, you don't hear Brits saying that they want to move to America for our health care.

Mark Frank said...


Stop relying on anecdotes and look up the actual processes and statistics. I live in the UK which is the most "socialist" of the European health systems. (I also lived in Atlanta for two years and had one child under each system.)

* There are no "death panels". NICE will decide at a strategic level which treatments it thinks are cost effective and will fund/recommend, but it does not make decisions at an individual level. This is done between doctors, patients and relatives as it should be. Like doctors all over the world they place individual patient priorities at the top and do the best they can. Figures show that the best is pretty similar to all other Western economies.

* Lines (or queues as we call them) are a problem for less urgent treatment. But bear in mind this service is offered for about half the cost of the US health service and every UK citizen has the option of taking out private health insurance (and many do) to supplement the NHS.

I can also mix NHS and private treatment. For example, pay for a private consultation to "jump the line" but then use NHS treatment or have an operation on the NHS but pay for a private bed during recovery.

We both live in systems which are partially state funded and partially privately funded. It is just that the UK has a far larger proportion that is state funded.

This has two side effects which
you might not expect.

Bureaucracy for the patient is almost non-existent. You need to register with a GP but after that no forms I am aware of. Just book an appointment with your GP or go to A&E in any hospital and get treated.

Choice of source of treatment is very wide (rather better than the choice you get with many US health policies which effectively tell you where to get treated). You have to register with a GP practice who has your address in its catchment area (although this is about to change). But for secondary treatment you can use any NHS hospital in the country and it is not uncommon for the NHS to fund treatment at a private hospital or even abroad.

It works.

Robert said...

Hello Mark Frank,

Interesting comments as they come from someone in a European country experiencing some of the things being thought about over here in the US. One question out of curiosity: I regularly see opinions expressed about Obama and his ideas related to health care here in US sources: what do the Europeans that you live with think about Obama and his health care ideas?


Mark Frank said...


Thanks for your comment. Obama is very popular in Europe. I don't think many Europeans understand what is being proposed (how many Americans do?). But I would guess most Europeans prefer their own systems to the US approach.

I should make it clear that the NHS is far from ideal and that other countries probably have systems that work better.

bossmanham said...


It'd be nice to see some sources for this.

Furthermore, yes the government "pays" for your healthcare, but you are paying exorbitant taxes.

Also, the UK is far less socialized than other European countries. I mentioned the case in Germany, which is much worse.

Why are 9,000 kidney patients refused dialysis each year?

"Take the health care systems of Britain and New Zealand, for example. In both countries hospital services are completely paid for by government. Yet both countries also have long waiting lists for hospital surgery. In Britain, with a population of about 55 mil- lion, the number of people waiting for surgery is almost 800,000. In New Zealand, with a population of three million, the waiting list is currently about 50,000. In both countries the adverse effect on patients is about the same. Elderly patients in need of a hip replacement may wait in pain and discomfort for years. Patients waiting for heart surgery are often risk- ing their lives"

"...a white, 65-year-old male in the U.S. can ex- pect to live 1.3 years longer than a 65-year-old British male. A white 65-year-old female in the U.S can expect to live 1.4 years longer than a 65-year-old British female."


Mark Frank said...


My post was about the way the NHS operates - the rules and processes. You want sources to verify these really are the rules and processes? I know how it works because I use it. It will be hard to provide concise sources but, for example, the role of NICE is written up on their web site:

There is also an NHS web site on choosing GPs and hospitals

I am sorry I don't have time to get more detailed.

Germany is more socialized than Britain in some respects - but not medicine. See "There is no such thing as "free" treatment in Germany, not even in state hospitals. All care, including emergencies, has to be paid for by you or your health insurance! "

The Heritage Foundation article is interesting but it is hardly a dispassionate neutral source and I wonder where it gets all its facts. For example, while there have been shortages of kidney dialysis machines in the past in the UK, the main reason patients with kidney problems do not get dialysis is because the UK preference for kidney transplants. See

"There are over 37,800 patients with end-stage renal failure in the UK. Nearly 21,000 are on dialysis, whilst the remainder have a transplant."

I should emphasise that dialysis is not refused - although a transplant may be highly recommended.

It has always stuck me as ironic that while life expectancy in the USA is famously lower than most other industrialised countries it does better for that population that have medicare available.

Mark Frank said...

While lookng up sources for the German health care system I came across this presentation

which rather nicely summarises the performance of many different health systems including the USA and UK. I think it is pretty neutral with respect to the USA as the emphasis is on evaluating the German system.