• I don’t have time for this

    I’m neck deep in grant reviews and I promised myself I wouldn’t get distracted, but I can’t let this pass.

    Avik Roy has returned from his self-imposed sorta-hiatus from the blogosphere to pen a piece on the return of death panels. He has defended the positions of others on this before, and I simply disagree. I think he’s twisting the words of others to try and make them rational. They’re not. And he‘s doing it to those on the Left as well:

    The Left’s solution is rationing: the government should determine when individuals are seeking care they don’t need, and prevent them from obtaining it. The Right’s solution is privatization: let individuals pay for the care they want, even if that means that some people are able to afford more care than others.

    I’m sorry, but this simply isn’t true. I think he’s accurately representing the position of many on the Right. But not the Left. I would say that the position of many on the Left (and it’s the “Lefty-Left”) is that government should determine what care individuals need and pay for that. For everything else, let individuals pay for the care they want, even if that means that some people are able to afford more care than others.

    Notice the difference? Avik implies that the Left wants to tell you that you can’t have care you’re willing to pay for. That’s simply not true. Avik implies that the Left wants to let the government tell you that you can’t have things even when you want to pay for it out of pocket.  I have met no one – at least no one serious – that wants this.

    Avik furthers this argument by once again cherry picking the UK:

    Donald Berwick’s nomination to head CMS was controversial precisely because he is a passionate advocate of the British system, in which there are indeed death panels that prevent patients from receiving life-extending therapies for cancer, blindness, and other conditions.

    Here’s the thing.  No one in the US is advocating we adopt the health care system of the UK.  No one.  Even the self-described socialist in the Senate isn’t trying to get us the NHS.  Those in the “Center-Left” brought us the PPACA, which is giving some people public money to buy private insurance.  Those on the “Lefty-Left” want Medicare for all. And, under Medicare, if you want to get care not covered by the government, you absolutely, positively can pay for it yourself and get it.

    I think Avik knows this.  And that’s what frustrates me.  I’ve corresponded with Avik and found him to be a reasonable guy.  But he’s making straw-man arguments in order to demonize the views of those who disagree with him.  He’s crying “Death Panels!”.

    Here’s what I believe to be a more accurate representation between those on the Left and those on the Right:

    1. I think some on the Left want to use public money to pay for care, but think we can have a panel of experts (which should include physicians) try and determine which care isn’t worth the money and stop spending as much public money on that. This will mean that if individuals want to get that care anyway, they have to pay for it themselves.
    2. I think some on the Right want to spend less public money on all care.  This will mean that individuals will pay for the care they want themselves, even if that means that some people are able to afford more care than others.

    As I’ve said before, to some out there one of these is evidently a “death panel” and the other is a great idea.  Personally, I believe the first is more sensible and the second is regressive; others disagree.  That’s a debate I’m willing to have.

    But no one is advocating what Avik suggests.  I wish he’d stop saying they were.

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    • The UK has a parallel private system. This suggests that even under the NHS individuals are able to purchase more care if they so desire. I realize that the vast majority of care is socialized but if ‘death panels’ were such a problem, wouldn’t consumption of private care be exploding?

    • I have been through this with Avik before. One point I always forget to mention is the implied assumption that physicians are dirtbags. Yes, there are some sleazy docs, but most are not going to give up their practice standards and start withholding care or tell patients to die because Medicare wants them to engage in end of life planning.

      Steve

    • “Avik implies that the Left wants to let the government tell you that you can’t have things even when you want to pay for it out of pocket. I have met no one – at least no one serious – that wants this.”

      Then I assume you have never come here to Canada. It is accepted as a truism by many here that allowing “the rich” to pay for their own care would bring down the public system.

      Whether you or Avik Roy is more correct regarding the American Left, I cannot say, but Avik Roy’s characterization of the Left’s position is plausible. If I may borrow your qualifiers, “some on the Left” very likely do want what Avik Roy says they want.

    • @Scott

      You’re playing the same game. Some on the Left? Who? Name me a politician who is advocating this. For that matter, name me a wonk who is advocating that. Name me an economist who is advocating that.

      If you can’t, then please stop. We have a Medicare system right now that does not deny people care for things they will pay for. It’s the way things are, today. No one is trying to change that.

    • See today’s WSJ editorial page on “death panels come back to life” — this issue is far from over and a sensible debate is still elusive. Here is the argument made:

      “There’s an enormous difference between government-imposed rationing and treatment decisions in the private sector. When insurance companies deny coverage…they do so based on contract language agreed to in advance by subscribers. If you don’t like what a particular insurer offers, you’re free to shop around… But when government denies approval of a medication, there will often be no appeal and no escape.”

      This is absurd and confusing two issues.

      The non-approval of Avastin for breast cancer was decided by FDA because of inadequate evidence of the medication’s safety and efficacy on average and among particular sub-groups, nothing to do with cost. If you don’t like the FDA decision, there is an appeal process. Most European countries have not approved Avastin for breast cancer use for the same reasons. The story charges that FDA is taking safety and efficacy decisions based on cost considerations; that is a serious charge, not borne out by the evidence presented.

      Then the authors mix FDA decisions up with decisions about use of public monies for given treatments. But if the government does not provide public finance for a medication because it is cost-ineffective given a budget constraint, yet the med is approved by the FDA on safety and efficacy grounds, people with money can obtain the medication in the private market via insurance or direct purchase. This has equity implications at the margin but does not violate individual rights.

      The drumbeat on the Right is getting really loud and annoying; their fact- and theory-free political rhetoric basically saying that health care rationing does not exist in a free market. Are people out there buying this snake oil???

    • “The non-approval of Avastin for breast cancer was decided by FDA because of inadequate evidence of the medication’s safety and efficacy on average and among particular sub-groups, nothing to do with cost.”

      This whole Avastin thing has been bizarre beyond belief, but then one of my close friends is a surgeon/researcher specializing in breast cancer research. When you look at the data, especially if you have had patients on the drug, there is little reason to use it for breast ca.

      Steve

    • Aaron,

      I’d amend your summary so that it fully takes into account the left’s position. My addition is in brackets.

      2. I think some on the Right want to spend less public money on all care. This will mean that individuals will pay for the care they want themselves, even if that means that some people [are not able to afford care they do need].