Death Panels

December 20, 2010
Posted by Jay Livingston

She was crying – a student in my ten o’clock class, sitting on a couch in the broad stairwell near the classroom. Her face was red, her body shook slightly. Another girl in the class was sitting next to her trying to comfort her. I stopped and sat down across from them.

The girl’s father was dying. He had been diagnosed many months ago, and the doctor had recommended a treatment available at only one hospital. But the hospital was not “in network,” and the insurance company had refused to cover the costs. The family was not at all wealthy – the girl was paying tuition with what she could scrape together from her job and loans – so that was that. Now the cancer had spread. It was inoperable, and his in-network hospital had sent him home with some liquid morphine and Dilaudid.

I told her not to worry about taking the final exam. We’d make some arrangement.

* * * *
I see Sara Palin is still using the “death panel” line (see her recent WSJ piece). Back when she introduced it, Politifact gave it their most flagrant false rating (“Pants on Fire”) on their Truthometer. But when you’ve come up with a catchy phrase that your base responds to, why not keep using it?

At the time, I wondered why Obamacare proponents didn’t point out that we already had death panels – not the fantasy ones in the imagination of Palin and her peeps, but real ones staffed by the insurance companies. “Recission,” the insurers called it – rescinding a policy on whatever pretext they could come up with when the patient’s bills threatened to run to real money. “Recission” sounds so much nicer than “death panels”; it has a precise, almost surgical ring to it.

The Democrats, even when they exposed the policy, continued to use the industry’s term. Insurance executives testifying to Congressional committees all said that recission is a minor matter, a distraction, since it affects only half of one percent of policy holders. Several bloggers later pointed out what was wrong with this math (my earlier post with links is here). But even at face value, it’s daunting. Half of one percent is five per thousand. If one-third of the population has health insurance, that’s 100 million. Five per 1000 is 5,000 per million, times 100 is half a million people.

I assume that this recission rate is lifetime, not annual. It’s not a huge number, especially if you translate it into that small-sounding percentage. So you really don’t have to think about it – not until you’re on your way to class, and you see a girl weeping for her dying father, and you still can’t get that image out of your head.


Bob S. said...

And what is the alternative?

For people to pay one rate of insurance and get unlimited medical care at the facilities of their choice?

Hate to sound heartless but the family gambled they wouldn't need a higher level of coverage.

The family gambled that they would have money in the bank when their need came up.

Now, when the gamble ran against them -- what do they expect?

They could have had the treatment but they didn't want to/couldn't pay for it.

Isn't that what it boils down to? Using other people's money?

I assume that the cancer wasn't something that was found and spread in the course of one semester, right?

So you really don’t have to think about it – not until you’re on your way to class, and you see a girl weeping for her dying father, and you still can’t get that image out of your head.

You talk about one girl, one family but the insurance company has to deal with hundreds of thousands, if not millions of families.

The age-adjusted incidence rate was 461.6 per 100,000 men and women per year.

Given a 305 million population that equals out 1.4 million people each year.

How do they make sure those families have the money available for the care they need?

Anonymous said...

Bob, you bring up valid points. Certainly fixing the healthcare system is no easy task, and ultimately, people are going to get sick and die. But to say that Obama is going to bring about death panels (and imply that we have nothing like that now) is to ignore the obvious facts.

Or maybe you and Ebenezer are right. If poor people can't afford insurance or healthcare, let 'em die. Bah humbug.

Bob S. said...


Sorry but I'm not ignoring anything.

There is a major difference between 'death panels' and not having sufficient coverage.

You'll not that the 'poor people' in the story had health insurance, they just didn't have enough.

That is a decision they made. They could have bought catastrophic care policies but they didn't.

And as far as poor people are concerned; let find out where you stand.

How many policies have you purchased for poor people not related to you?

How much of your money(unrelated to your own premiums) do you give to provide coverage for other people ?

Seems like too many people want to provide coverage but they want to do it with other people's money.

Jay Livingston said...

I’m not sure what the specifics of the case were. But suppose I think that I have pretty good health insurance and then discover that a treatment I really need is not covered because the place where it’s available is not “in network.”Should consumers really have to check every possible procedure they might ever need and make sure that for each one there is an in-network provider? (It also seems like this is a flaw of a fragmented health care “system.”)

As for “other people’s money,” that’s what government is all about – doing things that in principle are supposed to be for the general good and paying for them with tax money even though not all people will benefit directly. Anonymous may not drive a car. If so, when he looks out at all the snow-removal equipment on the road today, he might say, “Seems like people want clear roads to drive on, but they want to do it with other people’s money.” Anonymous may not have children, so he might say that people sending their kids to public schools are doing it with other people’s money. Anonymous may use only bottled spring water and inspect his own food carefully. That gives him the right to complain that I’m getting my (relatively) safe food and water thanks to other people’s money. Anonymous’s grandmother maybe doesn’t use the Internet – created largely thanks to government programs – so she sees us enjoying something thanks to other people’s money. And so on.

Bob S. said...


Other People's Money, i.e. Taxes, is supposed to be used for the common good -- isn't that in the Constitution?

Anon may not drive a car but (s)he gets goods that travel over those roads lowering costs and so on.

Medical costs are individual costs. As I pointed out to Anon - why aren't the people who don't want the poor paying for things stepping up?

That is the real issue.

Before people vote money out of my pocket, why are you and they others stepping up and paying for it?

Do you or Anon live on sustenance level while paying for other people's food, housing or medical care?

I'm betting not a chance in the world.

Nope. You and Anon want to do a good thing but you don't want to spend your money, you want to spend everyone else's.

Jay Livingston said...

The question is whether having a healthier population is a public good. With education, we decided this question long ago, and the answer was yes, though I’m sure that some people still disagree. (If you want your kid to go to school, don’t expect me to pay for it. And if you can’t pay the tuition, tough.) Perhaps there is a similar sentiment gathering about health. Even the Tea Party isn’t hollering for the repeal of Medicare, the nearest thing we have to socialized, single-payer health care.

Most public goods – things that are good for the nation generally – benefit some people more than others. You say that the highways benefit everyone. So does spending on the military. But in both of these benefit some people more directly and in greater proportion than others. That’s true of most government expenditures. Subsidies to agribusiness, energy companies, and other producers are an obvious case. But spending for the military directly benefits members of the military-industrial complex a lot more than it benefits me, just as highway expenditures benefit road builders and people who drive a lot much more than they benefit people who use public transportation.

Tax expenditures have this same quality. If the government taxes some people less, it has to tax others more. People who don’t own homes pay for the mortgage deductions of people who buy homes. People whose income is largely from salaries pay for the low tax on incomes derived from playing the financial markets. The bigget tax expenditures go to corporations. If GE isn’t paying any corporate income taxes, then taxpayers like me must make up what should have been their share. And frankly, I’d rather see my taxes go to improving the health of poor people than to JackWelch’s private jet.

Anyway, the uninsured are already an economic burden on the rest of us. When they show up at the emergency room, hospitals cannot legally turn them away. (I think there was a federal law to this effect passed during the Reagan years.) The cost for that treatment gets passed along to the rest of us.

Bob S. said...

Bravo Jay, Bravo !!

Great Speech and it doesn't change a bit.

How much money do you personally give for other people's healthcare?

You can talk about economic burden all you want but the fact of the matter you and Anon probably aren't giving what you can to relieve the burden of the poor.

Why do you think it is fair for 50.1% of the people to be able to vote money out of my pocket?

Unlike roads or the military, individual health care can not be used for the common good. No other person can use the medicine taken by an individual.

Stretching the 'common good' and commerce clause incredibly thin there.
If there is an economic burden due to people having to be treated, repeal that law.

Then get yourself down to the hospital with a wad of cash and start doling it out.

Why don't you and the others do that? Or start your own hospital where people can go and not have to pay for treatment?

By the way, nice straw man argument about Welch's plane. That is money the company earned by providing a service (just like the road builders) not a benefit given by the government.

Unless you are saying that getting to keep money we earn is a benefit?

Basically what I'm seeing is you want to decide what is a fair amount for everyone or every corporation to have, then you want to decide what to spend the rest on.