ObamaCare "Death Panel" Targeting 70-Year-olds?

For anyone who doubted Sarah Palin’s charge that ObamaCare would lead to government “death panels”, more evidence supporting her charge has surfaced. We Stand Firm, the website of Freedom and Individual Rights in Medicine, has posted excerpts of a conversation between an Illinois neurosurgeon and radio talk show host Mark Levin discussing “upcoming new guidelines from the Obama administration restricting how doctors can deliver medical care.”

In the FIRM post, Dr. Paul Hsieh compares this neurosurgeon’s comments to another neurosurgeon, Dr. Hendricks, a character in Atlas Shrugged who rebels against socialized medicine. The full transcript of the segment of the Mark Levin show can be found here. Notably, patients are referred to by government bureaucrats as “units”. This is the rhetoric of bean counters, not doctors.

In the transcript, the neurosurgeon, who called himself Jeff, said:

I just returned from Washington, DC, where we were reading over what the Obama health care plan would be for advanced neurosurgery for patients over 70, which we all found quite disturbing. As our population gets older, the majority of our patients are getting over 70. They'll require stroke therapy, aneurysm therapy, and basically what the document stated is that if you're over 70 and you come into an emergency room... if you're on government-supported health care, you'll get "comfort care".

You know, we always joke around -- 'it's not brain surgery' -- but I did nine years after medical school, I've been in training ten years, and now I have people who don't know a thing about what I'm doing telling me when I can and can't operate.

Apologists for the new healthcare law strenuously deny the death panel charge. But they are correct only in the very narrowest sense. ObamaCare does not specifically establish actual Death Panels, but it does establish the broad scope of power to do so, which is laced throughout the law. As John David Lewis explains in his Winter 2009-2010 Objective Standard article, What the “Affordable Health Care for America Act,” HR 3962, Actually Says, “This legislation empowers the executive branch, namely the Secretary of Health and Human Services and a ‘Health Choices Commissioner,’ to write thousands of pages of regulations, and to force Americans to comply with them.” In other words; death panels by a thousand edicts.

One of the apologists is PolitiFact.com which calls the death panel charge the "Lie of the Year." Yet buried within its own article debunking the charge, it unintentionally points to how the nature of the law proves Palin right:

History professor Ian Dowbiggin, who has written several books on medical history, euthanasia and eugenics, said he had never heard the term before Palin used it. He said the phrase invokes images of Nazi Germany, which denied life-saving care to people who were not deemed useful enough to broader society. Adolf Hitler ordered Nazi officials to secretly register, select, and murder handicapped people such as schizophrenics, epileptics, disabled babies and other long-stay hospital patients, according to Dowbiggin.

"It's not far-fetched to make the historical argument that as you get government more and more involved in health care, you create an environment that is more hospitable to the legalization of forms of euthanasia," Dowbiggin said. "But the Nazi example should be used very advisedly."

No, it's not far-fetched given the nature of ObamaCare and of government-run medicine generally. When the government coercively takes over responsibility for paying for something, it acquires the power to control. Who pays the bill, sets the terms, ultimately. When the government pays for healthcare, it will assume the power to make healthcare decisions for the patient and medical judgements for the doctor, including life and death decisions. And it’s not only about end-of-life situations (See my posts of 10/19/11 and 11/20/11).

Obama is not Hitler, and ObamaCare is not Nazism. But both empower government with the same kinds of authoritarian mechanisms as Germany had. Hitler drew upon the established German government powers of Bismarck’s 19th Century welfare state. The Obama administration is already on record - through a key adviser - as advocating overriding the Hippocratic oath with “social justice.” Just as Hitler placed the collective (the race, in his case) over the needs and rights of actual individual human beings, so “social justice” places the collective (society) over the needs of individuals. This means, in essence, that healthcare decisions must be weighed against “whether the money could be better spent on somebody else” – those, according to a key presidential adviser, who may be better qualified for “being or becoming participating citizens”. ObamaCare, like Hitler, will favor those “deemed useful enough to broader society.” When the responsibility for dealing with the cost of healthcare is stripped away from the individual, where it rightfully and morally belongs, and turned over to the government under the guise of calling it a national problem, which clearly it is not, the individual patient is reduced to a “unit” – expendable on the whims of bean counters and the alter of “communitarianism”.

[Important Note: FIRM has an update alerting us to the fact that the claims of Levin's talk show guest are being refuted. See Snopes Disputes Neurosurgery Rationing Claim. However, whether or not the claims of the guest are false, the fact remains that ObamaCare empowers government with such controlling authority.]

Forbes: "Death Panels ... We already have one"

Last month, I cited the U.S. Preventive Services Task Force's downgrading of PSA testing for prostate cancer as evidence that Sarah Palin's ObamaCare "Death Panels" charge was coming true. In that post, I quoted from a NJ Star-Ledger letter-to-the-editor correspondent who came to the same conclusion.

Recently, that viewpoint received some prominent support. In The Department of Health and Human Services' Death Panel, Steve Forbes wrote:

[T]he U.S. Preventive Services Task Force, a committee of “experts” appointed by the Department of Health & Human Services ... recently de-clared that men should not be routinely screened for prostate cancer. The most common test is the PSA, which is part of a blood test. The panel also said no to rectal exams and ultrasounds, claiming that testing does no good, that it doesn’t save lives.

The emphasis is mine. So, it's worse than I thought. Just as in my previous post on the subject I cited numerous examples of the success of regular screening, so Forbes points to his own:

After skin cancer, prostate cancer is the most common form of cancer found in men. Last year it killed 32,000 people in the U.S. The panel’s tortured reasoning is that oftentimes traces of cancer in the prostate don’t lead to a full-blown attack that can kill the patient. True enough, as far as that goes. But the panel ignored the inconvenient fact that physicians have a measurement called the Gleason score to determine how dangerous the disease is. If that score is low doctors will take a watchful attitude; if it gets high they’ll recommend action.

I know. A routine rectal exam last spring resulted in an alarming finding, subsequently confirmed by an ultrasound and a biopsy. The Gleason score was flashing red, so my prostate was removed, and—knock on wood—it seems the disease was caught early and successfully.

The task force makes a big deal about the unpleasant side effects in treating prostate cancer. But with a disease like cancer I’ll take the side effects of treatment over letting nature take its course.

In other words, the government - if and when these recommendations are adopted - will come between the doctor's judgement and his patient's fundamental right to make his own decisions about his health. Where would Mr. Forbes be if doctors were probibited from doing rectal exams and ultrasounds, let alone PSA tests?

When Palin made her famous Death Panel charge, ObamaCare defenders were quick to point out that nowhere in the bill are anything resembling Death Panels explicitly called for. Some opponents of ObamaCare concurred. In his Summer 2011 Objective Standard review of Why ObamaCare is Wrong for America, Jared M. Rhoads writes:

[I]n the section titled bluntly "Are There Death Panels In ObamaCare?" (to which they answer "no"), the authors explain how the contraversy arose and what protections are in place to prevent the emergence of death panels - and then acknowledge the legitimate basis for concern over this issue, which is the conflict of interest introduced when the federal government makes decisions about coverage while simultaneously trying to control costs (p. 92).

The emphasis in the above quote is mine. This is why, in my 10/19/11 post, I said that "these government studies can not be trusted" because:

The Federal government now controls almost 90% of healthcare spending, both directly through programs like Medicare and Medicaid and indirectly through its crony arm, the quasi-private health insurance industry. Consequently, the government now has a vested interest in controlling costs. The deep, inherent conflict of interest is apparent, and should scare all of us.

It is a mistake to take Sarah Palin literally. But that doesn't mean she was wrong. The truth is much more subtle and sinister than that. In John David Lewis's Winter 2009-2010 Objective Standard article, What the “Affordable Health Care for America Act,” HR 3962, Actually Says, Lewis writes:

This bill is 1,990 pages of mind-numbing legalese. It will reach deeply into federal and state regulations and laws, on a scale that will require years for experts to interpret. It will establish institutions that will be effectively irreversible. It will grant arbitrary powers to bureaucrats, who will have to interpret and enforce its dictates. A full analysis of its impact would require a commentary at least as long as the bill itself. American citizens cannot be expected to read and understand such legislation. But they should be aware that this is the nature of the laws being written by their (alleged) representatives in Washington.

This legislation empowers the executive branch, namely the Secretary of Health and Human Services and a “Health Choices Commissioner,” to write thousands of pages of regulations, and to force Americans to comply with them. For every line in this bill, many pages of regulations will be written. As a result, the bureaucracy will expand, the final cost will be many times more than the original estimates—and the impact on American medicine will be devastating.

Death Panels will arrive through the "arbitrary powers [of] bureaucrats" writing "thousands of pages of regulations" implementing policies often based upon the recommendations of reports such as the PSA study issued by the benign-sounding U.S. Preventive Services Task Force. The devastating results may not occur immediately. As Forbes writes:

Two years ago this task force said wom-en under the age of 50 shouldn’t get annual mammograms—a “finding” so preposterous even the Department of Health & Human Services ran away from it.

This latest dictate is meeting the same fate.

Though they may not yet be able to get away with this particular attack on prostate cancer screening, it is an indication of the kinds of hidden forces being unleashed against American healthcare. The dictatorial power over our health care being accumulated by our government will lead inexorably to Death Panel results sooner or later, if not repealed. It is our children and grandchildren who will ultimately pay the full price.

Echoing others, Forbes concludes:

If the government succeeds in dominating health care, as it’s now on its way to doing, we can expect more of these weird and lethal findings. The focus will be on rationing and saving money. What we need in health care is more free enterprise, not Soviet-style controls.

PSA Testing: Are Death Panels Arriving Under Cover of “Scientific Evidence”?

A recent widely publicized and controversial study released by the federal U.S. Preventive Services Task Force “will propose downgrading its recommendations for prostate-specific antigen (PSA) for prostate cancer,” according to Rob Stein of the Washington Post:

Task force chairwoman Virginia Moyer said the group based its draft recommendations on an exhaustive review of the latest scientific evidence, which concluded that even for younger men, the risks appeared to outweigh the benefits for those who are showing no signs of the disease.

It’s notable that the study was done under the purview of the same bureaucrats charged with administering federal health care programs, including ObamaCare:

The 16-member independent panel is organized by the Department of Health and Human Services to regularly assess preventive medical care. Its recommendations have a widespread impact, especially on what services Medicare and private insurers pay for. The group’s influence was enhanced by the new federal health-care law, which will base some of its requirements for coverage on the group’s ratings.

The proposed recommendations come as doctors, researchers and policymakers are increasingly questioning whether many tests, drugs and procedures are being overused, unnecessarily driving up health-care costs and exposing patients to the risks of unneeded treatment. (Emphasis added)

According to Stein, “The test … has significantly increased the number of prostate cancer cases being diagnosed at very early stages.” Despite this fact, however:

[I]t has been a matter of intense debate whether that translates into a reduction in the death rate from the disease. Prostate cancer often grows so slowly that many men die from something else without knowing they had it.

Because it is not clear precisely what PSA level signals the presence of cancer, many men experience stressful false alarms that lead to unnecessary surgical biopsies to make a definitive diagnosis, which can be painful and in rare cases can cause serious complications.

Even when the test picks up a real cancer, doctors are uncertain what, if anything, men should do about it. Many men are simply monitored closely to see whether the tumor shows signs of growing or spreading. Others undergo surgery, radiation and hormone treatments, which often leave them incontinent, impotent and experiencing other complications.

What is actually being said here? Note the vagueness surrounding terms like “appeared to outweigh”, “increasingly questioning”, “intense debate”, “not clear precisely”, and “doctors are uncertain”, and contrast that mush to the acknowledged fact that PSA testing “significantly increased” early cancer detection. Yet, this study is cited as a possible justification for “requirements for coverage” over both government and “private” coverage – imposed by HHS. Keep this in mind.

The recommendations drew immediate and forceful rebuttal:

The “decision of no confidence on the PSA test by the U.S. Government condemns tens of thousands of men to die this year and every year going forward if families are to believe the out-of-date evidence presented by the USPSTF,” said Skip Lockwood, chief executive of Zero, a patient-advocacy group. “A decision on how best to test and treat for prostate cancer must be made between a man and his doctor. This decision is coming from a panel that doesn’t even include a urologist or medical oncologist.”

Several other experts agreed.

“The bottom line is that we should encourage screening because it will give men the full range of options to avoid death from prostate cancer,” said William J. Catalona of the Northwestern University Feinberg School of Medicine.

J. Brantley Thrasher of the University of Kansas Medical Center said, “It appears to me that screening is accomplishing just what we would like to see: diagnose and treat the disease while it is still confined to the prostate and, as such, still curable.”

I didn’t devote much attention to Stein’s article (which was carried on the front page of the New Jersey Star-Ledger on 10/7/11) until two letters-to-the-editor were published in the 10/13/11 Ledger. Tina Levorse of Parsippany and John Schlager of Springfield strongly objected to the proposed recommendations, citing personal experiences regarding early prostate cancer detection thanks to PSA tests. But it was Levorse’s perceptive LTE that got my attention. Entitled “Are death panels here?” she wrote:

While I’m not a big Sarah Palin supporter, it appears she was right. The Obamacare death panels are here.

I left the following comments:

In the past two months, I had two close friends diagnosed with early stage prostate cancer thanks to PSA screening. After biopsies and consultations with their doctors, both are now pursuing courses of action they deemed best in their individual circumstances. Both Levorse and Schlager provide indisputable logic as to the value of regular screening.

On the face of it, the U.S. Preventive Services Task Force’s “recommendations” appear to make no sense at all. But, viewed within the context of the government’s ongoing takeover of healthcare, it makes perfect sense. The Federal government now controls almost 90% of healthcare spending, both directly through programs like Medicare and Medicaid and indirectly through its crony arm, the quasi-private health insurance industry. Consequently, the government now has a vested interest in controlling costs. The deep, inherent conflict of interest is apparent, and should scare all of us. Early screening leads to early detection, which leads to a much higher survival rate, which leads to more people living longer lives, which leads to – higher costs to government.

I believe Ms. Levorse has nailed it. Death panels are inherent in government-run medicine, and may be arriving under cover of “science”. Of course, there are no explicit death panels written into ObamaCare or any other government program. There don’t have to be. Through the bureaucratic tyranny set up by ObamaCare, those recommendations and others like them will become mandatory, and restrictions will be written into the guidelines doctors must follow. The freedom of the doctor to focus on the best interests of his patient and the freedom of the patient to decide for himself based upon his doctors’ recommendations, will be lost to professional bean counters. Such are the consequences of surrendering to government the responsibility for paying for one’s healthcare.

This should be another wakeup call to Americans, but for too many, it probably won’t be. But one thing is for sure: No study connected to government financing can be trusted, given the government’s massive role in healthcare.

I am by no means a medical professional or expert. So, I can not and will not offer opinions on the accuracy of the study or its conclusions. But that is really beside the point. The point is, these government studies can not be trusted. The entire character of this article proves the point. How can anyone be sure of the motives behind the conclusions?

The vagueness of the arguments against PSA screening must raise suspicions in light of HHS’s ObamaCare-mandated “cost containment” mission. Add to this deep conflict of interest an inherent contradiction. The article states early on that “the risks [of PSA screening] appeared to outweigh the benefits for those who are showing no signs of the disease”. The express purpose of PSA screening is precisely to detect “signs of the disease” via the red flag of high or rising PSA levels. As a 62-year-old man anxious to get many more quality years out of his life, I have a vested interest in getting an early jump on any health issues that I may confront. In light of the acknowledgement that it is “not clear precisely what PSA level signals the presence of cancer,” who would it be best for me to depend upon most, my doctor’s advice or some distant panel’s mandates? As I said in my comments, I have two friends dealing with PSA-detected cancer. Who knows: I may be next. Yet government officials who do not know I exist have the power to deny me my unalienable right to exercise my own judgement on this matter, by their control over healthcare spending - financed by me, and countless others like me, to boot. And that’s the point: They don’t focus on any individual:

“Unfortunately, the best evidence is that while some men might be helped by screening, others would be harmed, and on balance the test is not useful overall,” said Howard Brody of the University of Texas Medical Branch in Galveston.

No human being is “overall”. And here we come to the essential difference between government-run and free market healthcare – the irreconcilable clash between collectivism and individualism; between a non-existent statistical average and actual living breathing thinking individual men. There is no compassion behind the bean counters’ and their “greater good of society”. There is only a callous disregard for the value of individual lives. I do not mean to imply that every member of the government bureaucracy and his or her panels is callous. I mean to say that callousness is inherent in their jobs, by virtue of the fact that their “overall” findings disregard the unknown “some men [who] might be helped by screening”, and by the unknown agendas of the political masters whose funding they depend upon. They can be nothing but callous, because that’s the nature of the beast. Central planning by definition must focus away from any concern for the best interests of individual men and the judgements of individual doctors in favor of the statist apparition - the public health.

Leaving the treatment decision “between a man and his doctor” is a moral hallmark of the free market and the doctors’ Hippocratic Oath. Snatching decision-making power away from millions of men in favor of a 16-member independent [?] government-sponsored panel – which, incidentally, will also undermine the Oath - is the hallmark of government-run medicine. This is the fundamental issue here, regardless of whom is right about the value of PSA testing. As a layman, studies such as this can be a factor in my decision-making. But they should not pinch hit for my decision-making rights.

To again quote Skip Lockwood, “the decision of no confidence on the PSA test by the U.S. Government condemns tens of thousands of men to die this year and every year going forward.” This reminds me of a question I remember being posed by a champion of government-run medicine some years ago: “If socialized medicine is so bad, where are the victims?” The answer – “They’re all dead.”