THE SLIPPERY SLOPE REVISITED
There are two kinds of arguments against Obamacare. The first is philosophical: A clean, virtuous case can be made against much of the kind of health care reform being proposed by Obama and the Democrats based solely on conservative principles. From individual freedom issues, to issues involving the sanctity of every human life, there is a strong and compelling case that can be made against Obamacare.
Too bad more conservatives aren’t making it.
Instead, we seem to be relying mostly on the “slippery slope” arguments that, by nature, are more problematic and as I have shown, can degenerate into logical fallacies that are easily brushed aside by Obamacare supporters.
Admittedly, slippery slope arguments are sexier, and can more easily be employed to scare people with half truths and outright falsehoods. Just ask Sarah Palin whose “death panel” crack was the ultimate in dishonest slippery slope arguments.
But there is another slippery slope argument that can be made about the end of life counseling section that fulfills the requirements of being valid by showing how such “paid for by Medicare” sessions can indeed go far beyond what proponents of the provision - including yours truly - have argued.
Philip Klein writing in the American Spectator voices qualified support for the idea of end of life counseling (employing the Schiavo case as I did), but then, in a logical and reasonable fashion, demonstrates how the government might use that provision to worm their way into end of life decisions:
With that said, the provision has to be viewed within the larger context of the changes that President Obama envisions for the health care system as a whole. Though he denies it now, Obama was once a proud advocate of a single-payer system in which government is the sole purchaser of health care. Throughout the health care debate, he has cited erroneous statistics to promote the idea that government-run systems get better value for their health care spending. And through a web of subsidies, mandates, regulations, and the creation of a government-run plan, Obama hopes to make America function more like the foreign health care systems he prefers. Those systems do not control costs by using magic wands, but by rationing care to the sick.
Britain, for instance, has a panel of experts called National Institute for Health and Clinical Excellence that performs cost-benefit analysis to help determine what sorts of treatment the government will pay for, and for whom. According to a report in the New York Times, NICE “has decided that Britain, except in rare cases, can afford only £15,000, or about $22,750, to save six months of a citizen’s life.”
I wrote about the wildly inappropriately named “NICE” in this AIP column. Suffice it to say, “NICE” is not. (Neither are they a “death panel” by the way.) Klein is being a little disingenuous himself. The figure $22,750 is misleading because very often, there is nothing except highly experimental treatments and drugs that are at issue. Our own insurance industry has similar boards that routinely reject paying for the same kinds of treatments unless they have a gold plated policy that will pay for just about anything.
In short, the real cost of end of life treatment falls in hospital re-admissions for the same chronic illness during those last 6 months. At current rates, that 22 grand would pay for, depending on treatment, perhaps 3, 4, or 5 re-admissions where the patient stays 2-3 days. Hardly a death panel but still troubling if you consider what Klein shows is the potential for mischief:
NICE was one of the inspirations for Tom Daschle’s vision for a Federal Health Board, an idea Obama praised before originally tapping Daschle to lead his health care push. The idea for an expert panel has already manifested itself in the form of Obama’s Federal Coordinating Council for Comparative Clinical Effectiveness Research, created by the economic stimulus bill.
While Obama argues that his council will just be providing expert research to doctors and patients, if you read Tom Daschle’s book Critical: What We Can Do About the Health-Care Crisis, in the context of describing a Federal Health Board, he outlined how government could compel wider adoption of such a body’s recommendations. For instance, Daschle explained, there could be a requirement that all government programs would have to abide by its recommendations and that requirement could extend to any private insurer participating in the government health insurance exchange. And as Daschle wrote, “Congress could opt to go further with the Board’s recommendations. It could, for example, link the tax exclusion for health insurance to insurance that complies with the Board’s recommendations.”
Could something like this morph into government giving seniors little option except to sign on the dotted line for DNR’s, living wills, and hospice care? It would, if nobody noticed. Again, the “boiling frog” fallacy rears its ugly head. To assume the worst, you must believe that opponents wouldn’t notice the problem as it developed and could do nothing about it. You would have to posit the notion that Congress - even if still ruled by Democrats - wouldn’t become incensed at this closing down of options for seniors and order the health board to fix it.
But there is an equally troubling argument that Klein makes and it involves all of us; the idea that we are ignoring delicate problems involving end of life planning. Citing the Oregon assisted suicide program being paid for by government, Klein shows how such thinking can inevitably lead to unintended consequences:
This, of course, is the inevitable result of thinking of health care as a collective good that should be allocated by the state. If health care operates on a global budget, then it becomes a zero-sum game in which providing more care to one patient means depriving another patient of care. And suddenly life and death health decisions evolve from something that is between you, your faith, your family, and your doctor, into highly-politicized issues that are the business of government and your fellow taxpayers.
Instead of being honest about the natural tradeoffs involved in trying to “bend the health care cost curve,” Obama has promised Americans a utopia in which everybody is covered, quality improves, our debt actually decreases over time, only the very rich have to pay a tiny amount of extra taxes, and there will be no rationing of care. As Obama promised this week while in full salesman mode, “You will have not only the care you need, but also the care that right now is being denied to you — only if we get health care reform.”
But Obama’s disingenuousness doesn’t get conservatives completely off the hook, either. The right has been pushing back hard against the specter of government cutting off Medicare beneficiaries in their final days. Even if the House legislation did make that happen, however, is it clearly more ethical for conservatives to argue that we should dedicate an effectively unlimited amount of resources to treat those who are terminally ill or in a comatose state, while depriving others who are not old or sick or poor enough of any form of government benefits?
What any government board’s decision regarding end of life means is that the most intimate and personal decisions someone can make - how to manage their death - allows for a government bureaucrat to be in the room when one discusses such issues with their doctor. It is a humiliating loss of freedom that should be prevented by making such decisions off limits to government entirely. This could still be done in the context of Medicare paying for seniors to talk to their doctor about end of life issues while being aware of the potential for interference.
And Klein believes that this won’t let conservatives off the hook. Advocating unlimited resources being spent on those close to death may not be possible in the future - with our without Obamacare:
It’s an ugly issue that nobody wants to bring up precisely because of the reaction we’re seeing right now. But the dilemma will only become more pronounced with entitlement spending out of control, the development of life-preserving technologies expanding, and Baby Boomers set to retire. The reality is that we do not have a free market for health care in the United States and that government is responsible for 46 percent of health care spending. Nobody wants to be the heartless person who puts a price on human life and argues that we cannot afford to give a patient treatment that will mean the difference between death and survival. And certainly, nobody wants the person making that decision to be a government bureaucrat. But if conservatives believe in providing unlimited end-of-life care, then it necessarily means some combination of higher taxes, greater debt, or substantial cuts in other government services. In the coming years and decades, this reality will create friction between the desire of conservatives to protect human life in all of its forms and to limit the growth of government.
In that sense, the debate we’re having over the implications of end-of-life counseling is just a harbinger of problems to come, which Obamacare would only exacerbate.
In effect, there is a slippery slope argument to be made for both doing nothing, and adopting Obamacare. This is a consequence of the reality that health care reform is necessary but that Obamacare is the wrong way to go.
Is rationing our fate no matter if Obamacare fails? The future is grim and unless we can find someway to expand the health care pie without growing government or giving bureaucrats control over our health care system, these issues that are already on a slippery slope will slide us into choices that are unpalatable and would represent a loss of freedom.
I like how you use the word bureaucrat as a scare tactic. The actual definition of the word is slightly less evil than your context would have us believe. In fact, it applies to people who work at insurance corporations as well.
Let me see if I’ve got this technique down:
“It enrages me when some insurance company bureaucrat denies coverage for a test that my doctor says my child needs.”
Yeah, that feels about right. Now, let me go get on the phone for three hours with these insurance company bureaucrats and explain to them that their excellent private system seems to be having a bit of a problem in regards to not giving a shit about my kid.
Comment by Chuck Tucson — 8/17/2009 @ 9:50 am
But having an insurance company employee in the room is perfectly fine? Sorry, but you completely avoid the point that we already have a rationed health care system.
Comment by Postagoras — 8/17/2009 @ 10:43 am
I am dealing with health care issues at great rate of speed at the moment. At age 67, I have no assurance that my government won’t try to “off” me for the greater good. Of course, I’m also working full time (unlike a lot of the probable recipients of Obamacare largesse) so I’m utilizing my private health insurance as well. I’ve had one surgery on my carotid artery on the left side of my neck and the right side is already scheduled for September. That’s how uncomfortable I am with the future. As soon as the surgeries are done and my cat’s health is assured (you want to talk about expensive health care?), I’m moving to Mexico - where healthcare is more affordable and more loving and where I won’t have to sweat the prospect of Axelrod’s goon squad showing up on my admittedly conservative doorstep. I never thought I’d feel this way, but that arrogant pipsqueak in the White House has driven me to it!
Comment by Gayle Miller — 8/17/2009 @ 10:44 am
Besides, I’m a practicing Catholic. We don’t DO euthanasia! Of course, Madame Governor Palin was roundly dissed for claiming that to be part of Obamacare and told that she didn’t know what she was talking about. And THEN they announced that it had been withdrawn.I love watching her make them spin in their tidy whities!
Comment by Gayle Miller — 8/17/2009 @ 10:46 am
Andy McCarthy, a gentleman of ACTUAL achievement in his life outside of cyberspace self-love, disagrees with Moran.
http://corner.nationalreview.com/post/?q=NDMxYjViMTZlNWRmOTg4MmEwNDA1NTk4MjQzYmQyODM=
Comment by John Rogers — 8/17/2009 @ 12:31 pm
Another recent “squishy” con, who just weeks ago was in lock-step with Moran in fear of MEAN WORDS, turns back to The Good Side of The Force:
http://ace.mu.nu/archives/291004.php
Comment by John Rogers — 8/17/2009 @ 12:35 pm
Yes, we just have to find some way to expand the health-care pie, so lets throw the entire mess back into the marketplace and the laps of the people who have been so miserly with the pie: Insurance companies, Big Pharma and for-profit hospitals and health-care systems.
There is no free market in health insurance now. It is one of the most heavily regulated industries around. And I agree, reforms are necessary. One might wonder what a true free market in health insurance would look like because companies would no doubt spend most of their time cherry picking healthy people to cover.
But why not insurance pools where risk is spread out over dozens of companies and hundreds of thousands of people? This would certainly help the chronic/pre-existing conditions group. Right now, I’m looking at the Co-op option - doesn’t look very promising on a national scale but statewide might be interesting. And I still think the tax subsidy is the best way to insure those who don’t have insurance but want it.
Open competition over state lines would help also. As would tort reform - funny we never hear anything about that from your side even though a Price Waterhouse study concluded that 10% of heath care costs are derived from defensive medicine - a direct result of suit happy Americans who see dollar signs if they even imagine they can make a case against a doctor.
Efficiencies derived from reforming Medicare - especially how doctors and hospitals are re-imbursed and rewarding medical professionals for quality care - small, reasonable steps that would be followed by other small steps which would eventually change the system for the better.
ed.
Comment by shaun — 8/17/2009 @ 12:48 pm
Is the Federalist argument (10th Amendment) a philosophical or slippery slope argument?
C’Mon, smitty. Of course it’s a great philosophical argument. How the federalism argument against reform translates into death panels being anything but a deliberate exaggeration or some other arguments that make the jump from A to Z with no intervening logic or facts, I can’t figure. Enlighten me.
ed.
Comment by smitty — 8/17/2009 @ 12:51 pm
“Now, let me go get on the phone for three hours with these insurance company bureaucrats and explain to them that their excellent private system seems to be having a bit of a problem in regards to not giving a shit about my kid.”
Your implication is that a federally run government medical coverage plan would decrease the amount of time you had to waste on the phone? It’s comical to think a government run system on that scale would perform better or even come close in terms of customer satisfaction.
I battled the bureaucracy with both Medicare and a private insurance company during my mother’s hospital stay before she died. Neither was as responsive as I’d want.
Comment by sota — 8/17/2009 @ 5:05 pm
sota said:
No, my implication is that the private system is horrible, and has failed me and my family on numerous occasions. I reeealy love BEGGING some company that I pay a ridiculous amount of money to do everything in their power to NOT provide the service I’m paying them to provide.
Oh, what? It’s the private system, why not just switch insurance companies? Well, I have, and the grass is just as brown and dead on the other side of the fence.
Considering my experience with the system, it’s very difficult for me to believe that a government system could possibly be worse.
You guys have almost managed to terrify me into thinking that it might, though. You’re all incredibly adept at making people scared shitless. Well played, right wing.
Comment by Chuck Tucson — 8/18/2009 @ 8:20 am
Thank you for a terrific response, Rick.
Comment by shaun — 8/18/2009 @ 8:53 am
Health care is rationed as it is. None but the very wealthy can afford much in the way of health care outside of the insurance system and the insurance companies routinely deny, delay or otherwise obstruct coverage.
Those who can pay will always be able to buy more health care than those of us reliant on any risk sharing pool, whether government or private insurance. All such systems have limited resources and have to determine how and what to spend them on. There is nothing inherently better about the decisions a profit making system makes on what to spend the money on than a a non-profit system. Some insurance pools are non-profit as well.
More importantly, there is room for a combination of public and private insurance in the market. It exists currently and can continue to exist in a future with a “public option.” Such a system already exists in Germany, where the majority of people are insured through private non-profits under government charter. Many people purchase supplemental policies for “luxury” coverage such as single rooms in hospital etc.
As long as the health care providers themselves, doctors, hospitals etc., are not public employees or businesses, the insurance world will have more than one option and there can be freedom of choice. In fact, I had more freedom of choice, not less, under the German “public” insurance than I do with our high end private insurance here in the US.
Comment by Eric — 8/20/2009 @ 12:21 pm
The main fallacy in your argument is that under the bill as currently written, living wills are not compulsory. No one would be required to get counseling for a living will. The requirement specified in the bill is that Medicare would be required to reimburse the doctor for the counseling session once every five years. There is nothing in the bill that requires seniors to attend such a counseling session, only that IF they choose to, it is covered by insurance.
Comment by Geoff — 8/20/2009 @ 12:56 pm
Forget about the “public option” for a moment. How does the rest of the bill fair vis-a-vis taming the growth in cost that’s rampant in the health care industry? Why isn’t anybody actually talking about this very issue? After all, government merely has a fraction of $2.4 TRILLION industry under its management so where does the private sector’s reform fit in? Rather than prattling and spewing misplaced rage at the meetings, why isn’t somebody asking germane questions regarding this issue?
Comment by zish — 8/20/2009 @ 9:23 pm
I am so sick of seeing Sarah Palin’s statement being referred to as a falsehood. I have a genetic disorder. It’s called Marfan syndrome. I have never met a liberal who didn’t take for granted that I have no right to reproduce (and I know many conservatives who think so too). They take it as a matter of faith that anyone who knows their unborn child carries a genetic disorder ought to abort, because it is “cruel” to allow a less-than-perfect child to be born. This is how liberals think.
To admit this is not a slippery slope.
This is why we need Sarah Palin, because most people in the talking classes don’t have the foggiest clue what it’s like to be disabled, to live with a debilitating condition, or to constantly deal with condescension from liberals, the rich and the government.
Comment by JC — 8/21/2009 @ 1:42 am
Here’s what Sarah Palin Actually *said* about “Death Panels”…
OK. So Obama has created the talking point over the past several days that has led many, even many the right, to disparage Sarah Palin’s “death panels” comment as being over-the-top, inaccurate, etc.
As I’ve discussed in sev…
Trackback by The Lewis Crusade — 8/21/2009 @ 5:03 am