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.