My head hurts ......

The recent talk about 'death panels' in relation to health care reform has brought to mind something in the distant past (distant in 'modern' terms) - the Base Closure and Realignment Commission. Alert Americans will remember the BRAC - a way to cash-in the 'peace dividend'. So how does that relate to the 'death panels'?

Barack Obama spoke to David Leonhardt of the New York Times (back in April of this year) about a great many things, one of which was health care reform. In the interview, the president had this to say (referring his elderly grandmother):

"So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here."

When asked what to do about the problem, he replied:

"Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now."

Imagine, if you will, the country making medical decisions through a political process, rather than consulting with doctors. Does that sound good? Doesn't to me, either. But if I did have to call my representative, I would think he'd be for my enhanced medical care, because if he denied it, I might not be inclined to vote for him next election (if I made it that long).

Not a good solution.

Enter the Death Panel. But lets not call it that ..... too mean, too vicious. Lets call it ..... I don't know ... how about ...... Federal Coordinating Council for Comparative Effectiveness Research. That's much nicer. And government-sounding. But we all know it's the government word for death panel. And it's here that all the 'tough' decisions get made regarding health care.

This is where BRAC comes in. Remember what BRAC was for? BRAC was the mechanism by which the military was going to return the peace dividend to the country by closing now-unneeded bases. BRAC was also the mechanism to defeat politicians' desire to close the other guy's bases, not the bases in my district (because, well, hell .... he might lose votes!). BRAC presented a slate of bases for closure, and if approved by a senate subcommittee, would go to the full senate for an up-or-down vote ..... no cherry picking your pet military base.

So money was saved .... the Peace Dividend. Bases closed ...... money saved. A commission ..... bases closed .... money saved. Commission ...... money saved.

How is the Federal Coordinating Council for Comparative Effectiveness Research going to save money? By limiting, ultimately, the amount of health care that is paid for by the government. Oh, it won't be pulling the plug on grandma at first. All it will do is "give clinicians and patients valid information to make decisions that will improve the performance of the U.S. health care system." But slowly, surely, the government will start to nudge physicians not to do that procedure, or don't prescribe that drug, because they're not comparatively effective, or they don't add enough productive life-years, or make a complete life more likely. Because they don't improve the performance of the health care system.

But President Obama said that the commission guidance wouldn't be "determinative"! Then what good are its' recommendations, if they're not going to encourage doctors to follow them (and trust me, the federal government has all sorts of ways to encourage folks)? Well, that's the $1 trillion question, isn't it?!

The government will ration health care more and more (they do it now, just like the insurance companies do) in order to cover more Americans (and illegals, too?). And the more Americans that the government covers, the more rationing that will occur (and covering more Americans is the point of the public option plans).

A reform of the health care payment system cannot be accomplished in a few weeks ...... I imagine it could take the better part of a presidents' term, to be done right.

But it won't be done right.

It never is ........

pm