Paul Krugman recently came out of the closet to say that he supported “death panels.” He then posted the obligatory clarification on his blog.
So, what I said is that the eventual resolution of the deficit problem both will and should rely on “death panels and sales taxes”. What I meant is that
(a) health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they’re willing to pay for — not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care
(b) we’ll need more revenue — several percent of GDP — which might most plausibly come from a value-added tax
And if we do those two things, we’re most of the way toward a sustainable budget.
Frankly, Krugman deserves credit for intellectual honesty. When both sides of the aisle are more intellectually honest, at least a real debate can take place.
Regardless, when Heartland sent out one of its e-blasts discussing Krugman’ post, a friend of mine sent out a heart-felt e-mail looking for an ethical solution to some of the problems. This solution proposed a system of informed votes on what the government should and shouldn’t pay for in end-of-life care. His email prompted me to write up a response.
The questions raised by death panels expose the extreme moral dilemma of collectivizing questions of life and death. Once you take these questions out of the hands of families and individuals, you are on slippery slope that can only end with a rough landing.
No matter how clever the system, and no matter how many contingencies we attempt to plan for, collectivization necessitates “death panels,” which are really no more than resource allocation committees. This applies to both private (insurance) and/or public (government) resource allocation.
Keeping that in mind, the moment a government committee or collective dictates policy or creates a resource allocation policy, the entire process becomes 100% political. There are fair and good politics, and there are horrible politics, but it’s still 100% political.
Therefore, my friend’s attempt develop a good “process” is laudable, but essentially only exposes the futility of such efforts. Someone with more political clout and access – Rahm Emanuel’s brother, for instance – is going to control the process. Therefore, the powers that fund political winners will devise the system they want, and that “system” will not work.
I could make the case that today’s “crisis” is the natural result of overly complex collectivist systems. Once health care is taken out of the individual’s hands, it will eventually come down to some Czar, somewhere, dictating outcomes according to a process that Czar’s funders desire. It will eventually devolve to what can be described as “controlled chaos.”
I would make the argument that both our education and health systems have reached this point. They are expensive, ineffective, un-reformable, and unsustainable. To the extent that they can’t be dismantled, they will eventually dismantle/destroy the economy and culture, simply by their operational expense and incompetence.
The solution for health care – to the extent that it can be called one – is to transition, as rapidly as possible, to citizen/family empowerment. Individuals and families need to be empowered with choice, and collectives (governments, hospital associations, doctor’s associations, and insurance companies) must be aggressively disempowered to the point where they are mere servants of families and individuals.
I don’t pretend to have a silver bullet that gets us there, but I think the closest that anyone has come so far is Charles Murray, who wrote up a cogent set of ideas in his book, In Our Hands, a Plan to Replace the Welfare State.
I think any eventual solution to moral (death panel) dilemmas we face will have to take a form close to what Murray suggests. First, we need to understand that we will never devise a successful “rules-based” system. Second, Murray’s solution, while easily attacked as “imperfect,” is far superior on both moral and financial grounds. If there is a path to a “system” anywhere close to optimal, it will be found by empowering the millions, not the few who are empowered in the collectivist, bureaucratic systems.