The recent claim by Republicans that Obamacare would lead to death panels has unleashed a firestorm of protest from Democrats. How could anyone suggest, they cry, that our system would mean pulling the cord on Grandma?
The term "death panel" is perhaps hyperbolic, but the underlying concern is exactly right.
The administration has asserted that Obamacare can slow the growth of government spending on health insurance by enough to cover health insurance for another 46 million people, all without limiting care for those who already have coverage.
This claim does not pass the sniff test; neither common sense, nor history, suggests that creating more government can reduce government expenditure!
The administration is right, of course, that the US system is inefficient: we spend money on unproductive tests and procedures, we use reimbursement policies that encourage excessive care, we waste money on litigation and malpractice, and we fail to adopt certain cost-effective treatment approaches on wide scale.
But it is one thing to say the system is broken, and another thing to fix it. Most of the inefficiencies result from insurance, especially government-subsidized insurance. The way to improve the system, therefore, is to reduce government subsidized insurance, not increase it.
It is possible, of course, to expand subsidized health insurance and spend less on health care: by rationing. This might even be better than just subsidizing insurance; sometimes, for example, it might be better to withhold costly measures that extend life only minimally and instead use those resources for other purposes. That is, it might be efficient, in some cases, to pull the cord on grandma.
The crucial question, however, is who decides: government panels or indivduals, families, and their doctors. Obamacare will require rationing to avoid burgeoning expenditures, so it will mean more and more decisions made by government.
If advocates of Obamacare want to argue for death panels, that is their right. But they cannot avoid having that debate.