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Wednesday, February 3, 2016

The New York Times Exposes Death Panels

Sarah Palin was widely ridiculed for her use of “death panels” to describe the inevitable rationing of medical care under Obama Care. As Palin famously declared in August 2009:

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."

An outraged Politifact (a Pulitzer Prize winner, no less) pushed back.

“There is no panel in any version of the health care bills in Congress that judges a person's "level of productivity in society" to determine whether they are ‘worthy’ of health care.”
Politifact seems not to have understood that there was no need to formalize death panels under Obama Care. They will automatically come into play when bureaucratic intervention, price controls, and complicated administrative rules create shortages of surgeons, hospital rooms, imaging equipment, and medication.  With shortages that bureaucracies prevent from being eliminated by market forces, we will automatically have “death panels” or even worse procedures for allocating scarce medical resources.

Indeed, a New York Times’s exhaustive investigation reports that shortages of all sorts of drugs — anesthetics, painkillers, antibiotics, cancer treatments — have become the “new normal” in American medicine. The American Society of Health-System Pharmacists currently lists “inadequate supplies” of more than 150 drugs and therapeutics.” Per the NYT, with such shortages: “choices are …. made in ad hoc ways… resulting in contradictory conclusions, murky ethical reasoning and medically questionable practices.”

The Times delves into the various types of administrative panels that decide which patients receive life-saving medications and which do not. The Children’s Oncology Group’s guidelines (the largest international group of children’s cancer researchers) ration drugs based on added years of life, curability of a child’s cancer, improving survival chances, and participation in clinical research.  The group also advises that allocation rules be made public. The child oncologists are not happy with their foray into rationing: “We’ve been forced into what we think is a highly unethical corner.”

With widespread drug shortages, rationing rules are being applied generally in hospitals and medical centers to decide who gets drugs. The rationing panels are comprised of  physicians, ethicists, hospital administrators, insurance companies, or drug manufacturers and usually use indicators of productivity, worthiness, and even weight (obese patients require more of the drug). In many hospitals, patients are not told that their drug regimen has been changed due to shortages.

The Times seems uninterested in the causes of drug shortages. After all, if the medication is not a “shortage drug” no panel is required to determine its allocation among patients. In its 2,500 word investigative article, the Times authors devote one sentence to the reasons for the shortages, which (they say) range “from manufacturing problems to federal safety crackdowns, to drug makers abandoning low-profit products.”

There is no discussion of measures to create balances of supply and demand – perhaps by making it worthwhile for the manufacturer to produce at a profit. Instead, the focus is on administrative measures to decide who will get the medication. Why does the Times not investigate why, for example, aminocaproic acid, cheap, widely and safely used for decades in open-heart surgery, has become a shortage drug?  Has the increased involvement of the government played a role? It seems that this is a legitimate question, only one the Times ducks.

Of the three reasons given for shortages, we cannot determine the extent to which Obama Care’s bureaucratic intervention in medicine has caused “production problems,” or “safety crackdowns.” Of course, companies will abandon products due to low (or nonexistent) profit margins. But this was the original objection to Obama Care: It would dictate low drug prices, which would not be permitted to rise even with shortages. It seems that laws of economics are supposed to be suspended under Obama Care.

We do not have shortages of cars, electricity, home electronics, airline seats, and so on. Admittedly, medicine is complicated, but it is foolhardy to think that basic economic laws do not apply.

2 comments:

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