From bad to worse: Medicare proposal will surely lead to de facto 'death panels'

By Robert Kiefner
Concord (N.H.) Monitor, May 14, 2011

Say a patient comes to see us with poor appetite, low-grade temperature and progressive right lower quadrant pain, classic symptoms of appendicitis. The cure will be a date with a good local surgeon, during which he will bid farewell to his appendix and be home in a day or two to resume the joy of living. If the appendix is not removed, he will suffer a miserable death from rupture of the appendix and peritonitis.

Let's imagine that, for political causes or for reasons of institutional greed, the patient cannot avail himself of the cure. The appendectomy cannot be done because he does not have access to the surgeon or he decided to tough it out because he cannot afford the deductible and co-pays if insured, or the stratospheric costs if uninsured.

I'd like to apply that scenario to our current health care system, where we are, collectively, that patient with health care needs, forced to make life and death decisions based on cost. The Affordable Care Act may improve access to private insurance for a relative few, but does nothing to rein in costs. Our premiums will continue to rise unchecked, mirrored by rising co-pays and deductibles which will price many folks out of even using their insurance.

Now the brilliant Rep. Paul Ryan, whose credentials consist of being a political science major in college, wants to take the most medically vulnerable Medicare population and toss them into the for-profit insurance world with a pittance in their pockets to pay for their care. His plan would surely lead us down the path of de facto "death panels" for the elderly, who would be unable to negotiate the insurance nightmare, let alone afford it.

To be certain, Medicare needs to undergo a major overhaul - but it must be more widely applied, not abandoned. The overhead involved in the redundant hierarchies of private insurers amounts to $400 billion per year, enough to cover all of the uninsured for basic health care needs. For some reason (let me see, maybe the campaign contributions, the umpteen lobbyists, profound ignorance, or perhaps just callous disregard for their constituents), our elected officials continue to support the hideously expensive, inefficient and dangerous network of private insurers in this country.

In comparison with other industrialized countries, we spend twice as much per capita on health care, yet we rank 37th in the world relative to standard measures of health. Health care should not be a partisan issue. We need to do better with an informed citizenry and legislators who are willing to turn away from corporate special interest groups and ignore mind numbingly stupid extremist constituents.

So, back to the bedside of our patient. The doctors and nurses making that decision to take out the appendix need to make the decision to save the patient without regard for anyone's political or financial interests. And for the rest of us, the collective patient, we need to truly reform health care, break the cost curve, and support universal health coverage, a single payer system which places patients ahead of profits. It is the fiscally and morally responsible thing to do.

Robert Kiefner is a family physician in Concord.