I don’t have particularly strong views either way about health care reform, but it’s depressing that the one part of the Obama plan that seemed like an obviously, unambiguously good idea has become a casualty of the requirement that all political disagreement be cast as a war between good and evil. There are not a whole lot of free lunches to be found in the attempt to control health care costs, but encouraging doctors to discuss end-of-life care with patients in advance is one of them. That’s because studies indicate that having those conversations usually leads people to make better decisions than having to suddenly figure out what to do when the end inevitably approaches: The advance planners have outcomes just as good as those who don’t—they live just as long, and usually are more comfortable at the end—but their costs are 36 percent lower because they don’t end up opting for a lot of desperate and futile “heroic interventions” at the end. So: lower cost, same lifespan, patient still in the driver’s seat? If Newt Gingrich or Sarah Palin had proposed this, it would be hailed as a brilliant, choice-centered innovation. Oh, wait, they did both propose it.
On a related note, looking at some of the sad, strained attempts to stretch advisor Zeke Emmanuel’s pretty unexceptional bioethics writings into support for “death panels” makes me wonder how an academic philosopher could ever get involved in politics. What they do, after all, is concentrate on difficult ethical dilemmas where any of the options has some morally unattractive features, and then make the case for one of them. A vision of confirmation hearings keeps running through my head: “Isn’t it true, professor, that you’ve endorsed flinging the obese in front of runaway trolleys?” To be sure, I don’t share the horror many bioethicists seem to at the prospect of allocating scarce medical resources to the highest bidder… and I tend to think that the defensible progressive position is that this is objectionable because of background distributive injustice, not because health care is some sui generis magical good. That said, other things equal I think it’s sort of a no-brainer that if there’s one kidney available, and you’ve got a 90-year-old and an adolescent who both need it, the morally better result is for the kid with many more decades ahead of him to get it. If anything, it’s the reverse position that seems ghoulish. Anyway, under the status quo, your “productivity in society” sure as hell does determine whether you get care—Steve Jobs is productive enough to fly out for his cancer treatment in Tennessee where the waiting list for a liver transplant is 80% shorter than in Cupertino. Obviously, there are incentives as well as the purely allocative questions to consider, and I’m not especially sanguine about passing the ball to government either. But it would be nice to see both sides talking in a way that recognized that there’s no foreseeable health care system under which resources are infinite and people don’t die eventually.