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Continuing efforts to justify false “death panels” claim

Brendan Nyhan gives the story.

Here’s Sarah Palin’s statement introducing the now-notorious phrase:

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.

And now Brendan:

Palin’s language suggests that a “death panel” would determine whether individual patients receive care based on their “level of productivity in society.” This was — and remains — false. Denying coverage at a system level for specific treatments or drugs is not equivalent to “decid[ing], based on a subjective judgment of their ‘level of productivity in society.'”

Seems like an open-and-shut case to me. The “bureaucrats” (I think Palin is referring to “government employees”) are making decisions based on studies of the drug’s effectiveness:

An FDA advisory committee voted 12 to 1 on July 20 to withdraw Avastin’s authorization for advanced breast cancer based on two new studies that the advisers concluded had not shown that the drug extends life. Not only that, the committee concluded that the studies indicated the drug slowed tumor growth for even less time — perhaps as little as about a month. “The vast majority opinion of the committee was that the drug was not doing very much, and what it was doing was more than offset by the negative,” said Wyndham Wilson of the National Cancer Institute, who chaired the committee. Avastin can cause a variety of potentially serious side effects, including blood clots, bleeding and heart failure. “In our best judgment, we did not feel this drug was safe to give relative to its benefits,” Wilson said.

Nothing here about judgments of patients’ “level of productivity in society” or of individuals standing in front of any panels at all. It sounds more like Palin is taking concerns about the existing private insurance system–having to talk with faceless people on the phone who decide based on seemingly arbitrary criteria whether you have the right paperwork to be reimbursed–and transposing it onto a hypothetical government-run system of the future.

Palin might well be right that a government-financed health care system could end up magnifying all the worst flaws in our private insurance system, It’s true that countries all over the world, from France to Taiwan, have universal health-care systems that seem to run pretty well without the denial-of-coverage nightmares we see in our country. Still, the United States is different. We are starting from a system that is a bureaucratic nightmare of the private variety, and I could well imagine that the new system could move us to something even worse. I have no idea–I have no knowledge of what’s actually in the plan–I’m just saying that it seems like a legitimate argument that Palin and other opponents could employ.

But the death panel thing, that’s just silly.

What really bothers me, though . . .

As Brendan writes, “defining ‘death panels’ as rationing of any sort is totally nonsensical. By that standard, there are government and private ‘death panels’ throughout the health care system already.”

The thing that really bugs me about the death-panel discussion is that they seem to me, as a statistician, to be fundamentally anti-quantitative and anti-scientific. The idea that partisans will jump on any cost-benefit calculation–or, even, in this case, taking an analysis and labeling it as a cost-benefit calculation even when it’s not, just as a way to attack it–that doesn’t seem good at all. It reminds me of the fallacy of the one-sided bet: the sorts of arguments that deny the need for trade-offs (for example, bringing the levels of various pollutants all the way down to zero. It pollutes our discourse to take any discussion of a medical trade-off and call it a “death panel.”

P.S. Also go read the comments on Brendan’s blog. Some of the commenters who oppose the plan passed by the Democrats in Congress can’t seem to let go of the “death panel” idea. This seems related to one of Brendan’s general themes, that partisanship ties people to political positions that are, by themselves, illogical. It should be possible for someone to argue that
1. The Democrats’ health plan has serious problems, should never have been passed, and is worse than the previous system we had in the United States.
2. The plan does not introduce “death panels.” As Brendan writes, denying coverage at a system level for specific treatments or drugs is not equivalent to deciding someone’s treatment “based on a subjective judgment of their ‘level of productivity in society.'”

5 Comments

  1. Yes, partisans will jump on cost-benefit calculations, if they limit choices that some consumers will rationally want to make. Eg, suppose that the govt bans some cheap diagnostic test because it has a lot of false positives and leads to a lot of expensive treatments. An individual might have a different set of trade-offs and preferences, and be very annoyed that he cannot get the test.

  2. derek says:

    There's a system that lets people just die if they're not productive. It's called capitalism.

  3. Andrew Gelman says:

    Roger:

    I agree. The government can be in a good position to provide information (or to regulate the providers of information) so that individuals or groups can make better choices and do the cost-benefit calculations the way that makes the most sense for them.

  4. Allan says:

    Roger,
    We're not talking about the government banning treatments, just not paying for them on the public plan. (Not even that, really, since our system remains in private hands.)

    Your suggestion that someone would be unable to get a cheap test because of a lot of false positives is completely wrong. The government may not pay for that test, but the private individual could (and it's cheap, right, so they wouldn't need insurance to cover it!). And the government may not pay for all the people seeking treatments from that test until they are shown not to be false positives. But a private individual could decide to pay the huge expense if they are willing to take the chance of wasting all their money on an apparently statistically small chance they are actually treating something they have (that's the situation you have set up, remember?).

    The simple fact is, under our current system, no private insurance company would pay for an expensive treatment under the conditions you describe. If you find one, please post its name for all of us to sign up.

    Creating situations where the outcome would be the same under both a private and a government sponsored plan, and then only attacking the government sponsored plan is simply a fallacious argument.

  5. zbicyclist says:

    @Allan: "The simple fact is, under our current system, no private insurance company would pay for an expensive treatment under the conditions you describe. If you find one, please post its name for all of us to sign up. "

    Or not sign up — that coverage would likely be MUCH too expensive.

    (I agree with your general point that not paying for something is not at all the same as prohibiting it.)