- - Thursday, December 30, 2010

Those death panels that the White House first promised were never a part of Obamacare and then promised had been removed from Obamacare are back in Obamacare, but the White House promises us it’s nothing new. If this doesn’t trouble you, I’ll make a promise of my own: When your mother gets caught in the cross hairs, it will.

The liberal intelligentsia, prisoners of their own conditioned reflex response, mocked Sarah Palin when she warned America in a Facebook post of the Obamacare death panels. The excitable Keith Olbermann even crowned it a 2009 “Lie of the Year.” Specifically, the ex-governor of Alaska referred to the Advance Care Planning Consultation provision in the Affordable Care Act, Section 1233 of H.R. 3200, which specifically called to pay doctors to discuss - some say encourage - withholding end-of-life care with their elderly patients once every five years. The White House denied impropriety but removed the provision when fellow Democrats balked. Only then did the bill pass by a single vote.

The liberal talking class continued to mock Mrs. Palin and her supposedly mythical death panels, that is, until liberal icon and former Enron adviser Paul Krugman let the cat out of the bag that death panels are indeed a reality and, in his ghoulish vision, killing off senior citizens and taxing the survivors is a solution to America’s debt problem: “Some years down the pike, we’re going to get the real solution, which is going to be a combination of death panels and sales taxes.” This gives a chilling new meaning to death and taxes. Suddenly the inharmonious left fell silent.

So what is a death panel exactly? Nowhere will you find that term in the Patient Protection and Affordable Care Act, but then again, neither will a word search of the Constitution find the right to abortion or the separation of church and state. Admittedly, the term is provocative, but then again, so is the disquieting notion that a Washington panel should decide who lives and who dies. And make no mistake, when a nameless, faceless bureaucrat decides what treatments will and won’t be made available to your mother, that is precisely what is happening.

The Federal Coordinating Council for Comparative Effectiveness Research, in fact, was sneaked into the American Recovery and Reinvestment Act - the stimulus bill, of all places. It empowered the government to decide what conditions were hopeless and therefore would be left untreated. (Gee, I sure hope your mom doesn’t get one of those.) Obamacare gives even wider latitude to the Center for Medicare and Medicaid Services, the Department of Health and Human Services and even the Food and Drug Administration (FDA) to determine what care will be made available.

Speaker of the House Nancy Pelosi, California Democrat, famously said of Obamacare that “we have to pass the bill so that you can find out what is in it,” and sadly, she was right because most of the implementation rules were left unwritten at the time. Some estimate that the 2,700-page law will generate another 100,000 pages of rules written by bureaucrats - try to imagine - in the ultimate end run of Congress and the American people. Obamacare, if allowed to stand, will usher in a new crushing era of heavy-handed, European-style social-welfare bureaucracy.

As if on cue, Dr. Donald Berwick, President Obama’s choice as Medicare chief, in a profoundly arrogant move, reinstated, effective this week, the very end-of-life provision that Congress rejected, but with an accelerated payment scheme that effectively will result in even more elderly Americans being nudged to forgo medical care. Sidestepping Americans and their representatives in Congress is nothing new for Dr. Berwick. You’ll recall, he enjoyed a recess appointment, which allowed him to avoid congressional hearings that would have forced him to defend his deeply troubling statements: He’s “romantic” about the British government-run health system, he explicitly favors health care rationing, he thinks it’s the role of the health care system to redistribute wealth, and, perhaps most troubling of all, he thinks the once inviolable doctor-patient relationship is “no longer tenable” without government control.

To be sure, there is nothing certainly inappropriate about discussing end-of-life care with patients so long as the patient and their family can maintain complete trust that their doctor is providing caring - and this is crucial - uncoerced advice. Quite the contrary, it absolutely should be done, but it’s a far too important part of the doctor-patient relationship to permit the government to determine how and when. These difficult decisions are undermined unless they are made freely by the patient and his or her family, grounded in the unassailable trust the patient has in the doctor to provide caring and - this is crucial - uncoerced advice. Sadly, this administration already has shown a willingness to undermine patients’ trust in their doctors by falsely claiming surgeons will amputate legs or remove tonsils just to make a quick buck. Not only have I, as a physician, counseled many families in these trying end-of-life times - a heart-rending and life-changing experience for all of us involved - but I learned firsthand of their importance when my father, himself a physician, made his own wishes known to us in the final months of his life. If ever a family’s decision should be held sacred from the government, this is it.

Just as troubling, death panels exist elsewhere. The FDA’s role in pharmaceuticals was limited initially to safety, but expanded decades ago to policing efficacy, a move that delayed and prohibited lifesaving pharmaceutical approval with, quite literally, incalculable resultant deaths and suffering. And now FDA has gone even further, crossing an alarming moral line. For the first time in our history, the government has banned the use of a cancer drug based not on its safety or even efficacy, but on its financial cost. Just this month, the FDA revoked approval of Avastin to late-stage breast-cancer patients, dashing many women’s final and desperate hope for life.

Obamacare’s unkeepable promises just keep mounting, which doesn’t bode well for the veracity of the administration’s other key life-issue claim: that no taxpayer dollars would fund abortions. This was yet another promise without which Obamacare would not have passed.

Promises from the White House notwithstanding, Mrs. Palin indeed was right. Death panels are all too real, and no family deserves to be caught up in them. Granted, some may find the term “death panel” unnecessarily provocative, but then again, what exactly should we call a panel whose decisions result in death? Perhaps Mr. Krugman can suggest a more palatable name that embodies his lofty death-panel desires, but he had better hurry. The first deaths are about to occur.

Dr. Milton R. Wolf is a radiologist in Kansas and President Obama’s second cousin once removed. He blogs at miltonwolf.com.