Death Panels

This is a short response to those who automatically assume that the use of the phrase "death panels" is ignorant and stupid; that it can't possibly have anything to do with health care reform simply because the bill doesn't use that phrase. Of course, much of this knee-jerk reaction stems from an animosity to Sarah Palin, the one who used the phrase in the current health care non-debate. However, even the "Wall Street Journal" wrote recently as though doctors and nurses would not recognize that expression.

I have no idea what Sarah Palin believes or knows about health care; however, those who instantly dismiss her with ridicule only show their own ignorance and unwillingness to do a little investigations.

"Death panels" are too well-known among older physicians and nurses and those of us who have worked extensively in the health care system. When dialysis machines were conceived and first put to use (and believe me they were incredibly primitive) they were used for patients who had suffered acute renal failure. That is, their kidneys had quit working, but temporarily, probably as a result of another condition. The dialysis machines were not used for chronic--that is, permanent--renal failure. In addition, hospitals only had 1 or 2 machines. Therefore doctors' panels would convene to decide who would get dialysis treatment and who would not. Without the treatment, unless the patient's kidneys spontaneously restarted, the panel was consigning patients to death. Doctors and nurses referred to these panels as "death panels."

Now the interesting thing is that Teddy Kennedy successfully got Medicare Part B to cover ESRD (End Stage Renal Disease) patients, making the kidney the only entitled organ in the body. (People on Medicare probably skip the portions on ESRD in their "Medicare and You" books, but it is there.) At the time ESRD coverage passed, dialysis was still just used for acute patients, and was cheap. The fact that there was a governmental program reimbursing health care entities for dialysis created a new industry. For-profit centers were formed with many more machines, which at the same time were constantly improving. These for-profit centers were able to start providing treatment not only to patient with acute renal failure, but now also those with chronic renal failure. Today, there are ESRD chains, the largest in the world has 1,700 clinics in the U.S. alone. ESRD coverage has come to represent 8-10% of the Medicare budget even though the patient population is tiny. Each patient uses $60,00-$70,000 in dialysis services per year.

The profit motive, though catalyzed by Medicare, solved the problem of "death panels" in our hospitals. Of course, the concept of death panels is not limited to end stage renal disease patients. Many doctors have been required to participate on panels that decide whether treatments ought to be used for patients. However, the phrase "death panel" was used explicitly and commonly with regard to ESRD. Is it stupid, therefore, given the role of the profit motive in extending dialysis treatments to the chronically ill, to ask what will happen when the profit motive is mitigated?

Why should journalists automatically assume that Sarah Palin is too stupid to know anything about health care. As the governor of Alaska would she not have been responsible for the state's Medicaid program? Does Medicaid work differently in Alaska than in the rest of the states? Which of the 9 Medicare regions does Alaska belong to? Could she perhaps be familiar with Medicare programs? Given that she has a child with Downs Syndrome, isn't it possible that she's spent enough time in hospitals to have learned some of the hospital lingo? Even if Sarah Palin knows nothing of the history of "death panels" those who laugh at her for using the term, especially journalists, are showing their own ignorance of a true health care problem.