Health Care Reform Is About Education, Choice, and Efficiency. Isn’t It?

I think the very smart young invincible Brian Buetler gets one wrong here…

The problem is that for Bill Keller–and for so many of the other “centrists” whose first, last, and only policy recipe for dealing with every economic problem is long-term entitlement cuts–ascribing value judgments to different treatment regimes in general, and convincing the world that old, sick people have too free a ride and are exploiting the rest of us–is their core policy goal.

The health-policy and health-finance technocrats who designed the Affordable Care Act may have all been focused on improving access, improving efficiency, and educating people about what their end-of-life treatment choices and outcomes are likely to be. But that’s not what Bill Keller is focused on: He’s focused on graphs like this:

without understanding what such graphs mean, and concluding from them that granny needs to be set on the ice flow will-she nil-she.

Sarah Palin’s claim that “death panels” were in the ACA was a misleading smear. But the popular fear that there are influential people who think healthcare reform is not about giving people choices but rather keeping people from having the resources to make the choice to try to use medical care to extend their life–that fear is not crazy.

Brian Buetler: How Times columnist Bill Keller aids Sarah Palin’s “death panel” smear: “I bring this all up in response to a bizarre and thoughtless pair of opinion columns, written by Emma Keller… and her husband, Bill…Both articles implicitly and explicitly criticize Lisa Adams, a 44-year-old mother with metastatic cancer….

After reading and rereading both columns I detect no justification for either…. Emma Keller’s article mostly confines itself to a weird, insensitive aesthetic critique of Adams and other seriously ill patients who narrate their own improvements and setbacks to friends and followers. Bill Keller’s piece is significantly more problematic… even more insulting… [and] does the death panelists’ work more insidiously than Sarah Palin and other agitprop peddlers ever could. The whole article is premised upon an apprehension–one he never extends to his own lengthy meditation on his father-in-law’s death in the New York Times–that Adams will influence others by publicizing her struggle. In Keller’s world, people like his father-in-law, who died in palliative care at the age of 79, chose a course that’s “humane and honorable” compared to stop-at-nothing treatment regimes like the one Adams has chosen, and alleges that “Adams is the standard-bearer for an approach to cancer that honors the warrior, that may raise false hopes, and that, implicitly, seems to peg patients like my father-in-law as failures.”…

He implies that patients with terminal illness who don’t choose palliative care aren’t simply prolonging their own misery, but courting waste as well. His father-in-law presumably never enjoyed regular visits with a Caring Canine, and insinuates that such a program must be frivolous by lamenting that neither Adams nor her providers at Sloan-Kettering will tell him how much it costs or how it’s paid for. He stops just short of tut-tutting hospitals that employ paid staffers to deliver get-well-soon cards. Keller never entertains the possibility that the best course of treatment for a 79-year-old man with terminal illness might not be the same as the best course of treatment for a woman with three children, 35 years his junior.

What he does do, though, is undermine painstaking work more serious advocates have done to assure a nervous public that ascribing value judgments to different treatment regimes isn’t a core policy goal.