A 'death panel' by any other name (updated)

They laughed when Sarah Palin said Obamacare would require death panels to control medical costs. But for some reason no one laughs when New York times columnist Paul Krugman says the same thing. Maybe because he won--inexplicably--the Nobel Prize for Economics.

Yesterday he did it again both on This Week with Christiane Amanpour  and then further explaining in his New York Times column that no, he didn't really mean death panels just because he called them...death panels.

I said something deliberately provocative on This Week, so I think I'd better clarify what I meant (which I did on the show, but it can't hurt to say it again.)

So, what I said is that the eventual resolution of the deficit problem both will and should rely on "death panels and sales taxes". What I meant is that

(a) health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they're willing to pay for - not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we're willing to spend for extreme care

No they really are death panels. Having government officials -- panels, if you will -- deciding the cost and medical effectiveness of treatment v. the value of a person's life with the same compassion of Government Motors choosing to cease manufacturing Pontiacs and closing down dealers.

Death panels. Say it again, say it any which way but Sarah Palin nailed it the first time--a death panel by any other name is still a death panel.

Paul Krugman, if you want some highly paid government official deciding whether your life is worth sacrificing to control health care costs put that on your DNR (do not resuscitate) order not on mine.

Update - Randall Hoven adds:

Dr. Krugman prognosticates on ABC's This Week.

"If they were going to do reality therapy, they should have said, OK, look, Medicare is going to have to decide what it's going to pay for.  And at least for starters, it's going to have to decide which medical procedures are not effective at all and should not be paid for at all...  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.  It's going to be that we're actually going to take Medicare under control, and we're going to have to get some additional revenue, probably from a VAT."

ABC's panel is right about one thing: the real imbalance in the federal budget is due to health care spending.  Krugman's answer is for government bureaucrats to decide what medical procedures "should not be paid for at all."  He also favors a VAT.  As bad as all that sounds to many of us, that is exactly the solution the UK has already chosen.  Call it the European solution.

I will also agree with Krugman and the ABC panelists on this: our budget imbalance is impossible to solve if you leave revenues and Medicare/Medicaid alone.  I've said this before.  You could get rid of all defense spending, or all non-defense discretionary spending, and we'd still have deficits in perpetuity.  We must address the entitlements, especially Medicare/Medicaid/ObamaCare.

But this is not some unsolvable dilemma.  Paul Ryan's Roadmap addresses it.  It solves our budget problem with neither new revenues nor death panels.  And the solution is not from earmark reform or cutting "waste, fraud and abuse."  It comes from real reform of entitlements.  It has been scored by the Congressional Budget Office, which said "The economy would be considerably stronger under the [Ryan] proposal than it would be under the alternative fiscal scenario."  (And that was an understatement, since the "alternative" ceased to exist altogether by 2058.)

I'm not sure why the Simpson-Bowles Deficit Commission is getting all the media attention, when a perfectly good solution is staring us in the face, and has been for years.

If we are going to do "reality therapy", here are our choices.

  1.  Keep doing what we're doing; maybe cut some discretionary spending and other stuff recommended by the Deficit Commission.  This would lead to structural deficits in the trillion-dollar-a-year range and would eventually lead to default; hyper-inflation; collapse of pensions, Social Security, Medicare, etc.; economic depression and/or civil war.
  2. Take the Krugman/Europeanization route: death panels and a VAT - and the slow growth and smothering government that come with them.
  3. Follow Paul Ryan's Roadmap or something very much like it.  Government would actually shrink as a percentage of GDP.  Entitlements would not go away, and would not even be changed for those already over 55.  People would have more choices; government bureaucrats fewer.  And we'd get back to healthy economic growth.

I could even put names on the above choices:  A = Moderate/Independent, B = Democrat/Liberal, C = Republican/Conservative.  And that, folks, is what the fighting is all about.