Saturday, March 20, 2010

Palin is poison, but Jon Carroll stepped in it yesterday

Jon Carroll wrote a column in yesterday's SF Chronicle titled "What's so bad about death panels?" Carroll is a sly and entertaining columnist who often adopts a sort of bumbling, grandfatherly innocence to make his generally liberal, often sympathetic points. I don't read him every day he publishes, but when I do I often admire his point of view. Not yesterday.

Yesterday's column opened with a refresh of the "death panels" gibberish "first floated by Sarah Palin" as flak in the right wing fringe's war against health care reform; correctly points out that "Of course, it was a lie" (no health care reform proposal ever in play had anything to do with or say about "death panels"); and goes on to peg the failed VP candidate "something of an expert in the untruth department."

Check.

Then, he asks, "What's the matter with death panels? I'm serious."

Okay, I get that opening an essay with a bang is good technique for drawing in readers, and drawing in readers is much on the mind of a five-days-a-week newspaper columnist. And I appreciate that Carroll goes on in this essay to confront some hard, important questions:
"As our health care system learns how to prolong life more and more effectively, we are more and more likely to be confronted with the question: to what end? [...] Do you want to spend two years on a ventilator? How does the phrase 'medically induced coma' strike you?"

Read the column. The middle paragraphs are really sharp. Carroll doesn't go deep into it, but the fact is that we as a society decide -- via health care policy in effect today -- what conditions get treated, and how, and for whom, and therefore whether and how many people live or don't. We decide that now, and we decide collectively it for you and for me as individuals (I don't mean to imply here that the 'collective' decision-making process is in any way good, efficient, or fair). The only reason people aren't wigged out about today's heath care rationing is that the status quo is not something people usually notice ... it's when the status quo is tweaked that people get bent. Anyway. As you're reading Carroll's column, and getting toward the end -- hold onto your chair.

Carroll makes a classic liberal argument -- with which I would largely agree -- that
"Government, in its best iteration, is about collectivizing our shared will to help people."

(Warm. Fuzzy. Of course the problem with warm & fuzzy is that it encourages one to glaze over at the key caveats. For example, "in its best iteration.")

But where he really falls down is in the column's next and concluding paragraph:
"So suppose there were panels, funded by the government but not controlled by it, composed of various medical, social and legal experts. A person could go to the panel, present his case and say: Now what? The panel would come up with an answer. The answer would not be mandatory; it would be dispassionate and informed advice."

I just hate it when I agree with people who, in their most hyperbolic manifestations, run around having tea parties in camouflage, carrying weapons that no sensible framer of a constitution ever meant them to run around with, despite what the Roberts court thinks. But when I read claptrap like Carroll wrote yesterday -- "The panel would come up with an answer" -- I get really, really fidgety.

The reason that it's hard to figure out what to do when a person gets very old and/or very sick is that there is no answer. Or, equally, there are lots of answers, none intrinsically better or more true or more fitting than the others. Who are these 'various experts' of whom Jon Carroll speaks? Do they think with one mind, and speak with one voice? Do his experts have the same point of view as my experts? Does someone else's panel of experts include, say, a minister or a priest whose views diverge, sharply, from people with MD and MSW and JD degrees? What in the world could induce a thinking person to fantasize that a "panel" could come up with "an answer" to questions that are deep, complex, contested, shape-shifting, and, in the end, pretty much unanswerable?

I do believe that we should fund health care through our government. Not like the bill that will be voted on this weekend proposes, but through a single-payer system. Why? Because it would cut out (most of) our system's current profit-sucking and net-care-reducing bureaucracy, and more nearly equalize access to the forms of care humans know how to and can afford to provide. Because it would leave doctors free to treat patients rather than spend inordinate fractions of their careers filling out paperwork aimed at maximizing some shareholder's profits (paperwork whose bottom line effect is to deny care to people who need it). How to fund heath care is an economics and organizational question, of a type and in an area of human endeavor that I believe governments, even in their imperfect iterations, are better suited to deal with than the profit-sucking and net-care-reducing "market."

But as to whether a person who is very old or very ill should be advised or directed by a government panel to pursue health care or euthanasia? No. That is not an aspect of life that would benefit from government standardization, streamlining, or any other form of intervention.

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