Krugman Tries to Explain His Call for 'Death Panels' to Balance Budget

Someone must have told New York Times columnist Paul Krugman that he had opened up a can of worms with his call on Sunday's "This Week" to create "death panels" to help balance the budget.

Shortly after the ABC program aired on the East Coast, Krugman published the following explanation at his blog:

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

By trying to clarify, Krugman seems to be digging himself deeper into a hole, for "how much we’re willing to spend for extreme care" was part of Sarah Palin's point when she first wrote about this at Facebook in August 2009.

Palin elaborated about a week later after the President responded to her first piece:

The provision that President Obama refers to is Section 1233 of HR 3200, entitled “Advance Care Planning Consultation.” [2] With all due respect, it’s misleading for the President to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients. The issue is the context in which that information is provided and the coercive effect these consultations will have in that context.

Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often “if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program." [3] During those consultations, practitioners must explain “the continuum of end-of-life services and supports available, including palliative care and hospice,” and the government benefits available to pay for such services. [4]

Now put this in context. These consultations are authorized whenever a Medicare recipient’s health changes significantly or when they enter a nursing home, and they are part of a bill whose stated purpose is “to reduce the growth in health care spending.” [5] Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal end-of-life care? As Charles Lane notes in the Washington Post, Section 1233 “addresses compassionate goals in disconcerting proximity to fiscal ones.... If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?” [6]

Now, fifteen months later, Krugman said the following on "This Week" as previously reported by NewsBusters:

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. In other words, it should have endorsed the panel that was part of the health care reform.

If it's not even -- if the commission isn't even brave enough to take on the death panels people, then it's doing no good at all. It's not educating the public. It's not telling people about the kinds of choices that need to be made. [...]

Some years down the pike, we're going to get the real [budget balancing] 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. But it's not going to happen now.

This may have been "deliberately provocative," but so were Palin's comments which he now seems to be somewhat agreeing with albeit without having the nerve to admit it.

To cut Medicare costs in the future - an essential part of budget balancing according to Krugman - the government is going to have to decide which procedures it will cover and which it won't. These decisions will admittedly involve a cost-benefit analysis. This means the individual's rights are being subordinated to the government's financial interest.

As the government has deep budgetary problems, the cost-benefit analysis will naturally morph towards financial restraint thereby further limiting a patient's options and therefore his or her rights.

This budget balancing approach was similarly advocated by former Clinton labor secretary Robert Reich in 2007:

We're going to have to, if you're very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It's too expensive...so we're going to let you die

In the end, Krugman's attempt at being "deliberately provocative" was really him saying in front of the cameras what Palin and others warned was the danger of allowing further government intrusion into healthcare.

If only such dangers were better explained to the public before Congress voted on this bill in March.