The New Republic

Robert Kaus is a mini-Hamlet ever in contention with himself and others. Sarah Palin is an unemployed gasbag who no one - and I do mean no one - should take seriously.

- liberal reformer

August 10, 2009 at 11:24am

Even the most tenuous concern for journalistic integrity should require "Republican blogger Mickey Kaus" on first reference. The man is nearly as reflexively hostile to any Democratic politician or police, and forgiving of Republican statements, as Jonah Goldberg.

- rhubarbs

August 10, 2009 at 12:06pm

Actually, Palin has two points. And both of them have been drooled over by every editor at every water hole the elephants gather around. Indeed, she could insist that all the children of all the liberals be hunted down and shot and the likes of Rich Lowry and Bill Kristol would flip a coin to decide who gets to carry it out.

Alas, years from now the archives will be scoured to pin down the precise moment the human species began that long march back to the caves. They will call it the YouBetcha Age and marvel at way in which it only took a couple days after Palin's inauguration for it all collapse in on itself.

gw

- iambiguous

August 10, 2009 at 12:07pm

Jacobson has done a terrible job of defending something that should not be defended.  He succeeds in continuing Palin lines a false attacks and misleading statement.  Jacobson has defended Palin many times over the past year.  It is becoming a past time for him.  I commented on his "defense" my blog.  

theobservedblog.blogspot.com/.../newest-member-of-truths-death-panel.html

- johnsquinn

August 10, 2009 at 12:59pm

From Cornell Law Professor William A. Jacobson's "Legal Insurrection" Weblog

August 8, 2009

UPDATE: Michael Crowley at TNR's The Plank Blog either did not read this whole post or deliberately chose to misrepresent what I said, in making the following statement (italics mine):

   Jacobson doesn't even bother trying to defend the other phrase Palin puts into misleading quotation marks--"level of productivity in society"--which as far as I can tell has no connection to any proposal authored or even imagined by any Democrat currently in a position of power. Presumably that's another concept the currently-unemployed Palin didn't have time to spell out.

Are you kidding me? Almost this entire post is devoted to explaining the context and source of the "level of productivity in society" phrase. Crowley's post was "embarrassingly lame" (literally). And, you can add Chris Bodenner at Andrew Sullivan's blog to the list of people who do not read what they criticise.

====================================

An Inconvenient Truth About The "Death Panel"

Sarah Palin has kicked off (another) firestorm of criticism because of the statement she released on her Facebook page:

   The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

The incoming fire has been withering, as usual. Palin is accused of becoming the "Zombie Queen," certifiably insane, "clinically wrong," and espousing a "gruesome mix of camp and high farce."

These critics, however, didn't take the time to find out to what Palin was referring when she used the term "level of productivity in society" as being the basis for determining access to medical care. If the critics, who hold themselves in the highest of intellectual esteem, had bothered to do something other than react, they would have realized that the approach to health care to which Palin was referring was none other than that espoused by key Obama health care adviser Dr. Ezekial Emanuel (brother of Chief of Staff Rahm Emanuel).

The article in which Dr. Emanuel puts forth his approach is "Principles for Allocation of Scarce Medical Interventions," published on January 31, 2009. A full copy is embedded below. Read it, particularly the section beginning at page 6 of the embed (page 428 in the original) at which Dr. Emanuel sets forth the principles of "The Complete Lives System."

While Emanuel does not use the term "death panel," Palin put that term in quotation marks to signify the concept of medical decisions based on the perceived societal worth of an individual, not literally a "death panel." And in so doing, Palin was true to Dr. Emanuel's concept of a system which

   considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had a few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern the disproportionately large amounts of resources will be directed to young people with poor prognoses. When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable....

   When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.

Put together the concepts of prognosis and age, and Dr. Emanuel's proposal reasonably could be construed as advocating the withholding of some level of medical treatment (probably not basic care, but likely expensive advanced care) to a baby born with Down Syndrome. You may not like this implication, but it is Dr. Emanuel's implication not Palin's.

The next question is, whether Dr. Emanuel's proposal bears any connection to current Democratic proposals. There is no single Democratic proposal at this point, only a series of proposals and concepts. To that extent, Palin's comments properly are viewed as a warning shot not to move to Dr. Emanuel's concept of health care rationing based on societal worth, rather than a critique of a specific bill ready for vote.

Certainly, no Democrat is proposing a "death panel," or withholding care to the young or infirm. To say such a thing would be political suicide.

But one interesting concept which is central to the concepts being discussed is the creation of a panel of "experts" to make the politically unpopular decisions on allocating health care resources. In a letter to the Senate, Barack Obama expressed support for such a commission:

   I am committed to working with the Congress to fully offset the cost of health care reform by reducing Medicare and Medicaid spending by another $200 to $300 billion over the next 10 years, and by enacting appropriate proposals to generate additional revenues. These savings will come not only by adopting new technologies and addressing the vastly different costs of care, but from going after the key drivers of skyrocketing health care costs, including unmanaged chronic diseases, duplicated tests, and unnecessary hospital readmissions.

   To identify and achieve additional savings, I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under this approach, MedPAC's recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.

Will such a commission decide to curtail allocation of resources to those who are not deemed capable of "complete lives" based on prognosis and age, as proposed by Dr. Emanuel? There is no way to tell at this point since we do not have a final Democratic proposal, or know who would be appointed to such a commission.

To exclude the issue of allocating resources away from the elderly and infirm from the debate over "cost cutting," however, ignores the ethical elephant in the room. Let's have the debate, and understand specifically how resources would be reallocated, before any vote on a health care restructuring bill.

And before we create a commission to make such decisions for us, let's consider whether we should outsource these ethical issues or deal with them as part of the political process.

legalinsurrection.blogspot.com/.../inconvenient-truth-about-death-panel.html

- bkaplovitz

August 10, 2009 at 1:23pm

Jacobson is the guy who attacked Obama for ordering spicy mustard. He's a loon and not to be taken seriously -- let alone cut-and-pasted at such length.

- WoodyBombay

August 10, 2009 at 2:08pm

Arguing (cheekily, one hopes) that "Palin had a point," Mickey links to this guy , a Cornell

- Anonymous

August 10, 2009 at 3:05pm

The Republican argument: The Democrats are going to ration health care to save costs, and it is going to cost too much money!

- blackton

August 10, 2009 at 4:12pm

Charles Krauthammer notes that we ration health care now out of necessity and will do so ever more in the future. The right-wing nuts are trying to scare as many people as possible with their rationing" talk and their "death panel" lunacy.

- liberal reformer

August 10, 2009 at 6:39pm

The blogger Publius at Obsidian Wings has a very nice response to the Alaska Disasta:

"But that said, Palin is sort of right on one point -- there are people who weigh whether children like Trig are worthy of insurance.  They're called insurance companies, and they have decided that these children are not in fact worthy of coverage.  That's because Down Syndrome is a "pre-existing condition." "

obsidianwings.blogs.com/.../its-evil-alright.html

- WoodyBombay

August 10, 2009 at 9:08pm