Fatal decisions

There is plenty that is wrongheaded and even reprehensible about the Obamacare health plan being discussed every day during the current presidential campaign. But nothing is more objectionable than the aspect of the plan that vice presidential candidate Sarah Palin referred to in 2009 as its "death panels."

I know that big media have overwhelmingly tried to discredit the Palin charge. And you can argue if you want to be picky that Palin didn't help her case by framing the charge the way she did, drawing a grisly picture of a panel of bureaucrats issuing a Solomonic thumbs-up or a thumbs-down on whether her Down syndrome son would be allowed to live. If you're talking about a panel of cold-hearted men and women passing judgment on specific individuals, well then, yes-Palin's picture is theoretically overdrawn.

But, of course, that's not what the debate is about. The debate is about the Independent Payment Advisory Board, a presidentially appointed group of 15 experts charged with suppressing the cost of Medicare. Specifically, IPAB's task is to hold costs to the rate of inflation-plus 1 percent-in any given year.

To meet that goal, IPAB has to do what any management team must do: decide what to include as allowable costs, and what to exclude. Appendicitis gets included; a facelift doesn't. Injuries from a car wreck or even a skiing accident are included; a later model pacemaker than the one you got last year may not be. It's actually not that different from any typical insurance arrangement. You know full well that you can't get everything you want. Someone has to decide.

The difference with IPAB is that it's in effect the only insurance company in town. If you don't like the mix of coverage with IPAB, too bad. It sets the standard. To come back to Sarah Palin, if a board like IPAB says Down syndrome babies and the heart defects they frequently present aren't covered, that's the way it will be for the Palin family. No panel of judges ever sees little Trig Palin, face-to-face. Trig never hears an individual death sentence. But a panel of "experts" may well say in advance that someone with his condition just isn't eligible for coverage. That becomes the policy of little Trig Palin's government.

The evil in such an arrangement, mind you, isn't that somebody has to make those choices. That is life. The evil is in relegating responsibility for those choices to the federal government.

In real life, somebody indeed has to decide whether a 95-year-old should get a $100,000 heart transplant. Somebody indeed has to decide whether and when to turn off a ventilator for someone who's been in a coma for three months. The question is: Who makes those hard decisions? It should be that person, or that person's family, or that person's godly advisers, or God Himself-either through the working out of His actual providence or through trustworthy counsel. And maybe, just maybe, there should also be room for a person to elect, on his own volition, to allow the government to make the decisions for him.

But it should never be the government by unilateral edict.

To which some folks will say that the government makes all sorts of life-and-death decisions for its people. Starting with the military, moving on to air traffic safety, to the oversight and control of drugs and medicine-aren't life-and-death decisions precisely what government does?

To which we say: Too much so-already. But enough is enough. No government is smart and wise enough to do all that micromanaging well. We fully understand that no one's proposing a panel that will literally and personally evaluate Trig Palin-or any other American citizen. But when the president appoints 15 men and women to a commission that decides which medical issues will be supported under Obamacare, and which ones won't, don't be surprised if little Trig-and his family-worry a bit about something that to everyone in his right mind sounds very much like a death panel.

Email jbelz@worldmag.com