Pawlenty on MSNBC: Fear of death panels not irrational

In an appearance on the MSNBC program “Morning Joe,” hosted by former Repub Congressman Joe Scarborough, Gov. Pawlenty gave a complicated, nuanced, not-really-but-sort-of-yes defense of those who fear that federal bureaucrats may eventually decide who will get lifesaving health care treatments and who will not.

Pawlenty Watch

Before you get all excited, you should probably hear the whole exchange, and I’ll embed the video below. But, after listening to it a couple of times myself, I’d also like to set up a couple of analysis points (and you can check me, if you watch the video).

Pawlenty explicitly states that there is nothing in any of the health care bills to set up “death panels,” and nothing that empowers anyone to pull the plug on granny in order to save money. In that sense, he is repudiating the essence of the “death panel” lie that he otherwise seems to be defending.

Pawlenty’s calm, pseudo-rational defense of the Palinesque “death panel” hysteria is based on things that have almost nothing to do with Obamacare. He is concerned that ultimately the health care system will become so expensive that everyone will not be able to have every treatment or procedure they want, because there will not funds to pay for it. This is true, but it is true of every health care system in the world.

It is very unfashionable to acknowledge this, but there is no society so wealthy that it can guarantee to all its citiziens every health care procedure that they want, and not even every procedure that might do them some good. Unless the patient is Bill Gates or a Saudi prince who has essentially unlimited personal resources, every system has to take cost into account. The rationing-or-no-rationing portion of the health care policy debate is fundamentally ludicrous, but I don’t hear this explained very often.

Opponents of the current proposals also do not acknowledge this, but they are, at some level, saying that they do not want any government employees involved in rationing health care (the government is already deeply involved in it since the government already pays for a huge portion of U.S. health care), but that they are fine with a system in which bureaucrats who work for private insurance companies do the rationing.

I don’t get this, although I suppose the key is to never admit that the care is being rationed now. There is little reason to believe that, at its core, the rationing decisions of a private for-profit insurance company will be based entirely on what’s best for me, and not at all on what’s best for the company’s profits.

With that preface, here’s the full interview (length 7:31). The death panel stuff starts at about 1:30. (Although in the first minute, Pawlenty, who says several times that he wants his presentation to be based on facts, makes a pretty factual mistake. I’ll discuss that at the bottom.

The two key spots, for me, are:

Scarborough: “How does this bill get us to quote unquote death panels? You don’t believe it does, do you?”

Pawlenty: …”What if it becomes so expensive and the trajectory of it is even close to what’s being predicted, 10 years out, that they can no longer afford all that they promised and somebody has to scale back the care, and the federal government is now empowered to do that? If you look at examples around the world where that takes place, there are concerns about care being cut back by a federal government institution. And we can have a legitimate debate about whether that’s good or not. I don’t think it is.”

and then, when panelist Mike Barnicle asks Pawlenty if he wants a do-over, and here’s the second try:

“It is not irrational to say if this thing becomes so unaffordable and you put the fed government in charge of it, somebody is going to have to limit either the cost or the volume of procedures. If that someone is the federal government, that concerns people. That is not a crazy idea. Now, does the bill say: ‘There’s ‘death panels’? No. Does the bill say that somebody’s actually going say whether you can live or die. No. But the indirect concerns that I’m raising and that others have raised are not irrational.”

Lastly, you heard Pawlenty say that there is a difference of opinion, which he seems to consider valid and fact-based, about whether the current proposal provides health care for illegal aliens. And Pawlenty says:

“There’s an easy way to address that, and that is to say specifically what you mean in the bill. The fact that they refuse to do it causes concerns.”

In the House bill, H.R. 3200, Section 246 is TITLED: NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS. And it states:

“Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.”

Under current law, illegal aliens are ineligible for federal health care benefits (although many undocumented workers do get health insurance if they work for private companies that provide private health insurance). But every neutral analyst seems to agree that this bill will not legalize benefits for undocumented aliens and, contrary to the guv, the bill says so quite explicitly.

Comments (23)

  1. Submitted by Greg Kapphahn on 09/11/2009 - 12:28 pm.

    Ah… Tim. You see, the funny thing about government health care programs is that the level at which they are able to cover the citizens who elect that government is directly proportional to how much those citizens are willing and able to contribute to that government (yes, that means taxes).

    If the day comes when government health care becomes “unaffordable,” it will be because Tim and his friends have successfully convinced us that we should never pay taxes to support the government upon whose services we all depend. When it comes to government, far too many of us seem to think we are entitled to get everything for little or nothing.

    As is the case in so many areas, now, we will want and expect the government to be there for us when we need it (though the devil can take our neighbors), and scream bloody murder when it’s not, but continue to feel that, when it comes to financing the government we are entitled, especially the most fortunate among us, to all the benefits of a progressive and compassionate government without having to pay for it.

  2. Submitted by Thomas Swift on 09/11/2009 - 12:32 pm.

    You’re missing an important piece of this puzzle, but you can be forgiven because not many people with influence are bringing it up.

    Socialized medical systems are prone to the same major deficit that any other socialist construct is: Lack of private profit leads to lack of initiative and investment.

    Canadians wait for treatments that require the use of high tech equipment not only because there is not enough money to pay for it, or because there are not enough people in place to operate it, but because “it” isn’t there at all.

    CRT and MRI machines, which are to be found in nearly every hospital in America, are scarce in Canada.

    Add the critical shortage of medical professionals that are willing to trade 10 years of training and hundreds of thousands of dollars in tuition for the pittance socialized hospitals pay and you have pretty completely destroyed the very infrastructure.

    Unless you can afford not only to pay for your own treatment, but to transport yourself to a country that can provide it, you may well die waiting for treatment for you melanoma in Canada.

    That’s why Canada is rethinking it’s legal proscription against private clinics…they have to.

    Also, perhaps you missed ABC’s fact check of Obama’s tap dance around the illegal immigrant issue.

    http://restraininorder.blogspot.com/2009/09/results-are-in-you-lie.html

    There is a bit of plausible deniability, I aver, but Joe Wilson may have been out of line for saying “You lie” out loud, but he wasn’t wrong for thinking it.

  3. Submitted by Richard Schulze on 09/11/2009 - 12:35 pm.

    I wonder where the Governor Pawlenty that I voted for went to.

  4. Submitted by John Roach on 09/11/2009 - 12:42 pm.

    The anti-reformers’ proposed amendment that would impose a requirement for proving citizenship in order to get health care has been shot down. This is what they use as a hinge for their claim that HR3200 is “unclear” about the matter, when it is glaringly obvious that HR3200 is in fact quite clear about it.

    The anti- crowd knows that no one is going to vote for a national ID card, and no one is going to vote to require proof of citizenship simply to buy even unsubsidized health insurance or visit a doctor. The amendment was proposed simply to be able to use it to stir up their base about “illegals”.

    The object is not to create a bill with proper cost controls or enforcement mechanisms; the object is to destroy and derail the reform effort.

  5. Submitted by John Roach on 09/11/2009 - 01:13 pm.

    Mr. Swift injects “Canada” into the comment stream on US Health Care reform. “Canada” is not the US and nothing like their system is under consideration for the US. Referring to “Canada” is a way for anti-reformers to distract and change the subject, nothing more.

    Even though they have nothing to do with health care reform in the US, if anyone actually cares about Canadian wait times, Mr. Swift has grossly misrepresented them. There is never a wait list for emergencies. Actual, real-time wait times for all other procedures anywhere in Canada can be found here:

    http://www.hc-sc.gc.ca/hcs-sss/qual/acces/wait-attente/index-eng.php

  6. Submitted by Dean Wold on 09/11/2009 - 02:58 pm.

    Did he go off script (what will Rush do)?

    Did he admit that his friend and mentor Michelle Bachmann is lying?

    Does he understand that we cannot continue to spend the way we spend now for lower quality health care?

    He is gonna be slapped by Glenn and Rush.

  7. Submitted by Ann Spencer on 09/11/2009 - 03:19 pm.

    A professor from Southern Methodist University was interviewed yesterday on NPR about the issue of citizenship verification. Apparently, this requirement was imposed on Medicaid applicants to prevent illegal immigrants from receiving benefits. Experience showed that very few illegals were getting Medicaid, but many eligible American citizens were turned down because they could not produce the evidence of citizenship required.

    I have no idea why the Democrats voted against the amendments Rep. Wilson referred to, but it’s possible that they were rejected to facilitate citizens getting the benefits of health care reform, not to allow illegals to sneak in through the back door.

  8. Submitted by Paul Brandon on 09/11/2009 - 03:26 pm.

    Point one:
    Anyone who talks about THE Canadian health care system is demonstrating his ignorance, since there is a different system in effect in each province.
    It’s like talking about THE American health insurance regulation system: there are 50 of them.

    Point two:
    TP has demonstrated his position on rationing health care by reducing the number of people with health care coverage in Minnesota (the model he is recommending for the country in his run for the presidential nomination (MicheleB as VP?).

  9. Submitted by T J Simplot on 09/11/2009 - 04:00 pm.

    I voted for Pawlenty in the last two elections. If he would have acted then like he is now, he would not have gotten my vote. He is too busy kowtowing (sp?) to the Republican party and saying what they want to hear.

  10. Submitted by Thomas Swift on 09/11/2009 - 06:56 pm.

    “Anyone who talks about THE Canadian health care system is demonstrating his ignorance, since there is a different system in effect in each province.”

    Er. not so much.

    Canadian socialized medicine is administered by each province, but it’s provided and paid for by the federal government….just like Medicare and Medicaid are.

    And, oddly enough, that’s not the only trait they share….both are swimming in red ink.

  11. Submitted by Eric Schubert on 09/11/2009 - 07:01 pm.

    Sarah Palin is a buffoon, but at least she had the sense not to masquerade as Governor of her state while seeking to lead the goof balls of America.

  12. Submitted by Thomas Swift on 09/11/2009 - 08:01 pm.

    No one is forcing you to vote for him, Eric….pass the word to the others.

  13. Submitted by William Pappas on 09/11/2009 - 08:31 pm.

    Thank you Eric for including Pawlenty with the nutballs who find it necessary to lie and misrepresent the facts when discussing the health insurance reform proposals presented in congress. He quite simply has joined the legions of republicans who have decided they will whip up hysteria through false accusations about Obama’s health insurance reform proposals. It also points to a larger problem conservatives have. Economic fact seldom supports their economic theory. They are successful in advancing the principles of deregulation to the degree that they can repeat their mantra of free enterprise over and over and over again. Pawlenty’s tawdry display of lies and misrepresentations as he tours the country to fire up his base has really tarnished his reputation in Minnesota but will actually help history understand his pro business approach to government. Most Minnesotans think he has taken leave of his senses.

  14. Submitted by Richard Schulze on 09/12/2009 - 06:58 am.

    Someone seems to enjoy using the red herring of Canada. I prefer my herring right next to the Cisco’s and Lake Trout in my smoker with cherry or applewood producing the “smoke”.

    The vast majority of Americans are currently insured. Why would one presume that they are going to change what they already enjoy? If they like it they can keep it. That is a fact.

    I was not aware of a specific bill that has been passed by congress and then through the senate and on the presidents desk to be signed. When there is a bill, then we can dig into all the particulars. Up until that point it appears to be a bunch of hand wringing accompanied by the proverbial “smoke” and mirrors of the snip and paste crowd, while practicing their attempts at prestidigitation.

  15. Submitted by Dan Gerber on 09/12/2009 - 07:07 am.

    I had to provide proof of citizenship for MinnesotaCare
    a couple of years ago after that renewal requirement was
    added to all the other proofs being asked for. Having been born in the formerly Belgian Congo, I didn’t have a county courthouse to go to for a copy of a birth certificate. I couldn’t find my passport I’d had in college in the ’70’s when I spent a study trimester in Haiti. My parents did
    find a Belgian issued birth certificate, not one from a U.S. consulate, and a U.S. passport from the ’60’s which I used
    as proof.

    On Democracy Now!, Congressman Grijalva of Arizona responds to a question about immigrants and health reform legisla- tion, saying that legal and permanent residents would have to wait five years.

    http://www.democracynow.org/2009/9/10/a_robust_public_option_is_essential

    I don’t know that I can wait that long for exchanges to
    go into effect. I’m covered by MCHA, which appears to be
    the sort of plan the “catostrophic” coverage would be
    modled after for that interim period. My monthly premiums
    for $2,000 deductible are 30% of my income now, and $5,000
    deductible when I move into the next age bracket next year will cost about $30 per month less than now. At least I get
    non-smoking rates.

  16. Submitted by dan buechler on 09/12/2009 - 07:49 am.

    #15 thank you for your personal story. I heard a similar one on MPR yesterday. Best wishes.

  17. Submitted by Craig Westover on 09/12/2009 - 10:43 am.

    Eric,

    When you say “there is no society so wealthy that it can guarantee to all its citiziens every health care procedure that they want, and not even every procedure that might do them some good,” you are absolutely correct. But to say, “The rationing-or-no-rationing portion of the health care policy debate is fundamentally ludicrous,” is not true. The crucial question is the best way to optimize (ration) health care distribution.

    You are also wrong when you say “Opponents of the current proposals say … that they do not want any government employees involved in rationing health care … but that they are fine with a system in which bureaucrats who work for private insurance companies do the rationing.” What opponents want is control of their own rationing.

    Understand the system we have today is managed care, just as a government system would be. It is not a free market insurance system where insurance companies agree to pay for specific care (if they occur) in return for payment of specific premiums (which they collect whether care is required or not). Individuals and insurance companies balance out risk and reward and determine the value of a policy.

    As to death panels, here is the question I asked in the PiPress, which no one has answered.

    It is extremely expensive to try to save very low birth weight infants, the success rate is very low, and when we do succeed, often those children have ongoing medical expenses greater than normal birth weight children.

    In a free market, I can choose to purchase insurance to cover those costs based on the risk that they might occur and what I must pay to assume that risk. The choice is mine. In a government system, who is going to make the decision whether we continue to advance technology and care for a procedure that is extremely expensive, has a low success rate and produces greater costs when it is successful?

    The whole health care debate, Eric, boils down to who makes your health care decisions, you or someone else?

    But please, when you discuss health care, do not imply that the system we have today is a free market system — it is not.

  18. Submitted by Harris Goldstein on 09/12/2009 - 12:42 pm.

    Governor Pawlenty’s concern that “ultimately the health care system will become so expensive that everyone will not be able to have every treatment or procedure they want, because there will not funds to pay for it” is not only valid, it’s a near certainty. If fact, it’s already true for those that don’t have good insurance – whether working or not.

    So what are we doing about it? You can criticize Obama for not having enough true healthcare reform, but could you imagine the howls if he did?

    Absent reforms all plans, except the most gold plated, will be subject to increasingly draconian annual caps.

  19. Submitted by Eric Black on 09/12/2009 - 10:15 pm.

    To Craig Westover re: comment 17,
    What I was calling ludicrous was the idea that we now have a system with no rationing, but thanks to Obama’s initiative we will be moving to a system of rationing. You and I apparently agree that there is rationing now.

    And I certainly never meant to imply that what we have now is a free-market system. The government is already deeply involved in U.S. health care, through Medicare, Medicaid, the tax preference for employer-paid insurance, and by regulation of the private insurers.
    The idea that we now have a free-market, or even a mostly private sector health care system is a canard usually used by those who want to exaggerate the degree of additional government involvement implied by Obamaism. Cheers,

    Your idea of a self-rationing, which I take to be pretty close to a pure free-market system, seems quite radical and to me impractical. It would maximize freedom (although not for the low birthweight baby.)

  20. Submitted by Wally Carr on 09/13/2009 - 08:16 am.

    Contrary to post #2.

    Canada has no proscription against private clinics and never has. The clinics are private, and provincial governments reimburse the clinics for care. This is such an elementary fact about the Canadaian system as to ruin the credibility of anyone who gets it wrong.

    One recognized problem with this setup is that experimental procedures do not make it to the list of reimbursed procedures as quickly as they might. The upside of it is it makes medical device and pharmacutecal companies pay for their own clnical trials. In any event no one in Canada is suggesting that they fix their problems by moving to our model.

    By any objective set of measures Canada’s system outperforms ours. They pay less per capita, and get developed world outcomes.

  21. Submitted by Wally Carr on 09/13/2009 - 08:37 am.

    In regards to low birth-rate babies: this problem demonstrates the way conservatives allow their ideology to completely blind them to the real world.

    As a matter of fact: in our real world, hospitals expend unbelieveable amounts of resources to save such children. Whether to comply with existing laws, prevent themselves from being sued or prosecuted, or to keep pro-life zealots from bombing the building, they do it.

    There is a proven way to drastically reduce the number of low birth-weight infants: it’s called good prenatal care and nutrition. This approach cuts costs by an order of magnitude. It’s also something the conservatives fight tooth and nail.

    Amazing. The same movement that murders doctors to protect “babies”, fights beneficial research to make sure that zygotes are flushed down the drain instead of used for expanding knowledge, and screams about government spending (at least when a Democrat is President) will not execute a simple and cost effective approach to preventing low birth weight infants. Is it because the impoverished mother getting the care is “undeserving”? Or is it “socialism”, or is it in response to the well-coded race-baiting done by their politicians and in their media?

  22. Submitted by Joel Jensen on 09/14/2009 - 01:50 pm.

    Governor Pawlenty is apparently trying out his skills at dog-whistle politics and straw-man arguments.

    1. We already have death panels for both the uninsured and insured.
    2. We already have federal law encouraging end-of-life directives. (1990)
    3. We already have federal law mandating free care for various “illegals”. (1986)

    1. Pre-existing Death Panels

    Governor Pawlenty, in trying to re-orient the “death panel” charges away from the health directives and towards his scarifying selectively hypothetical “what-ifs” of rationing is trying to make political silk purses out of lipsticked sow’s ears.

    Thousands of people die each year in the US because they are refused care on the basis of their inability to pay because they are uninsured (corporate health provider death panels) or because even though they are insured, their insurance won’t cover the procedure or drops them when a covered illness or condition is claimed (insurance company death panels.) Many more are forced into bankruptcy and/or forclosure due to the same reasons.

    2. End-of-Life Directive (Federal Law)

    As far as the acutal real-life parts of the reform bills to which Palin and her ilk are referring, we’ve had federal law on end-of-life directives since 1990, the federal Patient Self-Determination Act (PSDA), and so far, no new death panels (other than those referred to above.)

    Part of that law required providers to inform their patient that if the patient wants to, the patient can create binding directions about how they wish to be treated, directions that would guide their care-givers and appointed substitute decision makers if and only if the patient could no longer effectively make and communicate their own wishes. http://www.health.state.mn.us/divs/fpc/profinfo/ib98_4.htm

    The proposal to allow Medicare payment to Doctors for talking with patients who want periodic consultation, an idea contained in the health care reform proposals, would be a step towards clarity, a step towards more informed patient decision-making and a step towards more effective implementation of that 1990 law.

    Are the “death panel” fear-mongers trying to keep patients from being informed or are they trying to force potentially painful and even harmful care onto unwilling or unwitting patients?

    Those concerns are not irrational either.

    http://www.health.state.mn.us/divs/fpc/profinfo/ib98_4.htm

    3. Mandated Care For “Illegals”

    The federally mandated “free” care is already in law and covers emergency care for everyone, including “illegals” (everyone from the ‘Charles Manson/Bernie Maddoff/Jeffrey Skilling/Dennis Kozlowski’ set to immigrants who came in illegally or stayed in illegally). This mandated anti-dumping law, the Emergency Medical Treatment and Active Labor Act (EMTLA), has existed since 1986, which unless I’m mistaken would mean it was signed into law by President Ronald Reagan and was passed by a Republican controlled U.S. Senate.

    Back then, the need to establish an “anti-dumping” law (attempting to assure that emergency care would be provided without condition or delay and that ER’s would stop “dumping” financially undesirable ER patients on other providers) was so well recognized as a moral obligation and basic human right (vs priviledge of citizenship) that even President Ronald Reagan and a GOP controlled Senate were willing to sign off on it.

    But this law mandates only emergency services for emergency conditions and if you have money, later they can come after you for it. Also, once you are stabilized, you are at the mercy of the corporate death panels mentioned above.

    Do Governor Pawlenty and Congressman Wilson propose repealing that law? For everyone or just some?

    Would they choose what kind of people deserve that emergency health care and what kind of people do not? Based on what criteria?

    Who’s the death panel then?

  23. Submitted by John E Iacono on 09/14/2009 - 02:15 pm.

    One need not go to Canada for examples of how government deals with rationing of health care.

    Medicare, when it first went into operation on a cost reimbursment basis, promptly found that outlays were triple the amounts expected.

    Politicians were unwilling either to cut stated benefits or to increase taxes. Instead, bureaucrats were instructed to make rules which had the effect of reducing government outlays. And they did. Some of us were there and were knowlegeable at the time.

    Those restrictions remain in place today, and have in some instances been strengthened.

    When politicians tell us that a public option will “not add one dime to the deficit” they are simply not telling the known truth.

    If all the care that is available if you have money today were made available at “affordable cost” to everyone, the demand would skyrocket: tell me I can buy a Maserati for the price of a Yugo, and watch the lines form.

    Health care is rationed now by government bureaucrats in Medicare. They don’t say you can’t have 100 days in the long term care facility if you need it. They just make qualifying for those 100 days so difficult that the average Medicare recipient is disqualified after less than ten days. It’s pretty slick, and it keeps government payments — though not costs — down.

    In a government panel to recommend “best practices” one can already see the outlines of the payment constriction methods that will surely be used.

    And the key point is that rationing will not in fact be based on health needs, or competitive market forces, but on politicians need to keep expenditures down while declaring they have “kept their promise” to Americans.

    “Death panels” is just a scary way to say the same thing.

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