Charles Krauthammer has not been entirely unreasonable in the current health reform battle. A few weeks ago, he proposed his own plan: malpractice reform and a government health care tax credit to replace the current tax exclusion for health care benefits–in other words, he favors a single-payer system (the government would be the payer via the tax credits), although the details are sketchy: would the system be universal? would the tax credits be refundable to those who don’t pay income taxes–the working poor, for example? And there was, as is often the case with conservatives, a glaring deficiency: he proposed no regulation of the insurance companies, no requirement that they cover all comers, regardless of pre-existing condition. (It is hilarious how Republicans want to reform lawyers but not insurance companies, and Democrats vice versa.)
Today, he takes on death panels. And again, he is close to reasonable: he starts by telling Sarah Palin to leave the room. But then he raises the highly dubious proposition that doctors would put subtle pressure on the elderly to pull the plug on themselves:
What do you think such a chat would be like? Do you think the doctor will go on and on about the fantastic new million-dollar high-tech gizmo that can prolong the patient’s otherwise hopeless condition for another six months? Or do you think he’s going to talk about — as the bill specifically spells out — hospice care and palliative care and other ways of letting go of life?
Actually, given the current fee-for-service structure, I suspect the doctor would go with the gizmo. Keep ’em alive and you can charge them for unnecessary blood tests, urine samples and so on and so forth, ad infinitum. That is one of the crucial problems in this mess: the incentive structure for doctors is wacked. But, unfortunately, neither Democrats nor Republicans have the courage to take on the docs. Which is one of the reasons why health care reform is so difficult.