Death Bureaucracies

Former Alaska Gov. Sarah Palin, along with many other Republicans and conservatives, have seized on the idea of “death panels” as a target against which to aim their opposition to the health care legislation being pushed by President Barack Obama and members of his party in the Congress.  While the health care bills being currently considered in both the House and the Senate do not contain “death panels” per se, the notion that the government would directly or indirectly engage in “end of  life counseling” or the idea that insurance reimbursements might be even indirectly tied by federal law to such considerations — both of which are on the table — is rightfully distasteful to most Americans. 

This is not a hypothetical debate.  There in fact is a real-life model to which those interested in federal health care legislation can turn, if they honestly want to gain an understanding of how bureaucracies can distort medical care for terminally or possibly terminally ill patients.  The “death committee” paradigm comes to us from the United Kingdom, which has practiced government-run health care for a number of years.  According to a recent article written by the medical correspondent for the respected Telegraph, and based on an extensive study of patients in the National Health System (NHS), patients with actual or suspected terminal illnesses were being pushed into a “self-fulfilling prophecy” resulting in a hastened death.  This “scheme” as the Telegraph describes it, involves a major component of the NHS — the Liverpool Care Pathway (”LCP”). 

Any elderly or terminally patient or family member even considering supporting a government-run health care system, should first study the history of the LCP.  One of the protocols administered by the Liverpool project, for example, involves placing patients determined to be “terminal” under continuous deep sedation.  This process, which results in a death rate in England that is twice that in Belgium or the Netherlands, disguises the actual condition of the patients and makes it virtually impossible for hospital personnel, including doctors, to determine whether the patient is making progress toward improvement.  In fact, one doctor said that taking patients off the “pathway” led to a number of them improving and living for a “significat” amount of time thereafter. 

Of course, taking patients off the heavy, continuous “terminal” sedation does not fit the government’s desire to transfer resources from hospice setting to other care.  It’s so much easier for bureaucrats and doctors operating at the direction of those government bureaucrats, to simply sedate elderly or seriously ill patients and leave them to die, than it would be to actually monitor and care for them in an effort to prevent or at least delay death.

35 comments Add your comment

Saul Good

September 23rd, 2009
7:55 am

More SPIN… they’re called “Living Wills” and “Health Care Proxies” and many people have them already and have for many many years!

Road Scholar

September 23rd, 2009
7:55 am

” In fact, one doctor said that taking patients off the “pathway” led to a number of them improving and living for a “significat” amount of time thereafter. ”

And what was their level of health and well being after they were removed from the “pathway”? While they may have been alive,what was the quality of their lives? The Terry Sciavo case was a travesty; let the doctors assess the condition, provide alternatives, and let the family (in her case the husband) decide what is best. Not a law, not a beaurucrat, not a politician, but the family based on sound medical advice.


September 23rd, 2009
8:21 am

Can the average British or Canadian citizen have a complete blood test yearly? Any other tests? If not, I can assure that euthanasia _without_ early diagnosis is murder. Euthanasia is the cheap way the Welfare State has found to “remedy” its own irrationalities (like lack of concern for early diagnosis).


September 23rd, 2009
9:08 am

Yet somehow they manage to do better than patients in the US and for far less $. Culd that possibly be beause of the corporate insurance death panels that deny care to people who have paid for coverage but have gotten too expensive for the CEO’s bonus?


September 23rd, 2009
9:12 am

Very revealing that someone who insinuates to be a Rhodes Scholar would take that quote and immediate cite Terry Sciavo. Problem Reaction Solution. We see through you. :)

Dunwoody Mike

September 23rd, 2009
9:13 am

Uh, Bob, the health insurance companies, the product of your oh-so-precious “free market” also have these death panels.


September 23rd, 2009
9:17 am

Bob you are saying that this subject should be a “hands off” for government. How would you feel about a federal law allowing patient induced euthanasia? Let the individual or family make the call.

And what do we do about insurance companies limiting medical care in this country? If it is not acceptable for the government to limit medical procedures, why is it OK for insurance companies to do so? My family has first hand experience with insurance saying no to doctor recommended procedures.

gloom and doomer

September 23rd, 2009
9:19 am

lovelyliz wrote at 9:08:

“Culd that possibly be beause of the corporate insurance death panels that deny care to people who have paid for coverage but have gotten too expensive for the CEO’s bonus?”

Oh, that’s “different”.

Like the Great Oz said: “Ignore the man behind the curtain!!”


September 23rd, 2009
9:59 am

What’s socialism is Sonny Perdue asking the President to offer federal (financial) assistance after the storms of the last week. I thought you people wanted government out of your lives completely?


September 23rd, 2009
10:20 am

The bills don’t put patients in contact with government bureaucrats to discuss end of life planning or living wills. It directs doctors to have this conversation with their patients and states they will be compensated for this conversation with their patients. So at the end of the day it’s merely pushing a doctor to speak with their patient (good thing) and hopefully allows the patient to dictate the amount/type of care they receive if they are uncapacitated and cannot make those choices at the time of need (good thing).


September 23rd, 2009
11:29 am

Our private health insurance has had end-of-life counseling all along. This has quietly been going on for a long time.

And in Texas hospitals can decide to pull the plug, regardless of the family’s wishes, if the doctors decide that it’s hopeless.

get out much?

September 23rd, 2009
11:39 am

I wonder why Mr. Barr went to England for his example. He could have looked at Grady Hospital and their efforts to close their outpatient kidney dialysis center.

Bozo the clown

September 23rd, 2009
12:04 pm

If I paid what Barr does for health insurance I wouldn’t want any change either. What is it Bob,about $270 a month for life?


September 23rd, 2009
12:27 pm

This wacko bob barr is still around preaching his special mix of republican hate, greed and lies?

Jim's a Cherry Picker

September 23rd, 2009
12:34 pm

Wow Bob,
You’re getting slammed today.
Probably because you’re trying to force your pre-canned notion of the world into this subject.
The bottom line is that late stage (last six months, say) care for individuals who have not otherwise defined their wishes tends to get ’spensive. Not sure of the statistic, but let’s say it accounts for 10 percent of total costs. Well, unfortunately, the doctors have every incentive to provide that care, regardless of whether or not the customer wanted it.
What we’re talking about here is basic market principles…what do you want and how much money do you want to spend? Unless we have the conversation, we’ll never know.
What’s wrong with that?

Billy Bob

September 23rd, 2009
1:00 pm

Let my people go…

Free the health insurance companies to compete across state lines, provide tax incentives for Health Savings Accounts, let employers pay for health insurance premiums by auto-deduction, encourage employers to contribute to paying health premiums and HSA’s (like 401(k)’s, etc.) and let the market take its course.

Let personal freedom and personal responsiblity reign!

Do the Math

September 23rd, 2009
1:03 pm

Republicans have tried to win back office/seats a number of ways…and failed.

Now they are trying to see if acting crazy works. Keep it up, really productive.

Billy Bob

September 23rd, 2009
1:49 pm

I was at my dentists office for the semi-annual tooth cleaning and oral tune-up this morning (8:30 AM). My hygenist, an amiable soul with a sparkling personality and thorough cleaning manner, suggested I have a “panoramic x-ray” as a means of diagnosing dental problems. While this service is optional, it does entail a not insignificant cost ($175) but offers an overall view of the sinus, mouth & jaw structures. This panoramic x-ray is in addition to the more specific x-rays taken of certain sections of the mouth where diagnosing gum tooth decay is the primary purpose. It sounded useful but how much so.

When she offered this diagnostic service, I questioned her on what it was meant to find. She suggested that it generally provided a broad view of the head and that I shouldn’t worry because my insurance would cover it. I shouldn’t worry because my insurance would cover it.

Now, regardless of whether this particular diagnostic test is merited, it struck me how casually she recommended that I base the decision to have the procedure on whether the insurance company would cover the cost. I was not to worry about this cost because someone else would pay the bill.

This small incident, multiplied millions of times each year, is why health care costs have spiralling up – always up – because the consumer’s natural inclination to find value has been replaced by a FAR LESS ADEPT health insurance or government bureaucracy.

It’s time to turn control back to the people who can make the best decisions for THEIR lives – the American people.

Bob Barr

September 23rd, 2009
2:44 pm

Contrary to what some of my blog readers think. I and my family pay for health insurance like everyone else. It has nothing to do with congressional employment, there is no special rate and it is damn expensive.

Gail Rubin

September 23rd, 2009
3:38 pm

My 82-year-old father-in-law died this year in April, and even with advance medical directives in place, real life gets messy. When a doctor told my mother-in-law her husband was probably going to die from a broken hip, she was offended. There was surgery to replace a broken femur head, and he wound up dying from pneumonia seven weeks later.

I still don’t know the all costs that went into extending his life during that time. When will we recognize that we are not immortal and spend countless dollars trying to achieve something we are not built to have in this plane of existence?

I write a blog called The Family Plot: Funeral Planning for those Who Don’t Plan to Die. You can read my father-in-law’s story at See how important it is to speak and listen with the head as well as the heart.

joe matarotz

September 23rd, 2009
3:53 pm

The following article was printed on the Senior Citizens League website. It tells about Congressional Health Care. Methinks Bob Barr speaks with a forked tongue. Read the article and judge for yourself. Be warned, though – if you are not a member of COngress, you could never hope to have health care this good.


Ask the Advisor: Congressional Health Care Benefits, the Rolls Royce of Health Plans?

Why not scrap Medicare in favor of something better? I refer to the cost-effective health plan enjoyed by all of Congress. I understand it includes prescription drugs. I’ve asked my Congressman, Joe Hoeffel (D-PA) to spell out what’s in his health plan, what he pays and how it is funded. He has ignored my requests. I’ve heard it referred to as the Rolls Royce health care plan. This seems like a good idea for everybody instead of trying to fix the damn-near broke Medicare.-T.M, Plymouth Meeting, PA

From the editor:
Members of Congress enjoy excellent health benefits under the Federal Employees Health Benefits Program (FEHBP). For 2002, Representative Hoeffel could choose from 11 different health care plans under FEHBP. All plans offer prescription drug benefits.

The government (meaning taxpayers like you and me) pays 72% of the average premium but not more than 75%. Your Congressman saw the remaining 25% deducted from his $12,500 monthly paycheck (also paid for by you and me). This is similar to the amount the government pays under Medicare. Under Medicare, the government pays 75% of the Part B premium and the other 25% monthly premium is deducted from your Social Security check (which is much, much less than $12,500 per month).

Among the 11 health plans, the federal employee share of monthly premiums ranges from a low of $55.58 per month to a high of $354.08 per month. These premiums compare with Medicare Part A hospital insurance and Medicare Part B doctors’ and outpatient services. But, they also include prescription drug coverage. Medicare Part B premiums in 2002 are $54 per month. Most Medicare beneficiaries pay nothing for Medicare Part A, but most supplement Medicare, and pay additional premiums for Medigap policies.

The Medicare deductibles in 2002 are $812 for Part A and $100 for Part B. FEHBP deductibles range from nothing for hospital stays to $500. Doctor and outpatient services deductibles range from none to $500. Prescription drug deductibles range from none to $600. The plan with the lowest combination of deductibles is $250; the plan with the highest is $1,150.

There is no Medicare Part A hospital co-insurance for the first 60 days. After that Medicare beneficiaries pay $203 per day for the 61st to 90th day in each period and $406 a day for the 91st to 150th day. Hospital inpatient co-insurance in FEHBP ranges from nothing to 35%. Medicare Part B coinsurance is generally about 20%. Under FEHBP the coinsurance ranges from 10% to as much as 35%.

FEHBP drug insurance co-insurance varies depending upon whether the prescription is generic, brand name or a non-formulary drug. Copayments start as low as $5 but co-insurance can be as high as 50% depending on the plan and the type of drug.

In 2000, the National Bipartisan Commission on the Future of Medicare ended with no agreement on a proposal to reform Medicare along lines similar to the FEHBP plans. The so-called “premium support” model would essentially privatize Medicare leaving the government in the role of negotiating contracts with participating health plans as they do for the FEHBP plans. Senator John Breaux (D-LA) introduced legislation in 2001 to reform Medicare along these lines but it remains in committee.

Even under such a system, the biggest problem for Medicare remains the financing. FEHBP plans aren’t necessarily that much more cost-efficient. FEHBP costs are rising by double-digit rates as well. Premiums rose in 2001 by an average of 13.3%. The Blue Cross standard option, popular with many retirees, rose by 20% for individual coverage. This increase was on top of a 2000 average increase of 10.5% and an increase of 21.2% in Blue Cross standard option.

No matter which system, with increasing numbers of persons becoming eligible and health care costs continuing to climb, Medicare remains as you say, “damn-near broke.”

To read more about the FEHBP, you can download a free copy of the 2002 Federal Employees Health Benefits guides for working employees as well as retirees online at If you do not have internet access, ask your library for help.

March 2002

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All Rights Reserved


September 23rd, 2009
8:35 pm

Euthanasia is far too complicated to be bandied about in a blog.

Deborah Fetkovich

September 23rd, 2009
8:53 pm

Great Britain – which has nationalized health care – today announced it is now going to permit assisted suicide with the caveat that no financial motive can be suspected. In Canada, another single-payer system, it is well known that the government doesn’t purchase many CAT scan machines, and therefore, there are long waits to receive the test which could permit early diagnosis of cancer and other diseases.

I recently heard Kathleen Sebelius, the current Director of HHS inform the public that we ranked only 36th – just above Cuba – in quality of health care delivered. She neglected to inform the public that there is no uniform standard for these statistics, and that many countries blatantly falsify them. For example, we count neonatal deaths as any death in utero after 26 weeks gestation. Other countries use 40 weeks. Also, just today, there was a news report that Russia is suspected of deliberately under-reporting deaths from H1N1 Swine Flu. So these comparisons are flawed at the outset and those who use them – like Kathleen Sebelius did – ought not be trusted since it’s obvious that they are pursuing an agenda that has little to do with ensuring the public gets accurate information.

We’ve known for many months that the government wasn’t going to have enough H1N1 vaccine for every American who wanted it. But presto! The government has announced that anyone age 25 and older is not “high risk” and therefore ineligible, unless there’s any leftovers. Nevermind that several healthy individuals in their 40s and 50s have died in recent weeks. They’re just inconvenient statistics.

For the overwhelming majority of us, our lives are precious, even when lived under severe hardship and pain. Just recently in Ohio, a man was unable to be put to death by lethal injection because his veins were so damaged from his history of drug abuse. His new execution date has been postponed as that man, still sitting on death row, has instructed his attorneys to fight to keep him alive.

My own father suffered terribly for the last six months of his life, refusing pain medications. He confided in me that his goal was to stay alive long enough to celebrate his 50th anniversary with my mother. It was a marker in his life and he knew it would be the last chance for him to participate in a family gathering for a celebration. He died 10 days after that 50th anniversary party.

Like me, I’m sure many of you saw Patrick Swayze’s last media interview where he was clearly in pain and described it as “a living hell”. But he had no intention of shortening his time left, even if his pain was unbearable. Life is that precious, and the closer we come to death, the more we want to cling to life. The idea that some faceless unknown governmental group or agency should be sitting in judgment placing values on our lives is a terrifying thought and the first step down a slippery slope.

The health care system we have now respects each individual to make the kinds of decisions pertaining to the value they place on their lives with the privacy and guidance of their own physician and their closest family or friends. Our government doesn’t dictate life or death decisions as it would have to do in a single payer system. Millions of American women, my mother among them, are alive today because they received prompt diagnosis and treatment for breast cancer. If my mother were a Canadian citizen, she wouldn’t be alive today.

Since the bulk of the medical costs occur as people age, in a single payer system, there’s a powerful incentive – even a requirement – to reduce that spending. That can only be accomplished by reducing the availability of expensive tests, drugs, and other treatment options and someone or panel of someone’s would be setting age limits for eligibility for various expensive medications and treatments.

There are currently 3 very good ways to reduce health care costs and at the same time, increase the quality of care delivered and provide greater consumer satisfaction. The first is tort reform. Economic losses should be fully compensated but “pain & suffering” rewards should be capped. The second is to permit people to purchase insurance across state lines, thereby creating greater market competition which always drives costs down. And the third is for CMS to restructure their reimbursement rates to make Family Practitioners and Gerontologists on par with other specialties. Every Family Practitioner is more than capable of managing most conditions of the elderly population, but very often refers them to specialists simply because the FP doesn’t get reimbursed for the extra time. Instead of simply paying the primary care physician more money, Medicare gets stuck paying the primary, plus an endocrinologist to manage simple Type II diabetes, a cardiologist to manage primary hypertension, a urologist for BPH and so on. The poor elderly patient – or his family member – is shuttled like a yo-yo to different specialists, most of them treating conditions that could be better managed by the primary physician who knows the patient best, but isn’t because Medicare won’t pay him or her to do that job. The waste of medicare money is well into the triple digits annually, due to the fact that CMS rigidly refuses to adequately compensate family practitioners.


September 23rd, 2009
9:27 pm

We Americans are so stupid. The health care, insurance bill has nothing to do with health, care or insurance. It’s socialized medicine. It must have a public option or the left wing won’t hear of it. The economic stimulus bill had nothing to do with the economy or stimulus or jobs & didn’t stimulate the economy or save or produce jobs. This bunch in DC during these few 8 mts. have nationalized our financial industry, 2 or our 3 auto makers & the largest insurance co. in the world (AIG). Now they must nationalize the best health insurance coverage in the world. The cap & trad/tax bill has nothing to do with global warming/climate change, whatever they call it today. Politicians can not control the climate, no matter how many toxic green light bulbs we buy. We are just stupid masses, according to the elite in DC. They know better how to spend our money, money we don’t have, money they are trying to borrow from our enemies or print. The federal deficit is now close to $12 Trillion, but people who don’t pay taxes don’t care & they will always outnumber those who do. Just spread the wealth around & be done with it.

Atlanta Native

September 24th, 2009
9:02 am

I read the same article you did and had the same response. I also read about the “assisted suicide” referenced above. I cannot help but flash back to “Soylent Green” at times like this. As we watch the snowball in the UK grow as it rolls downhill, I realize people are unaware of the doctrine of unintended consequences. As I have said many times before, I generally disagreed with you when you were in Congress, but you make a fine Cassandra in the AJC (especially next to the do no, see no, speak no crowd that share the stage with you)


September 24th, 2009
11:31 am

Some years ago I did research funded by the RWJ foundation about attitudes of death and dying leading to “marketing” of advanced directives (living wills). Two major findings were consistent: 1) Most people, 90 percent, do not want to be “hooked-up to machines spending their life savings for no real purpose (they will not survive)”; and, 2) about 75 percent were willing to take experimental drugs to relieve pain (for terminal diseases like cancer) even though the treatment could kill them. A third finding about quality of life, in relation to the findings above, presented the notion that any relative decrease in an individual’s quality of life would lead them to prefer “assisted suicide” over a continued “diminished” life. This research covered groups from all over the US.

Deborah Fetkovich

September 24th, 2009
11:50 am


You misunderstand the nature of the issue at hand. It has nothing to do with advanced directives or living wills and everything to do with denying routine and customary care to individuals because of the expense. It’s about denying 65 year-old vigorous men their choice of timely and expensive but highly effective treatments for prostate cancer. It’s about denying independent and strong 70 year-old women timely and expensive radiation therapy and combination chemotherapy to manage breast cancer.

And as far as deciding that folks who require machinery to breathe for them are useless — I think Christopher Reeve never received your memo.


September 24th, 2009
12:53 pm

Deborah Fetkovich,
I was not expressing my own opinion, only the findings of some extensive research. My point is, 90 percent of individuals in this research would prefer to have THE CHOICE of assisted suicide rather than continue expensive care that would only prolong inevitable death without an “acceptable” quality of life.

Now, my own 90 year old mother has received about $750,000.00 in Medicare and Medicaid paid medical services in the last 5 years at the finest hospitals in this area; with no more than $500.00 out of pocket. Never did anyone hesitate to provide care because of her age, or even ask me about advanced directives. So, I am a TRUE supporter of Medicare and Medicaid for everyone.

My personal views:
1) Public health coverage is a must because many people known the “working poor” may not qualify for public assistance. Further, this public plan should include illegals since more than 1/3 of the planet’s population is infected with incurable TB — would want one of them coughing on you?

2) More attention must be placed on prevention. If the causes of disease are eliminated the cost of treatment decreases.

3) Focus should be shifted away from individual behavior/lifestyle towards environmental contamination. Chemical production, distribution and consumption (especially coal) probably accounts for more than 70% of our chronic disease burden, including congenital anomalies. So, if we are not continuously poisoning ourselves we might have better health.

4) Public funding should be introduced, allocated and delivered for new forms of “treatment”, so that these treatments are publicly owned and publicly available. These include stem cell research, organ and tissue regeneration, artificial viruses as cellular catalysts and conduits, and nano-biotics.

5) Human conditions should not be transformed into treatable conditions for profit.

So, if the issue is about costs, then there are ways to reduce the costs of treatments by eliminating or reducing the need for treatments by eliminating the environmental poisons we consume, introducing new forms of treatment that provide an “all at once” cure and by NOT having disease viewed as a for profit commodity.

Deborah Fetkovich

September 24th, 2009
4:17 pm


As a Roman Catholic, I know it’s a sin to kill yourself, but if others choose to kill themselves, there are plenty of ways to accomplish the goal without assistance. The older the person is, the quicker they’ll die if they simply don’t eat or drink. Don’t go to a doctor. Dont take any medicine for that heart condition or that diabetes. Killing yourself is not only easy, but cheap.

As for the problem of illegals bringing contagious diseases into our country, the solution is not to enforce economic hardship on the productive members of society; you close the border. Congress voted to extend the fence, but as soon as Democrats gained majority control, they refused to fund it. The issue is so serious that I’d take it further and electrify the fence. Fences don’t call in sick, fall asleep on the job, or require vacations and other benefits. Border security checkpoints would not only stop the invasion of illegals, but also stop 90% of the cocaine and heroin that enters our country and destroys families and lives. It would also help in ensuring terrorists aren’t entering. A truy secure electrified fence would kill three birds with one stone and pay for itself in less than 3 years.


[...] Death Bureaucracies [...]


September 24th, 2009
5:02 pm

Deborah Fetkovich

Illegals do not enter through a single entrance. I do not advocate suicide.

I merely suggest that we, as a people, would experience better health status and health outcomes if we took the responsibility to create and maintain healthier living environments free of toxic air and water and much less stress — these are the things that make us sick and kill us.

Chris Salzmann

September 24th, 2009
9:37 pm


We aren’t going to be following the UK’s National Health System model. Nor are we going to be following the Canadian model. The other two countries you cite, Belgium and the Netherlands interestingly, also have universal health care. Another country next door to these two, France for example, has government subsidized health insurance with health care providers (doctors and hospitals) run by the private sector. The French are considered to have one of the best health insurance system in the world. And here’s the kicker, they spend $3600 per person for all of this (health care insurance and the associated care). We, in the United States, spend a little over $7200 per person on what we have. That’s TWICE the amount.

I liken this scenario to something like walking into a store to buy a suit. I get quoted a price of $720, for a suit that isn’t really that good. I go across the street into another store and see a pretty good suit, certainly better than the first one, and the price quoted in $360. Half the cost for a better suit! And we have some politicians and and the insurance industry as a whole, telling us that the $720 suit is a better deal! If that isn’t stupid, I don’t know what is.

BTW, we rank 37 in health care. The French are rated consistently in the top 3 in health care. Also, according to the Kaiser Institute, health care costs for those with employer provided health care will rise to over $30,000 in 10-15 years. That, even according to the most cynical people in the industry, is simply not sustainable.

Chris Salzmann

September 24th, 2009
9:50 pm


You talk about “Death Bureaucracies” within the NHS in the United Kingdom. Just for the record, we aren’t even heading in that direction. On the other hand, we have the “Death Bureaucracies” at insurance companies for those who are self-insured or are seeking to buy health insurance. First, they go through your medical history, which BTW is available to them in databases (so much for privacy) and find ways to find exemptions so they don’t have to cover you for those illnesses. Second, if you do get sick, they will do their level best to find reasons not to cover you. If they do cover your illness, they will then raise their premiums to an amount as to make it unaffordable. Examples of all these scenarios abound.

Also, according to a Harvard Study, 45000 lose their lives due to lack of health care insurance or because of under-insurance. Here’s the link to that story:

Lets not also not forget that over 60% of all personal bankruptcies in this country are related to health care costs. About 40% of those folks who fall in this category, had some form of health care insurance.

Pretty sad for a country that calls itself the “Greatest Nation on Earth”. If we judged ourselves by how we treat the weakest or most disadvantaged members of our society, we wouldn’t even come close to being “Great”. My opinion.

[...] Death Bureaucracies [...]

[...] Death Bureaucracies [...]