Howard Dean in WSJ: IPAB 'Essentially a Health-care Rationing Body'; Will He Share Palin's 2009 'Lie of the Year' Award?

Sarah Palin, call your office. PolitiFact, you've been refuted again.

In the later sections of a Wall Street Journal column on Sunday (in Monday's print edition), former Vermont Governor and unsuccessful 2004 Democratic presidential candidate Howard Dean wrote in opposition (HT Twitchy) to Obamacare's Independent Payment Advisory Board, calling it "essentially a health-care rationing body." We'll let former Alaska Governor Palin take it from there with her August 7, 2009 Facebook post (bolds are mine throughout this post):

Statement on the Current Health Care Debate

... 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.

... Rep. Michele Bachmann highlighted the Orwellian thinking of the president’s health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff, in a floor speech to the House of Representatives. I commend her for being a voice for the most precious members of our society, our children and our seniors.

Palin's "death panel" (in quotes) tag was considered the "Lie of the Year" in 2009 by PolitiFact. To be consistent, the web site should name Dean a co-recipient.

Howard Dean agrees with Sarah Palin not just on the word "rationing," but on its result:

By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.

However, Dean misses the mark on the fallout:

There does have to be control of costs in our health-care system. However, rate setting—the essential mechanism of the IPAB—has a 40-year track record of failure. What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic.

In Vermont, I suspect that citizens not only "got aggravated," but, because Vermont is a relatively small state, they were often actually able to do something about their aggravation.

The IPAB, on the other hand will be a very insulated, largely unaccountable board; a similar description of IPAB by Vice Presidential candidate Paul Ryan was labeled "Mostly False" by the pathetic potshot artists at PolitiFact; in reality, it's "almost completely true."

With far less recourse than the people of Vermont would have had, the IPAB which will be heavily influenced by the guiding hand of people like the aforementioned Ezekiel Emanuel.

In the November-December 1996 Hastings Report, while quite frequently using variations of the telltale word “communitarian,” Emanuel wrote:

... services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.


In a 2009 Lancet article (Page 6 at link), Emanuel advocated a very thorough rationing scheme called "the complete lives system":

This system incorporates five principles: youngest-first, prognosis, save the most lives, lottery, and instrumental value. As such, it prioritises younger people who have not yet lived a complete life and will be unlikely to do sowithout aid. Many thinkers have accepted complete lives as the appropriate focus of distributive justice: “individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate.”

Although there are important differences between these thinkers, they share a core commitment to consider entire lives rather than events or episodes, which is also the defining feature of the complete lives system. Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritising adolescents and young adults over infants. Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments.

... The complete lives system also considers prognosis, since its aim is to achieve complete lives. A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern that 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 substantial chance, whereas the youngest and oldest people get chances that are attenuated (figure)

Sarah Palin described Zeke the Bleak Emanuel's scheme perfectly: Under the "complete lives system," the sick, the elderly, and the disabled will suffer the most by having care withheld.

Howard Dean's op-ed, combined with Obamacare's virtual insulation of the IPAB from all accountability, demonstrate how correct Palin was in 2009, and how correct she remains today.

Paul Krugman at the New York Times also admitted to the inevitability, and apparently the desirability, of death panels earlier this year. So I guess the "Lie of the Year" plaque needs slots for three names.

A safe prediction is that PolitiFact will never have the integrity to admit to its mendacity.

A prediction which is just as safe is that the rest of the establishment press will pretend that Dean never wrote what he wrote.

Cross-posted at

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