The Two Faces of Obamacare – Neither is Pretty

Have you seen the internet ads? “Get Covered America” is literally popping up everywhere with its smiling faces, its semi-anonymous endorsements for Obamacare, and its offers to “help you on your journey to get covered.” At least there is some honesty, there. Far from a point and click process, let alone the semi-automatic process promised when Obamacare was being peddled, signing up for government healthcare has proven too complicated for the vast majority of Americans. Uninsured Americans must find guidance for their “journey” through the maze of regulations, options, and tables of costs in order to find the government-crafted plan providing the “best” coverage for them. Still, the “non partisan” “Get Covered America” is presenting the friendly face of Obamacare—the “we are here to help” face of socialized medicine.

The not-so-smiley-face of Obamacare has been more in shadow until quite recently. But it is beginning to come more into focus. For example, there is a recent article in the online journal Slate, titled “Canada has Death Panels—and that’s a good thing.” Here we learn about the Province of Ontario’s quasijudicial tribunal, the Consent and Capacity Board, which the Canadian Supreme Court recently confirmed has the authority to overrule close relatives of an incapacitated person, should the bureaucrats want to put that person to death—sorry, “end life support.” The author explicitly calls the Board a Death Panel, quite intentionally, in an attempt to get us used to the notion that “the question is no longer whether we can ‘play God,’ but when, how, and who should do so.” For the author, the answer is simple: “Experts” must decide. Who are the experts? Government appointed psychiatrists, lawyers, and “members of the general public” who presumably know what “justice” (the author’s term, here) demands when a person is helpless and viewed as a burden on the public purse. These “experts” must decide whenever the family has failed to get the message that those who are near death may need a little push. They see the issue as one of “justice” rather than compassion and human dignity because they operate within a system where the resources are doled out by the government, and must be shared according to common criteria, rather than accessed in different ways by different people exercising their own reason and conscience.

The problem is as simple as it is inevitable in a system of socialized medicine, in which the government determines what resources shall be made available to everyone and at what cost. Demand will exceed supply, and if charitable medical institutions (essentially nonexistent in Canada and increasingly uncommon and tied to public regulations in the U.S.) are not in a position to put morals ahead of utilitarian calculus, even as the market is replaced by the cost and inefficiency of pervasive centralized regulation, there will be far too many sick people for the system to handle. Enter the Death Panel. Always there to serve “the best interests of the patient,” such panels by nature dehumanize the person whose situation they consider, weighing costs and benefits on charts in the “objective” fashion so inimical to moral reasoning, which they condemn as mere “emotionalism.”

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Of course, in Ontario at least, and for now at least, the Death Panel must consult with the family before pulling the plug. But the right to consultation is not the right to be heard, only to speak in a given forum and have one’s opinions placed in a report. There is no more appropriate “right” for a government run system than that to have an “expert” pretend to listen to, then patronize and dismiss (on the appropriate forms, of course) the concerns of the citizen.

One can argue that the Death Panel scenario already exists in the United States, though in less formal fashion. After my father-in-law’s last heart attack, he laid in his hospital bed for several days, surrounded by his wife and ten children. Employees of this supposedly Catholic hospital systematically separated one child at a time from the group to try to convince them to have their father killed (taken off food and hydration, as well as medical support). They were disappointed, but one can easily imagine the destructive death-centric conflict that would have resulted if any one of those kids had chosen death for their father. My father-in-law lived for two years, not healthy, but able to communicate and visit with his family members, including his grandchildren, and even attended his daughter’s wedding.

The recent drumbeat to legitimize Death Panels should surprise no one, for it merely continues the logic of the left as it transforms society to meet its goals. As so often before, rational fears of where the logic of government-enforced equality leads were dismissed as a “slippery slope argument” we are supposed to see as somehow inherently illogical. (Remember when the very possibility of same sex marriage was angrily termed a far-fetched bogeyman argument supposedly put forward in bad faith when people brought it up in opposing the extension of spousal rights to homosexual partners?) The logic of socialized medicine demands Death Panels. Its proponents simply did not like the term, and wanted to introduce the reality in a slow, methodical fashion.

That introduction has been going on for some time. Back in 2009, Newsweek ran a cover story titled “The Case for Killing Granny.” When this creepy article appeared, its defenders argued that it was intended to be “cheeky,” that is, to shock readers with a crazy idea, then give us more reasoned and measured arguments for limited policy changes. And, sadly, the proposed policy changes weren’t radical at all—continuing efforts to take end-of-life decisions out of the hands of individual persons and their families, and place them ever-more-firmly in the hands of “experts” with the appropriate socialist mindset to weigh “quality of life” issues along with costs and benefits. Then there was the June, 2012 Time cover story, “How to Die,” setting forth the supposed wisdom and compassion of denying food and hydration to relatives at the ends of their lives as the author was forced to act as “my parents’ death panel.”

For years, attempts by opponents of socialized medicine have sought to point out that the increased bureaucratic overhead and other costs of the system would push us more quickly toward “innovations” like Death Panels decreeing that the old and sick be starved to death. These attempts consistently were dismissed as the crazed rantings of “Tea Party types.” Obamacare would be warm and fuzzy for everyone, letting poor people have the benefits we all enjoy. Now that Obamacare is law, however, we are seeing both faces of the policy. The happy face tells people with little education, let alone experience with vast, nested sets of computer options, that the government or its satellite non-profits will help them on their “journey” through digital bureaucratic Hell. The less happy, but more honest face of the Death Panel, promises to measure for us the quality of our lives, “consult with” our relatives, then decide whether we should live or die.

Welcome to our singularly unattractive New World.

Editor’s note: This column first appeared November 2013 on the Imaginative Conservative website and is reprinted with permission.


  • Bruce Frohnen

    Bruce Frohnen is Professor of Law at the Ohio Northern University College of Law. He is also a senior fellow at the Russell Kirk Center and author of many books including The New Communitarians and the Crisis of Modern Liberalism, and the editor of Rethinking Rights (with Ken Grasso), and The American Republic: Primary Source. His most recent book (with the late George Carey) is Constitutional Morality and the Rise of Quasi-Law (Harvard, 2016).

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