The Palin Principle


A few months ago, the Republican Party leadership was floundering in its search for principled reasons to oppose the arrogant, overreaching monstrosities emitted from both Houses of Congress in the name of health care reform. A soft-spoken voice from the North, unspoiled by years of cynical Washington politics, had the audacity to expose an immoral cadre of “intellectuals”, intent on seizing control of the most intimate life and death decisions made today by patients and their families.


She may not have been the first to call attention to this cynical plot, but her article marked the turning point of public opinion in the health care debate. In her honor, it is proposed that an amendment to the bill be offered to implement at least part of her life affirming philosophy.


Palin Principle (aka Grandma’s Law):  A medical procedure prescribed or recommended by a licensed physician, and agreed to with the informed consent of the patient, may not be denied by the government or any licensed private insurer based on the age or condition of the patient.  In other words, if Medicare or a private insurer pays for bypass surgery or a kidney transplant for a 25 year old man then they must pay for it for an 80 year old woman if her doctors recommend it.


Whether or not there is comprehensive change in medical care, it is hard to deny that Medicare funding needs to be addressed.


Since we are an aging democracy in which old people vote in large numbers, it is and should be difficult for the young to break their side of the bargain. This is a major reason that health care costs continue to spiral upward.


There is no sense sugar-coating the truth– medical care for the elderly is expensive.  From the perspective of oldies and their loved ones, it is worth it. Medicare is an intergenerational contract requiring the young to pay for the care of the old.


It is not a pretty picture. There is no single comprehensive solution. Nobody has suggested one. When Sarah Palin calls attention to “death panels”, she is not saying that the law explicitly designates a panel of seven people to vote thumbs up or thumbs down on applicants for care.  Nor is she saying that there will be mandatory euthanasia. What she is saying is that the terms of the legislation do not prohibit such excesses, and that the unfettered powers being granted to the executive are broad enough to permit them. The language of the proposed bill is vague enough that she is absolutely correct.  It is such an important issue that explicit protection is needed.


The ratifiers of the Constitution added the Bill of Rights because they feared that the government would abuse the powers granted to it by the Constitution and even unconstitutionally create new powers which were never granted.  Here too, it is preferable to be explicit.  Reassurances from the power corrupted thinkers behind of the Health Care legislation provide little comfort to those of us who see through their sinister schemes.


It is 100% rational for people to spend more of their own available resources on health care as they age. If they also vote, they will rationally spend some the resources of later generations as well. Ironically, there is one mechanism that excels above all others at the allocation of scarce resources and the creation of a higher supply at a lower price.  That mechanism is known as the Free Market, or Capitalism. The law of supply and demand can be mocked for just so long before it extracts a ferocious penalty.


It is claimed that significant savings can be wrung out of the Medicare budget by eliminating waste and fraud. The natural question asked by skeptics is why has this not been done in the last forty years. There are no precedents to suggest that very much can be done unless the definitions of waste and fraud are broadened.  The usual proposal is to introduce “best practices”. When you hear the phrase “best practices”, you should be very afraid. It sounds so benign. Who wants to use substandard practices?  But “best practices” refers to statistical studies which may or may not be germane in a particular case. One of the many bad effects is that to implement best practices, there has to be a ministry of best practices, presumably headed by a czar, probably Zeke Emmanuel or the quintessentially evil Peter Singer. (If you get nothing else from this article, please google Peter Singer!)


For now, no cuts in Medicare coverage should be enacted in anticipation of undetermined savings from cutting waste and abuse.


The Palin Principle is a proposal that should quell the fears of arbitrary and capricious rulings. Those who think it goes too far should be honest enough to admit it and propose other criteria for the inevitable rationing that will take place. Most Americans do not just want to punt it to a group of self-proclaimed experts who can be counted on only to protect the politically connected.


The Palin Principle can be considered part of a more general principle.  However, it is addressing the most inflammatory and divisive part of the debate. It is worth separating it out as a stand-alone provision, if only to quell fears among senior citizens. Few legislators will dare to vote against it, perhaps with its name changed to the Obama principle. Nevertheless, a broader principle along the following lines should be considered.


No health provider should be penalized for ordering a test or prescribing a treatment based on his or her best judgment even if it defies statistical or “best practices” criteria. The final decision rests with the patient.