For those of us already living under universal healthcare systems, seeing Americans getting hot and bothered over Trumpcare because it means Death Panels shows that they haven’t understood universal healthcare.
Any healthcare system in a developed country is going to have Death Panels.
The single-payer healthcare systems operating in Europe were designed at a time when treatment wasn’t all that expensive, because treatments for a lot of serious conditions simply didn’t exist.
When you were diagnosed with cancer in the 1960s, the only question was “How much longer have I got?”
Nowadays, large numbers of cancers can be treated with advanced drugs which cost a large amount per course of treatment.
(This doesn’t apply only to cancer, of course, but the consequences are the same.)
The cost of giving those treatments to each and every patient that contracts the condition would be astronomical, and as medical science develops more new and expensive drugs for more conditions, the costs balloon further. In government-run single-payer systems, there is a limit on cost imposed by the amount of tax that government can collect and hypothecate for healthcare. In other systems, the financial constraint is determined differently.
Saying that the current cost of certain treatments is far too high because of price-gouging by Big Pharma misses the point: every new treatment will cost a fortune to develop and then get to the point where it can be produced at a sensible price. And people will continue to do research and find new cures for new things, so there will always be a frontier zone where the treatments are incredibly expensive. The area inside the frontiers may grow at a greater or lesser rate, but there will always be a frontier.
So decisions have to be made about who gets the treatments and who gets palliative care only.
In the UK, the NHS has a system based on QALYs — quality-of-life years. In crude terms, it values a year of normal health at £30,000, so if the proposed course of treatment will cost £150,000, the patient would need to have good prospects of having five years of normal life once the treatment is over to get it. For a patient who would need assistance to live because they can’t walk more than a few steps or what have you, the QALY figure might drop to £15,000, so the patient would have to have an expectancy of 10 years of assisted life to get the treatment.
If you don’t like the judgement the doctors come to about the viability of the treatment, you do have the alternative of raising the necessary funding yourself, but if you can’t do that, you’re stuffed.
Dig into any other universal system, single-payer, single-provider, multi-payer, whatever, and you will find some similar mechanism in place: by “similar”, I mean some set of criteria by which expensive treatment is rationed, not that it has to be based on valuing a year of life at some monetary figure.
That medicine has advanced to the stage where treatments are available for most conditions rather than the limited subset it was capable of fifty years ago means that it cannot be given to everyone who wants it because there isn’t enough money available to do it.
The only debate to be had about death panels is who sits on them. Every system has a death panel: in the NHS, it’s basically run by doctors. Whether it’s Obamacare or Trumpcare in the USA, it’s run by insurance companies; those advocating a different American system need to work out who will run that system’s Death Panel.