“We need death panels,” writes Steven Rattner, former counselor to the Treasury secretary in the Obama administration, in today’s New York Times, adding in the next sentence:

Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.

Well, yes, death panels–exactly. That is what you can be forgiven for thinking if you read Mr. Rattner's article. You may even come away wanting to observer a few moments of silence for Sarah Palin, who had the courage to talk about this issue–or what Mr. Rattner condescendingly refers to as Ms. Palin’s “rant.”

Rattner, on the other hand, puts forth a sophisticated appreciation of death panels (is it okay to call them that now?):

But in the pantheon of toxic issues — the famous “third rails” of American politics — none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.

It is not surprising that Americans regard the idea of rationing Gramp’s medical care “toxic.” Mr. Rattner, who was one of the key behind-the-scenes figures in the automobile bailout, sees government as the entity that must step in and prevent old people from hogging “every conceivable medical procedure or pharmaceutical.”

Rattner rejects vice presidential candidate Paul Ryan’s proposal that the costs of medical treatment could be reduced through a system that allows more competition. In light of the tremendous cost increases created by a lack of competition and indiviidual concern over medical costs, Ryan's plan is promising. 

Rattner endorses the Independent Payment Advisory Board—IPAB—which is a rationing board of unelected bureaucrats that will make medical decisions to which there is no appeal.

Rattner concludes:

Medicare needs to take a cue from Willie Sutton, who reportedly said he robbed banks because that’s where the money was. The big money in Medicare is not to be found in Mr. Ryan’s competition or Mr. Obama’s innovation, but in reducing the cost of treating people in the last year of life, which consumes more than a quarter of the program’s budget.

No one wants to lose an aging parent. And with price out of the equation, it’s natural for patients and their families to try every treatment, regardless of expense or efficacy. But that imposes an enormous societal cost that few other nations have been willing to bear. Many countries whose health care systems are regularly extolled — including Canada, Australia and New Zealand — have systems for rationing care.

Take Britain, which provides universal coverage with spending at proportionately almost half of American levels. Its National Institute for Health and Clinical Excellence uses a complex quality-adjusted life year system to put an explicit value (up to about $48,000 per year) on a treatment’s ability to extend life.

At the least, the Independent Payment Advisory Board should be allowed to offer changes in services and costs. We may shrink from such stomach-wrenching choices, but they are inescapable.

One thing conspicuously missing in our national discussion of end of life issues—and in Rattner’s article—is any discussion of the morality involved in these decisions. When, in fact, is it right for an older person to be encouraged (note: encouraged, not coerced) into foregoing treatment? Is it ever right to withhold treatment just because somebody is of a certain age?

Do you trust one of the chief architects of the auto bailout to think clearly about your health care? Ryan is offering a plan to put gut-wrenching decisions in the hands of those whose guts will be wrenched: individuals and families. Sure, we need to bring costs down. But we don't need death panels.