Much ridicule has been hurled at Sarah Palin and others who predicted that Obamacare would bring “death panels” which would decide to withhold medical care from the old in favor of supposedly more worthy younger recipients. The liberal hue and cry was apoplectic about Palin and others who were proclaimed to be “fear mongering” by inventing such absurd notions as death panels that would throw grandma under the bus in a government healthcare takeover.

Yet today, NPR reports that a commission of American academics has been established by the Obama administration to study other countries’ national healthcare programs, particularly that of England.

Universal healthcare countries don’t need death panels; it turns out, because they have what the commission spokesperson calls “cost efficiency panels” instead.

Such panels are part of every nationalized health care system, and it is their job to decide if prolonging your life is worth the money required to do so. They decide whether your life is worthy of transplants and other enormously expensive procedures, based on considerations like how long you’ve lived, how long the treatment might extend your life, and the purported quality of life you might gain (or not) versus the required expenditure. Mightn’t limited healthcare money be better spent on a more…mmm…appropriate patient?

These cost efficiency panels make such decisions every day, although when they throw grandma under the bus they prefer to call it a cost efficiency measure rather than a death decision.

All this is before we talk about Obamacare provisions for slashing Medicare and Medicaid by cutting waste and short-changing medical providers. The government is going to eliminate waste, see. Look how well that’s worked so far. Not to mention recruiting the additional 10,000 primary care physicians the AMA says will be needed to even approach Obamacare mandates. Primary care doctors already work the longest hours for the least money in medicine.

Thus it seems that one man’s death panels are merely another’s cost efficiency panels. It just depends on which political party is describing them. Convenient, that.

So be it. It is just a brutal fact of life that there is never going to be enough public insurance premium and tax paying capacity for any nation to provide all extremes of health care to everyone. Some rationing is inevitable, even desirable, and yes, even morally valid.

Someone must make the cold call about whether grandma’s extra year of bedridden life is worth limited healthcare money urgently needed elsewhere to save a dying baby or a wounded veteran. Not so tough a call there (unless you’re grandma…), but here’s where it gets sticky. Another criteria will eventually become unavoidable as we try to provide healthcare for more people from a finite base of premium/tax payers: What health and/or moral decisions did you make poorly in your past, and says who?

What about a lifelong smoker who now needs a lung, or a chronic drug abuser who needs a liver, or a convicted murderer with cancer, and so on? This list is frighteningly long and subject to internecine and dicey value judgments.

Does a bankrupt gambler deserve a kidney that might otherwise be afforded a working mother of three toddlers? How about a career drug dealer versus a career police officer or fire fighter? Do we give ill doctors priority for the same reason we inoculate them first in epidemics?

An estimated thirty million in America are medically uninsured because they either cannot or will not purchase medical insurance. Healthcare, and by extension insurance for it, is expensive. Many uninsured are illegal aliens. Many more are the working young who don’t feel a need to be insured. Still more are between jobs. Some figure why should they bother buying health insurance when the insured and/or taxpayers will ultimately absorb their medical bills anyway.

The ‘cannots’ won’t suddenly pay healthcare premiums because of Obamacare. Likewise, it is constitutionally questionable that the ‘will nots’ can be extorted to do so, and whether this is practical even if it is ruled legal. The IRS is to be Obamacare’s enforcer, and they are not famous for efficiency, fairness or uniform inclusiveness.

This means that close to the same current premium/tax payer base will now have to pay for healthcare for a huge portion of those thirty million uninsured, soon. In a record recession. Are we to pretend away the reality that those “cost efficiency panels” are thus going to be real busy making some dreadful decisions about who deserves what from the healthcare piggy bank?

William Slusher is a writer in Riverside WA. His latest book is Cascade Chaos (www.cascadechaos.com). Mr. Slusher discloses that his wife is a family physician. He may be emailed at williamslusher@live.com.